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Understanding and Treating Eating Disorders

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Understanding and Treating Eating Disorders. Prof. Freedom Leung. Department of ... Russel's signs in bulimic patients. Brain-and-experience model of Anorexia ... – PowerPoint PPT presentation

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Title: Understanding and Treating Eating Disorders


1
Understanding and Treating Eating Disorders
Prof. Freedom Leung Department of
Psychology Chinese University of Hong
Kong fykleung_at_psy.cuhk.edu.hk
2
Biological mechanisms underlying eating
3
(1) Communication between stomach and brain
5
a. Weight pressure b. Ghrelin
b
2
a
1
4
3
4
(2) Communication between liver and brain
5
b
2
a
4
1
3
5
(3) Communication between external cues,
pancreas, and brain
5
3
b
2
a
4
1
3
6
Brain circuits regulating eating
7
(4) Communication between fat cells and brain
5
b
2
a
4
1
3
8
Leptin regulates Neuropeptile-Y (NPY) in PVN
9
Leptin genes and obesity
10
What would happen if we flood the PVN with NPY?
11
NPY and uncontrollable binge eating
12
What would happen if we damage the VMH?
13
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14
How does the brain process eating stimuli?
  • Stimulation from outside (seeing or smelling
    food) and/or from inside (biochemical changes).
  • Signals reach different parts of the hypothalamus
    that create eating urge.
  • Urge is registered consciously as desire by the
    PFC
  • PFC initiates actions to fulfill its desire.
  • Food intake leads to change in circulating levels
    of dopamine and other biochemical substances and
    a feeling of satisfaction.

15
Brain circuits regulating eating
16
Emotional awareness and regulation
1) Orbito-frontal inhibits inappropriate
actions, defer immediate reward in favor of
long-term advantage 2) Ventromedial emotions
are experienced and meaning assigned to our
perceptions 3) Dorsolateral to form plans and
concepts and choose actions 3) 4) Anterior
cingulate focus attention and tune in to own
thoughts
17
The pleasure pathway
18
How does the brain process eating stimuli?
3
5
2
1
4
19
Factors affecting weight and shape
20
Factors that affect weight and shape
  • Genetics that determine
  • a. basal metabolism rate
  • b. number and distribution of fat cells
  • Eating habit (food types and quantity)
  • Exercise habit
  • Age

21
Individual differences in metabolism and body
weight and shape
22
Factors that affect weight and shape
  • Genetics that determine
  • a. basal metabolism rate
  • b. number and distribution of fat cells
  • Eating habit (food types and quantity)
  • Exercise habit
  • Age

23
Genes, fat distribution, and body shapes
24
Facts about fat cells
25
Factors that affect weight and shape
  • Genetics that determine
  • a. basal metabolism rate
  • b. number and distribution of fat cells
  • Eating habit (food types and quantity)
  • Exercise habit
  • Age

26
Eating in a commercial habitat
27
Factors that affect weight and shape
  • Genetics that determine
  • a. basal metabolism rate
  • b. number and distribution of fat cells
  • Eating habit (food types and quantity)
  • Exercise habit
  • Age

28
Factors that affect weight and shape
  • Genetics that determine
  • a. basal metabolism rate
  • b. number and distribution of fat cells
  • Eating habit (food types and quantity)
  • Exercise habit
  • Age

29
The upper and lower limits of our weight
190 175 160 145 130 115 100 lbs 85
60 - 90
- 15
30
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31
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32
Who should lose weight?
  • Genetically fat and behaviorally fat very fat
  • Genetically fat and behaviorally thin still fat
  • Genetically thin but behaviorally fat fat
  • Genetically thin and behaviorally thin thin

33
Freedoms guidelines in losing weight
  • Do you really need to lose weight?
  • How much?
  • Lose it very gradually
  • Stick to food from natural food chains
  • Add water to your food
  • Exercise regularly
  • Keep the changes for life
  • Try your best, after, forget the fat!
  • ???,???,??????!

34
Understanding and treating Eating Disorders
35
Important terms
  • Non-purging weight loss behaviors (dieting,
    fasting, excessive exercise)
  • Bingeing
  • Purging behaviors (vomiting, laxative misuses)
  • Anorexia without binge/purge symptoms
  • Anorexia with b/p symptoms
  • Bulimia with previous anorexia
  • Bulimia without previous anorexia
  • Bulimia - purging vs. non-purging subtypes
  • Binge eating disorder

36
Natural course of losing weight
dieting-bingeing-compensating
  • Dieting to lose 10 - 15 of the healthy weight
  • Trigger self-regulatory mechanisms in the
    hypothalamus
  • Develop food preoccupation and binge-eating
  • Regain weight (increase in body fat ratio)
  • Compensatory behaviors (e.g., fasting, excessive
    exercise, self-induced vomiting, or laxatives
    misuse)

37
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38
Diagnostic criteria for Anorexia Nervosa
  • Self-evaluation is overly influenced by body
    weight and shape
  • Body weighs less than 85 of the expected weight
  • Have intense fear of gaining weight even
    underweight
  • Absence of at least 3 consecutive menses (in men,
    loss of sexual libido)
  • Subtypes restricting type vs. binge/purge
    type

