Ch.10: Eating Disorders

Front 1

Factors associated with distorted eating patterns

Back 1

Excess weight, body dissatisfaction, low self-esteem, depression, substance use, and suicidal ideation

Front 2

Facts about eating issues

Back 2

- 68% of adults and 16% of children are overweight or obese in the US

- weight and body shape concerns most common among young white females and also older women and some minorities

¬less common among African American women

- body dissatisfaction displayed by both men and women may be due to Media images of body types that few can achieve

**demonstrate more negative self-evaluation

- 60% of individuals treated and eating disorder program suffer from disordered eating that does not meet criteria for other eating disorders

Front 3

Muscle dysphoria

Back 3

-Dissatisfaction with one's muscularity

** wait to see dissatisfaction in adolescent boys and college males often revolve around desire to be heavier and more muscular

Front 4

Anorexia nervosa

Back 4

Refusal to maintain a body weight of the minimum normal weight because of intense fear of becoming obese and body image distortion

*weight is below normal weight

- engage in self-starvation, weigh themselves repeatedly, only eat small quantities of low calorie foods

- continue to insist they are overweight and deny that their skeleton like appearance is abnormal

- accuse peers who show concern to be jealous

- view weight loss as a sign of achievement and weight gain as a sign of failure

Front 5

Facts about anorexia nervosa

Back 5

- occurs primarily and adolescent girls in women

- 25% occur in men

- mortality rate is 6 times higher then of the general population due to Suicide, substance abuse, and psychological effects of starvation

Front 6

What are the two subtypes of anorexia

Back 6

Restricting type and binge eating / purging type

Front 7

Restricting subtype of anorexia

Back 7

-Accomplish weight loss through dieting or exercising

*Constant fasting

-Introverted, deny feelings of hunger or psychological distress

- perfectionism, conformity, rigidity

Front 8

Binge eating / purging subtype of anorexia

Back 8

Lose weight through the use of self-induced vomiting, laxatives, or diuretics often after binge eating

- extroverted, report more anxiety, depression, and guilt

- admitted more frequently to have a strong appetite (tended to be older)

- histrionic, emotionally volatile, impulse control, substance abuse

Front 9

Physical complications of anorexia

Back 9

Cardiac arrhythmias, low blood pressure, slow heart rate, lethargic, dry skin, brittle hair, hypothermia, enlargement of salivary glands, osteoporosis, crosis of the liver, borderline organ failure, bone loss, weakened heart muscle

Front 10

Course and outcome of anorexia

Back 10

Course is highly variable with some recovering after one episode, others showing fluctuating patterns of weight gain and relapse, on some having a chronic and deteriorating course

Front 11

Characteristics associated with anorexia

Back 11

Depression, anxiety, impulse control, loss of sexual interest, and substance use

- strive for Perfection and control over certain aspects in thier lives

Front 12

Bulimia nervosa

Back 12

Recurrent episodes of binge eating a large consumption of food for at least once a week for 3 months and eating continues until vomiting or abdominal pain occurs

- exhibit maladaptive beliefs about self

- most realize that eating patterns are not normal and are frustrated by such knowledge

- repid food consumption occur in private

- loss of self-control once bindge eating has begun

- temporary relief from physical discomfort and fear of gaining weight is followed by shame and despair

- more prevalent than anorexia

Front 13

Types of bulimia nervosa

Back 13

Purging type and non purging type

Front 14

Purging type of bulimia nervosa

Back 14

Person regularly vomits and uses laxatives or diuretics after rapid consumption of food

Temporarily relieves physical discomfort and fear of gaining weight

Front 15

Non purging type of bulimia

Back 15

Excessive exercise, severely restricted diet, or fasting is used to compensate for binges

Front 16

Is everyone with bulimia underweight?

Back 16

No, most diagnosed with this are of normal weight

Front 17

Physical complications of bulimia nervosa

Back 17

Erosion of tooth enamel from stomach acid

Dehydration, swollen salivary glands, puffy facial appearance, lowered potassium, weekend heart, arrhythmia, cardiac arrest, stomach rupture, gastrointestinal disturbances, inflammation of the esophagus, rectal irritation, and gastric irritation

Front 18

Associated features of bulimia

Back 18

Use eating as a way of coping with distressing thoughts

Correlation between emotional state and Disturbed eating

High rates of binge-eating occurred during negative emotional states such as anger or depression

Front 19

What is bulimia often comorbid with?

