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PSYCH 257 (72)
Chapter 8

Chapter 8: Eating & Sleep Disorders

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Allison Kelly

Chapter 8: Eating Disorders Eating Disorders: An Overview Bulimia Nervosa: out-of-control eating episodes “binges” are followed by “purging” Anorexia Nervosa: the person eats nothing beyond minimal amounts of food, so that body weight drops.  Pisa Study: 83% of people suffering from an eating disorder evidenced an extreme desire to be thin  20% of people suffering from an eating disorder over an extended period of time will die as a result of their disorder, 5% dying within ten years  Anorexia nervosa has the highest mortality rate of any psychological disorder  30% of anorexia related deaths are suicide – 50% higher than the general population  Eating disorders increased dramatically in Western countries from about 1960 to 1995  Between 1975 and 1986, anorexia rates rose slowly, where as bulimia rates rose rapidly Bulimia Nervosa Clinical Description  Subtyped into purging & non-purging (exercising or fasting) o Non-binging is rare: only 6-8% of bulimia patients  Vomiting reduces 50% of the calories consumed  Laxatives have little affect as they act long after the binge. Medical Conditions  Salivary gland enlargement – caused by repeated vomiting, and gives the face a chubby appearance.  Erosion of the dental enamel on the inner surface of the frontal teeth  Continued vomiting may upset the chemical balance of bodily fluids, including sodium and potassium levels: electrolyte imbalance 1 o Medical complications: cardiac arrhythmia, and renal failure, intestinal problems including severe constipation and permanent colon damage, and marked calluses on their fingers or backs of their hands from sticking their finger down their throat to induce vomiting. Associated Psychological Disorders  Individuals with bulimia usually present with other psychological disorders, particularly anxiety disorders & mood disorders  Almost all evidence indicates that depression follows bulimia & may be a reaction to it.  Indication of high prevalence of borderline personality disorder in patients with bulimia  Substance abuse commonly accompanies bulimia nervosa and vice versa  Most individuals with bulimia nervosa are within 10% of their normal body weight  Ashamed of both the problem and their lack of control, tend to be secretive about their symptoms Anorexia Nervosa  “Nervous Loss of Appetite”  Major difference between anorexia nervosa & bulimia nervosa: individuals with anorexia are successful  Proud of their diets and their extraordinary control – don’t see themselves as having an illness Clinical Description  Decreased body weight is most notable feature, but not the core  Severe exercise is common in anorexia  2 subtypes o Restricting type: individuals diet to limit caloric intake o Binge-eating/purging: binge on relatively small amounts of food, and binge more consistently  ½ of the individuals suffering from anorexia engage in the binge-purging  Never satisfied with staying the same weight – have to consistently loose weight daily for weeks on end to be satisfied – if not will cause panic, anxiety, and depression 2  DSM4 criteria states that weight must be 15% below that expected – the average is 25% - 30% below normal by the time treatment is sought Medical Consequences  Amenorrhea: Cessation of menstruation – occurs relatively often in bulimia o Inconsistent – likely to be dropped in DSM 5  Dry skin, brittle hair or nails, sensitivity or intolerance to cold temperatures  Lanugo: downy hands on limbs and cheeks  Chronically low blood pressure, and heart rate  If vomiting: electrolyte imbalance and resulting cardiac & kidney problems can occur as does in bulimia Associated Psychological Disorders  Anxiety and mood disorders  Obsessive – Compulsive Disorder: (OCD)  Substance abuse o When combined, is a strong predictor of morality, particularly by suicide Binge Eating Disorder  Individuals who experience marked distress due to binge eating but do not engage in extreme compensatory behaviors and therefore cannot be diagnosed with bulimia  Greater likelihood of occurring in males and a later age of onset  Greater likelihood of remission and a better response to treatment  20% of obese individuals in weight loss programs engage in binge eating  50% of individuals with BED try dieting before binging  50% start with binging and then attempt dieting o More affected by BED & tend to have additional disorders  33% of individuals with BED binge to alleviate “bad moods” or negative affect o More psychologically disturbed than the 67% who do not use binging to regulate mood 3 Statistics Cross-Cultural Considerations  Chinese Culture: emphasis of beauty on face not body – value curvaceous hips and narrow waste.  Anorexia Nervosa prevalent in Western Culture o Immigrants to western culture experience it as well  Associated with Caucasian middle-class values Developmental Considerations  Anorexia & bulimia are strongly related to development  Different patterns of physical development in boys and girls interact with cultural influences to create eating disorders o When puberty hits girls gain fatty tissue, where as boys gain muscle and lean tissue o Ideal Look in Western Culture: Tall, muscular men, and pre-pubertal women o Physical development brings boys closer to ideal, and girls farther away Causes Social Dimensions  Self worth, happiness and success are determined by body measurements and percentage of body fat  Ideal shape is similar to ideal shape in the 1920’s o That shape was achieved through fashion (use of girdles etc.) and there were no diet articles appearing in magazines  Size and weight of average woman has increased over the years because of improved nutrition -- women are no longer satisfied with their bodies  Increase in the amount of individuals dieting Dietary Restraint  Those with eating
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