HLTHAGE 1CC3 Lecture Notes - Lecture 6: Etiology, Borderline Personality Disorder, Body Dysmorphic Disorder
27 Jun 2018
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May 17, 2017
Mental Health Lecture 6
An eating disorder is usually described as severe disturbances in eating behaviour that result from the
sufferer’s obsessive fear about gaining weight.
Many people speculate that fears about gaining weight are not always primary.
Some prefer to call them dieting disorders, because they think there is not necessarily a precise line
between who is dieting and who has the disorder; it consists on a continuum; they all desire food
restrictions, and the idea to lose weight/not gain.
A new category from DSM5: binge eating disorder; which forces us to reconceive eating disorders in
general; because it’s not about dieting or food restriction, nor is it about an excessive fear of gaining
weight-there is something else going on here.
Anorexia Nervosa
Primary symptom is emaciation-biomarker (very thin; at least 15 % below what the normal body weight
would be); individuals diagnosed are often described as having some form of misconception of their
body-the way they see it, and feel about it, is different than what others see. They put too much value in
their body (how it looks, specifically weight, impacts how they feel about themselves).
Self evaluation is a direct correlation of social evaluation; how we see ourselves can stem from how
society views a “perfect body”.
Individuals remain hungry, but choose to starve themselves. Denying seriousness of low body weight,
pride in success (idea that you’re good at denying yourself food, you’ve mastered one of life’s basic
needs and found ways around it).
People diagnosed with this disorder often die; which differs from other mental disorders (not normally a
physical risk exists).
Food becomes an obsession, and preoccupation. They spend lots of time thinking, “is there going to be
food there, if so I don’t want to go”; “how will I navigate lunch when people are expecting me to eat,
how do I get out of it”.
As you continue to starve yourself, food becomes more and more on your mind (is this a consequence or
a cause?)
Amenorrhea-removed from DSM5 (used to be listed as a symptom).
Eating disorders are now more common at a younger age
Athletic body can be a cause of amenorrhea.
People were being denied treatment because they were not satisfying this criteria.
Problems that accompany A.N.
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May 17, 2017
Sexual difficulties and disinterest: many individuals diagnosed may stop having sex or avoid it, or have
no pleasure from it whatsoever.
Interesting; why is it that A.N. sometimes stems from the fact of wanting a beautiful body, yet
these individuals withdrawal from sex.
Lack of impulse control: e.g. the person starves themselves so much, their body is so starved that they
just jump into the nearest garbage can to eat what was inside.
Health problems: stomach pain, feeling cold, exhausted.
Development of hair over the body that was not there previously, cracked and dry skin, developing
cardiac and/or kidney problems.
Lots of people can recover from anorexia, but some of these problems might not ever go away.
E.g. can’t take Advil when an adult because lining of stomach is completely destroyed.
Electrolyte imbalances, cardiac arrest, and kidney failure are the leading causes of death in individuals
with A.N.
Comorbidity and Anorexia
High concordance rates with depression and OCD.
OCD: makes sense because the obsession is avoiding food, compulsions would be the
behaviours they do to avoid it.
Question: does this person have two separate disorders? Or the same thing?
Individuals who are depressed, typically have really low self evaluations, perhaps a person then
tries to change something in their life in order to feel better, what could this be? Their body.
Can be causal or a consequence.
When you starve yourself, physiologically you will be more lethargic, hormone levels will
be off, etc. OR anxious about going out to dinner with family because not wanting to
eat, stay at home-continue that lonely behaviour.
Bulimia Nervosa
Primary component/cardinal difference from A.N.: Episodes of binge eating, followed by inappropriate
compensatory behaviours.
Binge: inappropriate amount, lack of control. May be planned or spontaneous; subjective sense
during binge that you have lost control of your eating. Typically, food is high in caloric value, and
you eat far more food than typical.
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May 17, 2017
Contextual experience, i.e. not when you eat lots at thanksgiving. Also, what is
considered a binge for one person, may not be for another (i.e. eating a sandwich could
be a binge for someone who normally would only eat the tomato).
Individuals often feel guilt and shame; individuals feel lots of pressure from dieting/restricting food, that
they binge by eating lots which feels good, they then feel guilty because they’ve been obsessed for
losing it for so long.
Compensatory behaviour: purging (vomiting, inappropriately using laxatives/enema), really excessive
exercise activities (run for 4 h then swim for 2 h).
Individuals diagnosed are usually not described as being emaciated (i.e. normal body weight and shape;
not described as being excessively thin).
Self-evaluation is unduly impacted by a person’s weight/shape. I’m a good person when I lose weight,
I’m a bad person because I can’t fit into my pants, etc.
How they organize their day may begin to revolve around their weight; they organize their day
around food. Days become constructed around the process of “what can I eat to sustain
normalcy, and what can I do to normalize the process of purging”.
Complications and Comorbidities
Depression is most common, but anxiety disorders, borderline personality disorder, and substance
abuse are also common.
Again question of cause or consequence comes to mind.
Substance abuse: Substances can sometimes help lose weight (e.g. lots of cocaine, you don’t eat
as much). Often framed around control.
Medical complications that derive from the nature of bingeing and purging; wearing down enamel on
teeth, hyper-developed gag reflux, rupture of stomach/esophagus.
Anorexia vs Bulimia
**Chart here on slide 8.
Control point is very important
NOS
Until DSM5, NOS was the most common diagnosis for eating disorders (up to 50%) why though?
NOS: Not otherwise specified, don’t check off correct amount of boxes for either disorder, but
clinicians still thought there was something wrong.
Many people partaking in binge eating without the compensatory behaviour.
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