B B E E Eating Disorders H Chapter 10 H A A Anorexia nervosa - An eating disorder characterized V V by (1) maintenance of an abnormally low body weight, I I (2) a distorted body image, (3) intense fears of gaining O Eating Disorders and O weight, and (4) in females, amenorrhea. R R Sleep Disorders Bulimia nervosa - An eating disorder characterized D D by (1) recurrent binge eating followed by self-induced I I purging, (2) accompanied by overconcern with body weight and shape. S Sheila K. Grant, Ph.D. S O O R Professor R Eating disorder - A psychological disorder D D characterized by (1) disturbed patterns of eating and E E (2) maladaptive ways of controlling body weight. R R S S B B E Eating Disorders E Eating Disorders H H Results of a large, population based survey indicate A A that anorexia affects about 0.9% of women in our V V society (about 9 in 1,000). I I O O Bulimia is believed to affect about 1% to 3% of R R women. D D Rates of anorexia and bulimia among men are I I estimated at about 0.3% (3 in 1,000) for anorexia S S and 0.1% 0.3% (1 to 3 in a thousand) for O O bulimia. R R D D Many men with anorexia participate in sports, such as E E wrestling, that impose pressures on maintaining R R weight within a narrow range. S S B B E Overview of Eating Disorders E Subtypes of Anorexia H H A A There are two general subtypes of anorexia: V V I I (1) A binge eating/purging type and O O (2) a restrictive type. R R First type characterized by frequent episodes of binge D D eating and purging; the second type is not. I I S S Individuals with the eating/purging type tend to have O O problems relating to impulse control, which in R R addition to binge-eating episodes may involve substance D D abuse or stealing. E E R R S S 1 B Medical Complications of B E E Bulimia Nervosa H Anorexia H A A Bulimia derives from the Greek roots bous, meaning Anorexia can lead to serious medical complications “ox” or “cow,” and limos, meaning “hunger.” V that in extreme cases can be fatal. V I I O Losses of as much as 35% of body weight may O Bulimia nervosa is an eating disorder characterized by R occur, and anemia may develop. R recurrent episodes of gorging on large quantities of food, followed by use of Females suffering from anorexia are also likely to inappropriate ways to prevent weight gain. D encounter dermatological problems such as dry, D I cracking skin; fine, downy hair; even a I S S These may include purging by means of self- yellowish discoloration of the skin that may induced vomiting; use of laxatives, diuretics, or O persist for years after weight is regained. O R R enemas; or fasting or engaging in excessive D Cardiovascular complications include heart D exercise. E irregularities, hypotension (low blood pressure), and E R associated dizziness upon standing, sometimes causing R S blackouts. S B B E The Case of Ann E The Case of Tamora H H A A V V I I O O R R D D I I S S O O R R “If someone had told me how ugly I looked, being D D E “I was just afraid to go home and be around food.” E that thin, I wouldn’t have done it. I mean, it was R R …part beauty and part power.” S S B B E Bulimia Nervosa E Medical Complications of H H Bulimia A A V V Many medical complications stem from repeated I I vomiting: skin irritation around the mouth due to O O frequent contact with stomach acid, blockage of salivary R R ducts, decay of tooth enamel, and dental cavities. D D The acid from the vomit may damage taste receptors on I I the palate, making the person less sensitive to the taste S S of vomit with repeated purging. O O R R Decreased sensitivity to the aversive taste of vomit may D D help maintain the purging behavior E E R R S S 2 B B E Causes of E Sociocultural Factors H H A Anorexia and Bulimia A Pressure to achieve an unrealistic standard of thinness, V V combined with importance attached to appearance in I I defining female role in society, can lead young women Like other psychological disorders, anorexia and O O to become dissatisfied with their bodies (Stice, 2001). bulimia involve a complex interplay of factors (Polivy & R R Herman, 2002). These pressures are underscored by findings that among college women in one sample, 1 in 7 (14%) D D Most significant are social pressures that lead young reported that buying a single chocolate bar in a store I I women to base their self-worth on their physical would