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Chapter 10

Chap 10.docx

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Wilfrid Laurier University
Kathy Foxall

Chap 10 Introduction and historical perspective  Anorexia nervosa-eating disorder, characterized by the refusal to eat because they fear they will gain weight  In middle ages these girls were known as saints  The socio-cultural context of a beh helps determine how it is perceived and interpreted  Eating disorders have been around for 100`s of years  In the 60`s and 70`s western culture became more obsessed about thinness  In the late 70`s is when a new eating disorder was recognized called bulimia  From anorexia nervosas, ppl have a morbid fear of fatness, they perceive themselves as fat o There is an overemp on shape and weight for determining self-worth.  In bulimia nervosa, the periods of restriction alternate with periods of binge eating , excessive amounts of food are consumed, then it is followed by vomiting, laxatives or diuretic abuse or hyper exercising Typical characteristics Anorexia nervosa  It is hard for family and friends of individuals with eating disorders to understand y they do it o They are more concerned for their health . o Therefore, they may hid it more  The fear of gaining weight is paradoxical, reality that they are in face underweight.  The reduce weight gain they reduce the calories they eat and abstain from eating food  They think weight gain will occur immediately after they eat something  Many other maladaptive eating beh may also develop o Eg eating veggies first and then leaving high protein foods untouched o Some ppl exercises a lot to lose a lot of weight o Restlessness is common, due to over exertion and under eating o Other ppl engage in purging beh it includes self-induced vomiting, laxatives abuse  Many ppl who purge also binge eat o Lac of control over eating  An objective binge - consists of eating a large amount of food in a specific time period  Subjective binge – eating is small during episodes of binging  Anorexia nervosa not only is a drive to lose weight but also a disturbance in body image  They have a dissatisfaction of their overall weight or shape- linked to self –esteem and individuals may use body weight or shape as a primary method of determining self-evaluation  Ppl with anorexia may be hyper vigilant meaning they continuously weigh themselves, measuring their body parts Bulimia nervosa  Characterised by episodes of binge eating, followed compensatory behaviours designed to prevent the gain of weight  They also have low self-esteem , and use weight and shape information as their primary method of self-evaluation.  Other features such as cortisol isolation, depression are common in both bulimia and anorexia  Individuals with bulimia engage in objective binge eating , they also fast and exercise a lot  Many individuals with bulimia are within the normal weight range o The amount of purging may not be enough to lose that much weight  These purging beh have serious medical consequence , o These include impaired bowels , cardiovascular difficulties eg arrhythmias,  The foods typically binged on are cookies, chips, ice cream  The foods often consumed by bulimic are considered as `forbidden foods `and are avoided during periods of dieting and food restrictions  This pattern of avoidance sets up the cycle for binging and purging o After binging they fell physical discomfort, feelings of guilt  And worry about weight gain  Heatherton and baumeister have proposed that episodes of binge eating occur in an attempt to escape from high levels of aversive self-awareness.  According to this model , individuals who binge eats tend to have higher expectations of them.  Anorexia and bulimia features often overlap, but they both use weight and shape as their primary source of self-evaluation and have low self esteem o Bulimics and only some anorexics binge eat then purge. o The primary difference is that anorexia are always underweight, and individuals with bulimia are typically within in their normal weight range Incidence and prevalence  8116 individuals in Ontario fount that the life time prevalance of bulimia was 1.1 % in women and .1 % in men  Recent research suggested that partial syndrome eating are even more common than either anorexia or bulimia with a prevalence rate of 2.37 %  There is an increase in anorexia over the past century fombonne has argued that the true incidence of both anorexia and bulimia has not changed.  Hoek and can hoeken pointed out that regardless of whether the true incidence of anorexia nervosa is increasing, there has been an increase in the incidence of registered cases. Prognosis  Eating disorder has the highest mortality rates of other disorders ( 5 and 8 percent )  Most common causes are starvation and nutritional compilations  On avg 50% some show partial improvements and other show no change in the frequency of binge. Purge episodes at all.  