PS280 Chapter Notes - Chapter 10: Binge Eating Disorder, Binge Eating, Eating Disorder
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Chapter 10 – Eating Disorders
Introduction and Historical Perspective
Anorexia Nervosa – develop a morbid fear of fatness, perceive themselves as fat, and
reduce their food intake to points of emaciation
- Excessive exercise, general restlessness (pacing back and fourth), Purging
(vomiting, laxatives, etc. – much of this weight loss is due to dehydration)
- Objective binge: eating a large amount of food in a specific time period (less
than two hours)
- Subjective binge: eating a small or normal amount during these episodes (one
- Disturbance in body image (linked with low self-esteem)
- Other features concern: cognitive, emotional and physiological functioning,
social withdrawal, irritability, preoccupation with food, and depression
oMany of these features are linked to the state of semi-starvation the
person with anorexia is in as opposed to being a feature of the disorder
Bulimia Nervosa – periods of food restriction alternate with periods if binge eating,
wherein excessive amounts of food are consumed. The binges are compensated by either
vomiting, laxative, or diuretic abuse, hyper exercising or starving oneself.
- Often typically within the normal weight range
- Low self-esteem, social isolation, depression
- Fasting, Excessive exercise, Purging (vomiting, laxatives, etc. – much of this
weight loss is due to dehydration) serious medical complications such as
impaired renal function and cardiovascular difficulties (such as arrhythmias)
- The purging and compensatory behaviours that they engage in may not be
sufficient to produce weight loss, relative to the number of calories consumed
- Episodes of binging include high calorie foods, that are high in fat, and less
from protein, compared to calorie intake during non-binge eating episodes
- Cyclic pattern of restriction, binging, and purging
- Heatherton and Baumeister propose that binge eating occurs as a shift in
attention; attentional focus is narrowed such that it becomes focused on the
food present in the situation and on the sensations associated with consuming
food. In other words, binge eating results from shifting the focus of
individuals away from their failure to live up to their high standards and
toward the behavior and positive sensations associated with eating.
Overlapping features of Anorexia and Bulimia: Weight and shape as a primary source of
self-evaluation, low self-esteem. Binge eating as well as purging.
Differences: Anorexics are always underweight, Bulimics are normal weight range. All
individuals with bulimia engage in binge eating and compensatory behaviours, only some
individuals with anorexia exhibit these behaviours.
Assessing body weight and eating behaviours can allow clinicians to differentiate
Binge eating disorder – (new to DSM-5) – similar to Bulimia (without vomiting),
recurrent episodes of binge eating, associated with a variety of eating behaviours, feeling
guilt or disgust about the binge eating
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- Self hatred
- Individuals with BED are often overweight, and sometimes obese, some
normal weight range (similar concerns about eating, weight and shape, and
depression across weight ranges)
- Not obese range individuals tend to younger, suggesting that over time eight
game may occur in binge-eating episodes
-Eating disorders are classified together with Feeding disorders which include Pica
(eating non-food substances), Rumination disorder (repeatedly regurgitating food),
Avoidant/restrictive food intake disorder (ARFID) (Resembles anorexia in some ways:
it is characterized by a feeding disturbance that leads to being underweight and/or an
inability to eat enough food to meet nutritional/energy needs. However, individuals do
not perceive themselves as fat or have a distorted perception of their body weight or
Incidence and Prevalence
Prevalence – Females 0.3%, Males 0.2%
Incidence: 8 per 100,000 population/year
-Incidence of anorexia increased by almost threefold in women in their 20s and 30s
Whether the true incidence of anorexia nervosa is increasing, there has been an increase
in the incidence of registered cases (increase need for treatment facilities)
Prevalence – Females 1.0%, Males 0.1%
Incidence: 12 per 100,000 population/year
-Prevalence of bulimia in Canada is similar to prevalence in other Western countries
-Research has suggested that partial syndrome eating disorders are even more common
than either anorexia or bulimia, with a prevalence rate of 2.37% detected in a large
community sample of adolescents and young adults. However, because changes have
been made to the DSM-5 criterion for eating disorders, the prevalence of partial
syndrome eating disorders will decrease
-The incidence of bulimia also appears to have been increasing since it was first
described in the late 1970s, thought some reports indicate that this increase may have
peaked in the mid-1990s. Unclear if this increase in both eating disorders is a result of
increased awareness and recognition.
Only about 33% of community dwelling individuals with anorexia, and less than 10%
of individuals with bulimia, receive mental health care. Hence, a large proportion of
individuals who meet diagnostic criteria for an eating disorder do not receive appropriate
mental health care.
Binge Eating Disorder
-Just added as a distinct eating disorder, prevalence data are not yet available
-Estimated that average lifetime prevalence is around 1.9%
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-Less than 40% of individuals who had received a lifetime diagnosis of BED have
-Eating disorders have highest mortality rate of psychiatric disorders, 5-8%, the most
common cause of death include: starvation and nutritional complications (electrolyte
imbalance or dehydration) and suicide
-Approximately 50% of adults with bulimia are able to stop binge eating and purging
with current evidence-based individual therapy. The other 50% show some partial
improvements, and others show no change.
-Relapse rates are very high… One study found relapse occurred in 36% of women with
anorexia who had achieved remission, and 35% of women with bulimia.
-High mortality rate even among individuals who receive treatment. Herzog (2000) 5.1%
of participants who died during course of study had received individual psychotherapy
-It seems that despite the fact that a substantial minority of individuals continue to have
clinically significant eating disorders after received treatment, more patients recover after
receiving treatment than exhibit spontaneous recovery without treatment.
-Pursuit and maintenance of an extremely low body-weight. The DSM-5 defines it as the
restriction of energy intake leading to a body weight that is less than minimally
normal/expected. A significantly low weight can be assessed by calculating a body-mass
index (BMI) weight in kilograms divided by height in metres squared. WHO says those
with a BMI of less than 17 has a significantly low weight. However, those with higher
than 17 may also been considered to have a low weight depending on their clinical
-Part of the difficulty in defining a significantly low weight is that it is unreasonable to
specify a single standard for minimally normal weight that applies to all individuals.
Another reason why it is difficult to give a precise definition for low weight is that most
people who develop anorexia do so in adolescence when they are still growing, with the
typical onset between ages 14 and 18. For these individuals, an indication of significantly
low eight would be a failure to make expected weight gain during a period of growth.
Clinicians are instructed to consider an individual’s body build and weight history when
determining whether an individual meets the low weight criterion for anorexia nervosa.
-Second criterion is an irrational fear of gaining weight or of becoming fat, or persistent
behavior that interferes with weight gain, despite being at a significantly low weight.
Important to note that individuals with anorexia do not necessarily fear weight gain for
aesthetic reasons. Some fear because they fear losing some of the consequences of their
low weights that they view as beneficial. For example, many individuals report that they
fear gaining weight because they desire the emotional numbness that is associated with
-Criterion: Distortion in the experience and significance of body weight. (1) Disturbance
in perception of body weight or shape, such that the individual percepeives herself as
weighing more than she does or being larger than she is; alternatively, she may recognize
that she is underweight but may perceive a particular body part as being larger than it
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