Slides & Handouts by Karen Clay Rhines, Ph.D.
Seton Hall University
Chapter 11
Eating Disorders
Comer, Fundamentals of
Abnormal Psychology, 3e
1
Changing attitudes
Comer, Fundamentals of
Abnormal Psychology, 3e
2
Eating Disorders
• Although not historically true, current
Western beauty standards equate
thinness with health and beauty
• There has been a rise in eating disorders
in the past three decades
– The core issue is a morbid fear of weight gain
• Two main diagnoses:
– Anorexia nervosa
– Bulimia nervosa
Comer, Fundamentals of
Abnormal Psychology, 3e
3
Anorexia Nervosa
• The main symptoms of anorexia nervosa
are:
– A refusal to maintain more than 85% of
normal body weight
– Intense fears of becoming overweight
– A distorted view of body weight and shape
– Amenorrhea
Comer, Fundamentals of
Abnormal Psychology, 3e
4
Anorexia Nervosa
• There are two main subtypes:
– Restricting type anorexia
• Lose weight by restricting “bad” foods, eventually restricting
nearly all food
• Show almost no variability in diet
– Binge-eating/purging type anorexia
• Lose weight by vomiting after meals, abusing laxatives or
diuretics, or engaging in excessive exercise
• Like those with bulimia nervosa, people with this subtype
may engage in eating binges
Comer, Fundamentals of
Abnormal Psychology, 3e
5
Anorexia Nervosa
• About 90%–95% of cases occur in
females
• The peak age of onset is between 14 and
18 years
• Between 0.5% and 2% of females in
Western countries develop the disorder
– Many more display some symptoms
• Rates of anorexia nervosa are increasing
in North America, Japan, and Europe
Comer, Fundamentals of
Abnormal Psychology, 3e
6
Anorexia Nervosa
• The “typical” case:
– A normal to slightly overweight female has been on a
diet
– Escalation to anorexia nervosa may follow a stressful
event
• Separation of parents
• Move or life transition
• Experience of personal failure
– Most patients recover
• However, about 2% to 6% become seriously ill and die as a
result of medical complications or suicide
Comer, Fundamentals of
Abnormal Psychology, 3e
7
Anorexia Nervosa: The Clinical
Picture
• Despite their dietary restrictions, people
with anorexia are extremely preoccupied
with food
– This includes thinking and reading about food
and planning for meals
– This relationship is not necessarily causal
• It may be the result of food deprivation, as
evidenced by the famous 1940s “starvation study”
with conscientious objectors
Comer, Fundamentals of
Abnormal Psychology, 3e
8
Anorexia Nervosa: The Clinical
Picture
• People with anorexia nervosa also think in
distorted ways:
– Often have a low opinion of their body shape
– Tend to overestimate their actual proportions
– Hold maladaptive attitudes and misperceptions
• “I must be perfect in every way”
• “I will be a better person if I deprive myself”
• “I can avoid guilt by not eating”
Comer, Fundamentals of
Abnormal Psychology, 3e
9
Anorexia Nervosa: The Clinical
Picture
• People with anorexia may also display certain
psychological problems:
–
–
–
–
–
–
–
Depression (usually mild)
Anxiety
Low self-esteem
Insomnia or other sleep disturbances
Substance abuse
Obsessive-compulsive patterns
Perfectionism
Comer, Fundamentals of
Abnormal Psychology, 3e
10
Bulimia Nervosa
• Bulimia nervosa, also known as “bingepurge syndrome,” is characterized by
binges
– Bouts of uncontrolled overeating during a
limited period of time
• Eats objectively more than most people
would/could eat in a similar period
Comer, Fundamentals of
Abnormal Psychology, 3e
11
Bulimia Nervosa
• The disorder is also characterized by
compensatory behaviors:
– Purging-type bulimia nervosa
• Vomiting
• Misusing laxatives, diuretics, or enemas
– Nonpurging-type bulimia nervosa
• Fasting
• Exercising excessively
Comer, Fundamentals of
Abnormal Psychology, 3e
12
Bulimia Nervosa
• Like anorexia nervosa, about 90%–95% of
bulimia nervosa cases occur in females
• The peak age of onset is between 15 and
21 years
• Symptoms may last for several years with
periodic letup
Comer, Fundamentals of
Abnormal Psychology, 3e
13
Bulimia Nervosa
• Patients are generally of normal weight
– Often experience weight fluctuations
– Some may also qualify for a diagnosis of
anorexia
• Binge-eating disorder:
– Symptoms include a pattern of binge eating
with NO compensatory behaviors (such as
vomiting)
– This condition is not yet listed in the DSM-IVTR
Comer, Fundamentals of
Abnormal Psychology, 3e
14
Bulimia Nervosa:
Binges
• For people with bulimia nervosa, the number of
binges per week can range from 2 to 40
– Average: 10 per week
• Binges are often carried out in secret
– Binges involve eating massive amounts of food
rapidly with little chewing
• Usually sweet foods with soft texture
– Binge-eaters commonly consume more than 1000
calories (often more than 3000 calories) per binge
episode
Comer, Fundamentals of
Abnormal Psychology, 3e
15
Bulimia Nervosa:
Binges
• Binges are usually preceded by feelings of
tension and/or powerlessness
• Although the binge itself may be
pleasurable, it is usually followed by
feelings of extreme self-blame, guilt,
depression, and fears of weight gain and
“discovery”
Comer, Fundamentals of
Abnormal Psychology, 3e
16
Bulimia Nervosa
• The “typical” case:
– A normal to slightly overweight female has
been on an intense diet
– Research suggests that even among normal
subjects, bingeing often occurs after strict
dieting
• For example, a study of binge-eating behavior in a
low-calorie weight loss program found that 62% of
patients reported binge-eating episodes during
treatment
Comer, Fundamentals of
Abnormal Psychology, 3e
17
Bulimia Nervosa vs.
