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Eating Disorders


CHAPTER TEN Eating Disorders Eating Disorders Bulimia-nervosa: Description and classification Anorexia-nervosa: Description and classification Onset and ... – PowerPoint PPT presentation

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Title: Eating Disorders

Eating Disorders

Eating Disorders
  • Bulimia-nervosa Description and classification
  • Anorexia-nervosa Description and classification
  • Onset and epidemiology
  • Etiology of eating disorders
  • Treatment
  • Special topic Culture, media, and body image

Bulimia Nervosa Diagnostic Criteria
  • Binge eating occurring, on average, at least
    twice a week (for 3 months)
  • Recurrent, inappropriate compensatory behavior
    (also for 3 months)
  • Self-evaluation is unduly influenced by body
    shape and weight

Binge Eating Definition
  • Eating a greater amount of food in a fixed period
    of time (e.g., 2 hours) than what most people
    would eat in the same time period and
  • AND
  • Accompanied by a sense of lack of control over
    what and how much one is eating

Other characteristics
? May be planned or spontaneous ? Usually done in
secret ? Often triggered by unhappy moods ? Often
people eat until they are uncomfortably full and
feel ashamed
Bulimia Types
  • Purging type
  • Characterized elimination of consumed food (not
    effective in reducing caloric intake)
  • ? self-induced vomiting (90)
  • ? misuse of laxatives, diuretics, or enemas
    (less common)
  • Associated with more frequent binging
  • Associated with more psychopathology and family
  • Non-purging type
  • Characterized by fasting or excessive exercise
  • Less common

Bulimia Nervosa Associated Features
  • Self-esteem and much of daily routine center on
    weight, diet, and appearance
  • Very sensitive to others comments about their
    weight or appearance
  • Depression is the most common comorbid condition,
    and may precede or follow bulimic symptoms
  • Anxiety disorders, personality disorders
    (especially borderline), and substance abuse may
    also co-occur

Anorexia Nervosa Diagnostic Criteria
  • Refusal to maintain a normal body weight
  • Weight is less than 85 of what is considered
    normal for height
  • An intense fear of gaining weight, which is not
    reduced by weight loss.
  • Amenorrhea (in females) the loss or irregularity
    of the menstrual period.
  • Distorted sense of body shape

Body Image Distortion(studies using the
Schematic apperception task described in Fig.
  • Most women rate themselves as fatter than they
    really are
  • Most men rate their ideal woman as heavier than
    women rate what they think mens ideals are
  • Most men rate themselves as more muscular than
    they really are
  • Most women rate their ideal man as thinner than
    men rate what they think womens ideals are

Associated Features of Anorexia
  • may deny problems with weight
  • unduly influenced by their body weight or shape
    in self-evaluation
  • take pride in their ability to restrict
  • comorbid diagnoses of obsessive-compulsive
    disorder, obsessive-compulsive personality
    disorder, and depression are common.

Types of Anorexia(subtypes are equally common)
  • Restricting type
  • Limit the amount of food eaten
  • Rarely or never binge eat or purge
  • Binge-eating-purging type
  • Regular binge eating and purging

Onset of Bulimia Anorexia
  • Onset is the same for both disorders
  • Typically late adolescence/early adulthood.
  • This may be related to
  • hormonal changes
  • autonomy struggles
  • problems with sexuality
  • and reactions to normal changes in weight or
    shape (women gain fat during puberty)

Epidemiology of eating disorders (ethnicity)
  • Prevalence of eating disorders varies among US
    ethnic minority populations. Compared to
    Caucasian women
  • African American and Asian American women have
    lower prevalence rates
  • Latinas have similar prevalence rates
  • Native American women have higher prevalence rates

Epidemiology of eating disorders (ethnicity)
In general, research has shown that compared to
Caucasian adolescents, African American
adolescents ? have less body dissatisfaction ?
fewer weight concerns ? a more positive
self-image ? perceive themselves to be thinner
than actually are However, the gap is narrowing
with rates of eating disorders increasing for
African American adolescents
  • Both disorders are 10 times more common in
    females than males
  • Bulimia 1-3 of females
  • Anorexia .5-1 of females
  • Both are more common in North America, Western
    Europe and industrialized Asian nations
  • Rates of Bulimia suggest a cohort effect for
    females born after 1960

