Chapter 11
Eating Disorders

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
Slide 2

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
Slide 3

Anorexia Nervosa

There are two main subtypes:
•
Restricting type
• Lose weight by restricting “bad” foods, eventually restricting nearly all food
•
Show almost no variability in diet
• Binge-eating/purging type
•
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
Slide 4

Anorexia Nervosa

About 90–95% of cases occur in females

The peak age of onset is between 14 and 18 years

Around 0.5% 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
Slide 5

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
Slide 6

Anorexia Nervosa: The Clinical Picture

The key goal for people with anorexia nervosa is thinness
•
The driving motivation is FEAR:
•
Of becoming obese
• Of losing control of body shape and weight
Slide 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
Slide 8

Anorexia Nervosa: The Clinical Picture

People with anorexia nervosa also demonstrate distorted thinking:
• Often have a low opinion of their body shape
•
Tend to overestimate their actual proportions
• Adjustable lens assessment technique – overestimate size by 20%
•
Hold maladaptive attitudes and beliefs
• “I must be perfect in every way”
• “I will be a better person if I deprive myself”
• “I can avoid guilt by not eating”
Slide 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
Slide 10

Anorexia Nervosa: Medical Problems

Caused by starvation:
•
Amenorrhea
• Low body temperature
•
Low blood pressure
• Body swelling
•
Reduced bone density
• Slow heart rate
•
Metabolic and electrolyte imbalance
• Dry skin, brittle nails
•
Poor circulation
• Lanugo
Slide 11

Bulimia Nervosa
 Bulimia nervosa, also known as “binge-purge syndrome,” is characterized by binges:
•
Bouts of uncontrolled overeating during a limited period of time
•
Often objectively more than most people would/could eat in a similar period
Slide 12

Bulimia Nervosa

The disorder is also characterized by compensatory behaviors, which mark the subtype of the condition:
• Purging-type bulimia nervosa
•
Vomiting
•
Misusing laxatives, diuretics, or enemas
• Nonpurging-type bulimia nervosa
• Fasting
•
Exercising excessively
Slide 13

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
Slide 14

Bulimia Nervosa

Patients are generally of normal weight
•
May be slightly overweight
•
Often experience weight fluctuations
 “Binge-eating disorder” may be a related diagnosis
•
Symptoms include a pattern of binge eating with
NO compensatory behaviors (such as vomiting)
• This condition is not yet listed in the DSM
Slide 15

Bulimia Nervosa

Teens and young adults have frequently attempted binge-purge patterns as a means of weight loss, often after hearing accounts of bulimia from friends or the media

In one study:
•
50% of college students reported periodic binges
•
6% tried vomiting
• 8% experimented with laxatives at least once
Slide 16

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 1500 calories
(often more than 3000 calories) per binge episode
Slide 17

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”
Slide 18

Bulimia Nervosa:
Compensatory Behaviors

After a binge, people with bulimia nervosa try to compensate for and “undo” the caloric effects

The most common compensatory behaviors:
•
Vomiting
• Affects ability to feel satiated
 greater hunger and bingeing
•
Laxatives and diuretics
• Almost completely fail to reduce the number of calories consumed
Slide 19

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
Slide 20

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
Slide 21


Differences:
Bulimia Nervosa vs.
Anorexia Nervosa
•
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
Slide 22


Differences:
Bulimia Nervosa vs.
Anorexia Nervosa
•
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
Slide 23

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
Slide 24

What Causes Eating Disorders?
Societal Pressures

Many theorists argue 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
Slide 25

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
Slide 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
Slide 27


Eating disorder treatments have two main goals:
•
Correct abnormal eating patterns
•
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
Slide 28

Treatments for Anorexia Nervosa

The initial aims of treatment for anorexia nervosa are to:
•
Restore proper weight
•
Recover from malnourishment
• Restore proper eating
Slide 29

Treatments for Bulimia Nervosa

Treatment programs are relatively new but have risen in popularity

Treatment is frequently offered in specialized eating disorder clinics
Slide 30

Treatments for Bulimia Nervosa

The initial aims of treatment for bulimia nervosa are to:
•
Eliminate binge-purge patterns
•
Establish good eating habits
• Eliminate the underlying cause of bulimic patterns

Programs emphasize education as much as therapy
Slide 31