Eating Disorders
Abnormal Psychology
Chapter 10
Kate Moss vs. Marilyn Monroe
• Cultural Obsessions with thinness
• Increased incidence of diagnosis
• Statistics of dieting and body perception
Eating Disorder Subtypes
• Anorexia Nervosa- the refusal to maintain a
minimally normal body weight. Anorexia literally
means “loss of appetite” when in actuality people
suffering from anorexia are hungry but they starve
themselves, sometimes to death.
• Bulimia Nervosa- characterized by repeated
episodes of binge eating followed by inappropriate
compensatory behaviors suchas self-induced
vomiting, misuse of laxatives or excessive exercise.
Bulimia literally means “hungry enough to eat an
ox”. The person suffering from bulimia usually has a
normal appetite and maintain a normal weight.
Symptoms associated with Anorexia
1. Refusal to Maintain a Normal Weigh
2. Disturbance in evaluation weight or shape
3. Fear of Gaining Weight
4. Cessation of Menstruation (Amenorrhea)
Medical Complications
– Electrolyte imbalance that can lead to cardiac
arrest or kidney failure.
– Inability to maintain normal blood pressure and
temperature.
– Lanugo-development of a fine downy hair on the
face or trunk of the patient.
– Abnormally dry and cracked skin
– Infertility
– Dental erosion
– Bone loss
– Lethargy
– Anemia
Co-morbid Diagnosis
• Obsessive Compulsive Disorder
• Depression
• Obsessive Compulsive Personality
Disorder
• Bi-directionality with OCD and Depression
Bulimia
• Many people with bulimia have a history of
anorexia.
• (Def). Eating an amount of food in a fixed
period of time that is clearly larger than
most people would eat under a similar
circimstance.
• Societal Confounds to Def.
Binge Eating
• Spontaneous or planned
• Inappropriate Compensatory Behaviors
Excessive Emphasis on Weight or Shape
• Body perception and obsession shared
with anorexics.
• Exhilarated by positive comments or
interest in their appearance.
• Self –esteem falls with any negative
comments about their appearance
Co-morbid Psychological Disorders
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Depression
Anxiety Disorders
Personality Disorders
Substance Abuse
Medical Complications
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Dental erosion
Sensitized Gag reflex
Enlargement of the salivary glands
Electrolyte imbalance
Ruptured esophagus or stomach
Classification of Eating Disorders
• Anorexia Nervosa- Defined by the four symptoms
previously discussed:
– Refusal to maintain normal body weight
– Intense fear of weight gain
– Disturbance in perception of body shape including
denial of the seriousness of low body weight
– Amenorrhea
Two subtypes:
• Restricting-people who rarely engage in binge eating or purging
• Binge eating/purge eating-defined by regular binge eating and
purging during the course of the disorders.
Epidemiology of Eating Disorders
• Gender differences and Standards of Beauty
– 10 times more common among women than men.
– Cultural ideal of beauty changes over time, with the
ideal becoming more and more thin.
– Research on Beauty Pageant Contestants and
Playboy Centerfolds from 1959-1988.
– Barbie Doll
• Age of Onset
– - typically begin in late adolescence or early
adulthood.
– there is a significant rise in cases of anorexia during
early adolescence as girls approach puberty.
Etiology
• Social Factors
– Internalization of the ideal of thinness
– Troubled Family Relationships: Different in
Bulimia and Anorexia
• Bulimics-considerable conflict and rejection in
families.
• Anorexics - enmeshment hypothesis anorexics
Psychological Factors
• Psychologists have not yet identified
unambiguous contributing psychology
factors to eating disorders.
• Four most prominent theories
– Control Issues
– Depression/Dysphoria
– Body Image dissatisfaction
– Reaction to dietary restraint.
Struggle for Control Theory (Bruch)
• Cluster of psychological symptoms that
appear to contribute to the development of
eating disorders.
– Excessive External Control (Good Girls &
People Pleasers)
– Perfectionism
– Lack of Introceptive Awareness
Depression, Low Self Esteem, Dysphoria
• Depression, dysphoria (negative mood states), and
low self esteem have been shown to contribute to
the onset, or maintain cases of eating disorders.
• Anti-depressant medication has been shown to
reduce symptoms of bulimia.
• Family incidence
• Low self esteem and pre-occupation with social
self.
• Dysphoria triggers binge eating.
Negative Body Image
• Highly critical evaluation of one’s
weight and shape.
• Includes both a distorted perception
and a dissatisfaction with one’s body
evidenced by a large distance between
a person’s actual and ideal.
• Thought to be problematic when
combined with other risk factors such
as perfectionism and low self esteem.
Dietary Restraint
• Some symptoms of eating disorders are thought to
be direct consequences of restricted eating.