Cohort Effect
Etiology of Eating Disorders Troubled Family
  • Enmeshment
  • an extreme form of over-involvement and
  • intimacy (more common w/ anorexia)
  • Overprotectiveness
  • an extreme level of concern for each others
  • welfare (more common w/ anorexia)

Etiology of Eating Disorders Troubled Family
  • Rigidity
  • maintain the status quo and avoid dealing with
  • events that require change (e.g., the demand
  • that adolescence creates for increased
  • autonomy)
  • Lack of conflict resolution
  • either avoid conflict or are in a state of
  • conflict

Etiology of Eating Disorders
  • Efforts to control eating reflect attempts to
    exert their own control
  • Perfectionism socially oriented (trying to
    conform to the high standards imposed by others),
    conforming, eager to please
  • Preoccupation with their social selves how they
    present themselves and how others see them

Etiology of Eating Disorders
  • Genetics concordance rates of 23 for MZ twins
    and 9 for DZ twins have been found in bulimia
  • Poor introceptive awareness or recognition of
    internal cues like hunger and fullness
  • Dietary restraint may trigger binges due to
    increased hunger, preoccupation with food, and
    lowered attention to internal cues

Bulimia Nervosa Treatment
  • The first step in treatment is a medical exam and
    treatment (replacing fluid or electrolytes may be
  • Antidepressant medication is somewhat effective,
    psychotherapy is more effective
  • Most treatment for bulimia occurs in outpatient
    settings in individual, group or combination

Treatment of Bulimia Psychotherapy
  • Types of therapy used most often include
    cognitive behavioral or interpersonal therapy
  • Some specific techniques used in various
    treatment programs include
  • ? nutritional intervention (instructions on
    modifying eating patterns) and meal planning
  • ? psychoeducation
  • ? exposure and response prevention

Treatment of Bulimia CBT
  • Interrupting the bulimic behavior
  • Client and therapist identify cues (e.g.,
    dieting) that trigger bulimic behavior
  • Therapist begins with an explanation of the
    relationship between cognitions and eating
    behaviors and provides nutritional education
  • Self-monitoring of eating behavior with an
    emphasis on consistently eating three to four
    times a day

Treatment of Bulimia CBT
  • Coping with expected relapses
  • Situations that provide a high risk for relapse
    are identified
  • Patients are encouraged to develop plans for
    dealing with these, such as through the use of
    high-risk exposure, during the latter phases of

Bulimia Treatment Outcome
  • With treatment, about 50 of bulimia patients are
    free of all symptoms, but 20 continue to meet
    diagnostic criteria
  • Cognitive behavior therapy significantly reduces
    binge eating and purging (33-50 stop completely)
  • Comorbid psychological disorders appear to
    improve when bulimic symptoms end
  • Treatment is more effective for bulimia than for

Anorexia Nervosa Treatment
  • Two goals for treatment
  • Weight gain, including use of inpatient setting
    with coercive methods if necessary (e.g., forced
    feeding, strict behavior therapy programs)
  • Address the difficulties that cause or maintain
    the problems, commonly through individual and
    family therapy.
  • Treatment challenge Therapeutic alliance
  • Fear of weight gain often propels anorexia
    patients into defensive positions health
    professionals are often seen as dangerous or
  • Psychological characteristics may also contribute
    to a mistrust of interpersonal relationships.

Family Intervention for Anorexia
  • The first task may be to defuse unproductive
    blaming (education) and to redirect the familys
    effort toward providing mutual support.
  • Family therapy
  • aims to facilitate changes in family function
    that will assist the anorexic individual in
    recovery and concurrently improve emotional
    health of other family members.

Anorexia Treatment Outcome
  • In a longitudinal study, it was estimated that
    14 of patients die from suicide or from
    complications of anorexia
  • Only about 50 of patients return to normal
    weight, 75 show some improvement, 10-20 remain
    significantly below weight
  • The majority remain preoccupied with diet,
    weight, and shape
  • Anorexia is more difficult to treat than bulimia.

