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Essentials of Understanding Abnormal Behavior Chapter Fourteen

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Title: Essentials of Understanding Abnormal Behavior Chapter Fourteen


1
Essentials of Understanding Abnormal
BehaviorChapter Fourteen
  • Eating Disorders

2
Types of Eating Disorders
  • Anorexia nervosa
  • Bulimia nervosa
  • Binge-eating disorder
  • Eating disorder not otherwise specified

3
Eating Disorders
  • 13.4 of girls and 7.1 of boys engage in
    disordered eating patterns.
  • Paradox As emphasis on thinness is increasing,
    so is the problem of obesity
  • 7 million women and 1 million men in the U.S.
    suffer from eating disorders.
  • 15 of young women have substantially
    disordered eating attitudes and behaviors.

4
Factors Associated with Disordered Eating Patterns
  • Being overweight
  • Low self-esteem
  • Depression
  • Substance use
  • Suicidal ideation
  • More prevalent among females
  • Least likely among African American females

5
Table 16.1 Prevalence of Weight Concerns of
Youth in Grades 5-12
6
Figure 16.1 Disorders Chart Eating Disorders
7
Figure 16.1 Disorders Chart Eating Disorders
(contd)
8
Anorexia Nervosa
  • Eating disorder characterized by
  • Refusal to maintain a body weight above the
    minimum normal weight for a persons age and
    height
  • Intense fear of becoming obese that does not
    diminish with weight loss
  • Body image distortion
  • In females, absence of at least 3 consecutive
    menstrual cycles otherwise expected to occur

9
Table 16.2 Do You Have an Eating Disorder?
10
Anorexia Nervosa (contd)
  • Subtypes
  • Restricting Lose weight through dieting or
    exercising
  • Binge-eating/purging Lose weight through use of
    self-induced vomiting, laxatives, or diuretics

11
Anorexia Nervosa (contd)
  • Physical complications
  • Cardiac arrhythmia, low blood pressure, slow
    heart rate, weakened heart muscle
  • Lethargy, dry skin, brittle hair, swollen parotid
    glands, hypothermia
  • Males Osteoporosis, substance use disorder,
    antisocial personality disorder
  • Associated characteristics
  • Obsessive-compulsive behaviors and thoughts
  • Control

12
Anorexia Nervosa (contd)
  • Associated characteristics (contd)
  • Personality disorders/characteristics
  • Restricting introversion, conformity,
    perfectionism, rigidity
  • Binge eating/purging Extroverted, histrionic,
    emotionally volatile, impulse control problems,
    substance abuse

13
Anorexia Nervosa (contd)
  • Course and outcome Highly variable
  • Usually begins in adolescence
  • Better outcome for binge-eating/purging
  • More severe is associated with constricted/
    overcontrolled profile
  • 44 recover completely, 28 show some weight
    gain but remain underweight, poor outcome for
    24
  • Death 5-20, primarily from cardiac arrest or
    suicide

14
Bulimia Nervosa
  • Eating disorder characterized by
  • Recurrent episodes of binge eating (rapid
    consumption of large quantities of food) at least
    twice a week for 3 months, during which the
    person loses control over eating and uses
    vomiting, laxatives, and excess exercise to
    control weight
  • More psychopathology than non-bulimics Greater
    external locus of control, lower self-esteem and
    sense of personal effectiveness, negative
    self-image, although most are within normal
    weight range

15
Bulimia Nervosa (contd)
  • More prevalent than anorexia
  • Up to 3 of women suffer from bulimia, another
    10 report some symptoms
  • 10 of bulimics are male
  • Physical complications
  • Effects of vomiting Erosion of tooth enamel,
    dehydration, swollen parotid glands, low
    potassium (can weaken heart and cause arrhythmia
    and cardiac arrest)
  • Binge eating may cause stomach ruptures
  • Gastrointestinal disturbances

16
Bulimia Nervosa (contd)
  • Related to
  • Coping responses to stress
  • Mood disorders, especially seasonal affective
    disorder
  • Also shares characteristics of borderline
    personality

17
Bulimia Nervosa (contd)
  • Course and outcome
  • Generally begins late adolescence/early adulthood
  • Mixed, but better course than for anorexia
  • Some bulimics continue to show disturbed eating
    patterns, low self-esteem, depressive disorder,
    but most recover either fully or partially
  • Poorer prognosis with associated history of
    substance use and longer duration before treatment

18
Binge-Eating Disorder (BED)
  • Diagnostic category provided for further study
    in DSM-IV-TR
  • Involves a large consumption of food over a short
    period of time at least twice weekly for 6 months
  • Unlike bulimia, does not involve use of extreme
    behavioral attempts of vomiting, fasting, or
    excessive exercise as compensation for binge
    eating
  • Diagnosis History of binge-eating episodes at
    least 2 days/week for 6 months

19
Binge-Eating Disorder (contd)
  • Prevalence
  • Prevalence 0.7-4 of population
  • Females are 1.5 times as likely as males to have
    the disorder.
  • Prevalent among white, African American, and
    American Indian women (possibly 10), although
    white women are more likely to be seen for the
    disorder

20
Binge-Eating Disorder (contd)
  • Associated characteristics/risk factors
  • Overweight with history of weight fluctuation
  • Prevalence 2-5
  • Adverse childhood experiences, parental
    depression, vulnerability to obesity, repeated
    negative comments re weight and body
  • Binges preceded by poor mood, low alertness,
    feelings of poor eating control, cravings for
    sweets
  • Complications High blood pressure, high
    cholesterol, diabetes, and depression

