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Chapter 10

PSYB32H3 Chapter 10: PSYB32-CHAPTER 10

Course Code
Konstantine Zakzanis

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C h a p t e r 9 : E a t i n g D i s o r d e r s
Page 1
Chapter 9: Eating Disorders
Clinical Description
Anorexia and Bulimia share that there is an intense fear of being overweigh
Eating disorder not other wise specified (EDNOS)
o General diagnostic category has been seen as residual catch all category that
underscores problems inherent in the current diagnostic system
Night eating disorder: repetitive tendency to wake up and eat during the night and then get
quite upset about it
Purging disorder: this is a form of bulimia that involves self- induced vomiting or laxarive use at
least once a week fro a minimum of six months
o People with that disorder have levels of disturbed eating and associated forms of
psychopathology that are comparable with patients with other eating disorders
o People with that disorder have high impulsivity
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
o The persons weight is less than 85% of what is considered normal for that persons age
and height
o There 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 thin
o They believe in particular that their abdomen, buttocks and thighs are too fat
o Weigh themselves frequently, measure the size of different parts of the body, and gaze
critically at their reflections
o * Amenorrhea: loss of the menstrual period (least important to determining a diagnosis
for anorexia read point underneath)
But this loss of period occurs in a minority of women before any significant weight
loss so they took it out of the DSM requirements
o Overvaluation of appearance: tendency to link self-esteem and self-evaluation w/
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
The presence of anxiety disorder is a huge risk factor
No link between AN and drug use but there is a link between bulimia nervosa and drug use
2 types of anorexia
o Restricting type: weight loss is achieved by severely limiting food intake
o Binge eating-purging type: person regularly engages in binge eating and purging
More psychopathological
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
3 to10x more frequent in women than men
Prevalence of less than 1%
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C h a p t e r 9 : E a t i n g D i s o r d e r s
Page 2
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
They may lose their hair and develop laguna (fine, soft hair on their bodies)
Levels of potassium and sodium are altered
o Lower levels can lead to tiredness, weakness, cardiac arrhythmias and even sudden
Brain size declines (white matter volumes can restore, but gray matter are irreversible) and
neurological impairments
70% will recover
Take 6-7 years and relapses are common before a stable pattern of eating and maintenance of
weight is achieved
Death rates are 10x higher when compared to the normal population
Deaths are 20x higher in people with higher psychological disorders
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 and triggered by stress and the negative emotions it arouses and continue
until the person is uncomfortably full
High levels of interpersonal sensitivity as reflected in large increases in self criticism following
negative social interactions
Binge episodes tend to be preceded by poorer than average social experiences self concepts and
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
They have a morbid fear of fat
Fat talk: refers to the tendency for friends, particularly female friends to take turns disparaging
their bodies to each other
Beings in late adolescence or early adulthood
2 subtypes
o Purging type
o Non 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
Higher suicide rates
Diagnostic crossover: more than 18% with AN eventually develop BN wihle approximately 7% if
those with BN eventually develop AN
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
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