Eating disorders

Question 1

Major types of DSM-IV eating disorders

Answer 1

 Anorexia nervosa and bulimia nervosa
 Both involve severe disruptions in eating behavior
 Both can involve extreme fear and apprehension about gaining weight
 Both have strong sociocultural origins

Question 2

Other Sub types of DSM-IV Eating Disorders

Answer 2

 Binge-eating disorder

 Rumination disorder, pica, feeding disorder

Question 3

Gender Differences?

Answer 3

 More frequently diagnosed with women  Lifetime prevalence rate
 Anorexia
 0.5% - 1%
 More women diagnosed than men  Bulimia
 1-3%
 90% of all cases are women

Question 4

Characteristics

Answer 4

 See eating disorders increasing with men
 Sports where man must “make weight”
 Increased advertising aimed at ideal image
 Men are catching up (ideal muscle)
 Common in young adolescents and the college population
 Issues related to body image are culturally defined
 Current “ideal” weight in U.S.
 15-20% below our average weight
 Not case in all cultures
 Not case across all times in U.S.

Question 5

Anorexia Nervosa

Answer 5

 Diagnostically
 Refusal to maintain a minimally normal body
weight
 15% below expected weight
 Intense fear of gaining weight
 Image problems
 Significant disturbance in perception of shape or size of one’s body
 Undue influence of body weight or shape on self- evaluation
 Denial of the seriousness of current low body weight  Amenorrhea
 Absence of at least three consecutive menstrual cycles
 Most be postmenarchael female

Question 6

Anorexia Nervosa

Answer 6

 DSM-IVSubtypesofAnorexia  Restricting subtype
 Limit caloric intake via diet and fasting  Binge-eating-purging subtype
 Induced vomiting or the misuse of laxatives, diuretics, or enemas
 About 50% of those diagnosed  AssociatedFeatures
 Most are co-morbid for other psychological disorders
 Methods of weight loss can have severe life threatening medical consequences

Question 7

Anorexia Nervosa

Answer 7

 Over-controlofeatingbehavior
 Relentless pursuit of thinness
 Person becomes “phobic” about gaining weight
 Weight is below what would be considered “ideal” by many
 Many begin with normal diet
 Then become extreme
 e.g., Limit caloric intake to 600 calories/day
 Starveselvestothinnessanddeath
 Death from malnutrition is main concern here


Question 8

Anorexia Nervosa

Answer 8

  Personispreoccupiedwiththinness
  May become obsessed with food and food related
issues
  May become gourmet cook
  Cook for others though
  Oftentimespersonwilleatalone
  Maywearbulkyclothes(bigsweaters)asget thinner
  Camouflage thinness, and/or
  Because they are cold
  Loss of body fat (insulator)

Question 9

Anorexia Nervosa

Answer 9

  Appearance will change
  Develop brittle hair and nails
  Eyes become sunken
  Bodychanges
  Lower body temperature
  Pulse drops
  Develop constipation
  Cease menstruating (amenorrhea)
  Body will feed off own tissue to survive
  Initially fat stores then organs

Question 10

Anorexia Nervosa

Answer 10

 Psychologicalchanges
 Low self-esteem
 Clinical depression or chronically low mood
 Moodiness
 Poor school performance
 Person may report difficulty thinking clearly
 Withdrawal from previous friendships and other
peer-relationships
 Deterioration in relationships with the family
 Hospitalization is necessary at extreme ends to keep person alive
 Intravenous feedings


Question 11

Anorexia Research Data

Answer 11

  Majorityare   Female
  Caucasian
  From middle-to-upper middle class families
  Usuallydevelopsaroundage13orearly
  Tendstobemorechronicandresistantto treatment than bulimia
  LifetimeprevalenceratesforAnorexia
  Females = 0.5%
  Males = 0.1%
adolescence

