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Eating Disorders. Chapter 11. Eating Disorders. Although not historically true, current Western beauty standards equate thinness with health and beauty Thinness has become a national obsession There has been a rise in eating disorders in the past three decades

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Eating disorders

Eating Disorders

Chapter 11


Eating disorders1
Eating Disorders

  • Although not historically true, current Western beauty standards equate thinness with health and beauty

    • Thinness has become a national obsession

  • 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, Abnormal Psychology, 7e


Anorexia nervosa
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

    • Disturbed body perception

    • Amenorrhea

Comer, Abnormal Psychology, 7e


Anorexia nervosa1
Anorexia Nervosa

  • There are two main subtypes:

    • Restricting type

      • Lose weight by cutting out sweets and fattening snacks, 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

Comer, Abnormal Psychology, 7e


Anorexia nervosa2
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, Abnormal Psychology, 7e


Anorexia nervosa3
Anorexia Nervosa

  • The “typical” case:

    • A normal to slightly overweight female has been on a diet

    • Escalation toward 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, Abnormal Psychology, 7e


Anorexia nervosa the clinical picture
Anorexia Nervosa: The Clinical Picture

  • The key goal for people with anorexia nervosa is becoming thin

    • The driving motivation is fear:

      • Of becoming obese

      • Of giving in to the desire to eat

      • Of losing control of body shape and weight

Comer, Abnormal Psychology, 7e


Anorexia nervosa the clinical picture1
Anorexia Nervosa: The Clinical Picture

  • Despite their dietary restrictions, people with anorexia nervosa 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, Abnormal Psychology, 7e


Anorexia nervosa the clinical picture2
Anorexia Nervosa: The Clinical Picture

  • Persons with anorexia nervosa also think in distorted ways:

    • Usually have a low opinion of their body shape

    • Tend to overestimate their actual proportions

      • Adjustable lens assessment technique

    • 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, Abnormal Psychology, 7e


Anorexia nervosa the clinical picture3
Anorexia Nervosa: The Clinical Picture

  • People with anorexia nervosa 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, Abnormal Psychology, 7e


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 imbalances

Dry skin, brittle nails

Poor circulation

Lanugo

Anorexia Nervosa: Medical Problems

Comer, Abnormal Psychology, 7e


The vicious cycle of anorexia
The Vicious Cycle of Anorexia

  • Fear of obesity and distorted body image lead to…

Starvation

Preoccupation with food

Harder attempts at thinness

Increased anxiety & depression

Greater feelings of fear & loss of control

Medical problems

Comer, Abnormal Psychology, 7e


Bulimia nervosa
Bulimia Nervosa

  • Bulimia nervosa, also known as “binge-purge syndrome,” is characterized by binges:

    • Bouts of uncontrolled overeating during a limited period of time

      • Eat objectively more than most people would/could eat in a similar period

Comer, Abnormal Psychology, 7e


Bulimia nervosa1
Bulimia Nervosa

  • The disorder is also characterized by inappropriate 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 frantically

Comer, Abnormal Psychology, 7e


Bulimia nervosa2
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, Abnormal Psychology, 7e


Bulimia nervosa3
Bulimia Nervosa

  • Patients are generally of normal weight

    • Often experience marked weight fluctuations

    • Some may also qualify for a diagnosis of anorexia

  • “Binge-eating disorder” may be a related diagnosis

    • Symptoms include a pattern of binge eating with NO compensatory behaviors (such as vomiting)

    • This pattern is not yet listed in the DSM-IV-TR

Comer, Abnormal Psychology, 7e


Bulimia nervosa4
Bulimia Nervosa

  • Teens and young adults have frequently attempted binge-purge patterns as a means of weight loss, often after hearing accounts of bulimia nervosa from friends or the media

  • According to global studies, 50% of students report periodic binge-eating or self-induced vomiting

Comer, Abnormal Psychology, 7e


Bulimia nervosa binges
Bulimia Nervosa: Binges

  • For people with bulimia nervosa, the number of binges per week can range from 1 to 30

  • 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, Abnormal Psychology, 7e


Bulimia nervosa binges1
Bulimia Nervosa: Binges

  • Binges are usually preceded by feelings of great 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, Abnormal Psychology, 7e


Bulimia nervosa compensatory behaviors
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

      • Fails to prevent the absorption of half the calories consumed during a binge

      • Affects ability to feel satiated  greater hunger and bingeing

    • Laxatives and diuretics

      • Also almost completely fail to reduce the number of calories consumed

Comer, Abnormal Psychology, 7e


Bulimia nervosa compensatory behaviors1
Bulimia Nervosa: Compensatory Behaviors

  • Compensatory behaviors may temporarily relieve the negative feelings attached to binge eating

    • Over time, however, a cycle develops in which purging  bingeing  purging…

Comer, Abnormal Psychology, 7e


Bulimia nervosa5
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, Abnormal Psychology, 7e


