Anorexia nervosa

Diagnosis:

a.       Self-starvation: unable to maintain 15% of body weight (dip below 85%)

b.      Intense fear of becoming fat:

c.       Distorted body image:

d.      Amenorrhea: absence of at least 3 menstrual cycles

Types of anorexia nervosa

a.       Restricting type: a refusal to eat in order to prevent weight gain.

                                                               i.      Deep feelings of mistrust

                                                             ii.      denial of problem

                                                            iii.      missing menstrual cycles

b.      Binge-eating purging type: someone with anorexia who periodically engages in binging and then purges to prevent weight gain

                                                               i.      Binging is not a lot of food (they’re already starving themselves, so it’s not a lot of food, but desire to purge is still there)

                                                             ii.      More likely to have problems with unstable moods

                                                            iii.      Substance and alcohol abuse

                                                           iv.      This type is more chronic

Prevalence and groups at risk for anorexia

a.       Mostly young women (43% occurring in ages 16-20)

b.      8 million people are afflicted with eating disorders (including all 3)

c.       1 in 10 are male

d.      6% die

ANOREXIA:

f.        ~1% lifetime prevalence (90-95% female)

g.       Somewhat more likely in white women

h.      Usually begins in adolescence (15-19)

i.         ~50% fully recovered after 10 years of treatment

medical complications of anorexia nervosa

(6)

• Cardiovascular problems – slowing heart rate, irregular heart beat, heart failure
• Osteoporosis from bone density loss – estrogen levels get messed up
•    Kidney damage
• Impaired immune system functioning
• Acute expansion of stomach to point of rupturing
• Brain and nerves – can’t think right, sad, moody

Bulimia nervosa

Diagnosis

a.       Recurrent episodes of binge eating

                                                               i.      Eating large amounts of food in discrete time period

                                                             ii.      Feeling out of control when eating

b.      Compensation for binging – vomiting, laxatives, diuretics (when purging, only removing about 60% calories consumed)

c.       At least 2 times a week for 3 months

d.      Often normal or somewhat overweight

2 types of bulimia nervosa

a.       Purging type

b.      Non-purging type – primarily use exercise to control weight. Also fasting. Compared with AN, look at body weight

prevalence and at-risk groups for bulima

a.       .5-3% prevalence – more in women

b.      Whites

c.       Ages 15-29.

                                                               i.      15% college-aged women admitted to purging behavior

                                                             ii.      11% men in same study

d.      More than ½ teenage girls and 1/3 teenage boys engaging in behaviors such as: skipping meals, fasting, smoking cigs, vomiting, taking laxatives

medical complications due to bulimia (3)

a.       Electrolyte imbalances

                                                               i.      Due to vomiting and laxatives and diuretic abuse

                                                             ii.      Seizure, heart failure

b.      Dental problems

c.       Bone density loss

comorbidity of eating disorders

High comorbidities with anxiety disorders, substance abuse, depression (what comes first?)

Behaviors: suicidal ideation, low self-esteem, poor social relationships, poor physical health, lower life satisfaction

biological theories of eating disorders

•  Genetic predisposition
•  Predisposition to depression
• Dysregulation of hypothalamus

sociocultural theories of eating disorders

• Pressures to be thin, cultural norms of attractiveness
• Food as a way of coping with negative emotions
• Over concern with others’ opinions
• Rigid, dichotomous thinking-style, perfectionism
• Family dynamics
• History of sexual abuse

Hilde Bruch's theory of anorexia

• AN often occurs in girls who are high achievers, dutiful, compliant, daughters
• Eager to please
• Parents who are over-invester in their daughters’ compliance and achievement

Salvador Minuchin Theory

Enmeshed theory: extreme interdependence, lack of own identity

Family systems perspective on eating disorders

• Child’s D/O reflects disturbance in family- family problem must be dealt with
• Anorexia – families tend to be overprotective, rigid & superficially close
• Hilde Bruch’s Theory –
• Salvador Minuchin Theory:
• Fundamental deficits in sense of identity
• Experience themselves as always acting in response to others, rather than to own needs
• Do not accurately identify own feelings
• Do not accurately identify their own body sensations (hunger), which may contribute to ability to starve themselves
• Control of food intake:

                                                               i.     

Provides sense of control

                                                             ii.     

Elicits concerns from parents

                                                            iii.     

Power over family

Fairburn's cognitive model of eating pathology

women who internalize thinness standards are unhappy with their own bodies

connection is with HOW important body imageit is

Voh's and Colleagues model of eating pathology

eating disorders are especially likely to result when body dissatisfaction is paired with perfectionism and low self-esteem

binge eating disorder

resembles bulimia except there is no purging involved

often overweight

common among african americans and women

2% population

Treatments for anorexia nervosa

(4)

1. Hospitalization and refeeding
2. Behavior therapy - rewards tied to eating. relaxation techniques
3. Techniques to help patient value his/her emotions
4. family therapy

Treatments for bulimia nervosa

(4)

1. Cognitive-behavioral - teach patient to recognize cognitions around eating. introduce regular diet and confront irrational cognitions about it.
2. Interpersonal therapy - identify interpersonal problems
3. Supportive-expressive psychodynamic therapy - provide encouragment for expression of feelings
4. Tricyclic antidepressants and SSRI's