CLP chapter 8

Eating Disorders: An Overview

• Major types of DSM-5 eating disorders

  • Bulimia nervosa* (terms with an asterisk are key terms) and anorexia nervosa*

    • Severe disruptions in eating behavior

    • Weight and shape have disproportionate influence on self-concept

    • Strong sociocultural origins – driven by Western emphasis on thinness

• Binge eating disorder*

  • Involves disordered eating behavior

  • May involve fewer cognitive distortions about weight and shape

Binge Eating

• Bingeing* is the hallmark of bulimia nervosa and binge eating disorder

  • Eating excess amounts of food in a discrete period of time

  • Eating is perceived as uncontrollable

  • May be associated with guilt, shame, or regret or particularly stressful times

  • May hide behavior from family members

  • Foods consumed are often high in sugar, fat, or carbohydrates

Bulimia Nervosa

• Binges are accompanied by compensatory behaviors

  • Purging*

  • Excessive exercise

  • Fasting or food restriction

• Associated medical features

  • Most people with bulimia nervosa are within 10% of normal body weight

  • Purging can result in severe medical problems

• Associated psychological features

  • Most people with bulimia nervosa are overly concerned with body shape

  • Fear of gaining weight

  • Most people with bulimia nervosa have comorbid psychological disorders

Anorexia Nervosa

• Extreme weight loss is the hallmark of anorexia

  • Restriction of calorie intake below energy requirements

  • Intense fear of weight gain accompanied by body image distortion

  • Two subtypes: restricting and binge-eating-purging

• Associated medical features

  • Starving body borrows energy from internal organs, leading to organ damage including cardiac damage

  • Most deadly mental disorder due to physical consequences and suicide risk

• Comorbid psychological disorders are common:

  • 70% of people with anorexia are depressed at some point

  • Higher than average rates of substance misuse and obsessive-compulsive disorder

Binge Eating Disorder (BED)

• Characterized by binge eating without associated compensatory behaviors

  • Associated with distress and/or functional impairment (e.g., health risk, feelings of guilt)

  • Excessive concern with weight or shape may or may not be present

• Approximately 20% of individuals in weight-control programs have BED

• Approximately half of candidates for bariatric surgery have BED

• Better response to treatment than other eating disorders

Knowledge Check Activity 1

• Match the disorder to its description.

Knowledge Check Activity 1: Answers

• The correct matches are as follows:

Bulimia Nervosa: Facts and Statistics

• Majority are women – 90%+

• Some binge eating symptoms are relatively common in men

• Incidence among males is increasing, 0.8* bulimia, 2.9% BED

• 6 to 7% of college women suffer from bulimia at some point

• Onset typically in adolescence

• Tends to be chronic if left untreated

Anorexia Nervosa: Facts and Statistics

• Majority are female and white

• From middle- to upper-middle-class families

• Usually develops around early adolescence

• More chronic and resistant than bulimia

• Lifetime prevalence approximately 1%

• Cross-cultural factors

  • Develops in non-Western women after they move to Western countries

Poll Activity 1

Respond to each of the following with “yes” or “no.”

1. Do you make yourself sick because you feel uncomfortably full after eating?

2. Do you worry that you have lost control over how much you eat?

3. Have you recently lost 14 or more pounds in a three-month period?

4. Do you believe yourself to be fat when others say you are too thin?

5. Would you say that food dominates your life?

This is an adaptation of the SCOFF, a screening instrument for eating disorders. If you have concerns about your own eating, you may want to discuss your concerns with a mental health professional.

Source: https://link.springer.com/article/10.1007/s11606-019-05478-6 Links to an external site.

Figure 08.04 An Integrative Model of Eating Disorders

Discussion Activity 1

Much has been made of the influence of the media on body image and risk of disordered eating and eating disorders. In the past, this research has focused on traditional media like movies, television, and magazines, but research also indicates a strong relationship between high rates of social media use and body dissatisfaction and various types of disordered eating.

• What kinds of body images are represented on your social media?

• Have you seen any posts promoting body positivity? How do you respond to such posts?

• Have you seen any posts that promote unhealthy eating, like tips and tricks for restricting intake or purging? How do you respond to such posts?

• What about posts that promote healthy eating and exercise?

• Do you think social media platforms should do anything about weight- and body image-associated posts? What about those posts that encourage unhealthy or dangerous behavior?

Treatment of Bulimia Nervosa

• Cognitive-behavioral therapy

  • Treatment of choice

  • Principal focus is on the distorted evaluation of body shape and weight and on maladaptive attempts to control weight in the form of strict dieting and compensatory activities

• Medical and drug treatments

  • Antidepressants can help reduce bingeing and purging behavior

Treatment of Binge Eating Disorder

• Previously used medications for obesity are now not recommended

• Psychological treatment

  • CBT—effective

  • Interpersonal psychotherapy—equally effective as CBT

  • Self-help techniques—effective

Treatment of Anorexia Nervosa

• Initial treatment goal is attaining a weight in the healthy range

• Psychoeducation

  • Behavioral and cognitive interventions

  • Target food, weight, body image, thought, and emotion

• Treatment often involves the family

  • Has the most support from clinical trials for treating adolescents with anorexia

Breakout Group Activity 1

• Break into pairs or small groups for this activity.

