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PSY240H1 Chapter Notes -Bulimia Nervosa, Anorexia Nervosa, Extreme Weight Loss

Course Code
Martha Mc Kay

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Chapter XV: Eating Disorders
- More boys in grades 6, 8, and 10 are dissatisfied with their weight than girls,
and more girls in the same grades are satisfied with their weight but more
girls are dieting than boys
- Rates of dieting and weight dissatisfaction continue to increase in girls
- Studies suggest that weight concerns and disordered eating behaviours extend
through the lifespan
- Driving force: desire to be more attractive, increase self-esteem
- Traditionally ,women have felt more pressure than men to be very thin,
recently theres an emphasis on the superfit look of men
- Men who develop eating disorders generally display the same symptoms as
- Both men and women with eating disorders have high rates of depression and
substance abuse
- Men are more likely than women to have histories of being overweight and
binging before anorexia or bulimia nervosa developed
- Mix evidence between gay and heterosexual men, but no differences between
lesbian and heterosexual women
Psychiatric Comorbidities
- Depression
86% of anorexia nervosa and 63% of bulimia nervosa patients have a
lifetime history of major depression)
Suicide risk 23-fold higher among those with eating disorders compared to
the general population
- Anxiety
55-83% of anorexia nervosa and 68-71% of bulimia nervosa patients have
a lifetime history of at least one anxiety disorder
About a third of eating-disorder patients have current or past
obsessive-compulsive disorder
Social phobia and generalized anxiety disorder also common
Up to 35% of individuals with an eating disorder report a history of
trauma, especially in the form of sexual abuse
Traumatic events encountered in earlier life may act as a vulnerability
factor for eating disorders, esp. for binge/purge behaviour
- Substance abuse/dependence
Up to 35% of teenagers with eating disorders have substance abuse
Substance use associated with poorer outcome and increased severity
Street drugs that result in weight loss (including amphetamine-
containing substances and other stimulants)
Abuse of prescription drugs given for other conditions for the purpose of
weight loss

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Over-the-counter diet pills, diuretics and supplements such as ephedrine
to lose weight or maintain low weight
Alcohol and street drug abuse much more common in bulimia nervosa
than anorexia nervosa
- Personality/Temperament
Anorexia nervosacompulsive,
, socially avoidant,
conflict-averse, passive and fearful
Bulimia nervosaimpulsive,
, thrill-seeking; more likely
to engage in impulsive behaviors such as self-harm, stealing, substance
abuse and promiscuity
- Attention-deficit/hyperactivity disorder (ADHD)
As much as a quarter of bulimic patients report a childhood history of
Females with ADHD at 6-fold higher risk for developing an eating
disorder than controls
Inattention to internal sense of hunger, satiety and amount of food
consumed on a daily basis
Impulsivity and lack of inhibition may play a large role in triggering
Anorexia Nervosa
Intentional extreme weight loss
Distorted thoughts about ones body
Believe they are only good and worthy when they can control eating
A. Refusal to maintain body weight at or above a minimally normal weight for
age and height (15% below minimum healthy body weight/failure to gain
weight during period of growthweight 15% below minimum healthy body
B. Intense fear of gaining weight or becoming fat, despite being underweight
C. Distortions in the perception of ones body weight or shape, undue influence of
body shape on self-evaluation, or denial of the seriousness of the current low
body weight
D. Post menarche females: amenorrhea (absence of consecutive menstrual
- White women more likely than Black women to develop the disorder
- Usually begins in adolescence (ages 15-19)
- Half fully recover 10 years after treatment, remainder continue to suffer
- High mortality rate (5%-8%) and high suicide rate
- Leads to cardiovascular complications, acute expansion of the stomach, kidney
damage, impaired immune system
I. Restricting Type
- Simply refuse to eat (no binges, purges, or other compensatory behaviours)
- Some go for days without eating, most eat very little each day

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- More likely to mistrust others and deny they have a problem
II. Binge-Eating/Purging Type
- Periodically engage in binging or purging behaviours
- Different from bulimia nervosa: (1) continue to be more than 15% underweight;
(2) often develop amenorrhea
- Does not engage in binges in which she eats large amounts of food, but she will
feel like she binged after eating a small amount of food and will purge
- More likely to have problem with unstable moods, impulse control, alcohol,
drug use and self-mutilation
- More chronic course of the disorder
Bulimia Nervosa
Uncontrolled eating followed by behaviours to prevent weight gain
Often normal or somewhat overweight; BUT no weight criteria in DSM
- Quite common particularly among adolescent and young adult women
- Onset occurs between ages 15-29
- Death rate not as high, but also has serious medical complications (imbalance
in the bodys electrolytesheart failure)
- Tends to be a chronic condition; years of unremitting symptoms
- Garfinkel: Many people met criteria for the disorder except for the frequency
of binges, but same binge/purge behavioursfrequency of binge is not an
important criterion?
A. Recurrent episodes of binge eating (varies in sizes among people):
a) Eating an amount of food that is definitely larger than most people would
eat during similar discrete period of time (often 1-2 hours) and in similar
b) Sense of lack of control, compellation to eat
B. Recurrent inappropriate behaviours to prevent weight gain
C. Binge and purge both occur, on average, at least twice a week for three months
D. Self-evaluation is unduly influenced by body and weight
- Do not tend to show grossly distortions in their body images, but constantly
dissatisfied with their body shapes and weights
- Distinguished from the binge-purge type anorexia nervosa by body weight
I. Purging Type
- Use self-induced vomiting or purging medications
- Dentists can recognize them because frequent vomiting damage teeth
II. Non-Purging Type
- Use excessive exercise or fasting (compensatory behaviour, but do not purge)
- Can easily hide their bulimia if part of a group that values exercise
Partial-syndrome eating disorders: behaviours that are similar to anorexia or
bulimia nervosa but dont meet the full criteria;
- May binge at least once a week, but not multiple times per week
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