Abnormal Psych 3 31 20 PDF

Preview

Summary

Abnormal Psych Lecture Notes Eban Walters...

Description

Chapter 8: Eating Disorders ● Two major types of DSM-5 eating disorders ○ Anorexia nervosa and bulimia nervosa ○ Severe disruptions in eating behavior ○ Weight and shape have disproportionate influence on self-concept ■ Extreme fear and apprehension about gaining weight ○ Strong sociocultural origins - Westernized views ■ Emphasis on thinness ● Binge eating - hallmark of bulimia nervosa and binge eating disorder ○ Eating excess amounts of food in a discrete period of time ■ Until uncomfortable or painfully full ○ Must be accompanied by a sense of lack of control ■ In the moment or general pattern of uncontrolled eating ○ May be associated with guilt, shame, or regret ○ May hide behavior from family members ○ Foods consumed are often high in sugar, fat, or carbohydrates ○ Compensatory behaviors - designed to “make up for binge eating” ■ Most common - Purging ● Most common: self-induced vomiting ● May also include use of diuretics or laxatives ■ Excessive exercise ● Exercising for longer than is healthy ■ Fasting or food restriction ● Bulimia Nervosa: Associated Features ○ Medical ■ Most within 10% of normal body weight ■ Purging methods can result in severe medical problems ● Erosion of dental enamel, electrolyte imbalance ● Kidney failure, cardiac arrhythmia, seizures intestinal problems, permanent colon damage ○ Psychological ■ Most are overly concerned with body shape ■ Fear of gaining weight ■ Most have comorbid psychological disorders ● Anxiety, depression, OCD ● Bulimia ○ 90%+ female ○ Onset typically in adolescence ○ Lifetime prevalence is about 1.1% for females, 0.1% for males ○ 6-7% of college women suffer from bulimia at some point ○ Tends to be chronic if left untreated ● Anorexia Nervosa: ○ Extreme weight loss - hallmark of anorexia ■ Restriction of calorie intake below energy requirements

■ ■

May also involve binging and purging Defined as 15% below expected weight ● Now also classified in terms of BMI ■ Intense fear of weight gain and losing control over eating ■ People suffering from anorexia show a relentless pursuit of thinness ■ Often begins with dieting ○ Associated features ■ Most show marked disturbance in body image ■ Most are comorbid with other psychological disorders ■ Anorexia nervosa is one of the most deadly mental disorders ● Starving body borrows energy from internal organs leading to organ damage ● Most serious consequence is cardiac damage, which can lead to heart attack and death ● High suicide rate in individuals with anorexia ● Lanugo ○ 68-year old woman pictured above requested medical attention for a sudden increase in hair growth that she had noticed 11 months earlier. She had lost more than 30 kg during this same time. Physical examination revealed fine lanugo hair all over their face and a deeply furrowed tongue, which caused a burning sensation. A diagnosis of acquired hypertrichosis lanuginosa was made ● Muscle wasting (losing muscle) ● Majority are female and white ● From middle to upper-middle class families ○ Luxury to obsess over appearance ○ If you live somewhere food is hard to come by, you aren’t going to turn it down ● Usually develops around early adolescence ● More chronic and resistant htan bulimia ● Lifetime prevalence approximately 1% ● Cross cultural factors ○ Develop in non-western women after moving to western countries ○ Introduction of TV in Fiji ● Males are not immune to Eating DIsorders Biggest diff. Is people with anorexia are more successful at losing weight than bulimia Someone with bulimia has more of a shame and hiding aspect to it People with anorexia take pride in the ability to lose the weight and keep it off ● Binge Eating Disorders ○ New disorder in DSM-5 ○ Binge eating without associated compensatory behaviors ○ Lack of control ○ 3 or more of the following: ■ 1.) Eating much more rapidly than normal ■ 2.)Eating until uncomfortably full ■ 3.) Eating large amounts when not hungry

●

●

●

● ● ●

■ 4.) Eating alone b/c of embarrassment by how much one eats ■ 5.) Feeling disgusted with oneself, depressed or very guilty afterward ○ Associated with distress and/or functional impairment (ex: health risk, feelings of guilt) ○ Associated features of binge-eating disorder ■ Many persons with binge-eating disorder are obese ■ Some, but not all, have concerns about shape and weight ■ Often older than bulimics and anorexics ■ More psychopathology versus non-binge obese people ● Ex: binge to alleviate bad moods or negative affect Causes of bulimia and anorexia ○ Media and cultural considerations ■ Media portrayals: thinness linked to success, happiness ■ Cultural emphasis on dieting ■ Standards of ideal body size ● Change as much as fashion ● Difficult or impossible to achieve ○ Biological considerations ■ Partial genetic component ■ Deficits in serotonin associated w/ bingeing and impulsivity ■ Evolution Psychological and behavioral considerations ○ Low sense of personal control and self-confidence ○ Perfectionistic attitudes ■ Boitano thought his ability to ignore his body’s demands for fuel elevated him above his opponents who surrendered to their appetites. “When i was hungry it made me feel strong” ○ Distorted body image; intense preoccupation with how they appear to others ■ Jeremy Abbott, 32, a two time olympian who retired last year, strives for a healthy lifestyle, but said that even now, in all honesty, my body image is probably very low. I’m not in bad physical condition, I have the concept of that. But i still kind of look in the mirror and nitpick everything ○ Mood intolerance; anxiety ○ Imposed standards (ex: sports) Causes of bulimia and anorexia cont’d ○ Preoccupation with food ○ Dietary restraint ○ Family influences ■ Overbearing family and driven: Type A family → can be associated with anorexia and bulimia Study asking heterosexual men to say where on the scale they think is the ideal female appearance Then asked women to rate guys in terms of what body type they are most attracted to Discrepancy goes both ways

○

Men think that women want them to bigger and more muscular than women actually do ○ Women think that men want them to be smaller than they actually prefer ● Treatment (bulimia) ○ Psychosocial treatments ■ CBT ● Treatment of choice ● Basic components: psychoeducation, identifying maladaptive thinking patterns and behavioral habits, then gradual practice of new habits ■ Medical and drug treatments ● Antidepressants ○ Can help reduce binging and purging behavior ○ Usually not efficacious in the long-term Treatment of Binge Eating Disorder ● Previously used medications for obesity are now not recommended ● Psychological treatment ○ CBT ■ Similar to that used for bulimia ■ Appears efficacious ○ Interpersonal psychotherapy ■ Equally as effective as CVT ○ Self help techniques (guided CBT) ■ Also appear effective can be delivered out of Primary Care Physician's office ● Treatment of Anorexia ○ General goals and strategies ■ Weight restoration ● First and easiest goal to achieve ● Inpatient treatment may be necessary ■ Psychoeducation ■ Behavioral and cognitive interventions ● Target food, weight, body image, thought and emotion ■ Treatment often involves the family ■ Long-term prognosis for anorexia is poorer than bulimia ○ Preventing eating disorders...