Feeding and Eating Disorders PDF

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Book Notes over Feeding and Eating Disorders that Viken uses on exams...

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Feeding and Eating Disorders o Three feeding disorders: pica, rumination disorder, and avoidant/restrictive food intake disorder: typically begin in infancy or childhood o A fourth binge-eating disorder=a new diagnosis closely connected to the controversial question of whether obesity is a mental disorder.  Obesity is not a mental disorder (DSM-5) o Anorexia Nervosa  Extreme emaciation  “anorexia” literally means “loss of appetite”  ARE HUNGRY but not eating  Has the HIGHEST mortality rate of all mental disorders o Bulimia Nervosa  Characterized by repeated episodes of binge eating, followed by inappropriate compensatory behaviors  i.e. vomiting, misuse of laxatives, excessive exercise  Weight is typically normal to overweight in range  Bulimia means “ox appetite” but have average appetite  “hungry enough to eat an ox”  Kind of like a yo-yo with their weight  Most view binging as a failure to control  10 times more common among women in teens and early twenties  Increased incidence in young people reflects the focus on physical appearance and the difficulties that teen girls have adjusting to body changes with puberty  First time used 1979  60% of high school females were attempting to lose weight compared to half the percentage of males  Half of American women have a negative view of their body  European American and Latina women report higher rates of body dissatisfaction than African Americans. o Eating Disorders in Males  Adolescent boys often want to be bigger and stronger  Women rate themselves as being thin only when below 90% their expected body weight  Men see themselves as thin when they weigh as much as 105% below their expected weight  Men are equally divided between those who want to lose weight and those who want to lose weight  ADONIS COMPLEX: characterized by excessive emphasis on extreme muscularity and often accompanied by the abuse of anabolic steroids.  Men are less likely to seek treatment  Feel “unmanly” because of stigmas about men o Symptoms of Anorexia

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Significantly Low Weight  Often begins with a diet gone awry  Weight falls below normal and may plummet dangerously  DSM-5 doesn’t have a cutoff of what’s too thin but BMI under 18.5 is a useful indicator in adults  25-30% below normal body weight  Most are not treated until weight becomes life threatening  5% die of starvation, suicide, or medical complications from weight loss Fear of Gaining Weight  Presents problems for treatment  The fear of gaining weight isn’t solved by weight loss o It could make the fear grow Disturbance in Experiencing Weight or Shape  Usually don’t recognize their emaciation for what it is  Most deny their problems with their weight  Distorted body image: in inaccurate perception of body size and shape Amenorrhea  Cessation of menstruation  A reaction to the loss of body fat and associated physiological changes Medical Complications  Constipation, abdominal pain, intolerance to cold, and lethargy  Stem from the effects of semistarvation on blood pressure and body temperature, both of which fall below normal.  Skin can become dry and cracked  Lanugo: a fine, downy hair, on their face or trunk of their body  Anemia, infertility, impaired kidney function, cardiovascular problems, and osteoporosis.  Dangerous medication complication is an electrolyte imbalance, a disturbance in the levels of potassium, sodium, calcium, and other vital elements found in body fluids. o Can lead to cardiac arrest or kidney failure Struggle for control  Act impulsively but strive to be in control  Obsessively regulating dietary intake may make them feel in charge of one area of their lives. Comorbid Psychological Disorders  Associated with OCD and obsessive-compulsive personality disorder  Obsessed with food and diet  Obsessive-compulsive behavior may also be a reaction to starvation

Also show symptoms of depression o Sad mood, irritability, insomnia, social withdrawal, and diminished interest in sex  Often co-occurs with symptoms of bulimia o Symptoms of Bulimia  Binge eating  Consuming an amount of food that is clearly larger than most people would eat under similar circumstances in a fixed period of time o i.e. less than two hours  Inappropriate Compensatory Behavior  Most people engage in purging  Most common form is purging  May include misuse of laxatives, diuretics, and rarely enemas  Only limited effectiveness in reducing caloric intake  Vomiting prevents the absorption of about half the calories consumed during a binge o Other compensatory behaviors have few lasting effects  Laxatives, diuretics, and enemas  Also includes extreme exercise or rigid fasting  DSM-5 states that these behaviors have to occur once a week for at least three months  Excessive Emphasis on Weight and Shape  Self-esteem and daily routines can focus around weight and diet  Some are exhilarated by positive comments or interest in their appearance o Self-esteem can drop if negative comments are made or someone else draws attention  Other disorders may co-occur with bulimia nervosa o Anxiety disorders, personality disorders (specifically borderline personality disorders), and substance abuse (specifically alcohol or stimulants) o Depression is most common and most significant  Medical Complications  Repeated vomiting can erode dental enamel o Front teeth is most common o Severe cases: teeth can become chipped or ragged looking  Enlarged salivary glands o Face appears puffy  Damage to colon o From laxative abuse o Diagnosis of Feeding and Eating Disorders  Pica: eating of nonnutritive substances 

