clinical 9 final

Chapter 9: Eating Disorders

• Anorexia Binge/Purge Type: Very restrictive eating behaviors, but occasional binge episodes which are followed by purging 

• Bulimia: repeated binge eating, with repeated purging. Constant cycle. Often normal weight or underweight. Patients tend to be more concerned with pleasing others and more sexually experienced 

• Anorexia Restrictive Type: Very restrictive eating behaviors, typical anorexia. No binging to purging 

• Physical problems/Effects related to Anorexia:

  • Amenorrhea - no period

  • Lowered body temperature

  • Low blood pressure

  • Body swelling 

  • Reduced bone mineral density

• Binge eating disorders

  • Symptoms of Binge Eating Disorder: 

    • No control over eating behaviors

    • Eating much larger than usual amount in specific time such as over two hour period. 

    • Eating when you’re full or not hungry

    • Eating very fast during binges

    • Eating alone or in secret

    • Eating when you are uncomfortably full 

    • Recurrent binge-eating episodes

    • Binge-eating episodes include at least 3:

    • Unusually fast eating

    • Lack of hunger

    • Uncomfortably full

    • Secret eating due to shame

    • Subsequently feel self disgust, depression or guilt

    • Binges take place weekly over three months

    • No compensatory behaviors for BED only bulimia 

• Eating disorder: PICA

  • Mental health condition where a person compulsively swallows non-food items 

  • Common in children within certain conditions.

  • Treatable with therapy 

• Rumination syndrome:

  • Condition where person spits up food from stomach, rechews it, reswallows it or spits out

• ARFID:

  • Avoidant/restrictive food intake disorder.

• Hilde Bruch: believed that parents can respond either effectively or ineffectively

  • Effective parents: attend to their children’s biological and emotional needs

  • Ineffective parents: fail to attend to their children’s needs, deciding that their children are hungry, cold, tired without correctly interpreting that child's actual condition.  -These parents may have grown up confused of their own internal needs, unable to identify emotions

• Biological Factors of Eating Disorders

  • Relatives of people with eating disorders are up to six times more likely than other people to develop the disorder themselves.

  • The brain circuits linked to OCD, depression and anxiety are impacted when one has an ED. 

    • The insula (structure in the fear circuit) is abnormally large and active

    • Orbitofrontal cortex (structure in OCD circuit) is uncommonly large.

    • Striatum (another structure in the OCD circuit) is hyperactive

    •    Prefrontal cortex (in OCD depression and anxiety circuits) is unusually small

    • Activity levels of serotonin, dopamine and glutamate  (key neurotransmitters in those brain circuits) are abnormal in people with EDs. 

  • Lateral Hypothalmus produces hunger when activated

  • Ventromedial hypothalmus reduces hunger when activated