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Eating Disorders Presentation 6; ED Ch 7-8

by: AmberNicole

Eating Disorders Presentation 6; ED Ch 7-8 PSYC 2250

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These notes cover eating disorders presentation 6 and ED chapters 6-7. I used these notes on my quizzes and made a 100 on all of them. Hope it helps! -Amber
Eating Disorders
Dr. Greg Neimeyet
Study Guide
eating, disorders, Bulimia, Anorexia, nervosa
50 ?




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This 14 page Study Guide was uploaded by AmberNicole on Saturday October 1, 2016. The Study Guide belongs to PSYC 2250 at East Carolina University taught by Dr. Greg Neimeyet in Fall 2016. Since its upload, it has received 8 views. For similar materials see Eating Disorders in Psychology at East Carolina University.


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Date Created: 10/01/16
Presentation 6 Lecture Personality Variable and Genetics The psychology of anorexia  Intense fear of gaining weight/becoming fat  Sense of worth/esteem is contingent upon weight  Strong desire to please others (people pleasers)  Difficulty expressing emotion, especially negative emotions  Fear of conflict (conflict avoidant)  Need for structure (organization; ritual)  Tendency to be more shy and withdrawn than average  Often depressed, low self-esteem Fear of Fat  Intense fear of gaining weight leads to food restrictions, often eliminating whole food groups  Many eating disorders begin with a "simple" diet (avoid highly fatty or caloric foods)  About 33% of anorexics have a history of having been slightly overweight and trying to diet prior to the onset of the disease  However, even after significant weight loss, fear of gaining weight does not diminish and may actually intensify as they become more focused on calories and weight  Anorexics often overestimate body size Self-worth and weight  Underlying the ED is the belief that thinness will lead to happiness, beauty, acceptance/approval, love, etc... o Emotional issue o "if only" statements  Losing weight often gives the anorexic a sense of accomplishment/achievement and thus makes weight loss reinforcing for them o Reinforces further weight loss o Enough is never enough  They may view weight loss as a sign of discipline and strength of mind and eating as weak-willed  Anorexics often have the desire to be "perfect" themselves through their bodies o View people overweight as disgusting, not only physically but personality wise too People Pleasers  Anorexics often have the strong desire to please others o Have hard time inserting own option or being able to say no  Study: 40% of 9-10 year old girls tried to lose weight, usually at the urging of their mothers o Starting point of anorexia  Study: 19% of athletes began E-D behavior as a result of casual comments about their appearance  Self-silencing: pleasing others at own expense  Anorexics fear conflict others at own expense  Anorexics fear conflict and seek to avoid stressful situations Structure  Many anorexics have rigid personalities o See things black-white, good-bad, right-wrong, etc  They often have a storng need to follow rules  May create strict rules for themselves such as they can only have 3 carrots and two fat free crackers for lunch each day o Feel guilty if they go over  Often have specific and repetitive rituals o Preoccupations with food, weight, exercise (structure and schedule) o Eating the same thing/same number of food items every day o Compulsive exercising, even when ill or hurt  Goal is not pleasure seeking  Usually right after eating (in this case, very small amount of food)  There is a high comorbidity of obsessive-compulsive disorder (OCD) (repetitivity that must be done) and Compulsive Personality Disorder with anorexia nervosa (transituational: happens across a wide variety of context) (rule bound, orderly, ridgid)  Anorexics often have a high achievement orientation/perfectionistic personality Social isolation  Anorexics tend to be more shy than the average person and are less likely to have many friends or be in a romantic relationship than are bulimics  One source: as many as 1/3 of anorexics have avoidant personality disorder  Anorexics may avoid new situations/socializing o Avoid being the object of attention  As the ED becomes more severe, anorexics withdraw more from friends, family, which reduces the chance of a loved one intervening o Fear holidays because of this because people around huge amounts of food  40-96% of anorexics also are clinically depressed Denial: not just a river in Egypt  Anorexics are much more likely to deny that they have a problem than bulimics  Anorexics are also much less likely to seek treatment or to recover than bulimics o Fewer than 1 out of 10 individuals with anorexia seek treatment