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Chapter 10

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Department
Psychology
Course
PSYB32H3
Professor
Konstantine Zakzanis
Semester
Fall

Description
Abnormal Psychology ; Chapter 10 - Eating Disorders  eating disorders can cause long-term psychological, social and health problems CLINICAL DESCRIPTION  the most common diagnosis is a category called eating disorder not otherwise specified (EDNOS) - most common eating disorder diagnosis characterized by heterogeneous symptoms and associated features that do not fit the symptoms of other eating disorders [occurring between 40%-70% of patients]  purging disorder - a form of bulimia that involves self-induced vomiting or laxative use at least once a week for a minimum of six months  purging disorder patients have levels of disturbed eating and associated forms of psychopathology that are comparable with patients with other eating disorders  one distinguishing feature of purging disorder is high impulsivity - impulsivity in eating disorders is receiving increasing attention  the onset of the impulse control disorder preceded the eating disorder  most common impulse control disorders among women were compulsive buying disorder and kleptomania (ex. compulsive stealing)  it has been suggested that the "fear of fat" criterion may not apply to anorexic females in certain cultures  the diagnoses of anorexia nervosa and bulimia nervosa share several clinical features, the most important being the intense fear of being overweight Anorexia Nervosa  anorexia nervosa (AN) - anorexia refers to loss of appetite, nervosa indicates that this is for emotional reasons  most patients with anorexia nervosa actually do not lose their appetite or interest in food, most with the disorder become preoccupied with food; they read cookbooks constantly and prepare gourmet meals for their families  four features required for the diagnosis: 1. person must refuse to maintain a normal body weight; person weighs less than 85% of what is considered normal for that person's age and height 2. 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 - 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. the extreme emaciation causes amenorrhea - the loss of the menstrual period (least important to determining a diagnosis)  Eating Disorders Inventory (EDI) - questionnaire used to assess self-reported aspects of eating disorders  in another type of assessment, patients are shown line drawings of women with varying body weighs and asked to pick the one closest to their own and the one that represents their ideal shape 1 Abnormal Psychology ; Chapter 10 - Eating Disorders  DSM-IV-TR distinguishes two types of AN  restricting type - weight loss is achieved by severely limiting food intake  eating-purging type - the person also regularly engages in binge eating and purging  the purging subtype appears to be more psychopathological; patients exhibit more personality disorders, impulsive behaviour, stealing, alcohol and drug abuse, social withdrawal, and suicide attempts  bingeing-purging patients tend to weigh more in childhood, come from heavier families with greater familial obesity  AN typically begins in the early to middle teenage years  both men and women at risk for eating disorders were also prone to depression, panic disorder and social phobia Physical Changes in Anorexia Nervosa  self-starvation and use of laxatives produce numerous undesirable biological consequences in patients with AN  blood pressure falls, heart rate slows, kidney and gastrointestinal problems develop, bone mass declines, the skin dries out, nails become brittle, hormone levels change, 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 Prognosis  about 70% of patients with AN eventually recover - but often takes 6 -7 years and relapses are common  death most often results from physical complications of the illness or from suicide  suicide rates are not elevated in bulimia nervosa like they are in AN  people with bulimia nervosa are more likely to have suicide ideation Bulimia Nervosa  bulimia nervosa - involves 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  DSM defines binge as eating an excessive amount of food within less than two hours  bulimia nervosa is not diagnosed if the bingeing and purging occur only in the context of anorexia nervosa and its extreme weight loss  binges typically occur in secret and may be triggered by stress and the negative emotions its arouses and continue until the person is uncomfortably full  bulimics have high levels of interpersonal sensitivity 2 Abnormal Psychology ; Chapter 10 - Eating Disorders  the person who is engaged in a binge often feels a loss of control over the amount of food being consumed  patients with bulimia sometimes ingest an enormous quantity of food during a binge - often more than what a normal person eats in an entire day  after the binge is over, disgust, feelings of discomfort and fear of weight gain lead to the second step of bulimia - purging to undo the caloric effects of the binge  DSM diagnosis of bulimia nervosa requires that the episodes of bingeing and purging occur at least twice a week for three months  two subtypes of bulimia nervosa are distinguished: a purging type and a non-purging type in which the compensatory behaviours