Eating Disorders
Abnormal PsychologyChapter 10
Kate Moss vs. Marilyn Monroe
Cultural Obsessions with thinnessIncreased incidence of diagnosisStatistics of dieting and body perception
Eating Disorder Subtypes
Anorexia Nervosa-the refusal to maintain a minimally normal body weight. Anorexia literally means “loss of appetite” when in actuality people suffering from anorexia are hungry but they starve themselves, sometimes to death.Bulimia Nervosa-characterized by repeated episodes of binge eating followed by inappropriate compensatory behaviors suchas self-induced vomiting, misuse of laxatives or excessive exercise. Bulimia literally means “hungry enough to eat an ox”. The person suffering from bulimia usually has a normal appetite and maintain a normal weight.
Symptoms associated with Anorexia
Refusal to Maintain a Normal WeighDisturbance in evaluation weight or shapeFear of Gaining Weight4. Cessation of Menstruation (Amenorrhea)
Medical Complications
Electrolyte imbalance that can lead to cardiac arrest or kidney failure.Inability to maintain normal blood pressure and temperature.Lanugo-development of a fine downy hair on the face or trunk of the patient.Abnormally dry and cracked skinInfertilityDental erosionBone lossLethargyAnemia
Co-morbid Diagnosis
Obsessive Compulsive DisorderDepressionObsessive Compulsive Personality DisorderBi-directionality with OCD and Depression
Bulimia
Many people with bulimia have a history of anorexia.(Def). Eating an amount of food in a fixed period of time that is clearly larger thanmostpeople would eat under a similar circimstance.Societal Confounds to Def.
Binge Eating
Spontaneous or plannedInappropriate Compensatory Behaviors
Excessive Emphasis on Weight or Shape
Body perception and obsession shared with anorexics.Exhilarated by positive comments or interest in their appearance.Self –esteem falls with any negative comments about their appearance
Co-morbid Psychological Disorders
DepressionAnxiety DisordersPersonality DisordersSubstance Abuse
Medical Complications
Dental erosionSensitized Gag reflexEnlargement of the salivary glandsElectrolyte imbalanceRuptured esophagus or stomach
Classification of Eating Disorders
Anorexia Nervosa- Defined by the four symptoms previously discussed:Refusal to maintain normal body weightIntense fear of weight gainDisturbance in perception of body shape including denial of the seriousness of low body weightAmenorrheaTwo subtypes:Restricting-people who rarely engage in binge eating or purgingBinge eating/purge eating-defined by regular binge eating and purging during the course of the disorders.
Epidemiology of Eating Disorders
Gender differences and Standards of Beauty10 times more common among women than men.Cultural ideal of beauty changes over time, with the ideal becoming more and more thin.Research on Beauty Pageant Contestants and Playboy Centerfolds from 1959-1988.Barbie DollAge of Onset- typically begin in late adolescence or early adulthood.there is a significant rise in cases of anorexia during early adolescence as girls approach puberty.
Etiology
Social FactorsInternalization of the ideal of thinnessTroubled Family Relationships: Different in Bulimia and AnorexiaBulimics-considerable conflict and rejection in families.Anorexics- enmeshment hypothesis anorexics
Psychological Factors
Psychologists have not yet identified unambiguous contributing psychology factors to eating disorders.Four most prominent theoriesControl IssuesDepression/DysphoriaBody Image dissatisfactionReaction to dietary restraint.
Struggle for Control Theory (Bruch)
Cluster of psychological symptoms that appear to contribute to the development of eating disorders.Excessive External Control (Good Girls & People Pleasers)PerfectionismLack of Introceptive Awareness
Depression, Low Self Esteem, Dysphoria
Depression, dysphoria (negative mood states), and low self esteem have been shown to contribute to the onset, or maintain cases of eating disorders.Anti-depressant medication has been shown to reduce symptoms of bulimia.Family incidenceLow self esteem and pre-occupation with social self.Dysphoria triggers binge eating.
Negative Body Image
Highly critical evaluation of one’s weight and shape.Includes both a distorted perception and a dissatisfaction with one’s body evidenced by a large distance between a person’s actual and ideal.Thought to be problematic when combined with other risk factors such as perfectionism and low self esteem.