and that 1 is usally because of family or loved ones  Anorexics may become very hostile, defensive, and suspicious as a result of the physiology of starvation (which causes cognitive changes and irritability) o This is why it is difficult to help a friend with an eating disorder, especially anorexia o They have enough insight to know you see it as a problem, even though they do not see it as a problem The psychology of bulimia  Fear of becoming fat/gaining weight  Self-worth is dependent upon weight  Use of food as comforter  Feelings of shame/guilt  Loss of control/impulsivity (different from anorexia)  Need for approval from others  Fear conflict and have difficulty expressing negative emotions Emotional eating  Bulimics often use food in response to an emotional trigger (anger, sadness, loneliness, feelings of failure, etc...)  Bulimics often did not learn how to express or cope with negative emotions in their families  Food is used to provide comfort/escape from unpleasant situations/emotions  Bulimics often lose ability to determine whether they are hungry or full, thus they tend to ignore bodily signals by keeping themselves busy o Lose connection between hunger signals when actually hungry, instead it is in regard to emotions Shame  Bulimics are much more likely than anorexics to recognize their eating disordered behavior as a problem and to feel ashamed of it  Bulimic feel intense shame/guilt after bingeing, which leads to purging behaviors  Bulimics are often consumed by self-loathing o Shame prevent people from making changes (anorexics) o Guilt makes changes o They constantly think self-deprecating thoughtss such as "You are such a loser, nobody cares about you, you are a fat pig with no self-control whatsoever" Control and Impulsivity  Unlike anorexics, bulimics feel a loss of control over their eating  Bulimics are more likely to engage in drug and/or alcohol use, shoplifting, and promiscuity than the normal population  Study: 33% of bulimics abused alcohol & 28% abused drugs, with 18% overdosing repeatedly  Kleptomania (urge to steal) and sexual promiscuity were reported in about 50% of the cases  There is a high comorbidity of bulimia with Borderline Personality Disorder (up to 40%) (instability in interpersonal relationships) Need for approval  Bulimics are often people pleasers and have a high need for approval from others o Have a hard time saying no  They are often vigilant for any signs of dissatisfaction, disapproval, and anger from others  Bulimics tend to have trouble setting limits with others  In situations of conflict, bulimics tend to accept the blame and try to act as a peace-keeper  Bulimics often have feelings of failure/guilt if they don’t live up to others' expectations  Bulimics also have a high incidence of depression (40-96%)  They are also more likely to seek treatment than anorexics  They are more likely to be socially active and in a sexual relationship Sexual abuse  Both bulimics and anorexics are much more likely to have been sexually abused than the normal population  Anorexia use to be the fear of oral impregnation  Makes the girls look more boy like  Some studies show that up to 35% of those with ED have been sexually abused  Study: 294 women with a serious ED – 74% recalled a traumatic event, and half showed symptoms of PTSD  A history of sexual victimization can lead to o Body loathing o Desire to make the body unattractive o Using the ED as a means to regain control Genetics  There is some evidence of a genetic component in ED  Studies on fraternal and identical twins and anorexia showed a 24-58% heritability rate o General population is 1%  Study of 504 women with an ED o Bulimia 3.7 times more likely if have a first degree relative with bulimia (parents, siblings)  Made Anorexia 8-11 times more likely  Could be depression (genetic)  Difficult to sort out genetic from environment because twins show both environment similarities and genetic similarities  Role a nature-nurture is not well understood  Is evidence of genetic component in both anorexia and bulimia Chapter 7: Psychological factors in the development of eating disorders: The contributions of personality, behavior, and cognition  Personality has been defined as a stable way in which individuals perceive, react to, and interact with their environments that is influenced by both biology and experience  Temperament has been defined as a biologically based predisposition to experience certain emotional and behavioral responses  Four dimensions of temperament o Novelty seeking  Tendency to pursue rewards o Harm avoidance  Tendency to avoid punishment by inhibiting behaviors o Reward dependence  Tendency to continue rewarded behavior o Persistence  Tendency to continue behavior that is no longer rewarded  Three personality dimensions o Positive emotionality  