Anorexia Nervosa
• Similarities:
–
–
–
–
–
–
–
–
Onset after a period of dieting
Fear of becoming obese
Drive to become thin
Preoccupation with food, weight, appearance
Elevated risk of self-harm or attempts at suicide
Feelings of anxiety, depression, perfectionism
Substance abuse
Disturbed attitudes toward eating
Comer, Fundamentals of
Abnormal Psychology, 3e
18
Bulimia Nervosa vs.
Anorexia Nervosa
• Differences:
– People with bulimia are more worried about pleasing
others, being attractive to others, and having intimate
relationships
– People with bulimia tend to be more sexually
experienced
– People with bulimia display fewer of the obsessive
qualities that drive restricting-type anorexia
– People with bulimia are more likely to have histories
of mood swings, low frustration tolerance, and poor
coping
Comer, Fundamentals of
Abnormal Psychology, 3e
19
Bulimia Nervosa vs.
Anorexia Nervosa
• Differences:
– People with bulimia tend to be controlled by emotion
– may change friendships easily
– People with bulimia are more likely to display
characteristics of a personality disorder
– Different medical complications:
• Only half of women with bulimia experience amenorrhea vs.
almost all women with anorexia
• People with bulimia suffer damage caused by purging,
especially from vomiting and laxatives
Comer, Fundamentals of
Abnormal Psychology, 3e
20
What Causes Eating Disorders?
• Most theorists subscribe to a multidimensional
risk perspective:
– Several key factors place individuals at risk
– More factors = greater risk
– Leading factors:
• Sociocultural conditions (societal and family pressures)
• Psychological problems (ego, cognitive, and mood
disturbances)
• Biological factors
Comer, Fundamentals of
Abnormal Psychology, 3e
21
What Causes Eating Disorders?
Societal Pressures
• Many theorists believe that current
Western standards of female
attractiveness have contributed to the rise
of eating disorders
– Standards have changed throughout history
toward a thinner ideal
• Miss America contestants have declined in weight
by 0.28 lbs/yr; winners have declined by 0.37 lbs/yr
• Playboy centerfolds have lower average weight,
bust, and hip measurements than in the past
Comer, Fundamentals of
Abnormal Psychology, 3e
22
What Causes Eating Disorders?
Societal Pressures
• Certain groups are at greater risk from
these pressures:
– Models, actors, dancers, and certain athletes
• Of college athletes surveyed, 9% met full criteria
for an eating disorder while another 50% had
symptoms
• 20% of surveyed gymnasts met full criteria for an
eating disorder
Comer, Fundamentals of
Abnormal Psychology, 3e
23
What Causes Eating Disorders?
Societal Pressures
• Societal attitudes may explain economic and
racial differences seen in prevalence rates
– In the past, Caucasian women of higher SES
expressed more concern about thinness and dieting
• These women had higher rates of eating disorders than
African American women or Caucasian women of lower SES
– Recently, dieting and preoccupation with food, along
with rates of eating disorders, are increasing in all
groups
Comer, Fundamentals of
Abnormal Psychology, 3e
24
What Causes Eating Disorders?
