PSYC 3460 Chapter Notes -Binge Eating Disorder, Eating Disorder, Anorexia Nervosa

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Published on 19 Apr 2013
School
University of Guelph
Department
Psychology
Course
PSYC 3460
Ch 9 eating disorders
These disorders only appeared in the DSM for the first time in 1980 as one subcategory of disorders beginning in childhood or
adolescence
Stat Canada 2002, 0.5% of Canadians 15 yrs of age or older reported that they had been diagnosed with an eating disorder in the
preceding 12 months.
Women were more likely than men to report an E.D ---0.8% vs 0.2%
Among young women aged 15-24 1.5% reported that they had an E.D
Eating disorders can cause long term psychological, social and health problems
Hospitalization is sometimes necessary. Hospitalization rates are highest among young women in the 15-24 age range. Rates are also
highest among those ages 10-14 and 20-24
CLINICAL DESCRIPTION
The diagnoses of these two disorders share several clinical feautures the most imp being an intense fear of being overweight
Co-twins of patients diagnoses with A.N for ex are themselves more likely than average to have B.N
Anorexia Nervosa
Ms. A had A.N. anorexia refers to loss of appetite and nervosa indicates that this is for emotional reasons
Most patients with A.N actually do not lose their appetite or interest in food. They are preoccupied with food
Ms. A met all the four features required for the diagnosis:
1) the person must refuse to maintain a normal body weight, that is usually taken to mean that the person weights less than 85% of
what is considered normal for that persons age and height. Weight loss is typically achieved through dieting although purging (self
induced vomiting, heavy use of laxatives or diuretics) and excessive exercise can also be part of the picture
2) the person has an intense fear of gaining weight and the fear is not reduced by weight loss. They can never be thin enough
3) Patients with AN have a distorted sense of their body shape. They maintain that even when emaciated they are overweight or that
certain parts of their bodies esp the stomach, butt and thighs are too fat. To check on their body size they typically weight themselves
frequently, measure the size of diff parts of the body and gaze critically at their reflections in the mirror. Their self esteem is closely
linked to maintaining thinness. The tendency to link self esteem and self evaluation with thinness is known as over evaluation of
appearance
4) in females the extreme emaciation causes amenorrhoea the loss of the menstrual period. Of the four diagnostic criteria
amenorrhoea seems least imp to determining a diagnosis of anorexia. Moreover amenorrhoea occurs in a significantly minority of
women before any significant weight lose and the symptoms can persist after weight gain
eating disorder inventory (EDI). Was developed in Canada and is one of the most widely used measured to assess self reported
aspects of eating disorders
patients with AN overestimate their own body size and choose a thing figure as their ideal
DSM-IV-TR distinguishes two types of AN. In the restrictive type, weight loss is achieved by severely limiting food intake; in the
binge eating purging type the person also regularly engages in binge eating and purging
The binging purging subtype appears to be more psychopathological; patients exhibit more personality dis, impulsive beh, stealing,
alcohol and drug abuse, social withdrawal and suicide attempts than do patients with the restricting type of anorexia
Binging purging patients tend to weight more in childhood, come from heavier families with greater familial obesity and use more
extreme weight control methods.
Canadian research suggests that the diff between the two subtypes are becoming less distinct
An increasing proportion of patients were diagnosed with AN, the binging purging subtype, during each period. Over time,
participants in both groups appeared to weigh more and were less likely to report amenorrhoea. Patients from both groups reported
higher frequencies of purging beh, impulsive beh, and associated affective symptoms in the later time periods
AN typically begins in early to middle teenage years often after an episode of dieting and exposure to life stress. It is about 3-10 x
more frequent in women than in men with a lifetime prevalence about 1% in women
When AN does occur in men, symptomatology and other characteristics, such as family conflict, are generally similar to those
reported by women with the disorder
Found that males had lower levels of drive for thinness and body dissatisfaction but there were many more similarities than
differences between the males and females
Patients with AN are diagnosed frequently with depression, OCD, phobias, panic disorder, alcoholism, oppositional defiant disorder,
and various personality disorders
Comborbidty is higher in clinical samples than community samples. A growing concern is the high rate of occurring eating disorders
and substance use disorders
Physical Changes In AN
Blood pressure often falls, heart rate slows, kidney and gastrointestinal problems develop, bone mass declines, the skin dries
out, nails become brittle, hormone levels change and mild anemia may occur
Some patients lose hair from the scalp, and they may develop laguna, a fine, soft hair on their bodies. Levels of electrolytes such
as potassium and sodium are altered. These ionized salts present in various bodily fluids are essential for the process of neural
transmission and lowered levels can lead to tiredness, weakness, cardiac arrhythmias and even sudden death.
Brain size declines in patients with anorexia and EED abnormalities and neurological impairments are frequent
Deficits in white matter volumes in the brain are restored upon recovery from anorexia nervosa but deficits in grey matter
volumes appear irreversible at least in the short term.