Tendency to enjoy and be actively engaged in work and social interactions o Negative emotionality  Tendency to experience negative mood states (dysphoria, anxiety, anger) o Constraint  Tendency to inhibit impulses and show caution, restraint, and concentionalism  AN has a higher level of perfectionism  Minnesota Multiphasic Personality Inventory (MMPI) scores were observed as a consequence of significant weight loss  Research examining the temperament and personality features of patients with AN support early clinical descriptions Behavior  Operant conditions may play an important role in the acquisition and maintenance of eating disordered behaviors o Learned associations between behaviors and their consequences influence the likelihood that those behaviors will recur  Positive reinforcement is a desirable consequence of behaivor that increases the likelihood that behavior will recur  Negative reinforcement increases the likelihood of a behavior  Punishment is a negative consequence that inhibits behaivor  Many of the symptoms of eating disorders may be understood by their immediate or perceived consequences Cognition  Cognition involves processes related to thinking and include attention, perception, learning, and memory Attention  Stroop test has been used to evaluate attentional processes in women with eating disorders o Work green may be printed in red ink Cognitive distortions  Cognitive distortions are thoughts that do not adequately reflect reality  Dichotomous thinking (black and white thinking) is a cognitive distortion expressed in many of the features common to eating disorders  In a short term approach, abstinence from forbidden foods may provide some success because it may be easier to avoid some foods altogether than to eat a small amount of those foods  The introduction of cognitive regulation of dietary intake (eating in response to rules about when to eat and what to eat rather than eating in response to hunger) introduces opportunities for loss of control over eating (disinhibition)  Disinhibition could occur in response to a cognitive trigger, an affective trigger, or a pharmacological trigger  An example of a cognitive disinhibition is attending a friend's birthday party and being offered a piece of cake that is not allowed on a weight loss diet  Affective disinhibition is a fight with a loved one leading to frustration and sadness  Pharmacological disinhibitor is becoming intoxicated and losing track of what or how much was eaten  Restraint hypothesis: keeping track of how much he or she has eaten usually by a weight loss program  Selective abstraction occurs when one part comes to represent the whole  Societal messages that contribute to disordered eating, such as the importance of being thin, may be particularly salient to individuals who develop eating disorders Conclusion  Review of psychological contributions to the development of eating disorders reveals a high degree of overlap across cognition, behavior, and persoanlity and this overlap may be explained by the role of personality in shaping how individuals perceive, react to, and interact with their environments o Thus an individual who is highly perfectionist, constrained, and demonstrates high persistence and reward dependence may show a cognitive style that is marked by rigidity, dichotomous thinking, and selective abstraction and may be particularly sensitive to rewards that would encourage the learning of certain associations  This person would be more vulnerable to social messages concerning the importance of being thin  He or she also may be more likely to persist in the pursuit of this ideal, even when the rewards diminish in intensity o Conversely, an individual who is impulsive and disinhibited may show cognitive disinhibition more easily  He or she might find it more difficult to resist the rewarding aspects of food and eating and higher reward and punishment sensitivity may contribute to a vicious cycle of binge eating and purging  These patterns provide a fairly coherent explanation for the symptomatic differences between ANR and both ANBP and BN Chapter 8: Biological bases, correlated, and consequences of eating disorders Appetite and weight regulation  The hypothalamus is a structure in the brain responsible for appetite and weight control  Surgically damaging the ventromedial hypothalamus produces increased food intake and significant obesity  In contrast, surgically damaging the lateral hypothalamus produces dramatic decreases in food intake and weight loss  Electrical stimulation of these brain regions produces the opposite effect, suggesting that the ventromedial hypothalamus is responsible for inhibiting appetite and food intake and that the lateral hypothalamus is responsible for increasing them o These areas appear to work together in healthy individuals to maintain