21
Binge-Eating Disorder (contd)
  • Comorbid features
  • Major depressive disorder
  • Obsessive-compulsive personality disorder
  • Avoidant personality disorder
  • Course and outcome
  • Begins in late adolescence/early adulthood
  • Positive course compared with other eating
    disorders Most recover within 5 years
  • Weight remains high (over time, 1/3 meet
    criteria for obesity)

22
Eating Disorder Not Otherwise Specified
  • DSM-IV-TR Eating disorders not meeting criteria
    for anorexia or bulimia nervosa
  • Individuals with binge-eating disorder
  • Female who meets criteria for anorexia but has
    regular menses
  • Individual who has lost significant weight but is
    in normal weight range

23
Eating Disorder Not Otherwise Specified (contd)
  • DSM-IV-TR Eating disorders not meeting criteria
    for anorexia or bulimia nervosa (contd)
  • Individual engaging in binge eating and
    compensatory activities less than twice a week or
    less than 3 months
  • Normal weight individual who uses compensatory
    behaviors after eating, or who chews or spits out
    food without ingesting

24
Table 16.3 Overview of Major Risk Factors for
Eating Disorders
25
Etiology of Eating Disorders
  • Societal influences
  • Mass media portray ideal female body as 57 110
    lbs actual average is 54 162 lbs
  • Sociocultural demand for thinness
  • Peer influences
  • Criticisms by family members about weight
  • Dating

26
Etiology of Eating Disorders (contd)
  • Body dissatisfaction
  • Males see their bodies as smaller than what they
    believe is preferred females see their bodies as
    larger than what they believe is preferred
  • Most dissatisfaction parallels low self-esteem
  • Certain predisposition and characteristics lead
    some people to interpret images of thinness as
    evidence of their own inadequacy

27
Etiology of Eating Disorders (contd)
  • Exposure to ultra-thin ideal by media can lead
    to
  • Internalization of that image and eating patterns
    intended to bring about that ideal
  • Negative affect, which triggers dieting
  • Social comparison, which leads to disordered
    eating to meet external standards of comparison

28
Figure 16.4 Route to Eating Disorders
29
Etiology of Eating Disorders (contd)
  • Family and peer influences
  • Psychodynamic (for anorexia)
  • Fear of maturation
  • Growing up and separating from family
  • Developing own identity
  • Fulfills unconscious desire to remain a child
  • Family systems Problematic family communication
    patterns result in anorexia

30
Etiology of Eating Disorders (contd)
  • Family and peer influences (contd)
  • Socialization agents (peers and family)
  • Relationship problems and role models

31
Etiology of Eating Disorders (contd)
  • Cultural factors
  • Culture-bound (Western cultures) and other
    societies influenced by Western culture
  • Many African Americans seem insulated from
    thinness standard, but equally as likely to have
    binge-eating disorder
  • Internalization of U.S. societal values regarding
    attractiveness affects self-esteem and body
    dissatisfaction.

32
Table 16.5 Differences in Body Image and Weight
Concerns Among African American and White Females
33
Other Etiological Factors
  • Personality characteristics and negative
    emotional moods
  • Sexual abuse
  • Low self-esteem and feelings of helplessness
  • Passivity, dependence, nonassertivness
  • Anorexia Perfectionism, obedience, academic and
    athletic success, model children
  • Bulimia Perfectionism, seasonal affective
    disorder
  • Genetic factors First-degree relatives

34
Treatment of Eating Disorders
  • Prevention programs
  • Goals of school-based intervention program
  • Develop positive attitude toward ones body
  • Become aware of societal messages re being female
  • Develop healthier eating/exercise habits
  • Increase comfort in expressing feelings
  • Develop healthy strategies to deal with stress
  • Increase assertiveness skills

35
Treatment of Eating Disorders (contd)
  • Prevention programs (contd)
  • Teach females to examine consequences of gender
    messages
  • Institutional awareness of the problem is
    critical

36
Treatment of Eating Disorders (contd)
  • Anorexia nervosa
  • Inpatient/outpatient depends on weight and health
    of individual
  • Initial goal Restore weight with psychological
    support
  • Nutritional/physical rehabilitation
  • Identify/understand dysfunctional attitudes
  • Improve interpersonal/social functioning
  • Address comorbid psychopathology/psychological
    conflicts

37
Treatment of Eating Disorders (contd)
  • Anorexia nervosa (contd)
  • Family therapy Parents involved in meal
    planning, reduce criticism (understanding
    seriousness of anorexia), negotiate new
    relationship patterns, move toward separation and
    individuation

38
Treatment of Eating Disorders (contd)
  • Bulimia nervosa
  • Identify conditions contributing to purging
  • Identify physical conditions resulting from
    purging
  • Normalize eating pattern and eliminate
    binge-purge cycle

39
Treatment of Eating Disorders (contd)
  • Bulimia nervosa (contd)
  • Cognitive-behavioral therapy and use of
    antidepressants
  • Encourage eating 3 or more balanced meals a day
  • Reduce rigid food rules and body image concerns
  • Develop cognitive and behavioral strategies

40
Treatment of Eating Disorders (contd)
  • Binge-Eating Disorder
  • Similar to treatments for bulimia with fewer
    physical complications
  • Because most are overweight, therapy programs try
    to help individual lose weight
  • Three phases
  • Determine underlying cognitive factors
  • Use cognitive strategies to change distorted
    beliefs about eating
  • Relapse prevention strategies
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