Eating Disorder Not Otherwise Specified

(EDNOS)

-most common diagnosis

-general category - "catch-all"

-form of bulimia

-involves self-induced vomiting/laxative use

-at least once a week, minimum 6 months

-high impulsivity (extreme)

-"loss of appetite" "for emotional reasons"

-preoccupation w/ food

-refusal to maintain normal body weight (less than 85% of "normal" weight)

-weight loss through dieting

-excessive exercise & purging can be involved

-intense fear of weight gain (fear not reduced by weight loss)

-distorted sense of body shape

-amenorrhea: loss of menstrual period by extreme emaciation

Restricting:

-weight loss achieved by severely limiting food intake

Binge Eating-Purging:

-restricting type + binge eating and purging

-more psychopathological

-weigh more in childhood

-blood pressure often falls

-heart rate slows

-kidney, gastro-intestinal problems

-bone mass declines

-skin dries out

-brittle anils

-changes in hormonal levels

-mild anemia

-loss of hair from scalp

-develop laguna (fine hair)

-levels of eloctrolytes altered

-brain size declines

-~70% recover

-recovery takes ~6-7 years

-relapses common

-life-threatening: physical complications or suicide

-episodes of rapid consumption of a large amount of food, followed by compensatory behaviours (vomiting, fasting, excessive exercise)

-DSM: excessive amount of food w/in 2 hours

-triggered by stress

-typically in secret

-"loss of control" during a binge

-must occur 2x/week for 3 months

-intense fear of weight gain

Purging Type:

-compensatory behaviour is vomiting or laxative use

Non-Purging Type:

-compensatory behaviours are fasting or excessive exercise

-typically begins in late adolescence / early adulthood

-more common than AN among adolescents

-many overweight before onset of disorder

-~70% recover

-high comorbidity

-high suicide rates

-potassium depletion

-diarrhea (heavy use of laxatives)

-can lead to changes in electrolytes

-irregularities in the heartbeat

-tearing of stomach and throat tissue (vomiting)

-loss of dental enamel (vomiting)

-swollen salivary glands

-recurrent binges (2x/week for at leat 6 months)

-lack of control during bingeing episode

-distress about bingeing

-rapid eating, eating alone

-absence of weight loss

-absence of conpensatory behaviours

-more prevalent than AN/BN

-occurs more in women

-linked w/ impaired work/social functioning, substance abuse, dissatisfaction w/ body shape

-EDs result when several influences converge in a person's life

Biological Factors

-genetics & twin studies support

ED & the Brain

-research on animals w/ lesions to lateral hypothalamus: loss of weight/appetite

Socio-Cultural Variables

Gender Influences

Cross-Cultural Studies

AN: emphasis on fear of fatness, body image disturbance as motivating factors

-dieting and weight loss may be positively reinforced by the sense of mastery/self-control they create

-relevant to AN and BN

-symptoms of ED best understood by considering patient & how the symptoms are embedded in a dysfunctional family structure

-child seen as physiologically vulnerable

-child's family's characteristics:

-enmeshment: extreme overinvolvement and intimacy (parents may speak for child)

-overprotectiveness

-rigidity: try to maintain status quo

-lack of conflict resolution

-some studies show self-reports of childhood sexual abuse are higher than normal among patients w/ an ED

AN:

-perfectionistic, shy, compliant

BN:

-like AN + histrionic features, affective instability, outgoing social disposition

AN&BN:

-high in neuroticism and anxiety

-low in self-esteem

-perfectionism

Biological:

-BN: antidepressants (*Prozac)

Psychological (AN):

-goal 1: to gain weight

-operant-conditioning behaviour therapy programs somewhat successful

-isolated as much as possible

-rewarded for eating/gaining weight

-goal 2: long-term maintenance of weight gain

Psychological (BN):

-CBT best validated

-patient encouraged to Q society's standards

-uncover, change beliefs

-patient brings in "forbidden" food to eat during sessions