Eating Disorders

Anorexia Nervosa Sx

1. restriction of food leads to low body weight

2. an intense fear of gaining weight despite being very underweight

3. body image disturbance

4. subtypes

   a. restricting: just restrict intake

   b. binge-eating/purging: binges and purges but is still losing weight

Bulimia Nervosa

1. recurrent episodes of binge eating including eating A LOT in a short amt of time + lack of control while eating

2. recurrent compensatory behavior to prevent weight gain

3. sx continue on average at least once a week for 3 months

4. overconcern with body shape and weight

similarities of anorexia & bulimia

1. begin after a period of dieting

2. preoccupied with food, weight, and appearance

3. negative affect (sadness, anxiety)

4. body image disturbances

5. comorbidities: depression, anxiety, substance use

differences of anorexia & bulimia

1. anorexia binge-eating/purging vs bulimia

   • anorexia has more to do with being underweight

2. bulimics are more likely to recognize their behavior is pathological

3. bulimics are more interested in pleasing people, sexual-intimacy, and want to be seen as attractive

4. bulimics display fewer of the obsessive qualities

   • anorexics are rigid & inflexible

5. bulimics are more likely to have a comorbid personality disorder

6. anorexics are more likely to attempt suicide

etiology - biological factors

• both run in families

  • anorexia has a stronger genetic link

• hypothalamus

  • controls cortisol

  • lose lateral hypothalamus = decrease weight and apetite

• decreased Serotonin

personality traits associated with anorexics

1. perfectionism

2. persistence

3. rigid, methodical problem solving

4. emotional restraint

5. preference for familiarity

6. obsessive worrying

7. poor adaptability

8. hypersensitivity to rejection

9. extreme deference

etiology - relationship to mood disorders

• increased rates of mood disorders in relatives of those with anorexia and bulimia

• timing is important!

  • approx 50% experience depression during the acute phase

    • may be due to the effects of starvation

  • depression may onset before the disorder

• antidepressant are helpful for bulimics NOT anorexics

etiology - sociocultural factors

• emphasis on ideal body, health and dieting varies by time period

  • generally for women it has gotten thinner and men it has gotten muscular and strong

  • even when they know an image is altered they still feel bad that they don’t look as small as the picture

• gender differences

  • women are more likely to internalize the cultural ideal

    • objectification theory: women gain more value and self-esteem from their appearance

    • shame → disordered eating

    • thinness is highly valued for women and certain jobs

  • men can feel “reverse anorexia”

• model of development

  1. exposed to ideal of thinness

  2. internalize the ideal

  3. recognize a discrepancy between it and you

  4. dissatisfied with your body

  5. start to diet, show restraint

  6. end up restricting

etiology - Bruch’s psychodynamic approach

• focuses on disturbed parent child interactions

• effective parents → attend to the child’s needs

• ineffective parents → decide what their children need incorrectly

  • results in kids not being able to recognize their own internal biological states

• support

  • those with eating disorder have a harder time perceiving their own internal cues such as feelings or hunger

weight restoration

• anorexia

• can be done in a center or at home via

  • tube feedings

  • operant conditioning: reward healthy behavior

  • supportive nursing care/nutritional counseling

    • instead of using a tube you slowly increase the size of meals and snacks

    • focus on getting back to a healthy weight then the calories can be decreased

    • big focus on education and setting reasonable goals

3 main goals of therpay for anorexia

1. build autonomy and self-awareness

   • based on Bruch’s psychodynamic theory

2. correct disturbed cognitions

   • CBT

   • change misconceptions about weight, appearance, and food

3. changing interaction within the family

   • most preferred method

   • help family to recognize and change patterns

anorexia outcome

• 50-70% recover

• 50% have ongoing emotional problems

• predictors of poor outcome

  • lose more weight

  • longer time before starting treatment

  • premorbid psychological disorder

  • older

  • male

medication

• bulimia

  • antidepressants: SSRIs and Prozac

Fairburn’s CBT

• gold standard for bulimia treatment (50%)

• components

  • challenge beliefs about body size, weight, etc.

  • nutritional education

  • decrease dichotomous thinking

    • need them to be able to think in shades of gray

  • ERP = exposure with response prevention

    • eat a normal, healthy amt of food and prevent them from compensating. work on decreasing anxiety

bulimia outcome

• CBT is better than meds

• decreasing binging and purging is tied to a decrease in mood symptoms and an increase in self-esteem

• 68-75% recover

binge eating disorder sx

• recurrent binges (1 time per week for at least 3 months)

• lack of control during the episode

• distress

• rapid eating

• eating alone

• eating past feeling full

• absence of compensatory behavior or weight loss

• obesity