Chapter 8

1. Chapter 8 Eating Disorders

2. Eating Disorders: An Overview • Two major types of DSM-IV-TR eating disorders • Anorexia nervosa and bulimia nervosa • Severe disruptions in eating behavior • Extreme fear and apprehension about gaining weight • Strong sociocultural origins – Westernized views • Binge eating disorder • Obesity – A growing epidemic

3. Bulimia Nervosa: Overview and Defining Features • Binge eating – hallmark of bulimia • Binge • Eating excess amounts of food • Eating is perceived as uncontrollable

4. Bulimia Nervosa: • Compensatory behaviors • Purging • Self-induced vomiting, diuretics, laxatives • Some exercise excessively, whereas others fast • Purging subtype – most common subtype • Nonpurging subtype – about one-third of bulimics

5. Associated medical features • Most are within 10% of target body weight • Purging methods can result in severe medical problems • Erosion of dental enamel, electrolyte imbalance • Kidney failure, cardiac arrhythmia, seizures, intestinal problems, permanent colon damage

6. Bulimia Nervosa: Associated Features • Associated psychological features • Most are overly concerned with body shape • Fear of gaining weight • Most have comorbid psychological disorders

7. Anorexia Nervosa: Overview and Defining Features • Successful weight loss – hallmark of anorexia • Defined as 15% below expected weight • Intense fear of obesity and losing control over eating • Anorexics show a relentless pursuit of thinness • Often begins with dieting • amenorrhea

8. DSM-IV-TR subtypes of anorexia • Restricting subtype – limit caloric intake via diet and fasting • Binge-eating-purging subtype

9. Anorexia Nervosa: Overview and Defining Features • Associated features • Most show marked disturbance in body image • Most are comorbid for other psychological disorders • Methods of weight loss have life threatening consequences

10. Anorexia Nervosa: Overview and Defining Features • Methods of weight loss have life threatening consequences

11. Binge-Eating Disorder: Overview and Defining Features • Binge-eating disorder – appendix B of DSM-IV-TR • Experimental diagnostic category • Engage in food binges without compensatory behaviors

12. Binge-Eating Disorder: • Associated features • Many are obese • Concerns about shape and weight • Often older than bulimics and anorexics • More psychopathology vs. non-binging obese people

13. Bulimia and Anorexia: Facts and Statistics • Bulimia • Majority are female – 90%+ • Onset around 16 to 19 years of age • Lifetime prevalence is about 1.1% for females, 0.1% for males • 6-7% of college women suffer from bulimia • Tends to be chronic if left untreated

14. Bulimia and Anorexia: Facts and Statistics (continued) • Anorexia • Majority are female and white • From middle- to upper-middle-class families • Usually develops around age 13 or early adolescence • More chronic and resistant to treatment than bulimia • Cross-cultural considerations • Developmental considerations

15. Causes of Bulimia and Anorexia: • Media and cultural considerations • Being thin = success, happiness....really? • Cultural imperative for thinness • Translates into dieting • Standards of ideal body size • Change as much as fashion • Media standards of the ideal • Are difficult to achieve • Biological considerations • Can lead to neurobiological abnormalities

17. Causes of Bulimia and Anorexia: Toward an Integrative Model • Psychological and behavioral considerations • Low sense of personal control and self-confidence • Perfectionistic attitudes • Distorted body image • Preoccupation with food • Mood intolerance

18. Causes of Bulimia and Anorexia: Toward an Integrative Model • Dietary restraint • Family influences • Biological dimensions • Psychological dimensions • An integrative model

21. Medical and Psychological Treatment of Bulimia Nervosa • Psychosocial treatments • Cognitive-behavioral therapy (CBT) • Is the treatment of choice • Basic components of CBT • Medical and drug treatments • Antidepressants • Can help reduce binging and purging behavior • Are not efficacious in the long-term

22. Medical and Psychological Treatment of Binge Eating Disorder • Medical treatment • Sibutramine (Meridia) • Psychological treatment • CBT • Similar to that used for bulimia • Appears efficacious • Interpersonal psychotherapy • Equally as effective as CBT • Self-help techniques • Also appear effective

23. Goals of Psychological Treatment of Anorexia Nervosa • General goals and strategies • Weight restoration • First and easiest goal to achieve • Psychoeducation • Behavioral and cognitive interventions • Target food, weight, body image, thought and emotion • Treatment often involves the family • Long-term prognosis for anorexia is poorer than for bulimia • Preventing eating disorders

25. Obesity: Background and Overview • Not a formal DSM disorder • Statistics • In 2000, 30.5% of adults in the United States were obese; 33.8% in 2008 • Mortality rates • Are close to those associated with smoking • Increasing more rapidly • For teens and young children • Obesity • Is growing rapidly in developing nations

27. Obesity and Disordered Eating Patterns • Obesity and night eating syndrome • Occurs in 7-19% of treatment seekers • Occurs in 42% of individuals seeking bariatric surgery • Patients are wide awake and do not binge eat

28. Obesity and Disordered Eating Patterns • Causes • Obesity is related to technological advancement • Genetics account for about 30% of obesity cases • Biological and psychosocial factors contribute as well

29. Obesity Treatment • Treatment • Moderate success with adults • Greater success with children and adolescents • Treatment progression – from least to most intrusive options

30. Obesity Treatment • First step • Self-directed weight loss programs • Second step • Commercial self-help programs • Third step • Behavior modification programs • Last step • Bariatric surgery