CHAPTER 16
CHAPTER OUTLINE
I.
II.
Eating disorders. Although nearly 42 percent of adolescent females and 25 percent of
adolescent males report dieting to control their weight, the population of the United
States is becoming heavier. Between 30 and 67 percent of normal-weight adolescent and
college females believe they are overweight; their male age-peers also showed
dissatisfaction with weight, wanting to be more muscular. Perceptions of ideal body
weight and shape differed for males and females. Anorexia nervosa is characterized by a
refusal to maintain a body weight above the minimum normal weight for one’s age and
height, an intense fear of becoming obese that does not diminish with weight loss, body
image distortion, and (in females) the absence of at least three consecutive menstrual
cycles otherwise expected to occur. Prevalence is estimated as ranging from 0.5 to 1
percent of the female population. The restricting type loses weight through dieting or
exercising; the binge-eating/purging type loses weight through self-induced vomiting,
laxatives, or diuretics. There are serious physical complications, such as cardiac
arrhythmias, low blood pressure, lethargy, and irreversible osteoporosis. As evidenced
by the Internet, many women believe it is their right to refuse treatment. Comorbid
disorders include obsessive-compulsive behaviors and certain personality
characteristics. Bulimia nervosa is characterized by recurrent episodes of binge eating
high caloric foods at least twice a week for three months, during which the person loses
control over eating. In the purging type, the individual regularly vomits or uses
laxatives, diuretics, or enemas; in the nonpurging type, excessive exercise or fasting are
used to compensate for binges. Prevalence rate is 1-2 percent of women in the Untied
States; few males exhibit the disorder. Physical complications include erosion of tooth
enamel, dehydration, swollen parotid glands, and lowered potassium, which can weaken
the heart and cause arrhythmia and cardiac arrest. Comorbid mood disorders are
common, as well as characteristics of borderline personality. Onset is generally later
than for anorexia (late adolescence or early adulthood), and follow-up studies tend to
find almost 70 percent remission. Binge-eating disorder, a diagnostic category
“provided for further study” in DSM-IV-TR, involves consumption of large amounts of
food over a short period of time, accompanying feeling of loss of control, and marked
distress over the binges; but it lacks the compensatory behaviors of bulimia (e.g.,
vomiting). Females are one and one-half times more likely than males to have the
disorder; prevalence rate estimates range from 0.7 to 4 percent. Comorbid features
include major depression, obsessive-compulsive personality disorder, and avoidant
personality disorder. Onset is typically in late adolescence or early adulthood; although
most individuals make a full recovery even without treatment, weight is likely to remain
high. DSM-IV-TR includes the category eating disorder not otherwise specified, for
those that do not meet all the criteria for anorexia or bulimia nervosa.
Etiology of eating disorders. The etiology of eating disorders is believed to be
determined by social, gender, psychological, familial, cultural, and biological factors. In
the Biological dimension genetic influences may contribute to eating disorders since
disordered eating appears to run in families, especially among female relatives. Strober
and colleagues (2000) examined the lifetime rates of full or partial anorexia nervosa and
bulimia nervosa among first-degree relatives of patients with these eating disorders. In
the psychological dimension individuals with eating disorders often display excess
concern regarding body image, fragile or low self-esteem, moderate levels of
depression, and feelings of helplessness; they appear to use food or weight control as a
means of handling stress or anxieties. In the social dimension interpersonal interaction
patterns with parents and peers have also been put forth as explanations for eating
disorders. In the sociocultural dimension by far, the greatest amount of research has
been directed to sociocultural factors in the etiology of eating disorders and the
influence of unrealistic standards of beauty that are derived from mass media portrayals.
In the United States and most Western cultures, physical appearance is a very important
attribute, especially for females. The average American woman is five feet four inches
tall and weighs 162 pounds, but teenage girls describe their ideal body as five feet seven
inches, weighing 110 pounds, and fitting into a size five dress.
III. Treatment of eating disorders. Prevention programs in schools are aimed at reducing
the incidence of eating disorders and disordered eating patterns. Initial treatment for
anorexia focuses on weight gain (by feeding tube, contingent reinforcement for weight
gain, or both). Cognitive-behavioral and family therapy sessions are common after
weight gain, but relapse and continued obsession with weight are common. Bulimia is
initially assessed for conditions that may have resulted from purging, including cardiac
and gastrointestinal problems. In bulimia nervosa, treatment goals include (1) reducing
or eliminating binge eating and purging; (2) treating any physical complications; (3)
motivating the client to participate in the restoration of healthy eating patterns ; (4)
providing psychoeducation regarding nutrition and eating; (5) identifying dysfunctional
thoughts, moods, and conflicts that are associated with eating; (6) providing
psychotherapy to deal with these issues; (7) obtaining family support and conduct
family therapy, if needed; and (8) preventing relapse The disorder is treated with
psychotherapy, cognitive-behavioral treatment, and antidepressant medications; the
combination of cognitive-behavioral therapy and medications appears to be best,
although even with these approaches, only about 50 percent of those with the disorder
recover fully. Treatments for anorexia and bulimia both involve interdisciplinary teams
that include physicians and psychotherapists. Treatments for binge-eating disorder are
similar to those for bulimia, including weight reduction strategies, although there are
fewer physical complications for BED.
IV. Obesity. Obesity is defined as a body mass index (BMI)—an estimate of body fat
calculated on the basis of a person’s height and weight—greater than 30. DSM-IV-TR
acknowledges eating disorders such as anorexia and bulimia as mental disorders with
serious adverse outcomes but does not recognize obesity despite its devastating medical
and psychological consequences.
V. Etiology of obesity. Obesity is a product of biological/genetic, psychological, social,
and sociocultural influences. In the biological dimension estimates regarding genetic
contributions to obesity generally are derived by determining the frequency of obesity
among family members and twins. Others have investigated specific genetic variations
among the obese. In the psychological dimension individuals who are obese report
negative mood states and poor self-esteem. These responses are likely affected by the
weight stigma that exists in society with the resultant harassment, teasing, and
discrimination in school, work, and hiring practices. In the social dimension family
environments have also been associated with overweight and obese children and
adolescents, including reports of teasing by family members about weight issues. In the
sociocultural dimension attitudes regarding food and weight normalcy are developed in
the home and community. Rates of obesity tend to be highest among ethnic minorities.
In many ethnic groups, there is less pressure to remain thin, and being overweight is not
a big concern unless it is extreme.
VI. Treatments for obesity. Treatments for obesity have included dieting, lifestyle
changes, medications, and surgery. In general, dieting in and of itself may produce
short-term weight loss but tends to be ineffective long-term; some individuals gain back
more weight than was lost. Mann and colleagues (2007) concluded that most would be
better off not dieting because of the stress on the body as a result of weight cycling.
VII. Implications. Eating disorders and obesity are a heterogeneous group of disorders.
Scientists are only recently focusing on how genetics influence neurochemistry. Most of
the research has been done with anorexia nervosa and obesity with a focus on
dopaminergic activity that affects both a lack of appetite and overeating. However , we
must be aware that, in some cases, the behavior of overeating or not eating may, in fact,
result in changes in the level of dopamine in certain areas of the brain. Also, some
individuals may have an eating disorder or problem even without evidence of biological
predisposition. Thus it is important to consider psychological, social, and sociocultural
dimensions that may also be involved