AB PSYCH Pre-Fi

• Major types of DSM-5 eating disorders

  • Bulimia nervosa
  • Anorexia nervosa
  • Binge eating disorder
• Bulimia nervosa and Anorexia nervosa


  • Severe disruptions in eating behavior
  • Weight and shape have disproportionate influence on self-concept
  • Strong sociocultural origins – driven by Western emphasis on thinness
• Binge eating disorder


  • Involves disordered eating behavior
  • May involve fewer cognitive distortions about weight and shape
• Binge eating


  • Eating excess amounts of food in a discrete period of time
  • Eating is perceived as uncontrollable
  • May be associated with guilt, shame, or regret or particularly stressful times
  • May hide behavior from family members
  • Foods consumed are often high in sugar, fat, or carbohydrates
• Bulimia nervosa


  • Binges are accompanied by compensatory behaviors
  • Purging
  • Excessive exercise
  • Fasting or food restriction
• Associated medical features of bulimia nervosa

  • Most people with bulimia nervosa are within 10% of normal body weight
  • Purging can result in severe medical problems
• Associated psychological features of bulimia nervosa

  • Most people with bulimia nervosa are overly concerned with body shape
  • Fear of gaining weight
  • Most people with bulimia nervosa have comorbid psychological disorders
• Majority of people with bulimia nervosa are women – 90%+
• Some binge eating symptoms are relatively common in men
• Incidence of bulimia among males is increasing, 0.8%
• Incidence of binge eating disorder among males is 2.9%
• 6 to 7% of college women suffer from bulimia at some point
• Onset of bulimia nervosa typically in adolescence
• Bulimia nervosa tends to be chronic if left untreated
• Cognitive-behavioral therapy


  • Treatment of choice for bulimia nervosa
  • Principal focus is on the distorted evaluation of body shape and weight and on maladaptive attempts to control weight in the form of strict dieting and compensatory activities
• Medical and drug treatments

  Antidepressants can help reduce bingeing and purging behavior
• Anorexia nervosa


  • Extreme weight loss is the hallmark
  • Restriction of calorie intake below energy requirements
  • Intense fear of weight gain accompanied by body image distortion
  • Two subtypes: restricting and binge-eating-purging
• Associated medical features of anorexia nervosa

  • Starving body borrows energy from internal organs, leading to organ damage including cardiac damage
  • Most deadly mental disorder due to physical consequences and suicide risk
• Comorbid psychological disorders in anorexia nervosa

  • 70% of people with anorexia are depressed at some point
  • Higher than average rates of substance misuse and obsessive-compulsive disorder
• Majority of people with anorexia nervosa are female and white
• People with anorexia nervosa are usually from middle- to upper-middle-class families
• Anorexia nervosa usually develops around early adolescence
• Anorexia nervosa is more chronic and resistant than bulimia
• Lifetime prevalence of anorexia nervosa is approximately 1%
• Anorexia nervosa develops in non-Western women after they move to Western countries
• Treatment of anorexia nervosa

  • Initial treatment goal is attaining a weight in the healthy range
  • Psychoeducation
  • Behavioral and cognitive interventions target food, weight, body image, thought, and emotion
  • Treatment often involves the family
  • Has the most support from clinical trials for treating adolescents with anorexia
• Binge eating disorder (BED)


  • Characterized by binge eating without associated compensatory behaviors
  • Associated with distress and/or functional impairment (e.g., health risk, feelings of guilt)
  • Excessive concern with weight or shape may or may not be present
• Approximately 20% of individuals in weight-control programs have BED
• Approximately half of candidates for bariatric surgery have BED
• BED has a better response to treatment than other eating disorders
• Preventing eating disorders


  • Often focuses on promoting body acceptance in adolescent girls
  • Identify people who may be at increased risk (e.g., early weight concerns)
  • Screening for at-risk groups
  • Provide education
• Obesity


  • Defined as a body mass index (BMI) of 30 or higher
  • Not a DSM disorder, but is associated with some disorders
• In 2008, 33.8% of adults in the United States were obese; 37.5% in 2010
• Mortality rates from obesity are close to those associated with smoking
• Obesity is increasing more rapidly in children/teens
• Obesity is also growing rapidly in developing countries
• Relationship between binge eating and obesity

  • Binge eating increases risk of obesity
• Night eating disorder


  • Consume 1/3+ of daily calories after dinner
  • Get out of bed at least once during the night for a high-calorie snack
  • Often not hungry the next morning and skip breakfast
• Causes and correlates of obesity


  • Technological advancement promotes inactive, sedentary lifestyle
  • Genetics account for about 30% of variation in obesity
  • More likely to be obese if people in close social circles are also obese
• Obesity treatment


  • Progresses from least to most intrusive: self-directed weight loss programs, commercial self-help programs, behavior modification programs, bariatric surgery
  • Treatment is moderately successful at the individual level