psychopathology exam 3 class notes

main diagnoses of eating disorders

anorexia nervosa, bulimia nervosa and binge eating disorders

todays western socetys’s

in modern day western societies, they equate thinness with health and body

anorexia main symptoms

restricted net intake of nourishment which results in significantly low body weight

• DSM-5: less than minimally normal

intense fear of gaining weight (emotional competent)

persistent behavior that interferes with weight gain

distorted view of weight and shape (cognitive)

cognitive symptoms in anorexia 

maladaptive attitudes

overestimate size 

• see themselves was larger than they are 

low opinion of body shape 

two main subtypes of anorexia

restricting type and binge-eating/purging type

restricting type (anorexia)

lose weight by restricting food intake (dieting, fasting)

show almost no variability in diet

• usually starts by dieting

binge eating/purging type (anorexia)

may engage in eating binges

loosing weight by purging

• focusing oneself to vomit after meals or abuse of laxatives

• key goal is becoming thin

• key difference between this subtype and binge eating disorder is the significant low body weight

anorexia and food 

despite dieting restrictions, people with this disorder are preoccupied with food 

• not be causal rather the result of starvation 

comorbid psychological experiences and anorexia

depression, anxiety, obsessive completive patterns

facts about anorexia nervosa

• peak onset age is in between 14 and 20 years old

• around 75% ( up to 90%) of cases occur in females

• 0.6% of females in western countries develop anorexia

• 25-50 percent of college students experience symptoms

• most patients recover but 2 to 6 percent become seriously ill and die as a result

• 5x higher suicide rate

bulimia nervosa (binge-purge syndrome)

• characterized by binges,

• average to above average weight ,

• 2,000 to 3,400 calories consumed per binge,

• at least once a week for 3 months they perform binging and purging ( 1 to 30 x)

• often carries out in secret 

• after binge they try to undo the caloric effect by purging

binges

about of uncontrolled over eating during a limited period of time

compensatory behaviors in binge eating disorder

• most common techniques are vomiting, laxatives, and diuretics although also fasting and expecting can occur

• largely fails to prevent calories consumed, only 50% of calories consumed get out

• repeated vomiting effects the ability to feel satisfied → greater hunger and binging

negative reinforcement and bulimia eating

• purging increases binges because it takes away negative feelings overtime

• binging increases because the feeling os powerlessness and tension is taken away

positive reinforcement and binge eating disorder 

• binging is increased because its adding pleasure to someones life 

bulimia nervosa: compensatory behaviors 

• binges are preceded by feelings of powerlessness and/or tension 

• while biting may feel pleasurable its usually quickly followed by feelings of guilt, blame, depression and or fear of weight gain

• purging behaviors may temporality relieve these negative feelings attached to binge eating

  • biting overtime leads to a cycle

facts about bulimia nervosa

• 83% 0f bulimia nervosa occurs in females

• peak onset in between 15 and 20 years old

• symptoms may last for several years with periodic remission of symptoms (episodic)

• 1% of people are diagnosed over a lifetime

binge eating disorder

symptoms include a pattern of binge eating with distress

• no compensatory behaviors (not purging)

• uncontrollable, causes discomfort,

• two thirds become overweight or obese

population effected by binge eating disorder

affects about 2.8% of the population

• 67% of females

what perspective is used to explain eating disorders

multidimensional risk perspective

• Biopsychosocial

  • biological factors, cognitive-behavioral/mood (psychological), societal pressures/multicultural factors (sociocultural conditions)

cognitive-behavioral theorist and eating disorders 

cognitive distortion is at the core of eating disorders (maladaptive thoughts) 

• individuals judge themselves based on their shape, weight, and ability to control them 

• control makes them feel worthy and lovable (Rogers) 

mood factors and eating disorders

people with eating disorders experience symptoms of depression (especially those with bulimia)

• some therapist believe depression sets the stage of eating disorders

genes and eating disorders (biological factors)

relatives of people with eating disorders are up to 6 times more likely to develop the disorder themselves

• for example identical twins are at a 70% risk for anorexia while fraternal twins are at a 20% risk

• creations genes may leave some people susceptible to eating disorders

biological factors and eating disorders 

• brain circuitry: disregulation in parts of the brain 

• dysfunction of the hypothalamus: lateral and ventromedial 

later hypothalamus

releases peptides that release hunger

• increasing hunger perception

ventromedial hypothalamus

suppress hunger 

• decreases our perception of hunger 

weight thermostat (weight set point)

hypothalamus lateral and ventromedial hypothalamus, and chemicals are responsible fora persons particular weight level

• set by inheritance and early eating practices 

anorexia and weight thermostat

when someone with anorexia is getting to that lower weight point, their body is working to increase hunger and slow down their metabolism to get them back to their weight level

sociocultural factors and eating disorders

• western standards for female attractiveness

• western society not only glorifies thinness but also creates a climate of prejudice against overweight people

• dieting and preoccupation with thinness are increasing in all socioeconomic groups

men and eating disorders 

men account for approximately 25% of all cases if eating disorders 

• double/different standard for attractiveness 

• stigma associated with seeking treatment for a stereotypically female difficulty 

• different methods of weight loss favored 

subcultures at a greater risk for eating disorders

models, actors, dancers, and certain athetes

treatment for anorexia nervosa

treatment aims to regain lost weight recover from malnutrition, and work to eat normally in 8 to 12 weeks

• combination of supportive nursing care nutritional counseling (may include rewards)

• must also focus of underlying psychological problems to achieve lasting improvement

behavioral aspect in cognitive behavioral therapy in anorexia nervosa  

behavioral

• clients are required to monitor feelings thoughts, hunger levels, and food intake and the ties among those variables (diaries)

cognitive aspect in cognitive behavioral therapy in anorexia

• education about thinking patterns and body distortions 

• identify and correct their distorted thinking patterns and maladaptive attitudes towards eating and weight 

• recognize need for independence and teach more approbate ways to exercise control 

• alternative ways of coping with stress

treatments for bulimia nervosa

address binge-purge patterns and establish good eating habits

address the underlying psychological causes of bulimic patterns

• cognitive behavioral therapy with self monitoring + exposure and response prevention

exposure and response prevention (bulimia) 

exposing to binge like behavior, work to understand thoughts attached to negative feelings and not purge 

• constructive eating 

other forms of psychotherapy in eating disorders

interpersonal psychotherapy

group therapy

antidepressant medications

• drugs help as many as 40% of patients

anorexia improvement

75% show improvement after treatment that lasts several years

• not always permanent and may continue to have difficulties

bulimia improvement

80% of cases see improvement

• relapse if often triggered by stress