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Chapter 9

Study Guide of Chapter 9 for PSYB32

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University of Toronto Scarborough
Konstantine Zakzanis

CHAPTER 9 EATING DISORDERS -eating disorder only appeared in the DSM in 1980 as one subcategory of disorders beginning in childhood/adolescence -with the publication of DSM-IV, the eating disorders anorexia nervosa and bulimia nervosa formed a distinct category, reflecting the increased attention they received - Eating disorders can cause psychological, social and health problems. - Eating disorders are highest among young women between ages of 15 and 24. Clinical Description -the diagnoses of these two disorders share several clinical features, the most important being an intense fear of being overweight -some indications are that these disorders may not be distinct diagnoses but may be two variants of a single disorder -co-twins of patients diagnosed with anorexia nervosa are more likely than average to have bulimia nervosa Anorexia Nervosa -anorexia refers to loss of appetite, and nervosa indicates that this is for emotional reasons -term is not defined properly because most patients with anorexia nervosa actually do not loose their appetite or interest in food -on the contrary, while starving themselves, most patients with this disorder become preoccupied with food; they may read cookbooks constantly and prepare gourmet meals for their families, so they dont loise an interest in food and do not lose their appetite. -can be a life threatening condition and prevalent among young women who are under intense pressure to keep their weight low Four features required for the diagnosis 1) The person must refuse to maintain a normal body weight; this is usually taken to mean that the person weighs less than 85% of what is considered normal for the 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) Person has an intense fear of gaining weight and fear is not reduced by weight loss. They can never be thin enough 3) Have a distorted sense of their body shape. They maintain that even when an emaciated (thin), they are overweight or that certain parts of their bodies particularly the abdomen, buttocks and thighs, are too fat. To check on their body size, they typically weigh themselves frequently, measure the size of different parts of the body and gaze critically at their reflections in mirrors. Their self esteem is closely linked to marinating thinness. Over evaluation of appearance- the tendency to link self-esteem and self-evaluation with thinness. www.notesolution.com 4) In females, the extreme emaciation causes amenorrhea - the loss of menstrual period. Of the four diagnostic criteria, amenorrhea seems less important; comparisons conducted in Canada show few differences between women who meet all four criteria and women who meet the other three but not amenorrhea. Moreover amenorrhea occurs in a significant minority of women before any significant weight loss and the symptom persists after weight gain -distorted body image that accompanies anorexia nervosa has been assessed in several ways, most frequently by questionnaires such as the Eating Disorders Inventory EDI -EDI was developed in Canada and is one of the most widely used measures to assess self-reported aspects of eating disorders -in another type of assessment, patients are shown line drawings of women with varying weight and asked to pick the one closest to their own and one that represents their ideal shape. Patients with anorexia nervosa overestimate their own body size and choose a thin figure as their ideal -DSM-IV distinguishes two types of anorexia nervosa Restricting type is when weight loss is achieved by severely limiting food intake Binge eating-purging type is when the person regularly engages in binge eating and purging (vomiting/exercising) Binging-purging subtype appears to be more psychopathological; patients exhibit more personality disorders, impulsive behaviour, stealing, alcohol and drug abuse and suicidal attempts than do patients with the resting type of anorexia relative to restricting type, binging-purging patients tend to weigh more in childhood, come from heavier families and tend to use more extreme weight control methods -anorexia nervosa typically begins in the early to middle teenage years, often after an episode of dieting and exposure to life stress -10 times more frequent in women with a lifetime prevalence (being widespread) less than 1% -these patients are diagnosed frequently with depression, OCD, phobias, panic disorder, alcoholism and various personality disorders -comorbidity ( Coexistence with another disedeclines whith community rather than clinical samples are studied because clinical samples include people with more serious problems -women with anorexia nervosa are also likely to have sexual disturbances PHYSICAL CHANGES IN ANOREIXA NERVOSA -self starvation and use of laxatives causes blood pressure to fall, heart rates slow down, kidney and gastrointestinal problems develop, bone mass declines, skin dries out, nails become brittle, hormones level change and mild anemia (lower red blood cells) occurs -some patients lose hair from their scalp and form laguna, a fine soft hair on their bodies -brain size declines with these patients and EEG (printout of electrical activity in the brain) abnormalities -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 www.notesolution.com PROGNOSIS (Probable outcomes) -70% of these patients recover but takes 6-7 years and relapses are common before a stable pattern is formed -life threatening disease; death rates are 10 times higher among patients with the disorder than among the general population and twice as high as among patients with other psychological disorders -death most often results from physical complications of the illness eg. Congestive heart failure and from suicide 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 binging and purging occur only in the context of anorexia nervosa and its extreme weight lost; the diagnosis in such as case is anoreixa nervosa, binge eating-purging type -binges typically occur in secret, may be triggered by stress and the negative emotions it arouses and continue until the person is uncomfortably full -stressor that involve negative social interactions maybe influential on binge eating -bulimics have high levels of interpersonal sensitivity, as reflected in large increases in self criticism following negative social interactions -binge episodes tend to be preceded by poorer than average social experiences, self concepts and moods -binge episodes are followed by deterioration in self-concept, and mood state and social perception -person who is engaged feel that they cant control the amount of food being consumed -foods that can be rapidly consumed especially sweets such as ice cream/cake are part of binge -patients are usually ashamed of their binges and try to conceal them -they report that they lose control during binge, even to the point of experiencing something akin to a dissociative state, loosing awareness of what they are doing/feeling that is not really they who are binging -after binge is over, disgust, feelings of discomfort and fear of weight gain lead to the second step of Bulimia nervosa, purging to undo the caloric effects of the binge -patients often stick fingers down their throats to cause gagging, but after a time many can induce vomiting at will without gagging themselves -laxative and diuretic(increases flow of urine) abuse (do very little to reduce body weight) as well as fasting and excessive exercises are also used to prevent weight gain -although many people binge occasionally and some people also experiment with purging , the DSM diagnosis of bulimia nervosa requires that episodes of binging and purging occur at least twice a week for three months -like patients with anorexia nervosa, bulimia patients are afraid of gaining weight and their self-esteem depends heavily on maintaining normal weight -a morbid fear of fat is an essential diagnostic criterion for bulimia nervosa because www.notesolution.com
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