• Overly strict diet increases hunger, frustration and
lack of attention to internal cues, all of which make
binge eating more likely.
• Obsessive thoughts and compulsive eating rituals
have been found to be direct consequences of
semistarvation.
• Food restriction itself may trigger other behavior
patterns seen in eating disorders such as
obsessions about food, and rituals such as
compensatory behaviors.
Biological Factors
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Homeostatic Mechanisms
Weight set points
Hyperlipogenesis
Genetics
Anorexia:Treatment and Outcome
• Weight Gain
• Address Difficulties that lead to disorder in therapy
– Structured Family therapy
– Interoceptive awareness
– Cognitive Behavioral Therapy
• Outcome
– Current treatments not very effective
– Life long struggle with preoccupation with diet, weight and
body shape.
Bulimia:Treatment and Outcome
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Anti-depressant Medication
Cognitive Behavioral Therapy
Interpersonal Psychotherapy
Outcome
The Case of Florence
History:
Florence was a 30 year old single white female with a
Bachelors Degree in English.
Parents: Both living
One Brother: 34 married with children worked as a lawyer.
Medical Problems: None---except for previous in patient
treatment for Anorexia
Employment: She worked at as a regional manager for a
grocery store chain, and was forced to go to therapy by
her boss due to her increasing weight loss.
Symptoms
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Weight at 91 lbs at 5’9’’
Shivering—extremely cold at 73 degrees
Lanugo
Stringy hair
Poor eye contact
Flat affect
Admitted to feeling pressure from job and family
Forced into therapy by boss due to severe weight loss
Denial that anything was wrong, thought co-workers might
be jealous of how thin she was-claimed “she looked like a
fox”, was very proud of her 91 pounds, but her ideal was 87.
Background
• Normal childhood
• At age 13, she was made fun of for being fat, even though she
weighed 125 at 5’8”, she began exercising daily and dieting.
• Admired thin actresses and wanted to look like them.
• By 14 she was exercising 3 hours a day and her grades had
dropped. She had a boyfriend for a year, and was convinced her
liked her because she was thin, and broke up with her because she
gained weight.
• Eating rituals developed, she would only eat on certain days and at
certain times to maintain her 93 pounds in high school.
• Menstruation stopped—she decided this was a good thing as she
would not have to worry about getting pregnant when she did have
sex.
• At 15, she fainted at school and was diagnosed with Anorexia and
entered in patient therapy.
Therapeutic Insights as a teen-ager
• Florence realized she had a problem
during her first in patient treatment where
she underwent intensive therapy.
• Claimed to hate herself, not know who she
was. She also felt inferior to her family and
like she would not amount to much.
• She claimed the treatment helped, she
was released and went to college.
Relapse
• Florence did not continue treatment when she went to college as
she felt things were under control. However, upon gaining 20
pounds her freshman year. She was horrified at the weight gain, and
although she did not restrict, she exercises until she took the 20
pounds off.
• Florence anorexia stayed under control until crisis occurred in her
life, usually centering around work or men.
• Florence was hired by a supermarket chain just out of college where
she was very successful. Her symptoms returned when she started
graduate school part time and felt pressure to maintain good grades
and perform well at work. She was upset by gaining weight, and
turning 30.
• All symptoms returned at this time, as she weighted 93 pounds,
developed amennorhea and thought she looked fabulous.
• Concern of co-workers and boss forced her into treatment or she
would lose her job.
Assessment
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Unstructured Interview
Thematic Apperception Test
Becks Depression Inventory-mild
Physical Examination-family physician
hospitalized her immediately and she claimed he
scared her for the first time in her life by telling
her she was dangerously underweight and some
of the medical complications that could happen
due to her extreme weight loss.
Treatment Plan
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Slowly restore weight an normalize eating patterns. Weight gain needs to be
gradual at about 2-3 pounds per week, during which she had to remain in
the hospital (30 days after which she weighed 116).
Group Therapy-first involved with group therapy and then discontinued.
Anorexics often compare themselves to others and are jealous or upset by
women who are thinner and often want to drop out. Group therapy has
mixed results with all anorexics.
Family therapy-very helpful as communication between Florence and her
parents were poor. They admitted they had wanted her to be a doctor or
lawyer, and she felt their disappointment. They were able to communicate
being proud of her accomplishments.
Individual Therapy-Florence liked the one on one most and found it most
helpful.
Upon discharge, she agreed to go to some support groups for Anorexics
and found them very helpful. She also agreed to participate in family
therapy at a later time.
Continued in treatment for one year, at which time she was discharged. She
was effectively communicating with her family, doing well at work, and
maintaining her weight as well as a good body image.
Prognosis
• Fair
• Eating disorders are not thought to be
cured, but can definitely go into remission,
the patient must be aware of this and look
for any signs that the disorder is recurring.