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These consequences may be especially problematic for adolescents with AN
Prognosis
About 70% of patients with AN eventually recover. However recovery often takes 6 or 7 years and relapses are common before
a stable pattern of eating and maintenance of weight is achieved.
AN is a life threatening illness, death rates are about 10 x higher among patients with the disorder than among the general
population and twice as high as among patients with other psychological disorders
Death most often results from physical complications of the illness or from suicide
The standardized mortality rate for the 326 patients with AN was very high (10.5). standardized mortality rate is defined as the
ratio of observed deaths relative to expected deaths. Among the 17 AN patients who had died the leading cause was suicide
followed by pneumonia, hypoglycemia and live disease
Found that suicide rates are not elevated in B.N like they are in AN though ppl with BN are more likely to have suicide ideation.
Predictors of suicide in AN patients include purging beh, depression, substance abuse and a history of physical or sexual abuse
Bulimia Nervosa
Ms Bs beh is BN. Bulimia from a Greek word means ox hunger.
This disorder involves episodes of rapid consumption of a large amount of food, followed by compensatory beh such as
vomiting, fasting or excessive exercise to prevent weight gain
The DSM defines a binge as eating an excessive amount of food within less than two hours. BN is not diagnosed if the binging
and purging occur only in the context of AN and its extreme weight loss; the diagnosis in such as case is AN binge eating
purging subtype
Binges typically occur in secret may be triggered by stress and the negative emotions it arouses and continue until the person is
uncomfortably full.
Stressors that involve negative social interactions may be particularly potent elicitors of binges.
Bulimics have high levels of interpersonal sensitivity, as reflected in large increases in self-criticism following negative social
interactions.
Further binge episodes tend to be preceded by poorer than average social experiences, self concepts and moods
Also reported that the binge episodes are followed by deterioration in self concept, mood state and social perception
The person who is engaged in a binge often feels a loss of control over the amount of food being consumed. Foods that can be
rapidly consumed, esp sweets such as ice cream or cake are usually part of a binge. Although research suggests that patients with
BN sometimes ingest an enormous quantity of food during a binge.
Binges are not always as large as the DSM implies and there may be wide variation in the caloric content consumed by
individuals with BN during binges. Patients are usually ashamed of their binges and try to conceal them. They report that they
lose control during a binge even to the point of experiencing something akin to a dissociative state perhaps losing awareness of
what they are doing of feeling that it is not really they who are binging
After the binge is over disgust, feelings of discomfort and fear of weight gain lead to the 2nd step of BN—[urging to undo the
caloric effects of the binge. As seen with Ms. B purging can involve induced vomiting and excessive exercise. The use of
laxatives and diuretics is common even though this odes not actually result in weight loss
The DSM diagnoses of BN requires that the episodes of binging and purging occur at least twice a week for three months
Suggesting that there is a continuum of severity rather than a sharp distinction
Like patients with AN patients with BN are afraid of gaining weight and their self esteem depends heavily on maintaining
normal weight.
Observed that a morbid fear of fat is an essential diagnostic criterion for BN cuz 1) it covers what clinicians and researchers
view as the core psychopathology of BN 2) it makes the diagnosis more restrictive and 3) it makes the syndrome more closely
resemble the related disorder or AN
as with anorexia two subtypes of BN are distinguished: a purging type and a non purging type in which the compensatory beh
are fasting or excessive exercise. And recent evidence does not strongly support the validity of this distinction
BN typically begins in late adolescence or early adulthood. About 90% of cases are women and prevalence among women is
thought to be about 1 to 2% of the population.
Find tat lifetime rates for females are approx 1.1% of the population for BN and 0.5% of the population for AN
Suggests that bulimia is more common than anorexia among adolescents
One study found that by age 18 80% of young women in BC with normal height and weight indicate that they would like to
weight less.
Another study of more than 1,800 females from Ottawa, Hamilton, and T,O between the ages of 12 and 18 found that 27% has
disordered eating attitudes and beh and approx 1 in 7 participants engaged in binge eating with associated loss of control
Comparisons across time suggest that the frequency of BN may be increasing.
Cohort effect- with rates being higher among ppl born after 1960 who alsp tend to have younger ages of onset
BN patients are somewhat overweight before the onset of the disorder and that the binge eating often starts during an episode of
dieting.
Long term follow up of BN patients reveal that about 70% recover although about 10% remain fully symptomatic
BN is associated with numerous other diagnoses, notably depression, personality disorders ( esp borderline person disorder)
anxiety dis, substance abuse and conduct disorder
Suicide rates are much higher among ppl with BN than in the general population. A twin study had found that bulimia and
depression are genetically related
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Somewhat curiously BN has been associated with stealing. Patients with bulimia who steal tend also to be illicit drug users and
promiscuous. This combination of beh may reflect impulsivity or lack of self control, characteristics that may be relevant to the
beh of binge eating
Like anorexia bulimia is associated with several psychical side effects. Frequent purging can cause potassium depletion. Heavy
use of laxatives includes diarrhoea which can also lead to changes in electrolytes and cause irregularities in the heart beat.
