chapter 9: eating disorders

Eating disorders

An intense preoccupation with weight, body shape, and food, often driven by fear of gaining weight. Fear, especially fear of gaining weight, eating, or losing control over body size.

Anorexia nervosa

An eating disorder involving severe food restriction, significantly low body weight, fear of weight gain, and distorted body image. Anorexia is more common in women and girls, who account for about 75% of reported cases in the provided text.

Amenorrhea

The absence of menstrual periods.

Lanugo

Fine, soft hair that grows on the body of severely malnourished individuals.

Dangers of anorexia nervosa

Starvation, electrolyte imbalances, heart problems, low blood pressure, bone loss, organ damage, and increased risk of death.

Anorexia: thinking patterns

Distorted body image, food preoccupation, perfectionism, rigid thinking, and self-worth based mainly on weight and shape.

Anorexia: psychological problems

Depression, anxiety, low self-esteem, sleep disturbances, perfectionism, and obsessive-compulsive patterns.

Anorexia: physical symptoms

Very low body weight, lanugo, dry skin, brittle nails, hair loss, feeling cold, low blood pressure, and bone pain.

1940s starvation study

A study in which 36 average-weight men were semistarved for six months and developed food preoccupation and other starvation-related symptoms.

Food preoccupation

Food preoccupation can result from starvation rather than being the original cause of the disorder.

Bulimia nervosa

An eating disorder involving recurrent binge eating followed by inappropriate compensatory behaviors to prevent weight gain. Anxiety and tension can trigger bingeing; bingeing and purging may temporarily relieve distress, reinforcing the cycle.

Binge eating

Eating an unusually large amount of food in a short period while feeling unable to control the eating.

Compensatory behaviors

Behaviors intended to counteract eating or prevent weight gain, such as purging, fasting, or excessive exercise.

Purging

Attempting to compensate for eating through behaviors such as self-induced vomiting or misuse of laxatives or diuretics.

Diuretics

Substances that increase urination and are sometimes misused in attempts to lose weight.

Bulimia vs anorexia

People with bulimia are generally at a normal or healthy weight; people with anorexia are significantly underweight. Both can involve fear of weight gain, dieting, distorted body image, food preoccupation, perfectionism, anxiety, and depression. Perfectionism and obsessiveness are associated with both anorexia and bulimia; personality disorder characteristics are more common in bulimia.

risk groups for bulimia

Women and girls, LGBTQ+ individuals, and people experiencing food insecurity are identified as higher-risk groups in the provided text.

bulimia onset

Adolescence or young adulthood, usually between ages 15 and 20.

Bulimia traits

more concerned with pleasing others and being attractive. more sexually experienced or active than those with anorexia. Personality disorder characteristics, particularly borderline or avoidant traits, are common. Tooth enamel erosion, tooth decay, potassium deficiency, heart rhythm problems, esophageal damage, dehydration, and menstrual irregularities.

Binge eating disorder (BED)

An eating disorder involving recurrent binge eating and loss of control, without regular inappropriate compensatory behaviors.

Symptoms of binge eating disorder

Rapid eating, eating until uncomfortably full, eating when not hungry, eating alone from embarrassment, and feeling guilt or disgust afterward.

Compensatory behaviors in BED

People with BED do not regularly use purging, fasting, or excessive exercise to compensate for binges.

Hilde Bruch’s psychodynamic explanation

Eating disorders may develop from early relationship difficulties that interfere with autonomy and accurate awareness of internal needs.

Ineffective parenting

Parenting that fails to respond accurately to a child's biological or emotional needs.

Internal cues

Signals such as hunger, fullness, and emotional distress that help a person understand what their body or emotions need.

Alexithymia

Difficulty identifying and describing one's emotions.

Control and eating disorders

A person who feels little control over their life or body may try to gain control through strict control of food and weight.

Mood disorders and eating disorders

Eating disorders are associated with depression; the disorders may share psychological, brain-circuit, and neurotransmitter factors.

Concordance rate

The percentage of genetically related individuals, such as twins, who both have a particular disorder.

Eating disorders and family history

Relatives of people with eating disorders have an increased likelihood of developing an eating disorder themselves.