• What resources does your college or university have for students who may be struggling with disordered eating or eating disorders?

  • Are there any programs targeted to students as a whole?

  • What about to students at particular risk of eating disorders, like student-athletes or dance majors?

  • Are there any programs for students who want to reduce their weight in a healthy way?

  • How could your school do better?

• Discuss your ideas in the group and in your class.

Preventing Eating Disorders

• Often focuses on promoting body acceptance in adolescent girls

• Identify people who may be at increased risk

  • Early weight concerns

• Screening for at-risk groups

• Provide education

Breakout Group Activity 2

• Break into pairs or small groups of students.

• Use what you know about the causes of eating disorders to develop a eating disorders prevention program.

  • What group or groups would you target? Why?

  • What would the program focus on? Why? Remember to be specific.

• Present your program to the class for discussion.

Obesity

• Defined as a body mass index (BMI) or 30 or higher

• Not DSM disorder, but is associated with some disorders

• Statistics

  • In 2008, 33.8% of adults in the United States were obese; 37.5% in 2010

  • Mortality rates are close to those associated with smoking

  • Increasing more rapidly in children/teens

  • Obesity also growing rapidly in developing countries

Discussion Activity 2

Present the TED Salon Talk “The inaccurate link between body ideals and health Links to an external site.” or review the transcript.

• What can you learn from this TED Talk about cultural issues in the etiology and diagnosis of eating disorder?

• Consider your own body image. Where did you get your idea about what an ideal body is? Do you think you meet the ideal? Do you wish your own body looked different?

• What do you think of the idea of body diversity? Is it an important part of inclusivity?

Obesity and Disordered Eating Patterns

• Binge eating increases risk of obesity

• Night eating disorder*

  • Consume 1/3+ of daily calories after dinner

  • Get out of bed at least once during the night for a high-calorie snack

  • Often not hungry the next morning and skip breakfast

Causes and Correlates of Obesity

• Technological advancement

  • Technology promotes inactive, sedentary lifestyle

• Genetics account for about 30% of variation in obesity

• Psychosocial factors

  • More likely to be obese if people in close social circles are also obese

Obesity Treatment

• Treatment often progresses from least to most intrusive:

  • Self-directed weight loss programs

  • Commercial self-help programs

  • Behavior modification programs

  • Bariatric surgery*

• Treatment is moderately successful at the individual level

Discussion Activity 3

“Reality” series like “My 600 Pound Life,” and “1000-Lb. Sisters” have a large following. They have been praised for showing the realities of living with morbid obesity and the challenges faced in trying to lose weight, but have been criticized as being exploitative, as forcing the subjects of the episodes into humiliating situations, and as failing to provide necessary care, including psychological care.

• Have you ever watched a series or documentary about people with morbid obesity?

  • What did you think about the person? About their portrayal in the show?

• How might this type of show increase stigma about obesity?

• How might this type of show increase public awareness?

• In the balance, are shows focusing on the journeys of people with morbid obesity a good thing or a bad thing?

Assessment of Sleep

• Polysomnographic (PSG) evaluation* of sleep:

  • Electroencephalograph (EEG) – brain waves

  • Electrooculograph (EOG) – eye movements

  • Electromyography (EMG) – muscle movements

  • Detailed history, assessment of sleep hygiene and sleep efficiency

• Actigraph *

  • Wearable device sensitive to movement – can detect different stages of wakefulness/sleep

Sleep Disorders

• Two major types of sleep disorders

  • Dyssomnias*

    • Difficulties in amount, quality, or timing of sleep

  • Parasomnias*

    • Abnormal behavioral and physiological events during sleep

Insomnia (1 of 2)

• Insomnia* is one of the most common sleep disorders

  • Problems initiating/maintaining sleep (e.g., trouble falling asleep, waking during night, waking too early in the morning)

• 15% of adults report daytime sleepiness

• Only diagnosed as a sleep disorder if it is not better explained by a different condition like anxiety

Insomnia (2 of 2)

• Facts and statistics

  • Often associated with medical and/or psychological conditions

    • Anxiety, depression, substance use

  • Affects females twice as often as males

• Associated features

  • Unrealistic expectations about sleep

    • Believe lack of sleep will be more disruptive than it usually is

Figure 08.10 An Integrative, Multidimensional Model of Sleep Disturbance

Hypersomnolence Disorder

• Hypersomnolence disorder* is characterized by sleeping too much

  • Experience excessive sleepiness as a problem

• Often associated with other medical and/or psychological conditions such as depression

