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Chapter 10

Chapter 10: Eating Disorders

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PSYC 241
Shannon Zaitsoff

PSYC 241 EXAM REVIEW CHAPTER 10: EATING DISORDERS Anorexia Nervosa – individuals have an intense fear of gaining weight or becoming fat - Believe that eating forbidden foods (i.e. high calories) will result in significant amounts of weight gain - Some engage in excessive exercise as a means of achieving weight loss Similarities between - General restlessness is common Anorexia and Bulimia - Purging – self-induced vomiting, laxative abuse, or abuse of enemas or diuretics - Low self-esteem - Optional binge eating – identify if (1) objective binge and use of weight where one eats a large amount of food in a specific time and body shape period, or if it’s (2) subjective binge where it is in fact a information as normal or small amount of food (i.e. a chocolate bar) primary method of - Often linked with low self-esteem; one has a disturbance self-evaluation in body image - Self-isolation and - Common features: social withdrawal, irritability, depression preoccupation with food, and depression (may be linked to the state of semi-starvation) - Prevalence: 0.3% in females and 0.02% in males Differences between Anorexia and Bulimia DIAGNOSTIC CRITERIA for ANOREXIA NERVOSA 1. Pursuit and maintenance of an extremely low body - Body weight; weight o Below 85% of one’s expected body weight, or anorexia is always underweight while o Body Mass Index (BMI) of 17.5 bulimia typically 2. Irrational fear of gaining weight or becoming fat despite being significantly underweight within normal 3. Distortion in the experience and significance of body weight range weight o Disturbance in perception of body weight and shape o Denial of the seriousness of her current low weight o Determining self worth based primarily on body weight or shape 4. Amenorrhea – absence of 3 consecutive menstrual cycles Subtypes 1. Restricting Type – does not engage in binge eating or purging during the current episode of anorexia 2. Binge eating or purging type – engaged in these activities during the current episode of anorexia Bulimia Nervosa (p.222) – characterized by episodes of binge eating followed by compensatory behaviors designed to prevent weight gain - Low self-esteem and use of weight and body shape information as primary method of self-evaluation - Self-isolation and depression - Typically within the normal weight range - Purging and bingeing behaviors may be done in private so it becomes harder for family and friends to detect the problem - Engage in objective binge eating - Compensatory behaviors – purging, excessive exercise, laxative abuse - Foods high in calories are typically consumed; considered as “forbidden foods” - Feeling of physical discomfort (due to amount of food consumed) plus guilt and worry about gaining weight - Dieting and food restrictions - Episodes of binge eating occur in an attempt to escape from high levels of aversive self- awareness o Have high expectations of themselves, constantly monitor themselves, and often fail to meet high standards they set for themselves o Awareness of their failures leads to feelings of anxiety and depression o Binge eating shifts the focus from failure to positive sensations associations with eating - Prevalence: 1.0% in females and 0.1% in males DIAGNOSTIC CRITERIA for BULIMIA NERVOSA 1. Recurrent episodes of binge eating – characterized by… o Eating, in a discrete amount of time, an amount of food that is definitely larger than most people would eat o Lack of control during an eating episode – can’t stop eating or control what or how much one is eating 2. Recurrent inappropriate compensatory behavior to prevent weight gain o Self-induced vomiting; misuse of laxatives, enemas, diuretics, or any other medication; fasting; excessive exercise 3. Duration – binge and purge cycle occurs at least twice a week for three months 4. Self-evaluation is unduly influenced by body weight and shape 5. The disturbance does not occur exclusively during episodes of anorexia nervosa Subtypes 3. Purging Type –regularly engaged in self-induced vomiting or misuse of laxatives, diuretics, or enemas 4. Nonpurging type – used fasting or excessive exercise only as compensatory behavior Eating Disorder Not Otherwise Specified (EDNOS) (p.226) - More common than each anorexia and bulimia nervosa - Sometimes a person almost qualifies to be diagnosed as anorexic or bulimic but lacks a certain criteria DIAGNOSTIC CRITERIA for EDNOS 1. For females, all criteria for anorexia nervosa are met except that the individual has a regular menstrual cycle 2. All criteria for anorexia nervosa are met except that, despite significant weight loss, the individuals current weight is in the normal range 3. All criteria for bulimia nervosa are met except that binge eating and compensatory mechanisms occur at a frequency of less than twice a week for less than 3 months 4. Regular use of inappropriate compensatory behavior by an individual with normal body weight after eating small amounts of food (i.e. purging after eating 2 cookies) 5. Repeatedly chewing and spitting out, but not swallowing, large amounts of food 6. Binge eating disorder (BED) – bingeing without regular purging Prognosis (p.224) – eating disorders have the highest mortality rate of all of the psychiatric disorders; 5-8% - Common causes are starvation and nutritional complication (i.e. electrolyte imbalance, dehydration) - 50% of individuals with bulimia nervosa are able to stop with evidence-based individual therapy - Hsth relapse rates 22-63% in adults - 1 year following treatment there is a steady increase in the probability of relapse; this drops significantly after 14 months Making a Differential Diagnosis (p.227) – important to establish that symptoms are not due to a medical condition - Important to rule out major depressive disorder (because it may accompany severe weight loss or overeating) - However, individuals suffering from different disorders will not exhibit over concern for weight and body shape and will not engage in inappropriate compensatory behavior Assessing an Eating Disorder (p.228) – conducted using a structured or semi-structured interview - Eating Disorder Examination (EDE) – structured clinical interview with
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