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Chapter XV.docx

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Martha Mc Kay

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 women - 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 problems 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 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, over-controlled, socially avoidant, conflict-averse, passive and fearful Bulimia nervosaimpulsive, under-controlled, 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 ADHD 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 binges Anorexia Nervosa - KEY FEATURES: 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 weight) 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 3 consecutive menstrual cycles) - 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- 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 - KEY FEATURE: 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?
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