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Chapter 10

PSYB32 - Chapter 10 Notes.docx

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Health Studies

Chapter 10: Eating Disorders Clinical Description - many cultures are preoccupied with eating (especially in developed nations) - clinical descriptions of eating disorders didn’t appear in the DSM until 1980, but have received increased attention from clinicians and researchers over the past 3 decades - the lifetime prevalence estimates for anorexia and bulimia hover around 1% for women and 0.5% for men - only a small proportion of people requiring treatment actually sought out treatment - eating disorders can cause long-term psychological, social, and heath problems; hospitalization is sometimes necessary (rates are highest around women ages 15- 24) - the most common eating disorder diagnoses is EDNOS - eating disorder not otherwise specified (EDNOS): the most common eating disorder diagnosis characterized by heterogeneous symptoms and associated features that do not fit the symptoms of other eating disorders; applied to approx.. 40-70% of diagnosed patients  the extensive use of the EDNOS category reflects the great heterogeneity among individuals all deemed to have an eating disorder of some sort, but it also suggests that the eating disorder category needs some refinement - purging disorder: a form of bulimia characterized primarily by self-induced vomiting or laxative use at least once a week for a minimum of six months  features: high impulsivity -> can lead to an impulse control disorder (compulsive buying disorder, kleptomania, etc) - those with anorexia and bulimia share several clinical features, the most important = fear of being overweight Anorexia Nervosa - anorexia nervosa (AN): a disorder in which a person refuses to eat or retain any food or suffers prolonged and severe diminution of appetite. The individual has an intense fear of becoming obese, feels fat even when emaciated, refuses to maintain a minimal body weight, and loses at least 25% of his/her original weight - anorexia = loss of appetite; nervosa = for emotional reasons - most patients with AN actually don’t lose their appetite or interest in food, and some even become preoccupied with food (cooking it, reading about it, etc) - amenorrhea: loss of menstrual period, which is sometimes caused by eating disorders - the distorted body image that accompanies AN is mainly assessed by the Eating Disorders Inventory (a questionnaire) - in another type of assessment, patients are shown line drawings of women with various body weights and are asked to pick the one closest to their own and their ideal body shape -> patients with AN overestimate their own body size and choose a thin figure as their ideal - the DSM-IV-TR distinguishes two types of AN  1) the restricting type -> weight loss achieved by severely limiting food intake  2) binge eating-purging type -> person regularly engages in binge eating and purging; more psychopathological (patients exhibit more personality disorders, impulsive behavior, substance abuse, social withdrawal, and suicide attempts) - AN typically begins in the early to middle teenage years, often after an episode of dieting and exposure to life stress - The prevalence of AN is on the rise, especially among younger people, and comorbidity is high for depression, panic disorder, and social phobia - Self-starvation and the use of laxatives produce numerous bad biological consequences in patients with AN (low BP, slow heart rate, kidney + gastrointestinal problems, low bone mass, hormone levels change) - Brain size also declines in patients with AN, and neurological impairments are frequent - Around 70% of patients with AN eventually recover, but usually over the course of 6-7 years, with relapses being common - Changing patients distorted views of themselves is very difficult, especially in cultures that value thinness - AN is life-threatening, and death rates are 10x higher than the general population; death usually results from physical complications or suicide - There is also a tendency to engage in self-injury and self-harm - Famous examples = Princess Diana + Amy Winehouse - Most common forms of self-harm = cutting, self-hitting, scratching; for males, includes putting themselves in dangerous situations (driving recklessly, etc) - People engage in self-harm for: 1) interpersonal reasons 2) to suppress an unwanted social stimulus 3) to suppress negative emotions 4) to generate feelings - Things like online social interaction (games, forums, message boards) provided much needed support for those who self-harm Bulimia Nervosa - bulimia nervosa: a disorder characterized by episodic uncontrollable eating binges followed by purging either by vomiting or by taking laxatives - binge = eating an excessive amount of food within 2 hours; typically occur in secret and may be triggered by stress + negative emotions from stress -> continues until the person is uncomfortably full - bulimics have high levels of interpersonal sensitivity; reflected in large increases in self-criticism following negative social interactions -> low self esteem, bad mood, and low social perception of self - the person engaged in a binge often feels a loss of control over the amount of food being consumed; often foods are things that can be eaten easily like sweets - patients are usually ashamed of their binges and try to conceal them and feel disgust + discomfort + fear of weight gain - leads the patient to purge (induce vomiting + excessive exercise) in order to not gain weight - because many people binge/purge occasionally, the DSM diagnosis of bulimia nervosa requires that episodes of binging and purging occur at least twice a week for 3 months - like patients with AN, patients with bulimia are afraid of gaining weight; this “fear of fat” is a key characteristic of those with BN - two types of bulimia: purging type and a non-purging