Chapter 13 Eating Disorders and Related Conditions

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Chapter 13Eating Disorders and Related
Conditions
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Eating and Normal Development

• Problematic eating habits and picky eating are
  common in early childhood- almost 1/3 of children
  are described as picky eaters
• Societal norms and expectations affect girls more
  than boys, particularly by late childhood and
  adolescence

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Developmental Risk Factors

• Drive for thinness
• a key motivational factor for dieting and body
  image
• refers to the belief that losing more weight is
  the answer to overcoming problems
• Western sociocultural values and preoccupation
  with weight and dieting may be internalized and
  expressed at a very young age (as young as 7-10)

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Developmental Risk Factors (cont.)

• Risk factors for development of later eating
  problems include
• early problematic eating behaviors
• early pubertal maturation
• high percentages of body fat
• concurrent psychological problems
• poor body image
• Adolescence brings many changes (including
  physical maturation) which require major
  adjustments in self-image weight concerns
  intensify, especially for girls

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Developmental Risk Factors (cont.)
Figure 13.1 A developmental continuum of eating
habits and disorders.
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Developmental Risk Factors (cont.)

• Dieting is common, even among elementary school
  children
• Chronic dieting is associated with the onset of
  adolescent eating disorders
• Dieting may lead to false hope syndrome, as
  well as binge eating and subsequent purging

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Biological Regulators

• Metabolic rate, or balance of energy expenditure,
  is based on individual genetic and physiological
  makeup as well as eating and exercise habits
• An individuals natural weight is regulated by
  his or her own body weight set point, a
  biologically and genetically determined range of
  body weight that the body tries to defend and
  maintain
• Major hormonal determinants of physical growth
  rate during childhood are the growth hormone and
  thyroid hormone, with additional gonadal steroids
  kicking in during adolescence to produce a
  further growth spurt and skeletal maturation

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Feeding and Eating Disorders of Infancy and Early
Childhood

• Pica
• eating inedible, non-nutritive substances for a
  period of at least one month
• affects mostly very young children and those with
  MR
• causes include poor stimulation and poor
  supervision in home environment, and genetic
  factors in some cases of MR
• treatments usually based on operant conditioning
  procedures

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Feeding and Eating Disorders of Infancy and Early
Childhood (cont.)

• Feeding Disorder of Infancy of Early Childhood
• sudden marked deceleration of weight gain and a
  slowing or disruption of emotional and social
  development prior to age 6
• affects up to a third of young children (both
  boys and girls), particularly those from
  disadvantaged environments
• can lead to or be the result of failure to thrive

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Feeding and Eating Disorders of Infancy and Early
Childhood (cont.)

• Feeding Disorder (cont.)
• when there is no medical reason, it is often
  associated with poor care-giving, including
  maltreatment
• risk factors include family disadvantage,
  poverty, unemployment, social isolation, parental
  mental illness, and maternal eating disorders
• treatment involves a detailed assessment of
  feeding behavior and other forms of parent-child
  interaction

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Feeding and Eating Disorders of Infancy and Early
Childhood (cont.)

• Failure to Thrive
• characterized by weight below the 5th percentile
  for age, and/or deceleration in the rate of
  weight gain from birth to present of at least 2
  standard deviations
• associated with social and economic disadvantage,
  and inadequate or abusive care-giving in early
  infancy
• developmental outcome is highly related to the
  childs home environment

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Feeding and Eating Disorders of Infancy and Early
Childhood (cont.)

• Obesity
• a chronic medical condition characterized by
  excessive body fat (usually a BMI above the 95th
  percentile)
• significantly affects childrens psychological
  and physical health
• prevalence is increasing- as of 1990s, 15 of
  children were overweight
• low correlation between obesity in infancy and
  obesity later in childhood, but childhood-onset
  obesity is more likely to persist into
  adolescence and adulthood

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Figure 13.3 U.S. comparison with the next
highest countries and the country with the lowest
percentage of obese youth.
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Feeding and Eating Disorders of Infancy and Early
Childhood (cont.)

• Obesity (cont.)
• pre-adolescent obesity a risk factor for later
  EDs
• the U.S. has the highest percentage of overweight
  children, and rates of obesity seem to increase
  upon exposure to Western culture and its fast
  food industries
• causes include genetic predisposition (including
  leptin deficiencies), improper diet, unhealthy
  lifestyle, as well as family influences, such as
  poor communication, lack of support, and
  maltreatment
• proper nutrition and less sedentary lifestyle are
  the recommended treatments- restricting diets not
  usually recommended

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Figure 13.2 Bigger meals, bigger kids. Sources
Centers for Disease Control and Prevention,
McDonalds, and Newsweek.
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Eating Disorders in Adolescence

• Anorexia Nervosa
• characterized by refusal to maintain minimally
  normal body weight, intense fear of gaining
  weight, and disturbance in perception of body
  size
• denial of thinness a notable feature
• DSM-IV subtypes
• restricting type - individual loses weight
  through diet, fasting, or excessive exercise
• binge-eating/purging type - individual engages in
  episodes of binge eating or purging, or both
• numerous negative medical consequences

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Eating Disorders in Adolescence (cont.)

