Chapter Eleven: Eating Disorders
Anorexia Nervosa: A disorder marked by the pursuit of extreme thinness and by extreme weight loss
A person with anorexia will
Purposely maintain a significantly low body weight
Have intense fears of becoming overweight
Have a distorted view of their weight and shape
Be excessively influenced by their weight and shape in their self-evaluations
Restricting-type Anorexia Nervosa: A pattern of anorexia where one reduces their weight by restricting their intake of food
Binge-eating/Purging-type Anorexia Nervosa: A pattern of anorexia where one reduces their weight by forcing themselves to vomit after meals or by abusing laxatives or diuretics
May also engage in eating binges
75-90% of cases of anorexia occurs in females
Peak age of onset is 14-20 yrs
Disorder typically begins after a person who is slightly overweight or of normal weight has been on a diet
Escalation toward anorexia may follow a stressful event
Most people with the disorder recover, but as many as 6% become so seriously ill that they die
Medical problems brought about by starvation
Suicide - suicide rate for anorexics is 5x the rate of the general population
Fear is the motivation
Fear of becoming obese
Fear of giving in to their desire to eat
Preoccupied with food
Spend considerable time thinking about food
Plan their limited meals
Dreams are filled with images of food and eating
May be a result of food deprivation
Think in distorted ways
Low opinion of their body shape
Consider themselves unattractive
Likely to overestimate their actual proportions
Maladaptive attitudes and misperceptions
Psychological problems
Depression
Anxiety
ow self-esteem
Insomnia and other sleep disturbances
Substance abuse
Obsessive-compulsive patterns
Perfectionistic
Amenorrhea: The absence of menstrual cycles
Lowered body temperature
Low blood pressure
Body swelling
Reduced bone mineral density
Slow heart rate
Metabolic and electrolyte imbalances
Can lead to death by heart failure or circulatory collapse
Skin can become rough, dry, and cracked
Nails become brittle
Hands and feet are cold and blue
Bulimia Nervosa: A disorder in which people engage in binges and compensatory behaviors
Usually occurs in females
Begins in adolescence or young adulthood and often lasts for years, with periodic letup
Weight stays within a normal range, though it might fluctuate markedly within that range
Some people with this disorder become seriously underweight and may eventually qualify for a diagnosis of anorexia instead
25-50% of all students report periodic binge eating or self-induced vomiting but only some qualify for a diagnosis
Binge: A repeated episode of uncontrollable overeating
Takes place over a limited period of time during which the person eats much more food than most people would eat during a similar time span
May have between 1 and 30 binge episodes per week
Carry out the binges in secret
Consume an average of 2000-3400 calories during an episode
During the binge the person feels unable to stop eating
Feelings
Before: Feelings of great tension. feels irritable and powerless
During: Pleasurable bc it relieves the tension
After: Extreme self-blame, shame, guilt, depression, fears of gaining weight / being discovered
After a binge, ppl with bulimia try to compensate for and undo its effects
ex: Forcing themselves to vomit, misusing laxatives, fasting, or exercising excessively
Vomiting
Fails to prevent the absorption of half of the calories consumed during a binge
Repeated vomiting affects one’s general ability to feel satiated
Leads to greater hunger and more frequent and intense binges
Use of laxatives/diuretics largely fails to undo the caloric effects of binging
The Cycle
Vomiting and other compensatory behaviors may temporarily relieve the uncomfortable physical feelings of fullness or reduce the feelings of anxiety and self-disgust attached to binge eating
Purging allows more binging
Binging necessitates more purging
Causes people with the disorder to feel powerless and disgusted with themselves
Most fully recognize that they have an eating disorder
Bulimic pattern typically begins during or after a period of intense dieting, often one that has been successful and earned praise from family members and friends
Ppl with bulimia, compared to those with anorexia:
Tend to be more concerned about pleasing others, being attractive to others, and having intimate relationships
Tend to be more sexually experienced and active
More likely to have long histories of mood swings, become easily frustrated or bored, and have trouble coping effectively
More than ⅓ display the characteristics of a personality disorder
Only half are amenorrheic
Frequent vomiting can cause serious medical and dental problems
