Ch 9: Eating Disorders

• Feeding and eating disorders: characterized by persistent disturbance of eating behavior that results in significant changes in consumption/absorption of food and significantly impairs physical and psychological health
• Pica: the urge or actual consuming non food substances, sometimes occurs in pregnancy
• Rumination: (cows) chew things over lots but never swallow
• Avoidant/restrictive food intake disorder: mostly in kids, picky, won't meet weights and restrictive/maladaptive
• Anorexia Nervosa is a condition marked by restriction of food intake relative to needed energy requirements
• AN has a BMI of 18.5 or lower and have an intense fear of gaining weight
• AN is the most severe of eating disorders. Consists of restricting diet (lots of fasting and exercise) and Binge eating/purging (eat lots then compensatory behavior to not gain weight)
• AN have a denial of illness/ the severity of it. They put their self-worth in their weight. They use weight and shape as a measure of self. Their perception of body size and weight is distorted
• Women are 3x more likely to develop AN and the onset age is typically in adolescence. It is associated with perfectionism, neuroticism, and obsessiveness
• AN has the highest mortality rate of any psychiatric disorder because of the physical complications (body and organs shutting down) and due to death by suicide. Most people only even experience it for 3 months before death
• People with AN can experience relapse, remission, comorbidity (anxiety, MDD, OCD), and crossover between other eating disorders
• Binge episode: amount that is larger than most individuals would eat in a similar period of time under similar circumstances. Within 2 hour period. Associated with lack of control. Associated with Bulimia Nervosa and Binge Eating Disorder
• Inappropriate Compensatory behavior: any action that a person uses to counteract a binge episode/prevent weight gain such as vomiting, laxatives, diuretics/enemas, fasting, and excessive exercise
• Negative Reinforcement of binges: remove stress of binge and no weight gain so more likely to do it again
• Bulimia Nervosa is a recurrent episode of binge eating with inappropriate compensatory behavior to "undo" the effects of binge/prevent weight gain
• BN occurs in normal/slightly overweight individuals. More common in women, more common than AN. Onset age typically in adolescence. Comorbid with anxiety disorders, MDD, substance use and personality disorders.
• People with BN typically have perfectionism, are rigid, obsessive, high impulsivity, and novelty-seeking. Women are also much more likely to engage in purging
• Binge-Eating disorder is regular binge eating behaviors without compensatory behaviors
• BED has comorbidities, occurs generally in older/middle age populations that are overweight/obese. Unique to BED is feeling disgusted, depressed, or guilty. There is distress associated with the binge
• Hypothalamus: brain region that regulates certain metabolic processes
• Stress increases reinforcement value of food for BED
• Biological perspective of eating disorders: dysregulation of neurotransmitters serotonin and dopamine lead to a decreased appetite. Genetics plays a role since all the disorders have medium to high rate of heritability
• Psychological Perspective of Eating Disorders, Psychodynamic: pervasive sense of ineffectiveness (limited research to prove)
• Psychological Perspective of Eating Disorders, Family models: patterns of family dysfunction, enmeshment, rigidity, and over-protectiveness
• Psychological Perspective of Eating Disorders, Cognitive Behavioral: distorted cognitions about body shape, weight, eating, personal control. Recognizes negative reinforcement
• Enmeshment: no family boundaries and always in each others business
• Sociocultural perspective of eating disorders: preoccupation with thinness as beauty, thought that overweight is bad
• Overall goal for treatment of eating disorders is to normalize and stabilize eating behavior and weight
• Treatment goal of AN: increase caloric intake and weight gain
• Treatment goal of BN: eliminate/reduce binge episodes and compensatory behaviors
• Treatment goal of BED: eliminate/reduce binge episodes
• AN treatment can include inpatient hospitalization with psychotherapy, nutrition, and medical observation. Medications are not frequently used (unless there is a comorbid diagnosis). Family-based interventions are also an option but most effective for adolescents to fix meals, psychosocial stressors, and family dynamics
• Other treatments of eating disorders, CBT: focus on changing one's perceptions about body shape, weight, eating, and sense of control. Moderate efficacy for AN, stronger for BN and BED
• Other treatments of eating disorders, Interpersonal Psychotherapy (IPT): decrease eating disorder symptoms by enhancing social skills and relationships. Research to support this for BN and BED