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Chapter 13

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Psychology 2042A/B
Scott Wier

Child Psychology Chapter 13: Eating Disorders and Related Conditions Introduction  Discovered that many of the same factors underlying other major childhood disorders significantly influence early feeding and eating disorders  Unlike most disorders of childhood and adolescence, the causes of major eating disorders seem to be disproportionately related to sociocultural influences, rather than psychological and biological influences  Third most common illness in adolescent females Normal Development  Troublesome eating habits and limited food preferences are among the most distinguishing characteristics of early childhood  Picky eating is more common among girls than boys, but its relationship to the emergence of eating disorders during adolescence or adulthood is unclear  Beginning around age 9, girls are more anxious than boys about losing weight  These typical developmental patterns are, in part, a function of societal norms and expectations, especially for girls, as portrayed through images of thinness and attractiveness in magazines, television, and movies  Normal concerns about weight and appearance can either be reduced or increased by the comments of parents, friends, and romantic partners  Entering school is the next significant developmental landmark because of increasing social pressure to conform to narrow perceptions of desirable body type Developmental Risk Factors  Intriguing possibility of a continuum of “eating pathology” that ranges from dieting to clinical syndromes, across all developmental periods  Problem eating from a young age may contribute to being overweight or obese during childhood  Drive for thinness is a key motivational variable that underlies dieting and body image whereby the individual believes that losing weight is the answer to overcoming her troubles and to achieving success  Such behaviour creates the negative side effects of weight preoccupation, concern with appearance, and restrained eating, which increase the risk of an eating disorder Early Eating Habits, Attitudes, and Behaviours  Eating attitudes describe a person’s belief that cultural standards for attractiveness, body image, and social acceptance are closely tied to one’s ability to control diet and weight gain  Weight concerns and body image, in particular, appear to be significantly related to the onset of eating problems and eating disorders during adolescence  The desire to appear thin may be responsible for the near-epidemic rates of referral of young people with eating disorders, especially bulimia  Regular family meals may function as a protective factor for eating disorders Transition Into Adulthood  Research has consistently shown that anorexia and bulimia typically occur during adolescence and that onset thereafter is rare  The timing of maturation also affects dieting behaviour, because girls who mature early are likely to be heavier than their late-maturing peers  Although they readily acknowledge their interpersonal and social abilities, many post-pubescent girls say they frequently feel fat and unattractive  Contradictory societal messages implying that women must be successful both in traditionally feminine and masculine roles place added pressure on young women to aspire to some elusive superwomen caricature  Female adolescents who describe themselves in superwoman terms are more likely to associate thinness with autonomy, success, and recognition got heir independent achievements  However, they also are significantly more at risk for eating disorders  The all-too familiar interaction of pubertal weight gain, the beginning of social dating, and threats to achievement status often promote body dissatisfaction, distress, and perceived loss of control in young adolescents, especially because they occur cumulatively over a relatively short period  As you might expect, these changes also encourage smoking and other substance use among teenage girls, who feel that these activities protect them from the impulse to binge eat and the consequences of weight gain Dieting and Weight Concerns  A significant number of these students report feeling depressed after overeating and choose strict dieting as a form of weight control  Chronic dieting seems strongly related to both gender and developmental factors  Decreasing caloric intake reduces a person’s metabolic rate, which allowed fat to remain in the cells  This failure to lose weight sets the stage for a vicious cycle of increased commitment to dieting and vulnerability to binge eating  Psychological consequences also contribute to this cycle by creating what some researchers call the “false hope syndrome”  Loss of control may lead to binge eating and purging  Purging is the voluntary use of vomiting, laxatives, or other methods to rid the body of food  Purging is followed by disgust and self-recrimination, which promotes renewed views of abstinence, and sets the stage for the whole cycle of dieting, overeating, dietary failure, and affective distress to begin again  Dieting can be harmful or beneficial, depending on the individual and the condition  Symptoms may have lasting and significant effects on adolescents growth and development  Adolescents with an eating disorder may be deprived of key social, emotional, and biological developmental processes that normally develop during this period Biological Regulators  For most of us, eating, like sleeping, is a natural process, controlled by biorhythms that have adapted successfully over time to the stress and strain of our individual lives  However, normal patterns of eating and growth, as well as the disorders based on disturbances in these patterns, are influenced by physical and psychological processes that continuously interact  Metabolic rate, or balance of energy expenditure, is established based on individual genetic and physiological makeup, as well as eating and exercise habits  Individual metabolism, in turn, serves to self-monitor and self-regulate behaviour, which is why we may have trouble maintaining changes in