Dietary Restraint
Some symptoms of eating disorders are thought to be direct consequences of restricted eating.Overly strict diet increases hunger, frustration and lack of attention to internal cues, all of which make binge eating more likely.Obsessive thoughts and compulsive eating rituals have been found to be direct consequences of semistarvation.Food restriction itself may trigger other behavior patterns seen in eating disorders such as obsessions about food, and rituals such as compensatory behaviors.
Biological Factors
Homeostatic MechanismsWeight set pointsHyperlipogenesisGenetics
Anorexia:Treatment and Outcome
Weight GainAddress Difficulties that lead to disorder in therapyStructured Family therapyInteroceptive awarenessCognitive Behavioral TherapyOutcomeCurrent treatments not very effectiveLife long struggle with preoccupation with diet, weight and body shape.
Bulimia:Treatment and Outcome
Anti-depressant MedicationCognitive Behavioral TherapyInterpersonal PsychotherapyOutcome
The Case of Florence
History:Florence was a 30 year old single white female with a Bachelors Degree in English.Parents: Both livingOne Brother: 34 married with children worked as a lawyer.Medical Problems: None---except for previous in patient treatment for AnorexiaEmployment: She worked at as a regional manager for a grocery store chain, and was forced to go to therapy by her boss due to her increasing weight loss.
Symptoms
Weight at 91 lbs at 5’9’’Shivering—extremely cold at 73 degreesLanugoStringy hairPoor eye contactFlat affectAdmitted to feeling pressure from job and familyForced into therapy by boss due to severe weight lossDenial that anything was wrong, thought co-workers might be jealous of how thin she was-claimed “she looked like a fox”, was very proud of her 91 pounds, but her ideal was 87.
Background
Normal childhoodAt age 13, she was made fun of for being fat, even though she weighed 125 at 5’8”, she began exercising daily and dieting.Admired thin actresses and wanted to look like them.By 14 she was exercising 3 hours a day and her grades had dropped. She had a boyfriend for a year, and was convinced her liked her because she was thin, and broke up with her because she gained weight.Eating rituals developed, she would only eat on certain days and at certain times to maintain her 93 pounds in high school.Menstruation stopped—she decided this was a good thing as she would not have to worry about getting pregnant when she did have sex.At 15, she fainted at school and was diagnosed with Anorexia and entered in patient therapy.
Therapeutic Insights as a teen-ager
Florence realized she had a problem during her first in patient treatment where she underwent intensive therapy.Claimed to hate herself, not know who she was. She also felt inferior to her family and like she would not amount to much.She claimed the treatment helped, she was released and went to college.
Relapse
Florence did not continue treatment when she went to college as she felt things were under control. However, upon gaining 20 pounds her freshman year. She was horrified at the weight gain, and although she did not restrict, she exercises until she took the 20 pounds off.Florence anorexia stayed under control until crisis occurred in her life, usually centering around work or men.Florence was hired by a supermarket chain just out of college where she was very successful. Her symptoms returned when she started graduate school part time and felt pressure to maintain good grades and perform well at work. She was upset by gaining weight, and turning 30.All symptoms returned at this time, as she weighted 93 pounds, developed amennorhea and thought she looked fabulous.Concern of co-workers and boss forced her into treatment or she would lose her job.
Assessment
Unstructured InterviewThematic Apperception TestBecks Depression Inventory-mildPhysical Examination-family physician hospitalized her immediately and she claimed he scared her for the first time in her life by telling her she was dangerously underweight and some of the medical complications that could happen due to her extreme weight loss.
Treatment Plan
Slowly restore weight an normalize eating patterns. Weight gain needs to be gradual at about 2-3 pounds per week, during which she had to remain in the hospital (30 days after which she weighed 116).Group Therapy-first involved with group therapy and then discontinued. Anorexics often compare themselves to others and are jealous or upset by women who are thinner and often want to drop out. Group therapy has mixed results with all anorexics.Family therapy-very helpful as communication between Florence and her parents were poor. They admitted they had wanted her to be a doctor or lawyer, and she felt their disappointment. They were able to communicate being proud of her accomplishments.Individual Therapy-Florence liked the one on one most and found it most helpful.Upon discharge, she agreed to go to some support groups for Anorexics and found them very helpful. She also agreed to participate in family therapy at a later time.Continued in treatment for one year, at which time she was discharged. She was effectively communicating with her family, doing well at work, and maintaining her weight as well as a good body image.
Prognosis
FairEating disorders are not thought to be cured, but can definitely go into remission, the patient must be aware of this and look for any signs that the disorder is recurring.
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