Chapter 13 Eating Disorders and Related Conditions

1. Chapter 13Eating Disorders and Related Conditions

2. Eating and Normal Development • Problematic eating habits and picky eating are common in early childhood- almost 1/3 of children are described as picky eaters • Societal norms and expectations affect girls more than boys, particularly by late childhood and adolescence

3. Developmental Risk Factors • Drive for thinness • a key motivational factor for dieting and body image • refers to the belief that losing more weight is the answer to overcoming problems • Western sociocultural values and preoccupation with weight and dieting may be internalized and expressed at a very young age (as young as 7-10)

4. Developmental Risk Factors (cont.) • Risk factors for development of later eating problems include: • early problematic eating behaviors • early pubertal maturation • high percentages of body fat • concurrent psychological problems • poor body image • Adolescence brings many changes (including physical maturation) which require major adjustments in self-image; weight concerns intensify, especially for girls

5. Developmental Risk Factors (cont.) Figure 13.1 A developmental continuum of eating habits and disorders.

6. Developmental Risk Factors (cont.) • Dieting is common, even among elementary school children • Chronic dieting is associated with the onset of adolescent eating disorders • Dieting may lead to “false hope syndrome”, as well as binge eating and subsequent purging

7. Biological Regulators • Metabolic rate, or balance of energy expenditure, is based on individual genetic and physiological makeup as well as eating and exercise habits • An individual’s natural weight is regulated by his or her own body weight set point, a biologically and genetically determined range of body weight that the body tries to “defend” and maintain • Major hormonal determinants of physical growth rate during childhood are the growth hormone and thyroid hormone, with additional gonadal steroids kicking in during adolescence to produce a further growth spurt and skeletal maturation

8. Feeding and Eating Disorders of Infancy and Early Childhood • Pica • eating inedible, non-nutritive substances for a period of at least one month • affects mostly very young children and those with MR • causes include poor stimulation and poor supervision in home environment, and genetic factors in some cases of MR • treatments usually based on operant conditioning procedures

9. Feeding and Eating Disorders of Infancy and Early Childhood (cont.) • Feeding Disorder of Infancy of Early Childhood • sudden marked deceleration of weight gain and a slowing or disruption of emotional and social development prior to age 6 • affects up to a third of young children (both boys and girls), particularly those from disadvantaged environments • can lead to or be the result of failure to thrive

10. Feeding and Eating Disorders of Infancy and Early Childhood (cont.) • Feeding Disorder (cont.) • when there is no medical reason, it is often associated with poor care-giving, including maltreatment • risk factors include family disadvantage, poverty, unemployment, social isolation, parental mental illness, and maternal eating disorders • treatment involves a detailed assessment of feeding behavior and other forms of parent-child interaction

11. Feeding and Eating Disorders of Infancy and Early Childhood (cont.) • Failure to Thrive • characterized by weight below the 5th percentile for age, and/or deceleration in the rate of weight gain from birth to present of at least 2 standard deviations • associated with social and economic disadvantage, and inadequate or abusive care-giving in early infancy • developmental outcome is highly related to the child’s home environment

12. Feeding and Eating Disorders of Infancy and Early Childhood (cont.) • Obesity • a chronic medical condition characterized by excessive body fat (usually a BMI above the 95th percentile) • significantly affects children’s psychological and physical health • prevalence is increasing- as of 1990’s, 15% of children were overweight • low correlation between obesity in infancy and obesity later in childhood, but childhood-onset obesity is more likely to persist into adolescence and adulthood

13. Figure 13.3 U.S. comparison with the next highest countries and the country with the lowest percentage of obese youth.

14. Feeding and Eating Disorders of Infancy and Early Childhood (cont.) • Obesity (cont.) • pre-adolescent obesity a risk factor for later EDs • the U.S. has the highest percentage of overweight children, and rates of obesity seem to increase upon exposure to Western culture and its fast food industries • causes include genetic predisposition (including leptin deficiencies), improper diet, unhealthy lifestyle, as well as family influences, such as poor communication, lack of support, and maltreatment • proper nutrition and less sedentary lifestyle are the recommended treatments- restricting diets not usually recommended

15. Figure 13.2 Bigger meals, bigger kids. Sources: Centers for Disease Control and Prevention, McDonald’s, and Newsweek.

