Eating Disorders II March 31, 2014 PSYC 2340: Abnormal Psychology Brett Deacon, Ph.D.

1. Eating Disorders IIMarch 31, 2014PSYC 2340: Abnormal PsychologyBrett Deacon, Ph.D.

2. From Last Class • Suicide • Introduction to eating disorders • Anorexia nervosa • Bulimia nervosa • Binge eating disorder • Body shape ratings

3. From Last Class • Suicide • Introduction to eating disorders • Anorexia nervosa • Bulimia nervosa • Binge eating disorder • Body shape ratings

4. Inpatient Hospitalization • When should hospitalization be considered? • What are the pros and cons of involuntarily committing someone to an inpatient unit for their own safety?

5. The Case of Aaron Aaron was a 17-year-old male with severe, recurrent depression who did not improve with numerous inpatient treatments and antidepressant trials. In seeing him for psychotherapy it became clear that he perceived his life to be meaningless and his affect was actually much more flat (bored) than sad (depressed). One day during therapy he mentioned that he was having suicidal thoughts. He didn’t have a specific plan and was vague about his intentions. He could not provide any assurances that he wouldn’t commit suicide, but he also stated that he did not have any immediate intentions of killing himself. When discussing the possibility of hospitalization, Aaron became upset and stated his clear desire not to be hospitalized. He stated that he feels worse in the hospital and that an inpatient stay would disrupt his schoolwork and social life. He had previously been hospitalized on two occasions, one following a non-lethal suicide attempt.

6. Treating Aaron’s Suicidality • Civil liberty questions • On what basis can a patient’s civil rights be revoked? • Do patient’s have the right to be suicidal? • Do you believe psychiatrists should have the power to hospitalize people against their will? • What about forcibly drugging patients? • The psychiatric survivor movement

7. Eating Disorders • Video clip

8. Body Image Exercise 1. What is your gender? 2. What figure most approximates your current figure? 3. What figure represents what you would like to look like (ideal figure)? 4. What figure do you think would be most attractive to the opposite sex? 5. What figure of the opposite sex do you find most attractive?

9. Ratings for Women (averaged across classes) Actual men’s ideal figure M = 3.1 Perceived men’s ideal figure M = 2.8 Ideal figure M = 2.9 Current figure M = 3.7

10. Ratings for Men (averaged across classes) Actual women’s ideal figure M = 3.4 Perceived women’s ideal figure M = 3.3 Ideal figure M = 3.4 Current figure M = 3.7

11. Body Shape Pressures for Women • Substantial difference between current figure = 3.7 and: • Ideal figure = 2.9 • Perceived men’s ideal figure = 2.8 • Actual men’s ideal figure = 3.1 • The good news • The bad news

12. Body Shape Pressures for Men • For men, there is very little difference between: • Current figure = 3.7 • Ideal figure = 3.4 • Perceived women’s ideal figure = 3.3 • Actual women’s ideal figure = 3.4 • The good news • Limitations: thinness vs. muscle mass

13. 2012 Academy Awards: Best-Dressed Womenhttp://www.celebuzz.com/2012-02-26/best-dressed-celebs-at-2012-oscar-awards-photos/

14. Cultural Influences on Eating Disorders

15. Cultural Influences on Eating Disorders

16. Cultural Influences on Eating Disorders • Found mostly in Westernized cultures • Predominantly in middle and upper class Caucasian women • Major differences in prevalence (and in body shape concerns) among blacks and whites

17. Cultural Influences on Eating Disorders • Societal standards of ideal body shape change dramatically over time • Media standards are difficult to achieve • Influence of Westernized culture: research on prevalence of eating disorders among Egyptian and Asian women who move to the US and/or UK

18. Cultural Influences on Eating Disorders • NY Times: “The Americanization of Mental Illness” • http://www.nytimes.com/2010/01/10/magazine/10psyche-t.html?th&emc=th • “For more than a generation now, we in the West have aggressively spread our modern knowledge of mental illness around the world. We have done this in the name of science, believing that our approaches reveal the biological basis of psychic suffering and dispel prescientific myths and harmful stigma. There is now good evidence to suggest that in the process of teaching the rest of the world to think like us, we’ve been exporting our Western “symptom repertoire” as well. That is, we’ve been changing not only the treatments but also the expression of mental illness in other cultures. Indeed, a handful of mental-health disorders — depression, post-traumatic stress disorder and anorexia among them — now appear to be spreading across cultures with the speed of contagious diseases. These symptom clusters are becoming the lingua franca of human suffering, replacing indigenous forms of mental illness.”