a balance in weight and appetite and are thought to be important in understanding satiety function as it may relate to eating pathology  Hypothalamus regulated other body funcitons such as sexual activity and drinking  Hypothalamus is located near the pituitary gland at the base of the brain  The hypothalamus and pituitary gland are involved in two systems o The hypothalamic pituitary adrenal (HPA) axis o Hypothalamic pituitary gonadal (HPG) axis  Neurotransmitters and neuropeptides are related to appetite, weight, and mood  Neurotransmitters are chemicals that facilitate communication between brain cells (neurons) o Serotonin, norepinephrine, dopamine o Food intake is associated with the release of these three neurotransmitters in the hypothalamus o Activity of dopamine and norepinephrine in the lateral hypothalamus decreases food intake, whereas their activity in the medial hypothalamus increases food intake  Serotonin o 5-HT plays an important role in the regulation of mood, appetite, and impulse control o Diminished 5-HT function is associated with dysphoria, increased appetite, and decreased impulse control o Tryptophan, an amino acid required to make 5-HT, is found in food and can cross the BBB o More recent research has examined emotional and behaivoral responses to changes in blood tryptophan levels o Ability of 5-HT to facilitate communication between cells  In order for 5-HT to function, it must be released from one brain cell and bind to a receptor of another brain cell  These medications prevent the brain cell releasing 5-HT from reabsorbing it (reuptake) and give 5-HT more opportunity to bind to receoptors of another brain cell o Increased 5-HT function in the brain increases prolactin release in the blood o Fenfluramine, meta-chlorophenylpiperazine (m-CPP), and L-tryptophan (L-TRP are all 5-HT agonists (agents that increase 5-HT functions) o Lower prolactin release suggests that 5-HT is less responsive to agonists in patients with BN compared to controls  5-HT finding in BN model suggest periodic binge eating episodes cause sudden increase in 5-HT in the brain  This causes 5-HT receptors to become less sensitive (a process known as down regulation)  Although sustained low concentrations of 5-HT could lead to increased sensitivity of 5-HT receptors (up-regulation), down-regulation occurs more readily than up regulation in neurotransmitter systems  Prolactin responses to a 5-HT agonist in women in four diagnostic groups: AN, BN, BED, and healthy controls  Elbert found that levels of 5-HIAA are higher in patients with AN following weight recovery compared to controls o This has led to the hypothesis that AN may be marked by premorbidly high concentrations of 5-HT that contribute to overcontrol and undereating  Dopamine o Decreased dopamine funciton may be associated with binge eating because normal amounts of food may be less satisfying o Homovanillic acid (HVA) is the by product of dopamine use in the brain o Women who binged more frequently had lower HVA concentrations. However, HVA concentrations did not differ between women recovered from BN and healthy controls o Similar to findings in BN, decreased HVA concentrations have been found in women with AN o Findings for dopamine function in AN are mixed o Over function of dopamine in the lateral hypothalamus would make more sense for explaining the decreased food intake characteristic of AN. However, several studies have produced results that show similarity between patients with AN and patients with BN Norepinephrine  Norepinephrine can both increase and decrease food intake, depending upon where it the hypothalamus it is acting  Studies of norepinephrine and its by product (methoxy-hydroxy-phenylglycol, or MHPG) indicate reduced levels in the brain and body in patients with eating pathology compared to control, with lower levels found in both AN and BN  Majority of research on neurotransmitter function in eating disorders has focused on 5-HT function  Across studies, the most consistent evidence has pointed to decreased 5-HT function in women with BN. However, it remains unclear whether differences between women with BN and healthy controls reflect 5-HT's role in causing BN or the effect of BN on 5-HT function  Results of neurotransmitter function in AN are more mixed, likely reflecting the significant impact of starvation on neurotransmitter production in the brain Neuropeptides and eating disorders  Neuropeptides function similarly to neurotransmitters but are physically larger o Cholecystokinin, leptin, neuropeptide Y  Cholecystokinin o Cholecystokinin is a neuropeptide that is released in the small intestine following food ingestion o Does not cross the BBB. However, it binds to its receptors on the vagus nerve in the stomach which is a cranial nerve that sends signals directly to the brain, and