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lecture 1.doc

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Byron Williston

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Personality and eating disorders  Eating disorder itself can affect personality  Supports the idea that the personality of patients with eating disorders particularly those with anorexia is affected by their weight loss  Study- men lost 25% of their body weight. They soon became preoccupied with food. They also reported increased fatigue, poor concentration, lack of sexual interest, irritability, moodiness, and insomnia. Four became depressed and one developed bipolar disorder. This research shows how severe restriction of food intake can have powerful effects on personality and behaviour  Collected retrospective reports of personality before the onset of an eating disorder. This research described patients with anorexia having been perfectionist, shy and compliant before the onset of the disorder.  It described patients with bulimia as having the additional characteristics of histrionic features, affective instability and an outgoing social disposition  Retrospective reports in which a patient and his or her family recall what the person was like before diagnosis can be inaccurate and biased by awareness of the patients current problem  Both patients with anorexia and patients with bulimia are high in neuroticism and anxiety and low in self esteem. The role of neuroticism as a long-term predictor of anorexia was also confirmed in a recent twin study.  Patients with AN or BN also score high on a measure of traditionalism, indicating strong endorsement of family and social standards  Narcissists are characterized by an excessive focus on the self and a heightened sense of self importance and grandiosity.  These indiv are believed to be overcompensating for a fragile sense of self esteem however and they are highly sensitive and reactive to criticisms.  Pathological narcissism at extreme levels can take the form of a narcissists personality disorder  Have shown that AN and BN patients are characterized by high levels of narcissism that persist even when the eating disorder is in remission  Perfectionism is believed to be highly relevant to an understanding of eating disorder. Confirmed that perfectionism is elevated in indiv with eating disorders. The EDI perfectionism subscale provides a single global measure of perfectionism. Have found that perfectionism construct is multidimensional and this was even demonstrated by a reanalysis of the EDI items that showed the perfectionism subscale actually consisted of two factors reflecting self standards and external pressures imposed on the self  Created a multidimensional perfectionism scales that assess six dimensions: concern over mistake, high personal standards, doubts about actions, organization, high parental expectations, and high parents criticism  Meanwhile in Canada another multidimensional perfectionism scale that assess self oriented perfectionism, other oriented perfectionism, and socially prescribed perfectionism  There is a social pressure to attain unrealistic standards of physical perfection  Has shown that almost all of the perfectionism dimensions are elevated in eating disorders and that these dimensions of perfectionism remain elevated in women who have recovered from a bout of AN  Suggests that self oriented and socially prescribed perfectionism are both elevated in E.D  Reported that weight restored and underweight anorexics had elevated scores on self oriented perfectionism. In addition the underweight anorexics had higher scores on socially prescribed perfectionism relative to the control group  This study elevated that the E.D ppl had higher levels of self oriented perfectionism and socially prescribed perfectionism relative to established norms for these measures  They had elevated levels of self oriented and socially prescribed perfectiomsuim  Other research in t.o found that these two forms of perfectonmsin were elevated once again in E.D ppl and that anorexics who engage in excessive exercise are distinguished by high levels of self oriented perfectionism. Perfectionism is relevant to both anorexia and bulimia  Support for a three factor interactive model of perfectionism and bulimia symptom development. According to this interactive model bulimic symptoms are elevated among females who are characteriicstized not only by perfectionism but also by body dissatisfaction and low self esteem. Thus they have exceptionally high standards yet recognize a sense of self dissatisfaction for not attaining these impossible standards  Contemporary research has linked E.D with the tendency for some indiv to respond to social pressure to be perfect by engaging in a form of beh known as perfectionist self presentation that is these individual try to create an image of perfection and are highly focused on minimizing the mistake they make in front of other ppl  Women with e.d are high in public self consciousness and overly concerned with how they are viewed by others in part cyz they often feel like impostors and frauds who have not been detected yet by other ppl and are mistakenly seen by them as competent  Respond defensively by trying to create an impression of being perfect.  