Those with binge-eating disorder engage in repeated eating binges during which they feel no control over their eating, but don’t perform inappropriate compensatory behavior
Around half of people with binge-eating become overweight or obese
Most overweight people don’t engage in repeated binges
2-7% of the population have binge-eating disorder
64% women
Typically preoccupied with food, weight, and appearance, base their evaluation of themselves largely on weight, misperceive their body size and are extremely dissatisfied with their body
Not as driven to thinness
Doesn’t necessarily begin with efforts at extreme dieting
Typically develop it later than those with the other eating disorders (most often in their twenties)
Multidimensional Risk Perspective: A theory that identifies several kinds of risk factors that are thought to combine to help cause a disorder. The more factors present, the greater the risk of developing the disorder
Disturbed mother-child interactions lead to serious ego deficiencies in the child (including a poor sense of independence and control) and to severe perceptual disturbances that jointly help produce disordered eating
Parents may respond to their children either effectively or ineffectively
Effective parents
Accurately attend to their children’s biological and emotional needs
Give them food when they’re crying from hunger
Give them comfort when they’re crying out of fear
Ineffective parents
Fail to attend to their children’s needs
Decide that their children are hungry, cold, or tired without correctly interpreting the children’s actual condition
May feed their children when their children are anxious rather than hungry or comfort them when they’re tired rather than anxious
Children may grow up confused and unaware of their own internal needs, not knowing for themselves when they’re hungry or full and unable to identify their own emotions
Turn to external guides, such as their parents
Fail to develop genuine self-reliance
Feel unable to establish independence
To overcome their sense of helplessness, they seek excessive control over their body size and shape and over their eating habits
Parents of teens with eating disorders tend to define their children’s needs rather than allow the children to define their own needs
People with eating disorders perceive internal cues, including emotional cues, inaccurately
Alexithymic: A person who has great difficulty putting descriptive labels on their feelings
As a result of ineffective parenting, people with eating disorders improperly label their internal sensations and needs, generally feel little control over their lives, and want to have excessive levels of control over their body size and eating habits
Cognitive-Behavioral Therapies are among the most widely used of all treatments for eating disorders
Many people with eating disorders have symptoms of depression
Depressive disorders help set the stage for eating disorders
Many more people with an eating disorder qualify for a clinical depressive disorder than do ppl in the general population
Close relatives of people with eating disorders have a higher rate of depressive disorders
Depression-related brain circuit of many people with eating disorders shows abnormalities similar to those of people with depression
Ppl with eating disorders are sometimes helped by the same antidepressant drugs that reduce depression
Certain genes may leave some people particularly susceptible to eating disorders
Relatives of people with eating disorders are 6x more likely to develop those disorders themselves
If one identical twin has anorexia, the other develops the disorder in 70% of cases
Dysfunctional brain circuits in people with eating disorders
Circuits linked to generalized anxiety, obsessive-compulsive, and depressive disorders acts dysfunctionally in ppl with eating disorders
Insula is abnormally large and active
Orbitofrontal cortex is uncommonly large
Striatum is hyperactive
Prefrontal cortex is unusually small
Activity levels of serotonin, dopamine, and glutamate are abnormal
Dysfunction across the brain circuits could
Help cause eating disorders
Be a result of eating disorders
Reflect the fact that many people with eating disorders also suffer from anxiety, obsessive-compulsive, and/or depressive disorders
Hypothalamus: A part of the brain that helps regulate various bodily functions, including eating and hunger
Lateral Hypothalamus: Part of the hypothalamus that produces hunger when it’s activated
sides of the hypothalamus
Ventromedial Hypothalamus: Part of the hypothalamus that reduces hunger when it’s activated
Bottom and middle of the hypothalamus
GLP-1: Natural appetite suppressant
Weight Set Point: The weight level that a person is predisposed to maintain, controlled in part by the hypothalamus
Determined by genetic inheritance and early eating practices