stimulation of this nerve activates the ventromedial hypothalamus o Cholecystokinin causes contraction of the pyloric sphincter (a muscle that contorls the rate at which food passes from the stoamch to the small intestine)  Leptin o Leptin is a neuropeptide that provides a negative feedback loop in the brain's control of weight and food intake o Leptin receptors have been found in the paraventricular nucleus and ventromedial hypothalamus o Released from fat tissue in the body, thus, more lepin in the body, the more leptin is circulating in the blood o Leptin is produced by the ob gene o Diminished leptin in BN may contribute to binge eating episodes by increasing the physicological drive to eat. This effect may be mediated by leptin's influences on neuropeptide Y function and proopiomelanocortin (POMC) gene expression  Neuropeptide Y o Neuropeptide Y increased food intake and is inhibited by leptin o Elevated concentrations of neuropeptide Y in patients with AN and in anorectic patients with short term weight recovery compared to controls. However, no significant differences were found between long term weight recovered anorectic patients and healthy controls o No significant differences in neuropeptide Y concentrations were found between controls and women recovered from BN  Proopiomelanocortin o POMC is the precursor of melanocyte-stimulating hormone (MSH) o MSH and its receptor (melanocortin-4 receptor) appear to be necessary for a response to increased leptin concentrations o MSH agonists decrease food intake in humans Summary of brain function and eating disorders  The hypothalamus is responsible for the regulation of food intake and weight  The lateral hypothalamus increases eating and weight, and the paraventricular and ventromedial hypothalamus are associated with decreased eating and weight. However, these basic functions can be activated or inhibited, dependingupon what neurochemical is active in a given area  Inconsistent results have been found for neurochemical correlates of eating disorders  Given that many of the observed differences disappear after recovery, studies of neurophysiological function in patients with eating disorders may represent consequences of the illness more than causes. However, evidence of post recovery differences in leptin concentrations in BN, and of 5-HIAA concentration in AN, provide some hints to conditions that might predate and contribute to the onset of eating disorders Genetic contributions to eating disorders  In family studies, the individual affected with an eating disorder is referred to as a proband  First degree relative are more likely to suffer from eating disorder than second or third degree relatives  Families share genes as well as environments  Heritability estimates are a percentage representing how much genes contribute to the development of an eating disorder in a given group of people  Twins would not be representative of the general population (a violation of the representativeness assumption) and findings from twin studies would not accurately reflect how eating disorders develop in non twins  An assumption of twin models is that members of twin pairs reared together (whether MZ or DZ) share 100% of their home environment (equal environments assumption) Molecular genetic studies  A gene is a sequence of deoxyribonucleic acid (DNA) that is transcribed into a specific sequence of ribonucleic acid (RNA) that assists in building a chain of amino acids into proteins  Allele is one of several forms of the same gene  Resulting combination of alleles for a given gene is called a genotype  For some genes, there are only two possible forms of an allele  For other genes, there are numerous different forms an allele can take  When the alleles received from each parent are the same, the result is a homozygous genotype  When the alleles received from each parent differ, the result is a heterozygous genotype  The observable manifestation of a genotype is referred to as a phenotype  Association studies in which the frequency of alleles for specific genes (candidate genes) are compared between individuals affected with a disorder and those unaffected  Several candidate gene studies have examine allele frequencies for the gene that codes for building the H-5T2A receptor  In transmission disequilibrium tests (TDT) the frequency of allele transmission from heterozygous parents to affected offspring is compared to that expected if there is no association between the allele and the disorder  Both candidate gene studies and TDT studies rely on identifying a specific gene to examine  In contrast, a genome wide linkage study evaluates alleles at several genetic markers  Genetic markers are places in the genome where known genes reside, regardless of the specific function of the gene Genome wide linkage study  Because