Family Environment
– As many as half of the families of those with
eating disorders have a long history of
emphasizing thinness, appearance, and
dieting
– Mothers of those with eating disorders are
more likely to be dieters and perfectionistic
themselves
Comer, Fundamentals of
Abnormal Psychology, 3e
25
What Causes Eating Disorders?
Family Environment
–Minuchin cites “enmeshed family
patterns” as causal factors of eating
disorders
• These patterns include
overinvolvement in, and
overconcern about, family
member’s lives
Comer, Fundamentals of
Abnormal Psychology, 3e
26
What Causes Eating Disorders?
Ego Deficiencies and Cognitive
Disturbances
• Bruch argues that eating disorders are the
result of disturbed mother–child
interactions which lead to serious ego
deficiencies in the child and to severe
cognitive disturbances
Comer, Fundamentals of
Abnormal Psychology, 3e
27
What Causes Eating Disorders?
Ego Deficiencies and Cognitive
Disturbances
• Bruch argues that parents may respond to their
children either effectively or ineffectively
– Effective parents accurately attend to a
child’s biological and emotional needs
– Ineffective parents fail to attend to
child’s internal needs; they feed when
the child is anxious, comfort when the
child is tired, etc.
Comer, Fundamentals of
Abnormal Psychology, 3e
28
What Causes Eating Disorders?
Mood Disorders
• Many people with eating disorders,
particularly those with bulimia nervosa,
experience symptoms of depression
– Theorists believe mood disorders may “set
the stage” for eating disorders
Comer, Fundamentals of
Abnormal Psychology, 3e
29
What Causes Eating Disorders?
Mood Disorders
– More people with an eating disorder qualify for a
diagnosis of major depressive disorder than do
people in the general population
– Close relatives of those with eating disorders seem to
have higher rates of mood disorders
– People with eating disorders, especially those with
bulimia nervosa, have low levels of serotonin
– Symptoms of eating disorders are helped by
antidepressant medications
Comer, Fundamentals of
Abnormal Psychology, 3e
30
What Causes Eating Disorders?
Biological Factors
• Biological theorists suspect certain genes
may leave some people particularly
susceptible to eating disorders
– Consistent with this model:
• Relatives of people with eating disorders are 6
times more likely to develop the disorder
themselves
• Identical (MZ) twins with bulimia: 23%
• Fraternal (DZ) twins with bulimia: 9%
– These findings may be related to low
serotonin
Comer, Fundamentals of
Abnormal Psychology, 3e
31
What Causes Eating Disorders?
Biological Factors
• Other theorists believe that eating
disorders may be related to dysfunction of
the hypothalamus
– Researchers have identified two separate
areas that control eating:
• Lateral hypothalamus (LH)
• Ventromedial hypothalamus (VMH)
Comer, Fundamentals of
Abnormal Psychology, 3e
32
What Causes Eating Disorders?
Biological Factors
• Set point: genetic inheritance and early
eating practices determine our particular
weight level
• If weight falls below set point:  hunger, 
metabolism  binges
• If weight rises above set point:  hunger, 
metabolism
Comer, Fundamentals of
Abnormal Psychology, 3e
33
Treatments for Eating Disorders
• Eating disorder treatment goals:
– 1. Correct abnormal eating patterns
– 2. Address broader psychological and
situational factors that have led to and are
maintaining the eating problem
• This often requires the participation of family and
friends
Comer, Fundamentals of
Abnormal Psychology, 3e
34
Treatments for Anorexia
Nervosa
• The initial aims of treatment for anorexia
nervosa are to:
– Restore proper weight
– Recover from malnourishment
– Restore proper eating
Comer, Fundamentals of
Abnormal Psychology, 3e
35
Treatments for Anorexia
Nervosa
• In life-threatening cases, clinicians may need to
force tube and intravenous feedings on the
patient
– This may breed distrust in the patient and create a
power struggle
• Most common technique now is the use of
supportive nursing care and high-calorie diets
– Necessary weight gain is often achieved in 8 to 12
weeks
Comer, Fundamentals of
Abnormal Psychology, 3e
36
Treatments for Bulimia Nervosa
• Several treatment strategies:
– Individual insight therapy
• The insight approach receiving the most attention
is cognitive therapy, which helps clients recognize
and change their maladaptive attitudes toward
food, eating, weight, and shape
– As many as 65% stop their binge-purge cycle
Comer, Fundamentals of
Abnormal Psychology, 3e
37
Treatments for Bulimia Nervosa
• Several treatment strategies:
– Behavioral therapy
• Exposure and response prevention is used to
break the binge-purge cycle
Comer, Fundamentals of
Abnormal Psychology, 3e
38