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chapter 13 eating disorders.docx

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Psychology 2320A/B
Jeff St.Pierre

Chapter 13: Eating Disorders and Related Conditions Overview: - Despite centuries of bizarre and unusual eating habits around the world, only recently have eating problems been considered mental disorders - Studies of etiology and treatment of eating disorders have focused on physiological mechanisms and their associated biological consequences - Over the last quarter century, mental health professionals have begun to see that many factors that underlie other major childhood disorders significantly influence early feeding and eating disorders - What is peculiar about eating disorders is thaty they are linked to western culture, where food is plentiful and physical appearance is highly valued o In western society, third most common illness in adolescent females How eating patterns develop: - Normal development o Problematic eating habits and picky eating re common in early childhood: approximately one in four children under age 12 are descried as picky eaters by their parents o Societal norms and expectations affect girls more than boys, particularly by late childhood and adolescence  Beginning around age 9, girls are more anxious than boys about losing weight  Most important impact on fundamental biological process is early parent- child relationship  Next most significant developmental landmark is entering school with its pressure to conform to perceptions of desirable body type Developmental Risk Factors: - Continuum of “eating pathology” ranges from dieting to clinical syndromes across all developmental periods - Drive for thinness is a key motivational factor for dieting and body image: belief that losing more weight is - Answer to overcoming problems and achieving success o Such behaviour create negative side effects of weight preoccupation, concern with appearance, and restrained eating, which increase the risk of an eating disorder - Early eating habits, attitudes and behaviours: o Western sociocultural values and preoccupation with weight and dieting may be internalized and expressed in children as young as age 7-10 o Constellation of physical and psychological factors linked to early eating problems and distorted beliefs Developmental Risk Factors (CONT’D): - Transition into adolescence: o Anorexia and bulimia typically occur during adolescence, a time when significant body changes require adjustments in self-image (onset after adolescence is rare) o Affect girls, who place greater emphasis on self- perceptions of their physical appearance, more than boys o Contradictory social messages implying that women must be successful in traditional feminine and masculine roles o Changes encourage smoking and other substance use to prevent impulse to binge eat and consequences of weight gain - Dieting and weight concerns: o Restrictive dieting is common in North America, even among elementary school children o Chronic dieting is associated with gender and developmental factors  By mid- adolescence, two thirds of girls report being on a diet during the previous year; 10% of those girls, but only 2% of boys are chronic dieters o Dieting may lead to a vicious cycle of weight loss and weight gain, overeating and the “false hope syndrome,” as well as binge eating and subsequent purging o Man young people diet, but only a small minority develop eating disorders Biological Regulators: - Metabolic rate, or balance of energy expenditure, is based on individual genetic and physiological makeup as well as eating and exercise habits - Body weight o An individual’s natural weight is regulated by his or her own body weight set point, a biologically and genetically determined range of body weight that the body tries to “defend” and maintain - Growth o Major hormonal determinants of physical growth rate during childhood are the growth hormone (GH) and thyroid hormone with additional gonadal steroids kicking in during adolescence to produce a further growth spurt and skeletal maturation Obesity: - Approximately one in six children and adolescents (aged 2-19) in North America are obese - Childhood obesity: a chronic medical condition characterized by excessive body fat o Usually defined in terms of body mass index (a height-to-weight ratio) above the 95 percentile o Severely stigmatized in North American society, and carries many social and health hazards o Significantly affects children’s psychological and physical development Prevalence and Development: - In U.S. and Canada, obesity rate nearly tripled for boys age 7-13 and more than doubled for girls between the early 1980s to mid- 2000s - Worldwide, prevalence of childhood overweight and obesity has increased from 4.2% in 1990 to 6.7% in 2010 - Although obesity during infancy and obesity during later childhood are not strongly related, childhood- onset obesity is more likely to persist into adolescence and adulthood - Risks include cardiovascular problems, diabetes and elevated cholesterol and tryglycerides o Obesity is a mojor factor in reducing life expectancy in North America o Preadolescent obesity is a risk