weight or exercise  If you burn more energy than you take in, a state of chronic negative energy balance, or hypocaloric malnutrition, can occur  Malnutrition, even for brief periods of time, is followed by physical attempts to adapt, which can produce significant biological, behavioural, and psychological effects, including loss of circadian rhythm, increase in the release of growth hormones, dermatological changes with the loss of fatty tissue or hair pigmentation, and emotional and behavioural changes such as lethargy, depression, and apathy  These changes can have long term consequences if they occur during crucial developmental stages, or during the acquisition of fundamental stages, or during the acquisition of fundamental cognitive abilities Body Weight  Each person is biologically and genetically programmed to weigh within a certain, natural weight range  A person’s natural weight is regulated around his or her own set point, which is a comfortable range of body weight that the body tried to “defend” and maintain  People who gain or lose weight will experience metabolic changes that strive to bring the body back to its natural weight  If fat levels decrease below our body’s normal range, the brain compensates by slowing metabolism  In this state of relative deprivation, uncontrollable urges to binge are common because our bodies are telling us that they need more food than they are getting to function properly  The body fights against weight gain by increasing metabolism and raising body temperature in an effort to burn off extra calories Growth  The biology of growth fundamentally involves the manner in which circulating hormones interact with available nutritional resources to produce changes throughout the skeletal system  The most significant hormonal determinants of growth rate during childhood are the growth hormone (GH) and thyroid hormone, with additional gonadal steroids kicking in during adolescence to produce a further growth spurt and skeletal maturation  Individual growth depends on GH circulating throughout the body  The release of GH from the pituitary gland is determined by the hypothalamus and the higher brain structures that affect it  These higher brain structures are involved in emotional sensation and response, which may account for the connection between eating and emotional disorders  To accomplish this task, the hypothalamus releases two controlling hormones that exert opposite effects  The growth hormone inhibiting factor essentially inhibits with GH response to internal signals of hunger, so we stop eating  In contrast, the growth hormones releasing factor has the specific function of telling our body when, how, and where to grow by releasing growth hormones form the pituitary Obesity  Childhood obesity is considered to be a chronic medical condition similar to hypertension or diabetes, and is characterized by excessive body fat  Persons with obesity regulate their weight appropriately, but their set point is elevated  Obesity usually is defined in terms of a BMI, essentially a height-to-weight ratio  Although obesity clearly is not a mental disorder, it can affect a child’s psychological and physical development significantly Prevalence and Development  The number of children who are overweight or obese is increasing  The exponential increase in fast-food restaurants and convenient junk foods can also contribute to the rise in obesity rates  Although obesity during infancy and obesity during later childhood are not strongly related, childhood onset obesity is more likely to persist into adolescence and adulthood  Even during their youth, individuals with obesity risk many health concerns, such as cardiovascular problems and elevated cholesterol and triglycerides  Obesity during childhood may have long-term effects in that many lifestyle and behavioural choices associated with obesity develop during the school- age years  One troubling finding is that preadolescent obesity is a risk factor in the later emergence of eating disorder, especially for females, primarily due to the manner in which peers ignore or tease children who are obese  Obesity is strongly correlated with teasing by age-mates a tan early age; teasing, in turn, predicts overall dissatisfaction with appearance and body image, and sets in motion a chain of restrictive and high risk eating practices  Overweight students in middle and high schools use fewer healthy weight- control strategies and more unhealthy strategies than non-overweight students Culture and SES  Rates of obesity and eating disorders seem to increase upon exposure to Western culture  The US had the highest percentage of overweight children, whether compared to age or gender  Other countries have obesity rates that are catching up  Minorities make up a significant proportion of low-SES populations in North America  Fast food and junk food tends to be relatively inexpensive; thus rates of consumption of these foods are higher in low SES groups  An additional problem for low SES groups is that many of their neighborhoods are unsafe, and parents may keep their children at home out of safety concerns, which severely limits a child’s opportunities for physical activities Causes  Body weight is to a large extent a function off pedigree  Although heritability may account for a substantial proportion of the variance in obesity, other individual and family-related factors, such as dietary and lifestyle preferences, also play a role  Researchers have identified an obesity gene among mice that carries instructions to produce a protein called leptin  Leptin deficiencies have been found among children with severe obesity  Persons with obesity are somehow resistant to leptin’s effect  Leptin levels decreased with dieting, so leptin is less likely to provide feedback to the hypothalamus  This connection between dieting and lower leptin levels may explain why dieting increases hunger and slows metabolism, and results in gaining back the lost weight  Despite strong biological forces, proper diet and exercise still play a critical role in determining a child’s level of obesity  Inexperienced or highly pressured parents may respond