chapter 9

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Published on 10 Dec 2010
School
UTSC
Department
Psychology
Course
PSYB32H3
Chapter 9 ± Eating Disorders
- 0.5% of Canadians 15 years of age or older reported that they had been diagnosed wit an eating
disorder in the preceding 12 months
- women are more likely than men to report an eating disorder
- 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 range; rates are also high among those aged 10-14 and 20-24
Clinical Description
- anorexia nervosa and bulimia nervosa both share features; the most important being an intense fear of
being overweight
Anorexia Nervosa
anorexia nervosa (AN) ± a disorder in which a person refuses to eat or to retain any food or suffers a
prolonged and severe decrease 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 refers to loss of appetite and nervosa indicates that this is for emotional reasons
- there are 4 features required for the diagnosis:
Æ the person must refuse to maintain a normal body weight
this is usually taken to mean that the person weighs less than 85% of what is considered
normal for that peUVRQs 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
Æ the person has an intense fear of gaining weight
and the fear is not reduced by weight loss; they can never be thin enough
Æ patients with AN have a distorted sense of their body shape
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
Æ in females, the extreme emaciation causes amenorrhea, the loss of the menstrual period
of the 4 diagnostic criteria, amenorrhea seems least important to determining a diagnosis
of anorexia; comparisons conducted in Canada show few differences between women
who meet all 4 criteria and women who meet the other 3 but not amenorrhea;
amenorrhea occurs in a significant minority of women before any significant weight loss
and the symptom can persist after weight gain
amenorrhea ± loss of menstrual period that is sometimes caused by eating disorders
- the distorted body image that accompanies AN has been assessed in several ways, most frequently by
questionnaires such as the Eating Disorders Inventory (EDI)
- the EDI is one of the most widely used measures to assess self-reported aspects of eating disorders
- patients with AN overestimate their own body size and choose a thin figure as their ideal
- DSM-IV-TR distinguishes 2 types of AN
- in the restricting 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
disorders, impulsive behavior, stealing, alcohol and drug abuse, social withdrawal, and suicide attempts
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than do patients with the restricting type of anorexia
- also, relative to the restricting type, binging-purging patients tend to weigh more in childhood, come from
heavier families with greater familial obesity, and use more extreme weight-control methods
- AN typically begins in the early to middle teenage years, often after an episode of dieting and exposure
to life stress
- LWVDERXW-10 times more frequent in women than in men, with a lifetime prevalence of 1% in women
- twas 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
- comorbidity is higher in clinical samples than community samples
Physical Changes in Anorexia Nervosa
- self-starvation and use of laxatives produce numerous undesirable biological consequences in patients
with 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 the bodies
- levels of electrolytes, such as K and Na are altered; these 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 AN, and EEG abnormalities and neurological impairments are
frequent
- deficits in white matter volumes in the brain are restored upon recovery from AN, but deficits in grey-
matter volumes appear irreversible, at least in the short term
Prognosis
- about 70% of patients with AN eventually recover; recovery often takes 6-7 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 times higher among patients with the disorder
than among the general population and twice as high among patients with other psychological disorders
- suicide rates are not elevated in bulimia nervosa like they are in AN, though people with BN are more
likely to have suicide ideation
Bulimia Nervosa
bulimia nervosa (BN) ± a disorder characterized by episodic uncontrollable eating binges followed by
purging either by vomiting or by taking laxatives
- this disorder involves episodes of rapid consumption of a large amount of food, followed by
compensatory behaviors, 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 2 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 a case is AN, binge eating-purging type
- binges typically occur in secret, may be triggered by stress and the negative emotions it arouses, and
continue until the person feels uncomfortably full
- the person who is engaged in a binge often feels a loss of control over the amount of food being
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consumed; foods that can be rapidly consumed, especially sweets such as ice cream or cake, are usually
part of a binge
- 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
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- after the binge is over, disgust, feelings of discomfort, and fear of weight gain lead to the 2nd step of
BN ± purging to undo the caloric effects of the binge
- purging can involve induced vomiting and excessive exercise; the use of laxatives and diuretics is
common, even though this does not actually result in weight loss
- although many people binge occasionally and some people also experiment with purging, the DSM
diagnosis of BN requires that the episodes of binging and purging occur at least twice a week for 3
months
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binge/purge less frequently with twice a week but they can still have BN
- like patients with AN, patients with BN are afraid of gaining weight, and their self-esteem depends
heavily on maintaining normal weight
- 2 subtypes of BN are distinguished: a purging type and a non-purging type in which the compensatory
behaviors are fasting or excessive exercise
- BN typically begins in late adolescence or early adulthood
- about 90% of cases are women, and prevalence among women is thought to be about 1-2% of the
population
- Canadian studies of rates of eating disorders in community samples find that lifetime rates for females
are about 1.1% of the population for BN and 0.5% of the population for AN
- research conducted in Canadian schools also suggests that bulimia is more common than anorexia
among adolescents
- comparisons across time suggest that the frequency of BN may be increasing
- BN is associated with numerous other diagnoses, notably depression, personality disorders (especially
borderline personality disorder), anxiety disorders, substance abuse, and conduct disorder
- suicide rates are much higher among people with BN than in the general population
- a twin study has found that BN and depression are genetically related; BN has been associated with
stealing and patients with BN who steal tend also to be illicit drug users and promiscuous
- like AN, BN is associated with several physical side effects; frequent purging can cause K depletion;
heavy use of laxatives induces diarrhea, which can also lead to changes in electrolytes and cause
irregularities in the heartbeat; recurrent vomiting may lead to tearing of tissue in the stomach and throat
and to loss of dental enamel as stomach acids eat away at the teeth, making them ragged; the salivary
glands may become swollen
- mortality tends to be much less common in BN than in AN
Binge Eating Disorders
binge eating disorder (BED) ± categorized in DSM-IV as a diagnosis in need of further study; include
recurrent episodes of unrestrained eating
- this disorder includes recurrent binges (2 times per week for at least 6 months), lack of control
during the binding episode, and distress about binging, as well as other characteristics, such as
rapid eating and eating alone
- it is distinguished from AN by the absence of weight loss and from BN by the absence of compensatory
behaviors (purging, fasting, or excessive exercise)
- BED appears to be more prevalent than either AN or BN
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