type (compensatory behaviours = fasting or excessive exercise rather than vomiting) - BN typically begins in late adolescence or early adulthood; research suggests that it’s more common than AN - research also suggests that children particularly at risk of obtaining an eating disorder can be identified at a fairly young age; found among girls as BMI increases, body satisfaction decreases - BN is associated with depression, personality disorders (esp. BPD), anxiety disorders, substance abuse, and conduct disorders; suicide rates much higher compared to general population - BN can also cause several physical side-effects, like AN Binge Eating Disorder - binge eating disorder (BED): recurrent episodes of unrestrained eating; characterized in the DSM as a diagnosis needing further study - includes lack of control during binging episode, distress about binging, as well as rapid eating - distinguished from AN by the absence of weight loss, and from BN by the absence of compensatory behaviours - BED is also more prevalent than AN or BN; around 1/25 women meet criteria for BED - Occurs more often in women than in men; associated with obesity and a history of dieting - Linked with impaired work + social functioning, low self-esteem, depression, and substance abuse - Major risk factor = childhood obesity Etiology of Eating Disorders - eating disorders typically result when several influences converge in a person’s life Biological Factors - role of genetics was largely ignored, due to emphasis on socio-cultural factors, but has been gaining interest due to the fact that AN and BN run in families - key features of eating disorders (dissatisfaction with one’s body and strong desire to be thin) appear to be heritable - hypothalamus -> key brain centre in regulating hunger and eating - lateral hypothalamus: a section of the brain that, if lesioned, is associated with a dramatic loss of appetite - the levels of hormones regulated by the hypothalamus (like cortisol) are abnormal in patients with AN  these hormone changes don’t cause the disorder, but occur as a result of self- starvation -> return to normal levels following weight gain - endogenous opioids = substances produced by the body that reduce pain sensations, enhance ood, and suppress appetite among those with low body weight  released during starvation -> results in a positively reinforcing euphoric state  bulimia is mediated by low levels of these opioids, which promote craving (euphoric state that is produced by the ingestion of food -> reinforces binging) - binges of patients with bulimia could also result from a serotonin deficit -> cause the patient to not feel satisfied as they eat Sociocultural Variables - throughout history, the standards set by society about the ideal body (esp. female) have varied greatly - there has been a steady progression toward thinness - even toys like Barbie have the effect of exposing young girls to unrealistic body images - Scarlett O’Hara effect: a tendency to eat lightly in an attempt to project an image of femininity - While cultural standards and pressures to be thin were increasing, more people were becoming overweight - Some attribute the increasing prevalence of obesity (20-30% of North Americans) to an evolutionary tendency for humans to eat in excess to store energy in their bodies for a time when food may be less plentiful - This tendency to overcome = opposite of the unrealistic pressure to maintain ideal bodyweights - Younger women are usually the ones dissatisfied, and women are more likely than men to wish that they weighed less -> place greater emphasis on appearance than men - As society has become more health + fat conscious, dieting to lose weight has become more common; diet industry (books, pills, videos, foods) is increasing - The media has a huge impact on body image ideals + dissatisfaction - Obese people are often stereotyped, and this anti-fat bias is widespread in most Western nations - Females with below-average weights are overrepresented in most television shows, and most of the heavier female characters have negative comments directed toward her (reinforced by audience laughter) - There has also been pro-anorexia websites all across the internet - Activity anorexia: the loss of appetite that results from being engaged in extreme physical activity; applies to athletes, dancers, etc. Gender Influences - primary reason for the greater prevalence of eating disorders among women compared to men is because women have been more heavily influenced by the cultural ideal of thinness - women are typically valued more for their appearance -> more concerned about being thin, more likely to diet = more vulnerable to eating disorders Dieting - the dieting industry is a multi-billion dollar business -> eating disorders + obesity rates have gone up - some people find it hard to diet because of the brain’s homeostatic system and it’s hedonic system (controls pleasure) - heredity also plays a role in eating and obesity; hard for people to diet (or gain weight) if parental genes says otherwise - stress and negative moods also trigger people to eat (esp. high calorie sweets) - some groups, like feminists, have also spoke out against dieting and the “need to be thin” by saying that women shouldn’t be defined by physical characteristics - potential danger of dieting -> often a precursor to eating disorders - false hope syndrome: a tendency for the initial positive results of attempts at weight loss to foster an overly positive inclination to pursue unrealistic weight loss goals, eventually resulting in profound disappointment - it’s known that many diets achieve weight loss in the short-term (like 1 year), but the weight is typically regained later -> suggests that diets don’t work long-term Cross-Cultural Studies - eating disorders = common in industrialized societies (USA, Canada, Japan, Western Europe, Austral
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