Psychopathology Eating Disorders

Anorexia diagnostic criteria

1. food restriction that leads to a significantly below normal body weight

2. intense fear of weight gain or repeated behaviors that interfere with it

3. body image disturbance

Anorexia subtypes

1. restricting → weight loss achieved through intake restriction

2. binge/purge → weight loss achieved through regular bp

Anorexia physical consequences

1. low blood pressure and heart rate, anemia

2. renal, gastroinstestinal, hormonal, and bone problems

3. hair loss or lanugo

4. electrolyte disturbance (affects neural transmission and can cause death)

Anorexia prognosis

• 50-70% recover or significantly improve

• recovery usually takes 6-7 years

Anorexia mortality

• death rates 10x the general population, 2x other psychological disorders

• highest ED mortality

• 3-5% in women

Bulimia diagnostic criteria

1. recurrent binge eating episodes

2. recurrent compensatory behaviors (e.g. vomiting)

3. body shape and weight are extremely important for self-evaluation

Bulimia prevalence

90% women, 1-2% of the population

Bulimia onset

late adolescence or early adulthood

Bulimia comorbidity

depression, PDs, ADs, SUDs, conduct disorder

Bulimia suicide rate

higher than average but lower than anorexia

Physical consequences of self induced vomiting

1. potassium depletion

2. esophageal or gastric tear

3. dental erosion

4. salivary gland swelling

Physical consequences of laxative abuse

1. electrolyte disturbance → cardiac problems

2. chronic diarrhea/constipation

3. organ damage

Bulimia prognosis

1. 68-75% recover but 10-20% remain fully symptomatic

2. early intervention is linked to better prognosis

3. more frequent b/p, substance use, or a history of depression is linked to worse prognosis

Bulimia mortality

lower than anorexia but higher than other disorders

Binge eating disorder diagnostic criteria

1. recurrent binge eating episodes

2. no compensatory behavior

3. at least 3+: eating more quickly, until over full, in large amounts if not hungry, alone due to embarrassment, and with bad feeling after

Binge eating disorder prevalence

1. most prevalent, 0.2-4.7%

2. more common in men

3. higher in those with childhood obesity, critical comments about being overweight, weight loss attempt in childhood, and childhood abuse

Binge eating disorder comorbidity

MDs, ADs, ADHD, SUDs, conduct disorder

Obesity related physical consequences of binge eating

1. cardiovascular problems

2. chronic back pain

3. headaches

4. type 2 diabetes

Non obesity related physical consequences of binge eating

1. sleep problems

2. anxiety and depression

3. IBS

4. early onset menstruation

BED recovery

about 60% recover but may take longer than AN or BN

BED mortality

lower than anorexia but higher than other disorders

AN genetic etiology

1. high heritability (0.48-0.74)

2. 1st degree relatives more than 10x as likely to have the disorder

3. a study identified significant location on chromosome 12

AN neurobiological etiology (hippocampus)

1. decreased activity in the hippocampus

2. regulates hunger, causing weight and appetite loss when lesioned

3. likely caused by the starvation, does not account for body image or persistent hunger

AN neurobiological etiology (striatum)

1. when seeing or tasting food, ventral striatum (reward) was more active in all women

2. dorsal striatum (habitual choices and anxiety) was more active in women with AN

3. disordered behavior is a habituated, rewarding response to prevent anxiety

Endogenous opioids and EDs

1. reduce pain, enhance mood, and suppress appetite

2. released during starvation (and exercise), elevating mood

3. BN and BED have low levels of beta-endorphin (might be caused by disorder)

Serotonin in EDS

1. promotes fullness, disrupted by starvation

2. lower in AN and BN

3. linked to co-morbid depression

Dopamine and EDs

1. reward-driven motivation (food)

2. AN and BN have greater expression of (the dopamine transporter gene) DAT

3. higher dopamine levels linked to higher rates of weight gain

4. the incentive-sensitization theory states that binge eating is fueled by dopamine, causing more wanting triggered by cues, but not always liking

Bulimia genetic etiology

1. moderately heritable (0.55-0.62)

2. 1st degree relatives of women with bulimia are about 4x as likely to have the disorder (does not apply to men)

BED genetic etiology

1. moderately heritable (0.49)

2. relatives of those with BED and obesity are more likely to have BED than relatives of those with obesity alone

Anorexia cognitive behavioral etiology

1. positively reinforcing motivating factors

2. personality

3. cultural idealization of thinness

4. criticism about weight

5. emotions

Motivating factors that positively reinforce AN

1. dieting

2. praise

3. reduced anxiety about weight gain

4. sense of self-control

Personality factors that make restriction in AN more rewarding

perfectionism and sense of inadequacy can cause body concerns that make dieting more reinforcing

How cultural idealization of thinness is related to insecurity in AN

comparison of self with the ideal leads to dissatisfaction with self

Criticism about weight and ED development

in girls age 10-15 obesity led to peer criticism, which lead to dissatisfaction, and the development of an ED

Bulimia cognitive behavioral etiology

1. self worth is heavily tied to body

2. purging alleviates negative feelings after a binge

3. binges are regulatory behaviors in response to stress

Idealized thinness in BN and BED

extreme diets can lead to binge eating

Anorexia sociocultural etiology

1. thinness is pushed on women

2. exposure to thin models is linked to body dissatisfaction

Why women are disproportionately affected by AN

1. western cultural standards reinforce thinness as attractive for women

2. women are sexualized and defined in worth by their body, men are esteemed more for accomplishments

3. women internalize objectifying messages in media, feeling distress when their body doesnt match the ideal