Eating Disorders

behavioral disorder→ dont have to do with mood, have to do with behavior

anorexia nervosa

• very brief history

  • 12th and 13th century religious themes to starvation

    • kosher, lent, fasting holidays

  • St. Catherine of siena 12th century

  • 16th century: no longer accepted by catholic church

  • 17th century: english physician Richard Morton in 1689 gave the first clear medical description → “wasting” disease

  • Lasegue(1873) and Gull(1874) recognized the physiological aspects of the condition

  • in 1973, Hilde Bruch published eating disorders: obesity, anorexia nervosa, and the person within

anorexia nervosa: restriction of caloric intake PLUS distorted self-image PLUS intense fear of gaining weight PLUS lack of recognition of seriousness(always below normal weight regardless of subtype)

• subtypes

  • restricting (most familiar) → caloric restriction

  • binge eating/purging→ caloric conscious but sometimes has periods of binge eating and purging (over exercising or vomiting to counteract the binge eating)

• who is at risk

  • anyone whose job involves appearance

• physical consequences: all symptoms associated with starvation

• characteristic behavior:

  • calorie counting

  • checking weight (several times a day)

  • excuses/distractions

• epidemiology: varies from 0.9% of females to 0.3% of males (possible as high as 5% to 20% of the general population)

• chronic relapsing → may come back and go away (not one and done)

• eating disorders→ highest morbidity rate of any psychiatric disorder

  • 5-10% death rate within 10 years

  • 18-20% death rate within 20 years

  • reasons: caloric malnutrition → weakened immune system

    • comorbidity: depression and anxiety

Bullimia Nervosa

• core symptoms

  • behavior→ purging

  • thoughts → feeling out of control, impulsive

  • within 10% of normal weight (unlike anorexia who are always underweight)

• recurrent inappropriate compensatory behaviors after binging (1000s of calories)

  • purging(throwing up)

  • excessive exercise

  • fasting

• frequency:

  • DMS: average of once a week for 3 months

• subtypes:

  • purging (most common)

    • vomiting, laxatives, enemas

  • nonpurging (6%-8%)

    • excess exercise, fasting

binge eating disorder: was considered for research in DSM 4→ added in the DSM 5

• eating in a discrete period of time an amount of food that is definitely larger than what most people would eat in a similar period of time

• a sense of lack of control

• report of distress over binge eating

• 3 or more symptoms

  • eating rapidly

  • eating past the point of feeling full

  • eating large amounts of food when not physically hungry

  • eating alone due to embarrassment

  • feeling disgusted with oneself, depressed, or guilty

• severity dependent no frequency of eating binges

• 1/3 of the people who seek medical treatment for obesity

• controversial

  • diagnosing the normal

other eating disorders(RARE)

• pica: eating non organic substances

  • chalk, glue, paper

  • a lot of young kids → eating rocks

    • sign of malnutrition or intellectual disability

• rumination disorder: someone regurgitates what they ate, chew and then swallow it

• avoidant/restrictive food intake disorder: as an adult is very restrictive on what food they eat (more intense than just a picky eat)

  • excessive to the point where individual becomes malnourished

  • example: someone who only eats dominos pizza and nothing else

eating disorder possible causes:

biological factors

• genetics

  • risk of anorexia from relatives is 11.4 times greater than normal controls

  • risk of bulimia for relatives is 3.7 times higher than healthy controls

  • genome-wide association for anorexia nervosa on chromosome 12, which is associated with type 1 diabetes

• brain abnormalities

  • anorexia: ventromedial hypothalamus (homeostasis and appetite)

  • damage to frontal and temporal cortex seem to be linked to the development of anorexia nervosa in some cases and bulimia nervosa and others

• set points:

  • our bodies have a well-established tendency to resist variation from some sort of biologically determined set point or weight that our individual bodies try to “defend”

• serotonin(found in brain but mostly in stomach)

  • neurotransmitter serotonin is implicated in obsessionality, mood disorders, and impulsivity; also modulate appetite and feeding behavior

  • active area of research

• reward sensitivity

  • new research centers on brain pathways and neurotransmitters (such as dopamine) involved in reward processing

  • theory that reward and punishment systems get contaminated

    • normally rewarding stimuli such as food become aversive

    • stimuli associated with self-starvation become valued

    • the garcia effect

sociocultural factors

• the media and publications exert influence in defining the culture’s “ideal body shape” and creating pressures to be thin. AKA the “thin ideal”

• socioeconomic status: eating disorders more common among middle to upper class people

family influences

• more than 1/3 of patients reported that family dysfunction contributed to the development of anorexia

  • parents overly preoccupied with thinness, dieting, and good physical appearance

  • associated family behaviors include rigidity, parental overprotectiveness, excessive control, and marital discord (family systems theory)

    • more sick the child is, the less the parents fight and more stable the family becomes (unconscious)

  • rigidity and control

• bulimic family characteristics include:

  • high parental expectations

  • perceiving one’s family to be less cohesive (less control)

psychodynamic

• personality based factors (very difficult personality between each disorder)