factor in the later emergence of eating disorders - Culture and SES: o Among U.S. children and adolescents:  Hispanic boys are significantly more likely to be obese than non-Hispanic White boys  Non- Hispanic Black girls are significantly more likely to be obese than non-Hispanic White girls o Based on data from 15 industrialized countries, the U.S. has the highest percentage of overweight children and rates of obesity and eating disorders increase upon exposure to Western culture and its fast food industries o Problems for low income populations:  Low cost and availability of fast food and junk food  Diminished physical activities due to living in unsafe neighbourhoods Causes: - Heritability accounts for a substantial portion of the variance in obesity o Leptin: hormone that carries instructions to the brain to regulate energy and appetite  Deficiencies have been found among children with severe obesity o Individual and family-related related factors, such as dietary and lifestyle preferences also play a role  Parents determine food availability and they model an approach to exercise and diet  Family disorganization: poor communication, lack of perceived family support, and sexual and physical abuse Treatment: - Prevention or intervention of childhood obesity involves the individual’s health and family resources o Restricting diets are not usually recommended - Focus on addressing parents’ knowledge of nutrition and increasing children’s physical activity o Treatments should instill active, less sedentary routines for both parents and children - Other interventions focus on making child’s eating behaviours and physical activity patterns more adaptive and self- managed - Schools also play a role by education children in nutrition exercise, and awareness of healthy eating attitudes and body image Feeding and Eating Disorders: - Feeding and eating disorders that occur during infancy or early childhood constitute a general diagnostic category o Feeding disorder of infancy or early childhood o Pica o Failure to thrive Feeding Disorder of Infancy or Early Childhood - Characterized by a sudden or makred deceleration of weight gain and a slowing or disruption of emotional and social development prior to age 6 - Prevalence and development: o Affects up to one-third of young children o Equally common among boys and girls o Because many factors lead to the initial problem, there is no typical developmental outcome  Onset during first two years of life can lead to malnutrition with serous developmental consequences  May be related to medical problems or poor caregiving and can lead to or be the result of failure to thrive - Causes and treatment: o Many interacting risk factors influence child’s adaptation to a certain level of caloric intake and whether child shows normal or abnormal behaviour development o Associated with family disadvantage, poverty, unemployment, social isolation, parental mental illness, and maternal eating disorders (specific risk factor)  Failure to thrive is associated with mothers who have a history of disturbed eating habits and attitudes o Treatment involves detailed assessment of feeding behaviour and parent-child interactions, while allowing parents to play a role in the infant’s recovery Pica: - Ingestion of inedible, non-nutritive substances (eg. Hair, insects, and paint) for a period of at least one month - Affects mostly very young children and those with intellectual disability - May be life-threatening if it continues into adolescence - Prevalence and development: o More prevalent among institutionalized children and adults, especially those with severe impairments and mental retardation o 0.3-14.4% of children and adults with intellectual disabilities; 9-25% of those in institutions - Causes and treatment: o Specific causes have not been isolated o Poor stimulation and supervision in home environment o Vitamin or mineral deficiency but now specific biological abnormalities have shown causal link o No evidence of genetic factors except in some cases of intellectual disability o Due to risk of lead poisoning or intestinal obstruction, can be serious and substantial problem o Treatments usually based on operant conditioning procedures and teaching caregivers to keep the child’s environment tidy and removing dangerous substances Failure to Thrive: - Growth disorder associated with early feeding disturbances o Can have severe consequences for a child’s physical and psychological development o Associated with social and economic disadvantages - Prevalence: o Characterized by weight below the fifth percentile for age and/or deceleration in the rate of weight gain from birth to present of at least two standard deviations - Causes: o Controversy:  Infant with failure to thrive has been deprived of maternal stimulation and love, which results in emotional misery, developmental delays and eventually, physiological changes o Poor quality of caregiver- child attachment, poverty, family disorganization and limited social support, as well as child’s temperament and acute physical illnesses o Developmental outcome is highly related to the child’s home environment
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