When a person’s weight falls below their set point, the LH is activated
Produce hunger
Lower metabolic rate
When a person’s weight rises above their set point, the VMH is activated
Reduce hunger
Increase metabolic rate
Weight Set Point Theory: When people diet and fall to a weight below their weight set point, their brain starts trying to restore that lost weight
Produce a preoccupation with food and a desire to binge
Trigger bodily changes that make it harder to lose weight and easier to gain weight
Metabolic Rate: The rate at which the body expends energy
Eating disorders are more common in Western countries
Western standards of female attractiveness are partly responsible for the emergence of eating disorders
Performers, models, and athletes are more prone than others to anorexia and bulimia
Anorexia and Bulimia more common among women higher on the socioeconomic scale
Western society glorifies thinness and prejudices overweight people
People who spend more time on Facebook are more likely to display eating disorders, have negative body image, eat in dysfunctional ways, and want to diet
Half the families of people with anorexia or bulimia have a history of emphasizing thinness, physical appearance, and dieting
Mothers are more likely to diet and be perfectionistic
Abnormal interactions and forms of communication within a family may set the stage for an eating disorder
Enmeshed Family Pattern: A family system in which members are overinvolved with each other’s affairs and overly concerned about each other’s welfare
Can be affectionate and loyal
Can be clingy and foster dependency
Parents allow little room for individuality and independence
70% of African Americans were dissatisfied with their weight and body shape, compared with 90% of non-Hispanic white American teens
Different ideals of beauty
Whites
Tall girls weighing 100-110 pounds
To be happy and popular, you have to be the perfect weight
African Americans
To be perfect, you have to have a good personality
Favored fuller hips
Less likely to diet
Body image concerns are on the rise for minority groups
Shift in eating disorders and eating problems is partly related to acculturation
Males account for 10% of all people with anorexia and bulimia
Men are more likely to exercise to lose weight and women are more likely to diet
Why do men develop anorexia or bulimia?
Linked to the requirements and pressures of a job or sport
Jockeys, wrestlers, distance runners, body builders, swimmers
Body image
Want a lean, toned, thin shape rather than the muscular shape of the typical male ideal
Reverse Anorexia Nervosa / Muscle Dysmorphia
Very muscular but still see themselves as scrawny and small
Continue to strive for a perfect body through extreme measures
Feel shame about their bodies
Have a history of depression, anxiety, and self-destructive compulsive disorder
⅓ also engage in related dysfunctional behaviors such as binge eating
Goals: Correct the dangerous eating pattern and address the broader psychological and situational factors that led to the eating problem
⅓ of those with anorexia receive treatment
Restore proper weight and normal eating
Nutritional rehabilitation
Tube and intravenous feedings
Rewards as positive reinforcement
Supportive nursing care, nutritional counseling, and a relatively high-calorie diet
Motivational Interviewing: An intervention that uses a mixture of empathy and inquiring review to help motivate clients to recognize they have a serious eating problem and commit to making constructive choices and behavior changes
Patients in nutritional rehab programs usually gain the necessary weight over 8-12 weeks
Lasting changes
Combination of education, psychotherapy, and family therapy
Psychotropic drugs are limited in helping
Cognitive-Behavioral Therapy
Clients are required to monitor their feelings, hunger levels, and food intake
Taught to identity their core pathology
Taught alternative ways of coping with stress and of solving problems
Recognize their need for independence
Better identify and trust their internal sensations and feelings
Help clients change their attitudes about eating and weight
Identify, challenge, and change maladaptive assumptions
Educate clients about body distortions typical of anorexia
Help them see that their own assessments of their size are incorrect
Very effective
Most successful at preventing relapses when it continues for at least a year beyond a patient’s recovery
Changing family interactions
Try to help the person with anorexia separate her feelings and needs from those of other members of her family
Family therapy can be helpful in the treatment of this disorder
Aftermath
Weight is often quickly restored once treatment begins
Treatment gains may continue for years
Most females with anorexia menstruate again when they regain their weight, and other medical improvements follow
