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Chapter 9

PSYB32_Chapter 9

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Konstantine Zakzanis

Chapter 9-Eating Disorders  These disorders appeared form the first time in the DSM in 1980  Hospitalization rates are highest for women 15-24 Clinical Description  The two main disorders share an intense fear of being over weight  There is some speculation that these may be two variants of a single disorder Anorexia Nervosa  Anorexia nervosa—anorexia refers to the loss of appetite and nervosa indicates that this is for emotional reasons  However most patients become preoccupied with food instead of loss of appetite  Four features required for diagnosis: o The person must refuse to maintain a normal body weight (less than 85% of what is considered normal) o Person has an intense fear of gaining weight o Have a distorted sense of their body shape (always believe they are too fat)  The tendency to link self-esteem and self-evaluation with thinness is known as overevaluation of appearance o In females, extreme emancipation causes amenorrhea—loss of the menstrual period  This is the least important in diagnosis of anorexia  It can occur before significant weight loss and even after weight gain  The distorted body image that accompanies anorexia is assessed using the Eating Disorders Inventory (EDI)  In another assessment patients are shown a line of drawings of women in varying body weights and they are asked to pick the one that suits them and the ideal one  Two types of anorexia: o Restrictive type—weight loss is achieved by limiting food intake o Binge eating-purging type—regularly engages in binge eating and purging  More pathological, is associated with personality disorders, social withdrawal, drug and alcohol abuse  Tend to weigh more in childhood, and come from heavier families  Use more intensive weight control methods  Increasing number of patients diagnosed with the second type  There are many more similarities that differences between males and females with AN  Comorbidity is higher in clinical samples than community samples of AN Physical Changes in Anorexia Nervosa  Blood pressure falls, heart rate slows, kidney and gastrointestinal problems  Skin dries out, nails brittles, lose hair from scalp, may develop laguna—fine soft hair on their bodies  Levels of electrolytes such as potassium are altered, lowered levels lead to tiredness and even sudden death  Brain size declines—white matter is restored upon recovery but grey matter is not Prognosis  70% patients with AN recover  Relapse is common  Death rates are twice more than any psychological disorder  NOTE: Standardized mortality rate is ratio of observed deaths relative to expected deaths  Suicide rates are not as high in BN as they are in AN thought people with BN are more likely to have suicide ideas  Predictors of suicide in AN patients is substance abuse, history of physical or sexual abuse, depression, and purging behaviours Bulimia Nervosa  Bulimia Nervosa is episodes of rapid consumption of large amounts of food followed by compensatory behaviours such as vomiting, fasting, excessive exercise to prevent weight gain  Bulimia means ox hunger  DSM defines a binge as eating large amounts of food within less than two hours  BN is not diagnosed if the binging and purging occur in the context of anorexia and extreme weight loss  Binges may be triggered by stress, particularly negative social interactions  Bulimics have a high level of interpersonal sensitivity and have high self criticism following a social interaction  The person engaged in a binge often feels loss of control, like a dissociative state losing awareness of what they are doing  After the binge is over, feelings of disgust, and fear of weight gain lead to the second step purging  The DSM requires the episodes of binging and purging to occur twice a week for three months, but there is suggestion that there is a continuum of severity rather than a sharp distinction  “Morbid fear of fat” is an essential diagnostic criterion for BN because: o It covers the core psychopathology of the disorder o It makes diagnosis more restrictive o It makes the syndrome more closely resemble the disorder Anorexia  Bulimia Nervosa has two subtypes: o A purging type—compensatory behaviour is fasting o Non-purging type—compensatory behaviour is excessive exercise  Typically begins in late adolescence or early adulthood and is more common among adolescents than anorexia  Frequency of BN may be increasing with higher rates and earlier onset for individuals born after 1960  Bulimia and depression are genetically related  Bulimia has also been associate with steeling and tend to become drug users this reflects their characteristic impulsivity and lack of control  Many physical side effects, lack of electrolytes (potassium) from purging, tearing of tissue and enamel, irregularities in heart beat Binge Eating Disorder  Binge eating disorder includes binges (twice a week for 6 months) and lack of control about binging and distress about binging o Eats alone  It is distinguished by Anorexia as there is no weight loss, and Bulimia as there is no compensatory behaviour (purging, exercise etc)  Is more prevalent than AN or BN  One advantage of including BED as a diagnosis is that it would apply to patients who do not meet the criteria for AN or BN  Risk factors for developing BED include childhood obesity, critical comments regarding being overweight, low self concept, childhood physical or sexual abuse  Researchers still see binge eating as a less severe form of BN Etiology of Eating Disorders Biological Factors Genetics  There may be a genetic influence or a diathesis and key features of a eating disorder such as dissatisfaction with body and strong desire to be thin appear to be heritable Eating Disorders and the Brain  Hypothalamus is key to regulating eating and hunger  Animals with lesions in the lateral hypothalamus lose weight and have no appetite  Level of hormones regulated by it are abnormal in patients with anorexia such as cortisol—result of starvation  However these animals with lesions are indifferent to food where as anorexia patients are preoccupied with it and still hungry  Thus this theory is disregarded  Endogenous opioids reduce pain, enhance mood, and suppress appetite o Released during starvation  Starvation by people with anorexia might release opioids and positively reinforce it by creating a euphoric state  Excessive exercise does the same purpose  People with bulimia have low levels of opioids (beta endorphin) which promote craving, the binging is reinforced by the euphoric state food produces  Serotonin promotes satiety (feeling full), thus binges of bulimia patients could be due to a serotonin deficit  This could be linked to the negative mood that follows the binge episodes  People with bulimia also show a smaller reaction to serotonin initiators Socio-cultural Variables  Throughout history the ideal female body has varied  Female bodies increased in thinness, males in muscularity  Females feel more pressure from the promotion of ideal body images o Example. The impossible Barbie  Scarlet O’Hara effect—eating lightly to appear feminine  The prevalence of obesity has actually doubled recently  This is due to the evolutionary tendency to eat excess to store energy (which is now not needed because of abundant food)  This tendency is in conflict with ideal body weights  Women are more likely than men to wish they weighed less and to try and lose weight  Women place greater emphasis on appearance  Society has become more health and fat conscious thus dieting has become more common  Increases in eating disorder symptoms were associated with increased exposure to fashion magazines and was not associated with the amount of television viewed  However soap operas is associated with an increased drive to be thin  Being fat has negative connotations, people believe they are less smart, lazy, unhealthy, unsuccessful etc.  Media promote these stereotypes  Activity anorexia is the loss of appetite when engaged in physical activity (discussed above due to opioids) o This is why dancers relative to models have higher rates of anorexia  Two interrelated factors account for activity anorexia: o Food deprivation increases the reinforcement effectiveness physical activity o Physical activity decreases the reinforcement effectiveness of food Gender Influences  Main thing is women are more influenced by cultures ideal to be thin  Women typically valued for appearance, men typically valued for accomplishments To Diet or Not to Diet?  Dieting is a precursor for an eating disorder and can lead to binging  Why is dieting difficult
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