39
Secondary physical symptoms of Anorexia
  • Skin and bone problems
  • dry cracking skin
  • fine downy hair
  • brittle nails
  • carotene pigmentation
  • Osteoporosis
  • Gastro-intestinal problems
  • bloating
  • abdominal pain
  • early satiety
  • constipation
  • bloody diarrhea (caused by laxative abuse)
  • laxative dependency
  • bowel obstruction
  • Cardiovascular complications
  • electrolytes (potassium) imbalances
  • muscular weakness
  • heart irregularities
  • hypotension and associated dizziness
  • occasional blackouts

40
Diagnostic criteria for Bulimia Nervosa
  • Self-worth is overly influenced by body weight
    and shape
  • Uncontrollable binge eating
  • Engage in compensatory behaviors (e.g., fasting
    or severe dieting, excessive exercise,
    self-induced vomiting or laxative abuse)
  • Binge/purge twice a week, for 3 months
  • Subtypes purging type vs. non-purging type

41
Secondary physical symptoms of Bulimia
  • Oral problems
  • gum recession and enamel breakdown
  • swollen or infected salivary glands
  • damaging the esophageal walls
  • Gastro-intestinal problems
  • bloating
  • abdominal pains
  • early satiety
  • chronic under-hydration
  • constipation
  • Menstrual irregularities
  • Cardiovascular complications
  • electrolytes (potassium) imbalances
  • muscular weakness
  • heart irregularities/sudden death (particularly
    among those also abusing diuretics)

42
Russels signs in bulimic patients
43
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44
Brain-and-experience model of Anorexia
  • Neurobiological predispositions
  • Insensitive weight self-regulatory mechanisms in
    the brain
  • High obsessive personality trait
  • Upbringing experiences
  • Parent-child relationships that impair
    self-esteem
  • Parental attitudes toward appearance
  • Peer pressures and influence
  • Socio-cultural beauty standards
  • Psychological propensities
  • Emotionally feel inadequate and unsure of own
    self-worth
  • Cognitively preoccupied with body and shape
    issues
  • Diet to gain social approval and acceptance

45
Brain-and-experience model of Bulimia
  • Neurobiological predispositions
  • Sensitive weight self-regulatory mechanisms in
    the brain
  • High impulsive personality trait
  • Upbringing experiences
  • Parent-child relationships that impair
    self-esteem
  • Parental attitudes toward appearance
  • Peer pressures and influence
  • Socio-cultural beauty standards
  • Psychological propensities
  • Emotionally unstable and feel inadequate
  • Cognitively preoccupied with body and shape
    issues
  • Diet to gain social approval and acceptance

46
Motivations behind self-starvation The principle
of equifinality
  • Control eating to achieve self-perfection in the
    eyes of God
  • Control eating to gain a sense of self-control
    from intrusive parents
  • Control eating/weight to gain social approval

47
The 3 big questions for EDs patients
  • What are you trying to lose?
  • What are you trying to gain?
  • What is the real nature of your problem? Eating
    or self-concept ?

48
Assessment and treatment of EDs
  • Assessment of weight history
  • Assessment of eating pattern food diary
  • Psychoeducation about weight and shape
  • Assessment of problem nature

49
References
  • Friedman, J. (1997).  The alphabet of weight
    control.  Nature, 385, 119-120.
  • Horvath, T.L., Diano, S., Tschop, M. (2004).
    Brain circuits regulating energy homeostasis.
    Neuroscientist, 10, 235-246.
  • Jacobi, C., et al. (2004). Coming to terms with
    risk factors for eating disorders Application of
    risk terminology and suggestions for a general
    taxonomy. Psychological Bulletin, 130, 19-65.
  • Leung, F., Lam, S., Sze, S. (2001). Cultural
    expectations of thinness in Chinese women.
    Eating Disorders the Journal of Treatment and
    Prevention, 9, 339-350.
  • Leung, F., Schwartzman, A., Steiger, H. (1996).
    Testing a dual-process family model in
    understanding the development of eating
    pathology A structural equation modeling
    analysis. International Journal of Eating
    Disorders, 20, 367-375.
  • Leung, F., Wang, J.P., Tang, W.Y. (2004).
    Psychometric properties and normative data of the
    Eating Disorder Inventory among 12 to 18 year old
    Chinese girls in Hong Kong. Journal of
    Psychsomatic Research, 57, 59-66.
  • Striegel-Moore, R.H. Bulik, C.M. (2007). Risk
    factors for eating disorders. American
    Psychologist, 62, 181-198.
  • Scott, J.  (1996).  New chapter for the fat
    controller.  Nature, 379, 113-114.
  • Stanley, B. Gillard, E. (1994).  Hypothalamic
    neuropeptide Y and the regulation of eating
    behavior and body weight.  Current Directions in
    Psychological Science, 3, 9-15.
  • Winn, P. (1995).  The lateral hypothalamus and
    motivated behavior An old syndrome reassessed
    and a new perspective gained. Current Directions
    in Psychological Science, 4, 182-187.
  • Wonderlich, S.A. et al. (2007). Eating disorder
    diagnoses Empirical approaches to
    classification, 62, 167-180.
  • Woods, S. et al. (1998).  Signals that regulated
    food intake and homeostasis.  Science, 280,
    1378-1383.
  • Woods, S. et al. (2000).  Food intake and the
    regulation of body weight.  Annual Review of
    Psychology, 51, 255-277.
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