Death rate from anorexia is falling
As many as 25% of ppl with anorexia remain seriously troubled for years
recovery isn’t always permanent
½ of those who have suffered from anorexia continue to have certain psychological problems years after treatment
The more weight people have lost and the more time that passes before they enter treatment, the poorer the recovery rate
43% of those with bulimia receive treatment
Nutritional Rehab: Helping clients to eliminate their binge-burge patterns and establish good eating habits
A combination of therapies aimed at eliminating the underlying causes of bulimic patterns
Emphasize education as much as therapy
Cognitive-Behavioral Therapy is particularly helpful
Antidepressant drug therapy is very effective
Cognitive-Behavioral Therapy
Keep diaries of their eating behavior, changes in sensations of hunger and fullness, and the ebb and flow of other feelings
Exposure and Response Prevention: Require clients to eat particular kinds and amounts of food and then prevent them from vomiting
Help clients recognize and change their maladaptive attitudes
Other forms of psychotherapy
Interpersonal Psychotherapy: Treatment that is used to help improve interpersonal functioning
Psychodynamic therapy
Group therapy formats
Antidepressant Medications
Helps as many as 40% of patients
Reduces binges and vomiting
Seems to work best in combination with other forms of therapy
Aftermath
Left untreated, bulimia can last for years, sometimes improving temporarily but then returning
Treatment produces immediate, significant improvement in 40% of patients
Another 40% show a moderate response
Around 75% of people with bulimia have recovered, either fully or partially
Relapses are usually triggered by a new life stress
44% of people with binge-eating disorder receive treatment
Psychotherapy is generally more helpful than antidepressants
⅓ of recovered individuals showed total improvement
High risk of relapse
Weight problems are often resistant to long-term improvement
Body Project: A program that offers weekly group sessions where members are guided through exercises that critique Western society’s beauty ideals
Based on CDT
Cognitive Dissonance Theory (CDT): When people adopt new attitudes that contradict their other attitudes and behaviors, they’ll experience emotional discomfort that they seek to eliminate by changing their old attitudes and behaviors
Performed well in research
Anorexia Nervosa: A disorder marked by the pursuit of extreme thinness and by extreme weight loss
A person with anorexia will
Purposely maintain a significantly low body weight
Have intense fears of becoming overweight
Have a distorted view of their weight and shape
Be excessively influenced by their weight and shape in their self-evaluations
Restricting-type Anorexia Nervosa: A pattern of anorexia where one reduces their weight by restricting their intake of food
Binge-eating/Purging-type Anorexia Nervosa: A pattern of anorexia where one reduces their weight by forcing themselves to vomit after meals or by abusing laxatives or diuretics
May also engage in eating binges
75-90% of cases of anorexia occurs in females
Peak age of onset is 14-20 yrs
Disorder typically begins after a person who is slightly overweight or of normal weight has been on a diet
Escalation toward anorexia may follow a stressful event
Most people with the disorder recover, but as many as 6% become so seriously ill that they die
Medical problems brought about by starvation
Suicide - suicide rate for anorexics is 5x the rate of the general population
Fear is the motivation
Fear of becoming obese
Fear of giving in to their desire to eat
Preoccupied with food
Spend considerable time thinking about food
Plan their limited meals
Dreams are filled with images of food and eating
May be a result of food deprivation
Think in distorted ways
Low opinion of their body shape
Consider themselves unattractive
Likely to overestimate their actual proportions
Maladaptive attitudes and misperceptions
Psychological problems
Depression
Anxiety
ow self-esteem
Insomnia and other sleep disturbances
Substance abuse
Obsessive-compulsive patterns
Perfectionistic
Amenorrhea: The absence of menstrual cycles
Lowered body temperature
Low blood pressure
Body swelling
Reduced bone mineral density
Slow heart rate
Metabolic and electrolyte imbalances
Can lead to death by heart failure or circulatory collapse
Skin can become rough, dry, and cracked
Nails become brittle
Hands and feet are cold and blue
Bulimia Nervosa: A disorder in which people engage in binges and compensatory behaviors
Usually occurs in females
Begins in adolescence or young adulthood and often lasts for years, with periodic letup
Weight stays within a normal range, though it might fluctuate markedly within that range
