chapter 9

Question 1

Feeding and eating disorders

Answer 1

• Anorexia Nervosa*
• Bulimia Nervosa*
• Binge-Eating Disorder*
• Pica
• Rumination Disorder
• Avoidant/Restrictive Food Intake Disorder

Question 2

Eating disorders

Answer 2

• Eating disorders have dramatically increased as thinness has become a national obsession
• Anorexia nervosa
• Bulimia
• Binge-eating disorder

Question 3

Anorexia Nervosa checklist and definition

Answer 3

disorder marked by the pursuit of extreme thinness and by extreme weight loss

1. Individual purposely takes in too little nourishment, resulting in body weight that is very low and below that of other people of similar age and gender.
2. Individual is very fearful of gaining weight, or repeatedly seeks to prevent weight gain despite low body weight.
3. Individual has a distorted body perception, places inappropriate emphasis on weight or shape in judgments of herself or himself, or fails to appreciate the serious implications of her or his low weight.

Question 4

Anorexia Nervosa Specifiers/Two Main Types:

Answer 4

Restricting-type

Binge-eating purging type

Question 5

• Anorexia Nervosa Two main subtypes

Answer 5

• Restricting type
• Lose weight by cutting out sweets and fattening snacks, eventually eliminating nearly all food
• Show almost no variability in diet
• Binge-eating/purging type
• Lose weight by forcing themselves to vomit after meals or by abusing laxatives or diuretics
• May engage in eating binges

Question 6

• Anorexia Nervosa Progression

Answer 6

• A normal to slightly overweight
female has been on a diet
• Escalation toward anorexia nervosa may follow a stressful event
• Most patients recover, but as many as 6 percent do not

Question 7

• Anorexia Nervosa Clinical picture
key goal is to become
driving motivation is

Answer 7

• Key goal is becoming thin
• Driving motivation is fear
• Preoccupation with food occurs
• Thinking is distorted (see next slide)
• Usually have a low opinion of their body shape
• Tend to overestimate their actual proportions
• Hold maladaptive attitudes and misperceptions

Question 8

• Anorexia Tend to think in distorted ways:

Answer 8

• 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”

Question 9

• Anorexia Potential psychological problems and medical problems

Answer 9

• Potential psychological problems
• Depression, anxiety, low self-esteem, sleep disturbances
• Substanceabuse
• Obsessive-compulsive patterns and perfectionism
• Medical problems
• Amenorrhea-loss of menstruation
• Lanugo-soft feathery hair that babies have
•Lowered body temperature, low blood pressure, body swelling, reduced bone mineral density, slow heart rate
• Metabolic and electrolytei mbalances
• Skin, nail, and hair problems
2% to 6% become seriously ill and die

seriously ill, amnherio and lanugo

Question 10

Annorexia Nervosa Medical problems: Caused by starvation:

Answer 10

• 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 • Lose hair
• Lanugo
2% to 6% become seriously ill and die

Question 11

Bulimia Nervosa checklist and definition

Answer 11

engage in repeated episodes of uncontrollable overeating and binges with compensatory behaviors

1. Repeated binge-eating episodes.
2. Repeated performance of ill-advised compensatory behaviors (e.g., forced vomiting) to prevent weight gain.
3. Symptoms take place at least weekly for a period of 3 months.
4. Inappropriate influence of weight and shape on appraisal (evaluation) of oneself.

Question 12

• Progression Bulimia

Answer 12

• Normal to slightly overweight female has been on intense diet
• As with anorexia nervosa, 75 to 90 percent of bulimia nervosa cases occur in females
• Begins in adolescence or young adulthood, lasts for years with periodic let-ups
• Weight fluctuates but often stays within normal range

Question 13

• Binges

Answer 13

• Episodes of uncontrollable eating during which a person
ingests a very large quantity of food
• May involve 1 to 30 episodes per week and 2,000 to 3,400 calories per episode
• Often carried out in secret, usually with sweet, high-calorie, soft-texture foods
• Usually preceded by great tension, which is relieved by eating
• Followed by extreme self-blame, shame, guilt, depression, and weight gain fear

-ingest a lot of high calorie food in secret to relieve tension and feels guilty

Question 14

• Compensatory behaviors Bulimia

Answer 14

try to compensate for and undo binge effects
• Disorder is also characterized by inappropriate compensatory
behaviors
• Vomiting
• Laxative or diuretics use
• Compensatory behaviors effectiveness • Some temporary positive effects
• Caloric bingeing effects not undone- only loose half of calories

