PSYCH66 - Eating Disorders

3 Eating Disorders

• Anorexia Nervosa

• Bulimia Nervosa

• Binge Eating

Define Anorexia Nervosa

marked by the pursuit of extreme thinness by extreme weight loss

2 types of anorexia nervosa

1. restricting-type

2. binge-eating/purging type

Anorexia nervosa: Restricting-type

purposeful starvation

Anorexia nervosa: Binge-eating/purging type

compensatory behaviors to avoid weight gain

* different from bulimia nervosa

• examples: excessively going to the gym, using diuretics , forced vomiting

What is the real goal for Anorexia Nervosa?

becoming extremely thin

• if weight is mentioned/underweight = anorexia

What must you be to be diagnosed with anorexia?

Underweight

Things to know about Anorexia Nervosa

90-95% of sufferers are female, does NOT mean men + older ppl can’t have anorexia

• distorted body image, lack of awareness of problem (thinks others are the problem and try to hide their d/o), motivated by fear of gaining weight

• 6-10% of clients die - DEADLY d/o

• needs to be connected with doctor/physician for weight issues

Diagnostic Criteria - Anorexia Nervosa

• Restricted net intake of nourishment —> significantly low body weight

• intense fear of gaining weight , even though significantly underweight

• disturbed body perception, undue influence of weight or shape on self-evaluation or persistent denial of the seriousness of the current low weight

  • influence on self evaluation - means that they use their weight or shape to determine their worth (skinny = good, fat = bad)

• No timeline - based on symptoms and body weight

Anorexia: Medical Problems

Amenorrhea - no menstrual cycle

Decreases in:

• body temp

• blood pressure

• heart rate

• bone mineral density

Dry skin, cracked nails, cold + blue extremities, lose hair

BODY IS STARVING

Who is impacted by Anorexia?

90-95% are female - does happen in males as well

Common in females of European Ancestry

What are the onset peaks (first experience of this d/o) for Anorexia?

14-20 years old, but can happen at any age

Define Bulimia Nervosa

Binging-Purging syndrome

Define binging

repeated episodes of overeating

• usually occurs w/in 2 hr periods, eats way more than the avg person during this time

• Ex: 2,500 calories in 2 hours

Define purging

compensatory behaviors

• after binges, always —> purge

Onset age for Bulimia Nervosa

typically 15-21 years old, can reappear periodically over lifespan

Bulimia nervosa: affected population

90-95% female, but can occur in males too

Main differences Bulimia has from Anorexia

sufferers —> normal body weight

sufferers —> have awareness that there is a problem

What is the goal of people with Bulimia Nervosa

To look pleasant/attractive to others

• NOT to look super skinny

Other info about Bulimia Nervosa

1/3 bulimics display characteristics of PDs

Diagnostic Criteria of Bulimia Nervosa

• recurrent episodes of binge eating

• recurrent inappropriate compensatory behavior to prevent weight gain

• symptoms continuing (on avg) at least once a week for 3 months

• Undue influence of weight or shape on self-evaluation

How many binges/purges would occur per week

Between 1-30 binge episodes per week, usually kept secret

• eats very fast w/ minimal chewing

• typically sweets or soft foods, forbidden food

• about 2000 - 3400 cal per binge although some ppl take in abt 10k cal

How do people with Bulimia Nervosa emotionally feel about eating?

feelings of tension, irritability, and powerlessness to control overwhelming need to eat

• may seem pleasurable at the moment, later feels self-blame, shame, guilt, or depression

What comes after binges?

Compensation — purging

Binging and purging is a cycle

How does purging help after the binge for people with Bulimia?

Doing these things temporarily relieves physical and psychological discomfort

What are examples of purging?

forced repeated vomiting is the most common and popular one

• also, overuse of laxatives or excessive amounts of exercise

Medical Problems for people with Bulimia Nervosa

½ women have irregular cycles (in anorexia, most have irregular/no menses)

Serious dental problems - from vomiting too much —> loss of teeth, breakdown of enamel

Damage to esophagus

Frequent vomiting and diarrhea can —> potassium deficiencies , could result in weakness, intestinal d/o, kidney disease, or heart disease

Similarities of Anorexia + Bulimia

• period of dieting by ppl fearful of becoming obese

• struggle w/ depression, anxiety, obsessiveness, need to be perfect

• driven to be thin

• heightened risk of suicide attempts + fatalities

• substance abuse

• believe they weigh too much, look too heavy

• disturbed attitudes toward eating

Differences between Anorexia + Bulimia

People who are bulimic —>

• more concerned abt pleasing others, being attractive, have intimate relationships

• more sexually active

• easily frustrated/bored

• trouble coping/controlling impulses

• 1/3 of pts display characteristics of PD (usually borderline/avoidant)

• serious dental problems

• long term cardiovascular disease

• dangerous potassium deficiencies

What is Binge-eating D/O?