Question 12

Anorexia Research Data

Answer 12

 People suffering from eating disorders have the highest mortality rate of any mental illness
 National Association of Anorexia Nervosa and Associated Disorders
 5-10% of anorexics die within 10 years after contracting the disease
 18-20% of anorexics will be dead after 20 years
 only 30-40% ever fully recover

Question 13

Anorexia Research Data

Answer 13

 Death from anorexia nervosa
 12 times higher than ALL of combined
causes of death for females 15-24 years of age
 20% will prematurely die from complications related to their eating disorder
 Including suicide and heart problems
 30-50% of these deaths are from suicide


Question 14

Anorexia Treatment

Answer 14

 Medicaltreatment
 There are none with demonstrated efficacy
 Psychologicaltreatment  Weight restoration
 First and easiest goal to meet
 Treatment involves education, behavioral, and
cognitive interventions
 Treatment often involves the family
 Long-term prognosis for anorexia is poorer than
for bulimia

Question 15

Bulimia Nervosa

Answer 15

 Diagnostically
 Recurrent episodes of binge eating
 Eating, in a discrete period of time (e.g., within any 2-hour period), an amount of food that is definitely larger than most people would eat during a similar period of time and under similar circumstances
 Sense of lack of control over eating during the episode
 e.g., Feeling that one cannot stop eating or control what or how
much one is eating
 Recurrent inappropriate compensatory behavior to prevent
weight gain
 e.g., Self-induced vomiting; misuse of laxatives, diuretics,
enemas; fasting; or excessive exercise
 Occurs, on average, at least twice a week for 3 months
 Self-evaluation is unduly influenced by body shape and
weight
 Cannot occur exclusively during Anorexia Nervosa

Question 16

Bulimia Nervosa

Answer 16

 Characterized by binge eating and inappropriate compensatory methods to prevent weight gain
 Compensatory behaviors
 Purging
 Self-induced vomiting, diuretics, laxatives
 Some exercise excessively, others fast

Question 17

Bulimia Nervosa

Answer 17

 Binge cycling
 Rapid consumption of large amounts of food followed by some kind of purging
 Binge has been defined as 1200 calories at once
 Average binge is 4000-5000 calories  Problem
 People can define binge as very small caloric intake (1 candy bar) and must immediately purge this
 Probably still talking about Bulimia here

Question 18

Subtypes of bulimia

Answer 18

 DSM-IV Subtypes of bulimia  Purging subtype
 Most common subtype
 e.g., Vomiting, laxatives, enemas  Nonpurging subtype
 About6-8%ofcases
 e.g., Excess exercise, fasting

Question 19

Bulimia Nervosa

Answer 19

 Associated behaviors
 Person tends to be very secretive in both eating and purging
 Person often feels very depressed afterwards
 Most are over concerned with body shape, fear gaining weight
 Most are within 10% of target body weight
 Can be very painful to ingest massive amounts of calories

Question 20

Bulimia Nervosa

Answer 20

  Purgingmethodsleadtoseveremedical problems
  Very negative outcomes are possible with bulimia
  Damage the electrolyte system
  Damage to stomach
  Death is a possibility with bulimia
  Psychologicalfeatures
  Become more and more withdrawn
  Mood disorders
  Anxiety disorders
  Substance Abuse
  e.g., diet pills

Question 21

Bulimia Research Data

Answer 21

 Lifetime prevalence  1-3% for females
 90% are female
 6-10% of college women suffer from bulimia  0.1% for males
 Onset around 16 to 19 years of age  Tends to be chronic if left untreated

Question 22

Bulimia Research Data

Answer 22

 10% of individuals suffering from bulimia will die from either
 Starvation
 Cardiac arrest
 Other medical complications  Suicide

Question 23

Bulimia treatment

Answer 23

 MedicalTreatment
 Antidepressants can help reduce binging and
purging behavior
 Antidepressants are not efficacious in the long-
term
 PsychologicalTreatment
 Cognitive-behavior therapy (CBT) is the treatment of choice
 Interpersonal psychotherapy results in long-term gains similar to CBT
 Somedifficultieswithreplication

Question 24

College Populations

Answer 24

 Eating Problems  Research Data
 61% of college women have some kind of eating disturbance
 Chronic dieting, restrained eaters
 Not all diagnosable Eating Disorders
 About .1 to 1% of college women meet criteria for anorexia
 Bulimia is more common
 1-5% of freshman women are bulimic
 College athletes show high number of higher risk
eating/dieting behaviors  Making weight, etc.

