Abnormal Child Psychology, 3rd Edition, Eric J. Mash, David A. Wolfe
Chapter 13: Eating Disorders and Related Conditions
Chapter 13
Eating Disorders and Related Conditions
Abnormal Child Psychology, 3rd Edition, Eric J. Mash, David A. Wolfe
Chapter 13: Eating Disorders and Related Conditions
Eating and Normal Development
 Problematic eating habits and picky eating are
common in early childhood- almost 1/3 of children are
described as picky eaters
 Societal norms and expectations affect girls more
than boys, particularly by late childhood and
adolescence
Abnormal Child Psychology, 3rd Edition, Eric J. Mash, David A. Wolfe
Chapter 13: Eating Disorders and Related Conditions
Developmental Risk Factors
 Drive for thinness
 a key motivational factor for dieting and body
image
 refers to the belief that losing more weight is the
answer to overcoming problems
 Western sociocultural values and preoccupation with
weight and dieting may be internalized and
expressed at a very young age (as young as 7-10)
Abnormal Child Psychology, 3rd Edition, Eric J. Mash, David A. Wolfe
Chapter 13: Eating Disorders and Related Conditions
Developmental Risk Factors (cont.)
 Risk factors for development of later eating problems
include:
 early problematic eating behaviors
 early pubertal maturation
 high percentages of body fat
 concurrent psychological problems
 poor body image
 Adolescence brings many changes (including
physical maturation) which require major adjustments
in self-image; weight concerns intensify, especially for
girls
Abnormal Child Psychology, 3rd Edition, Eric J. Mash, David A. Wolfe
Chapter 13: Eating Disorders and Related Conditions
Developmental Risk Factors (cont.)
Figure 13.1 A developmental continuum of eating habits and disorders.
Abnormal Child Psychology, 3rd Edition, Eric J. Mash, David A. Wolfe
Chapter 13: Eating Disorders and Related Conditions
Developmental Risk Factors (cont.)
 Dieting is common, even among elementary school
children
 Chronic dieting is associated with the onset of
adolescent eating disorders
 Dieting may lead to “false hope syndrome”, as well as
binge eating and subsequent purging
Abnormal Child Psychology, 3rd Edition, Eric J. Mash, David A. Wolfe
Chapter 13: Eating Disorders and Related Conditions
Biological Regulators
 Metabolic rate, or balance of energy expenditure, is
based on individual genetic and physiological
makeup as well as eating and exercise habits
 An individual’s natural weight is regulated by his or
her own body weight set point, a biologically and
genetically determined range of body weight that the
body tries to “defend” and maintain
 Major hormonal determinants of physical growth rate
during childhood are the growth hormone and thyroid
hormone, with additional gonadal steroids kicking in
during adolescence to produce a further growth spurt
and skeletal maturation
Abnormal Child Psychology, 3rd Edition, Eric J. Mash, David A. Wolfe
Chapter 13: Eating Disorders and Related Conditions
Feeding and Eating Disorders of Infancy and Early
Childhood
 Pica
 eating inedible, non-nutritive substances for a
period of at least one month
 affects mostly very young children and those with
MR
 causes include poor stimulation and poor
supervision in home environment, and genetic
factors in some cases of MR
 treatments usually based on operant conditioning
procedures
Abnormal Child Psychology, 3rd Edition, Eric J. Mash, David A. Wolfe
Chapter 13: Eating Disorders and Related Conditions
Feeding and Eating Disorders of Infancy and Early
Childhood (cont.)
 Feeding Disorder of Infancy of Early Childhood
 sudden marked deceleration of weight gain and a
slowing or disruption of emotional and social
development prior to age 6
 affects up to a third of young children (both boys
and girls), particularly those from disadvantaged
environments
 can lead to or be the result of failure to thrive
Abnormal Child Psychology, 3rd Edition, Eric J. Mash, David A. Wolfe
Chapter 13: Eating Disorders and Related Conditions
Feeding and Eating Disorders of Infancy and Early
Childhood (cont.)
 Feeding Disorder (cont.)
 when there is no medical reason, it is often
associated with poor care-giving, including
maltreatment
 risk factors include family disadvantage, poverty,
unemployment, social isolation, parental mental
illness, and maternal eating disorders
 treatment involves a detailed assessment of
feeding behavior and other forms of parent-child
interaction
Abnormal Child Psychology, 3rd Edition, Eric J. Mash, David A. Wolfe
Chapter 13: Eating Disorders and Related Conditions
Feeding and Eating Disorders of Infancy and Early
Childhood (cont.)