Relapse rates are high for eating disorders  In terms of rates of relapse, six months after completion of day hospital treatment the relapse rate was 38 percent, at one year it was 41 percent and at 18 months is increased to 48 percent Anorexia nervosa  There are two examples of minimal normal weight o 1. 85% of ones expected weight o 2. Is having a body mass index- of 17.5  For these individuals the criterion is a failure to make expected weight gain during a period of growth. The second criterion is tan irrational feat of gaining weight  Finally they must have a distortions of: 1) body weight , 2) denial of seriousness of low weight 3) determining self-worth based primarily on body weight or shape  The final criterion for anorexia requires that females who are past puberty exhibit amenorrhea.  Amenorrhea is defined as the absence of three consecutive menstrual cycles.  The DSM-IV-TR subtypes anorexia into restricting type and binge eating or purging types  Restricting type individuals attain their extremely low body weights thru strict dieting and excessive exercise.  Binge eating and or purging type individuals not only engage in strict dieting but also regularly engage in binge eating and or purging beh Bulimia nervosa  Three critions o 1. Self-evasions is influenced by body shape o Distortion of image o Requires episodes of binge eating and purging at least twice a week for three months  If they fail to meet these criterions they are still considered to have an eating disorder but not bulimia  Person with bulimia are classified as purging type or no purging types ( Eg fasting and excessive exercise) Eating disorder not otherwise specified (EDNOS)  Binge eating disorder (BED) characterized another subgroup of individuals who are diagnosed with EDNOS  There is some disagreement as to whether BED is a discrete distort or a type of bulimia Diagnostic issues  It is not possible to have more than one type of eating disorder  If the patent only uses restriction of food intake to compensate for binges, it is difficult to determine the degree Validity of diagnostic criteria and classification Some researchers have proposed that eating disorder can be conceptualized on a spectrum rather than as separate diagnostic categories. They say that the eating beh and other psychopathology of individuals with eating disorders exist on a spectrum of severity.  According to fairburn , in mid adolescence, eating disorders must typically resemble anorexia nervosa, whereas, the eating disorders of late adolescence and early adult hood ten to resemble bulimia nervosa.  A related controversy is about the specific diagnostic criteria for anorexia and bulimia nervosa  The DSM-IV-TR does acknowledge that it is unreasonable to specify a single standard for minimally normal weight that applies to all individuals and it therefore indicates that 85 % of chart average weight and BMI Assessment  Usually conducted using a structure or semi structured interview  Use the eating disorder examination to aid their assessments  It forvidses numerical ratings of the frequency and degree of eating disorder symptoms and also provides normative data on dietary restraint and the severity of dietary restriction.   Also to assess for the presence and absence of other psychological disorders  Another component of eating disorders assessment is a medical examination, determines the presence of any physical or medical compilations associated with eating disorders.  The final component of many assessment is the administration of self-reporting questionnaires to complements the information gathered thru the clinical interview Physical and psychological complications  Agras indicated that across all of the eating disorder subtypes , individuals experience reduced quality of life and their social relationships are negatively affected.  Anorexics often have lowered heart rates and low blood pressure , decreased fertility and dry skin  Lanugo, a fine downy hair, may grow on the body to keep warm  Also have increased irritability and difficulty concentrating.  Bulimics have dental problems  Individuals who self-induce vomiting may exhibit Russell’s sign ( scrapes on the back of hands and knuckles, )  As in anorexia , emotional functioning may also be affected in individuals with bulimia nervosa,  One compilation involved In studying the physical and psychological symptoms of eating disorders is distinguishing between whether a factor is a cause or a consequence of eating disorder Etiology Genetic and biological theories  There seems to be a heritable component to eating disorders,  The rate of eating disorders in relatives of individuals with anorexia nervosa 4.5 times higher than in relatives of a healthy comparison groups  Genetics play a significant role in the development of eating disorders, with estimates that more than 50 percent of the variant in eating disorder and disordered eating beh can accounted for by genetic factors  In recent years numerous genetic studies on eating disorders have emerged, many different
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