Narcolepsy

• Principal symptom of narcolepsy* is recurrent intense need for sleep, lapses into sleep, or napping

  • Accompanied by at least one of the following:

    • Cataplexy

    • Hypocretin deficiency

    • Going into REM sleep abnormally fast

• Rare condition

  • Affects about .03% to .16% of the population

  • Slightly more common among males

  • Onset during adolescence

Breathing-Related Sleep Disorders (1 of 2)

• Three types of breathing-related sleep disorders* :

  • Obstructive sleep apnea hypopnea

    • Airflow stops, but respiratory system works

    • Associated with age and obesity

  • Central sleep apnea (CSA)

    • Respiratory systems stops for brief periods

  • Sleep-related hypoventilation

    • Decreased breathing during sleep not better explained by another sleep disorder

Breathing-Related Sleep Disorders (2 of 2)

• People with the disorder may be minimally aware of it

  • Often snore, sweat during sleep, wake frequently

  • May have morning headaches

  • May experience episodes of falling asleep during the day (due to poor sleep quality at night)

• Obstructive sleep apnea occurs in 10 to 20% of population

  • More common in males

  • Associated with obesity and increasing age

Circadian Rhythm Sleep-Wake Disorder

• Circadian rhythm sleep-wake disorder* :

  • Disturbed sleep leading to distress and/or functional impairment

• Affects suprachiasmatic nucleus, which stimulates melatonin and regulates sense of night and day

• Types:

  • Shift work type – job leads to irregular hours

  • Familial type – associated with family history of dysregulated rhythms

  • Delayed or advanced sleep phase type – person’s biological clock is naturally “set” earlier or later than a normal bedtime

Knowledge Check Activity 2

• Match the disorders and descriptions

Knowledge Check Activity 2: Answers

• Match the disorders and descriptions.

Treatments for Sleep Disorders (1 of 2)

• Relaxation and stress reduction

• Stimulus control to improve sleep hygiene

• Insomnia

  • Benzodiazepines and over-the-counter sleep medications for short-term use only

  • Cognitive-behavioral therapy

• Hypersomnia and narcolepsy

  • Stimulants (i.e., Ritalin)

  • Cataplexy may be treated with antidepressants

Treatments for Sleep Disorders (2 of 2)

• Breathing-related sleep disorders

  • May include medications, weight loss, or mechanical devices that keep the airway open

• Circadian rhythm sleep-wake disorders

  • Phase delays

    • Moving bedtime later (best approach)

  • Phase advances

    • Moving bedtime earlier (more difficult)

  • Use of very bright light

    • Trick the brain’s biological clock

The Parasomnias: Non-REM Sleep Arousal Disorders

• Sleep terrors*

  • Recurrent episodes of panic-like symptoms during non-REM sleep

  • More common in children (~6%) than adults

• Sleepwalking*

  • More common in children than adults

  • Problem usually resolves on its own without treatment

  • Seems to run in families

Poll Activity 2

• How much sleep do you think you need each night?

• How much sleep do you actually get per night?

• Do you feel sleepy during the day?

• Do you worry about having insomnia?

• Do you worry about having hypersomnolence disorder?

Poll Activity 2 Debrief

• How much sleep do you think you need each night?

  • According to the American Sleep Foundation, young adults (18 to 25 years) and adults (26 to 64 years) require 7 to 9 hours of sleep a night.

• How much sleep do you actually get per night?

  • A survey by the University of Georgia suggests college students average about 6 hours of sleep per night.

• Do you feel sleepy during the day?

  • About half of college students report feeling sleepy during the day.

• Do you worry about having insomnia?

  • Between 10% and 30% of adults report symptoms of chronic insomnia.

Self-Assessment

• Consider what you have learned about eating disorders and obesity.

  • What have you learned about the symptoms, causes, and treatments?

  • What might you do if you are concerned about your own weight or advise a friend to do if they are concerned?

• Consider what you have learned about sleep and sleep disorders.

  • What have you learned about the symptoms, causes, and treatments of these disorders?

  • What can you do to improve your own sleep?

Summary

Now that the lesson has ended, you should have learned how to:

• 08.01 - Differentiate bulimia nervosa, binge-eating disorder, and anorexia nervosa in terms of their key features as outlined in the DSM-5.

• 08.02 - List the reasons that the development of an eating disorder is a particular risk for young women in developed countries.

• 08.03 - Draw connections between the biological, psychological, and social causes of eating disorders and the symptoms of eating disorders.

• 08.04 - Compare the effectiveness of psychological treatments for eating disorders versus medical treatments for eating disorders.

• 08.05 - Explain how obesity as a medical condition differs from eating disorders.

• 08.06 - Discuss how to test an individual for the presence of dyssomnias in terms of formal medical assessment.

• 08.07 - Describe the different types of parasomnias in terms of their symptoms and treatment.

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