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Allison Kelly

PSYCH 257:Textbook Notes Chapter 8: Eating Disorders - Patients with bulimia and patients with anorexia both share the drive to be thin - Anorexia has the highest mortality rate of any psychological disorder, including depression - There has been a dramatic increase in the number of new cases of anorexia and bulimia - Eating disorders tend to occur in young females in families with upper-middle and upper-class socioeconomic status who live in a socially competitive environment Bulimia Nervosa: eating disorder involving recurrent episodes of uncontrolled excessive eating followed by compensatory actions to remove the food (eg. deliberate vomiting, laxative abuse, excessive exercise) CLINICAL DESCRIPTION - Eating a larger amount of food (usually more junk food) than most people would eat under similar circumstances - Eating is experienced as out of control - Individual attempts to make up for the binge eating by purging techniques, fasting for long periods, or excessive exercise o Purging techniques: self-induced vomiting, laxatives, diuretics - Those who use laxatives are generally more impulsive - Bulimia is subtyped into purging (most common) and non-purging - In those that purged, their eating disorder developed at a younger age, higher rates of depression, anxiety disorders, alcohol abuse, and earlier rates of sexual abuse - Self-evaluation is shaped by her body shape and weight - Tend to be ashamed of the problem and their lack of control, secrecy Medical Consequences - Repeated vomiting causes salivary gland enlargement, giving the face a chubby appearance - Repeated vomiting erodes the dental enamel on the inner surface of the front teeth - Vomiting upsets the chemical balance of bodily fluids including potassium and sodium levels → electrolyte imbalance o Could result in disrupted heartbeat and kidney failure - Young women with bulimia develop more body fat than healthy women - Laxative abuse can cause severe constipation or permanent colon damage - Marked calluses on fingers or the back of the hand from repeatedly trying to stimulate the gag reflex Associated Psychological Disorders - Bulimia seems to be related to anxiety disorder, mood disorders, substance use disorders, borderline personality disorder, and impulse control disorder Anorexia Nervosa: eating disorder characterized by recurrent food refusal leading to dangerously low body weight - People with anorexia are proud of their success at losing weight and extraordinary control → do not see themselves as having an illness CLINICAL DESCRIPTION - Excessive exercise may be an early warning sign for anorexia - People with anorexia have an intense fear of obesity and relentlessly pursue thinness - Patients with anorexia tend to over report their weight - Dramatic weight loss is achieved through severe caloric restriction or by combining restriction with purging - 2 subtypes: restricting type (diet to limit calorie intake) and binge-eating/purging type o Binge-eating/purging type is different from bulimia in that they rely on small amount of food and purge more consistently o Many restricting types will begin to binge/ purge → may be stages instead of types - Continued weight loss every day is satisfactory; not maintaining the same weight - There is a marked disturbance in the way a person sees and feels about her body - Some anorexic individuals show interest in cooking and food Medical Consequences - Cessation of menstruation; but does not occur in all cases - Dry skin, brittle hair or nails, and sensitivity or intolerance of cold temperatures - Lanugo: downy hair on the limbs and cheeks - Cardiovascular problems (low BP and HR) - If vomiting is involved, electrolyte imbalance and resulting cardiac and kidney problems Associated Psychological Disorders - Bulimia, anxiety disorders, and mood disorders are often present with anorexia - OCD co-occurs frequently o Individual engages in ritualistic behaviour to rid herself of the unpleasant thoughts - Substance abuse o strong predictor of mortality by suicide Binge-Eating Disorder: pattern of eating involving distress-inducing binges not followed by purging behaviours - compared to other eating disorders, this has a different pattern of heritability, greater likelihood of occurring in males, and later age of onset - greater likelihood of remission and better response to treatment - associated more with severe obesity - about half of the individuals try dieting before bingeing; the other half start with bingeing and try dieting o those who binge first become more severely affected by BED and are more likely to have additional disorders - share the same concerns about shape and weight as people with anorexia and bulimia - those with BED binge to alleviate “bad moods” or negative affect → more psychological disturbed than those that do not binge to relieve mood Statistics - Overwhelming majority of bulimics are women - Homosexual or bisexual orientation appears to a specific factor risk for males that develop bulimia - Men have lower levels of personality factors (eg. perfectionism) associated with bulimia; explains why it is predominantly women - A
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