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Chapter 10

PSYB32H3 Chapter 10: Eating disorder


Department
Psychology
Course Code
PSYB32H3
Professor
Konstantine Zakzanis
Chapter
10

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Chapter 10 Eating disorder
Many cultures are preoccupied with eating, given the intense interest in food and eating, it is not surprising that this
aspect of human behavior is subjected to disorder.
The disorders were similar in terms of age onset, ranging from late teen years to early 20s, there have shown to be
greater prevalence among younger people.
Particularly alarming is the growing tendency for children between the age of 5 to 9 years old to be admitted
to a hospital for an eating disorder
There is a clear sex difference regarding the lifetime prevalence, it is still the case overall that one in 3, or one in 4
cases involve boys or young men, the lifetime prevalence for the three most commonly known eating disorders are
as follows,
Anorexia nervosa were 0.9% for women and 0.3% for men.
Bulimia nervosa were 1.5% for women, and 0.5% for men
o Bulimia not only have an earlier onset, but also a longer persistence, on average 6.3 years
Binge eating disorder were 3.5% for women and 2.0% for men
o It was found that the prevalence of binge eating disorder was higher than the rate of bulimia nervosa
(1.4% vs 0.8%)
10.1 Clinical Description
Referring to the clinical description of DMS-IV, although anorexia nervosa, bulimia nervosa, and binge eating
disorders are the three most commonly known eating disorders, they are not the most commonly diagnosed ones.
There is a great heterogeneity in eating disorder symptoms expression, therefore the most common clinical diagnosis
is a category called eating disorder not otherwise specified EDNOS
This has been seen as a residual "catch-all" category that underscores problems inherent in the diagnostic
system
However, the extensive used of the EDNOS category reflects the great heterogeneity among all individuals all
deemed to have an eating disorder of some sort, but it also suggests that the categories themselves need
refinement.
DSM-5 dropped the EDNOS, in favor of two new designations,
(1) Unspecified feeding or eating disorders UFED, and
Can be used for any condition that cues cliniclaly significant distress or impairment, but does
not meet diagnostic thresholds
This diagnosis can used when there is insufficient information such as in hospital emergen room
situations
(2) Other specified feeding or eating disorder OSFED
This applies to atypical, mixed, or subthreshold conditions
It also includes a variety of conditions, including subthreshold bulimia nervoas ad subthreshold
binge eating disorder
Night eating syndrome, is also being captured, the repetitive tendeny to wake up and eat during
the night and then get quite upset about it
Purging disorder, is a variation of this category, this is a form of bulimia that involves self-
induced vomiting, or laxative use at least once a week for minimum of 6 months
The clinical descriptions for both anorexia nervosa, and bulimia nervosa have now come with fewer restrictions that
preclude making a diagnosis, therefore there shuoold be a lower proportion of EDNOS/ OSFED diagnosis than in
the past
The two disorders shard several clincial features, and the most important being the intense fear of being
overweight
Diagnostic crossover, there are some lines of evidence indicating that the two disorders might be two
variations of a single disorder
o Co-twins people diagnosed with AN, are themselves more likely than average to have bulimia nervosa

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10.2 Anorexia Nervosa (AN)
Anorexia, meaning a loss of appetite; nervosa, meaning this is for emotional response. Although the term is
something of a misnomer because most people with anorexia nervosa actually do not lose their appetite or interest in
food; in fact, they are often preoccupied with food
There are a number of criteria must be fulfilled in order to be diagnosed with AN, with some of them being revised
in DSM-5
The person must refuse to maintain a normal body weight and weighs less then 85% of what is considered
normal for the person's age and height
o DSM-5 has the modification that this criteria no longer refers to thee 85% guideline;
o Revised guideline is restriction of energy intake, resulting in significant low body weight within the
context of the persons age, sex and physical health status
The person has an intense fear of gaining weight, and the fear is not being reduced by weight loss, meaning
they can never be thin enough
They have a distorted sense of their body shape.
In females, the extreme emaciation causes amenorrhea, the loss of the menstrual period
o DSM-5 has eliminated this criteria for several reasons,
o Many girls and young women who clearly suffering and fulfill the other criteria of AN do not show
this symptom
o Amenorrhea occurs in a significant minority of women before any significant weight loss and the
symptom can persist after weight gain
o Boys and men with AN cannot meet the criteria
Over-evaluation of appearance, refers to the tendency to link self-esteem and self-evaluation with thinness,
therefore there is a close relationship between the self-esteem and the thinness
Recent study showed that among people with acute anorexia nervosa, lower body weight was actually
associated with increased self-esteem
The distoredted body image that accompanies anroexia nervosa can be assessed in the following ways,
(1) Eating disorders inventory EDI
It was devleoped in Canada and is one of the most widely used measures to assess self reported
aspects of eating disorders
(2) assessment of body images
Respondents are shown line drawings of women with varying body weights and asked to choose
the one closets to their own and the one that represents their ideal shape
Clients with AN would overestimate their own body shape, and choose a thin figure as their
ideal
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