Eating Disorders

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Eating Disorders

• Abnormal Psychology

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Why these problems are important

• mean age of onset is 17 years
• prevalence is high among high school girls and
  college women
• 40 percent of normal weight college women
  consider themselves fat
• 80 percent report eating episodes that seem
  beyond their control
• long-term mortality rate for anorexia is
  approximately 6 (starvation, suicide, etc)

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DSM-IV Criteria for Anorexia Nervosa

• refusal to maintain normal body weight
• (85 percent of expected weight)
• intense fear of gaining wt or becoming fat
• disturbance in the way body weight or shape is
  experienced
• amenorrhea (absence of at least 3 consecutive
  menstrual cycles)

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Subtypes of Anorexia

• RESTRICTING TYPE rigid adherence to diet or
  exercise
• tend toward compulsive personality
• inflexible strict about rules and morals
• BINGE-EATING / PURGING TYPE
• tend toward impulsiveness and substance abuse

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How Thin is Too Thin?

• DSM-IV says 85 of expected body weight
• be careful with Table 10-1 (p. 360) considers
  height and weight
• e.g., 56 and 112 pounds -- below that the
  person is significantly underweight

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Other Characteristics of Women with Anorexia

• weight loss is viewed as an extraordinary
  achievement
• lack insight
• excessive weighing, using mirrors to look for
  fat
• brought to treatment by family members
• conforming and eager to please

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Associated Features (from starvation)

• depressed mood
• social withdrawal
• irritability
• insomnia
• preoccupied with food
• ONSET often follows stressful event, such as
  parents divorce or move away from home

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DSM-IV Criteria for Bulimia Nervosa

• recurrent episodes of binge eating, characterized
  by the following
• eating a very large amount of food (within a
  2-hour period)
• a sense of lack of control over eating during the
  episode

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DSM-IV Criteria for Bulimia Nervosa

• recurrent inappropriate compensatory behavior,
  such as self-induced vomiting
• bingeing and compensatory behaviors occur at
  least twice a week for 3 months
• self-evaluation unduly influenced by body shape
  and weight
• doesnt occur exclusively during episodes of
  anorexia nervosa

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Subtypes of Bulimia Nervosa

• PURGING TYPE (vomiting or laxatives)
• NON-PURGING TYPE (fasting, excessive exercise,
  manipulation of insulin doses by diabetic persons)

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Additional Descriptors for Bulimia

• most have normal (or above normal) body weight
• binge on high-calorie foods (sweets)
• bingeing is done secretly
• leads to guilt, shame, disgust
• more likely to have insight than anorexics
• high co-morbidity with depression

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Health Consequences of Bulimia

• serious dental problems
• lining of the mouth, throat, stomach
• heart and kidney problems
• electrolyte imbalance (e.g., sodium, chlorine,
  potassium, and bicarbonate -- dissolved salts or
  ions in body fluids that conduct electrical
  energy in cells)

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Long-term Outcome of Bulimia Nervosa

• Pamela Keel, James Mitchell et al (1999)
• started with 222 bulimic women followed up 173
  of them at least 10 years after initial
  evaluation (1 died -- suicide)
• mean age 35 99 white
• narrow definition of remission no eating
  problems for at least 6 months
• and weight did not unduly influence how person
  felt about herself
• broad definition of remission no eating
  problems for 8 weeks

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Status of 177 Bulimic Women at 10-year Follow-up
(percent remission)
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Long-term Outcome of Bulimia Nervosa

• 11 still met full criteria for bulimia nervosa
• 1 met criteria for anorexia nervosa
• 18 met criteria for eating disorder NOS (not
  otherwise specified)
• mean duration of symptoms was 6 years

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Epidemiology of Eating Disorders

• prevalence has increased dramatically
• much more common among women
• anorexia affects about 1 percent of adolescent
  females
• bulimia affects about 3 percent of adolescent
  females

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Psychiatric Disorders in 1st-Degree Relatives of
People with Eating Disorders

• Lilenfeld et al. (1998) from Western Psychiatric
  Institute in Pittsburgh
• direct interviews with relatives of women with
  anorexia (n26), bulimia (n47), and control
  women (n44)
• included both male and female relatives
• found 93 relatives in the AN group, 177 relatives
  in the BN group, and 190 relatives in the control
  group (CW)

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Co-Morbidity Lifetime Psychiatric Disorders
Among Probands (Anorexia or Bulimia) and Control
Women
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Lifetime Rates of Eating Disorders in Relatives
of Probands with Eating Disorders (percent
affected)
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Lifetime Rates of Mood and Substance Use
Disorders in Relatives of Probands with Eating
Disorders
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Lifetime Rates of Anxiety Disorders in Relatives
of Probands with Eating Disorders
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Cultural Factors and Eating Disorders

• great emphasis placed on womens appearance
• eating disorders much more common in
  industrialized countries
• more common in higher socioeconomic groups

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Gender Differences and Eating Disorders

• physical attractiveness predicts self-esteem in
  adolescent girls
• physical competence predicts self-esteem among
  adolescent boys

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Body Image Rating Scale
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Womens Ratings of Idea, Attractive, and Current
Body Size
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Mens Ratings of Idea, Attractive, and Current
Body Size
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Body Image Ratings by Women who Scored High on
Distorted Attitudes Toward Eating

• Rate ideal shape, current shape, and shape most
  attractive to the opposite sex (actual ratings by
  men shown as other attractive)

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Body Image Ratings by Women who Scored Low on
Distorted Attitudes Toward Eating

• Rate ideal shape, current shape, and shape most
  attractive to the opposite sex (actual ratings by
  men shown as other attractive)

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Psychological Factors and Eating Disorders

• Janet Polivy and Peter Hermanns research program
  on dietary restraint
• restrained eaters are more likely to binge after
  violation of diet

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Risk Factors for Bulimia Nervosa (Fairburn et
al., 1997)

• interviewed 102 women with bulimia nervosa, 204
  healthy control women (without an eating
  disorder), and 102 women with other psychiatric
  disorders (depression and anxiety disorders)
• general conclusions bulimia results from
  exposure to general risk factors for psychiatric
  disorders plus risk factors for dieting

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Personal Vulnerability Domains (factors possibly
related to onset of bulimia)

• childhood characteristics (e.g., negative
  self-evaluation, no close friends)
• premorbid psychiatric disorder (e.g., major
  depression)
• behavioral problems (e.g., conduct problems,
  school absence, deliberate self-harm)
• parental psychiatric disorder (e.g., depression,
  alcoholism, drug abuse)

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Personal Vulnerability Factors (percent of people
reporting by number of factors)
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Environmental Vulnerability Domains

• parental problems (e.g., separation from parents,
  criticism, minimal affection)
• disruptive events (e.g., severe personal health
  problems)
• parental psychiatric disorder (e.g., depression,
  alcoholism)
• teasing and bullying (not about shape/weight)
• sexual or physical abuse

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Environmental Vulnerability Factors (percent of
people reporting)
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Dieting Vulnerability Domains

• dieting risk (e.g., family members diet, critical
  comments from family about weight or shape)
• obesity risk (e.g., parental obesity, childhood
  obesity)
• parental eating disorder (either anorexia or
  bulimia)

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Dieting Vulnerability Factors (percent of people
reporting)