Recurrent vomiting may lead to dental enamel as stomach acids eat away at the teeth, making them ragged. The salivary glands
may become swollen. However mortality appears to be much less common in BN than in AN
Binge Eating Disorder
DSM-IV-TR includes binge eating disorder (BED) as a diagnosis in need of further study rather than a formal diagnosis. This
disorder includes recurrent binges (2 x per week for at least 6 months), lack of control during the binging episode, and distress
about binging as well as other characteritcs such as rapid eating and eaing alone.
It is distinguished from AN by the absence of weight loss from BN by the absence of compensatory beh (purging, fasting or
excessive exercise)
Binge eating disorder appears to be more prevalent than either AN or BN
One advantage of including BED as a diagnosis is that it would apply to many patients who are now given the vague diagnosis
of eating disorder not otherwise specified since they do not meet criteria for anorexia or bulimia
BED has several features that support its validity. It occurs more often in women than in men and is associated with obesisty and
a history of dieting.
Its linked with impaired work and social functioning, depression, low self esteem, substance abuse and dissatisfaction with body
shape
Risk factors for developing BED include childhood obesity, critical comments regarding being overweight, low self concept,
depression, and childhood physical or sexual abuse
Recent data also indicate that the average life time duration of BED (14.4 yrs) may be greater than the duration of AN (5.9 yrs)
or BN (5.8 yrs)
Reported that only about half of the women with an apparent binge eating disorder reported feeling “out of control”
Do not view binge easting disorder as a discrete diagnostic category seeing it instead as a less severe version of BN.
Found few differences between patients with binge eating disorder and the non purging form of BN but the preponderance of
evidence seems to support the distinction between these disorders
ETIOLOGY OF EATING DISORDERS
A single factor is unlikely to cause an eating disorder
including genetics, the role of the brain, socio-cultural pressures to be thin, the role of the family and the role of the environment
table 9.1 pg 257 and table 9.2 pg 261
Biological Factors
Genetics
both AN and BN run in families. 1st degree relatives of young women with AN are about 4 x more likely than average to have
the disorder themselves
twin studies of eating disorders also suggest a genetic influence. Most studies of both anorexia and bulimia report higher
identical than fraternal concordance rates
a strong genetic component was found with a herabtability estimate of 56%
research has also shown that key features of the eating disorders such as dissatisfaction with ones body and a strong desire to be
thin appear to be heritable
eating disorders and the brain
the hypothalamus is a key brain centre in regulating hunger and eating. Research on animals with lesions to the lateral
hypothalamus indicates that they lose weight and have no appetite thus its not surprising that the hypothamlus has been proposed
to play a role in anorexia. The paraventicular nucleus has also been implicated.
The level of some hormones regulated by the hypothalamus such as cortisol are indeed abnormal in patients with anorexia; rather
than causing the disorder however these hormonal abnormalities occur as a reulst of self starvation and levels return to normal
following weight gain
Animals appear to have no hunger and become indifferent to food, whereas patients with anorexia continue to starve themselves
despite being hungry and having an interest in food. Nor does the hypothalamic model account for body images disturbances or
fear of becoming fat.
A dysfunctional hypothalamus thus does not seem a high likely factor in anorexia nervosa
Endogenous opiods- are substances produced by the body that reduce pain sensations, enhance mood and suppress appetite at
least among those with low body weight.
Opiods are released during starvation and have been viewed as playing a role in both anorexia and bulimia.
Starvation among patients with anorexia may increase the levels of endogenous opiods resulting in positively reinforcing
euphoric state
The excessive exercise seen among some patients with eating disorders would increase opiods and thus be reinforcing
Hypothesized that bulimia is medicated by low levels of endogenous opiods which are though to promote craving; a euphoric
state is then produced by the ingestion of food thus reinforcing binging
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Document Summary

These disorders only appeared in the dsm for the first time in 1980 as one subcategory of disorders beginning in childhood or. Stat canada 2002, 0. 5% of canadians 15 yrs of age or older reported that they had been diagnosed with an eating disorder in the adolescence preceding 12 months. Women were more likely than men to report an e. d ---0. 8% vs 0. 2% Among young women aged 15-24 1. 5% reported that they had an e. d. Eating disorders can cause long term psychological, social and health problems. Hospitalization rates are highest among young women in the 15-24 age range. Rates are also highest among those ages 10-14 and 20-24. The diagnoses of these two disorders share several clinical feautures the most imp being an intense fear of being overweight. Co-twins of patients diagnoses with a. n for ex are themselves more likely than average to have b. n.

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