Eating Disorders: Current Topics

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Eating DisordersCurrent Topics Trends

• Rebecca L. Rogers, Ph.D.
• Augusta State University

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• Do not allow the body to attain extreme
  thinness, for that, too, is treacherous, but
  bring it only to a condition that will naturally
  continue unchanged, whatever that may be.
• -Hippocrates

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Anorexia Nervosa

• refusal to reach or maintain 85 body weight
• fear of fat
• disturbance in body image, excessive influence of
  weight/shape, denial of seriousness of problem
• absence of at least 3 consecutive menstrual
  cycles
• Restricting and Binge-Eating/Purging subtypes

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Demographics

• mean age of onset is 17 years old
• mostly in industrialized societies
• majority female
• majority Caucasian
• primarily in middle upper class
• prevalence among late adolescent and young adult
  females 0.5 - 1.0
• increase risk in first degree biological
  relatives
• mortality rates reported as high as 1/5

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Physical signs

• emaciated
• lanugo hair
• discolored and/or dry skin
• decrease in subcutaneous fat
• hair loss
• bradycardia, hypotension
• hypothermia
• decrease in estrogen, loss of menses
• edema, especially with refeeding

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Associated medical complications

• arrhythmias
• cardiomyopathy
• congestive heart failure
• gastrointestinal dysfunction
• mild anemia
• osteoporosis/osteopenia
• ovarian cysts
• gray matter deficits

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Associated psychological features

• Axis I
• depression
• anxiety
• social phobia
• obsessive compulsiveness
• Axis II
• cluster C, cluster A
• obsessiveness
• dependency

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Recent etiological theories

• biological factors
• serotonin
• leptin
• psychological factors
• Axis I
• Axis II
• social factors
• prevalence is higher in industrialized societies
• prevalence is higher is certain subcultural groups

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Treatment goals

• normalize body weight
• correct irrational preoccupation with weight
• prevent relapse

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Bulimia Nervosa

• recurrent episodes of binge eating compensatory
  behaviors to prevent weight gain
• 2x/week for 3 months
• excessive influence of weight/shape
• Purging and Nonpurging subtypes

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Demographics

• modal age between mid-adolescence and age 20
• greater diversity in ses and ethnicity
• majority female
• prevalence among teen and young adult females
  1.0 - 2.7
• increased frequency in first degree relatives

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Physical signs

• scars on hands
• puffy cheeks
• gastritis
• bradycardia, hypotension
• edema, especially after cessation of purging
• menstrual irregularities
• dental problems

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Medical complications

• fluid and electrolyte abnormalities
• dehydration
• muscle weakness, fatigue
• arrhythmias
• seizures
• cardiac and skeletal myopathies
• gastrointestinal problems (e.g., reflux,
  gastritis, hiatal hernia, gastric dilation)

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Associated psychological features

• Axis I
• depression
• anxiety
• social phobia
• substance abuse/dependence
• Axis II
• cluster B
• impulsiveness
• dependency

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Recent etiological theories

• biological factors
• restricted intake
• disturbed satiety
• serotonin
• psychological factors
• Axis I
• Axis II
• social factors
• increased incidence
• prevalence is higher in industrialized societies
• prevalence is higher in certain subcultural groups

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Treatment goals

• terminate compensatory behaviors
• normalize eating behaviors
• correct irrational preoccupation with weight
• prevent relapse

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Eating Disorder NOS

• disorders of eating that do not meet full
  criteria for any specific eating disorder
• examples
• females who meet criteria for AN except for lack
  of menstrual cycle
• criteria for AN except, despite significant
  weight loss, person is not considered underweight
• criteria for BN except frequency or duration of
  binge eating and compensatory behaviors
• regular use of inappropriate compensatory
  behaviors by normal weight person eating small
  amounts
• repeated chewing and spitting out (but not
  swallowing) large amounts of food
• binge eating disorder

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Binge Eating Disorder

• recurrent episodes of binge eating without
  compensatory behaviors
• eating and unusually large amount of food in a
  discrete period of time
• sense of being out of control
• eating when not hungry
• eating quickly
• eating until uncomfortably full
• eating in secrecy
• feelings of shame or guilt
• 2/week for 6 months
• the person experiences distress

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Demographics

• onset is usually late adolescence or early
  twenties, often soon after significant weight
  loss from dieting
• more common in women
• more evenly distributed across age, gender, ses,
  ethnicity than other eating disorders
• chronic course
• prevalence rates in weight control programs 15
  - 50
• prevalence rates in nonpatient community samples
  .7 - 4.0

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• Physical signs
• Medical complications
• Associated psychological features
• Axis I
• Axis II

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Recent etiological theories

• biological factors
• genetic predisposition to obesity
• history of restricting diet
• unstructured eating behaviors
• psychological factors
• non-specific risk factors for psychiatric
  disorders (e.g., adverse parental depression)
• feelings of depression, anxiety, tension
• dissociative quality
• social factors
• ?

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Treatment goals

• structure eating
• correct irrational preoccupation with weight
• prevent relapse

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• Do not allow the body to attain extreme
  thinness, for that, too, is treacherous, but
  bring it only to a condition that will naturally
  continue unchanged, whatever that may be.
• -Hippocrates