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Lecture 6

PSY240 Lecture 6

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University of Toronto St. George
M.Mc Kay

PSY240 Lecture 6 June 6: Eating Disorders (Chapter 15) Binge eating disorder Binge eating is a disorder, but obesity is not. Comparisons of eating disorders The eating disorders vary on these characteristics: Symptom AN* Restricting AN* Binge-Purge BN* Purging BN* Non-purging Binge-eating disorder Body weight Must be Must be Often normal or Often normal of somewhat Often underweight by underweight by somewhat overweight significantly more than 15% more than 15% overweight overweight Body image Severely disturbed Severely disturbed Over-concerned Over-concerned with weight Often disgusted with weight with overweight Binges No Yes Yes Yes Yes Purges or other No Yes Yes No but yes: No compensatory While they dont purge, behaviours they might use other comp. behaviours like exercise Sense of lack of No During binges Yes Yes Yes control overeating Amenorrhea in Yes Yes Not usually No No females Binge-eating disorder Another eating disorder that resembles bulimia nervosa in many ways, except that the person with binge-eating disorder does not regularly engage in purging, fasting, or excessive exercise to compensate for his or her binges Not recognized in DSM at present because the basis for the diagnosis has yet to be sufficiently researched DSM-IV-TR Binge-eating disorder b. Eating, in a limited amount of time, an amount of food that is considerably larger than most people would eat under similar circumstances c. A sense of lack of control over eating d. Three or more of the following: 1. Eating much more rapidly than normal 2. Eating to the point of feeling uncomfortably full 3. Eating large amounts when not hungry 4. Eating alone due to embarrassment about how much one is eating 5. Feelings of disgust, guilt, or depression after overeating e. Marked distress amount binge eating f. Binge eating occurs at least twice a week for 6 months Binge eating disorder: characteristics Prevalence rates: 1-3% Often significantly overweight History of frequent dieting, members of weight control programs More common in women Case example Male, age 45, nitially seen for assessment of depression Comorbid binge eating Typical binges included: dinner, bag of chips, ice cream and bag of cookies 2-3 binges per week for past 8 months Expressed extreme guilt over the fact that he was doing thing At the time Martha saw him, he was overweight with significant health issues 50 Treatment of BED Psychotherapy CBT, IPT (interpersonal-psychotherapy) Pharmacotherapy SSRIs Efficacy: o Psychotherapy works better than to treatment o Medication and CBT is equivalent to CBT alone o Treatments impact binge eating behaviour, but does not translate into successful weight reduction Biological theories of binge eating disorders Dysregulation or disruption of the hypothalamus Imbalance or dysregulation in levels of serotonin, norepinephrine, or dopamine (neurotransmitters) or in levels of cortisol or insulin (hormones) Sociocultural and psychological factors in binge eating disorders Binge eating to regulate emotion: dieting versus depression-coping subtypes of binge eating Emotional eating theory: individuals eat in response to distress Other factors? Impulsivity, decision-making skills Meta-analysis of cognition in eating disorders showed most impairment in these abilities Depression and emotional eating Marthas research! Obesity How is normal weight determined? Energy balance surplus vs. deficiency BMI formula that is calculated based on height and weight 6 categories underweight to obese What might be some issues with the way BMI is calculated? Obesity Obesity epidemic? 1980 2002 obesity rates have tripled Estimates are as high as 59% adults either overweight or obese Increased risk for other health concerns (e.g. type 2 diabetes, cardiovascular) Childhood obesity rates are of concern (26% overweight or obese) Obesity is not a DSM diagnostic category Obesity social/environmental contributions? Sedentary lifestyles Society of convenience Abundance of high fat/caloric food readily available Portion sizes have increased over the years Obesity Focus of prevention programs, especially for children (e.g. Michelle Obamas Lets Move!) Sparked a number of investigations into causes biological, psychological, social Neurobiology of food intake see diagram Hypothalamus and eating One of the regions that has been established as related to eating Large established hypothalamic regions control eating Lateral hypothalamic region known as the hunger centre Ventromedial hypothalamus known as satiety centre 51Recent discoveries of appetite and weight hormones Leptin: o Produced in fat cells o Acts to reduce food intake o Increased body fat leads to increased leptin levels and decreases food intake Ghrelin: o Produced in stomach o Appetite stimulator o Increases before meal (acts as hunger single), rapidly decreases post food consumption (satiety signal) o Levels of ghrelin are high in anorexic populations and low in obese populations Hypothalamic appetite regulation by ghrelin and leptin see diagram Ghrelin stomach Leptin adipose tissue Role of neurobiology in obesity Dysregulation of these hormones (and others) can lead to obesity How does this contribute to the obesity epidemic? Expanding areas of research The role of stress? Stress and eating Stress-induced eating sound familiar? Emotional eating theory individuals eat in response to distress Emotional eating linked with obesity parallel increase in emotional eating and weight increase (Tatjana van Strein) Does this make sense biologically, to eat in response to stress? o E.g. fight/flight response decreases appetite But do people always eat in r
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