Psychopathology
Psychopathology: Foundations for a Contemporary Understanding
Summary Chapter 12 Eating Disorders
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🥗 Overview
Eating disorders are serious mental health conditions characterized by disturbances in
eating behaviors and related thoughts and emotions. The main categories are Anorexia
Nervosa, Bulimia Nervosa, Binge-Eating Disorder, Avoidant/Restrictive Food
Intake Disorder (ARFID), and Other Specified or Unspecified Feeding or Eating
Disorders (OSFED/UFED).
Although long thought to affect mainly affluent White women, they occur across all
genders, races, ages, and socioeconomic groups.
⚖️ Diagnostic Criteria & Core Features
Anorexia Nervosa
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Core features: Severe restriction of food intake → significantly low body weight;
intense fear of gaining weight; distorted body image.
Two subtypes:
o Restricting type: weight loss mainly via dieting, fasting, or exercise.
o Binge-eating/purging type: includes recurrent bingeing/purging (vomiting,
laxatives).
Severity: Based on BMI and clinical judgment.
ICD-11 vs DSM-5-TR: ICD includes categories for “significantly low” and
“dangerously low” weight and allows diagnosis even if weight is not currently low
but there has been rapid loss.
Bulimia Nervosa
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Core features:
o Recurrent binge-eating episodes (loss of control while eating unusually
large amounts).
o Recurrent compensatory behaviors (vomiting, laxatives, fasting,
excessive exercise).
o Occurs ≥ once per week for 3 months.
o Self-worth overly influenced by weight and shape.
Severity: Based on frequency of compensatory behaviors.
ICD-11: Focuses more on loss of control than the amount eaten; recognizes both
objective and subjective binge episodes.
Psychopathology
Psychopathology: Foundations for a Contemporary Understanding
Summary Chapter 12 Eating Disorders
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Binge-Eating Disorder (BED)
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Recurrent binge episodes without compensatory behaviors.
Requires ≥3 of the following: eating rapidly, until uncomfortably full, when not
hungry, alone (embarrassment), or with feelings of guilt/disgust.
Distress about bingeing is required.
Individuals often have above-average weight, but obesity ≠ BED.
Frequency: ≥1 episode/week for 3 months.
ICD-11: Similar criteria; emphasizes loss of control and distress rather than food
quantity.
Avoidant/Restrictive Food Intake Disorder (ARFID)
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Restriction of food intake due to sensory sensitivity, fear of choking/vomiting, or
lack of interest in eating.
Leads to weight loss, nutritional deficiencies, or psychosocial impairment.
Not due to body image concerns.
OSFED / UFED
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OSFED: Clinically significant symptoms that don’t meet criteria for other eating
disorders (e.g., atypical anorexia, purging disorder, subthreshold bulimia/BED).
UFED: Used when symptoms don’t fit existing categories and reasons are
unspecified.
📊 Course, Incidence, and Prevalence
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Onset typically in adolescence or young adulthood, but possible at any age.
Lifetime prevalence (U.S. data):
o Anorexia nervosa: 1.42% women, 0.12% men
o Bulimia nervosa: 0.46% women, 0.08% men
o Binge-eating disorder: 1.25% women, 0.42% men
Global findings: Eating disorders are not culture-bound; they occur worldwide.
Recent trends: Increased cases during the COVID-19 pandemic, particularly
among adolescent girls.
Diagnostic crossover (e.g., from AN → BN) occurs but is less common than
once believed.
Psychopathology
Psychopathology: Foundations for a Contemporary Understanding
Summary Chapter 12 Eating Disorders
� Comorbidity
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90% of individuals with eating disorders have at least one comorbid disorder.
Common comorbidities: mood disorders, anxiety, PTSD, substance use,
borderline personality disorder, and conduct disorder.
Disorders involving emotion dysregulation and impulsivity (e.g., borderline
PD) are especially prevalent in those with binge/purge symptoms
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⚠️ Risk and Maintenance Factors
Sociocultural & Environmental Factors
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Thin ideal internalization → body dissatisfaction → dieting → eating disorder
(Stice’s dual-pathway model).
