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Eating Disorders. Anorexia Nervosa Bulimia Nervosa Binge Eating Disorder. Disorders of conflict. Between food and the effects of food Between parents and children But more as perceived by the patient About goals and competing images Health and beauty Self-perception About control.

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Eating Disorders

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    1. Eating Disorders Anorexia Nervosa Bulimia Nervosa Binge Eating Disorder

    2. Disorders of conflict • Between food and the effects of food • Between parents and children • But more as perceived by the patient • About goals and competing images • Health and beauty • Self-perception • About control

    3. Anorexia nervosa • Failure, apparently by choice, to maintain adequate weight (DSM-IV: “Refusal” • Guidelines: • 85% of Metropolitan Life tables or pediatric growth charts (DSM-IV) • Body Mass Index of 17.5 kg/m2 (mass in kg/ height in meters2) (Used in ICD-10) • Due to restricted eating (not just of high calorie foods), purging, and exercise

    4. More features of anorexia nervosa • “Intense fear of gaining weight or becoming fat” is not lessened by weight loss • Perceive body weight and size in distorted ways (cf. Body Dysmorphic Disorder) • Overall distortion in some • Others distort only certain parts, especially thighs, buttocks, and abdomen • Self-esteem is tied to perceived body weight and size

    5. And some more… • Weight loss is celebrated, while weight gain is mourned as evidence of personal failure. • Medical consequences of low weight are denied. • Fertile females with anorexia nervosa cease menstruating: amenorrhea

    6. Subtypes of anorexia nervosa • Restricting type • Dieting, fasting, exercise • Binge-eating/Purging type • Vomiting, laxatives, diuretics, enemas

    7. Associated features • Depression, due to starvation • Loss of sexual interest, as pituitary function diminishes • Less so in Binge-purge type • Obsessive-compulsive preoccupation with food • Health consequences of starvation and purging

    8. Statistics • 90% of cases are female • Prevalence: 0.5 - 1.0% of women under 40 • Higher in recent decades • Higher in United States, Canada, Australia, New Zealand, Japan, South Africa, and Europe • May appear in other cultures without distortion of body perception, with reason given as stomach pain or food taste.

    9. Non-Western Eating Disorders • Parry-Jones (1991) suggests that eating disorders are evolving, and that less severe, incipient forms occur in non-Western cultures • Srinivasan, Suresh, Vasantha Jayaram & Fernandez (1995) describe Eating Distress Syndrome, with 15% of 210 students affected.

    10. Bulimia Nervosa • Binge eating: Rated in comparison with others • A sense of loss of control while eating • Compensating actions: Vomiting, laxatives, diuretics, enemas, fasting, excessive exercise • At least twice/week for 3 months • Normal or higher weight • Also has purging and non-purging types

    11. Bulimia statistics • 30-50% have comorbid personality disorders, usually Borderline, Antisocial, Histrionic, or Narcissistic • 33% have substance-related disorders • >90% of cases are female • Prevalence: 1 - 3 % of females aged 13 - 30 • Symptoms start in adolescence • Course tends to be chronic and episodic

    12. Binge-eating Disorder (NOS) • Suggested for further research • Binge episodes without compensatory actions

    13. Etiology • Social influence • Models and ideals • The health craze • The meaning of fat • Self-control and dieting • Concurrent PTSD? Gleaves et. al (1998) found current PTSD symptoms in over half of 154 women hospitalized with an eating disorder

    14. Biological factors • Family history • Dieting and starvation • Opioid reinforcement • Low levels of serotonin and norepinephrine • SSRIs increase 5-HT activity, counter bulimia • 5-HT2A receptor polymorphism correlates with anorexia nervosa, and with OCD, but not with bulimia nervosa (Enoch, Kaye, et al., 1998). 5-HT2A receptors are thought to be involved in eating and anxiety • Perhaps 5-HT2A receptor levels are low in AN and OCD • But not eating lowers 5-HT levels, ending obsessions and feelings of anxiety.(Kaye, 1998)

    15. Familial factors • Models and attitudes • Family dynamics (Minuchin) • Enmeshment • Overprotectiveness • Rigidity • Lack of conflict resolution • BUT: Among patients with Anorexia Nervosa, degree of enmeshment varies greatly, conflict levels are low, and family functioning improves as the patient improves, contradicting Minuchin. In observational study, few family differences are found.

    16. Personality factors • Anorexia: Perfectionistic, shy and compliant, harm-avoiding, obsessional, related to OCD • Bulimia: Histrionic, labile, and outgoing, not related to OCD • Negative self-beliefs similar to depression (Cooper et al., 1998) • Both: Lack of interoceptive awareness • “I get confused about what emotion I’m feeling.” • “I don’t know what’s going on inside me.” • “I get confused as to whether or not I’m hungry.”

    17. Cognitive factors • Body dissatisfaction: Ideas that: • thinness is an ideal • fat is evil • Criticism about being overweight • Focus on health • Binging as a cognitively-mediated consequence of control failure • Cognitive Behavior Therapy is effective

    18. Elise Warriner, The Anger Within “This painting is about the inability to express emotions on the outside, and the wish to totally isolate the mind from the heart and stomach. I see anorexia as a silent anger. Whilst one looks completely numb on the outside, there is incredible turmoil inside, and the energy needed to keep the anger inside leads to physical exhaustion and isolation.” -1993