engage in binge eating but DO NOT demonstrate compensatory behaviors

• preoccupied with weight/food, NOT driven toward thinness

Other info about Binge-eating D/O

• share common cognitive distortions + base self worth on weight + body image

• common pattern —> overweight or obese

• most prevalent ED

• women outnumber men at 64%

• view large amounts of food as moderate + can significantly affect those who live with food insecurity

How are binges in binge-eating d/o similar to bulimia?

types of food, amounts, sense of loss of control

Diagnostic criteria for Binge-Eating D/O

• recurrent episodes of binge eating

• binge eating episodes must be associated with 3 of the following

  • unusually fast eating

  • absence of hunger

  • uncomfortable fullness

  • secret eating due to sense of shame

  • subsequent feelings of self-disgust, depression, severe guild - sig distress regarding binge eating

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

• No pattern of inappropriate compensatory behavior

Binge Eating D/O medical problems

• sufferers are often overweight and obese

• most likely to develop —> diabetes, high blood pressure, heart disease, high cholesterol, stroke

  • can even develop these without being obese —> joint pain, headaches, gastrointestinal problems, shortness of breath

Psychodynamic Factors for developing Eating D/Os

Parenting plays a role that “disturbed mother-child” interactions —> ego deficiencies + perceptual disturbances in the child

Who researched Psychodynamic factors in developing Eating D/O?

Hilde Bruch

Is research on attachment and parenting styles, and their influence on eating disorders legit?

YES, there is lots of research on this attachment theory and is known to be true

What are ego deficiencies?

Poor sense of independence and control

Two types of parenting

Effective parenting and Ineffective parenting

Describe effective parents

respond to child’s biological needs appropriately

• if child is hungry —> parents respond in timely and appropriate manner

• results in healthy relationship w/ children

Describe ineffective parents

do not interpret their child’s needs correctly and therefore do not meet the effective needs

• results in children having lack of understanding of their internal needs —> eating d/o

• can’t rely on internal signals from themselves, feel as if they have no control over impulses

• leads to —> desire to have excessive control over their bodies

What is the Multidimensional risk perspective for eating disorders?

a broader view of how eating disorders can manifest in individuals, taking in several ideas into account

Western society/Societal pressure in Eating Disorders

thin = healthy + beauty

• a person’s value based on their appearance

• unrealistic expectations perpetuated by media

• ig filter; photoshop; celebrities; thigh gap

Cognitive distortions in Eating Disorders

judge themselves exclusively on their body weight + shape + their ability to control it

• known as “core pathology” in CBT

Biological factors in Eating Disorders

• relatives are 6x more likely to develop an ED

• abnormal levels of serotonin, dopamine, + glutamate

• structural issues + problems w/ brain circuits (e.g. hypothalamus)

Family environment + control in Eating Disorders

deteriorating relationships w/ family and friends

• Enmeshed family systems

What are enmeshed family systems

a lack of healthy boundaries in the family system, in a toxic and unhealthy way

• ex: a sick child justifies over involvement and poor boundaries

Depression as a cause of ED

• ½ of those with ED have symptoms of depression

• people with ED are helped by the same antidepressant related to depression

• many people with ED qualify for diagnosis for MDD

Who does Eating Disorders impact at higher rates in modern day society? Why is this important to know?

People of color

• more young women of color than ever before

• partly due to acculturation displayed by minority group women

Treatment must be helpful for all different types of people, not just white women

How does the internet play a role in Eating disorders

It encourages people to develop and continue having an eating disorder

• more than 500 pro-ana sites

• makes anorexia a lifestyle and NOT a psych D/O

• gives tips on starving, hiding weight loss

• more influences on Social Media

What are the 2 general goals of treatment?

1. Treat + correct dangerous eating behavior

2. Treat the broader psychological + situational aspect of the d/o, and find + address the root problem

Why is it important to find and address the root problem of an eating disorder?

because the patient will just relapse and not be able to get away from their eating disorder

• if there’s no treatment in the family system, they’re gonna relapse if the root problem is the family

Are there any treatments specific for a certain eating disorder?

No, they treat all types of ED

CBT treatment for Eating Disorders

Cognitive therapy

Milieu

Family therapy

Cognitive therapy: Eating Disorders

goal: change pt’s view on food + self esteem

How do food journals help people with Eating Disorders?

monitors food intake, feelings, hunger levels, identifying a connection between feelings and food

What is milieu and how does it help those with ED?

Looks like a normal house, where patients meet up to simply live together for a day

• eat meals together to establish how their relationship should be with food and living

• provides a sense of support, a kind of group therapy

• supportive environment for pt along therapy + nutritional support —> encourage pt to eat and feel confident

Family therapy: Eating disorders

restructuring toxic family systems

• improve communication

• increase healthy expectations + boundaries

Works to find and resolve the root problem of ED

Antidepressants: ED

lessen feelings of guilt + depression —> self-destructive ED behaviors

Which is the most popular and one of the most effective treatments for Eating Disorders?

Milieu