 Failure to Thrive
 characterized by weight below the 5th percentile
for age, and/or deceleration in the rate of weight
gain from birth to present of at least 2 standard
deviations
 associated with social and economic
disadvantage, and inadequate or abusive caregiving in early infancy
 developmental outcome is highly related to the
child’s home environment
Abnormal Child Psychology, 3rd Edition, Eric J. Mash, David A. Wolfe
Chapter 13: Eating Disorders and Related Conditions
Feeding and Eating Disorders of Infancy and Early
Childhood (cont.)
 Obesity
 a chronic medical condition characterized by
excessive body fat (usually a BMI above the 95th
percentile)
 significantly affects children’s psychological and
physical health
 prevalence is increasing- as of 1990’s, 15% of
children were overweight
 low correlation between obesity in infancy and
obesity later in childhood, but childhood-onset
obesity is more likely to persist into adolescence
and adulthood
Abnormal Child Psychology, 3rd Edition, Eric J. Mash, David A. Wolfe
Chapter 13: Eating Disorders and Related Conditions
Figure 13.3 U.S. comparison with the next highest countries and the country with the
lowest percentage of obese youth.
Abnormal Child Psychology, 3rd Edition, Eric J. Mash, David A. Wolfe
Chapter 13: Eating Disorders and Related Conditions
Feeding and Eating Disorders of Infancy and Early
Childhood (cont.)
 Obesity (cont.)
 pre-adolescent obesity a risk factor for later EDs
 the U.S. has the highest percentage of overweight
children, and rates of obesity seem to increase
upon exposure to Western culture and its fast food
industries
 causes include genetic predisposition (including
leptin deficiencies), improper diet, unhealthy
lifestyle, as well as family influences, such as poor
communication, lack of support, and maltreatment
 proper nutrition and less sedentary lifestyle are the
recommended treatments- restricting diets not
usually recommended
Abnormal Child Psychology, 3rd Edition, Eric J. Mash, David A. Wolfe
Chapter 13: Eating Disorders and Related Conditions
Figure 13.2 Bigger meals, bigger kids. Sources: Centers for Disease Control and
Prevention, McDonald’s, and Newsweek.
Abnormal Child Psychology, 3rd Edition, Eric J. Mash, David A. Wolfe
Chapter 13: Eating Disorders and Related Conditions
Eating Disorders in Adolescence
 Anorexia Nervosa
 characterized by refusal to maintain minimally
normal body weight, intense fear of gaining
weight, and disturbance in perception of body size
 denial of thinness a notable feature
 DSM-IV subtypes:
 restricting type - individual loses weight through
diet, fasting, or excessive exercise
 binge-eating/purging type - individual engages
in episodes of binge eating or purging, or both
 numerous negative medical consequences
Abnormal Child Psychology, 3rd Edition, Eric J. Mash, David A. Wolfe
Chapter 13: Eating Disorders and Related Conditions
Eating Disorders in Adolescence (cont.)
 Bulimia Nervosa
 primary feature is recurrent binge eating
 binges are followed by either purging (self-induced
vomiting or misuse of laxatives or diuretics) or by
non-purging compensation (fasting, excessive
exercise)
 as with anorexia, self-evaluation is greatly
influenced by body shape and weight
Abnormal Child Psychology, 3rd Edition, Eric J. Mash, David A. Wolfe
Chapter 13: Eating Disorders and Related Conditions
Eating Disorders in Adolescence (cont.)
 Bulimia Nervosa (cont.)
 two subtypes: dietary-depressive subtype show
more eating pathology, social impairment,
psychiatric comorbidity, and persistence of
symptoms over five years than women with only
the dietary subtype
 significant medical consequences, but not as
severe as those from anorexia
 Binge Eating Disorder (BED)
 similar to bulimia without the compensatory
behaviors
 3.1% of girls, and 0.9% of boys
Abnormal Child Psychology, 3rd Edition, Eric J. Mash, David A. Wolfe
Chapter 13: Eating Disorders and Related Conditions
Figure 13.4 Compensatory behaviors of full-syndrome bulimia nervosa among
community samples. Data from Garfinkel et al., 1995
Abnormal Child Psychology, 3rd Edition, Eric J. Mash, David A. Wolfe
Chapter 13: Eating Disorders and Related Conditions
Eating Disorders of Adolescence (cont.)