Bulimia nervosa vs anorexia nervosa
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

    • Feelings of anxiety, depression, obsessiveness, perfectionism

    • Substance abuse

    • Distorted body perception

    • Disturbed attitudes toward eating

Comer, Abnormal Psychology, 7e


Bulimia nervosa vs anorexia nervosa1
Bulimia Nervosa vs. Anorexia Nervosa

  • Differences:

    • People with bulimia nervosa are more worried about pleasing others, being attractive to others, and having intimate relationships

    • People with bulimia nervosa tend to be more sexually experienced and active

    • People with bulimia nervosa are more likely to have histories of mood swings, low frustration tolerance, and poor coping

Comer, Abnormal Psychology, 7e


Bulimia nervosa vs anorexia nervosa2
Bulimia Nervosa vs. Anorexia Nervosa

  • Differences:

    • People with bulimia nervosa tend to be controlled by emotion – may change friendships easily

    • People with bulimia nervosa are more likely to display characteristics of a personality disorder

    • Different medical complications:

      • Only half of women with bulimia nervosa experience amenorrhea vs. almost all women with anorexia nervosa

      • People with bulimia nervosa suffer damage caused by purging, especially from vomiting and laxatives

Comer, Abnormal Psychology, 7e


What causes eating disorders
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:

      • Psychological problems (ego, cognitive, and mood disturbances)

      • Biological factors

      • Sociocultural conditions (societal and family pressures)

Comer, Abnormal Psychology, 7e


What causes eating disorders psychodynamic factors ego deficiencies
What Causes Eating Disorders? Psychodynamic Factors: Ego Deficiencies

  • Hilde Bruch developed a largely psychodynamic theory of eating disorders

  • 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, Abnormal Psychology, 7e


What causes eating disorders psychodynamic factors ego deficiencies1
What Causes Eating Disorders? Psychodynamic Factors: Ego Deficiencies

  • 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.

  • There is some empirical support for Bruch’s theory from clinical reports

Comer, Abnormal Psychology, 7e


What causes eating disorders cognitive factors
What Causes Eating Disorders? Cognitive Factors

  • Bruch’s theory also contains several cognitive factors

    • According to cognitive theorists, such deficiencies contribute to a broad cognitive distortion that is at the center of disordered eating (e.g., disproportionate concerns about body shape and weight)

Comer, Abnormal Psychology, 7e


What causes eating disorders mood disorders
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, Abnormal Psychology, 7e


What causes eating disorders mood disorders1
What Causes Eating Disorders? Mood Disorders

  • There is empirical support for the claim that mood disorders set the stage for eating disorders:

    • Many more people with an eating disorder qualify for a clinical 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 serotonin abnormalities

    • Symptoms of eating disorders are helped by antidepressant medications

Comer, Abnormal Psychology, 7e


What causes eating disorders biological factors
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 up to 6 times more likely to develop the disorder themselves

      • Identical (MZ) twins with anorexia: 70%

      • Fraternal (DZ) twins with anorexia: 20%

      • Identical (MZ) twins with bulimia: 23%

      • Fraternal (DZ) twins with bulimia: 9%

    • These findings may be related to low serotonin

Comer, Abnormal Psychology, 7e


What causes eating disorders biological factors1
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, Abnormal Psychology, 7e


What causes eating disorders biological factors2
What Causes Eating Disorders? Biological Factors

  • Some theorists believe that the LH and VMH are responsible for weight set point – a “weight thermostat” of sorts

    • Set by genetic inheritance and early eating practices, this mechanism is responsible for keeping an individual at a particular weight level

      • If weight falls below set point:  hunger,  metabolic rate  binges

      • If weight rises above set point:  hunger,  metabolic rate

    • Dieters end up in a battle against themselves to lose weight

Comer, Abnormal Psychology, 7e


What causes eating disorders societal pressures
What Causes Eating Disorders? Societal Pressures

  • Many theorists believe that current Western standards of female attractiveness are partly responsible for the emergence 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, Abnormal Psychology, 7e


What causes eating disorders societal pressures1
What Causes Eating Disorders? Societal Pressures

  • Members of certain subcultures 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 appear to have an eating disorder

Comer, Abnormal Psychology, 7e


What causes eating disorders societal pressures2
What Causes Eating Disorders? Societal Pressures

  • Societal attitudes may explain economic and racial differences seen in prevalence rates

    • Historically, women of higher SES expressed more concern about thinness and dieting

      • These women had higher rates of eating disorders than women of the lower socioeconomic classes

    • Recently, dieting and preoccupation with food, along with rates of eating disorders, are increasing in all groups

Comer, Abnormal Psychology, 7e


What causes eating disorders societal pressures3
What Causes Eating Disorders? Societal Pressures

