Eating Disorders

• Anorexia Nervosa


  Eating disorder characterized by restriction of energy intake leading to significantly low body weight, intense fear of gaining weight, and distorted body image
• DSM-5 Criteria for Anorexia Nervosa


  • Restriction of energy intake leading to significantly low body weight
  • Intense fear of gaining weight
  • Distorted body image, overvaluation of weight and shape, denial of low weight's seriousness
• Subtypes of Anorexia Nervosa

  • Restricting Type: Weight loss through food restriction
  • Binge-Eating/Purging Type: Weight loss through vomiting, laxatives, diuretics, or binge-eating
• Progression of Anorexia Nervosa

  Often begins with dieting, escalating after stressful events
• Clinical Picture of Anorexia Nervosa

  • High motivation to be thin
  • Preoccupation with food
  • Distorted thinking (overevaluation of shape/weight, maladaptive attitudes)
  • Psychological problems: Depression, anxiety, low self-esteem, sleep disturbance, substance abuse, obsessive-compulsive traits
  • Medical problems: Amenorrhea, lowered body temperature, low blood pressure, swelling, bone density loss, slow heart rate, metabolic and electrolyte imbalances, skin/hair problems
• Minnesota Starvation Experiment


  1. phase study (baseline, starvation, rehabilitation) illustrating the physical and psychological consequences of prolonged starvation
• Key Findings of Minnesota Starvation Experiment

  • Physical: Slowed metabolism, heart changes, edema, skin/hair problems, fatigue, concentration difficulties
  • Emotional: Apathy, depression, anxiety, anger
  • Behavioral: Preoccupation with food, binges, collection of recipes/equipment, social withdrawal
• Bulimia Nervosa


  Eating disorder characterized by recurrent binge eating episodes with a sense of lack of control, and recurrent compensatory behaviors to prevent weight gain
• DSM-5 Criteria for Bulimia Nervosa


  • Recurrent binge eating episodes with a sense of lack of control
  • Recurrent compensatory behaviors to prevent weight gain (vomiting, laxatives, diuretics, fasting, excessive exercise)
  • Bingeing and compensatory behaviors occur at least once a week for three months
  • Self-evaluation is unduly influenced by body shape and weight
• Progression of Bulimia Nervosa


  Often starts with intense dieting in slightly overweight individuals
• Binges


  Uncontrollable eating of large quantities of food, often in secret, high-calorie, soft-texture foods
• Compensatory Behaviors


  • Vomiting, laxative or diuretic abuse
  • Temporary positive effects but not effective in undoing binge effects
• Body Dissatisfaction


  • The leading contributor to dieting and eating disorders
  • More common in females
• Binge Eating Disorder


  Eating disorder characterized by recurrent binge eating episodes with at least three of the following: rapid eating, absence of hunger, uncomfortable fullness, secret eating, self-disgust, depression, guilt
• DSM-5 Criteria for Binge Eating Disorder


  • Recurrent binge eating episodes with at least three of the following: rapid eating, absence of hunger, uncomfortable fullness, secret eating, self-disgust, depression, guilt
  • Episodes occur at least weekly for three months
  • No compensatory behaviors
• Prevalence of Binge Eating Disorder

  1. 7% of the population, 64% female
• Consequences of Binge Eating Disorder

  Overweight or obese due to frequent binges
• Comparison of Eating Disorders

  • Anorexia Nervosa: Lowest prevalence, highest mortality, most severe weight loss
  • Bulimia Nervosa: Moderate prevalence, less severe weight loss, higher risk for dental problems, electrolyte imbalance
  • Binge-Eating Disorder: Highest prevalence, not associated with extreme weight loss but greater risk of weight gain and obesity
• Key Factors in the Causes of Eating Disorders

  • Psychodynamic: Ego deficiencies from disturbed mother-child interactions
  • Cognitive-Behavioral: Distorted thinking about body shape/weight, lack of control over life, improper labeling of internal sensations
  • Biological: Genetic predisposition, brain circuit dysfunction (larger insula, orbitofrontal cortex, striatum; smaller prefrontal cortex), neurotransmitter abnormalities (serotonin, dopamine, glutamate), hypothalamic involvement, weight set point
  • Societal Pressures: Thin ideal, prejudice against overweight individuals, pressure in specific subcultures (models, dancers, athletes), social networking influence
  • Family Environment: Emphasis on thinness, dieting mothers, enmeshed family patterns
  • Multicultural: Gender differences, racial/ethnic differences, varying ideals of beauty
• Goals of Eating Disorder Treatment

  • Restore weight
  • Normalize eating patterns
  • Stop compensatory behaviors
  • Address underlying psychological and situational factors
• Immediate Aims of Anorexia Nervosa Treatment

  • Weight restoration
  • Stop compensatory behaviors
• No Evidence-Based Treatments for Anorexia Nervosa in Adults
• Treatments Under Investigation for Anorexia Nervosa


  • CBT-E (Enhanced Cognitive Behavioral Therapy)
  • MANTRA (Maudsley Anorexia Nervosa Treatment for Adults)
  • SSCM (Specialist Supportive Clinical Management)
• Focus of Physical Recovery in Anorexia Nervosa Treatment

  • Restoring nutritional balance
  • Addressing medical issues
• Focus of Psychological Changes in Anorexia Nervosa Treatment

  • Improve self-esteem
  • Reduce overevaluation of shape/weight
  • Enhance psychosocial functioning
• Family involvement is often essential for lasting changes in Anorexia Nervosa treatment
• Immediate Aims of Bulimia Nervosa Treatment


  • Eliminate binge-purge patterns
  • Establish healthy eating habits
• Treatments for Bulimia Nervosa


  • CBT-E
  • Interpersonal Psychotherapy (IPT)
• Outcome of Bulimia Nervosa Treatment


  Improvement in 40% of cases within 10 years, but relapses are common
• Treatment of Binge-Eating Disorder is similar to Bulimia Nervosa: Address binge-eating patterns, improve eating habits
• Weight Management Interventions for Binge-Eating Disorder


  May be needed for those with obesity
• Body Shaming


  • Increasingly prevalent, fueled by internet and media
  • Counter-trend by celebrities raising awareness
• Future focus in prevention of eating disorders is the development of prevention programs to address the root causes