 Paper or dirt  Common in children with intellectual abilities  Rumination disorder: repeated regurgitation of food  Sometimes rechewing  Occurs in infants  Sometimes in the context of neglect and/or intellectual abilities  Avoidant/Restrictive food intake disorder: characterized by an apparent lack of interest in food  Occurs in infants  Binge eating disorder: episodes of binge eating without compensatory behavior  New diagnosis in DSM-5  Obesity: BMI greater than 30  Controversial because of link with obesity  Diagnosis of Anorexia Nervosa  Restricting type: people who have not engaged in binge eating or purging in the past three months  Binge eating/purging: defined by binge eating and purging  Diagnosis of Bulimia Nervosa  DSM-5 criteria chart o Frequency of Anorexia and Bulimia  Annual incidence of anorexia nervosa rose from one case per million people in 1930-1940 to 54 cases per million people in 1995-1996.  Anorexia is far more common particularly young women  DSM-5 indicates that 12-month prevalence of anorexia is 0.4% among females  Disorder is 10 times more common among women than men  Cohort: group that shares some features among individuals in the group  i.e. year of birth  Cohort effects: differences that distinguish one cohort from another  The lifetime prevalence for bulimia nervosa was far greater among women born after 1960 than those before 1950.  Bulimia nervosa has a lifetime prevalence of 1.5% among U.S women  Binge-eating and occasional binge eating are even more common  3.5% lifetime prevalence  4.9% among women  2.0% and 4.0% among men  About 50% of all people with anorexia nervosa engage in episodes of binge eating and purging  Standards of Beauty and the Culture of Thinness  Pop. Culture in the U.S transmit the idea that “looks are everything” and thinness is essential to good looks  Men are considered to be larger and more muscular than it is for women

 Men are more likely to have a negative body image  Age of Onset  Both typically begin in adolescence or early adulthood  For adolescent’s onset may because of autonomy struggles or various sexual problems  An alternative explanation is the natural and normal changes in adolescent body shape and weight o Weight gain is normal, but addition of a few pounds can trouble a young woman o Breast and hip development also affect self-image, social interaction, and the fit of familiar clothes  Early pubertal timing is a risk factor for anorexia o Supporting the importance of self-evaluation and social comparison as a girl’s shape develops normally in early adolescence  Men become MORE concerned with their weight as they age. o Causes of Anorexia and Bulimia  Social Factors  Culture of thinness and the premium placed on young women’s appearance contribute to causing eating disorders.  Eating disorders are far more common among young women than young men  The prevalence of eating disorders has risen as the image of the ideal woman has increasingly emphasized extreme thinness  Eating disorders are even more common among young women working in fields that emphasize weight and appearance o i.e. modeling, ballet dancing, and gymnastics  Young women are particularly likely to develop eating disorders during adolescence and young adult life  Eating disturbances are more common among young women who report greater exposure to popular media, endorse more genderrole stereotypes, or internalize societal standards about appearance.  Eating disorders have been more common among white vs. African American women o Whites are more likely to equate thinness with beauty  Psychological Factors  A struggle for perfection and control o Perfectionism is associated with disordered eating and can be a part of excessive compliance with parental goals o Set unrealistically high standards, are self-critical, and demand a nearly flawless performance from themselves

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o Interoceptive awareness: recognition of internal cues, including hunger and various emotional states  Depression, Low-esteem, and Dysphoria o Antidepressant medications reduce some symptoms of bulimia nervosa  Suggesting that bulimia is a reaction to depression o Depression may be a reaction to an eating disorder o Depression improves following successful group psychotherapy for bulimia o Social self: how they present themselves in public and how other people perceive and evaluate them o Women with bulimia nervosa or a negative body image report more public self-consciousness, social anxiety, and perceived fraudulence o Dysphoria or negative mood states commonly trigger episodes of binge eating  May be brought on by social criticism or conflict, dissatisfaction with eating and diet, or an ongoing depressive episode o Negative body image  Highly critical evaluation of one’s weight and shape  Dietary restraint o Direct consequences over overly restrictive eating o Adolescent girls who try to lose weight by fasting for 24 hours or more engage in more binge eating and develop bulimia more often five years later o Weight suppression: defined as highest adult weight minus current  Predicts the maintenance and onset of bulimia 10 years later o An overly restrictive diet increases hunger, frustration, and lack of attention to internal cues, all of which make binge eating more likely o Dietary restraint also may directly cause some of the symptoms of anorexia nervosa Biological Factors  Weight set points: fixed weights or small ranges of weight o Weight regulation around set points results from the interplay between behavior, peripheral physiological activity, and central physiological activity o Think of it like a thermostat

