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Eating Disorders

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Think of cultural or familial attitudes with respect to food and eating behavior. ... Involve eating massive amounts of food rapidly with little chewing ... – PowerPoint PPT presentation

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Title: Eating Disorders


1
Chapter 11
Slides Handouts by Karen Clay Rhines,
Ph.D. Seton Hall University
  • Eating Disorders

2
Group Discussion
  • Think of cultural or familial attitudes with
    respect to food and eating behavior.
  • Do you think any of these attitudes might
    influence eating disordered behavior?

3
Eating Disorders
  • Two main diagnoses
  • Anorexia nervosa
  • Bulimia nervosa

4
Anorexia Nervosa
  • The main symptoms of anorexia nervosa are
  • A refusal to maintain more than 85 of normal
    body weight
  • Intense fears of becoming overweight
  • A distorted view of body weight and shape
  • Amenorrhea
  • Two main subtypes
  • Restricting type
  • Binge-eating/purging type

5
Anorexia Nervosa
  • About 9095 of cases occur in females
  • The peak age of onset is between 14 and 18 years
  • Between 0.5 and 2 of females in Western
    countries develop the disorder
  • Many more display some symptoms
  • Rates of anorexia nervosa are increasing in North
    America, Japan, and Europe

6
Anorexia Nervosa
  • The typical case
  • A normal to slightly overweight female has been
    on a diet
  • Escalation to anorexia nervosa may follow a
    stressful event
  • Separation of parents
  • Move or life transition
  • Experience of personal failure
  • Most patients recover
  • However, about 2 to 6 become seriously ill and
    die as a result of medical complications or
    suicide

7
Anorexia Nervosa The Clinical Picture
  • The key goal for people with anorexia nervosa is
    becoming thin
  • The driving motivation is fear
  • Despite their dietary restrictions, people with
    anorexia are extremely preoccupied with food
  • This includes thinking and reading about food and
    planning for meals
  • This relationship is not necessarily causal

8
Anorexia Nervosa The Clinical Picture
  • People with anorexia nervosa also think in
    distorted ways
  • Often have a low opinion of their body shape
  • Tend to overestimate their actual proportions
  • Hold maladaptive attitudes and misperceptions
  • I must be perfect in every way
  • I will be a better person if I deprive myself
  • I can avoid guilt by not eating

9
Anorexia Nervosa The Clinical Picture
  • People with anorexia may also display certain
    psychological problems
  • Depression (usually mild)
  • Anxiety
  • Low self-esteem
  • Insomnia or other sleep disturbances
  • Substance abuse
  • Obsessive-compulsive patterns
  • Perfectionism

10
Anorexia Nervosa Medical Problems
  • Caused by starvation
  • Amenorrhea
  • Low body temperature
  • Low blood pressure
  • Body swelling
  • Reduced bone density
  • Slow heart rate
  • Metabolic and electrolyte imbalances
  • Dry skin, brittle nails
  • Poor circulation
  • Lanugo

11
The Vicious Cycle of Anorexia
  • Fear of obesity and distorted body image lead to

Starvation
Preoccupation with food
Harder attempts at thinness
Increased anxiety depression
Greater feelings of fear loss of control
Medical problems
12
Bulimia Nervosa
  • Characterized by binges
  • Also characterized by compensatory behaviors
  • Purging-type bulimia nervosa
  • Nonpurging-type bulimia nervosa

13
Bulimia Nervosa
  • Like anorexia nervosa, about 9095 of bulimia
    nervosa cases occur in females
  • The peak age of onset is between 15 and 21 years
  • Symptoms may last for several years with periodic
    letup

14
Bulimia Nervosa
  • Patients are generally of normal weight
  • Often experience weight fluctuations
  • Some may also qualify for a diagnosis of anorexia
  • Binge-eating disorder may be a related
    diagnosis
  • Symptoms include a pattern of binge eating with
    NO compensatory behaviors (such as vomiting)
  • This condition is not yet listed in the DSM-IV-TR

15
Bulimia Nervosa Binges
  • Number of binges per week can range from 2 to 40
  • Average 10 per week
  • Often carried out in secret
  • Involve eating massive amounts of food rapidly
    with little chewing
  • Binge-eaters commonly consume more than 1000
    calories (often more than 3000 calories) per
    binge episode

16
Bulimia Nervosa Binges
  • Emotions/Cognitions
  • Tension and/or powerlessness
  • Pleasure
  • Extreme self-blame, guilt, depression, and fears
    of weight gain and discovery

17
Bulimia Nervosa Compensatory Behaviors
  • Most common
  • Vomiting
  • Laxatives and diuretics
  • Temporary relief
  • Cycle develops in which purging ? bingeing ?
    purging
  • The typical case
  • A normal to slightly overweight female has been
    on an intense diet

18
Bulimia Nervosa vs. Anorexia Nervosa
  • Similarities
  • Onset after a period of dieting
  • Fear of becoming obese
  • Drive to become thin
  • Preoccupation with food, weight, appearance
  • Elevated risk of self-harm or attempts at suicide
  • Feelings of anxiety, depression, perfectionism
  • Substance abuse
  • Disturbed attitudes toward eating

19
Bulimia Nervosa vs. Anorexia Nervosa
  • Differences
  • People with bulimia are more worried about
    pleasing others, being attractive to others, and
    having intimate relationships
  • People with bulimia tend to be more sexually
    experienced
  • People with bulimia display fewer of the
    obsessive qualities that drive restricting-type
    anorexia
  • People with bulimia are more likely to have
    histories of mood swings, low frustration
    tolerance, and poor coping

20
Bulimia Nervosa vs. Anorexia Nervosa
  • Differences
  • People with bulimia tend to be controlled by
    emotion may change friendships easily
  • People with bulimia are more likely to display
    characteristics of a personality disorder
  • Different medical complications
  • Only half of women with bulimia experience
    amenorrhea vs. almost all women with anorexia
  • People with bulimia suffer damage caused by
    purging, especially from vomiting and laxatives

21
What Causes Eating Disorders?
  • Most theorists subscribe to a multidimensional
    risk perspective
  • Several key factors place individuals at risk
  • More factors greater risk
  • Leading factors
  • Sociocultural conditions (societal and family
    pressures)
  • Psychological problems (ego, cognitive, and mood
    disturbances)
  • Biological factors

22
Anonymous Five-Minute Essay
  • Take the next five minutes to write down a list
    of assumptions/thoughts that you make/have when
    you see a (1) thin person or a (2) fat person.