Media exposure increases body dissatisfaction, but alone doesn’t cause eating
disorders—it interacts with other vulnerabilities.
Gender:
o Women 3–12× more likely to have eating disorders, particularly those
emphasizing thinness.
o Men may exhibit muscle dysmorphia, mirroring anorexia’s cognitive
distortions.
o Transgender and gender-diverse individuals have elevated risk linked
to body dysphoria and gender expression.
Race/Ethnicity: Similar rates of bulimia and binge-eating across racial groups;
treatment access lower for people of color.
Family: No evidence for specific “causal” parenting styles; family can often be a
key support system.
Trauma: High rates of childhood abuse, neglect, or assault; trauma may
contribute through emotional dysregulation and avoidance.
Individual & Biological Factors
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Heritability:
o Anorexia nervosa: 48–74%
o Bulimia nervosa: 28–83%
o Binge-eating disorder: ~45%
Neurobiology: Serotonin and dopamine system disturbances may contribute,
though findings are inconclusive.
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Psychopathology
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Psychopathology: Foundations for a Contemporary Understanding
Summary Chapter 12 Eating Disorders
 Puberty: Genetic influence on eating disorder risk increases during mid-to-late
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puberty (especially in girls).
Personality traits: Perfectionism, negative emotionality, impulsivity, harm
avoidance, and poor interoceptive awareness increase vulnerability.
Maintenance Factors
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Transdiagnostic Cognitive Behavioral Model (Fairburn et al., 2003):
o Central feature: Overvaluation of weight and shape.
o Leads to dieting/restriction → bingeing → compensatory behaviors →
further reinforcement of body image preoccupation.
o Maintained by low self-esteem, perfectionism, interpersonal difficulties,
and poor emotion regulation.
💬 Prevention
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Primary prevention: School and community programs promoting body
acceptance, media literacy, and self-esteem (e.g., The Body Project).
Secondary prevention: Early detection and intervention in subclinical cases.
Protective factors: Family connectedness, self-compassion, and positive body
image.
💊 Treatment
Approach
Psychotherapy
Pharmacotherapy
Nutritional Rehabilitation
Details
• Cognitive-Behavioral Therapy (CBT-E): Evidencebased, targets overvaluation of weight and shape.
• Family-Based Therapy (FBT): Particularly effective
for adolescents with anorexia.
• Dialectical Behavior Therapy (DBT) and
Acceptance & Commitment Therapy (ACT): Support
emotion regulation and acceptance.
• SSRIs (e.g., fluoxetine) reduce bingeing/purging in
bulimia.
• Limited evidence for medication efficacy in anorexia;
used mainly for comorbidities.
Focus on restoring healthy eating patterns and
normalizing weight.
Psychopathology
Psychopathology: Foundations for a Contemporary Understanding
Summary Chapter 12 Eating Disorders
Approach
Hospitalization/Intensive
Programs
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Details
For severe cases (e.g., BMI <15, medical instability).
🔮 Prognosis
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Recovery is possible but variable:
o Anorexia nervosa: 50–70% partial or full recovery; highest mortality
among psychiatric disorders (5–10%).
o Bulimia nervosa: 45–65% full recovery.
o Binge-eating disorder: generally favorable outcomes with treatment.
Better outcomes linked to early intervention, family involvement, and integrated
medical + psychological treatment.
� Key Takeaways
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Eating disorders are multifactorial biopsychosocial conditions—no single
cause.
Sociocultural pressures, genetic vulnerability, and emotional dysregulation
interact dynamically.
The transdiagnostic model provides a unified framework for understanding and
treating these disorders.
Equity in diagnosis and treatment across gender and racial lines remains a
critical need
Psychopathology
Psychopathology: Foundations for a Contemporary Understanding
Summary Chapter 12 Eating Disorders
🍽️ Eating Disorders Study Sheet
Overview
Core Concept
Description
Persistent disturbances in eating behavior and related thoughts/emotions causing
Definition
significant impairment.
