Eating Disorders Exam 2

moral anxiety

• attempting to violate superego’s beliefs/ideas

neurotic anxiety

• fear of losing control of id’s impulses

• violates superego’s moral standards

psychoanalytic model/an

• rejection of femininity

• fear of oral impregnation

  • self-starvation b/c of this

• maturity fears → drive self-starvation; attempt to revert to a prepubertal state

• fear of becoming fat

• symptoms are defenses to reduce neurotic anxiety over conflict between ego/id

  • developed during preoedipal stage where primary gratification is through oral drives (ages 0-1)

• parents not off the hook:

  • mom’s aggressive/castrating (not a good role model for femininity)

  • dad’s kind/passive (good model for femininity except he’s male)

  • conflict emerges in adolescence when girls are supposed to adopt more adult (sex-specific) roles

psychoanalytic model/bn

• over identification w/ femininity

• desire for pregnancy

feminist psychodynamic theory

• specific to female children

• parents still not off the hook

  • mom’s controlling b/c she’s powerless outside the home

  • dad’s distant/passive

  • child defines her self-worth based on how she perceives others’ reactions to her/learns that power can only be achieved by attaining a relationship w/ a man

  • problems emerge in adolescence b/c girl doesn’t know how to socialize w/ men (no practice w/ father)

    • enters vicious cycle of attempting to literally “fit” in through her weight/thinness

Bruch’s psychodynamic theory

• mothers still not off the hook

  • during daughter’s infancy, mother didn’t respond appropriately to daughter’s cues for hunger, fatigue, distress

  • b/c daughter’s unable to change mother’s behavior, infant adapt to accept what mother offers

    • apparent “perfection” → become perfectionists later in life

    • profound sense of ineffectiveness → kind of stuck later in life

    • fundamental inability to distinguish among driven states (alexithymia)

  • when adolescence places pressures on girls to develop autonomy, they feel overwhelmed/rebel against symbolic source of material nurturance-food

alexithymia

fundamental inability to distinguish among driven states; poor interoceptive awareness

family systems

• parents still to blame

  • adolescent w/ AN is “identified patient” however, illness is systemic

    • problem is in the family system, not within the individual

    • AN families enmeshed, overprotective, rigid, conflict avoidant

    • creates problems when child enters adolescence b/c family’s unable to adjust to child’s need to develop autonomy

    • b/c family conflict cannot be expressed openly, it’s expressed bodily (self-starvation in AN, but could be expressed other ways) → somaticizing

somaticizing

not being able to express family conflict openly leads to the bodily expression of it

• ex: AN would be through self-starvation

• could be through other ailments like allergies, diabetes

learning

• EDs run in families

• children learn disordered eating attitudes/behaviors from their parents (just like they learn anything else)

• social learning through modeling

  • ex: mom’s constantly dieting

  • direct instruction

    • ex: mom tells girls she’s getting too fat/puts her on a diet

klein et al. (2017)

• college students completed surveys in college/at 20-year follow-up

• reported on their own drive for thinness at both time points as well as baseline:

  • frequency of parental dieting

  • frequency of parental comments other weight/eating

• examine prospective association between modeling (dieting frequency) vs. direct comments on changes in drive for thinness

• baseline:

  • men/women didn’t differ in reports of parental dieting, both reported that moms dieted more than dads

  • women reported getting more comments from both parents on their own weight/eating compared to men

• 20-year follow-up

  • mom’s dieting frequency/dad’s comments predicted increased drive for thinness in women

  • no associations found in men

social contagion theory

• Crandall (1988)

  • studied binge eating in sorority sisters in two sororities at the beginning/end of academic year

    • binge eating increased over time, and those who bingers at similar frequency to others were the most popular

peer selection/socialization

• Zalta/Keel (2006)

  • studied similarity among selected peers, unselected peers, non-peers on self-esteem, perfectionism, bulimic symptoms

  • participants were most similar to selected peers on these outcomes, regardless of duration of contact/period of separation

    • implies that it’s not just the time spent together that factors into this

objectification theory

• women who come to view their bodies as objects rather than agents experience increased pressure to conform to thin ideal

wick/keel (2020)

• study 1

  • self-report surveys of college students regarding use of apps to edit appearance on photos posted to IG/disordered eating

  • results:

    • higher EAT-26 scores in those who posted edited photos

    • higher likelihood of having an ED I those who posted edited photos compared to those who didn't

    • non-hispanic White/Asian students more likely to edit compared to AA/Black students

