Eating Disorders

Eating Disorders • It has not always done so, but Western society today equates 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 • The main symptoms of anorexia nervosa are: • A refusal to maintain more than 85% of normal body weight • Intense fears of becoming overweight • Distorted view of weight and shape • Amenorrhea

Anorexia Nervosa • There are two main subtypes: • Restricting type • Lose weight by cutting out sweets and fattening snacks, eventually eliminating nearly all food • Show almost no variability in diet • Binge-eating/purging type • Lose weight by forcing themselves to vomit after meals or by abusing laxatives or diuretics • Like those with bulimia nervosa, people with this subtype may engage in eating binges

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 away from home • 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

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 size and shape

Anorexia Nervosa: The Clinical Picture • Despite their dietary restrictions, people with anorexia nervosa are 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

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”

Anorexia Nervosa: The Clinical Picture • People with anorexia nervosa also display certain psychological problems:

Anorexia Nervosa: Medical Problems • Caused by starvation:

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

Bulimia Nervosa • The “typical” case: • A normal to slightly overweight female has been on an intense diet • Research suggests that even among normal participants, bingeing often occurs after strict dieting • 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

Bulimia Nervosa • The disorder is also characterized by inappropriate compensatory behaviors, which mark the subtype of the condition: • Purging-type bulimia nervosa • Forced vomiting • Misusing laxatives, diuretics, or enemas • Nonpurging-type bulimia nervosa • Fasting • Exercising frantically

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

Bulimia Nervosa: Binges • People with bulimia nervosa may have between 1 and 30 binge episodes per week • Binges are often carried out in secret • Binges involve eating massive amounts of food very rapidly with little chewing • Usually sweet, high-calorie foods with soft texture • Binge-eaters commonly consume between 1,000 and 10,000 calories per binge episode

Overlapping Patterns Of Anorexia Nervosa, Bulimia Nervosa, And Obesity

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 being discovered

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 • Repeated vomiting affects the ability to feel satiated  greater hunger and bingeing • Laxatives and diuretics • Also largely fails to reduce the number of calories consumed

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…

Bulimia Nervosa vs. Anorexia Nervosa

Binge Eating Disorder • Repeated eating binges during which they feel no control over their eating • These individuals do not perform inappropriate compensatory behavior • As a result of their frequent binges, around two-thirds of people with binge eating disorder become overweight or even obese

What Causes Eating Disorders? • Most theorists and researchers use a multidimensional risk perspective to explain eating disorders: • Several key factors place individuals at risk • More factors = greater likelihood of developing a disorder • Leading factors: • Psychological problems (ego, cognitive, and mood disturbances) • Biological factors • Sociocultural conditions (societal, family, and multicultural pressures)

Psychodynamic Factors: Ego Deficiencies • Hilde Bruch developed a largely psychodynamic theory of eating disorders • Argued that eating disorders are the result of disturbed mother–child interactions, which lead to serious ego deficiencies in the child and to severe perceptual disturbances

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 needs; they feed when the child is anxious, comfort when the child is tired, etc. • Such children may grow up confused and unaware of their own internal needs and turn, instead, to external guides • Clinical reports and research have provided some empirical support for this theory

Cognitive Factors • Bruch's theory also contains several cognitive factors, like improper labeling of internal sensations and needs • According to cognitive theorists, these deficiencies contribute to a broad cognitive distortion that lies at the center of disordered eating (e.g., negative self-judgment based on body shape and weight)

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

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

Biological Factors • Biological theorists suspect certain genes may leave some people particularly susceptible to eating disorders • Consistent with this idea: • 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

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)

Biological Factors • Some theorists believe that the hypothalamus, related brain areas, and chemicals together 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

Societal Pressures • Many theorists believe that current Western standards of female attractiveness are partly responsible for the emergence of eating disorders • Western 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

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

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 thinness, along with rates of eating disorders, are increasing in all groups

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 • A recent survey of adolescent girls tied eating disorders and body dissatisfaction to social networking, Internet activities, and television browsing

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

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

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 • The study also suggested that the groups had different ideals of beauty

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

Multicultural Factors: Racial and Ethnic 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 for attractiveness 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

Multicultural Factors: Racial and Ethnic 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

Multicultural Factors: Racial and Ethnic Differences • For other men, body image appears to be a key factor • Last, some men seem to be caught up in a new kind of eating disorder – reverse anorexia nervosa or muscle dysmorphobia

How Are Eating Disorders Treated? • Eating disorder treatments have two main goals: • Correct dangerous 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

Treatments for Anorexia Nervosa • The immediate aims of treatment for anorexia nervosa are to: • Regain lost weight • Recover from malnourishment • Eat normally again

Treatments for Anorexia Nervosa • In the past, treatment took place in a hospital setting; it is now often offered in day hospitals or outpatient settings • 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

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

Treatments for Anorexia Nervosa • In most treatment programs, a combination of behavioral and cognitive interventions are included • 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”

Treatments for Anorexia Nervosa • Therapists help patients recognize their need for independence and control • Therapists help patients recognize and trust their internal feelings • A final focus of treatment is helping clients change their attitudes about eating and weight • Using cognitive approaches, therapists correct disturbed cognitions and educate about body distortions • Family therapy is important for anorexia nervosa treatment • The main issues are often separation and boundaries

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

Eating Disorders