Some people with this disorder become seriously underweight and may eventually qualify for a diagnosis of anorexia instead
25-50% of all students report periodic binge eating or self-induced vomiting but only some qualify for a diagnosis
Binge: A repeated episode of uncontrollable overeating
Takes place over a limited period of time during which the person eats much more food than most people would eat during a similar time span
May have between 1 and 30 binge episodes per week
Carry out the binges in secret
Consume an average of 2000-3400 calories during an episode
During the binge the person feels unable to stop eating
Feelings
Before: Feelings of great tension. feels irritable and powerless
During: Pleasurable bc it relieves the tension
After: Extreme self-blame, shame, guilt, depression, fears of gaining weight / being discovered
After a binge, ppl with bulimia try to compensate for and undo its effects
ex: Forcing themselves to vomit, misusing laxatives, fasting, or exercising excessively
Vomiting
Fails to prevent the absorption of half of the calories consumed during a binge
Repeated vomiting affects one’s general ability to feel satiated
Leads to greater hunger and more frequent and intense binges
Use of laxatives/diuretics largely fails to undo the caloric effects of binging
The Cycle
Vomiting and other compensatory behaviors may temporarily relieve the uncomfortable physical feelings of fullness or reduce the feelings of anxiety and self-disgust attached to binge eating
Purging allows more binging
Binging necessitates more purging
Causes people with the disorder to feel powerless and disgusted with themselves
Most fully recognize that they have an eating disorder
Bulimic pattern typically begins during or after a period of intense dieting, often one that has been successful and earned praise from family members and friends
Ppl with bulimia, compared to those with anorexia:
Tend to be more concerned about pleasing others, being attractive to others, and having intimate relationships
Tend to be more sexually experienced and active
More likely to have long histories of mood swings, become easily frustrated or bored, and have trouble coping effectively
More than ⅓ display the characteristics of a personality disorder
Only half are amenorrheic
Frequent vomiting can cause serious medical and dental problems
Those with binge-eating disorder engage in repeated eating binges during which they feel no control over their eating, but don’t perform inappropriate compensatory behavior
Around half of people with binge-eating become overweight or obese
Most overweight people don’t engage in repeated binges
2-7% of the population have binge-eating disorder
64% women
Typically preoccupied with food, weight, and appearance, base their evaluation of themselves largely on weight, misperceive their body size and are extremely dissatisfied with their body
Not as driven to thinness
Doesn’t necessarily begin with efforts at extreme dieting
Typically develop it later than those with the other eating disorders (most often in their twenties)
Multidimensional Risk Perspective: A theory that identifies several kinds of risk factors that are thought to combine to help cause a disorder. The more factors present, the greater the risk of developing the disorder
Disturbed mother-child interactions lead to serious ego deficiencies in the child (including a poor sense of independence and control) and to severe perceptual disturbances that jointly help produce disordered eating
Parents may respond to their children either effectively or ineffectively
Effective parents
Accurately attend to their children’s biological and emotional needs
Give them food when they’re crying from hunger
Give them comfort when they’re crying out of fear
Ineffective parents
Fail to attend to their children’s needs
Decide that their children are hungry, cold, or tired without correctly interpreting the children’s actual condition
May feed their children when their children are anxious rather than hungry or comfort them when they’re tired rather than anxious
Children may grow up confused and unaware of their own internal needs, not knowing for themselves when they’re hungry or full and unable to identify their own emotions
Turn to external guides, such as their parents
Fail to develop genuine self-reliance
Feel unable to establish independence
To overcome their sense of helplessness, they seek excessive control over their body size and shape and over their eating habits
Parents of teens with eating disorders tend to define their children’s needs rather than allow the children to define their own needs
People with eating disorders perceive internal cues, including emotional cues, inaccurately