  • The socially accepted prejudice against overweight people may also add to the “fear” and preoccupation about weight

    • About 50% of elementary and 61% of middle school girls are currently dieting

Comer, Abnormal Psychology, 7e


What causes eating disorders family environment
What Causes Eating Disorders? Family Environment

  • Families may play an important role in the development of eating disorders

    • 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, Abnormal Psychology, 7e


What causes eating disorders family environment1
What Causes Eating Disorders? Family Environment

  • Abnormal interactions and forms of communication within a family may also set the stage for an eating disorder

    • Influential family theorist Salvador Minuchin cites “enmeshed family patterns” as causal factors of eating disorders

      • These patterns include overinvolvement in, and overconcern about, family member’s lives

Comer, Abnormal Psychology, 7e


What causes eating disorders multicultural factors racial and ethnic differences
What Causes Eating Disorders? Multicultural Factors: Racial and Ethnic Differences

  • A widely publicized 1995 study found that eating behaviors and attitudes of young African American women were more positive than those of young white American women

    • Specifically, nearly 90% of the white American respondents were dissatisfied with their weight and body shape, compared to around 70% of the African American teens

Comer, Abnormal Psychology, 7e


What causes eating disorders multicultural factors racial and ethnic differences1
What Causes Eating Disorders? Multicultural Factors: Racial and Ethnic Differences

  • Unfortunately, research conducted over the past decade suggests that body image concerns, dysfunctional eating patterns, and eating disorders are on the rise among young African American women as well as among women of other minority groups

    • The shift appears to be partly related to acculturation

Comer, Abnormal Psychology, 7e


What causes eating disorders multicultural factors racial and ethnic differences2
What Causes Eating Disorders? Multicultural Factors: Racial and Ethnic Differences

  • Eating disorders among Hispanic American female adolescents are about equal to those of white American women

  • Eating disorders also appear to be on the increase among Asian American women and young women in several Asian countries

Comer, Abnormal Psychology, 7e


What causes eating disorders multicultural factors gender differences
What Causes Eating Disorders? Multicultural Factors: Gender Differences

  • Males account for only 5% to 10% of all cases of eating disorders

  • The reasons for this striking difference are not entirely clear, but Western society’s double standard is, at the very least, one reason

  • A second reason may be the different methods of weight loss favored:

    • Men are more likely to exercise

    • Women more often diet

Comer, Abnormal Psychology, 7e


What causes eating disorders multicultural factors gender differences1
What Causes Eating Disorders? Multicultural Factors: Gender Differences

  • For other men, body image appears to be a key factor

    • A new kind of eating disorder has emerged and is found almost exclusively among men – reverse anorexia nervosa or muscle dysmorphobia

Comer, Abnormal Psychology, 7e


What causes eating disorders multicultural factors gender differences2
What Causes Eating Disorders? Multicultural Factors: Gender Differences

  • It seems that some men develop eating disorders as linked to the requirements and pressures of a job or sport

    • The highest rates of male eating disorders have been found among:

      • Jockeys

      • Wrestlers

      • Distance runners

      • Body builders

      • Swimmers

Comer, Abnormal Psychology, 7e


How are eating disorders treated
How Are Eating Disorders Treated?

  • 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

Comer, Abnormal Psychology, 7e


Treatments for anorexia nervosa
Treatments for Anorexia Nervosa

  • The initial aims of treatment for anorexia nervosa are to:

    • Regain lost weight

    • Recover from malnourishment

    • Eat normally again

Comer, Abnormal Psychology, 7e


Treatments for anorexia nervosa1
Treatments for Anorexia Nervosa

  • In the past, treatment took place in a hospital setting; it is now often offered in an outpatient setting

  • 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

    • In contrast, behavioral weight-restoration approaches have clinicians use rewards whenever patients eat properly or gain weight

Comer, Abnormal Psychology, 7e


Treatments for anorexia nervosa2
Treatments for Anorexia Nervosa

  • The most popular weight-restoration technique has been the combination of supportive nursing care, nutritional counseling, and high-calorie diets

    • Necessary weight gain is often achieved in 8 to 12 weeks

  • Researchers have found that people with anorexia nervosa must overcome their underlying psychological problems to achieve lasting improvement

Comer, Abnormal Psychology, 7e


Treatments for anorexia nervosa3
Treatments for Anorexia Nervosa

  • Therapists use a combination of therapy and education to achieve this broader goal, using a combination of individual, group, and family approaches; psychotropic drugs have been helpful in some cases

Comer, Abnormal Psychology, 7e


Treatments for anorexia nervosa4
Treatments for Anorexia Nervosa

  • In most treatment programs, a combination of behavioral and cognitive interventions are applied

    • On the behavioral side, clients are required to monitor feelings, hunger levels, and food intake and the ties among those variables

    • On the cognitive sides, they are taught to identify their “core pathology”

