Eating Disorders

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Eating Disorders
04-20-05
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Eating Disorders

• Anorexia Nervosa
• Bulimia Nervosa
• Binge-Eating Disorder

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Anorexia Nervosa

• Refusal to maintain minimally normal body weight
  (85 expected for age height)
• Intense fear of gaining weight or becoming fat,
  even though underweight
• Body image disturbance
• Absence of at least 3 consecutive menstrual
  cycles in females

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Anorexia Nervosa

• 90 are white females (0.5-1 females)
• Rate peaks in 15-19 year olds
• Highest mortality rate of any major psychiatric
  disorder, primarily from cardiac arrest or
  suicide (5-20 APA, 2000)
• Physical complications include cardiac
  arrhythmias from electrolyte imbalance, low blood
  pressure, slow heart rates

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Anorexia Nervosa

• Restricting Type person has not regularly
  engaged in binge-eating or purging behavior
  (person loses weight with diet and exercise)
• Binge-Eating/Purging Type person has regularly
  engaged in binge-eating or purging behavior
  (i.e., self-induced vomiting, laxatives,
  diuretics, enemas)

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Personality Correlates

• Restricting Type introversion, conformity,
  perfectionism, rigidity
• Binge-Eating/Purging Type extroversion,
  emotional volatility, impulsivity, substance
  abuse
• Both types may exhibit obsessive-compulsive
  behaviors worse prognosis for constricted/over-co
  ntrolled profile
• Many patients with restricting type later develop
  the binge-eating/purging type.

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Bulimia Nervosa

• Recurrent episodes of binge eating, characterized
  by both of the following
• 1) eating, in a discrete period of time (e.g.,
  within any 2-hour period) an amount of food that
  is definitely larger than most people would eat
• 2) a sense of lack of control over eating during
  the episode

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Bulimia Nervosa (continued)

• Recurrent inappropriate compensatory behavior in
  order to prevent weight gain (e.g., self-induced
  vomiting misuse of laxatives, diuretics, enemas
  fasting or excessive exercise).
• Both behaviors 2x/week for 3 months
• Self-evaluation is unduly influenced by body
  shape weight
• Does not meet criteria for Anorexia Nervosa

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Bulimia Nervosa

• Purging Type person has regularly engaged in
  self-induced vomiting or misuse of laxatives,
  diuretics, or enemas
• Nonpurging Type person has used other
  inappropriate compensatory behaviors (e.g.,
  fasting or excessive exercise)

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Bulimia Nervosa

• 90 are white females (1- 3 females)
• Onset in late adolescence/early adulthood
• Most are within normal weight range
• Prognosis is better than for Anorexia
• More than 75 of patients with bulimia practice
  self-induced vomiting
• Associated with mood disorders (SAD),
  impulsivity, emotional instability, substance
  abuse

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Binge-Eating Disorder

• Recurrent episodes of binge eating
• Three or more of the following
• 1) eating much more rapidly than normal
• 2) eating until feeling uncomfortably full
• 3) eating large amounts of food when not
  physically hungry
• 4) eating alone because of being embarrassed by
  how much one is eating
• 5) feeling disgusted with oneself, depressed, or
  guilty after overeating

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Binge-Eating Disorder (cont.)

• Marked distress regarding binge eating
• Binge eating at least 2 days/week for 6 months
• Binge eating is not associated with regular use
  of inappropriate compensatory behaviors (e.g.,
  purging, fasting, excessive exercise)
• Does not meet criteria for Anorexia Nervosa or
  Bulimia Nervosa

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Binge-Eating Disorder

• 1.5 to 1 female to male ratio (0.7 4
  prevalence)
• Onset in late adolescence/early 20s
• African American and American Indian rates are
  comparable to whites for women
• Risk factors adverse childhood experiences,
  parental depression, vulnerability to obesity,
  negative comments from family re body shape,
  weight, eating
• Comorbidity with major depression