Class 20 (Eating disorders: bulimia nervosa + BED)

body dissatisfaction

feeling negatively about physical appearance

body dissatisfaction over the lifespan

• occurs throughout the lifespan

• striking increases in prevalence of dieting and desire to lose weight in girls beginning at puberty

• other youth don’t show this increase

body dissatisfaction is both a characteristic and predictor of _____

future eating disorder

main eating disorders in the DSM

• anorexia nervosa

• bulimia nervosa

• binge eating disorder

core features of all eating disorders

• over- or under- control of eating behaviors

• self-esteem tied to physical appearance

• difficulties with interoceptive awareness

what overlaps do anorexia nervosa and bulimia nervosa share?

most commonly emerge during one of two life transitions

1. from puberty to adol

2. from adol into emerging adulthood

95% of cases in ages 11-25

4-5x more common in females than other youth

diagnostic criteria for bulimia nervosa

recurrent episodes of binge eating; an episode is characterized by both of the following:

• eating, in a discrete period of time (e.g. within any 2-hour period), an amount of food that is definitely larger than what most individuals would eat in a similar period of time under similar circumstances

• a sense of lack of control over eating during the episode (e.g. feeling that one cannot stop eating or control what/how much one is eating)

recurrent inappropriate compensatory behaviors in order to prevent weight gain, such as self-induced vomiting; misuse of laxatives, diuretics, or other medications; fasting; or excessive exercise

the binge eating and inappropriate compensatory behavior both occur, on avg, at least once a week for 3 months

self evaluation is unduly influenced by body shape and weight (like feelings about yourself)

the disturbance does not occur exclusively during episodes of anorexia nervosa

how much food is binging?

no set amount of food constitutes a binge, but many binges involved about 5x as many calories as in a normal meal

what component is really critical to what is considered binging?

context (e.g. Thanksgiving is not a binge)

why does bulimia nervosa start in adol for females (class’ ideas)?

• females go thru puberty earlier than males

• changes (within the body, appearance) are quicker

• overall weight gain

• self consciousness, increased social comparison

• peer victimization, pubertal asynchrony

why does bulimia nervosa start in adol for females?

• intense societal focus on female physical appearance begins as girls mature physically

• media body image (very few women possess the body type depicted in mass media)

intense societal focus on female physical appearance begins as girls mature physically

many adol girls have difficulty adjusting to this societal focus, coupled w/ rapid changes in body shape and weight that begin at puberty

media and body image

• amt of media exposure (of all types — from social media to advertising) predicts levels of body dissatisfaction and eating disorders

  • idea of the “ideal body”

• viewing media images of thin models in lab is linked with immediate increases in body dissatisfaction and changes in food choices

Nadroga, Fiji 1995 naturalistic study of tv

introduction to satellite tv and first regular exposure to western mass media

n = 128 adol girls

from 1995-1998

• prevalence of dieting rose 69%

• prevalence of purging rose 12%

• 75% of girls surveyed in 1998 reported they felt “too fat”

• girls with tv sets at home were 3x more likely to report clinically significant levels of body dissatisfaction

eating disorders across cultures

eating disorders are disproportionately more prevalent in North America, Western Europe, and Japan

• in these cultures, wealth correlates inversely w weight

• in other cultures (particularly less industrialized ones), wealth correlates positively with weight and larger figures are considered signs of both beauty and success

eating disorders in America

• prevalence of eating disorders in the US has risen as the image of ideal woman has increasingly emphasized thinness

• eating disorders are more common among young women in fields which emphasize thinness (e.g. dancers, gymnasts, models, figure skaters, etc.)

• eating disorders are considerably more common among middle- and upper- class Americans of all racial and ethnic backgrounds

objectification

perceiving another person as an object or commodity, without consideration of personality or dignity

what comes out of constant physical scrutiny of female bodies?

consequences: discrimination (both subtle and overt), diminished attributions of agency and intelligence

when does objectification begin?

frequently begins at puberty

objectification theory

for women, having a reproductively mature body results in physical scrutiny based on physical appearance, and creates a set of psychological risks, including disordered eating, that stem from the social experience of being evaluated based on physical appearance

self objectification

girls and women are socialized to internalize the observer’s view of themselves as important indicators of their worth and value

why is self objectification important?

a self concept that is excessively tied to physical appearance is a key nomothetic feature of disordered eating

how do we view objects: there are different cognitive processes are involved in perceiving visual stimuli as human or non-human, so what are the 2 types?

