PSYB32H3 Chapter Notes - Chapter 9: Interpersonal Psychotherapy, Playgirl, Endorphins
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Ch 9 eating disorders
These disorders only appeared in the DSM for the first time in 1980 as one subcategory of
disorders beginning in childhood or adolescence
Stat Canada 2002, 0.5% of Canadians 15 yrs of age or older reported that they had been
diagnosed with an eating disorder in the preceding 12 months.
Women were more likely than men to report an E.D ---0.8% vs 0.2%
Among young women aged 15-24 1.5% reported that they had an E.D
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 age range. Rates are also highest among those ages 10-14 and 20-24
The diagnoses of these two disorders share several clinical feautures the most imp being an intense
fear of being overweight
Co-twins of patients diagnoses with A.N for ex are themselves more likely than average to have
Ms. A had A.N. anorexia refers to loss of appetite and nervosa indicates that this is for emotional
Most patients with A.N actually do not lose their appetite or interest in food. They are preoccupied
Ms. A met all the four features required for the diagnosis:
1) the person must refuse to maintain a normal body weight, that is usually taken to mean that the
person weights less than 85% of what is considered normal for that persons 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
2) the person has an intense fear of gaining weight and the fear is not reduced by weight loss.
They can never be thin enough
3) Patients with AN have a distorted sense of their body shape. They maintain that even when
emaciated they are overweight or that certain parts of their bodies esp the stomach, butt and thighs
are too fat. To check on their body size they typically weight themselves frequently, measure the
size of diff parts of the body and gaze critically at their reflections in the mirror. 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
4) in females the extreme emaciation causes amenorrhoea the loss of the menstrual period. Of the
four diagnostic criteria amenorrhoea seems least imp to determining a diagnosis of anorexia.
Moreover amenorrhoea occurs in a significantly minority of women before any significant weight
lose and the symptoms can persist after weight gain
eating disorder inventory (EDI). Was developed in Canada and is one of the most widely used
measured to assess self reported aspects of eating disorders
patients with AN overestimate their own body size and choose a thing figure as their ideal
DSM-IV-TR distinguishes two types of AN. In the restrictive 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 dis, impulsive beh, stealing, alcohol and drug abuse, social withdrawal and suicide
attempts than do patients with the restricting type of anorexia
Binging purging patients tend to weight more in childhood, come from heavier families with
greater familial obesity and use more extreme weight control methods.
Canadian research suggests that the diff between the two subtypes are becoming less distinct
An increasing proportion of patients were diagnosed with AN, the binging purging subtype, during
each period. Over time, participants in both groups appeared to weigh more and were less likely to
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report amenorrhoea. Patients from both groups reported higher frequencies of purging beh,
impulsive beh, and associated affective symptoms in the later time periods
AN typically begins in early to middle teenage years often after an episode of dieting and
exposure to life stress. It is about 3-10 x more frequent in women than in men with a lifetime
prevalence about 1% in women
When AN does occur in men, symptomatology and other characteristics, such as family conflict,
are generally similar to those reported by women with the disorder
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
Comborbidty is higher in clinical samples than community samples. A growing concern is the
high rate of occurring eating disorders and substance use disorders
Physical Changes In 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 their
bodies. Levels of electrolytes such as potassium and sodium are altered. These ionized salts
present in various bodily fluids 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 anorexia and EED abnormalities and neurological
impairments are frequent
Deficits in white matter volumes in the brain are restored upon recovery from anorexia
nervosa but deficits in grey matter volumes appear irreversible at least in the short term.
