Unit 3 Abnormal

what is the chief characteristic / motivating factor of eating disorders?

all-encompassing desire to be thin

Eating disorders tend to occur in a small segment of the population. More than 90% of severe cases are…

young females who live in a socially competitive environment

Unlike most disorders, the strongest contributions to etiology seem to be ___ rather than psychological or biological factors?

sociocultural

Prevalence of Body Dissatisfaction in men and women

• women: 83%

• men: 74% (hald bc overweight, half underweight)

obessity

excessive body fat resulting in a BMI of 30+

• not an official disorder

is obesity an official disorder?

no

close to __% of US adults are overweight. __% are obese

70%; 35%

obesity increases one’s risk for…

• cardiovascular disease

• respiratory disease

• muscular skeletal probs

• hormone-related cancers

Bulimia Nervosa

eating disorder characterized by recurrent episodes of uncontrolled excessive (binge) eating followed by compensatory actions (vomiting, laxative abuse, excessive exercise)

Bulimia Nervosa Criteria

1. recurrent episodes of bing eating (abnormally large, uncontrollable intake of food within a 2hr period) — at least 1/week for 3 months

2. recurrent inappropriate compensatory behavior to prevent weight gain (vomiting, misuse of laxatives/diuretics, fasting, exercise)

3. both occur at least 1/week for 3 months

4. self-evaluation is unduly influenced by body shape and weight

T or F: The sense of being out of control is just as important as the amount of food eaten when considering a bulimia diagnosis

true

T or F: Those with bulimia nervosa tend to develop more body fat compared to age and weight matched controls (most are still within 10% of normal body weight)

true

how do those with bulimia compare to age- and weight-matched controls regarding body fat?

tend to develop more body fat (most still within 10% of normal weight)

Compensatory Behaviors

behaviors designed to make up for binge eating (vomiting, laxatives, diuretics, exercise, fasting between binges)

Compensatory Behaviors: Purging Type

• vomiting

• laxatives (relieve constipation)

• diuretics (urination)

Compensatory Behaviors: Non-Purging Type

• excessive exercise

• fasting for long periods between binges

Is purging an efficient method of reducing caloric intake?

• vomiting reduces 50% of calories and less if delayed

• laxative and related procedures have little effect

Medical Consequences of Bulimia Nervosa

• salivary gland enlargement, resulting in a chubby face

• erodes dental enamel on the inner surface of the front teeth

• tears the esophagus

• electrolyte imbalance

• intestinal problems, resulting in severe constipation or permanent colon damage

what causes salivary gland enlargement in those with bulimia nervosa?

repeated vomiting

what causes intestinal problems in those with bulimia nervosa?

laxative use

describe electrolyte imbalances seen in those with bulimia nervosa?

imbalance of chemical balance of bodily fluids, including sodium and potassium levels that may lead to serious/fatal medical complications

• cardiac arrhythmia

• seizures

• kidney failure

Bulimia is strongly related to anxiety disorders and womewhat less to __ and __ disorders

mood and substance abuse

bulimia & anxiety/mood disorder comorbidities

• 80.6% have anxiety disorder

• 20-70% have mood disorders

Are eating disorders a way of expressing depression?

depression follows bulimia and may be a reaction to it

bulimia and anorexia rates of comorbidity with substance abuse disorders

• bulimia 36.8%

• anorexia 27%

what might account for patterns of comorbidity between eating disorders and substance abuse disorders?

underlying traits of emotional instability and novelty-seeking

anorexia nervosa

eating disorder characterized by recurrent food refusal and/or vigorous exercise to offset food intake

Anorexia Nervosa Criteria

1. restriction of energy intake relative to requirements, leading to a significantly low body weight in the context of age, sex, development trajectory, and physical health

2. intense fear of gaining weight or persistent behavior that interferes with wight gain

3. disturbance in the way which one’s body weight or shape is experienced

is anorexia or bulimia more common?

bulimia

what is the most notable feature of anorexia nervosa? what is considers the core of the disorder?

• notable feature: decreased body weight

• core: intense fear of obesity and relentlessly pursuing thinness

how does anorexia begin?

often in adolescence when one believes they are overweight, begin to diet and then develops an obsessive preoccupation with being thin

T or F: Those with anorexia are satisfied once they lose a certain amount of weight

false; never satisfied—staying the same weight or gaining weight causes intense panic, anxiety, and depression

Two Subtypes of Anorexia Nervosa

• Restricting Type (diet and limit caloric intake)

• Binge-Eating-Purging Type: those who binge on small amounts of food and purge more consistently

__% of anorexias engage in binge eating and purging

50%

Medical Consequences of Anorexia Nervosa

• ammenorrhea

• dry skin, brittle hair/nails, sensitivity/intolerance of cold

• lanugo (fine hair on limbs and cheeks)

• cardiovascular problems (low BP and HR)

