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Part 3- L3.docx

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Gareth Treharne

Part 3- L3 Eating and body image- abnormality of self-acceptance?? Q: Why are body image and eating a concern in psychology? A: These are universal considerations because: - We all are a body - We all require nutrition Entirely normal but can become abnormal - Abnormal od over-eating OR under-eating What is the norm for a body in biomedicine? - Age youngish - Sex male - Ethnicity white - SES high - Sexuality hetero - Function able-bodied - Size medium but toned Standard BMI categories - Used to define ‘normal’ - Calculated as the ration of weight to height squared o Under 18.4 kg/m underweight o 18.5-25.0 kg/m normal o 25.0-30.0 kg/m overweight o Over 30.0 kg/m obese Eating disorders - Anorexia o Literally means ‘no desire’ to eat o Refusal to maintain body weight above a minimally normal weight for age and height o Intense fear of gaining weight even though underweight o Disturbed body perception, undue influence of weight and shape on self- evaluation, or the denial of the seriousness of current low weight o Cessation of menstruation if this has already begun o 80-90% are female o Typical age of onset between 14 and 18 years o 0.5-2% of women are likely to develop anorexia o In a cohort study 16% of anorexia participants had died because of the disorder o Highest among highest socioeconomic groups and high academic achievers - Bulimia o Literally meaning ‘really hungry’ o Feel unattractive o Fear of becoming fat and consider selves heavier than they actually are o Attempts to avoid being fat are more chaotic than anorexia o Periods of physical and psychological tension > eating relieves this o Compensation reduces discomfort and anxiety after binge  80-90% use vomiting  30% use laxatives  Others exercise excessively o Causes abdominal pain, digestive problems, dehydration, decay of teeth etc. o 1-3% of women will develop bulimia over life time  Half will revert back to bulimia at one point - Nervosa o Literally meaning ‘nervous in origins’ o Hence anorexia nervosa and bulimia nervous - Binge o About to over-indulge - Criteria o Five criteria  Recurrent episodes of binge eating (amount and control)  Binge eating, 3+ of: × Eating much more rapidly than normal × Eating until feeling uncomfortably full × Eating when not ‘physically hungry’ × Eating alone (while knowing the binge is abnormal) × Feeling guilty afterwards  Marked distress regarding binge eating = functional impairment  Average binge frequency must be: × At least once a week × For 3+ months × (only in the evening = night eating syndrome  No regular use or inappropriate compensatory behaviours BMI- mortality study - 77’782 women nurses aged 34-59 - Free from heart disease and cancer in 1980 (baseline) - When followed up in 2004 based on baseline o Under 18.4 kg/m underweight > 1.5% of sample (excluded) o 18.5-25.0 kg/m normal > set as reference group (=1) o 25.0-30.0 kg/m overweight >1.18 times more likely to have died o Over 30.0 kg/m obese > 1.67 times more likely to have died - Limitations o Treats obesity as a disorder in itself o Is obesity just a symptom rather than a disorder?  Obesegenic environment can lead to obesity  Psychological disorder can lead to obesity  Biological disorder can lead to obesity o BMI treated as absolute categories o Not a comparison of body fat vs. muscle o Not a direct measure of the spread of fat Predictors of weight loss - Psychological interventions - Fat absorption blocking medication (Xenical = orlistat) - Neurochemical medication (reductil = sibutramine) - Very low calorie diet - Time spent exercising - Other “compensatory” behaviours Bulimia Nervous criteria - All of the following o Recurrent episodes of binge eating o Recurrent inappropriate “compensatory” behaviours  Purging subtype × Vomiting or misuse of laxative  Non purging subtype × Fasting × Excessive exercise o Frequency  At least once a day  3+months o Self-concept unduly influenced by body shape and weight o Not during a period of anorexia nervosa  Adults weight in NZ Anorexia nervosa criteria - All of the following o Restriction of energy intake  Inconsistence on remaining underweight for height (BMI)  Can involve purging or exercising o Intense fear of gaining weight, even though underweight o Any of the following  In denial of seriousness of current low body weight  Undue (excessive) influence of body weight or shape on self-concept  Disturbance in perception of one’s body weight or shape Body dysmorphic disorder criteria - Dysmorphic o Literally means “malformed” - All of the following o Preoccupation with a perceived “defect” in physical appearance  Either imagined or appears “slight” to others o Repetitive behaviour or thoughts  i.e. mirror checking o preoccupation causes clinically significant distress or impairment  In social life, work etc. o Preoccupation not about weight in someone with an eating disorder Film - Diagnosis o Binge eating disorder  Feeling in control, so not really bing
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