• study 2

  • experiment in which some participants from study 1 who endorsed editing photos brought into the lab, photographed, assigned to 1 of 4 conditions

  • results:

    • those randomly assigned to edit/post photos experienced significant increases in ED cognitions

      • maintained urges to engage in extreme weight control behaviors

    • all effects were temporary

personality

• stable way in which individuals perceive, react to, interact w/ their environments that’s influenced by both biology/experience

  • broader concept encompassing temperament, learned behaviors, and life expectancies

temperament

• biologically-based predisposition to experience certain emotional/behavioral response

  • building block upon which personality develops

  • four dimensions:

    • novelty seeking

    • harm avoidance

    • reward dependence

    • persistance

novelty seeking

• related to temperament

  • tendency to pursue rewards

  • behavioral activation system (BAS)

harm avoidance

• related to temperament

  • tendency to avoid punishment by inhibiting behavior

  • behavioral inhibition system (BIS)

reward dependance

• related to temperament

  • tendency to continue rewarded behavior

persistence

• related to temperament

  • tendency to continue behavior not immediately rewarded despite frustration/fatigue

  • linked to ambition, obstinacy, obsessive-compulsive features

ed relations to personality

• AN:

  • low novelty seeking

  • high harm avoidance

  • high persistence

• BN:

  • high harm avoidance

  • high novelty seeking

• ED patients more sensitive to punishments than controls

• BED:

  • high novelty seeking

  • high harm avoidance

  • no difference compared to obese non-BED individuals

positive emotionality

tendency to enjoy and actively engage in work and social interactions

negative emotionality

tendency to experience negative mood states

• ex: sadness, anxiety, anger

constraint

tendency to inhibit impulses and show caution, restraint, conventionalism

ed relation to constraint

• AN:

  • high levels of constraint

  • high levels of negative emotionality

  • low levels of positive emotionality

• BN:

  • low levels of positive emotionality

  • high levels of negative emotionality

  • lower constraint compared to AN

• BED:

  • no difference between BED/non-obese individuals

• perfectionism increases risk for AN/BN

positive reinforcement

• in relation to operant conditioning

  • ex: dieting accompanied by initial weight loss → reinforcement through compliments/attention

  • patients w/ AN complimented more even when they looked emaciated

  • binge eating episodes usually w/ foods associated w/ rewards

    • ex: ice cream, cookies, etc

negative reinforcement

• in relation to operant conditioning

  • not engaging in the behavior has undesired consequences

  • feeling nothing is better than feeling distressed

  • sometimes more powerful than positive reinforcement

punishment

• in relation to operant conditioning

  • ex: patients w/ AN feel like eating is a punishment

  • these decrease a behavior

    • ex: not going to go work out at the gym b/c they feel shame

• research shows those w/ EDs may be more sensitive to immediate responses/don’t think about long-term consequences

attention

• women w/ EDs pay more attention to food and body weight-related things compared to women w/out EDs

  • could be both conscious/unconscious effort

• attentional bias could be seen especially w/ AN patients

  • maintain vigilance over perceived threat of their self-worth

cognitive distortions

• experiences/thoughts that don’t correctly reflect reality

  • perceptual disturbance required for diagnosis of AN

dichotomous thinking

• cognitive distortion expressed in many of the features common to Eds

  • black-and-white thinking

  • AN ex: thin = good, fat = bad

  • BN ex: either eat nothing or eat everything

disinhibition

• loss of control over eating → cognitive control is lost

  • cognitive disinhibitor

  • affective disinhibitor

  • pharmacological disinhibitor

cognitive disinhibitor

• type of disinhibition

  • ex: going to a party, being offered cake, feeling like they “blew” the diet so they might as well eat everything

affective disinhibitor

• type of disinhibition

  • ex: having a fight w/ a loved one, feeling sad, eating to cope w/ distress

pharmacological disinhibitor

• type of disinhibition

  • ex: being intoxicated and losing track of how much one has eaten

selective abstraction

• a part come to represent the whole

  • particularly for perfectionists

  • ex: if thighs seem fat, they think every other part of their body is fat

restraint hypothesis

• hypothesis

  • consumption of unusually large amount of food due to the loss of cognitive function that helps determine whether someone’s hungry or full

personality traits

• enduring patterns of perceiving, relating to, and thinking about the environment and oneself that are exhibited in a wide range of social and personal contexts

  • lens through which cultural messages could be magnified and impact behaviors

    • including seeking out environment that further reinforce disordered eating behaviors

big 5

• openness to experience

• consciousness

• extraversion

• agreeableness

• neuroticism