• electrolyte imbalance

lanugo

medical consequence of anorexia; fine hair on limbs and cheeks

psychological consequences of anorexia

• high rates of anxiety and mood disorders

• depression (71%)

• OCD

• substance abuse

• suicide risk

Psychological Disorders Associated with Anorexia

anxiety and mood disorders, OCD, substance abuse

Anorexia and Anxiety/Mood Disorder Comorbidities

71% of those with anorexia have depression at some point

anorexia and substance abuse comorbidities

substance abuse is a strong predictor of mortility, particularly by suicide

Those with anorexia are proud of their extraordinary control and diets. Those with bulimia are ___ of their eating issues and lack of control.

ashamed

Binge Eating Disorder

eating disorder characterized by distress-inducing binges not followed by purging behaviors; occurring at least 1x/wk for 3 months

Binge Eating is associated with…

• eating more rapidly then normal

• eating until uncontrollably full

• eating large amound of food when not physically hungry

• eating alone because embarrassed about amount of food

• feeling disguisted with oneself, depressed, or guilty after the binge

Which has the highest remission and best treatment response: anorexia, bulimia, or binge-eating disorder?

binge-eating disorder

Binge-Eating Disorder is common among individuals in weight loss programs. → __% of individuals in weight loss programs have BED

20%

Binge-Eating Disorder is common among individuals in weight loss programs. → up to __% of bariatric surgery candidates have BED

50%

Two Pathways to BED

• 50% try dieting before binging

• 50% start binging and then try to diet

One pathway to BED involves the person trying to diet before their first binge episode. Describe this pathway.

individual tries to control weight but eventually starts to deprive themselves into a binge episode

One pathway to BED involves the person binging first and then attempting to diet. Describe the outcomes of these individuals.

• more severely affected by BED

• more likely to have additional disorders

• more likely to experience depression

• more depression/anxiety comorbidities

What distinguished BED from obesity?

BED involves concerns about shape and weight

Median Eating Disorder Age of Onset

18-21

Anorexia Age of Onset

early adolescence; as young as 15

Bulimia Age of Onset

as early as 10

BED Age of Onset

25

13% of girls will experience an eating disorder by age __

20

what is the strongest predictor that bulimia will follow a chronic course?

childhood obesity and overemphasis on thinness

What are some predictors that anorexia will follow a chronic course?

persistently low BMI, distorted perceptions of shape and weight

Which type of eating disorder is most resistant to treatment?

anorexia

Which eating disorder(s) are chronic and resistant to treatment?

anorexia and bulimia

Describe the gender differences in lifetime prevalence rates of eating disorders.

adolescent girls are at most risk; 2-3x greater risk of anorexia/bulimia in females

Anorexia: Gender Prevalence

majority females in middle- to upper-class families

Bulimia: Gender Prevalence

90-95% women

BED: Gender Prevalence

more likely in males

What group of males is at most risk for bulimia?

gay/bisexual males and athletes that require weight regulation

Anorexia and Bulimia are overwhelmingly associated with Western Cultures. What about women who move to western countries?

non-western women will develop anorexia/bulimia after moving to western countries

Anorexia/Bulimia in African American Women

rarer—tend to have less body dissatisfaction, fewer weight concerns, more positive self-image, and perceive themselves to be thinner than they are

Recent research shows rising rates of eating disorders among people of color. However, they often face ___

cultural medical symptoms

what are some cultural factors for developing eating disorders?

• cultural food norms and stigma

• family and community influences

• healthcare disparities

Are black or white teens more likely to exhibit bulimic behavior?

blacks are 50% more likely

Are hispanics or non-hispanic adolescents more likely to develop bulimia?

hispanics

Gordon, Brattole, Wingate, & Joiner Study: How did clinicians respond when presented with identical cases of eating disorders with the only difference being race?

• 44% identified white women’s behavior as problematic

• 41% identified hispanic women’s behavior as problematic

• 17% identified black women’s behavior as problematic

Anorexia in boys

Patterns of ___ in girls and boys interact with cultural linfluences to create eating disorders

physical development

How does physical development impact the development of eating disorders?

girls gain weight in fat tissue after puberty (farther from ideal) while boys develop muscle and lean tissue (closer to ideal)

By 9 years old, __% of girls reported trying to lose weight. __% by age 14

20%; 40%

Body image concerns tend to ___ with age

decrease

The size and weight of the average women have increased over the years with improved nutrition. The collision between culture and physiology have caused women to…

become dissatisfied with their bodies

Describe the findings on men’s reality vs ideal body size (Fallon & Rozin; Pope et. al.)

• rated ideal body size as heavier than what women considered attractive

• believed women prefer men 30lb more muscular than their current size

Describe the findings on women’s reality vs ideal body size (Fallon & Rozin; Pope et. al.)

• rated their body size as heavier than actual

• rated the most attractive body size as thinner and rated their ideal body size as even thinner

Men use anabolic steroids to increase muscle mass. What problems might this lead to?

binge-drinking, drug addiction, etc

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