Question 25

Characteristics of Women with Eating Disorders

Answer 25

 As children tend to be  High achieving  Perfectionistic  Often overly compliant  Come from family that places great emphasis on physical beauty  70% of these women on diets as early as elementary school

Question 26

IF A FRIEND HAS THIS

Answer 26

```  Bedirect  Tell person you’re concerned  Don'tcommentrepeatedlyonthethinness  May take this as compliment or as you being jealous  May be reinforcing  Instead,emphasizecaringaboutthisperson  Commenton  What you have observed  What your concerns are specifically ```

Question 27

IF A FRIEND HAS THIS

Answer 27

 Ifpersonopensup  May be great relief in getting this secret out in the open  Person may be angry at you for bringing this up  Be compassionate with the person  Want to be there with how they feel  Be comforting  Encourage person that people get better  Hang in there and support them

Question 28

Eating disorders and body image

Answer 28

 Socialization  Woman is told she can never be too thin  Thinness in advertising is linked to success in other areas  Overall, an incredible pressure in society to stay thin  Pressures are changing for ideal male image  Considertheseimagesfromthemedia

Question 29

Body Image Disturbance

Answer 29

```  Emergingareaofresearch  Continuum  Body image satisfaction  Body image dissatisfaction  Body image disturbance  Body Dysmorphic Disorder ```

Question 30

Body Dysmorphic Disorder

Answer 30

 Defined(DSM-IV-TR;APA,2000)  Preoccupation with perceived defect in appearance  If slight physical anomaly is present, concern is markedly excessive  Preoccupation causes clinically significant distress or impairment in social, occupational, or other important areas of functioning  Not better accounted for by another mental disorder (e.g., Anorexia Nervosa)  Prevalence: 4 - 40% US population  College: 4 - 18%

Question 31

Problems with BI disturbance

Answer 31

 Relationship to over all psychological distress  Relationship to seeking elective cosmetic surgery  As increase BID, more likely to seek surgery  Literature suggests may assist with distress  May become worse  Note that seeking surgery does not equal BID

Question 32

Body Dysmorphic Disorder

Answer 32

 Conceptualizations  Somatoform Disorder  Body-based problem (pain, hypochondriasis)  Eating disorder  BDD present, subsumed by Anorexia Nervosa  Obsessive compulsive spectrum disorder  Cyclic pattern of checking, symptom alleviation  Psychotic disorder  Delusional quality of perceptions and beliefs

Question 33

Body Dysmorphic Disorder

Answer 33

 Challenge of multiple conceptualizations  Etiology unclear  Treatment (theoretically) depends on formulation  Multiple formulations – where to start?  Each has very different implications (drugs, therapy, etc.)  Convoluted clinical science

Question 34

Body Dysmorphic Disorder

Answer 34

 Intrapersonalfactors  Seek to remove or eliminate experience of emotional or cognitive distress (experiential avoidance)  Negatively reinforced escape and avoidance repertoire  Avoidance of thoughts related to perceived deficit  Efforts to escape or neutralize those thoughts  Checking, camouflaging, surgeries  Unworkable strategy  Increased problems  Acceptance Commitment Therapy (ACT)  Hayes, Strosahl, & Wilson (2000)

Question 35

Conclusion

Answer 35

```  BehavioralfactorsareimportantinBDD  Experientialavoidance  Predicts BDD case  Does not predict BDD severity  Interpersonalproblemswithexpressionof emotional experiences  Do not predict BDD case  Predict BDD severity  Currentlybuildingspecificassessments  Empirically-basedtreatmentbuilding  Principally based intervention given these data ```