Last lesson….
• Describe two examples of the application of
cross-cultural studies in Psychology and
discuss the potential effect of cultural bias in
their interpretation (12 marks)
Anorexia Nervosa
Eating Disorders
• The main two types of eating disorders are
Anorexia Nervosa and Bulimia.
• Do you know what the differences are?
• You only need to know anorexia nervosa.
Symptoms of Anorexia Nervosa
• Refusal to eat and maintain a minimum
average expected body weight.
• Fear of gaining weight
• Distorted body image
• Amenorrhea (absence of at least three
consecutive menstrual cycles)
• Weight less than 85% of expected
Cut and Stick Explanations worksheet
How does Holmes and Rahe’s diathesis Stress Model
relate to Eating Disorders?
Learning Approach-Social Learning
• SLT suggests anorexia nervosa may be due to
role models in the media.
• Young people may feel they have to get to
around the same weight as thin celebrities in
order to be accepted
Social Learning Theory
• Teenagers pay attention to the fact that many
celebrity role models are extremely thin.
• They retain this information.
• They have the ability to reproduce being thin if
they diet excessively and will do it if they are
motivated to do so.
• They can see that their role models are famous
and rich and this may motivate them to be thin
too. Teenagers may think that being thin is what
is needed to be rich and famous or even just
Evaluation of the Learning Approach
+ Lai (2000) found that the rate of
anorexia increased for chinese
residents in Hong Kong as the culture
slowly became more westernised.
+Crisp et al. (1976) found that dancers
and fashion models were more likely
to develop anorexia nervosa.
+Mumford et al. (1991) found that Arab
and Asian women were more likely to
develop eating disorders if they
moved to the West.
Doesn’t explain why the disorder
usually develops in adolescence.
Everyone sees the pictures of slim
people, so why is it only some of the
population develop an eating
There are psychodynamic
explanations for anorexia nervosa
such as fear of growing up and family
Hospitalization of anybody for a mental disorder can often be a confusing
and emotion-wrought decision.
Family members or significant others may need to intervene in the patient's
life to ensure they do not starve themselves to death.
In these cases, hospitalization is not only necessary, but a prudent treatment
Family members should be aware that individuals who suffer from anorexia
nervosa will often resist treatment of any sort, especially hospitalization.
It is important, therefore, to come to an agreement about the need for such
a step and not be swayed by the patient's pleas for seeking alternative
treatment options. Often these have already been tried to no success.
Treatment-Token Economy
• Uses operant conditioning to get sufferers of
anorexia nervosa to eat.
• Eating food is reinforced by the use of tokens.
• Tokens can be exchanged for privileges such as makeup, outings and watching favourite TV programmes.
Living as an in-patient
• A behaviourally-oriented token economy often exists in
psychiatric inpatient units specializing in eating disorders.
• This program rewards patients for eating regular meals
and ensuring they do not purge afterwards.
As the patient gains weight, additional hospital privileges may be granted.
A specific target weight should be set as the treatment goal, upon which time the
patient (ideally), should graduate from the hospital into an outpatient program
consisting of individual therapy, group therapy, or simply a support group. Often this
is not possible because of financial limitations.
Treatment will usually then continue in an outpatient modality.
If such a behavioural program is not implemented in the inpatient treatment facility
the individual is in, treatment progress will likely be much slower and less steady.
How does it work?
Daily fluid intake and weight should be tracked.
If the person vomits after meals, they should be watched for a few hours after each meal to
ensure no vomiting occurs.
The individual's diet should begin between 1,500 and 2,000 calories per day. This calorie
intake can increase gradually as the patient makes treatment gains.
The patient should have six equal feedings throughout the day, although this may not
always be possible.
Severely anorexic patients can be started on a liquid food supplement (e.g., Sustagen) or an
IV, if necessary.
Inpatient programs (especially) should be careful not to overemphasize the importance of a
person's weight, however. Weight is only the symptom in this disorder of poor body image
and self-esteem problems. These primary difficulties should be the focus of any treatment
approach for an eating disorder.
Weight gain can be used as an objective measure as to treatment progress.
How to search for research…….
A useful undergraduate tool!
Research – have a go at APRC
A case of anorexia nervosa successfully treated by behavior therapy in an outpatient clinic.
Sonoda, Junichi;Hirayama, Kiyotake;Nozoe, Shinichi;Takayama, Iwao
[Journal Article]Japanese Journal of Child Psychiatry, Vol 15(3),
May-Jun 1974, 115-123.
Reports the case of a 10-yr-old girl treated for anorexia nervosa on an outpatient basis with behavioral therapy
(operant conditioning).
The patient was one of monozygotic twins who started to lose weight after an appendectomy operation. Her
replacement as the baby of the family by a younger brother born when she was 6 and the special care and attention,
especially in regard to food, she received from her mother during her hospitalization for the operation were important
factors in triggering the symptomatic response.
At the time of treatment she weighed 20.4 kg, about 30% below normal. She was treated for 2 mo with appetite
stimulants without result. The successful behavioral therapy included the following techniques: (a) praise and
encouragement for eating but no attention for refusal, and no comments about the girl's emaciated condition; (b) more
frequent feedings, with reduced amounts; (c) covert reinforcement with hypnotherapy; and (d) a token economy
system. After acquiring 4 tokens she would be rewarded with a coveted bicycle. A token was rewarded for each kilo
At first her weight increase was very slow. Only after the introduction of the token system did she begin to gain weight
at the approximate rate of 1 kg/mo. She reached her target of 25 kg in 9 mo.
A follow-up study 10 mo after treatment shows good home and school adjustment and continued normal weight gain.
(English summary) (18 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)
Token Economy Evaluation
+It is good at getting sufferers to a reasonable
weight after which the issues can be addressed.
+ It can be used in conjunction with other
- Token economy does not deal with the
underlying issues.
- May only work short-term whilst the person is
being treated in an institution.
- Considered to violate human rights. (Key issue /
debate of Social Control).
Write a conclusion for a 12 mark essay on
behavioural Treatments of Anorexia.

SLT summary and TEP for anorexia