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Chapter 9

Abnormal Psych Chapter 9.doc

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University of Toronto Scarborough
Konstantine Zakzanis

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 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 emacinated 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 o But 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 o Restricting type: weight loss is achieved by severely limiting food intake o Binge eating-purging type: person regularly engages in being eating and purging  More psychopathological 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  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 occur • 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 death • Brain size declines (white matter volumes can restore, but gray matter are irreversible) Prognosis • 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 months 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 • They have a morbid fear of fat • 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 disorder • 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 Biological Factors Genetics • Both anorexia and bulimia run in families • First degree relatives are 4x more likely Eating Disorders and the Brain • Hypothalamus – regulates hunger and eating • Lesions to lateral hypothalamus show lose in weight and appetite • Cortisol hormone • Endogenous opioids: substance produced by the body to reduce pain sensations, enhance mood and suppress appetite, at least among those with low body weight 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 o Released during starvation o The disorder is seen to have increased levels of opioids resulting in a positively reinforcing euphoric state o But bulimia is scene to have low levels of it • Serotonin deficit may be related to bulimia nervosa as well Sociocultural Variables • Models and our culture to be thin • Scarlett O’Hara effect: phenomenon of eating lightly to project femininity • But there actually has been an increase in overweight people also • Diet industry is valued at more than $30 billion per year • Obsess people are viewed by others as less smart and stereotyped as being lonely, shy and greedy for affection of others • Media continues to promote these stereotypes • Activity anorexia: loss of appetite when engaged in physical activity • 2 interrelated motivational factors account for activity anorexia o Food deprivation increases the reinforcement effectiveness of physical activity o Physical activity decreases the reinforcement effectiveness of food Gender Influences • Women appear to have more heavily influenced than men by the cultural ideal of thinness • White, upper socioeconomic status women are commonly trying to diet and lose weight and is a group with highest rate of eating disorders Cross cultural studies • More common in industrialized societies (US, Canada, Japan, Australia & Europe) • Women who immigrate to industrial western countries are more prone to developing eating disorders (rapid cultural changes and pressures) • Anorexia nervosa may be much more common across cultures, and the genetic heritability of anorexia, relative to bulimia nervosa, may show less variability across cultures Racial Differences • White teenage girls have it more than coloured • But it’s more of an issue of social class than race • The emphasis on thinness and dieting has now begun to spread beyond white upper and middle class women to women of the lower social classes, and the prevalence of eating disorders has increased among these later groups Psychodynamic Views • Core cause lies in disturbed parent child relationships and certain core personality traits (low self esteem and perfectionism) are found among individuals with eating disorders 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 • Symptoms of an eating disorder fulfill some need, to increase one’s sense of personal effectiveness (having a strict diet) or to avoid growing up sexually • Early models – interpret symptoms of anorexia from a conflict perspective (drives; sexual in nature) • Contemporary – symptoms as a form of deficit perspective (to compensate for defects in the self) • Several theories focus on family relationships o Attempt by children who have been raised to feel ineffectual to gain competence and respect and to ward off feelings of helplessness, ineffectiveness, and powerlessness • (Goodsitt) bulimia in females stems from failure to develop an adequate sense of self because of conflict ridden mother daughter relationship (food becomes a symbol of failed relationships • The food is a symbol of the child need for the mother and the desire to reject her Family Systems Theory • Salvador Minuchin • Relevant to both anorexia and bulimia • Symptoms of an eating disorder are best understood by considering both the patient and how the symptoms are embedded in a dysfunctional family structure • Child is seen as physiologically vulnerable, and the child’s family has several characteristics that promote the development of an eating disorder • The child eating disorder plays an important role in helping the family avoid other conflict • Thus, the child’s symptoms are a substitute for other conflicts within the family • The families of eating disorders exhibit the following characteristics o Enmeshm
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