Eating Disorders Outline
AN = the pursuit of thinness; phobic response to the fear of eating. This results in a dramatic
restriction of food intake. Also referred to the “weight-gain phobia”.
What the eating behavior looks like.
Mood issues related to AN.
Appetite Issues.
Subtypes of AN: restricting subtype (limits food intake but does not engage in binge eating or
purging (e.g. self-inducted vomiting, or misuse of laxatives, diuretics, or enemas); and bingeeating/purging subtype.
BN = dyscontrol over eating.
normal-weight or overweight individuals who display
followed by compensatory behavior.
recurrent eating binges
Sense of loss of control
Feelings of shame, anxiety, depression
Self-damaging behavior
AN and BN – related to compulsive dieting? Polivy and Herman (1993).
Evidence for this?
Other Eating syndromes: EDNOS; binge eating disorder (BED).
The Restricter/Binger Distinction
History of AN and BN
Thomas Morton cases in 1689
Marce and simultaneous reports of Sir William Gull and Charles Lasegue (1860). Gull =
introduction of the term AN. Marce = “hypochondriacal delirium” and Lasegue = “hysteria”.
1970s BN is introduced.
“bulimos”
Epidemiology
Eating Disorders Outline
Prevalence of AN in Western school-aged females .5 to 1%. BN 1-2%. In subthreshold forms,
diagnosed using less-stringent criteria.
BN develops later than AN, during the transition to adulthood.
Rare in males – 1/10th as common in men as women.
Racial issues.
Incidence went from 0.35 to 4.06 per 100,000 Stereotypes
Comorbidity: affective, anxiety, substance-abuse, and personality disorders.
25-50% AN = concurrent major depression
50-75% will suffer depression sometime in their lifetime
Binge/purge syndromes = similar rates.
BN 41% of bulimics are clinically depressed.
Other reports talk about concurrent and lifetime rates of depression to be 20 and 38%,
respectively.
Garfield (1995) Major depression across restricter and binger/purger anorexics to be 30% for
restricters and 53% for bingers/purgers.
69% of BN were noted to show signs of comorbid seasonal affective disorder. 25% of those
with SAD also have ED, most often BN.
Why the overlap?
Anxiety Disorders: AN = 20% to 75%. In BN, 13-60%. The specific disorders include GAD,
social and simple phobias, agoraphobia, panic disorder, and esp. OCD.
The structure of the EDs resemble OCD
Lifetime prevalence of OCD in ED women – 15-70% in AN and 10=-30% in BN.
Substance-abuse disorders
10-55% of BN patients = abuse substances.
25-40% of female alcoholics show some form of ED
Why the overlap? Holderness et al (1994)
Eating Disorders Outline
Dissociative disorders
Personality Disorders
Retrospective studies looking at premorbid personality in ED sufferers = “soft” evidence
Rastam (1992)
Etiology: multidimensional
Sociocultural context
Gardner and Garfinkel (1980)
Lee, Ho, and Hsu (1993)
Biological Factors:
Genetics: (Strober et al, 1990).
Twin data:
Treasure and Holland (1995)
Temperamental Traits: Strober (1991)
Humphrey (1991)
Neurobiology:
1) Norepinephrine
2) Cholecystokinin (CCK)
3) Serotonin
Neuropsychology
Psychological and Developmental Factors:
Individual Psychological Features
Bruch (1973)
Crisp (1980)
Psychometric findings on ED
Problems with impulsivity
Eating Disorders Outline
Newton and colleagues (1993)
Body-Image Disturbances
Dietary Restraint
Polivy, Herman and others
Heatherton and Baumeister (1991
Family Factors:
Family Dynamics
Palazolli (1978
Family models of BN
Johnson (1991)
Humphrey (1991)
Sexual Trauma
An example of an integrative model