PSYCH257 Lecture Notes - Interpersonal Psychotherapy, Psychoeducation, Family Therapy

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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
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- 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
- Age of onset is 16-19 years but signs can occur earlier
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Document Summary

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) Eating a larger amount of food (usually more junk food) than most people would eat under similar circumstances. Individual attempts to make up for the binge eating by purging techniques, fasting for long periods, or excessive exercise: 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.

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