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Chapter 9

PSYB32H3 Chapter Notes - Chapter 9: Amenorrhoea, Dysfunctional Family, Laxative


Department
Psychology
Course Code
PSYB32H3
Professor
Konstantine Zakzanis
Chapter
9

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Chapter 9: Eating Disorders
Clinical Description
Anorexia and Bulimia share that there is an intense fear of being
overweight
Anorexia Nervosa
Anorexia: Loss of appetite
Nervosa: caused by emotional reasons
But most patients with anorexia nervosa actually don’t lose their
appetite in food
Most patients starve themselves but they become preoccupied with
food; they may read cookbooks constantly and prepare gourmet meals
for their families
Features for the diagnoses
o* The person must refuse to maintain a normal body weight
oThe persons weight is less than 85% of what is considered
normal for that persons age and height
oThere is dieting or purging (self-induced vomiting, heavy use of
laxative or diuretics), excessive exercise
o* Intense fear or gaining weight and the fear is not reduced by
weight loss
o* Have a distorted sense of their body shape even when they are
emacinated
oThey believe in particular that their abdomen, buttocks and
thighs are too fat
oWeigh themselves frequently, measure the size of different parts
of the body, and gaze critically at their reflections
o* Amenorrhea: loss of the menstrual period
oBut this loss of period occurs in a minority of women before any
significant weight loss
Eating disorder inventory: self report of eating disorders;
questionnaire
There is another test where they show a picture of 3 bodies and they
are asked to pick the one that looks like themselves; the patient with
anorexia nervosa overestimate their own body size and chose the
thinner one as their ideal
2 types of anorexia
oRestricting type: weight loss is achieved by severely limiting
food intake
oBinge eating-purging type: person regularly engages in being
eating and purging
More psychopathological
C h a p t e r 9 : E a t i n g D i s o r d e r s
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Patient exhibit more personality disorders, impulsive
behaviour, stealing, alcohol and drug abuse, social
withdrawal and suicide
Tend to weigh more in childhood, come from heavier
families with greater familial obesity and tend to use more
extreme weight-control methods
Typically begins in early to middle teenage years, often after an
episode of dieting and exposure to life stress
10x more frequent in women than men
Prevalence of less than 1%
Patients are frequently diagnosed with depression, obsessive
compulsive disorder, phobias, panic disorder, alcoholism, oppositional
defiant disorder, and various personality disorders
Women are more likely to have sexual disturbances
Physical changes in Anorexia Nervosa
Self starvation and use of laxatives
Blood pressure 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
They may lose their hair and develop laguna (fine, soft hair on their
bodies)
Levels of potassium and sodium are altered
oLower levels can lead to tiredness, weakness, cardiac
arrhythmias and even sudden death
Brain size declines (white matter volumes can restore, but gray matter
are irreversible)
Prognosis
70% will recover
Take 6-7 years and relapses are common before a stable patter of
eating and maintenance of weight is achieved
Death rates are 10x higher when compared to the normal population
Death result mostly from physical complications of the illness
Bulimia Nervosa
Bulimia nervosa: episodes of rapid consumption of a large amount of
food, followed by compensatory behaviours, such as vomiting, fasting
or excessive exercise, to prevent weight gain
Binge: eating excessively within less than 2 hours
Mostly done in secret
High levels of interpersonal sensitivity
Often feel they can’t control the amount they eat
So they eat in high volumes and feel like they have lost their
awareness then they purge it out through gagging and vomiting
Bulimia nervosa requires that the episode of binging and purging occur
at least 2x a week for 3 months
C h a p t e r 9 : E a t i n g D i s o r d e r s
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They have a morbid fear of fat
2 subtypes
oPurging type
oNon purging type – fasting or excessive exercise
Typically begins in late adolescence or early adulthood
90% women with a prevalence of 1-2%
70% recover 10% remain fully symptomatic
Associated with depression, personality disorder, anxiety disorder,
substance abuse, and conduct disorder
Higher suicide rates
Associated with stealing (lack of self control)
Side effects: potassium depletion, diarrhoea, irregular heartbeat,
tearing of tissue in stomach and throat and loss of dental enamel,
swollen salivary gland
Lower mortality rate
Binge Eating Disorder
Diagnosis that needs further study
Includes recurrent binges (2x / peek for at least 6 months), lack of
control during the binging episode, and distress about binging as well
as other characteristics, such as rapid eating and eating alone
Distinguished from anorexia but the absence of weight loss and from
bulimia nervosa and absence of compensatory behaviours (purging,
fasting, or excessive exercise)
More prevalent than the other two
Occurs more in women, associated with obesity and history of dieting
Linked to impaired work and social functioning, depression, low self-
esteem, substance abuse, and dissatisfaction with body shape
Risk factors: childhood obesity, critical comments regarding being
overweight, low self concept, depression and childhood physical or
sexual abuse
Etiology of Eating Disorder
Biological Factors
Genetics
Both anorexia and bulimia run in families
First degree relatives are 4x more likely
Eating Disorders and the Brain
Hypothalamus – regulates hunger and eating
Lesions to lateral hypothalamus show lose in weight and appetite
Cortisol hormone
Endogenous opioids: substance produced by the body to reduce
pain sensations, enhance mood and suppress appetite, at least among
those with low body weight
C h a p t e r 9 : E a t i n g D i s o r d e r s
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