cause them to feel embarrassed (Rozin, Bauer, & S S appearance, especially their weight. Catanese, 2003). O O R R In another study, peer pressure to adhere to a thin body D D shape emerged as a strong predictor of bulimic E E behavior in young women (Young,McFatter,& Clopton, R R 2001). S S B B E Sociocultural Factors E Thinner and thinner. H H A Exposure to media images of ultrathin women can A V lead to the internalization of a thin ideal, setting the V I stage for body dissatisfaction (Blowers et al., 2003; I O Cafri et al., 2005). O R R Even in children as young as eight, girls express more D dissatisfaction with their bodies than do boys D I (Ricciardelli & McCabe, 2001). I S S O Body mass index (BMI) - A standard measure of O R overweight and obesity that takes both body weight R D and height into account. D E E R R S S B B E Psychosocial Factors E H H Death by Although cultural pressures to conform to an ultrathin A A Starvation. V female ideal play a major role in eating disorders, the V A leading fashion model, I great majority of young women exposed to these I pressures do not develop eating disorders. Brazilian Ana Carolina Reston, O O was just 21 when she died in R R 2006 from complications due A pattern of overly restricted dieting is common to to anorexia. At the time of her death, the 5'7" Reston weighed D women with bulimia and anorexia. D only 88 pounds. Anorexia is a I I Women with eating disorders typically adopt very rigid widespread problem among S S fashion models today, as it is O dietary rules and practices about what they can eat, O among people in other R how much they can eat, and how often they can eat. R occupations in which great emphasis is put on unrealistic D D standards of thinness. E E R R S S 3 B B E Family Factors E Family Factors H H A Eating disorders frequently develop against a A Families of young women with eating disorders tend V backdrop of family problems and conflicts. V to be more often conflicted, less cohesive and I I nurturing, yet more overprotective and critical than O Some theorists focus on the brutal effect of self- O those of reference groups (Fairburn et al., 1997). R starvation on parents. R The parents seem less capable of promoting D They suggest that some adolescents refuse to eat to D independence in their daughters. I punish their parents for feelings of loneliness and I S alienation they experience in the home. S Conflicts with parents over issues of autonomy are O O often implicated in the development of both anorexia R R nervosa and bulimia. D D E E R R S S B B E Biological Factors E Treatment of H H A Low levels of the chemical, or lack of sensitivity of A Eating Disorders serotonin receptors in the brain, may prompt binge- V V People with anorexia may be hospitalized, especially eating episodes, especially carbohydrate bingeing I I when weight loss is severe or body weight is falling (Levitan et al., 1997). O O rapidly. R R This line of thinking is buttressed by evidence that In the hospital they are usually placed on a closely antidepressants, such as Prozac, which increases D D monitored refeeding regimen. I serotonin activity, can decrease binge-eating episodes I in bulimic women (Walsh et al., 2004). S S Behavioral therapy is also commonly used, with O O rewards made contingent on adherence to the We also know that many women with eating disorders R R refeeding protocol. D are depressed or have a history of depression, and D imbalances of serotonin are implicated in depressive E E Commonly used reinforcers include ward privileges disorders. R R and social opportunities. S S B B E Treatment of E Binge-Eating Disorder H Eating Disorders H A A Binge-eating disorder (BED) - A disorder characterized by recurrent eating binges without V Cognitive-behavioral therapy (CBT) has emerged as V purging; classified as a potential disorder requiring I an effective treatment approach for bulimia and is I further study. O currently recognized as the treatment of choice for O R this disorder. R Binge-eating disorder is classified in the DSM manual as a potential disorder requiring further study. D Interpersonal psychotherapy (IPT), a structured form D Too little is known about the characteristics of people I of psychodynamic therapy, has also been used I with BED to include it as an official diagnostic S effectively in treating bulimia.