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Week 9 (part 1).docx

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PSYC 3390
Mary Manson

Week 9 - Chapter 9 – Eating Disorders and Obesity - According to the DSM-IV, eating disorders are characterized by a severe disturbance in eating behaviour - At the heart of Bulimia Nervosa and Anorexia Nervosa, is the intense fear of becoming overweight and fat, and an accompanying pursuit of thinness that is relentless and sometimes deadly - Obesity is not considered an eating disorder or a psychological condition in the DSM; however its prevalence is rising at an alarming rate. Obesity also accounts for more morbidity and mortality than all other eating disorders combined Clinical Aspects of Eating Disorders Anorexia Nervosa - Defined: lack of appetite induced by nervousness - Lack of appetite is not the real problem - It is an intense fear of gaining weight or becoming fat, combined with a refusal to maintain even a minimally low body weight - First known medical account of anorexia nervosa – 1689 by Richard Morton - Disorder received its name in 1873 when Charles Lasegue and Sir William Gull described the clinical syndrome - “without apparent cause, to evince a repugnance of food; and soon afterwards declined to take any whatever, except half a cup of tea or coffee” - women who continue to menstruate but meet all the other diagnostic criteria for anorexia nervosa are just as ill as those who have amenorrhea (not getting their periods at all) - for men, the equivalent of the menstruation criterion is diminished sexual appetite and lowered testosterone levels - patients with anorexia deny having any problems and are quietly proud of their weight loss - conceal thinness by wearing baggy clothes or carrying hidden bulky objects to make themselves look heavier than they are - before being weighed, they will drink large amounts of water to increase their weight temporarily - 2 types of anorexia nervosa: the restricting type and the binge eating/pursuing type o the central difference between these two is how patients maintain their very low weight - In the restricting type, every effort is made to limit how much food is eaten and caloric intake is tightly controlled. Patients avoid eating in the presence of other people, they eat excessively slowly, cut their food in small pieces and dispose of food secretly - Patients with binge eating/pursuing type of anorexia nervosa differ from patients with restricting AN because they either binge, purge or binge and purge. The binge involves eating out of control amounts of food that are far greater than what most people would eat in the same amount of time and under the same circumstances. Binges may be followed by efforts to purge. - 30 to 50% of patients transition from the restricting type to the binge/purging type of anorexia nervosa during the course of their disorder - methods of purging include self-induced vomiting or misuse of laxatives, diuretics, and enemas - purging strategies do not prevent the absorption of all calories from food. Laxatives do not lead to actual weight loss because their site of action is the large intestine, where they cause temporary loss of fluids, but not any loss of fat or calories - ballet dancers are at especially high risk for eating disorders – 35 students from Canada’s National Ballet school found that 25.7 percent had AN and 14.2 percent had either bulimia nervosa or other eating problem (Gelsey Kirkland) - mortality rate for females with AN is more than 12 times higher than the mortality rate for females aged 15 to 24 in the general population - when death occurs it is usually the result of either the physiological consequences of starvation or suicidal behaviour - death as a result of bulimia is rare - severe anorexics, even if they do survives, may suffer from irreversible brain atrophy DSM-IV-TR Criteria for Anorexia Nervosa - refusal to maintain a body weight that is normal for the persons age and height (ie a reduction of body weight to about 85 percent of what would normally be expected) - intense fear of gaining weight or becoming fat, even though underweight - distorted perception of body shape and size - absence of at least three consecutive menstrual periods Bulimia Nervosa - characterized by binge eating and by efforts to prevent weight gain using self-induced vomiting and excessive exercise - psychiatric syndrome found relatively recently - British G. F. M. Russelll (1979) propsed the term and it was adopted by the DSM in 1987 - Comes from greek word “bous” (means ox) and limos (means hunger) and is meant to denote a hunger of such proportions that the person “could eat an ox” - Binge aeating/pursuing type of anorexia is similar (difference is weight) o The person with AN is severly underweight, opposite to people with bulimia - If the person who binges or purges also meets criteria for AN they are considered anorexic not bulimic - The anorexia nervosa diagnosis trumps the bulimia nervosa diagnosis because there is much greater mortality associated with AN than BM. The DSM requires that the most severe form of eating pathology takes precedence diagnostically - Bulimic patients are typically normal weight or sometimes overweight - Bulimia begins with restricted eating motivated by the desire to be slender - Eat forbidden foods such as chips, pizza, pop, etc. approximately 4800 calories before vomiting, exercising or using laxatives - The purging serves to alleviate the extreme fear of gaining weight that comes from eating - Costly disorder – high food bills create financial difficulties and resort to stealing food from housemates - Purging and non purging types of bulimia whether the person has emploed purgative methods of preventing weight gain - Purging type is most common (80%) - In the non purging type the person may fast or exercise but does not vomit or use laxatives or diuretics to counteract the effects of binging - The mind set of the average patient with BN patient it not complacent, they are preoccupied with