Feeding and Eating Disorders

feeding and eating disorders

characterized by a persistent disturbance of eating behavior that results in the altered consumption/absorption of food and that impairs physical health or psychosocial functioning; includes: Pica, Rumination Disorder, Avoidant/Restrictive Food Intake Disorder, Anorexia Nervosa, Bulimia Nervosa, Binge Eating Disorder

anorexia nervosa

characterized by three essential features: persistent energy intake restriction leading to significantly low weight, intense fear of gaining weight or of becoming fat/persistent behavior that interferes with weight gain, a disturbance in self-perceived weight or shape

significantly low weight

refers to a weight that is less than minimally normal; psychologists measure how thin their patients are by calculating body mass index

two subtypes of anorexia nervosa

restricting: patients maintain their low weight only by reducing their caloric intake and increasing their physical activity

binge eating/purging: patients engage in either binge eating (eating an unusually large amount of food in a short period of time and feeling out of control) or purging (self-inducing vomiting or using laxatives, diuretics, enemas)

disturbances in self-weight/shape

patients can: experience their weight or shape as large even when they are emaciated; place undue importance on body weight and shape as a measure of self-evaluation; lack of recognition of the seriousness of the low body weight

personality and anorexia nervosa

some personality traits are associated with this disorder:

perfectionism: a strive for flawlessness and setting excessively high performance standards

obsessionality: having a compulsive preoccupation with an idea or an unwanted feeling or emotion

neuroticism: characterized by persistent anxiety, fear, moodiness, or worry

comorbidity with anorexia nervosa

depression and anxiety are commonly present; patients can suffer from osteoporosis and difficulties with fertility and childbirth

mortality of anorexia nervosa

anorexia has the highest mortality rate of any psychiatric disorder; patients are 10.5 times more likely to die than their age and sex matched peers; causes of death include starvation and suicide

prevalence of anorexia nervosa

lifetime prevalence: 0.9% in women, 0.3% in men; 12 month prevalence among young females: 0.4%; less is known about prevalence among males but in clinical populations it is generally a 10:1 female to male ratio

bulimia nervosa

involves a constant obsession with eating and desire for food that leads to large consumptions of food in short periods of time; due to an immense fear of gaining weight, self-induced vomiting, and other purging techniques are used in addition to calorie restriction; characterized by three essential features:

recurrent episodes of binge eating, recurrent inappropriate compensatory behaviors to prevent weight gain, self evaluation that is unduly influenced by body shape and weight

episode of binge eating

refers to having an amount of food that is definitely larger than most individuals would eat in a similar period of time under similar circumstances

subjective binge: eating a typical or even small amount of food coupled with the feeling that the eating is out of control

objective binge: eating a comparatively large amount of food plus feeling out of control

triggers to binge eating

the most common antecedent of binge eating is negative affect (anger, contempt, disgust, guilt, nervousness, etc.); other triggers include: dietary restraint, negative feelings related to body weight, body shape, and food, boredom

compensatory behaviors of binge eating

refers to any actions that a person uses to counteract a binge or prevent weight gain; vomiting is the most common; other purging behaviors include the misuse of laxatives, enemas, and diuretics

personality and bulimia

some personality traits are associated with this disorder are:

novelty seeking (neophilia): love or enthusiasm for what is new or novel

impulsivity: the tendency to act with no or very little thinking

comorbidity with bulimia

depression and anxiety are usually present; substance use and personality disorders are also common; up to about one-third display the characteristics of a personality disorder, particularly borderline personality disorder

other health risks of bulimia

leads to erosion of dental enamel; swelling of the salivary glands; fluid loss and dehydration; electrolyte abnormalities; serious metabolic problems; permanent loss of normal bowel function; gastric rupture; cardiac arrhythmias

prevalence of bulimia

12 month prevalence among young females: 1-1.5%; lifetime prevalence estimates: 1-3% for women, 0.1-0.5% for men; approximately 10:1 female to male ratio

anorexia nervosa vs bulimia nervosa

anorexia: more likely to be underweight in terms of BMI (

binge eating disorder

involves consumption of large amounts of food, even when the person is not hungry; while eating, there is a feeling of a lack of control over the amount of food or type of food; often accompanied by obsessive feelings of food and body image as well as feelings of guilt and disgust about the amounts of food eaten; the essential feature is binge eating must occur on average, at least once per week for three months; binge eating must have three of the following features:

eating much more rapidly than normal; eating until feeling uncomfortably full; eating large amounts of food when not feeling physically hungry; eating alone because of feeling embarrassed by how much one is eating; feeling disgusted with oneself, depressed, or very guilty afterwards