Special Topic
  • Culture, Media,
  • Body Image

Unattainable Body-Images Can they cause eating
  • Research has demonstrated
  • that cultural standards of
  • beauty and the medias
  • exaggeration of these
  • standards can cause eating
  • disorders
  • Differences over time in the U.S.
  • Differences between countries
  • Differences among cultural groups
  • Longitudinal studies of media exposure

Media exposure predicts eating disorders
  • Longitudinal study with thinness-promoting
    magazines and television with 232 female and 190
    male undergrads in 1994
  • ? Quantity of media use
  • ? Content of media
  • TV thin, average, heavy characters
  • Magazines fitness, fashion, news, gossip, and
  • ? Outcome variables
  • Disordered eating
  • Body dissatisfaction
  • Drive for thinness
  • Perfectionism
  • Ineffectiveness

Magazine Exposure
  • 15.1 of the females met the cutoff for
    disordered eating
  • Fitness/diet magazines predicted symptoms of
  • Fitness/diet fashion magazines predicted
  • ? body dissatisfaction
  • ? drive for thinness

TV Exposure
  • Television exposure in general predicted
  • ? Body dissatisfaction
  • ? Drive for thinness
  • ? Ineffectiveness
  • Only exposure to thin TV shows predicted
    symptoms of anorexia nervosa

Media Exposure Men
  • Magazine television exposure predicted
    endorsement of diet and thinness for themselves
  • Endorsement of thinness for women (by men)
  • Fitness magazine exposure related to belief that
    a slim figure is an important characteristic in
    a woman
  • Magazine exposure correlated with mens
    anticipated disappointment in meeting an
    overweight blind date
  • Viewing a heavy TV show related to how
    important it is to their friends that a woman
    they date be thin

Internalization of the IdealThompson, Stice
Colleagues (1994-2001)
  • The more that people agree with these items,
  • the more they have internalized societys
  • standards of beauty.
  • I would like my body to look like the women that
    appear in TV shows and movies.
  • I wish I looked like the women pictured in
    magazines that model underwear.
  • Slender women are more attractive.
  • Women with toned bodies are more attractive.

How the Ideal Leads to Eating DisordersThompson,
Stice Colleagues (1994-2001)
In longitudinal research, it has been shown that
  • Media image of ideal, peers family reinforce
  • Internalization of the ideal
  • Body dissatisfaction
  • Dieting
  • Binging to counteract calorie deprivation or to
    relieve negative affect
  • Purging/or other compensatory behavior

What can we do about the media?
What can we do about the media?
  • Reduce exposure to media images.
  • Reduce internalization of the ideal
  • Education on becoming a critical consumer has
    been shown to reduce ideal internalization
  • Dissonance-based intervention persuaded women to
    voluntarily argue against this ideal through
    written, verbal, and behavioral exercises
  • Interrupt the social comparison process
  • Internet?

Optional Slides
What is a Healthy Weight?
  • BMI
  • Body Mass Index is used by physicians and
    experts to determine whether someone is
    underweight, normal weight or overweight by using
    height and weight
  • Formula BMI (weight)/(height in inches2) x
  • (Note that amount of muscle mass is not part of
    the formula)
  • Under 15 anorexic (56 woman, 92 lbs. or
  • Under 20 underweight (56 woman, under 123
  • 20-25 healthy (56 woman, 123-154 lbs.)
  • 25-30 overweight (56 woman, 154-185 lbs.)
  • 30 obese (56 woman, over 185 lbs.)

Anorexia Nervosa Epidemiology
  • Anorexia is found among .5 to 1 of adolescent
    and young adult females
  • Prevalence in males is .05 to .1
  • Typically begins in late adolescence/early
  • Most prevalent in North America, Western Europe
    and industrialized Asian nations than other areas

Garner et al. (1980) Playboy Centerfolds
Seifert (2005) Sypeck et al. (2006) Update on
Playboy Centerfolds
Garner et al., (1980) Diet articles