Question 15

Bulimia Nervosa Versus Anorexia Nervosa

similarities

Answer 15

• Similarities
• Distorted body perception
• Fear of becoming obese
• Preoccupation with food, weight, and appearance
• Disturbed eating attitudes
• Feelings of anxiety, depression, obsessiveness, and perfectionism
• Heightened risk of suicide attempts and fatalities

Question 16

• Differences: Bulimia

Answer 16

• More concern about
pleasing others
• Tend to be more sexually experienced
• Mood swings, frustration and boredom, and impulsivity more likely
• Dental problems more likely
• Amenorrhea less likely

Question 17

Body Dissatisfaction is the single

Answer 17

• Body dissatisfaction is the single most powerful contributor to dieting and to the development of eating disorders.
• People who evaluate their weight and shape negatively are experiencing body dissatisfaction.
• Approximately 73 percent of all girls and women are dissatisfied with their bodies, compared with 56 percent of all boys and men.
• The vast majority of dissatisfied females believe they are overweight. In contrast, half of dissatisfied males consider themselves overweight and half consider themselves underweight.

Question 18

Binge-Eating Disorder

checklist

Answer 18

1. Recurrent binge-eating episodes.
2. Binge-eating episodes include at least three of these features:
   • Unusually fast eating
   • Absence of hunger
   • Uncomfortable fullness
   • Secret eating due to sense of shame
   • Subsequent feelings of self-disgust, depression, or severe guilt.
3. Significant distress.
4. Binge-eating episodes take place at least weekly over the course of 3 months.
5. Absence of excessive compensatory behaviors.

Question 19

Binge Eating Disorder definition

Not the same drive to

Answer 19

Repeated eating binges during which people feel no control over their eating and do not engage in inappropriate compensatory behavior
• Found in 2 to 7 percent of the population
• At least 64 percent are female
• Has a later age of onset
• As a result of their frequent binges, half become overweight or even obese
• Many shared features with bulimia nervosa or anorexia nervosa, but not the same drive to thinness

Question 20

What Causes Eating Disorders? (part 1)

Answer 20

• Most theorists and researchers use a multidimensional risk perspective
• Several key factors place individuals at risk
• More factors = greater likelihood of developing a disorder
• Leading factors
• Psychodynamic
• Cognitive-behavioral
• Biological
• Societalpressures
• Family environment
• Multicultural

Question 21

• Psychodynamic factors:

Answer 21

ego deficiencies

• Bruch: Psychodynamic theory of eating disorders
• Disturbed mother–child interactions lead to serious child ego deficiencies and severe perceptual disturbances
• Children of ineffective parents(fail to attend child needs) become confused adults who are unaware of their internal needs
• People with eating disorders inaccurately perceive internal cues (alexithymic) and are more likely to worry about how they are viewed by others

Question 22

• Cognitive-behavioral factors

Answer 22

• Bruch: Several cognitive factors, such as improper labeling of
internal sensations and needs, contribute to eating disorders
• Little control over life may result in excess control of body size
• This contributes to a broad cognitive distortion that lies at the center of disordered eating—for example, negative self- judgment based on body shape and weight

Question 23

• Depression

Answer 23

• Helps set the stage for eating disorders
• Many more people with eating disorders are diagnosed with major depressive disorders than in the normal population
• Close relatives with eating disorders have higher rates of depressive disorders
• Similar brain circuit abnormalities in those with eating disorders and depression
• Antidepressant drugs sometimes help persons with eating disorders

Question 24

• Biological factors

Answer 24

• Certain genes may cause susceptibility to eating disorders
• Relatives of people with eating disorders are six times more likely to develop eating disorders themselves
• Brain circuit dysfunction linked to interconnectivity problems
• Larger and more active insula, orbitofrontal cortex, and striatum; smaller prefrontal cortex
• Abnormal activity levels of serotonin, dopamine, and glutamate

Question 25

other biological factors

Answer 25

* Other biological theorists focus on the hypothalamus * Lateral hypothalamus(LH):Produces hunger * Ventromedial hypothalamus(VMH):Reduces hunger * Weight set point * Set by genetic inheritance and early eating practices * Responsible for keeping an individual at a particular weight level

Question 26

• Societal pressures

Answer 26

* Western standards for female attractiveness * Socially accepted prejudice against overweight people * Higher risks for eating disorders within certain subcultures (e.g., models, actors, dancers, and certain athletes) * Economic and racial differences in eating disorders prevalence rates * Social networking, Internet activity, and television browsing

Question 27

• Family environment

Answer 27

* Families may impact and maintain eating disorders * History of emphasis on thinness, appearances, or dieting * Dieting and perfectionistic mothers * Enmeshed family patterns (overinvolvement; overconcern) (Minuchin)-force child to take on sick role

