Eating Disorders

Intro

Defining Abnormal Behavior

Statistical infrequency

Violation of norms

Unexpectedness

Personal distress

Disability/dysfunction

EATING DISORDERS

ANOREXIA NERVOSA

BULIMIA NERVOSA

EATING DISORDERS

ANOREXIA NERVOSA (AN)

Restricting type

Binge-eating-purging type

EATING DISORDERS

BULIMIA NERVOSA (BN)

Purging type

Non-purging type

Eating Disorders - Anorexia Nervosa

Eating disorder characterized by self-starvation

· 85% or less of normal weight

(child fails to make expected weight gains)

· intense fear of gaining weight even though underweight

· distorted sense of their body shape / denies seriousness of current low body weight

Eating Disorders - Anorexia Nervosa

· In females, leads to loss of menstrual period for 3 successive months

o Amenorrhea

· Lifetime prevalence of anorexia nervosa is less than 1%

o 10 times more frequent in women than men

Eating Disorders - Anorexia Nervosa

Two types of anorexia nervosa:

· Restricting type

o Severely limiting amount of food consumed (i.e. dieting, fasting, or excessive exercise); no regular binge eating

· Binge-eating-purging type

o Binges (large amount of food consumed) following by purging (e.g. vomiting or use of laxatives, diuretics, & enemas)

Eating Disorders - Anorexia Nervosa

Both types of AN often accompanied by:

depressed mood,

social withdrawal,

irritability,

insomnia, and

diminished interest in sex

Anorexia Nervosa

Binge-Eating / Purging Type

Often accompanied by:

· May have impulse control problems

· Usually involves rituals related to food

Eating Disorders - Anorexia Nervosa

Physical Effects

Physical effects include

· Altered electrolyte levels (potassium & sodium) ð changes in nerve & muscle function

· Low blood pressure

· Slow heart rate

· Kidney & gastrointestinal problems

· Bone mass declines

· Skin dry & nails brittle

· Hair loss

· Death from life-threatening illness or suicide

Eating Disorders - Anorexia Nervosa

Prognosis

70%

recover within 7 years

Eating Disorders – Bulimia Nervosa

· A fear of gaining weight & methods to prevent it

· Episodes of rapid overeating (binges) followed by compensation for caloric intake

“Binge” =

Eating an excessive amount of food within two hours

Bulimia Nervosa

Subtypes

Purging type

· vomiting, laxatives, diuretics, enemas

Nonpurging type

· None of above but does fast or exercise excessively

Bulimia Nervosa

· Prevalence: 1-2% of female population. 10 times higher than for males

· Usually within normal weight. Can occur with obesity

· 70% recovery rate within 7 years

· Often accompanied by:

depressed mood,

anxiety,

substance abuse (esp. stimulants),

suicide,

illegal behavior (esp. stealing)

· Physical consequences of purging

i.e. electrolytes, irritation of stomach and intestines, loss of dental enamel, amenorrhea
Etiology of Eating Disorders

Biological theories/paradigm

· Genetic

o Anorexia & bulimia run in families

§ Twin studies show genetic contribution to anorexia & bulimia

§ No evidence from adoption studies

o Endogenous opioids may play role in bulimia

o Hypothalamus regulates hunger and may be dysfunctional

o Neurotransmitter serotonin may be deficient in bulimia

Etiology of Eating Disorders

Psychoanalytic

· Fixation in oral stage

· Reflects conflicts with parents due to undergratification or overgratification of food

Etiology of Eating Disorders

Humanistic/Existential

· Society’s pressure to be thin interferes with self-actualization

Behavioral & Cognitive-Behavioral

· Society’s reinforcement contingencies encourage/reward behavior

· Cognitive distortions of appearance

Elite Women Athletes & Eating Disorders

Sundgot-Borgen (1994)

Prevalence:

· Aesthetic sports (figure skating, gymnastics) 35%

· Weight dependant sports (judo, wrestling) 29%

· Endurance sports (cycling, swim, run) 20%

· Technical sports (golf, high jumping) 14%

· Ball game sports (volleyball, soccer) 12%

Elite Women Athletes & Eating Disorders con’d

Reasons athletes report for eating disorder:

· Prolong periods of dieting/weight fluctuation: 37%

· New coach 30%

· Injury/illness 23%

· Casual comments by others about weight 19%

· Leaving home/failure at school or work 10%

· Problem with relationship 10%

· Problem with family 7%

· Illness/injury to family member 7%

· Death of significant other 4%

· Sexual abuse 4%

Eating Disorders – Docudrama of Catherine

What type of eating disorder did Catherine exhibit?

AN

· Restricting type?

· Binge-eating-purging type?

BN

· Purging?

· Nonpurging?

Eating Disorders – Video

Catherine’s Assets

· Intelligent

· Social skills (history of being outgoing and having friends)

· Vocational skills (secretary and nanny)

· Spirituality (did not commit suicide prior to starving self to death)

Eating Disorders – Video

Catherine’s Maladaptive Behavior

· Food restriction

· Binging

· Purging

· Deception

· Rituals

· Body dysmorphia

· Cognitive disortions

· Social skills (regression; enmeshment)

· Depression

Eating Disorders - Video

Catherine’s Maladaptive Family

· Overprotection by mother

· Avoidance by mother

· Avoidance by both

· Aggressive

· Parental conflicts and trust issues

· Enabling by parents and sister

Eating Disorders – Video

Treatment

· Inpatient operant conditioning

· Tube feeding

· Hospitalized by commitment (‘sectioned’)

· Doctor indicates Catherine’s problems are a protest of parental conflicts

· Doctor indicates AN is Catherine’s reaction to "being disturbed" (TAUTOLOGY)

· Confrontation by doctor and mother

Eating Disorders – Video

Treatments that might have helped

· Empathy versus judgment by doctor

· Marriage counseling

· Family counseling

· Social skills training

· Self-control of emotions skills training

· Cognitive restructuring

· Relaxation training

· Stress management