Psychopathology - Eating Disorders

types of EDs

anorexia nervosa, bulimia nervosa, binge-eating

anorexia nervosa criteria

1. restriction of food that leads to very low body weight; body weight significantly below normal (BMI less than 18.5 for adults)

2. intense fear of weight gain or repeated behaviors that interfere with weight gain

3. body image disturbance (distortion)

anorexia severity ratings

BMI:

mild = ≤17

moderate = 16-16.99

severe = 15-15.99

extreme = < 15

types of anorexia

restricting type

binge eating/purging type

** not that useful, people fluctuate between types

onset for anorexia, lifetime prevalence, woman:men frequency

early to middle teenage years, 1% (stable), 3x more in women

bulimia nervosa criteria

1. recurrent episodes of binge eating (eating excessive amount of food in a short period of time and feeling of losing control over eating)

2. recurrent compensatory behaviors to prevent weight gain

3. body shape and weight are extremely important for self-evaluation

*at least once a week for 3 months

key difference between bulimia and anorexia

people w/ anorexia lose a tremendous amount of weight, people w/ bulimia do not

severity ratings for bulimia

compensatory behaviors:

mild = 1-3 per week

moderate = 4-7

severe = 8-13

extreme = 14+

bulimia onset, gender difference, prevalence

late adolescence or early adulthood, 90% women, 1-2% of population

bulimia binges more likely to occur:

when someone is alone, after a negative social encounter, & in the morning/afternoon

prognosis for anorexia, bulimia, binge-eating

anorexia: 50-70% recover or significantly improve, takes 6-7 years typically, relapses are common

bulimia: 68-75% recover, 10-20% remain fully symptomatic

binge-eating: 25-82% recover (less research)

binge-eating disorder criteria

1. recurrent binge eating episodes

2. episodes include at least 3 of:

   • eating more quickly than usual

   • eating until over full

   • eating large amounts even if not hungry

   • eating alone due to embarassment about large food quantity

   • feeling bad (e.g. disgusted, guilty, depressed) after binge

3. no compensatory behavior present

*1x week for at least 3months

most people w/ this disorder are obese (BMI>30)

binge-eating severity

number of binges per week

mild = 1-3

moderate = 4-7

severe = 8-13

extreme = 14+

binge-eating onset, prevalence, gender difference

more prevalent than other two- .2 to 4.7%, slightly more common in women than men

etiology - genetics

EDs run in families; first-degree relatives of women with anorexia were 10x more likely to have it; same with bulimia (4x more likely) and binge-eating

etiology - neurobiological

**don’t know if brain changes are causes or effects of EDs (so maybe not that important?)

+ don’t account for intense fear of gaining weight

despite hypothalamus regulating hunger + eating it does not seem to be a causal factor in anorexia

role of endogenous opioids (enhance mood, suppress appetite); released during starvation & exercise —> positively reinforce

low levels of opoids in people w/ bulimia (unknown whether cause or effect)

dorsal striatum activation differs in women w/ anorexia —> dieting may become habitual, and habits become rewarding

seratonin —> related to eating and satiety; underactive seratonin system?

dopamine —> related to the rewarding aspects of food; same incentive-sensitization theory as with SUD (cues about food elicit dopamine responses which create cravings and promote overeating/binging)

etiology - cognitive behavioral

OVERALL: theories focus on body dissatisfaction, preoccupation w/ thinness, negative emotion, & attention and memory

• people w/ EDs pay greater attention to and better remember stimuli about food and body image (own and others’)

anorexia

disturbed body image as the motivating factor reinforcing weight loss; onset is usually after weight loss/dieting

behaviors maintaining thinness are negatively reinforced by reduction in anxiety, positively reinforced by positive comments from others and a sense of self-control; criticism for being overweight also contribute

role of emotion: stronger negative emotions, low positive emotion differentiation: intense feeling of, e.g. pride after restrictive behavior which is indistinguishable from happiness

bulimia & binge eating

view self-worth in terms of weight and shape, more controllable than other aspects

bulimia schematic !!

propensity of negative emotion/stress can predict binges

bulimia cognitive behavioral schematic (cycle)

low self-esteem and high negative affect

—> dieting to feel better about self

—> food intake restricted too severely

—> diet broken

—> binge

—> compensatory behavior to reduce fears of weight gain

etiology - sociocultural

society’s preoccupation with thinness is linked w/ dieting efforts

& media portrayals of thin woman predicts increase in body dissatisfaction

stigma associated with being overweight

objectification of women’s bodies —> self-objectification

role of perfectionism also (personality factors)

treatment - medications

not much success with anorexia and binge eating

bulimia often comorbid with depression —> antidepressants (however, high quitting rate + relapse after quitting)

psychological treatment - anorexia

immediate goal: help person gain weight to avoid medical complications and death

second goal: long-term maintenance of weight gain (more challenging)

• CBT, supportive psychotherapy, education about anorexia, family therapy

psychological treatment - bulimia

• CBT !! best-validated and current standard for bulimia treatment; goal is to develop more healthy eating patterns

  • question society’s standards for physical attractiveness

  • change beliefs that motivate starving selves to avoid becoming overweight

  • altering all or nothing thinking —> eating more moderately

  • identify triggers for binges and learn coping mechanisms

prevention for EDs (children and adolescents)

1. psychoeducational approaches (education to prevent symptom development)

2. deemphasizing sociocultural influences (helping them resist pressure to be thin)

3. risk factor approach (identifying people with risk factors such as weight/body image concern or food restriction, and intervening)