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Chapter 15

Chapter 15 - Eating Disorders.docx

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Ryerson University
PSY 325
Stephanie Cassin

Chapter 15: Eating Disorders  Health Behaviours in School Aged Children Survey finds pronounced gender differences in dieting behaviour in every country surveyed  Rates of dieting & weight dissatisfaction increase in teen girls  Interventions starting in elementary school for eating disorders  Overweight: shorter life spans, risk for diabetes/hypertension, heart disease  What we eat & how much we exercise linked to feelings of worth, merit, guilty, sin, rebelliousness, defiance instead of just for improving our health  3 types of eating disorders: 1. Anorexia nervosa: pursuit of thinness leading people to starve themselves 2. Bulimia nervosa: cycle of binging followed by extreme behaviours to prevent weight gain such as self induced vomiting 3. Binge-eating disorder: regularly binge but do not purge  Traditionally, more pressure on women to be thinner – eating disorders more common in women  More recently: emphasis on men & obtaining muscular, fit bodies  Those with eating disorders have high rates of depression & substance abuse  Gender differences: men more likely than women to have history of being overweight & binging before their anorexia or bulimia nervosa develops  No difference in prevalence between homosexual & heterosexuals 1. ANOREXIA NERVOSA Diagnosis, Prevalence, & Prognosis  DSM-IV-TR: intentional extreme weight loss + distorted thoughts about one’s body 1. Person refuse to maintain a body weight that is healthy for their age & height (weight loss leading to weight at least 15% below average) 2. Intense fear of gaining weight or becoming fat despite being underweight 3. Distortions in perception of one’s body weight or shape (emaciated but feels obese), denial of seriousness of current body weight 4. Amenorrhea in females who have their periods (absent for at least 3 consecutive cycles  Believe they are only worthy when they have complete control over their eating & their weight  Weight loss leads to chronic fatigue, develop elaborate rituals with food  Life time prevalence of 1%  90-95% diagnosed are female, white women more likely than black women to be diagnosed  Usually begins at age 15-19  Death rate: 5-8%, most common cause is suicide  Other complications: cardiovascular (bradycardia, arrhythmia, heart failure), acute expansion of stomach (can rupture), bone strength (especially those with amenorrhea since low estrogen affects bone strength), kidney damage, impaired immune system Types of Anorexia Nervosa  Restricting type: refuse to eat as a way of preventing weight gain – may eat small amounts to survive or because of social pressures to eat o Must be underweight by more than 15% o Severely disturbed body image, amenorrhea o No binging, purging, or lack of control over eating o More likely than binge-purge type to be mistrustful of others & tendency to deny they have a problem  Binge-purge type: periodically engage in binging or purging behaviours – self induced vomiting, misuse of laxatives or diuretics o Must be underweight by more than 15% o Binging = eating small amounts of food o Lack of control over eating during binges, amenorrhea o More likely than restricting type to have unstable moods, problems with impulse control, alcohol/drug abuse, self mutilation, more chronic courses 2. BULIMIA NERVOSA  DSM-IV-TR: regularly binge eat & attempt to avoid gaining weight from their binge o Recurrent episodes of binge eating characterized by:  Eating, in discrete periods of time (e.g. 2 hour period), an amount of food larger than most people would eat in the same period of time & circumstances  Sense of lack of control over eating during episode – compelled to eat even though they’re not hungry o Recurrent inappropriate behaviours to prevent weight gain: self induced vomiting, misuse of laxatives, diuretics, enemas, other medications, or excessive exercising o Binge eating & inappropriate purging both occur at least 2/week for 3 months o Self-evaluation is influenced by body shape & weight  Do not show gross distortions of body image versus those with anorexia nervosa – more realistic perception of self but still dissatisfied with their shapes & weights, concerned with weight loss  No weight criteria for diagnosis  Purging type: those who use self induced vomiting or purging medications  Non-purging type: those who use excessive exercise or fasting to control their weight but don’t engage in purging  Lifetime prevalence: 1.1% (females), 0.1% (males)  Partial syndrome eating disorders: behaviours that are similar to anorexia or bulimia but don’t meet the full criteria o May binge once a week versus several (however, frequency of binge eating has been conclude to not be an important criterion of the disorder) o May be underweight but not the full 15% o Highly concerned about weight & judge themselves based on their weight o Just as likely as those with eating disorders to have anxiety disorders, substance abuse, depression, attempted suicide, lower self esteem, poorer social relationships & physical health, lower life satisfaction, less likely to earn a bachelor’s degree, more likely to be unemployed  Self induced vomiting is most common – bulimia usually discovered by family, roommate, friends of people who are caught vomiting or see their messes after  Damaged teeth due to stomach acid  Onset usually between age 15-29, usually normal weight or slightly overweight  Complications: electrolyte imbalances – fluid loss following excessive & chronic vomiting, laxative abuse, diuretic abuse  Tends to be a chronic condition  Factors associated with more persistent course of disorder: childhood obesity, excessive valuation of shape & low weight, increasing dietary restraint, high level of social maladjustment Cultural & Historical Trends  Paul Garfinkel: eating disorders are culture bound; occurs in wealthy, developed countries where food is abundant & thinness is highly valued  Anorexia nervosa: cases of self starvation evident since medieval times & in most region of the world however in non westernized countries & centuries past, fasting had more to do with stomach discomfort or for religious purposes rather than for weight loss o Asian countries: no distorted body image, admit they’re very thin but still refuse to eat  Bulimia nervosa: more common in the past 50 years, more common in Westernized cultures versus non- Westernized cultures o The binging part of the disorder requires an abundance of food versus in anorexia nervosa where starvation does not depend on availability of food 3. BINGE-EATING DISORDER  Resembles bulimia but does not involve purging, fasting, or excessive exercise to compensate  Not officially recognized as a disorder – too little research done  Eat large of amount of food in a short period of time, may be continuous throughout day with no set mealtimes  Some binge in response to stress, feelings of anxiety or depression – eat rapidly, almost in a daze  Often person is significantly overweight & say they are disgusted of their bodies & ashamed of their weight  Usually have history of dieting, memberships in weight control programs, family obesity  Lifetime prevalence: 1-3%  More common in women than men; have high rates of depression, anxiety, alcohol abuse, personality disorders than some without the disorder UNDERSTANDING EATING DISORDERS Biological Theories  Anorexia & bulimia tend to run in families (based on twin studies) o Anorexia: 48-74% variability is due to genetics o Bulimia: 59-83% variability is due to genetics s  Hypothalamus: receives messages about body’s recent food consumption & nutrient level & sends messages to cease eating when nutritional needs have been met o Carried by norepinephrine, serotonin, dopamine, hormones (cortisol & insulin) o Eating disorders might be caused by imbalances/dysregulation of neurochemicals or structural/functional problems of the hypothalamus  Anorexia: lowered functioning of the hypothalamus, abnormalities in levels of serotonin & dopamine  unclear if they are causes or consequences  Bulimia: abnormalities in neurotransmitter serotonin o 5-HT system regulates mood, impulsivity & eating behaviour o Deficiency in serotonin may lead body to crave carbohydrates o Also abnormalities in dopamine levels
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