Alexithymic: A person who has great difficulty putting descriptive labels on their feelings
As a result of ineffective parenting, people with eating disorders improperly label their internal sensations and needs, generally feel little control over their lives, and want to have excessive levels of control over their body size and eating habits
Cognitive-Behavioral Therapies are among the most widely used of all treatments for eating disorders
Many people with eating disorders have symptoms of depression
Depressive disorders help set the stage for eating disorders
Many more people with an eating disorder qualify for a clinical depressive disorder than do ppl in the general population
Close relatives of people with eating disorders have a higher rate of depressive disorders
Depression-related brain circuit of many people with eating disorders shows abnormalities similar to those of people with depression
Ppl with eating disorders are sometimes helped by the same antidepressant drugs that reduce depression
Certain genes may leave some people particularly susceptible to eating disorders
Relatives of people with eating disorders are 6x more likely to develop those disorders themselves
If one identical twin has anorexia, the other develops the disorder in 70% of cases
Dysfunctional brain circuits in people with eating disorders
Circuits linked to generalized anxiety, obsessive-compulsive, and depressive disorders acts dysfunctionally in ppl with eating disorders
Insula is abnormally large and active
Orbitofrontal cortex is uncommonly large
Striatum is hyperactive
Prefrontal cortex is unusually small
Activity levels of serotonin, dopamine, and glutamate are abnormal
Dysfunction across the brain circuits could
Help cause eating disorders
Be a result of eating disorders
Reflect the fact that many people with eating disorders also suffer from anxiety, obsessive-compulsive, and/or depressive disorders
Hypothalamus: A part of the brain that helps regulate various bodily functions, including eating and hunger
Lateral Hypothalamus: Part of the hypothalamus that produces hunger when it’s activated
sides of the hypothalamus
Ventromedial Hypothalamus: Part of the hypothalamus that reduces hunger when it’s activated
Bottom and middle of the hypothalamus
GLP-1: Natural appetite suppressant
Weight Set Point: The weight level that a person is predisposed to maintain, controlled in part by the hypothalamus
Determined by genetic inheritance and early eating practices
When a person’s weight falls below their set point, the LH is activated
Produce hunger
Lower metabolic rate
When a person’s weight rises above their set point, the VMH is activated
Reduce hunger
Increase metabolic rate
Weight Set Point Theory: When people diet and fall to a weight below their weight set point, their brain starts trying to restore that lost weight
Produce a preoccupation with food and a desire to binge
Trigger bodily changes that make it harder to lose weight and easier to gain weight
Metabolic Rate: The rate at which the body expends energy
Eating disorders are more common in Western countries
Western standards of female attractiveness are partly responsible for the emergence of eating disorders
Performers, models, and athletes are more prone than others to anorexia and bulimia
Anorexia and Bulimia more common among women higher on the socioeconomic scale
Western society glorifies thinness and prejudices overweight people
People who spend more time on Facebook are more likely to display eating disorders, have negative body image, eat in dysfunctional ways, and want to diet
Half the families of people with anorexia or bulimia have a history of emphasizing thinness, physical appearance, and dieting
Mothers are more likely to diet and be perfectionistic
Abnormal interactions and forms of communication within a family may set the stage for an eating disorder
Enmeshed Family Pattern: A family system in which members are overinvolved with each other’s affairs and overly concerned about each other’s welfare
Can be affectionate and loyal
Can be clingy and foster dependency
Parents allow little room for individuality and independence
70% of African Americans were dissatisfied with their weight and body shape, compared with 90% of non-Hispanic white American teens
Different ideals of beauty
Whites
Tall girls weighing 100-110 pounds
To be happy and popular, you have to be the perfect weight
African Americans
To be perfect, you have to have a good personality
Favored fuller hips
Less likely to diet
Body image concerns are on the rise for minority groups
Shift in eating disorders and eating problems is partly related to acculturation
Males account for 10% of all people with anorexia and bulimia
Men are more likely to exercise to lose weight and women are more likely to diet
Why do men develop anorexia or bulimia?