23
Treatments for Eating Disorders
  • Eating disorder treatments have two main goals
  • Correct abnormal eating patterns
  • Address broader psychological and situational
    factors that have led to and are maintaining the
    eating problem
  • This often requires the participation of family
    and friends

24
Treatments for Anorexia Nervosa
  • The initial aims of treatment for anorexia
    nervosa are to
  • Restore proper weight
  • Recover from malnourishment
  • Restore proper eating

25
Treatments for Anorexia Nervosa
  • Researchers have found that people with anorexia
    must overcome their underlying psychological
    problems in order to achieve lasting improvement

26
Treatments for Anorexia Nervosa
  • Therapists use a mixture of therapy and education
    to achieve this broader goal, using a combination
    of individual, group, and family approaches
  • One focus of treatment is building autonomy and
    self-awareness
  • Therapists help patients recognize their need for
    independence and control
  • Therapists help patients recognize and trust
    their internal feelings

27
Treatments for Anorexia Nervosa
  • Another focus of treatment is correcting
    disturbed cognitions, especially client
    misperceptions and attitudes about eating and
    weight
  • Using cognitive approaches, therapists correct
    disturbed cognitions and educate about body
    distortions

28
Treatments for Anorexia Nervosa
  • Another focus of treatment is changing family
    interactions
  • Family therapy is important for anorexia
  • The main issues are often separation and
    boundaries

29
Treatments for Anorexia Nervosa
  • The use of combined treatment approaches has
    greatly improved the outlook for people with
    anorexia nervosa
  • But even with combined treatment, recovery is
    difficult
  • The course and outcome of the disorder vary from
    person to person

30
Treatments for Anorexia Nervosa
  • Positives of treatment
  • Weight gain is often quickly restored
  • 83 of patients still showed improvements after
    several years
  • Menstruation often returns with return to normal
    weight
  • The death rate from anorexia is declining

31
Treatments for Anorexia Nervosa
  • Negatives of treatment
  • Close to 20 of patients remain troubled for
    years
  • Even when it occurs, recovery is not always
    permanent
  • Anorexic behaviors recur in at least one-third of
    recovered patients, usually triggered by stress
  • Many patients still express concerns about body
    shape and weight
  • Lingering emotional problems are common

32
Treatments for Bulimia Nervosa
  • Treatment programs are relatively new but have
    risen in popularity
  • Treatment is frequently offered in specialized
    eating disorder clinics

33
Treatments for Bulimia Nervosa
  • The initial aims of treatment for bulimia nervosa
    are to
  • Eliminate binge-purge patterns
  • Establish good eating habits
  • Eliminate the underlying cause of bulimic
    patterns
  • Programs emphasize education as much as therapy

34
Treatments for Bulimia Nervosa
  • Several treatment strategies
  • Individual insight therapy
  • The insight approach receiving the most attention
    is cognitive therapy, which helps clients
    recognize and change their maladaptive attitudes
    toward food, eating, weight, and shape
  • As many as 65 stop their binge-purge cycle

35
Treatments for Bulimia Nervosa
  • Several treatment strategies
  • Individual insight therapy
  • If cognitive therapy isnt effective,
    interpersonal therapy (IPT), a treatment that
    seeks to improve interpersonal functioning, may
    be tried
  • A number of clinicians also suggest self-help
    groups or self-care manuals

36
Treatments for Bulimia Nervosa
  • Several treatment strategies
  • Behavioral therapy
  • Behavioral techniques are often included in
    treatment as a supplement to cognitive therapy
  • Diaries are often a useful component of treatment
  • Exposure and response prevention (ERP) is used to
    break the binge-purge cycle

37
Treatments for Bulimia Nervosa
  • Several treatment strategies
  • Antidepressant medications
  • During the past decade, antidepressant drugs have
    been used in bulimia treatment
  • Most common is fluoxetine (Prozac), an SSRI
  • Drugs help as many as 40 of patients
  • Medications are best when used in combination
    with other forms of therapy

38
Treatments for Bulimia Nervosa
  • Several treatment strategies
  • Group therapy
  • Provides an opportunity for patients to express
    their thoughts, concerns, and experiences with
    one another
  • Helpful in as many as 75 of cases, especially
    when combined with individual insight therapy

39
Treatments for Bulimia Nervosa
  • Left untreated, bulimia can last for years
  • Treatment provides immediate, significant
    improvement in about 40 of cases
  • An additional 40 show moderate improvement
  • Follow-up studies suggest that 10 years after
    treatment about 90 of patients have fully or
    partially recovered

40
Treatments for Bulimia Nervosa
  • Relapse can be a significant problem, even among
    those who respond successfully to treatment
  • Relapses are usually triggered by stress
  • Relapses are more likely among persons who
  • Had a longer history of symptoms
  • Vomited frequently
  • Had histories of substance use
  • Have lingering interpersonal problems

41
Treatments for Bulimia Nervosa
  • Finally, treatment may also help improve overall
    psychological and social functioning
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