These consequences may be especially problematic for adolescents with AN
About 70% of patients with AN eventually recover. However recovery often takes 6 or 7
years and relapses are common before a stable pattern of eating and maintenance of weight is
AN is a life threatening illness, death rates are about 10 x higher among patients with the
disorder than among the general population and twice as high as among patients with other
Death most often results from physical complications of the illness or from suicide
The standardized mortality rate for the 326 patients with AN was very high (10.5).
standardized mortality rate is defined as the ratio of observed deaths relative to expected
deaths. Among the 17 AN patients who had died the leading cause was suicide followed by
pneumonia, hypoglycemia and live disease
Found that suicide rates are not elevated in B.N like they are in AN though ppl with BN are
more likely to have suicide ideation. Predictors of suicide in AN patients include purging beh,
depression, substance abuse and a history of physical or sexual abuse
Ms Bs beh is BN. Bulimia from a Greek word means ox hunger.
This disorder involves episodes of rapid consumption of a large amount of food, followed by
compensatory beh 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 two 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 as case is AN binge eating purging subtype
Binges typically occur in secret may be triggered by stress and the negative emotions it
arouses and continue until the person is uncomfortably full.
Stressors that involve negative social interactions may be particularly potent elicitors of
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Bulimics have high levels of interpersonal sensitivity, as reflected in large increases in self-
criticism following negative social interactions.
Further binge episodes tend to be preceded by poorer than average social experiences, self
concepts and moods
Also reported that the binge episodes are followed by deterioration in self concept, mood state
and social perception
The person who is engaged in a binge often feels a loss of control over the amount of food
being consumed. Foods that can be rapidly consumed, esp sweets such as ice cream or cake
are usually part of a binge. Although research suggests that patients with BN sometimes
ingest an enormous quantity of food during a binge.
Binges are not always as large as the DSM implies and there may be wide variation in the
caloric content consumed by individuals with BN during binges. 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 awareness of
what they are doing of feeling that it is not really they who are binging
After the binge is over disgust, feelings of discomfort and fear of weight gain lead to the 2nd
step of BN—[urging to undo the caloric effects of the binge. As seen with Ms. B purging can
involve induced vomiting and excessive exercise. The use of laxatives and diuretics is
common even though this odes not actually result in weight loss
The DSM diagnoses of BN requires that the episodes of binging and purging occur at least
twice a week for three months
Suggesting that there is a continuum of severity rather than a sharp distinction
Like patients with AN patients with BN are afraid of gaining weight and their self esteem
depends heavily on maintaining normal weight.
Observed that a morbid fear of fat is an essential diagnostic criterion for BN cuz 1) it covers
what clinicians and researchers view as the core psychopathology of BN 2) it makes the
diagnosis more restrictive and 3) it makes the syndrome more closely resemble the related
disorder or AN
as with anorexia two subtypes of BN are distinguished: a purging type and a non purging type
in which the compensatory beh are fasting or excessive exercise. And recent evidence does
not strongly support the validity of this distinction
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 to 2% of the population.
Find tat lifetime rates for females are approx 1.1% of the population for BN and 0.5% of the
population for AN
Suggests that bulimia is more common than anorexia among adolescents
One study found that by age 18 80% of young women in BC with normal height and weight
indicate that they would like to weight less.
Another study of more than 1,800 females from Ottawa, Hamilton, and T,O between the ages
of 12 and 18 found that 27% has disordered eating attitudes and beh and approx 1 in 7
participants engaged in binge eating with associated loss of control
Comparisons across time suggest that the frequency of BN may be increasing.
Cohort effect- with rates being higher among ppl born after 1960 who alsp tend to have
younger ages of onset
BN patients are somewhat overweight before the onset of the disorder and that the binge
eating often starts during an episode of dieting.
Long term follow up of BN patients reveal that about 70% recover although about 10%
remain fully symptomatic
BN is associated with numerous other diagnoses, notably depression, personality disorders
( esp borderline person disorder) anxiety dis, substance abuse and conduct disorder
Suicide rates are much higher among ppl with BN than in the general population. A twin
study had found that bulimia and depression are genetically related
Somewhat curiously BN has been associated with stealing. Patients with bulimia who steal
tend also to be illicit drug users and promiscuous. This combination of beh may reflect
impulsivity or lack of self control, characteristics that may be relevant to the beh of binge
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