19. The “Americanization” of Eating Disorders? • Excerpt from article: anorexia in Hong Kong

20. Causes of Bulimia and Anorexia • Psychological and behavioral considerations • Low sense of personal control and self-confidence • Perfectionistic attitudes • Preoccupation with food and appearance • Mood intolerance • Distorted body image

21. The Influence of Dieting • Societal pressure for thinness leads to dieting • Hunnicut & Newman (1993): 60.6% of 8th and 10th grade girls were dieting; 28.4% of men • Effects of dieting: • Preoccupation with food • Restriction leads to binge eating • Binge eating elicits compensatory behavior (exercise, purging) • Guilt, low self-esteem, more dieting….

22. Biological Influences • Genetic predisposition for EDs • Among women twins, concordance rate for EDs in identical twins is 23% vs. 9% of fraternal twins • No specific ED genes have been found

23. Biological Influences • From your text: • “If investigators do find a strong association between neurobiological functions and eating disorders, the question of cause and effect remains. At present, the consensus is that some neurobiological abnormalities do exist in people with eating disorders, but they are a result of semistarvation or a binge-purge cycle rather than a cause, although they may well contribute to the maintenance of the disorder once it is established.”

24. Biological Influences • Prolonged starvation produces neurobiological abnormalities (so does prolonged alcohol and drug use) • Do the presence of such abnormalities mean that eating disorders are biological diseases?

25. Biological Influences • “Eating Disorders: Fighting Stigma with Science by Cynthia Bulik” http://www.psychologytoday.com/blog/the-woman-in-the-mirror/201302/eating-disorders-fighting-stigma-science-2 • “Truth 3. Eating disorders are caused by a combination of genetic and environmental factors. Decades of replicated research has shown that anorexia nervosa, bulimia nervosa, and binge eating disorder are heritable, i.e. that genes play a role... Pure sociocultural theories of illness have not withstood the test of time. Their dominance is in part due to the tyranny of face validity. People see pictures of ultra-thin models, are told that individuals with anorexia nervosa are striving to look like those models, and the belief that they are related persists because the explanation is highly face valid. But alas, it is false. Anorexia nervosa is not a choice, it is a biologically based mental illness. Genes play a role, but environment does matter. Genes load the gun and the environment pulls the trigger. We all vary in how sensitive we are to various triggering events.” • Are eating disorders brain diseases?

26. Biomedical Model: F.E.A.S.T. http://www.feast-ed.org/ • “F.E.A.S.T. believes eating disorders are treatable biologically based brain illness.” • “Eating disorders are inherited illness: 50-80% of the risk is genetic.” • “The head of the US NIMH refers to anorexia nervosa as a brain disorder.” • “Brain chemistry, function, and structure are altered in eating disorder patients.”

27. Biomedical Model: NIMH Director Dr. Thomas Insel • “Within the realm of eating disorders, especially anorexia nervosa, we are talking about brain disorders.”

28. Biomedical Model: Academy for Eating Disorders Position Paper • EDs are “A condition that current medical science affirms is caused by a neurobiological disorder of the brain, significantly impairs cognitive function, judgment, and emotional stability, and limits the life activities of the person with the illness.” (Klump et al., 2009; p. 98)

29. Biological Influences • Politics of eating disorders • My experience at the 2012 Academy for Eating Disorders conference • Why might some people wish to emphasize the biological causes of EDs and minimize the psychosocial causes?