Anorexia Nervosa AN

1
Anorexia Nervosa (AN)

• Drive for Thinness, intense fear of gaining
  weight
• 15 below expected weight
• Body image distortion (feel fat)
• Preoccupation with food
• Amenorrhea (3 cycles)
• Many anorexics also binge (they feel starved)
• These tend to be less introverted, more
  impulsive, than the non-binge anorexics)

2
Bulimia Nervosa (BN)

• Recurrent episodes of binge eating (at least
  twice a week for 3 months)
• Feel a loss of control during binge
• Binge on high-caloric foods (i.e. not carrots)
• Usually perceive binges as shameful, keep them
  secretive
• Typically engage in purgingvomiting, laxatives,
  diuretics also, intense exercise or dieting is
  common
• Preoccupied with body shape and weight

3
Prevalence of AN and BN

• Increased prevalence in past half-century, with
  biggest increases in younger women (ages 15-24),
  ethnic minority groups (although still most
  predominant in Whites) Prevalence for Anorexia
  ages 15-24 (AN) 14.6 females/100,000 (approx
  1), 1.8 males/100,000
• Rates for Bulimia (BN) higher, roughly 2 of
  female teens (5x as many females as males)
• AN BN rare in non-Western countries

4
Subclinical Problems

• Approximately 40-60 of h.s. girls diet to lose
  weight.
• Approximately 10-15 purge or compensate for
  eating by vomiting, laxatives, diuretics, or use
  dieting pills

5
Precursors

• In early childhood
• picky eaters, digestive problems predict later
  anorexia
• Pica, conflict regarding eating predict bulimia.
• In school age children
• Approx 1/3 of those with later eating disorders
  try to lose weight, and many of those children
  have distortions in body image (see themselves as
  fat).

6
Precursors, ctd

• Early adolescence
• Disliking ones body during pubertal development
• Mood swings, and problems regulating (coping
  with) moods, especially in BN
• Inhibited, overcontrolled personality (AN)
• Difficult communication with parents (although
  research findings are inconsistent)
• High conflict associated with BN
• Enmeshed/overprotected, overcontrolled in AN
• Parents who are preoccupied with diets

7
Other risk factors

• Other factors
• Media and cultural over-emphasis on thinness in
  women
• History of sexual abuse (esp for BN)
• Heritability modest

8
Treatment of Anorexia

• First, weight gain (in consultation with
  nutritionist)
• Hospitalization (brief) may be necessary for
  weight gain, other health concerns
• Family therapy best results
• Family insists on weight gain in supportive way,
  mutual communication and problem-solving
• Medication especially if depressed
• Individual therapy cognitive-behavioral, as well
  as other modalities, more widely studied in
  adults than adolescents.

9
Cognitive-Behavioral Therapy

• Focus on cognitive errors, e.g.
• Selective abstraction (over-focusing on one
  aspect) I cannot eat any carbohydrates, or I
  will become obese
• Magnification Ive gained 2 pounds, so now I
  look so horrible I cannot wear a pair of shorts
  anymore
• Dichotomous (black/white) thought If I am not
  in complete control, I lose all control If I
  cannot master being thin, my whole life will be a
  failure.
• Superstitious thought If I eat a sweet, it is
  instantly converted to fat on my stomach.
• Personalization I know I look horrible, and you
  are looking at me, thinking how horrible I look

10
Treatment of Cognitive Errors

• Have adolescent state their beliefs out loud
• Decentering Ask if she is as aware of others as
  she thinks others are of her
• Question the shoulds
• Decatastrophizing Questioning what would happen
  if the feared event were to occur
• Reattribution point out that these are
  automatic, re-occurring thoughts, and they cannot
  be trusted
• Challenge cultural drive for thinness
• Teach self-soothing
• Assertiveness training