Eating disorders

Serious mental illnesses, can include:

• Limiting amount of food eaten

• Eating very large quantities of food at once

• getting rid of food eaten through unhealthy means e.g. making themselves sick

Anorexia Nervosa

Can cause individuals to limit how much they eat/drink

Bulimia Nervosa

involves cycle of eating large quantities & then trying to compensate for it through various means

Behavioral signs of AN

• Irritability

• Eating very slowly

• Hiding foo

• Avoiding eating with others

• Missing meals/fasting

• Counting calories excessively

Psychological signs of AN

• Fear of fatness/pursuit of thinness

• Excessive focus on body weight

• Spending lost/most of their time thinking about food

• Anxiety, particularly about eating in front of others

• Low confidence & self-esteem

• Difficulty concentrating

Physical signs of AN

• Weight loss

• Irregular/stopped periods

• Difficulty sleeping

• Dizziness

• Hair loss

• Physical weakness

Behavioural signs of BN

• Bingeing

• Purging after bingeing (vomiting, over exercising etc)

• Hoarding food

• Mood swings

• Misuse of alcohol

• Secrecy esp. about eating

Psychological signs of BN

• Difficulty concentrating

• Low confidence & self-esteem

• Fear of gaining weight

• Worries about weight & shape

• Feelings of loss of control overeating

Physical signs of BN

• Tiredness

• Damage to teeth

• Stomach pain

• Swollen salivary glands

• Irregular/stopped periods

• Bloating

Psychoanalytic perspective (childhood origins & the unconscious)

Many adult EDs begin with unresolved childhood experiences that are pushed into the unconscious. These suppressed emotions & conflicts can later influence behaviour around food

fixation in the oral stage

May develop due to fixation in the oral stage.  Can create personality issues later in life – may show themselves through overeating/restriction

imbalance in the personality

Can occur due to unbalanced personality. Binge eating (BN) may result from a dominant id while anorexia (AN) may stem from an overpowering superego

thanatos vs eros

Proposed the death instinct (Thanatos) may override the life instinct (Eros) in EDs leading to self-destructive behaviours e.g. extreme restriction

eating as a substitute for sexual expression

Suggested eating can act as a substitute for sexual urges, restricting/overeating may represent attempts to repress/control unwanted sexual feelings

AN as regression

Saw AN as a form of regression to childhood, avoiding adult sexuality & responsibilities. Reflected in desire for childlike body shape & loss of periods

early traumas & repression

Early traumatic experiences e.g. sexual abuse may be repressed into the unconscious. Can later reappear as AN – may represent unconscious attempt to destroy/reject the body due to feelings of shame/disgust

Hilde Bruch (1)

Also linked AN to sexual immaturity claiming young women fantasise about oral impregnation & confuse fatness with pregnancy & ∴ starve themselves to avoid ‘pregnancy’

(2)

Also argued EDs = attempt by adolescents to establish & control their own identities, particularly if they have domineering parents, allowing them to achieve self-control & independence

(3)

Psychoanalysis used to help clients uncover unconscious emotional conflicts responsible for AN & BN

aim of psychoanalytic therapy (1)

Helps individuals cope with inner emotional conflicts linked to EDs

(2)

Uncovering unconscious anxieties & past experiences believed to contribute to disordered eating

(3)

Increasing insight & self-understanding to identify psychological causes of symptoms

Overall purpose

aim to access unconscious mind. Therapist interprets hidden conflicts contributing to ED. Client works through conflicts leading to catharsis & psychological change

free association

Clients speak freely about whatever comes to mind. Reveals unconscious thoughts & conflicts

word association

Therapist says word, client replies with first word that comes to mind – reveals emotional blocks/hidden associations

dream analysis

Clients report dreams for interpretation. Freud viewed dreams as the ‘royal road to the unconscious’

transference

Clients redirect feelings from early relationships onto therapist. Helps uncover unresolved childhood conflicts influencing EDs

projective tests

Clients respond to ambiguous stimuli e.g. inkblots to identify emotional functioning, thought disorders & defence mechanisms that a patient might not openly disclose

Freudian slip

Accidental statements that may reveal unconscious thoughts/feelings e.g. expressing desire to stop eating while intending to talk about something else. Interchanging words related to control, hunger, body image

Cognitive perspective: understanding (1)

Focuses on thoughts & beliefs suggesting that irrational thoughts & beliefs cause EDs

(2)

Irrational thoughts are clearly documented in research, shows individuals with AN perceive own size & weight inappropriately e.g. describe themselves as much fatter than they are, will draw pictures of themselves as fat even when very underweight

(3)

Negative cognitions influence behaviour e.g. refusing to eat, not going out with friends, telling lies about eating, purging, bingeing etc

(4)

Since EDs are caused by maladjusted thinking, to understand people with EDs, its necessary to understand their thought processes

(5)

Beck: referred to the irrational/maladaptive assumptions & thoughts that lead to EDs as cognitive errors

Claims they’re rooted in the maladaptive ways people think about:

• Themselves: e.g. I’m disgusting if I can’t get into this pair of jeans

• The world: e.g. it’s necessary to be thin to be liked

• The future: e.g. I’ll never be happy & normal

(6)

Referred to as a cognitive triad of negative, automatic thoughts. Negative schemas dominate thinking & EDs result

(7)

Ellis: also argued that irrational thoughts are main cause of EDs – lead to self-defeating internal dialogue of negative self-statements e.g. ‘I’ll never be a happy person; my life may as well be over’

Identified 11 basic irrational beliefs that are emotionally self-defeating & commonly associated with problems:

• I must be loved & accepted by absolutely everybody

• I must be excellent in every respect, otherwise I’m worthless

EDs begin with an:

• Activating event e.g. not fitting into a particular size, leading to a…

• Belief; rational e.g. I need to try the next size up/lose a few lbs or irrational e.g. I’m far too fat, I’m ugly, leading to…

• Consequences; adaptive e.g. I’ll try a different size/cut back on treats or maladaptive e.g. developing an ED

Treatment (1)

Focuses on changing irrational/inappropriate thoughts causing the ED

Cognitive restructuring

aims to change cognitive distortions/negative thoughts by challenging them in therapy over a series of sessions, usually by considering evidence for negative statements

Therapist will ask questions such as:

What is the evidence supporting the conclusion currently held by the client e.g. that they’re fat & ugly

What is another way of looking at the same situation but reaching another conclusion e.g. life could be better if they weren’t always focusing on eating

What will happen if, indeed, the current conclusion/opinion is correct e.g. if someone really is overweight what could happen

(2)

Aim is to mover client away from negative cognitive processes & towards positive cognition

RET

aims to challenge irrational beliefs linked to EDs but therapist is more active & directive than CR. Techniques: challenging clients to prove unrealistic statements like ‘I’m really fat’ & role-playing different situations during therapy e.g. eating with others

REBT

also addresses behaviour change with behavioural tasks set by therapist between sessions e.g. gradually introducing small amounts of new foods into the diet

Social perspective (1)

EDs can be regarded as being influenced by role models

(2)

Argued that ‘size 0 models’ may be influential

(3)

Focuses on role of social context in development of EDs ∴ family relationships are sometimes seen as influential

(4)

Family therapy used as treatment

Behaviourist perspective (classical conditioning)

Explains EDs as a learned association between food (stimulus) & avoidance due to anxiety about weight gain (response) ∴ not eating becomes a ‘habit’

Scenario: critical comment leads to conditioned fear (1)

• Unconditioned stimulus: a naturally upsetting event

• Example: someone makes a harsh/shaming comment about person’s body (‘you’re gaining weight’)

(2)

• Unconditioned response: natural emotional reaction

• Example: feeling hurt, anxious, embarrassed or ashamed

(3)

• Conditioned stimulus: a previously neutral stimulus that becomes associated with distress

• Example: eating high-calorie foods or even eating in general

(4)

• Conditioned stimulus: learned reaction to conditioned stimulus

• Example: feeling fear/anxiety about possibility of gaining weight when thinking about or engaging in eating

operant conditioning (1)

Slimming is positively reinforced e.g. by praise for looking good from friends/family – behaviours that lead to weight loss are learned & AN develops

Scenario: praise reinforces restrictive eating

• Behaviour: person eats less or avoids certain foods

• Consequences (positive reinforcement): receive praise/compliments e.g. ‘you look so good’ or ‘you’re losing weight – that’s great’

• Effect: person = more likely to repeat restrictive eating behaviour as praise acts as rewarding stimulus

(2)

For BN, bingeing is reinforced – provides sense of indulgence but also causes anxiety when purging reduces ∴ both bingeing & purging = reinforced

negative reinforcement

• Behaviour: person engages in compensatory behaviour after an episode of overeating

• Consequence: experience temporary relief from intense feelings e.g. anxiety, guilt, shame, fear of weight gain

• Effect: because unpleasant feelings go away, behaviour becomes negatively reinforced

positive reinforcement through bingeing

• Behaviour: binge eating

• Consequence (positive reinforcement): during binge, person experiences temporary feelings of indulgence, comfort, pleasure, emotional escape

• Effect: brings positive internal experience (even if brief), behaviour becomes positively reinforced

(3)

Reinforcement also takes form of attention from parents who are worried about the family member

(4)

Not eating can also be interpreted as a way of punishing parents

Treatment (1)

Behaviour modification techniques based on operant conditioning have been used

(2)

Starts with measuring & quantifying problem behaviours e.g. observing eating behaviour & quantifying intake of food

Punishment

inappropriate behaviours are punished e.g. pocket money, or a shopping trip may be withdrawn if meals aren’t eaten or a residential setting may cancel a weekend home visit

positive reinforcement (1)

appropriate behaviour = positively reinforced e.g. giving points for eating at mealtimes; by accumulating points, clients can earn treats like time at home if they’re in a residential setting

(2)

eating behaviours are carefully monitored to check for improvement. This type of programme can be followed at both a residential setting & at home – consistency = essential