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Chapter 9

Chapter 9 - Detailed

Course Code
Konstantine Zakzanis

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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
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
They may lose their hair and develop laguna (fine, soft hair on their bodies)
Levels of potassium and sodium are altered
Chapter 9 : Eat i ng Disorders
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oLower levels can lead to tiredness, weakness, cardiac arrhythmias and even sudden
Brain size declines (white matter volumes can restore, but gray matter are irreversible)
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
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
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
Chapter 9 : Eat i ng Disorders
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