genome wide linkage studies examine alleles at multiple genetic markers across the genome, study results are interpreted according to locations on chromosomes that may hold genes that contribute to the etiology of eating disorders Conclusions about genetic contributions to the risk of eating disorders  Behavioral genetic studies have clearly supported a genetic diathesis to eating disorders, but molecular genetic studies have yet to clearly identify the specific genes that increase the risk  As with most psychiatric disorders, the genetic diathesis to eating disorders is likely to involve complex inheritance rather than Mendelian inheritance  Mendelian inheritance refers to the action of a single gene on the expression of a phenotype (such as eye color)  Complex inheritance refers to the combined action of many genes on the expression of a phenotype  eating disorders are associated with a higher prevalence than typical Mendelian diseases. This is because diseases that are associated with decreased ability to survive and have children (decreased reproductive fitness) tend to be quickly eliminated from the gene pool, as individuals with those genes die without reproducing  the risk of eating disorders to first degree relatives of eating disordered probands (risk ratio) is far below that expect in Mendelian diseases with a dominant gene or a recessive gene  Although reduced penetrance (the genotype does not lead to the phenotype), variabl eexpressivity (the genotype leads to the variable phenotypes), and phenocopies (the phenotype occurs in the absence of the genotype) diminish the risk the ratios for Mendelian diseases, these ratios remain well above those reported for eating disorders  In complex inheritance, each gene contributes a small amount to developing a disorder, and a large number of research participants is needed to show a reliable effect of a specific gene. Thus, some inconsistencies in research findings may be caused by inadequate sample sizes Physical consequences of eating disorders Neuroanatomical changes  Patients with AN have increased ventricle size compared to healthy controls  Ventricles contain cerebrospinal fluid, and relative increases in ventricle size reflect relative decreases in brain mass. Thus, in addition to triggering the breakdown of fat, muscle, and bone, starvation triggers the breakdown of brain matter. Some of the lost brain matter is regaiend with recovery; however, evidence of diminished gray matter persists after recovery from AN Bone mineral density  Decreased bone mineral density and increased rates of osteoporosis in patients with AN compared to controls  Bone mineral loss has been attributed to a combination of starvation and hormonal changes that result from starvation – notably decreased concentrations of sex hormones such as estrogen and progesterone and increased concentrations of cortisol Consequences of purging  Purging through self induced vomiting and severe laxative and diuretic abuse has been associated with electrolyte imbalances in the bloodstream  The loss of stomach acid in vomit decreases the presence of positively charged ions such as potassium  Patients with eating disorders can have decreased blood concentrations of magnesium and calcium  Electrolyte imbalances can contribute to fluid retention (edema) when patients attempt to reduce disordered eating patterns  Eating disorders can lead to death Conclusion  The contribution of biology to the etiology of eating disorders is indisputable  Studies of 5-HT function in individuals with eating disorders indicate several abnormalities; however, many of these normalize upon recovery  Finding of decreased 5-HT function following recovery in women with BN and increased 5-HT function following recovery in patients with AN  Clear evidence supports the role of genes in increasing the risk of developing an eating disorder  Mirroring results from physiological studies, preliminary results suggest that genes are involved in 5-HT function may increase the risk of eating disorders  Many of the studies of biological function in patients with eating disorders likely represent correlates or consequences of the disorder  To the extent that biological indices are directly correlated with the severity of symptoms in terms of low weight or binge frequency, studies may be indexing state rather than trait qualities the influence of eating disorders on biological function has long been appreciated  it is difficult to dramatically alter food intake without causing significant alterations in the biological function of an organism  Understanding the biological consequences of eating disorders is an important area of inquiry, as it may improve our undersandinf of the treatment and long term outcome associated with these disorders


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