(4) Problematic Consequences: Anorexia Nervosa and Bulimia Nervosa

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Body image and anorexia nervosa

• many famous people acme AN and some of them died

• But there are websites to promote AN as a lifestyle choice (pro-ana)

Anorexia Nervosa

• refusal to keep body weight at or above minimally normal weight for age and height

• instease FEAR of gaining weight or becoming fat

• Disturbance in body weight/shape experiences, undue influence of body weight/shape on self-evaluation, or denial of seriousness of current low body weight

Diagnostic significance and clinical relevance

• body dissatisfaction = most immediate antecedent to AN

• even after weight restoration, worry excessively about weight and shape

• body dissatisfaction is predictor of relapse and major impediment to lasting change

Diagnostic significance and clinical relevance

Parling et al. (2012)

METHODS

• Body-shape attitudes of 17 AN women and 17 controls

RESULTS

• Both groups: PRO-THIN attitudes toward SELF and OTHERS

• AN group: stronger ANTI-FAT attitudes towards SELF

• AN group: PRO-FAT attitudes toward OTHERS

• AN group: stronger STRIVE FOR THINNESS and AVOIDANCE OF FATNESS

Perceptual body size distortion

• Clinical relevance

  • though understand they’re terribly underweight, many overestimate their body size

  • whole body methodologies produce larger differences than body part methodologies

  • perceptual distortion not due to sensory deficit

  • body size distortion shouldn’t be used in diagnosis because body size overestimation is relatively weak, unstable, as it’s triggered by various factors

  • body size distortion can predict higher levels of psychopathology

• Explanatory constructs of body size overestimation

  • patient relieves fatter self-image from her memory, which is reflected on overestimation

  • smaller bodies harder to estimate accurately

  • information-processing bias reflects cognitive judgment rather than perceptual experience

body dissatisfaction: cognitive-evaluative features

• cultural, developmental, familial, and dispositional factors determine body dissatisfaction in AN

  • Sociocultural pressures for thinness → belief that personal failures applicable to weight/shape or attainment of thin body to self-esteem

• importance to appearance and its connection to self-evaluation but physical defect can be corrected by weight loss → body dissatisfaction translates into maladaptive beliefs about weight/shape → reasoning and information-processing errors and positive/negative reinforcement contingencies associated with success/failure at weight loss → process is further maintained by attitudinal, affective, and physiological factors

• many patients are satisfied with, or proud of, their emaciated body but average patient has similar level of body dissatisfaction with normal female once diagnostic criteria are met

• body dissatisfaction needs to be interpreted within context of actual body weight because same level of body dissatisfaction may have different clinical implications at different body weights

Bulimia Nervosa

• there are websites to promote BN, too (pro-mid)

• BN can increase risk for subsequent obesity, substance abuse, major depression

• Recurrent episodes of binging characterized by both:

  • eating, in discrete period of time, amount of food larger than what most people would eat in similar period of time and under similar circumstances

  • sense of lack of control over eating during binging episode

• recurrent inappropriate compensatory behaviors to prevent weight gain (e.g. self-induced vomiting, misuse of laxatives, diuretics, enemas, fasting, excessive exercise)

• self-evaluation unduly affected by body shape and weight

body image disturbance in bulimia nervosa

• body dissatisfaction increases risk for BN through two mechanisms

1. body dissatisfaction/distortion → elevated dieting behavior due to belief that dieting is effective to lose weight; dieting increases risk for BN because females may binge to counteract effects of coloric deprivation, or violating strict dietary rules can lead to emotional overeating

2. body dissatisfaction/distortion → negative affect → binging to provide comfort and distraction from negative affect

• females might use radical purging behaviors to reduce anxiety about weight gain about binging or because they believe purging can be emotional catharsis

sociocultural influences of bulimia nervosa

• BN patients report elevated thin-deal internalization, appearance investment, body dissatisfaction, body size distortion

• distinction between risk and maintenance factors important because former are relevant to prevention whereas latter treatment; elevations in body dissatisfaction and weight concerns can predict persistence of BN