Eating Disorders and the Psychology of Adolescence - PBL-J-2015

Eating Disorders and the Psychology of Adolescence
• The major developmental tasks of Adolescence are:
 Achieving independence from parents and other adults
 Development of a realistic, stable, positive self identity
 Formation of a sexual identity
 Negotiating peer and intimate relationships
 Development of a realistic body image
 Formulation of their own moral/value system
 Acquisition of skills for future economic independence
Eating Disorders
• There are a number of biological, psychological, social and cultural factors which influence appetite
Lesions to lateral areas of hypothalamus lead to anorexia while ventromedial lesions to
hypothalamus lead to overeating
Imbalance of certain neurotransmitters, in particular serotonin, which are responsible for
appetite regulation
Increase in digestive hormone leptin causes satiation whilst decrease stimulates feeding
Increase in digestive hormone ghrelin stimulates feeding whilst decrease causes satiation
Exercise can suppress appetite
Delusional perception of body image
Anxiety (including social anxiety)
Obsessive tendencies (especially obsessive need for control)
Past experience of traumatic event (emotional, physical or sexual abuse)
Social and Cultural
 High-pressures of increasingly materialistic world in Western culture – where ideal = thin
(Studies show lower rates of eating disorders in non-Western countries)
 Certain activities/occupations emphasise body image (anorexia nervosa 4-25x higher in ballet
 Role-conflicts and complex pressures of socialisation may lead to eating disorders
 Family issues – parent or sibling that has eating disorder, feeling of insecurity in family
environment can all lead to increase in eating disorders
• There are two main types of eating disorders: Anorexia nervosa and Bulimia nervosa
1. Anorexia nervosa
• Is characterised by self-induced weight loss through various means due to a marked distortion of
body image
• Most commonly seen in young women and its incidence is approximately 0.5%
• It has a significant mortality rate: 10-15% (2/3 physical complications, 1/3 suicide)
• It has various aetiological features and the main ones include:
 Genetic factors – some studies suggest genetic predisposition and some even indicated
hereditability factor. Studies show people with family history of anorexia are 12 x more likely
to develop it
 Biological factors – hypothalamic dysfunction, neurotransmitter imbalances
 Psychological factors – disturbed body image, diminished sense of control, low self-esteem
 Adverse life events – physical or sexual abuse
Clinical features
Physical – significant weight loss, thinning or loss of hair, amenorrhoea (young women), insomnia,
Behavioural – unusual eating habits, excessive exercise, social withdrawal
Psychological – depression, perfectionism, unwarranted belief of being fat or intense fear of
becoming fat
Diagnostic Criteria – DSM IV for Anorexia nervosa
A. Refusal to maintain body weight at or above a minimally normal weight for age and height
(body weight less than 85% of what is expected)
B. Intense fear of gaining weight or becoming fat, even though underweight
C. Disturbance in the way in which one’s body weight or shape is experienced, undue influence
of body weight or shape on self-evaluation, or denial of the seriousness of the current low
body weight.
D. In postmenarcheal females, amenorrhea, i.e. the absence of at least three or more
consecutive menstrual cycles. (A woman is considered to have amenorrhea if her periods
occur only following hormone, e.g. oestrogen, administration).
Specific subtypes
 Restricting Type: during current episode of Anorexia nervosa, person has not regularly
engaged in binge-eating or purging behaviour
 Binge-eating/Purging type: during current episode of Anorexia nervosa, person has regularly
engaged in binge-eating or purging behaviour
• Coercive/threatening approach is counterproductive. It requires supportive combined approach of:
 Pharmacological – selective serotonin reuptake inhibitors such as Fluoxetine (especially if
there are clear obsessional ideas regarding food)
 Psychological – involvement of family in treatment, individual behavioural therapy, use of
psychologists and psychiatrists
 Education – nutritional education (dietary advice, use of food diary)
• Hospital admission should only be considered if there are serious medical problems
2. Bulimia nervosa
• Is characterised by recurrent binge eating and purging, accompanied with delusional perception of
body shape and weight
• Most commonly seen in young women and its incidence is approximately 2%
• Often history of Anorexia nervosa (30-50%) of people who have Bulimia nervosa
• It has similar aetiology to Anorexia Nervosa
• It has similar clinical features except in physical characteristics patient can present with normal
weight. Also get fluctuation of weight due to bingeing and purging, and swollen salivary glands
• It has similar treatment method as Anorexia nervosa
Final thought
• There are certain behavioural characteristics or personality traits which contribute to the
development of eating disorders. They include:
 Obsessive-compulsive type behaviours
 Depression
 Anxiety
 Perfectionists
 Low self-esteem/poor sense of identity