to any sign of distress in the infant or toddler by attempts to feed, by neglect, or by both reactions  Parent of obese children sometimes have greater difficulty setting limits  Obesity and poor eating habits are related to the degree of family disorganization, ranging from poor communication and a lack of perceived family support, to sexual and physical abuse Treatment  Prevention or intervention of childhood obesity involves not only the individuals health but also the family’s resources  Pediatricians often recommend proper nutrition to arrest weight gain until the child’s height and weight are proportional  However, that this nutrition program does not involve putting the child on a diet, since energy-restricted or unbalanced diets can place a child in jeopardy of medical or learning problems  Efforts to curb childhoods obesity often focus on addressing parent’s knowledge of nutrition and increasing children’s physical activity  Obese and overweight children need parental encouragement, so many effective weight-loss programs teach parents and children ways to be more active  Pitfalls of weight control plans must be anticipated and removed to allow the child’s environment and daily routines to be altered  Their behavioural interventions focus on the goal of making the child’s eating behaviours and physical activity patterns more adaptive and self-managed  Self-control procedures encourage children to set their own goals for diet, weight, and exercise, and teach them the necessary skills to achieve these goals with minimal outside directives from parents or therapists  Even if some children are unable to reach or maintain their intended goal of weight loss, self-control training encourages a greater sense of perceived control among children with obesity  The increase in the involvement of educators was sparked by the alarming number of overweight children over the past decade  School-based programs now address children’s and teens desire for knowledge and support in developing a healthy body image and eating attitudes  Schools have been active in developing educational strategies that involve the whole school environment, from classroom education, to cafeteria and vending machine selections, to training staff to recognize signs of disordered eating and promote healthy eating attitudes Feeding Disorder of Infancy or Early Childhood  Feeding disorder of infancy or early childhood is characterized by a sudden or marked deceleration of weight gain in an infant or a young child and a slowing or disruption of emotional and social development  This disorder can lead to physical and mental retardation and even death Prevalence and Development  Feeding disorders and failure to gain weight are relatively common  If not identified early, feeding disorders are particularly troublesome because they can have lasting effects on growth and development  Equally common among males and females  No typical development outcome among children with feeding disorders, probably because many of the factors that initially led to the problem in the first place also affect the course of the illness  Onset of feeding disorder commonly occurs during the first 2 years of life, which can lead to malnutrition with serious developmental consequences  Feeding disorder can lead to, or be the result of, a failure to thrive  The factors that lead to more serious problems over time include the degree and chronicity of malnutrition, the degree and chronicity of developmental delay, the severity and duration of the problems in the infant-caregiver relationship Causes and Treatment  Many interacting risk factors influence how a child adapts to a certain level of caloric intake, and influence whether the child showed normal or abnormal behavioural development  Family disadvantage, poverty, unemployment, social isolation, and parental mental illness, considerable attention has been focused on those concerns  Maternal eating disorder have been identified as a specific risk factor for an infants eating or feeding disorder  Treatment regimens involve a detailed assessment of feeding behaviour and parent-child interactions like smiling, talking, and soothing, while allowing the parents to playa role in the infant’s recovery Pica  Pica is the ingestion of inedible substances, such as hair, insects, or chips of paint, and primarily affects very young children and those with mental retardation  Infants and toddlers typically put things into their mouths, since taste and smell are their preferred ways of exploring the physical world  One of the more common and usually less serious eating disorders found among very young children, yet an infant or young child who eats inedible, nonnutritive substances for a period of one month or longer may have a more serious problem  The disorder begins during infancy and lasts for several months, at which time it remits on its own or in conjunction with added infant stimulation and improved environmental conditions  For individuals with intellectual disability, however, pica may continue into adolescence before it begins to diminish gradually Prevalence and Development  Pica is more prevalent among institutionalized children and adults, especially persons with more severe impairments and mental retardation  The degree of severity often is related to the degree of environmental deprivation and mental retardation in individuals suffering from the more extreme forms of pica Causes and Treatment  Historically, pica was sometimes encouraged by fashions and social pressures that were similar to those affecting body image and appearance today  Pica may appear during the first and second years of life, even among otherwise normally developing infants and toddlers  The only distinguishing characteristic of these children is that they typically have poor stimulation in their home environment and may be poorly supervised  Researchers have suspected vitamin or mineral deficiencies among persons with pica, although no specific biological abnormalities have show a casual link to the disorder  No evidence, except in cases of intellectual disability, that genetic factors play a role in the etiology of