    • Such approaches can take place in either individual or group therapy formats

Comer, Abnormal Psychology, 7e


Treatments for anorexia nervosa5
Treatments for Anorexia Nervosa

  • Therapists help patients recognize their need for independence and control

  • Therapists help patients recognize and trust their internal feelings

  • Another focus of treatment is correcting disturbed cognitions, especially client misperceptions and attitudes about eating and weight

    • Using cognitive approaches, therapists correct disturbed cognitions and educate about body distortions

Comer, Abnormal Psychology, 7e


Treatments for anorexia nervosa6
Treatments for Anorexia Nervosa

  • Another focus of treatment is changing family interactions

    • Family therapy is important for anorexia nervosa treatment

    • The main issues are often separation and boundaries

Comer, Abnormal Psychology, 7e


Treatments for anorexia nervosa7
Treatments for Anorexia Nervosa

  • The use of combined treatment approaches has greatly improved the outlook for people with anorexia nervosa

    • But even with combined treatment, recovery is difficult

  • The course and outcome of the disorder vary from person to person

Comer, Abnormal Psychology, 7e


Treatments for anorexia nervosa8
Treatments for Anorexia Nervosa

  • Positives of treatment:

    • Weight gain is often quickly restored

      • 83% of patients still showed improvements after several years

    • Menstruation often returns with return to normal weight

    • The death rate from anorexia nervosa is declining

Comer, Abnormal Psychology, 7e


Treatments for anorexia nervosa9
Treatments for Anorexia Nervosa

  • Negatives of treatment:

    • Close to 20% of patients remain troubled for years

    • Even when it occurs, recovery is not always permanent

      • Anorexic behavior recurs in at least one-third of recovered patients, usually triggered by new stresses

      • Many patients still express concerns about their weight and appearance

    • Lingering emotional problems are common

Comer, Abnormal Psychology, 7e


Treatments for bulimia nervosa
Treatments for Bulimia Nervosa

  • Treatment is frequently offered in specialized eating disorder clinics

  • The immediate 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

Comer, Abnormal Psychology, 7e


Treatments for bulimia nervosa1
Treatments for Bulimia Nervosa

  • Cognitive-behavioral therapy is particularly helpful:

    • Behavioral techniques

      • Diaries are often a useful component of treatment

      • Exposure and response prevention (ERP) is used to break the binge-purge cycle

Comer, Abnormal Psychology, 7e


Treatments for bulimia nervosa2
Treatments for Bulimia Nervosa

  • Cognitive-behavioral therapy is particularly helpful:

    • Cognitive techniques

      • Help clients recognize and change their maladaptive attitudes toward food, eating, weight, and shape

      • Typically teach individuals to identify and challenge the negative thoughts that precede the urge to binge

Comer, Abnormal Psychology, 7e


Treatments for bulimia nervosa3
Treatments for Bulimia Nervosa

  • Cognitive-behavioral therapy is particularly helpful:

    • Other forms of psychotherapy

      • If clients do not respond to cognitive-behavioral therapy, other approaches may be tried

      • A common alternative is interpersonal therapy (IPT); a treatment that seeks to improve interpersonal functioning may be tried

      • Psychodynamic therapy has also been used

Comer, Abnormal Psychology, 7e


Treatments for bulimia nervosa4
Treatments for Bulimia Nervosa

  • Cognitive-behavioral therapy is particularly helpful:

    • Other forms of psychotherapy

      • Various forms of psychotherapy are often supplemented by family therapy and may be offered in either individual or group therapy format

        • Group therapy provides an opportunity for patients to express their thoughts, concerns, and experiences with one another

        • Group therapy is helpful in as many as 75% of cases, especially when combined with individual insight therapy

Comer, Abnormal Psychology, 7e


Treatments for bulimia nervosa5
Treatments for Bulimia Nervosa

  • Antidepressant medications

    • During the past decade, all groups of antidepressant drugs have been used in bulimia nervosa treatment

      • Drugs help as many as 40% of patients

    • Medications are best when used in combination with other forms of therapy

Comer, Abnormal Psychology, 7e


Treatments for bulimia nervosa6
Treatments for Bulimia Nervosa

  • Left untreated, bulimia nervosa can last for years

  • Treatment provides immediate, significant improvement in about 40% of cases

    • An additional 40% show moderate response

  • Follow-up studies suggest that 10 years after treatment about 90% of patients have fully or partially recovered

Comer, Abnormal Psychology, 7e


Treatments for bulimia nervosa7
Treatments for Bulimia Nervosa

  • Relapse can be a significant problem, even among those who respond successfully to treatment

    • Relapses are usually triggered by stress

    • Relapses are more likely among persons who:

      • Had a longer history of symptoms

      • Vomited frequently

      • Had histories of substance use

      • Have lingering interpersonal problems

Comer, Abnormal Psychology, 7e