16. Eating Disorders in Adolescence • Anorexia Nervosa • characterized by refusal to maintain minimally normal body weight, intense fear of gaining weight, and disturbance in perception of body size • denial of thinness a notable feature • DSM-IV subtypes: • restricting type - individual loses weight through diet, fasting, or excessive exercise • binge-eating/purging type - individual engages in episodes of binge eating or purging, or both • numerous negative medical consequences

17. Eating Disorders in Adolescence (cont.) • Bulimia Nervosa • primary feature is recurrent binge eating • binges are followed by either purging (self-induced vomiting or misuse of laxatives or diuretics) or by non-purging compensation (fasting, excessive exercise) • as with anorexia, self-evaluation is greatly influenced by body shape and weight

18. Eating Disorders in Adolescence (cont.) • Bulimia Nervosa (cont.) • two subtypes: dietary-depressive subtype show more eating pathology, social impairment, psychiatric comorbidity, and persistence of symptoms over five years than women with only the dietary subtype • significant medical consequences, but not as severe as those from anorexia • Binge Eating Disorder (BED) • similar to bulimia without the compensatory behaviors • 3.1% of girls, and 0.9% of boys

19. Figure 13.4 Compensatory behaviors of full-syndrome bulimia nervosa among community samples. Data from Garfinkel et al., 1995

20. Eating Disorders of Adolescence (cont.) • Prevalence • among female adolescents, estimated prevalence of anorexia is 0.3%, and bulimia is 1% • both AN and BN are much more common among females • Eating Disorders- Not Otherwise Specified (EDNOS) is a category of eating disorders that covers problems that do not quite fulfill criteria for AN or BN; prevalence may be much higher than AN and BN

21. Eating Disorders of Adolescence (cont.) • Young men that are affected with eating disorders place more emphasis on athletic appearance or attractiveness than on thinness • Among American minorities, it was found that Hispanics had equal, Blacks and Asians lower, and Native American women higher rates of eating disorders compared to Caucasians

22. Eating Disorders of Adolescence (cont.) • Development • onset of anorexia usually between ages 14 and 18, and is sometimes linked to stressful life events; fewer than 1/2 show full recovery; many fluctuate between recovery and relapse • onset of bulimia usually late adolescence to early adulthood; binge eating often develops after a period of restrictive dieting; may follow a chronic course or occur intermittently; between 50%-75% show full recovery • although disordered eating tends to decline in early adulthood, body dissatisfaction remains an issue for many young adults

23. Eating Disorders of Adolescence (cont.) • Causes • Biological dimension • neurobiological factors play only a minor role in precipitating anorexia and bulimia, but likely contribute to their maintenance because of effects on appetite, mood, perception, and energy regulation • genetic contribution – inherit a biological vulnerability that interacts with social and psychological factors • imbalances of serotonin may be implicated • biochemical similarities found between people with eating disorders and those with OCD

24. Eating Disorders of Adolescence (cont.) • Causes (cont.) • Social dimension • belief in Western culture that self-worth, happiness, and success are determined by physical appearance • sex-role identification and social conformity can contribute to eating problems • possible family influences include family dysfunction, an overemphasis on weight and dietary control, and child sexual abuse

25. Eating Disorders of Adolescence (cont.) • Causes (cont.) • Psychological dimension • adolescents with anorexia show a triad of personality features: avoidance of harm, low novelty seeking, and reward dependence • affect disturbance is often comorbid with anorexia • bulimia is associated with mood swings, poor impulse control, obsessive-compulsive behaviors, depression, anxiety, and substance abuse • almost 90% of persons with eating disorders have other Axis I disorders, usually depression, anxiety, or OCD

26. Eating Disorders of Adolescence (cont.) • Treatment for anorexia and bulimia • hospitalization in some cases • antidepressants and SSRIs may be helpful for bulimia, but not anorexia • psychosocial interventions are proving to be effective and are generally more effective than medications alone • Resolution of family problems may be crucial • Anorexia is generally less responsive to treatment than bulimia

27. Eating Disorders of Adolescence (cont.) • Treatment (cont.) • for anorexia, family-based interventions often required to restore healthy communication patterns, and cognitive-behavioral methods may be used to modify rigid beliefs, self-esteem, and self-control processes • for bulimia, cognitive-behavioral therapies that focus on attitudes, beliefs, and behaviors supporting problematic eating are effective, as is interpersonal therapy that addresses situational and personal issues contributing to the development and maintenance of the disorder