the disorder  Because of the limited number of treatment studies, no conclusions can be drawn about the relative success of any treatment for pica  Emphasize operant conditioning procedures  Positive forms of attention provide additional stimulation and are especially beneficial, because the disorder often is related to inadequate interaction with caregivers  Caregivers are also taught to keep the child’s environment tidy and to remove or safely store dangerous substances Failure to Thrive  Failure to thrive (FTT) is a growth disorder associated with early feeding disturbances, which can have severe consequences for a child’s physical and psychological development  This associated disorder is embedded in social and economic disadvantage, and often is connected to inadequate or abusive caregiving that originates during early infancy  Considered the final common pathway or multiple biological, psychological, and social factors that influence growth and viability of the infant or toddler Prevalence th  Characterized by weight below the 5 percentile for age  The eating and feeding disorders of early childhood previously described can lead to, coexist with, or be the result of failure to thrive Causes  A prominent controversy concerns the significance of emotional deprivation and malnutrition  Children who have suffered fro failure to thrive as a result of early abuse exhibit poorer outcomes than children whose failure to thrive resulted from neglect, lack of parenting, or feeding difficulties  Findings support the notion that eating and growth disorders during early infancy are highly related to the poor quality of the caregiver-child attachment, which is likely to reflect the insensitive treatment the caregiver received as a child  Poverty, family disorganization, and limited social support contribute to the likelihood of malnutrition and growth failure, as do infants whoa re difficult to feed and nurture because of temperament and acute physical illnesses  Hospitalization to achieve weight gain, without consideration of ways to improve the parent-child relationship, is often insufficient to protect the child from further harm  Significant changes in quality of care and in the emotional environment results in better adjustment even for children who failed to thrive because of abuse  Early FTT may affect physical growth in childhood, but there is no evidence tat it affects future cognitive functioning Eating Disorders of Adolescence  Most likely to appear during two important periods of adolescent development: the early passage into adolescence and the movement from later adolescence to young adulthood  Early and middle childhood risk factors, such as eating problems, dieting patterns, and negative body image, clash with the ongoing challenges that confront adolescents  This clash leads some teens, particularly girls, to exert excessive control over their eating in a misguided effort to manage stress and physical changes  In some instances this controlled pattern of eating, coupled with other ill- conceived efforts to overcompensate for eating and weight changes, leads to major eating disorders  Conflict between parents and children could drive some teenage girls to refuse food as an expression of their feelings of rejection  Ideal body sizes changes with the times and with cultural preferences  The meaning of food and eating for females identity, the role for family and social class in determining body image and food choices, and th use of weight regulation as a substitute for self-regulation as a substitute for self-regulation and control in adolescence remain salient causes of eating disorders to this day Anorexia Nervosa  An eating disorder characterized by: o The refusal to maintain a minimally normal body weight o An intense fear of gaining weight o A significant disturbance in the individuals perception and experiences of his or her own size  Anorexia nervosa is a severe eating disorder with serious health and mental health consequences if left untreated  Persons who have it deny they are too thin or that they have a weight problem  Weight loss is accomplished deliberately through a very restricted diet, purging, or exercise  Although many persons occasionally use these methods to lose weight, the individual with anorexia intensely fears obesity and pursues thinness relentlessly  Young persons who suffer from anorexia show a major distortion in how they experience their weight and shape  They may become obsessed with measuring themselves to see whether the “fat” has been eliminated  To such an individual weight loss is a triumph f self-discipline  With anorexia there is never enough weight loss  Two subtypes of anorexia based on the methods used to limit caloric intake  This distinction has to do with possible difference in etiology and treatment avenues  In the restricting type, individuals seek to lose weight primarily through diet, fasting, or excessive exercise  In the binge-eating/ purging type, the individual regularly engages in episodes of binge eating or purging or both  Compared with persons with bulimia, those with the binge-eating/pursuing type of anorexia eat relatively small amounts of food and commonly purge more consistently and thoroughly  Recent studies have failed to find significant evidence of the differences between the binge-purge and restricting subtypes of anorexia in comorbid psychopathology, recovery, relapse, or mortality rates  The anorexia binge-purge subtype may represent a more severe form of anorexia rather than a distinct diagnostic sub category Bulimia Nervosa  Bulimia nervosa is far more common than anorexia  The primary hallmark of bulimia nervosa is binge eating  Binge is an episode of overeating that must involve an objectively large amount of food, and lack of control  Persons with bulimia attempt to conceal binge eating out of shame  Although binges are not planned, a ritual may form wherein the person, sensing no one around, makes a split-second decision to stop, purchase, and consume massive quantities of food  Typically, binge eating follows changes in mood or interpersonal
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