Anorexia Nervosa (AN), Bulimia Nervosa (BN), Binge-Eating Disorder (BED),
Main Diagnoses
ARFID, OSFED/UFED
Common
Distorted body image, weight/shape overvaluation, disordered eating patterns,
Features
emotional dysregulation.
Population
Occurs across all genders, ages, and ethnicities (not culture-bound).
1️⃣ Anorexia Nervosa (AN)
Feature
Core
symptoms
Subtypes
Onset
Prevalence
Medical risks
Treatment
Medication
Description
Restriction → significantly low body weight; fear of gaining weight; distorted body
image.
Restricting type / Binge–Purging type.
Typically adolescence.
~1.4% women, 0.1% men.
Organ failure, electrolyte imbalance, bradycardia, bone loss; highest psychiatric
mortality (5–10%).
Family-Based Therapy (FBT) for adolescents; CBT-E, nutritional rehab;
hospitalization for severe cases.
Limited benefit—SSRIs for comorbid anxiety/depression only.
2️⃣ Bulimia Nervosa (BN)
Feature
Core
symptoms
Frequency
Body image
Prevalence
Comorbidity
Treatment
Prognosis
Description
Recurrent binge eating + compensatory behaviors (vomiting, laxatives, fasting,
exercise).
≥1/week for 3 months.
Self-worth tied to shape/weight.
~0.5% women, 0.1% men.
Depression, anxiety, substance use, borderline PD.
CBT-E (targets binge–purge cycle); DBT for emotion regulation; SSRIs (fluoxetine).
45–65% full recovery.
3️⃣ Binge-Eating Disorder (BED)
Feature
Core
symptoms
Description
Binge eating without compensatory behaviors; distress about bingeing.
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Psychopathology
Psychopathology: Foundations for a Contemporary Understanding
Summary Chapter 12 Eating Disorders
Feature
Criteria
Prevalence
Body weight
Treatment
Prognosis
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Description
≥1/week for 3 months; ≥3 features: rapid eating, uncomfortably full, not hungry, eating
alone, guilt/disgust.
~1.25% women, 0.42% men.
Often above-average, but obesity ≠ BED.
CBT, DBT, ACT; possible SSRIs or lisdexamfetamine; group therapy effective.
Generally good with treatment.
4️⃣ ARFID (Avoidant/Restrictive Food Intake Disorder)
Feature
Core
symptoms
Impairments
Treatment
Distinctive
Description
Restriction due to sensory sensitivity, fear of choking/vomiting, or lack of interest (no
body image concerns).
Weight loss, nutritional deficiency, psychosocial dysfunction.
Exposure-based therapy, CBT-AR, nutritional and family support.
Not driven by body image or weight concerns.
5️⃣ OSFED / UFED
Feature
Description
Definition Clinically significant eating disturbance not meeting full criteria for other disorders.
Atypical anorexia (normal weight but restrictive behaviors), purging disorder, subthreshold
Examples
BN or BED.
Treatment Similar to most fitting “parent” disorder (CBT-E or FBT).
⚠️ Risk & Maintenance Factors
| Biological | High heritability (AN: 48–74%, BN: up to 83%); neurotransmitter and hormonal
dysregulation. |
| Psychological | Perfectionism, low self-esteem, emotion dysregulation, poor interoceptive awareness. |
| Sociocultural | Thin/muscular ideals, media exposure, peer/family pressure, trauma. |
| Maintenance | Fairburn’s transdiagnostic CBT model: overvaluation of shape/weight → restriction →
binge/purge → self-criticism → reinforcement cycle. |
💬 Prevention & Prognosis
| Prevention | Body image programs (e.g., Body Project), self-compassion training, early intervention. |
| Prognosis | Early treatment → best outcomes. AN = most severe; BED = best prognosis. Full recovery
possible across disorders. |