Anorexia twin concordance rates

About 70% for identical twins and 20% for fraternal twins, according to the provided text.

Bulimia twin concordance rates

About 23% for identical twins and 9% for fraternal twins, according to the provided text.

Serotonin and eating disorders

A neurotransmitter involved in mood and brain functioning that is implicated in eating disorders, particularly bulimia.

Hypothalamus

A brain region involved in regulating hunger and eating.

Lateral hypothalamus (LH)

The hypothalamic region associated with stimulating hunger when activated.

Ventromedial hypothalamus (VMH)

The hypothalamic region associated with suppressing hunger when activated.

Weight set point

The body's proposed preferred weight range, which influences hunger and metabolism.

Societal pressures and eating disorders

Thinness ideals, weight stigma, body shaming, and social media can contribute to body dissatisfaction and disordered eating.

Professions and subcultures associated with eating disorders

Modeling, dancing, acting, performing, and competitive sports, where appearance or weight may be emphasized.

Family environment and eating disorders

Family emphasis on thinness, appearance, dieting, perfectionism, or weight-related teasing may contribute to risk.

Enmeshed family pattern

A family dynamic in which members are overly involved in one another's lives, limiting individual independence.

Eating disorders across racial and ethnic groups

The provided text describes eating disorders across racial and ethnic groups and notes that people of color may be underdiagnosed or undertreated.

Eating disorders and sexual orientation

The provided text describes elevated eating-disorder risk among LGBTQ+ populations, particularly gay men and transgender or nonbinary individuals.

Two main goals of treatment

Correct dangerous eating behaviors and address the psychological, cognitive, interpersonal, and situational factors maintaining the disorder.

Anorexia treatment

Usually begins with nutritional rehabilitation and weight restoration, followed by psychotherapy and sometimes family therapy.

Nutritional rehabilitation

Restoring adequate nutrition and addressing malnutrition through a structured eating plan and medical support.

Supportive nursing care

Care involving encouragement, nutritional counseling, progress monitoring, and support for safe weight restoration.

Positive outcomes of anorexia treatment

Weight restoration, possible return of menstruation, reduced mortality, and full or partial recovery for many patients.

Challenges in anorexia treatment

Some patients experience persistent symptoms, relapse, body-image concerns, depression, social anxiety, or obsessive thinking.

Treatments for bulimia

CBT, nutritional rehabilitation, interpersonal therapy, psychodynamic therapy, group therapy, support groups, and antidepressants.

Eating diaries

Records used to track eating patterns, feelings, hunger, and triggers for bingeing or purging.

Exposure and response prevention (ERP)

A behavioral technique involving exposure to feared situations while resisting the usual compulsive response.

CBT effectiveness for bulimia

The provided text reports that CBT stops or significantly reduces bingeing and purging in up to 75% of patients.

Medical treatment for bulimia

Antidepressants may reduce bingeing and vomiting, especially when combined with psychotherapy.

Anorexia follow-up outcomes

Many patients show full or partial improvement, but some remain seriously ill or relapse after recovery.

Bulimia follow-up outcomes

Many patients improve with treatment, although relapse can occur, especially with a longer illness history or substance abuse.

Most common eating disorder among women

Binge eating disorder, according to the prevalence figures in the provided text.

Least common eating disorder among women

Anorexia nervosa, according to the prevalence figures in the provided text.

Eating disorder treated most successfully

Bulimia nervosa, according to the long-term treatment outcomes in the provided text.

Eating disorder hardest to treat

Anorexia nervosa, which has comparatively lower long-term recovery rates in the provided text.

Average lifetime duration of anorexia

About 6 years, according to the provided text.

Average lifetime duration of bulimia

About 6 years, according to the provided text.

Average lifetime duration of BED

About 14 years, according to the provided text.

Binge eating disorder treatment

CBT, interpersonal therapy, dialectical behavior therapy, group therapy, and sometimes medication.

Medication for binge eating disorder

The provided text identifies antidepressants, Vyvanse, and Topamax as medications that may be used.

BED treatment outcomes

The provided text reports that up to 60% of clients no longer meet the diagnostic criteria by the end of treatment.