shame, guilt, self-depreciation, and efforts at concelment DSM-IV-TR Criteria for Bulimia Nervosa - recurrent episodes of binge eating, in a fixed period of time, amounts of food eaten are greater than anyone might eat under normal circumstances – while the binge is occurring, there is a complete lack of control over eating and the person is unable to stop - recurrent and inappropriate efforts to compensate for the effects of binge eating including self-induced vomiting, use of laxatives, or excessive exercise. Some patients take thyroid medication to enhance their metabolic rate - self-evaluation is excessively influenced by weight and body shape Age of Onset and Gender Differences - 1970s and 1980s when eating disorders attracted attention - as young as age 7 - Average age for onset AN is 18.9 years - Bulimia begins at average age of 19.7 - Far more common in women - 10 females for every male with an eating disorder - gender may be centrally involved in the nature and genesis of these disorders Medical Complications of AN and BN - AN is one of the most lethal psychiatric disorders – patients look extremely unwell - Hair on scalp and nails thin and become brittle - Skin becomes dry, downy hairs grow on face, neck, arms, back and legs - Yellowish ting to their skin - Difficult time dealing with cold - Hands and feet are too cold to touch with blue tinge that is from problems with temperature regulation and lack of oxygen - Low blood pressure therefore feel tired, weak, dizzy, faint - Thiamin Deficiency (Vitamin b1) may also be present – account for some of the depression and cognitive changes found in low weight anorexics - Affect patterns of growth as well as development of healthy bones and brain function - Die from irregular heart beats caused by imbalances in key electrolytes such as potassium, low potassium can also result in kidney damage and renal failure - BN can cause electrolyte imbalances and low potassium as well as damage to heart muscle which can be caused by using ipecac to induce vomiting - Patients with BN also develop calluses on their hands from sticking their fingers down their throats - Tears to the throat can occur when people use objects to induce vomiting - Patients damage their teeth through the acid from the stomach as well as mouth ulcers and cavities, and small red dots around the eyes caused by the pressure of vomiting - Patients with bulimia have swollen salivary glands caused by repeated vomiting “puffy cheeks” Other Forms of Eating Disorders - Eating disorder not otherwise specified (EDNOS) o Do not fit criteria of specific diagnosis - A women who meets criteria for AN but not the menstrual cycle part, would be diagnosed with EDNOS - 40% of all patients who seek treatment are diagnosed with this (most prevalent eating disorder among females) - Binge-Eating Disorder (BED) o Sepearate from BN, nonpurging type o Difference lies with that patient with BED binges at a level comparable to a patient with BN but does not engage regularly in this behaviour to limit weight gain o Much less dietary restraint in BED o Patients with BED are usually older (30-50 years old) o Not uncommon in men, only 1.5 females are not affected for each male with this disorder o Overweight or obese o Distinct clinical syndrome DSM-IV-TR Criteria for Binge-Eating Disorder (BED) - eating a considerably larger amount of food than most people would, in a small amount of time - sense of lack of control over eating - 3 or more of the following: o eating much more rapidly than normal o eating to the point of feeling uncomfortably full o eating large amounts of food when not hungry o eating alone due to embarrassment about the amount one is eating o feelings of disgust, guilt or depression after overeating - marked distress about binge eating - binge eating occurs at least twice a week for 6 months Distinguishing among Diagnoses - many who have meet criteria for BN have been diagnosed with AN in the past - some ENDOS reflect long term end state of anorexia nervosa - diagnosis at one time may not be the same diagnosis at a later date - clinical features of eating disorders evolve – anorexia nervosa “morphing” into bulimia nervosa Association of Eating Disorders with Other Forms of Psychopathology - comorbidity such as depression when someone has AN or BN - OCD is also common in those with anorexia - There has been found a relationship between substance-use disorders and eating disorders as well as comorbid personality (axis 2) disorders - Restrictive type of anorexia are inclined toward personality disorders in the avoidant cluster - Eating disorders that involve binging or purging syndromes are more likely to be associated with dramatic, emotional, or erratic (cluster B) problems, especially borderline personality disorder - More than 1/3 of patients with eating disorders have engaged in self harming behaviours that are symptomatic of borderline personality disorder - These symptoms may be due to mal nourishment – starvation increases irritability and obsessionality - Even though the physiological consequences of eating disorders may exacerbate personality disturbances, they may be only enhancing traits that were there in the first place - 2/3 of a sample of patients with anorexia nervosa reported that they were rigid and perfectionistic, even as children Prevalence of Eating Disorders - lifetime prevelance rates of AN, BN, and BED are 0.9 percent, 1.5 percent, and 3.5 percent for women and 0.3, 0.5 and 2.0 percents for men - while the actual diagnostic criteria of these disorders is strict, many people have disordered eating patterns Eating Disorders Across Cultures - most eating disorder research is in north America and Europe - but it is also a clinical problem in Japan, hong kong, Taiwan, Singapore and korea, India, Africa, Iran - being white appears to be associated with having the kinds of subclinical problems that put people at high risk for developing eating disorders - meta-analysis showing these attitudes are more common in whites Course
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