Chapter 11

1. Slides & Handouts by Karen Clay Rhines, Ph.D. Seton Hall University Chapter 11 Eating Disorders Comer, Fundamentals of Abnormal Psychology, 3e

2. Changing attitudes Comer, Fundamentals of Abnormal Psychology, 3e

3. Eating Disorders • Although not historically true, current Western beauty standards equate thinness with health and beauty • 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, Fundamentals of Abnormal Psychology, 3e

4. 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 • A distorted view of body weight and shape • Amenorrhea Comer, Fundamentals of Abnormal Psychology, 3e

5. Anorexia Nervosa • There are two main subtypes: • Restricting type anorexia • Lose weight by restricting “bad” foods, eventually restricting nearly all food • Show almost no variability in diet • Binge-eating/purging type anorexia • 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, Fundamentals of Abnormal Psychology, 3e

6. 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, Fundamentals of Abnormal Psychology, 3e

7. Anorexia Nervosa • The “typical” case: • A normal to slightly overweight female has been on a diet • Escalation to 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, Fundamentals of Abnormal Psychology, 3e

8. Anorexia Nervosa: The Clinical Picture • Despite their dietary restrictions, people with anorexia 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, Fundamentals of Abnormal Psychology, 3e

9. Anorexia Nervosa: The Clinical Picture • People with anorexia nervosa also think in distorted ways: • Often have a low opinion of their body shape • Tend to overestimate their actual proportions • 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, Fundamentals of Abnormal Psychology, 3e

10. Anorexia Nervosa: The Clinical Picture • People with anorexia 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, Fundamentals of Abnormal Psychology, 3e

11. Bulimia Nervosa • Bulimia nervosa, also known as “binge-purge syndrome,” is characterized by binges • Bouts of uncontrolled overeating during a limited period of time • Eats objectively more than most people would/could eat in a similar period Comer, Fundamentals of Abnormal Psychology, 3e

12. Bulimia Nervosa • The disorder is also characterized by compensatory behaviors: • Purging-type bulimia nervosa • Vomiting • Misusing laxatives, diuretics, or enemas • Nonpurging-type bulimia nervosa • Fasting • Exercising excessively Comer, Fundamentals of Abnormal Psychology, 3e

13. 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, Fundamentals of Abnormal Psychology, 3e

14. Bulimia Nervosa • Patients are generally of normal weight • Often experience weight fluctuations • Some may also qualify for a diagnosis of anorexia • Binge-eating disorder: • Symptoms include a pattern of binge eating with NO compensatory behaviors (such as vomiting) • This condition is not yet listed in the DSM-IV-TR Comer, Fundamentals of Abnormal Psychology, 3e

15. Bulimia Nervosa: Binges • For people with bulimia nervosa, the number of binges per week can range from 2 to 40 • Average: 10 per week • 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, Fundamentals of Abnormal Psychology, 3e

16. Bulimia Nervosa: Binges • Binges are usually preceded by feelings of 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, Fundamentals of Abnormal Psychology, 3e

17. 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, Fundamentals of Abnormal Psychology, 3e

18. 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 • Elevated risk of self-harm or attempts at suicide • Feelings of anxiety, depression, perfectionism • Substance abuse • Disturbed attitudes toward eating Comer, Fundamentals of Abnormal Psychology, 3e

19. Bulimia Nervosa vs. Anorexia Nervosa • Differences: • People with bulimia are more worried about pleasing others, being attractive to others, and having intimate relationships • People with bulimia tend to be more sexually experienced • People with bulimia display fewer of the obsessive qualities that drive restricting-type anorexia • People with bulimia are more likely to have histories of mood swings, low frustration tolerance, and poor coping Comer, Fundamentals of Abnormal Psychology, 3e

20. Bulimia Nervosa vs. Anorexia Nervosa • Differences: • People with bulimia tend to be controlled by emotion – may change friendships easily • People with bulimia are more likely to display characteristics of a personality disorder • Different medical complications: • Only half of women with bulimia experience amenorrhea vs. almost all women with anorexia • People with bulimia suffer damage caused by purging, especially from vomiting and laxatives Comer, Fundamentals of Abnormal Psychology, 3e

