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Eating Disorders


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

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

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?

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

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

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

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

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

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

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

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

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

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

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

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
  • 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

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

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

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

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

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
  • People with bulimia display fewer of the
    obsessive qualities that drive restricting-type
  • People with bulimia are more likely to have
    histories of mood swings, low frustration
    tolerance, and poor coping

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

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
  • Psychological problems (ego, cognitive, and mood
  • Biological factors

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.

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

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

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

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
  • Therapists help patients recognize their need for
    independence and control
  • Therapists help patients recognize and trust
    their internal feelings

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

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

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
  • The course and outcome of the disorder vary from
    person to person

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
  • The death rate from anorexia is declining

Treatments for Anorexia Nervosa
  • Negatives of treatment
  • Close to 20 of patients remain troubled for
  • Even when it occurs, recovery is not always
  • 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

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

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
  • Programs emphasize education as much as therapy

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

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

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

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

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

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

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

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