Eating Disorders

1
Eating Disorders

• Anorexia Nervosa
• Bulimia Nervosa
• Binge Eating Disorder

2
Disorders of conflict

• Between food and the effects of food
• Between parents and children
• But more as perceived by the patient
• About goals and competing images
• Health and beauty
• Self-perception
• About control

3
Anorexia nervosa

• Failure, apparently by choice, to maintain
  adequate weight (DSM-IV Refusal
• Guidelines
• 85 of Metropolitan Life tables or pediatric
  growth charts (DSM-IV)
• Body Mass Index of 17.5 kg/m2 (mass in kg/
  height in meters2) (Used in ICD-10)
• Due to restricted eating (not just of high
  calorie foods), purging, and exercise

4
More features of anorexia nervosa

• Intense fear of gaining weight or becoming fat
  is not lessened by weight loss
• Perceive body weight and size in distorted ways
  (cf. Body Dysmorphic Disorder)
• Overall distortion in some
• Others distort only certain parts, especially
  thighs, buttocks, and abdomen
• Self-esteem is tied to perceived body weight and
  size

5
And some more

• Weight loss is celebrated, while weight gain is
  mourned as evidence of personal failure.
• Medical consequences of low weight are denied.
• Fertile females with anorexia nervosa cease
  menstruating amenorrhea

6
Subtypes of anorexia nervosa

• Restricting type
• Dieting, fasting, exercise
• Binge-eating/Purging type
• Vomiting, laxatives, diuretics, enemas

7
Associated features

• Depression, due to starvation
• Loss of sexual interest, as pituitary function
  diminishes
• Less so in Binge-purge type
• Obsessive-compulsive preoccupation with food
• Health consequences of starvation and purging

8
Statistics

• 90 of cases are female
• Prevalence 0.5 - 1.0 of women under 40
• Higher in recent decades
• Higher in United States, Canada, Australia, New
  Zealand, Japan, South Africa, and Europe
• May appear in other cultures without distortion
  of body perception, with reason given as stomach
  pain or food taste.

9
Non-Western Eating Disorders

• Parry-Jones (1991) suggests that eating disorders
  are evolving, and that less severe, incipient
  forms occur in non-Western cultures
• Srinivasan, Suresh, Vasantha Jayaram Fernandez
  (1995) describe Eating Distress Syndrome, with
  15 of 210 students affected.

10
Bulimia Nervosa

• Binge eating Rated in comparison with others
• A sense of loss of control while eating
• Compensating actions Vomiting, laxatives,
  diuretics, enemas, fasting, excessive exercise
• At least twice/week for 3 months
• Normal or higher weight
• Also has purging and non-purging types

11
Bulimia statistics

• 30-50 have comorbid personality disorders,
  usually Borderline, Antisocial, Histrionic, or
  Narcissistic
• 33 have substance-related disorders
• 90 of cases are female
• Prevalence 1 - 3 of females aged 13 - 30
• Symptoms start in adolescence
• Course tends to be chronic and episodic

12
Binge-eating Disorder (NOS)

• Suggested for further research
• Binge episodes without compensatory actions

13
Etiology

• Social influence
• Models and ideals
• The health craze
• The meaning of fat
• Self-control and dieting
• Concurrent PTSD? Gleaves et. al (1998) found
  current PTSD symptoms in over half of 154 women
  hospitalized with an eating disorder

14
Biological factors

• Family history
• Dieting and starvation
• Opioid reinforcement
• Low levels of serotonin and norepinephrine
• SSRIs increase 5-HT activity, counter bulimia
• 5-HT2A receptor polymorphism correlates with
  anorexia nervosa, and with OCD, but not with
  bulimia nervosa (Enoch, Kaye, et al., 1998).
  5-HT2A receptors are thought to be involved in
  eating and anxiety
• Perhaps 5-HT2A receptor levels are low in AN and
  OCD
• But not eating lowers 5-HT levels, ending
  obsessions and feelings of anxiety.(Kaye, 1998)

15
Familial factors

• Models and attitudes
• Family dynamics (Minuchin)
• Enmeshment
• Overprotectiveness
• Rigidity
• Lack of conflict resolution
• BUT Among patients with Anorexia Nervosa, degree
  of enmeshment varies greatly, conflict levels are
  low, and family functioning improves as the
  patient improves, contradicting Minuchin. In
  observational study, few family differences are
  found.

16
Personality factors

• Anorexia Perfectionistic, shy and compliant,
  harm-avoiding, obsessional, related to OCD
• Bulimia Histrionic, labile, and outgoing, not
  related to OCD
• Negative self-beliefs similar to depression
  (Cooper et al., 1998)
• Both Lack of interoceptive awareness
• I get confused about what emotion Im feeling.
• I dont know whats going on inside me.
• I get confused as to whether or not Im hungry.

17
Cognitive factors

• Body dissatisfaction Ideas that
• thinness is an ideal
• fat is evil
• Criticism about being overweight
• Focus on health
• Binging as a cognitively-mediated consequence of
  control failure
• Cognitive Behavior Therapy is effective

18
Elise Warriner, The Anger Within This painting
is about the inability to express emotions on the
outside, and the wish to totally isolate the
mind from the heart and stomach. I see anorexia
as a silent anger. Whilst one looks completely
numb on the outside, there is incredible
turmoil inside, and the energy needed to keep
the anger inside leads to physical exhaustion
and isolation. -1993