Back 19

*Comorbid with mood disorders, seasonal affective disorder(depressive disorder), borderline personality

*Depression or borderline personality traits may precede eating disorder or may be consequence of eating disorder so interpretation of coexistence can be difficult

Front 20

Bulimia course and outcome

Back 20

Begins at late adolescence or early adult life

As in anorexia mortality and suicide rate is relatively High

Prognosis is more positive than for anorexia however still has a mixed course

Front 21

Binge eating disorder BED

Back 21

*Consumption of large amounts of food within a two hour period accompanied by feelings of loss of control, distress over eating during the episodes

*Is not followed by inappropriate compensatory behaviors following after eating episode

* secretively eats large amounts of food and sometimes may not even be hungry

*Must occur at least once a week within 3 months

Front 22

Associated characteristics of bulimia

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-Likely to be overweight

-Contributes to the development of obesity

- risk factors include adverse childhood parental depression repeated exposure to negative comments about body shape weight or eating

- binges often preceded by poor mood decreased alertness feelings of poor eating control and cravings

- have high lifetime rate for major depressive disorders, OCP, avoidant personality

Front 23

Physical complications of BED

Back 23

Medical conditions associated with obesity, high blood pressure, high cholesterol level, type 2 diabetes

Front 24

Course and outcome of BED

Back 24

Findings of prognosis are mixed

Some remain overweight while others fully recover

Front 25

Eating conditions not elsewhere classified

Back 25

Seriously Disturbed eating patterns that do not meet criteria for anorexia nervosa bulimia or binge eating disorder

Many was this diagnosis continue on to develop bulimia nervosa or binge eating disorder and display number of emotional and psychological problems

Front 26

Types of eating conditions not elsewhere classified

Back 26

Atypical anorexia nervosa, sub-threshold bulimia nervosa, sub-threshold binge eating disorder, purging disorder, night eating syndrome

Front 27

Atypical anorexia nervosa

Back 27

Individuals who meet criteria for anorexia but is often normal weight

Front 28

Sub-threshold bulimia nervosa

Back 28

Meet criteria for bulimia but frequency is less than once a week and less than 3 months

Front 29

Sub-threshold binge eating

Back 29

Meets criteria for binge eating except occurs less than once a week and is present less than 3 months

Front 30

Purging disorder

Back 30

Does not engage in binge eating but use (recurrent purging) self induce vomiting, misuse of laxatives, diuretics as a means to control weight or shape

Typically has normal weight but suffers from body image distortion and fearful of becoming fat

Front 31

Night eating syndrome

Back 31

Engage in recurrent patterns of binge eating after Awakening from sleep or late at night

Individual is clinically depressed by this eating Behavior

Front 32

Psychological dimension of the etiology of eating disorders

Back 32

- body image dissatisfaction / distortion ( discrepancy between one's perceived versus desired body )

- low self-esteem, lack of control, dependence, perceived social incompetence

- maladaptive perfectionism or other personality characteristics

- childhood sexual or physical abuse

** depression may be the result not the cause of having a eating disorder

Front 33

Social dimension in the etiology of eating disorders

Back 33

- parental attitudes and behaviors

- parental comments regarding appearance

- wait concerned mothers

- history of being teased about size or weight

- pure pressure regarding weight / eating

- childhood maltreatment

- influence of the media parents family friends on the ideal of being thin

Front 34

Socio-cultural dimension of the etiology of eating disorders

Back 34

- social comparison(evaluate self in regards to external standards)

- media: TV & magazines presenting distorted images

- cultural definitions of beauty

- objectification: female and male bodies evaluated through appearance

-thin ideal internalization (strong aggreement with social standard of "beauty")

**women are socialized to be conscious about thier body

** only 5% women meet the size of a model

Front 35

Gay men vs lesbian women on eating disorders

Back 35

Compared to lesbian women gay men appear to have a greater prevalence of disturbed eating patterns

Front 36

Ethnic minorities and eating disorders

Back 36

Hispanic and Asian American women have equal levels of body dissatisfaction as white women

Black woman show body dissatisfaction but a lower level than other comparison groups

Front 37

Cross-cultural studies on eating disorders

Back 37

Countries or groups that have been exposed to Western values show an increasing concern over eating and body size so wait normalcy is influenced by cultural beliefs and practices

However in Belize it was found that women have not changed their minimum concern with bodies with of exposure to Western media

Front 38

Biological dimension of eating disorders

Back 38

- genetic factors

**fun in families especially for females

**high heritability(55% in MZ twins)

- neurological and neurotransmitter vulnerabilities(reinforce effects of food: high dopamine= low appetite)

- obesity / weight / pubertal weight gain

-high genetic×environment influence

Front 39

Group based intervention programs involved for all eating disorders

Back 39

1. Becoming aware of societal messages

2. Developing more positive body image

3. Developing healthier eating and exercise habits

4. Increasing comfort and expressing feelings to pierce family members and significant others

5. Developing healthy strategies to deal with stress and pressure

6. Increasing assertiveness (coincidence) skills

Front 40

Treatment between Physicians, psychiatrist, and psychotherapist, typically involve following for anorexia