• Bulimia Nervosa
• primary feature is recurrent binge eating
• binges are followed by either purging
  (self-induced vomiting or misuse of laxatives or
  diuretics) or by non-purging compensation
  (fasting, excessive exercise)
• as with anorexia, self-evaluation is greatly
  influenced by body shape and weight

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Eating Disorders in Adolescence (cont.)

• Bulimia Nervosa (cont.)
• two subtypes dietary-depressive subtype show
  more eating pathology, social impairment,
  psychiatric comorbidity, and persistence of
  symptoms over five years than women with only the
  dietary subtype
• significant medical consequences, but not as
  severe as those from anorexia
• Binge Eating Disorder (BED)
• similar to bulimia without the compensatory
  behaviors
• 3.1 of girls, and 0.9 of boys

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Figure 13.4 Compensatory behaviors of
full-syndrome bulimia nervosa among community
samples. Data from Garfinkel et al., 1995
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Eating Disorders of Adolescence (cont.)

• Prevalence
• among female adolescents, estimated prevalence of
  anorexia is 0.3, and bulimia is 1
• both AN and BN are much more common among females
• Eating Disorders- Not Otherwise Specified (EDNOS)
  is a category of eating disorders that covers
  problems that do not quite fulfill criteria for
  AN or BN prevalence may be much higher than AN
  and BN

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Eating Disorders of Adolescence (cont.)

• Young men that are affected with eating disorders
  place more emphasis on athletic appearance or
  attractiveness than on thinness
• Among American minorities, it was found that
  Hispanics had equal, Blacks and Asians lower, and
  Native American women higher rates of eating
  disorders compared to Caucasians

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Eating Disorders of Adolescence (cont.)

• Development
• onset of anorexia usually between ages 14 and 18,
  and is sometimes linked to stressful life events
  fewer than 1/2 show full recovery many fluctuate
  between recovery and relapse
• onset of bulimia usually late adolescence to
  early adulthood binge eating often develops
  after a period of restrictive dieting may follow
  a chronic course or occur intermittently between
  50-75 show full recovery
• although disordered eating tends to decline in
  early adulthood, body dissatisfaction remains an
  issue for many young adults

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Eating Disorders of Adolescence (cont.)

• Causes
• Biological dimension
• neurobiological factors play only a minor role in
  precipitating anorexia and bulimia, but likely
  contribute to their maintenance because of
  effects on appetite, mood, perception, and energy
  regulation
• genetic contribution inherit a biological
  vulnerability that interacts with social and
  psychological factors
• imbalances of serotonin may be implicated
• biochemical similarities found between people
  with eating disorders and those with OCD

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Eating Disorders of Adolescence (cont.)

• Causes (cont.)
• Social dimension
• belief in Western culture that self-worth,
  happiness, and success are determined by physical
  appearance
• sex-role identification and social conformity can
  contribute to eating problems
• possible family influences include family
  dysfunction, an overemphasis on weight and
  dietary control, and child sexual abuse

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Eating Disorders of Adolescence (cont.)

• Causes (cont.)
• Psychological dimension
• adolescents with anorexia show a triad of
  personality features avoidance of harm, low
  novelty seeking, and reward dependence
• affect disturbance is often comorbid with
  anorexia
• bulimia is associated with mood swings, poor
  impulse control, obsessive-compulsive behaviors,
  depression, anxiety, and substance abuse
• almost 90 of persons with eating disorders have
  other Axis I disorders, usually depression,
  anxiety, or OCD

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Eating Disorders of Adolescence (cont.)

• Treatment for anorexia and bulimia
• hospitalization in some cases
• antidepressants and SSRIs may be helpful for
  bulimia, but not anorexia
• psychosocial interventions are proving to be
  effective and are generally more effective than
  medications alone
• Resolution of family problems may be crucial
• Anorexia is generally less responsive to
  treatment than bulimia

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Eating Disorders of Adolescence (cont.)

• Treatment (cont.)
• for anorexia, family-based interventions often
  required to restore healthy communication
  patterns, and cognitive-behavioral methods may be
  used to modify rigid beliefs, self-esteem, and
  self-control processes
• for bulimia, cognitive-behavioral therapies that
  focus on attitudes, beliefs, and behaviors
  supporting problematic eating are effective, as
  is interpersonal therapy that addresses
  situational and personal issues contributing to
  the development and maintenance of the disorder