are fasting or excessive exercise  bulimia nervosa typically begins in late adolescence or early adulthood  BN is associated with numerous other diagnoses, notably depression, personality disorders anxiety disorders, substance abuse, and conduct disorder  bulimia is associated with several side effects - frequent purging can cause potassium 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  mortality appears to be much less common in BN than in AN Binge Eating Disorder  binge eating disorder (BED) - includes recurrent binges (two times per week for at least 6 months), lack of control during the bingeing episode, and distress about bingeing, rapid eating and eating alone  it is distinguished from AN by the absence of weight loss  it is distinguished from BN by the absence of compensatory behaviours (purging, fasting, or excessive exercise)  BED has several features that support its validity - it occurs mostly in women, associated with obesity and a history of dieting - linked with impaired work and social functioning, depression, low self-esteem, substance abuse and dissatisfaction with body shape  risk factors for developing BED include: childhood obesity, critical comments regarding being overweight, low self-concept, depression and childhood physical or sexual abuse ETIOLOGY OF EATING DISORDERS  genetics, the role of the brain, socio-cultural pressures to be thin, the role of the family, and the role of environmental stress - suggest that eating disorders result when several influences converge in a person's life 3 Abnormal Psychology ; Chapter 10 - Eating Disorders Biological Factors Genetics  AN and BN run in families  first-degree relatives of young women with AN are about 4 times more likely than average to have the disorder themselves  twin studies of eating disorders also suggest a genetic influence  key features of the eating disorders, such as dissatisfaction with one's body and a strong desire to be thin, appear to be heritable Eating Disorders and The Brain  the hypothalamus is a key brain centre in regulating hunger and eating  levels of some hormones regulated by the hypothalamus, such as cortisol are indeed abnormal in patients with anorexia; these hormonal abnormalities occur as a result of self-starvation and levels return to normal following weight gain  endogenous opioids are substances produced by the body that reduce pain sensations, enhance mood and suppress appetite at least among those with low body weight  opioids are released during starvation and play a role in AN and BN  starvation among patients with AN may increase the levels of endogenous opioids, resulting in a positively reinforcing euphoric state  excessive exercise would increase opioids and thus be reinforcing  in BN, low levels of endogenous opioids, which are thought to promote craving; a euphoric state is then produced by the ingestion of food - thus, reinforcing bingeing  serotonin deficit may well be related to BN - low levels of serotonin in patients with BN Socio-Cultural Variables  women respond to these socio-cultural pressures by eating lightly in an attempt to project images of femininity  women who are portrayed as eating heavily are seen as less feminine and more masculine than women who are portrayed as eating light meals - Scarlett O'Hara effect - eating lightly to project femininity  increases in eating disorder symptoms were associated with increased exposure to fashion magazines and these increases were not associated with the amount of television viewed  some people become anorexic because of a pursuit of fitness rather than a pursuit of thinness  activity anorexia - the loss of appetite when engaged in physical activity  two interrelated motivational factors account for activity anorexia: food deprivation increases the reinforcement effectiveness of physical activity and physical activity decreases the reinforcement effectiveness of food Gender Influences  primary reason for the greater prevalence of eating disorders among women than among men is that women appear to have been more heavily influenced by the cultural ideal of thinness 4 Abnormal Psychology ; Chapter 10 - Eating Disorders  women are typically valued more for their appearance, whereas men gain esteem more for their accomplishments  onset for eating disorders is typically preceded by dieting and other concerns about weight (perceived fatness, fear of weight gain) Cross-Cultural Studies  eating disorders appear to be far more common in industrialized societies such as US, Canada, Japan, Australia, Europe  young women who immigrate to industrialized Western cultures may be prone to developing eating disorders owing to the experience of rapid cultural changes and pressures  AN may be much more common across cultures, and the genetic heritability of AN, relative to BN may result in less variability of AN across cultures Cognitive-Behavioural Views Anorexia Nervosa  cognitive-behavioural theories of AN emphasize fear of fatness and body image disturbance as the motivating factors that make self-starvation and weight loss powerful reinforcers  behaviours that achieve or maintain thinness are negatively reinforced by the reduction of anxiety of becoming fat  dieting and weight loss may be positively reinforced by the sense of mas
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