Eating Disorders

1
Eating Disorders
2
An Overview of Eating Disorders

• Two Main Types
• Anorexia Nervosa
• Bulimia Nervosa
• Share Strong Drive to be Thin
• Largely a Westernized, Female Problem
• Largely an Upper SES Problem

3
Assessment of Eating Disorders

• Interview
• Observation
• Reports from family/friends
• Objective Psychological Tests
• (e.g., Eating Disorder Inventory)

4
Bulimia Nervosa

• Bingeing
• Eat Large Amounts of Food
• Eating is Out of Control

• Compensatory Behaviors
• Purging via
• Self-Induced Vomiting, Enemas
• Laxatives, Diuretics, Exercise, Fasting
• Binge-Purge occur, on average, at least 2 X wk
  for 3 months
• Self-evaluation is unduly influenced by body
  shape and weight

5
The Nature of Bulimia Nervosa

• Medical Consequences

• Salivary Gland Enlargement
• Eroded Dental Enamel
• Electrolyte Imbalance
• Intestinal Problems
• Calluses on Fingers and Hands

6
The Nature of Bulimia Nervosa

• Facts and Statistics

• 90-95 are Women
• Onset 16-19 Years of Age
• 6-8 of college women
• About 2.8 Population Overall
• Chronic if Left Untreated

7
The Nature of Anorexia Nervosa

• Clinical Description

• Intense fear of
• Gaining weight
• Becoming fat

• Refusal to maintain body weight
• 15 Below Expected Normal
• Distorted body image
• Amenorrhea (in females)

8
The Nature of Anorexia Nervosa

• Two Subtypes

• Restricting Type
• Excessive Dieting

• Binge-Eating / Purging Type
• Rely on Purging
• About Half of All Cases

9
The Nature of Anorexia Nervosa

• Medical Consequences

• Dry Skin, Brittle Hair or Nails
• Sensitivity to Cold (Lanugo)
• Risk of death (suicide, starvation, electrolyte
  imbalance, heart problems)

10
The Nature of Anorexia Nervosa

• Associated Features and Facts

• Begins in adolescence (onset often associated
  with a stressful life event)
• Perfectionistic High-Achievers
• All-or-None Thinking
• Obsessive and Orderly
• Comorbid DSM Disorders
• Obsessive-Compulsive Disorder
• Substance Abuse

11
The Nature of Eating Disorders

• Causes

• Social and Cultural Factors
• - examples?
• Media
• Sets Impossible Idealized Images

12
The Nature of Eating Disorders

• Causes

• Biological Influences
• Runs in Families
• Unclear What is Inherited
• The Serotonin-Hypothesis BN represents an
  underlying hyposerotonergic condition

13
The Nature of Eating Disorders

• Causes

• Dieting When food is restricted, we become
  preoccupied with it! (The PsychoBiological
  Impasse)
• Family Influences (esp. in AN)
• Successful and Driven
• Concerned About Appearances
• Eager to Maintain Harmony
• Deny or Ignore Conflicts
• Lack of Open Communication

14
The Treatment of Eating Disorders

• Psychosocial Treatments for BN

• Cognitive-behavioral treatments
• Education about eating behavior
• Scheduled eating
• Exposure / Response prevention

15
The Treatment of Eating Disorders

• Psychosocial Treatments

• Anorexia Nervosa
• First restore normal weight!
• many will gain weight keeping the weight on
  is harder
• residential treatment
• control issues? IPT

16
The Treatment of Eating Disorders

• Biological treatments

• Bulimia Nervosa
• Because serotonin is thought to play an
  important role in mediating satiety, SSRIs have
  been tried
• e.g., fluoxetine (Prozac) has demonstrated
  effectiveness
• Anorexia (not effective)