21. 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: • Sociocultural conditions (societal and family pressures) • Psychological problems (ego, cognitive, and mood disturbances) • Biological factors Comer, Fundamentals of Abnormal Psychology, 3e

22. What Causes Eating Disorders? Societal Pressures • Many theorists believe that current Western standards of female attractiveness have contributed to the rise 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, Fundamentals of Abnormal Psychology, 3e

23. What Causes Eating Disorders? Societal Pressures • Certain groups 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 met full criteria for an eating disorder Comer, Fundamentals of Abnormal Psychology, 3e

24. What Causes Eating Disorders? Societal Pressures • Societal attitudes may explain economic and racial differences seen in prevalence rates • In the past, Caucasian women of higher SES expressed more concern about thinness and dieting • These women had higher rates of eating disorders than African American women or Caucasian women of lower SES • Recently, dieting and preoccupation with food, along with rates of eating disorders, are increasing in all groups Comer, Fundamentals of Abnormal Psychology, 3e

25. What Causes Eating Disorders? Family Environment • 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, Fundamentals of Abnormal Psychology, 3e

26. What Causes Eating Disorders? Family Environment • Minuchin cites “enmeshed family patterns” as causal factors of eating disorders • These patterns include overinvolvement in, and overconcern about, family member’s lives Comer, Fundamentals of Abnormal Psychology, 3e

27. What Causes Eating Disorders? Ego Deficiencies and Cognitive Disturbances • 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, Fundamentals of Abnormal Psychology, 3e

28. What Causes Eating Disorders? Ego Deficiencies and Cognitive Disturbances • 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. Comer, Fundamentals of Abnormal Psychology, 3e

29. 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, Fundamentals of Abnormal Psychology, 3e

30. What Causes Eating Disorders? Mood Disorders • More people with an eating disorder qualify for a 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 low levels of serotonin • Symptoms of eating disorders are helped by antidepressant medications Comer, Fundamentals of Abnormal Psychology, 3e

31. 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 6 times more likely to develop the disorder themselves • Identical (MZ) twins with bulimia: 23% • Fraternal (DZ) twins with bulimia: 9% • These findings may be related to low serotonin Comer, Fundamentals of Abnormal Psychology, 3e

32. 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, Fundamentals of Abnormal Psychology, 3e

33. What Causes Eating Disorders? Biological Factors • Set point: genetic inheritance and early eating practices determine our particular weight level • If weight falls below set point:  hunger,  metabolism  binges • If weight rises above set point:  hunger,  metabolism Comer, Fundamentals of Abnormal Psychology, 3e

34. Treatments for Eating Disorders • Eating disorder treatment goals: • 1. Correct abnormal eating patterns • 2. 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, Fundamentals of Abnormal Psychology, 3e

35. Treatments for Anorexia Nervosa • The initial aims of treatment for anorexia nervosa are to: • Restore proper weight • Recover from malnourishment • Restore proper eating Comer, Fundamentals of Abnormal Psychology, 3e

36. Treatments for Anorexia Nervosa • 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 • Most common technique now is the use of supportive nursing care and high-calorie diets • Necessary weight gain is often achieved in 8 to 12 weeks Comer, Fundamentals of Abnormal Psychology, 3e

37. Treatments for Bulimia Nervosa • Several treatment strategies: • Individual insight therapy • The insight approach receiving the most attention is cognitive therapy, which helps clients recognize and change their maladaptive attitudes toward food, eating, weight, and shape • As many as 65% stop their binge-purge cycle Comer, Fundamentals of Abnormal Psychology, 3e

38. Treatments for Bulimia Nervosa • Several treatment strategies: • Behavioral therapy • Exposure and response prevention is used to break the binge-purge cycle Comer, Fundamentals of Abnormal Psychology, 3e