occurs in normal, overweight, or obese individuals; most obese individuals do not engage in recurrent binge eating; compared with weight-matched obese individuals, those with disorder:

consume more calories; have greater functional impairment; lower quality of life; more subjective distress; greater psychiatric comorbidity

prevalence of binge eating disorder

12 month prevalence among adults in US: 1.6% for females, 0.8% for males; more prevalent among females from racial or ethnic minority groups than white females; more prevalent among individuals seeking weight loss treatment than in the general population

other specified feeding and eating disorders

created to reduce the use the use of Eating Disorder Not Otherwise Specified (EDNOS); five categories:

anorexia nervosa (within or above normal weight); bulimia nervosa (lower frequency and/or limited duration); binge eating disorder (lower frequency and/or limited duration); purging disorder (exclusively purging, no binge eating); night eating syndrome (eating after waking up during the night)

etiology of eating disorders (family studies)

relatives of people with eating disorders are up to six times more likely than other people to develop an eating disorder themselves;

estimated heritability rate for anorexia: 60%

estimated heritability rate for bulimia: 28-83%

estimated heritability rate for BED: 41%

etiology of eating disorders (genetics)

genes related to serotonergic, opioidergic, and dopaminergic function have been linked to anorexia; a specific area of chromosome 10, that has also been linked to obesity, has been associated with bulimia; one genetic variation associated with the serotonin system has been linked with symptoms of impulsivity and affective instability of women with eating disorders that include binging and purging

role of the hypothalamus

hypothalamus: regulates certain metabolic processes and other autonomic activities; researchers have located two separate areas that help control eating in mice:

lateral hypothalamus: lesions caused reduced food intake

ventromedial hypothalamus: lesions cause an increase in overeating

addiction model of binge eating

addiction related processes may play a role in the development of binge eating disorder; studies have found when exposed to a food stimulus, individuals with BED had increased levels of dopamine release as well as increased activity in the orbitofrontal cortex

psychodynamic theory

suggests that disturbed parent-child interactions lead to serious ego deficiencies (including a poor sense of independence and control) and severe perceptual disturbances that leads to disordered eating

family models

families may play an important role in the development and maintenance of eating disorders; abnormal interactions and forms of communication within a family may set the stage for an eating disorder; among individuals with anorexia, Salvador Minuchin noted four dysfunctional family patterns:

Enmeshment (being overly involved in each other's affairs and over concerned with the details of each other's lives)

Rigidity (difficulty adapting to developmental needs/changes)

Overprotectiveness (shielding children from age appropriate experiences)

Poor conflict resolution (difficulty dealing with problematic, negative situations)

cognitive theory

proposes that broad cognitive distortions lies at the center of eating disorders; individuals with eating disorders judge themselves, often exclusively, based on their shape and weight and their ability to control it

sociocultural model/ societal pressures

many theorists believe that Western standards of female attractiveness are partly responsible for the development of eating disorders; the sociocultural model believes that exposure to the ideal of thinness leads to internalizing this ideal. Then there is a discrepancy between the actual and ideal body, dissatisfaction occurs which leads to restriction; Western society not only glorifies thinness but also creates a climate of prejudice against overweight people; cruel jokes about obesity are standard in the media and research indicates that the prejudice against obese people is deeply rooted

treatment of eating disorders

the aims for treatment are to correct the dangerous eating pattern as quickly as possible and to address the broader psychological and situational factors that have led to and maintain the eating problem; in life-threatening cases, clinicians may need to force tube and intravenous feedings on a patient who refuses to eat

treatment for anorexia

psychotherapeutic approaches include individual psychotherapy, family therapy, and group therapy; usually uses a multidisciplinary team; hospitalization is at times necessary; individuals who are below 75% of their ideal body weight should be hospitalized

treatment for bulimia

Fluoxetine (Prozac), an antidepressant, has shown to be effective for reducing symptoms of binge eating and purging and is now an approved treatment for bulimia

common psychotherapy approaches for eating disorders

cognitive behavioral therapy; dialectical behavioral therapy; interpersonal therapy; family based interventions

family based interventions

therapy involves the members of the family, points out troublesome family patterns and helps family members make appropriate changes; may help the individual with an eating disorder separate their feelings and needs from those of other members of the family

the maudsley method

an approach to empower parents to take an active role in achieving successful treatment; based on seven principles which include:

work with experts who know how to help you, work together as a family, blame the illness instead of your child or yourself, self-care