1. configural processing

2. analytic processing

configural processing

involved in recognizing visual stimulus as a person, involves perceiving relations among the diff parts of a stimulus

analytic processing

recognizing a visual stimulus as an object; does not take into account spatial relationships of diff parts of the stimulus

inversion effect

accuracy of recall and recognition changes when visual stimulus is inverted vs non-inverted

• analytic processing (e.g. objects) tends not to be affected by inversion

• configural processing is subject to inversion effect, much harder to recognize and identify ppl when they are upside down

literal objectification (Bernard et al 2012)

• participants were shown upright and inverted pictures of female and male targets

• participants recognized male pictures better when they were upright == inversion effect, indicating they used configural processing)

• no difference in recall for female pictures regardless of image orientation == indicates that participants used analytic processing consistent with perceiving objects

at a basic cognitive level, sexualized men were perceived as persons, whereas sexualized women were perceived as objects

girls’ dissatisfaction with their bodies seems related to the greater societal enviro, but all girls are exposed to these messages and not all of them develop eating disorders

as with all disorders, we see a lot of equifinality in eating disorders

• equifinality same outcome can be reached through different paths or starting points

interoceptive awareness

recognition of internal physical cues — such as hunger, cold, pain

interoceptive awareness and eating disorders

• longitudinal studies show that ppl with poor interoceptive awareness are more likely to develop disordered eating 1-4 yrs later

• poor interoceptive awareness also explains why ppl who self-objectify have more symptoms of disordered eating

• the more ppl come to view themselves from an external, observer’s perspective, the more they seem to lose touch with their own internal sensations, including feeling hungry or full

binge eating disorder vs anorexia and bulimia

binge eating disorder differs in 2 key ways

1. not more common in females than other genders

2. emerges throughout the lifespan, whereas the others emerge during adol

diagnostic criteria for binge eating disorder (BED)

recurrent episodes of binge eating; an episode is characterized by both of the following:

• eating, in a discrete period of time (e.g. within any 2-hour period), an amount of food that is definitely larger than what most individuals would eat in a similar period of time under similar circumstances

• a sense of lack of control over eating during the episode (e.g. feeling that one cannot stop eating or control what/how much one is eating)

the binge eating episodes are associated with 3 or more of the following:

• eating much more rapidly than normal

• eating until feeling uncomfortably full

• eating large amts of food when not feeling physically hungry

• eating alone bc of feeling embarrassed by how much one is eating

• feeling disgusted with oneself, depressed, or very guilty afterward

marked distress regarding binge eating is present

the binge eating occurs, on avg, at least once a week for 3 months

the binge eating is not associated with the recurrent use of inappropriate compensatory behavior as in bulimia nervosa and does not occur exclusively during the course of bulimia nervosa or anorexia nervosa

two common antecedents of a binge

1. hunger (when you’re hungry)

2. emotional distress (when you’re upset)

binge trajectory

1. binge

2. feel immediately better (relief, comfort, positive emotions)

3. later feel intense guilt and shame

4. restrict diet and other compensatory behaviors in bulimia but not in BED (fosters the likelihood of a future binge)

intervention for bulimia nervosa and BED

CBT is the “first-line” treatment for both bulimia nervosa and BED

other empirically supported treatments include:

• interpersonal psychotherapy (a short term protocol focusing on 1 of 4 diff interpersonal domains)

• SSRIs

CBT for bulimia nervosa and BED

• emphasizes self-monitoring of food intake and emotions to improve interoceptive awareness

• regular, stable eating schedule (3 meals, 3 snacks)

• reducing distorted perceptions of weight, educate clients on functions of binge

how fast does CBT for bulimia nervosa and BED work?

really quickly

• > 70% of participants show significant changes within first 3 wks

• approx 80% show complete remission after treatment

• approx 75% of those who achieve remission maintain those gains 1 yr later

body dissatisfaction in ppl without eating disorders

good news: how ppl feel about their bodies changes over the lifespan!

normative changes in body satisfaction and weight

• 20 yr longitudinal study of body satisfaction and eating habits

• although body weight tends to increase with age, we see dramatic declines in body dissatisfaction, drive for thinness, dieting, and disordered eating symptoms in women in the 20 yrs after college graduation