Question 28

-Multicultural factors: Gender Differences

Answer 28

• Males account for only 10 percent of all cases of eating disorders • Influenced by Western society's double standard for attractiveness • Different methods of weight loss favored-prefer to exercise instead of diet-no eating disorder • Influenced by job or sports pressure • Reverse anorexia nervosa or muscle dysmorphobia found in men-want to be muscular

Question 29

• Multicultural factors: racial and ethnic differences

Answer 29

* Different ideals of beauty * Young African American females demonstrate healthier eating behaviors and attitudes, although a shift is now occurring * Hispanic American female attitudes are more similar to those of young white American females * Increase in eating disorders in Asian American females noted

Question 30

• Eating disorder treatment goals

Answer 30

* Correct dangerous eating patterns * Address broader psychological and situational factors that have led to, and are maintaining, the eating problem correct and identify

Question 31

Basic Treatments for | anorexia nervosa

Answer 31

* Immediate aims of treatment for anorexia nervosa * Regain lost weight * Recover from malnourishment * Eat normally again

Question 32

* Treatments for anorexia nervosa | * Restoring weight and normal eating methods

Answer 32

* Nutritional rehabilitation * Intravenous feedings * Behavioral weight-restoration approaches-reward no reward * Combination of supportive nursing care, nutritional counseling, and high-calorie diet * Motivational interviewing

Question 33

• Achieving lasting changes | Cognitive-behavioral therapy for anorexia

Answer 33

• Identification of core pathology and alternative stress and problem-solving strategies • Monitoring ties between feelings, hunger levels, and food intake-diary • Changing attitudes about weight and eating • Most successful when continued for at least a year beyond recovery and supplemented by other approaches behavioral-diary cognitive-identify core pathology(cause)

Question 34

• Achieving lasting changes with family for anorexia

Answer 34

* Changing family interactions * Involvement of whole family * Separation of feelings and needs from those of other family members

Question 35

• Treatment aftermath for anorexia nervosa

Answer 35

• Weight is quickly restored and continued improvement is evident for the majority of clients • Medical improvements and fewer deaths • One-fourth of patients experience a continued a variety of difficulties • Psychological problems may persist

Question 36

• Treatments for bulimia nervosa-immediate treatment aims

Answer 36

* Treatment is frequently offered in eating disorder clinics * Immediate treatment aims * Eliminate binge-purge patterns * Establish good eating habits * Eliminate the underlying cause of bulimic patterns * Programs emphasize education as much as therapy

Question 37

• Treatments for bulimia nervosa | cognitive behavioral therapies

Answer 37

* Cognitive-behavioral therapy * Behavioral techniques • Diaries * Exposure and response prevention (ERP) -eat food prevent them from throwing up • Cognitive techniques • Help clients recognize and change maladaptive attitudes toward food, eating, weight, and shape • Typically teach individuals to identify and challenge negative thoughts that precede the urge to binge -change maladaptive attitudes and negative thoughts

Question 38

• Treatments for bulimia nervosa | other forms of psychotherapy

Answer 38

* Other forms of psychotherapy in individual or group formats * Interpersonal psychotherapy-help interpersonal relationships functioning * Psychodynamic therapy * Family therapy * Antidepressant medications

Question 39

• Treatment aftermath for bulimia nervosa | untreated bulimia can last

Answer 39

* Untreated bulimia nervosa can last for years * Treatment provides immediate, significant improvement in about 40 percent of cases; 40 percent show moderate response * Ten years after treatment, about 75 percent of patients are fully or partially recovered * Relapses are often triggered by stress

Question 40

• Treatments for binge-eating disorder and how effective is it

Answer 40

* Treatments are often similar to those for bulimia nervosa • Reduction or elimination of binge-eating patterns * Cognitive-behavioral therapy * Other forms of psychotherapy * Antidepressant medications help reduce or eliminate the binge- eating patterns and change disturbed thinking such as being overly concerned with weight and shape * Short-term effectiveness; high relapse risk * Additional weight management interventions are often needed

Question 41

Trending: Shame on Body Shamers

Answer 41

* Body shaming has been noted since the mid-nineteenth century * Today’s Internet and media provide a larger platform for cruel comments * 94 percent of teen girls and 64 percent of boys have experienced body shaming * A counter-trend led by influential celebrities is raising awareness

Question 42

Prevention of Eating Disorders: Wave of the Future

Answer 42

* Various treatments for eating disorders have improved but do not bring about a full recovery * Some clinical theorists believe that researchers must invest more work into the development of programs that prevent the onset of eating disorders * Prevention programs address a critical need in the clinical field’s commitment to overcome eating disorders and are likely to increase in the years to come