chap11+eating+disorders

Chapter 11: Eating Disorders

• Abnormal Psychology, Twelfth Edition by Ann M. Kring & Sheri L. Johnson, revised by Tracy S. Bennett, Ph.D.

DSM-5 Feeding & Eating Disorders

• Important Categories:

  • Pica

  • Rumination Disorder

  • Avoidant/Restrictive Food Intake Disorder

  • Anorexia Nervosa

  • Bulimia Nervosa

  • Binge-eating Disorder

  • Other Specified Feeding or Eating Disorder

  • Unspecified Feeding or Eating Disorder

Anorexia Nervosa

• DSM-5 Diagnostic Criteria:

  • Restriction of food leading to very low body weight (BMI < 18.5)

  • Intense fear of gaining weight, persistent despite weight loss

  • Distorted body image

• Subtypes:

  • Restricting Type

  • Binge-eating/Purging Type

  • Specification of subtypes based on past 3 months rather than just current episode

Body Image Assessment

• Comparison of distorted attitudes toward eating in women with different scores on body image assessments.

Body Mass Index (BMI)

• Important for understanding weight categories:

  • Underweight

  • Healthy

  • Overweight

  • Obese

  • Extremely obese

• Table provides BMI calculations across various weights and heights.

Onset and Prevalence of Anorexia Nervosa

• Common onset in early to middle teen years; often triggered by dieting and stress.

• Women are 10 times more likely than men to develop anorexia; symptoms similar in men.

• Comorbidities include phobias, PTSD, depression, OCD, bipolar disorder, and substance dependence.

• High suicide rates associated:

  • 5% complete

  • 20% attempt suicide.

Physical Changes and Medical Complications in Anorexia

• Medical issues include:

  • Cardiovascular complications (heart failure)

  • Kidney failure

  • Osteoporosis

  • Muscle loss and weakness

  • Fatigue and sensitivity to cold

  • Skin issues: acne, gum disease, dry hair/skin/nails

  • Death rate estimated at 1 in 10.

Prognosis for Anorexia Nervosa

• Recovery rates between 50-70%, requiring 6-7 years on average.

• Relapse is common due to persistent distorted self-perception and cultural pressures valuing thinness.

• Death rates are 10 times higher than the general population, primarily due to physical complications.

Bulimia Nervosa

• DSM-5 Diagnostic Criteria:

  • Recurrent episodes of binge eating.

  • Recurrent compensatory behaviors (e.g., vomiting) to prevent weight gain.

  • Importance of body shape/weight for self-evaluation.

  • Binge defined as excessive food intake in less than 2 hours; occurs at least once a week for three months.

• Key differences from anorexia:

  • Typically normal or above normal weight in bulimia.

Emotional and Behavioral Aspects of Bulimia

• Binges often triggered by stress and negative emotions; typically involve high-calorie foods.

• Feelings of loss of control during binge episodes; sequences often lead to shame and secrecy.

Compensatory Behaviors in Bulimia

• Compensatory methods include:

  • Vomiting, laxative misuse, fasting, excessive exercise.

  • Driven by discomfort, disgust, and fear of weight gain.

Medical Complications of Bulimia

• Complications include:

  • Disrupted fullness detection

  • Menstrual irregularities

  • Enlarged salivary glands

  • Gastrointestinal issues

  • Fatigue due to potassium depletion

  • Kidney failure

  • Heart irregularities, gum diseases, and dental issues.

Prognosis for Bulimia Nervosa

• Recovery rates about 75%; 10-20% remain symptomatic.

• Early intervention is linked to better outcomes; comorbid depression/substance abuse negatively affects prognosis.

Binge Eating Disorder

• DSM-5 Diagnostic Criteria:

  • Recurrent binge eating episodes with at least three of the following symptoms:

    • Eating quickly

    • Eating until uncomfortably full

    • Eating large amounts when not hungry

    • Eating alone due to embarrassment

    • Post-binge feelings of disgust or guilt.

  • No compensatory behaviors present; often related to obesity (BMI > 30).

Health Consequences of Binge Eating Disorder

• Associated health risks: heart disease, diabetes, hypertension, high cholesterol, stroke, liver disease, gallbladder disease, and certain cancers.

Prognosis for Binge Eating Disorder

• More prevalent in women than anorexia or bulimia.

• Recovery rates estimated between 25-82%; duration of symptoms averages slightly over 4 years.

• Comorbidities include mood disorders, anxiety disorders, and ADHD.

• Key risk factors: childhood obesity, critical comments about weight, and low self-concept.

Etiology of Eating Disorders: Genetics

• Family studies show that first-degree relatives of individuals with anorexia or bulimia have significantly higher chances of developing the disorders themselves.

• Genetic factors contribute to key features of eating disorders, along with environmental influences.

Etiology of Eating Disorders: Neurobiological Factors

• Hypothalamus involved in food regulation but not directly in eating disorders.

• Low levels of endogenous opioids lead to abnormal eating patterns, particularly during starvation.

• Serotonin and dopamine levels are also linked to appetite regulation, satiety, and emotional responses related to food.

Etiology of Eating Disorders: Psychodynamic Factors

• Disturbed parent-child relationships can contribute.

• Personality traits like perfectionism, negative emotions, and body dissatisfaction play a role in eating disorders.

Etiology of Eating Disorders: Cognitive Behavioral Factors

• Dependence of self-worth on weight and distorted perceptions of body image.

• Rigid eating patterns can lead to binges, increasing disordered eating behaviors.

Sociocultural Factors in Eating Disorders

• Societal ideals place value on thinness, leading to body dissatisfaction.

• Media portrayals contribute to unrealistic body standards, leading to shame among individuals who do not match them.

Other Influencing Factors

• Severe food restriction can negatively impact personality and behavior, leading to irritability and concentration issues.

• Family conflict and abuse during childhood also correlate with higher rates of eating disorders.

Treatment of Eating Disorders

• Often, individuals do not seek treatment due to denial.

• Psychological Treatments:

  • CBT has shown effectiveness, especially in bulimia.

  • Family-based therapy demonstrates potential for better outcomes in anorexia.

• Goals include restoring normal eating habits, identifying reinforcing factors, and building healthier perceptual habits.

Prevention of Eating Disorders

• Psychoeducational interventions focus on reducing societal pressures and promoting healthy weight management.

• Identifying at-risk individuals for early intervention is crucial.

Treatment Plan Outline for Eating Disorders

• Goals:

  • Restore normal eating habits.

  • Identify life events contributing to feeding behaviors.

  • Use CBT techniques for anxiety management and cognitive restructuring.

  • Implement gradual exposure to disordered eating triggers.

• Family therapy may support overall treatment success.