Eating Disorders

symptoms of anorexia nervosa

• restriction of energy intake relative to requirements, leading to a significantly low body weight in the context of age, sex, developmental trajectory, and phsical health

• intense fear of gaining weight or becoming fat or persistent behavior that interferes with weight gain, even tho at a significantly low weight

• disturbance in the way in which one’s body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or persistent lack of recognition of the seriousness of the current low body weight

subtypes of anorexia nervosa

◦Restricting: weight loss through dieting, fasting, excessive exercise

◦Binge-eating/purging: bingeing and recurrent self-induced vomiting, misuse of laxatives, etc.

restricting anorexia nervosa

weight loss through dieting, fasting, excessive exercise

binge-eating/purging in anorexia nervosa

bingeing and recurrent self-induced vomiting, misuse of laxatives, etc.

bulimia symptoms

• recurrent episodes of binge eating (characterized by eating a larger amount of food in a discrete period of time and a sense of lack of control over eating during the episode)

• recurrent inappropriate compensatory behaviors in order to prevent weight gain

• binge eating and inappropriate compensatory behaviors both occur on average at least once a week for 3 months

• self-evaluation is unduly influenced by body shape and weight

• disturbance does not occur exclusively during episodes of anorexia nervosa

main difference between anorexia and bulimia

weight

• low weight = anorexia

• normal-above = bulimia

insight into problem

• low/none = anorexia

• shame/guilt = bulimia

physical consequences of bulimia and anorexia

◦Amenorrhea

◦Dental Enamel erosion

◦Vital sign and lab abnormalities (heart arrhythmias)

◦Loss of bone density

high suicide risk is especially observed in…

anorexia

prevalence, course, and comorbidity of eating disorders

◦12-month prevalence: 1% each

◦Gender ratio: 10 females: 1 male

◦Onset: Adolescence to early adulthood

◦Course: Varies, can have single episode, relapsing/remitting, or chronic

◦High suicide risk, especially in anorexia

◦Comorbidity: 70% have comorbid diagnosis, mood/anxiety/substance use most common

biological causes of eating disorders

◦Genetics

• Increased risk in first degree relatives

• Serotonin transporter gene

◦Brain changes

• Alternations in circuit of hypothalamus (appetite/eating), temporal and parietal lobes (body perception), and frontal lobes (pleasing/rewarding aspects of stimuli)

◦Childhood obesity and early puberty (for bulimia)

psychological causes of eating disorders

◦Personality

• Neuroticism

• Perfectionism

◦Distorted schemas surrounding weight and eating

• Negative body image

• Internalized thin ideal

◦Examples

• People will reject me unless I’m thin

• An imperfect body reflects an imperfect person

social-cultural causes of eating disorders

◦Family Dysfunction

• Low cohesive/communication

• Rigid/perfectionistic

• Pre-occupation with physical appearance/dieting

◦Childhood sexual abuse

◦Cultural value of thinness

• Highest prevalence among post-industrialized, high-income countries

• Stronger and positive ethnic identity in Black girls associated with lower risk

◦Occupations/Sports that value thinness/weight control

quantity of average binge

2000 cal in an hour

treatments for eating disorders

◦Inpatient hospitalization for weight gain

◦Medications

• Antidepressants or antipsychotics

◦Therapy

• Family Therapy for anorexia

**Focus on family meals, increasing family communication/support

◦Cognitive behavioral therapy for bulimia

• Modify beliefs about weight/eating

• Modify behaviors surrounding food, coping with stress

goal of cognitive behavioral therapy for bulimia

◦Modify beliefs about weight/eating

◦Modify behaviors surrounding food, coping with stress