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PSY240H1 (233)


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University of Toronto St. George
Konstantine Zakzanis

Chapter 9: Eating Disorders Clinical Description Anorexia and Bulimia share that there is an intense fear of being overweight Anorexia Nervosa Anorexia: Loss of appetite Nervosa: caused by emotional reasons But most patients with anorexia nervosa actually dont lose their appetite in food Most patients starve themselves but they become preoccupied with food; they may read cookbooks constantly and prepare gourmet meals for their families Features for the diagnoses o * The person must refuse to maintain a normal body weight o The persons weight is less than 85% of what is considered normal for that persons age and height o There is dieting or purging (self-induced vomiting, heavy use of laxative or diuretics), excessive exercise o * Intense fear or gaining weight and the fear is not reduced by weight loss o * Have a distorted sense of their body shape even when they are thin o They believe in particular that their abdomen, buttocks and thighs are too fat o Weigh themselves frequently, measure the size of different parts of the body, and gaze critically at their reflections o Overevaluation of appearance: tendency to link self-esteem and self-evaluation w/ thinness o * Amenorrhea: loss of the menstrual period (least important to determining a diagnosis for anorexia read point underneath) o But this loss of period occurs in a minority of women before any significant weight loss Eating disorder inventory: self report of eating disorders; questionnaire There is another test where they show a picture of 3 bodies and they are asked to pick the one that looks like themselves; the patient with anorexia nervosa overestimate their own body size and chose the thinner one as their ideal 2 types of anorexia o Restricting type: weight loss is achieved by severely limiting food intake o Binge eating-purging type: person regularly engages in binge eating and purging More psychopathological Patient exhibit more personality disorders, impulsive behaviour, stealing, alcohol and drug abuse, social withdrawal and suicide Tend to weigh more in childhood, come from heavier families with greater familial obesity and tend to use more extreme weight-control methods Typically begins in early to middle teenage years, often after an episode of dieting and exposure to life stress 3 to10x more frequent in women than men Prevalence of less than 1% Patients are frequently diagnosed with depression, obsessive compulsive disorder, phobias, panic disorder, alcoholism, oppositional defiant disorder, and various personality disorders Women are more likely to have sexual disturbances Physical changes in Anorexia Nervosa Self starvation and use of laxatives Blood pressure falls, heart rate slows, kidney and gastrointestinal problems develop, bone mass declines, the skin dries out, nails become brittle, hormone levels change and mild anemia may occur They may lose their hair and develop laguna (fine, soft hair on their bodies) C h a p t e r 9 : E a t i n g D i s o r d e r s Page 6 Levels of potassium and sodium are altered o Lower levels can lead to tiredness, weakness, cardiac arrhythmias and even sudden death Brain size declines (white matter volumes can restore, but gray matter are irreversible) Prognosis 70% will recover Take 6-7 years and relapses are common before a stable pattern of eating and maintenance of weight is achieved Death rates are 10x higher when compared to the normal population Death result mostly from physical complications of the illness Bulimia Nervosa Bulimia nervosa: episodes of rapid consumption of a large amount of food, followed by compensatory behaviours, such as vomiting, fasting or excessive exercise, to prevent weight gain Binge: eating excessively within less than 2 hours Mostly done in secret High levels of interpersonal sensitivity Often feel they cant control the amount they eat So they eat in high volumes and feel like they have lost their awareness then they purge it out through gagging and vomiting Bulimia nervosa requires that the episode of binging and purging occur at least 2x a week for 3 months They have a morbid fear of fat 2 subtypes o Purging type o Non purging type fasting or excessive exercise Typically begins in late adolescence or early adulthood 90% women with a prevalence of 1-2% 70% recover 10% remain fully symptomatic Associated with depression, personalit
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