Slowing of the metabolic rate, the rate at which the body expends energy, and movement toward hyperlipogenesis, the storage of abnormally large amounts of fat in fat cells throughout the body  The body does not distinguish between intentional attempts to lose weight and potential starvation  Genetic factors also contribute to eating disorders o Early twin study of bulimia nervosa found a concordance rate of 23% for MZ twins and 9% for DZ twins o Higher MZ than DZ concordance rates for anorexia nervosa and for dysfunctional eating attitudes have also been reported  Eating disorders are unlikely to be directly inherited o Genes may influence personality characteristics  i.e. anxiety o Or certain body type may be inherited o Genetics contribute to BMI  Inheriting a thin body type may increase risk for anorexia  Genes influence eating pathology AFTER puberty but not before  Genetic influences are also stronger among women who engage in dietary restraint  Eating disorders (in rare cases) have been linked with a specific biological abnormality, such as a hormonal disturbance or a lesion in the hypothalamus o The area of the brain that regulates routine biological functions o Treatments for Anorexia and Bulimia  Approaches to treating anorexia  Goal 1: Help the patient gain at least a minimal amount of weight o If weight loss is severe, the patient may be treated in an impatient setting o Hospitalized patients may receive forced or IV feeding, or participate in strict behavior therapy programs that make privileges contingent on weight gain  Goal 2: Address the broader eating difficulties o Family therapy is more effective than individual treatment o Bruch’s modified psychodynamic therapy designed to increase interoceptive awareness and correct distorted perceptions of self o Feminist therapies which encourage young women to pursue their own values rather blindly adopting prescribed social roles o Various cognitive behavioral approaches 

Course and outcome of anorexia o Limited effectiveness of treatment o 10 to 20-year follow-up nearly half of patients have a weight within normal range  20% remain significantly below their healthy body weight  Around 5% starve to death or die Approaches to treating bulimia  Cognitive Behavior Therapy o First, the therapist uses education and behavioral strategies to normalize eating patterns. The goal is to end the cycle where extreme dietary restraint leads to binge eating and to purging o Second, the therapist addresses the client’s broader dysfunctional beliefs about self, appearance, and dieting. Techniques include a variation of Beck’s cognitive therapy to address perfectionism or depression. Individual problems, such as poor impulse control or troubled relationships, also may be addressed at this stage. o Third, the therapist attempts to consolidate gains and prepare the client for expected relapses in the future. Key goals at this final stage of treatment are to develop realistic expectations about eating, weight concerns, and binge eating, as well as clear strategies for coping with relapses in advance. o Overall leads to 70-80% reduction in binge eating and purging o Between 1/3 and ½ of all clients are able to cease the bulimic pattern completely  Interpersonal Psychotherapy o Focuses on difficulties in close relationships o Initially was studied as a placebo treatment o Allegiance effect: therapists’ expectations that a treatment will work  Antidepressant medications o Medication alone is NOT the treatment of choice o Not good when medication is stopped Course and outcome of bulimia nervosa  Has more favorable course than anorexia nervosa  About 5 years after diagnosis, 70% are free of symptoms 

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Issue

Anorexia Nervosa

Bulimia Nervosa

Differences

Eating/weight View of disorder Feelings of control

Binge eating/compensatory behavior; normal Extreme diet; below minimally normal weight Denial of anorexia; proud of “diet” weight Aware of problem; secretive/ashamed of bulimia Distressed by lack of control Comforted by rigid self-control

Similarities

Self-evaluation Comorbidity of AN/BN SES, age, gender

Unduly influenced by body weight/shape Unduly influenced by body weight/shape Many cases of BN have history of AN Prevalent among Some cases of AN also binge and purge Prevalent among high SES, young, female high SES, young, female

Table 10.1 Anorexia Nervosa and Bulimia Nervosa: Key Differences and Similarities...