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Lecture 8

PS280-Z Lecture 8 – Thursday August 1st, 2013.docx

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Kathy Foxall

st PS280-Z Lecture 8 – Thursday August 1 , 2013 Eating Disorders - Anorexia and bulimia have been described for hundreds of years o They were rare o 60s and 70s – extreme thinness became „valued‟ in Western women o Bulimia is becoming much more common o Every 5-10 cases of bulimia are of men Prevalence - Increasing prevalence of eating disorders, particularly bulimia, among girls, young women, and young men - Lifetime prevalence of bulimia: 1.1% for women and 0.1% for men - Prevalence for anorexia in females estimated at 0.3% - Prevalence of eating disorder symptoms is twice as high as full syndrome rates o There is a greater number of people walking around who don‟t „meet the criteria‟ for eating disorders but do come close to it  May not have enough symptoms or their symptoms are not as severe Binge-Eating Disorder (BED) - In the DSM-5 - Do not purge or over exercise - Binge eating on 2 days a week for 3 months - 1.3 females: male ratio - Prevalence 0.4-0.7% of the general population - Many people with this disorder are obese - Often associated with depression - Has a good recovery rate Prognosis in Anorexia - Mortality rate 5-8% - Common causes of death o Dehydration o Problems with the heart o State of ketosis o Stomach rupture (rare but it can happen)  If someone binges and purges, the stomach can stretch and get damaged o Dental problems o Osteoporosis (indirectly) o Suicide - More people recover with treatment than without treatment - 50% of bulimics stop binge eating and purging with individual therapy - Of the remainder, some undergo partial improvement and others do not improve - For adults – 30-50% - After 13-14 months people become more stable - Toronto General Hospital study DSM Criteria for Anorexia - Refusal to maintain minimal expected weight; weigh 15% less than expected - Irrational fear of gaining weight - Distortion in the experience and significance of body weight o Most people over-estimate their weight - Amenorrhea for females Other Details about Anorexia - About half of patients are restricting type and the other half are binge-eating/purging type - Irrational beliefs and attitudes about food are common - Relations with family and peers are often disturbed - Social withdrawal, depression, and anxiety common Restricting Type of Anorexia - Several restrict food intake to maintain a low body weight - May binge and purge, but not 2x a week for 3 months Binge-Eating/Purging Type of Anorexia - Recurrent binge eating - During binge, person loses control and uses vomiting, laxatives, and excess exercise to control weight - Poorer outcome than with restrictive anorexia - Higher incidence of personality disorders and impulsive behaviour such as theft, alcohol, and drug abuse, and suicide attempts - Anorexics who purge know that their eating patterns are abnormal - Disgusted, ashamed, hide it from others - Restrict eating excessively, then they lose control - Often restrict during the day, lose control in the evening Binge-purging Anorexia vs. Bulimia - In anorexia, whether or not the person binge or purges, he/she maintains a body weight that is at least 15% lower than what is expected - People with bulimia nervosa are generally in the normal weight range The Binge-Purge Cycles 1. Triggers o Stress and distress o Dieting o Forbidden food o Drinking alcohol o Being alone 2. Immediate reward…but later: o Feeling out of control, shame, disgust, depression o Anxiety over weight gain o Bloating, abdominal pain, headache, fatigue 3. Adverse consequences lead to PURGING which relieves negative mood and discomfort but RESETS TRIGGERS o Forcing themselves to vomit o Laxatives o Excessive exercise with no end Binge - Discrete period of time, usually 2 hours, involving the consumption of much larger quantities of food than most people would eat in that period of time under similar circumstances - Lack of control during an episode Binge-Purging Type of Bulimia - Usually begins in adolescence or early adulthood - 90% female - 1-3% of the population - Some studies indicate that many are overweight when they develop the disorder, which often begins with dieting - Associated with depression and personality disorders, especially BPD, anxiety disorders, substance abuse, and conduct disorder - Eat to sooth themselves - Often overeat in afternoon and at night - Seasonal affective disorder - Suicide rates higher than in general population Physical Consequences of Bulimia - Potassium depletion, electrolyte imbalance - Damage to stomach lining and esophagus - Damage to tooth enamel - Salivary glands may become enlarged - Mortality rate much lower than in anorexia o Because the body weight is close to normal Prognosis for People with Bulimia - In one study, the majority continued to have disturbed eating and low self esteem, though symptoms decrease over time - 40% met criteria for major Differential Diagnosis - Important to rule out medical reasons for symptoms Validity of Diagnostic Criteria and Classification - Some suggest that eating disorders should be conceptualized on a spectrum - Many individuals move from one diagnostic category to another - There is some concern about specific criteria for anorexia and bulimia Assessment of Eating Disorders - Eating Disorder Examination (EDE) o Structured clinical interview o Assess for the presence and absence of other psychological disorders o Determine presence of any physical and/or medical complications Physical and Psychological Complications - Across all of the eating disorder subtypes, individuals experience a reduced quality of life and the
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