 Prevalence
 among female adolescents, estimated prevalence
of anorexia is 0.3%, and bulimia is 1%
 both AN and BN are much more common among
females
 Eating Disorders- Not Otherwise Specified
(EDNOS) is a category of eating disorders that
covers problems that do not quite fulfill criteria for
AN or BN; prevalence may be much higher than
AN and BN
Abnormal Child Psychology, 3rd Edition, Eric J. Mash, David A. Wolfe
Chapter 13: Eating Disorders and Related Conditions
Eating Disorders of Adolescence (cont.)
 Young men that are affected with eating disorders
place more emphasis on athletic appearance or
attractiveness than on thinness
 Among American minorities, it was found that
Hispanics had equal, Blacks and Asians lower, and
Native American women higher rates of eating
disorders compared to Caucasians
Abnormal Child Psychology, 3rd Edition, Eric J. Mash, David A. Wolfe
Chapter 13: Eating Disorders and Related Conditions
Eating Disorders of Adolescence (cont.)
 Development
 onset of anorexia usually between ages 14 and
18, and is sometimes linked to stressful life
events; fewer than 1/2 show full recovery; many
fluctuate between recovery and relapse
 onset of bulimia usually late adolescence to early
adulthood; binge eating often develops after a
period of restrictive dieting; may follow a chronic
course or occur intermittently; between 50%-75%
show full recovery
 although disordered eating tends to decline in
early adulthood, body dissatisfaction remains an
issue for many young adults
Abnormal Child Psychology, 3rd Edition, Eric J. Mash, David A. Wolfe
Chapter 13: Eating Disorders and Related Conditions
Eating Disorders of Adolescence (cont.)
 Causes
 Biological dimension
 neurobiological factors play only a minor role in
precipitating anorexia and bulimia, but likely
contribute to their maintenance because of
effects on appetite, mood, perception, and
energy regulation
 genetic contribution – inherit a biological
vulnerability that interacts with social and
psychological factors
 imbalances of serotonin may be implicated
 biochemical similarities found between people
with eating disorders and those with OCD
Abnormal Child Psychology, 3rd Edition, Eric J. Mash, David A. Wolfe
Chapter 13: Eating Disorders and Related Conditions
Eating Disorders of Adolescence (cont.)
 Causes (cont.)
 Social dimension
 belief in Western culture that self-worth,
happiness, and success are determined by
physical appearance
 sex-role identification and social conformity can
contribute to eating problems
 possible family influences include family
dysfunction, an overemphasis on weight and
dietary control, and child sexual abuse
Abnormal Child Psychology, 3rd Edition, Eric J. Mash, David A. Wolfe
Chapter 13: Eating Disorders and Related Conditions
Eating Disorders of Adolescence (cont.)
 Causes (cont.)
 Psychological dimension
 adolescents with anorexia show a triad of
personality features: avoidance of harm, low
novelty seeking, and reward dependence
 affect disturbance is often comorbid with
anorexia
 bulimia is associated with mood swings, poor
impulse control, obsessive-compulsive
behaviors, depression, anxiety, and substance
abuse
 almost 90% of persons with eating disorders
have other Axis I disorders, usually depression,
anxiety, or OCD
Abnormal Child Psychology, 3rd Edition, Eric J. Mash, David A. Wolfe
Chapter 13: Eating Disorders and Related Conditions
Eating Disorders of Adolescence (cont.)
 Treatment for anorexia and bulimia
 hospitalization in some cases
 antidepressants and SSRIs may be helpful for
bulimia, but not anorexia
 psychosocial interventions are proving to be
effective and are generally more effective than
medications alone
 Resolution of family problems may be crucial
 Anorexia is generally less responsive to treatment
than bulimia
Abnormal Child Psychology, 3rd Edition, Eric J. Mash, David A. Wolfe
Chapter 13: Eating Disorders and Related Conditions
Eating Disorders of Adolescence (cont.)
 Treatment (cont.)
 for anorexia, family-based interventions often
required to restore healthy communication
patterns, and cognitive-behavioral methods may
be used to modify rigid beliefs, self-esteem, and
self-control processes
 for bulimia, cognitive-behavioral therapies that
focus on attitudes, beliefs, and behaviors
supporting problematic eating are effective, as is
interpersonal therapy that addresses situational
and personal issues contributing to the
development and maintenance of the disorder