Back 40

1. Restoration of healthy weight

2. Treatment of physical complications, such as the symptoms related to starving and reactions to refeeding

3. Enhancement of motivation to participate in program

4. Psychoeducation about healthy eating patterns

5. Identification of attitudes (i.e., dysfunctional thoughts beliefs, Etc)

6. Psychotherapy to deal with emotional disturbances

7. Mobilization of family support and use of family therapy

8. Relapse prevention

Front 41

Psychological interventions for anorexia

Back 41

1. Understand / cooperate with nutritional and physical rehabilitation

2. Identify and understand the dysfunctional attitudes

3. Improve interpersonal and social functioning

4. Address comorbid Psychopathology and psychological conflicts

Front 42

Behavioral approach for anorexia

Back 42

Designed to correct irrational preoccupation with weight

Use of positive reinforcement to encourage weight gain

Start off with inpatient treatment and then Outpatient Treatment when person has gained sufficient weight

Front 43

Family therapy for anorexia

Back 43

1. Parents help refeed using meal plans

2. Reduce parental criticism by understanding disease

3. Negotiating new pattern of family relationship

4. Assisting family with development process of separation and individualization

**coaching style: family is encouraged to help patient form skills and attitudes needed for appropriate development

Front 44

Goals in treating bulimia nervosa

Back 44

1. Reducing / eliminating binge eating and purging

2. Treat physical complications

3. Motivate client to participate in restoration of healthy eating pattern

4. Provide psychoeducation regarding nutrition

5. Identify dysfunctional thoughts

6. Provide Psychotherapy to deal with issues

7. Obtain family support with family therapy if needed

8. Prevent relapse

Front 45

Medications for bulimia

Back 45

Antidepressant SSRIs are helpful

Front 46

Cognitive behavioral approach for bulimia

Back 46

-Develop sense of control

-Encourage consumption of three or more balanced meals a day

-Reduce rigid food rules and body image concerns

-Identify triggers for binging

-Developing coping strategies

Front 47

Exposure and response prevention in treating bulimia

Back 47

When added with cognitive behavioral strategies appears to improve long-term outcomes

Front 48

Treating binge eating disorder

Back 48

Focus on dealing with prejudice towards overweight individuals and on healthy approaches to reduce weight

Cognitive behavioral therapy can produce significant reductions in binge eating but is less successful in reducing weight

Front 49

Obesity

Back 49

Condition involving body mass index greater than 30

Not recognized as a specific disorder in the DSM-5

Front 50

Body mass index BMI

Back 50

An estimate of body fat calculated on person's height and weight

Front 51

Overlapping characteristics between obesity and substance dependence

Back 51

- development of Tolerance

- withdrawal symptoms

- larger amounts of food ingested than intended

- considerable time spent thinking about consuming food

- overeating despite attempt to stop amount consumed

- overeating despite adverse physical and psychological consequences

Front 52

What is obesity often comorbid with

Back 52

Depression, anxiety, low self-esteem, poor body image, and healthy eating patterns, night eating syndrome,

Front 53

Statistics on obesity

Back 53

-Worldwide phenomenon that affects more than 300 million people

-Second only to Tobacco in terms of being preventable cause of disease and

-Prevalence of being overweight in the US has doubled since 1970s

-Minorities such as Americans, Mexican Americans, indian Americans, and women show even higher rates of obesity

Front 54

Physiological issues with obesity

Back 54

Type 2 diabetes, high cholesterol, cancer, coronary heart disease, stroke, gallbladder disease, osteoarthritis, sleep apnea, respiratory problems, and obese kids have increased risk of coronary heart disease

Front 55

Biological dimension of obesity

Back 55

- genetic influence on appetite

(Obese children have abnormal production of hormone leptin that regulates good intake)

- Thrifty genotype

- dopamine receptors and pleasure in eating

Front 56

PsychologicalPsychological psychological dimension of obesity

Back 56

- negative mood state

- binge eating(due to negative mood state)

- poor self-esteem due to harassment and society view of weight

Front 57

Social dimension on obesity

Back 57

- teasing from family members or peers

- overweight friend(chance of being obese increase by 57%)

**people infect people in thier social network

- parental attitudes regarding eating

Front 58

Socio-cultural dimension of obesity

Back 58

- cultural influences on body preference(higher among minorities due to less pressure to remain thin)

- poor neighborhoods, less access to healthy food

- advertising of high-calorie foods

Front 59

Dieting / lifestyle changes for the treatment of obesity

Back 59

-Low calorie diet and exercise

-May produce short term weight loss and tends to be inaffective long-term

**yo yo effect

-Outcomes for children are more successful

Front 60

Drug treatment for obesity

Back 60

Blocks gastrointestinal up take bye up to 30%

Resulted in weight loss of about 7 lb

Front 61

Gastric bypass surgery for obesity

Back 61

For individuals identified as morbidly obese

Weight loss of about 80 lbs for 70% of participants

Common for weight gain to occur after the initial period of rapid weight loss

Front 62

What is the best way to maintain weight loss in obesity

Back 62

Comprehensive interventions that combine lifestyle changes with drug and or surgery appear to be the most effective in sustaining weight loss