Perfectionism dimensions are indeed elevated in the various e.d. however one significant limitation of this work is that the causal role of these dimensions of perfectionism has yet to be firmly established by longitudinal research cognitive behavioural view (imp one)  AN- emphasize fear of fatness and body image disturbance as the motivating factors that make self starvation and weight loss powerful reinforcers.  Beh that achieve or maintain thinness are negatively reinforced by the reduction of anxiety about becoming fat.  Dieting and weight loss may be positively reinforced by the sense of mastery or self control they create  Also include personality and socio cultural variables 2 explain how fear of fatness and body image disturbances develop  1 Canadian study even brief exposure to pics of fashion models can instil negative moods in young women and women who are dissatisfied with their bodies seem especially vulnerable when exposed to these images  initially chronic dieters actually feel thinner after looking at idealized images of the thin body and this motivates them to diet  this effect labelled the thinspiration effect can begin a process of dieting that can ultimately lead to distress among diets unable to attain unrealistic body image standards  another imp factor in producing a strong drive for thinness and disturbed body image is criticism from peers and parents about being overweight st nd  obesity at the 1 assessment was related to being teased by peers and at the 2 assessment to dissatisfaction with their bodies. Dissatisfaction was in turn related to symptoms of e.d  it is known that binging frequently results when diets are broken  ppl with anorexia who do not have episodes of binging and purging have amore intense preoccupation with and fear of weight gain or may me more bale to exercise self control  BN- ppl with BN are thought to be overconcnered with weight gain and body appearance- they judge their self worth mainly by their weight and shape. They also have low self esteem and cuz weight and shape are somewhat more controllable than other feature of the self they tend to focu son weight and shape hoping their effots in this area will make them feel better  They try to follow a rigid pattern of eating that has strict rules regarding how much to eat, what kinds of food to eat and when to eat. These rules are broken and the lapse escalates into a binge. After the binge feelings of disgust and fear of becoming fat build up leading to compensatory actions such as vomiting.  Although purging temporarily reduces the anxiety from having eaten too much this cycle lowers the persons self esteem which triggers still more binging and purging vicious cycle that maintains desired body weight but has serious medical consequences  Patients with BN typically binge when they encounter stress and experience negative moods  Bulimia ppl reported more negative moods in the hour just prior to their bineges. The binge may therefore function as a means of regulating negative moods  Evidence also supports the idea that purging is reinforced by anxiety reduction. Ppl with bulimia report increased levels of anxiety when they eat a meal and are not allowed to purge.  Similarly anxiety levels decline after purging TREATMENT OF EATING DISORDERS  The person typically denies that he or she has a problem. For this reason the majority of ppl with eating disorders – up to 90% of them are not in treatment and those who are in treatment are often respectful.  Some ppl with bulimia only wind up in treatment cuz their dentist has spotted one key indicator- the erosion of teeth enamel as a result of the stomach acid coming into contact with the teeth during vomiting  Hospitalization is frequently required to treat ppl with anorexia so that the patients ingestion of food can be gradually increased and carefully monitored.  Weight loss can be severe that intravenous feeding is necessary to save the patients life  For anorexia and bulimia both biological and psychological interventions have been employed Biological Treatments  Cuz BN is often comorbid with depression it has been treated with various antidepressants. Instead has focused on fluoxetine (Prozac)  Fluoxetine was shown to be superior to a placebo in reducing binge eating and vomiting; it also decreased depression and lessened distorted attitudes toward food and eating  Confirm the efficacy of a variety of antidepressants in reducing purging and sometimes even bringing about complete remission  On the negative side many more patients drop out of drug therapy in studies on bulimia than drop out of the kind of cognitive –behavioural interventions  In the multi centre fluoextine study cited almost one third of the patients dropped out before the end of the 8 week treatment primarily cuz of the side effects of the drug.  This figure compares with dropout rates of under 5% with cognitive behavioural therapy. Moreover most patients relapse when various kinds of antidepressant medication are
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