Linked to the requirements and pressures of a job or sport
Jockeys, wrestlers, distance runners, body builders, swimmers
Body image
Want a lean, toned, thin shape rather than the muscular shape of the typical male ideal
Reverse Anorexia Nervosa / Muscle Dysmorphia
Very muscular but still see themselves as scrawny and small
Continue to strive for a perfect body through extreme measures
Feel shame about their bodies
Have a history of depression, anxiety, and self-destructive compulsive disorder
⅓ also engage in related dysfunctional behaviors such as binge eating
Goals: Correct the dangerous eating pattern and address the broader psychological and situational factors that led to the eating problem
⅓ of those with anorexia receive treatment
Restore proper weight and normal eating
Nutritional rehabilitation
Tube and intravenous feedings
Rewards as positive reinforcement
Supportive nursing care, nutritional counseling, and a relatively high-calorie diet
Motivational Interviewing: An intervention that uses a mixture of empathy and inquiring review to help motivate clients to recognize they have a serious eating problem and commit to making constructive choices and behavior changes
Patients in nutritional rehab programs usually gain the necessary weight over 8-12 weeks
Lasting changes
Combination of education, psychotherapy, and family therapy
Psychotropic drugs are limited in helping
Cognitive-Behavioral Therapy
Clients are required to monitor their feelings, hunger levels, and food intake
Taught to identity their core pathology
Taught alternative ways of coping with stress and of solving problems
Recognize their need for independence
Better identify and trust their internal sensations and feelings
Help clients change their attitudes about eating and weight
Identify, challenge, and change maladaptive assumptions
Educate clients about body distortions typical of anorexia
Help them see that their own assessments of their size are incorrect
Very effective
Most successful at preventing relapses when it continues for at least a year beyond a patient’s recovery
Changing family interactions
Try to help the person with anorexia separate her feelings and needs from those of other members of her family
Family therapy can be helpful in the treatment of this disorder
Aftermath
Weight is often quickly restored once treatment begins
Treatment gains may continue for years
Most females with anorexia menstruate again when they regain their weight, and other medical improvements follow
Death rate from anorexia is falling
As many as 25% of ppl with anorexia remain seriously troubled for years
recovery isn’t always permanent
½ of those who have suffered from anorexia continue to have certain psychological problems years after treatment
The more weight people have lost and the more time that passes before they enter treatment, the poorer the recovery rate
43% of those with bulimia receive treatment
Nutritional Rehab: Helping clients to eliminate their binge-burge patterns and establish good eating habits
A combination of therapies aimed at eliminating the underlying causes of bulimic patterns
Emphasize education as much as therapy
Cognitive-Behavioral Therapy is particularly helpful
Antidepressant drug therapy is very effective
Cognitive-Behavioral Therapy
Keep diaries of their eating behavior, changes in sensations of hunger and fullness, and the ebb and flow of other feelings
Exposure and Response Prevention: Require clients to eat particular kinds and amounts of food and then prevent them from vomiting
Help clients recognize and change their maladaptive attitudes
Other forms of psychotherapy
Interpersonal Psychotherapy: Treatment that is used to help improve interpersonal functioning
Psychodynamic therapy
Group therapy formats
Antidepressant Medications
Helps as many as 40% of patients
Reduces binges and vomiting
Seems to work best in combination with other forms of therapy
Aftermath
Left untreated, bulimia can last for years, sometimes improving temporarily but then returning
Treatment produces immediate, significant improvement in 40% of patients
Another 40% show a moderate response
Around 75% of people with bulimia have recovered, either fully or partially
Relapses are usually triggered by a new life stress
44% of people with binge-eating disorder receive treatment
Psychotherapy is generally more helpful than antidepressants
⅓ of recovered individuals showed total improvement
High risk of relapse
Weight problems are often resistant to long-term improvement
Body Project: A program that offers weekly group sessions where members are guided through exercises that critique Western society’s beauty ideals
Based on CDT
Cognitive Dissonance Theory (CDT): When people adopt new attitudes that contradict their other attitudes and behaviors, they’ll experience emotional discomfort that they seek to eliminate by changing their old attitudes and behaviors
Performed well in research