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Presentation 7; ED ch 6; May/June Review

by: AmberNicole

Presentation 7; ED ch 6; May/June Review PSYC 2250

Marketplace > East Carolina University > Psychology > PSYC 2250 > Presentation 7 ED ch 6 May June Review

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These notes cover everything for the quizzes.
Eating Disorders
Dr. Greg Neimeyet
Study Guide
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This 7 page Study Guide was uploaded by AmberNicole on Friday October 7, 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 6 views. For similar materials see Eating Disorders in Psychology at East Carolina University.


Reviews for Presentation 7; ED ch 6; May/June Review


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Date Created: 10/07/16
Presentation 7: Family and Cultural Characteristics on Eating Disorders  Family functioning is related to eating Family influence on the risk of developing an ED  Preoccupation with food, cooking, weight, exercise, and dieting within the family  Parental control over children's eating (what they can eat, how much, and negative/positive comments about child's eating)  Affection expressed through giving food (ex: rewarding good grades or behavior with ice cream)  Parental role modeling (how invested the parents are in their own appearance, history of dieting, comments parents make about their own weight and body, parents' eating behavior) Family influence on the risk of developing an ED  Attractiveness of siblings: the less attractive sibling is at higher risk for an eating disorder o More attractive sibling gets more attention from others including parents so self worth suffers o Tries to control weight to look better  Getting teased about appearance by family or peers  Father hunger: when the father is distant or non-invested in the child's life, the child may try harder to try to win his approval/please him Father hunger  Often, fathers distance themselves from their daughters when the girls reach puberty  They are unsure how to relate to the daughter's new sexual maturity or how to not show affection and love  Instead of working to find new ways of relating to their daughters, many dads give up and distance themselves  Girls may interpret this as disapproval o Make girls self conscious  The father may also be experiencing mid life identity issues at the same time and increasing dissatisfaction with their own appearance  The father may also begin to experience health concerns at his age, particularly related to cardiac health  In response, the father may become more vigilant and rigid about his own eating and exercise habits  When daughters are simultaneously dealing with the insecurities and uncertainty about their changing appearance and weight during puberty, the father's behavior around food may cause eating issues for the daughter Familial factors influencing the risk of anorexia  Double messages: when a parent is at times affectionate and at other times neglecting of the child's needs and feelings o Makes kid feel guilty for going out with friends instead of staying home with them  This may cause the child to be ambivalent about expressing feelings  Rigid adherence to rules and structure o No reason for them  Avoidance of open conflict and lack of conflict resolution within the family o Family does not do well with conflict Familial factors influencing the risk of anorexia  Conservative values  A family history of anorexia and/or mood disorders  An excessively close relationship with parents (enmeshment) o Girls want approval from mother  Restricted expression of feelings, especially negative feelings  Failure to acknowledge the client as an individual in her/his own right or respect his/her opinions and needs o "You must be this way" Familial factors influencing the risk of anorexia  An over emphasis by the family on the child's achievement (school, athletics, music, chess, etc...) and appearance o Expresses your worth  An atmosphere of tension, fighting, or other problems within the family (ex: alcoholism)  Sexual abuse by a family member Familial factors influencing the risk of bulimia  Hostile enmeshment: an excessively close relationship that is marked by conflict. This makes it more difficult for the child to develop as an assertive individual who is separate from her parents  Negative mealtime experiences (stress, conflict, verbal abuse, over- controlling parent)  Use of food as a punishment or reward o Good you get food o If you are bad you lose food  Disturbed parental eating patterns  An emphasis on dieting and weight within the family  A history of obesity in one or both parents  One parent who is caring, even over involved and another parent who is distant/uninvolved  A chaotic family environment (frequent moves, fighting, lack of structure, etc...) o Substance abuse o It is destructive because it is laced with an emotional un-regulation o Emotionality and dysregulation  Parents with alcoholism or drug abuse The role of trauma  Studies show that between 20 and 50% of those with an ED have been sexually abused o Reclaiming control of body o Fear of oral impregnation  One study of 294 women showed that 74% recalled a traumatic event from childhood/adolescence and 50% showed some symptoms of PTSD  Individuals with ED are more likely to be the victim of emotional, psychological and sexual abuse, experience physical and emotional neglect, have a parent with a major mental illness or alcoholism, witness spousal abuse, and be separated from their caregiver  Those with ED who have experienced trauma are more likely to have comorbid conditions such as depression, dissociation, anxiety, PTSD, alcohol and substance abuse, and personality disorders  They are also more likely to be distrustful and have difficulty forming interpersonal relationships  Trauma victims often have distorted views of themselves like they are damaged, evil, or somehow flawed compared to others  They also often have difficulty regulating their emotions and feel out of control  Dieting may represent a cleansing or purifying, an attempt to repel future perpetrators of violence, and the illusion of power Bodily changes during puberty  Early development: some research shows a link between early physical maturation in girls (but not boys) and the risk of ED  Why?: Bodily change is related to societal standards: when girls mature, they gain more fat and thus become father away from the ideal of beauty for women; men gain more muscle and become closer to their ideal o Higher substance abuse in early developing girls  Fear of fat: some girls fear puberty because of the possibility of gaining fat and broadening in the hips  Symbolism of maturity: some girls fear bodily maturity because it symbolizes sexual maturity (especially if they have been abused) and also taking on more adult responsibilities  Obesity and "phantom fat": men and women who were overweight during childhood/adolescence psychologically still feel fat even if they lost the weight o Its not real but it feels real ED Chapter 6: Family Factors in the development of eating pathology  Eating disorders often begin during adolescence when families provide a primary social context  A focus of the family environment also reflected the dominant theoretical models for mental disorders when AN emerged – namely, psychoanalytic and, later, psychodynamic model  Building on the emergence on AN symptoms near the onset of puberty and a view of neurotic illness as stemming from unconscious sexual conflicts, psychoanalytic theory interpreted AN as a fear of sexual maturity o This arose in families in which the father was kind but passive and the mother was aggressive and castrating (a psychoanalytic term meaning disempowering)  Because mothers provided unfit models of femininity, girls in these families feared becoming women like their mothers o this fear became symbolized as a fear of oral impregnation  Identification with kind, passive father and hostility toward aggressive, castrating mother leads to sexual role conflict which breaks off into either anorexia nervosa (rejection of femininity or fear of oral impregnation) or bulimia (over identification with femininity or desire for pregnancy)  Women with eating disorders are actually more likely to accept the traditional female role when they are actively ill than are women without eating disorders which are consistent with Boskind-Lodahl's feminist psychoanalytic interpretation of AN  If thethest way to a man's heart was through his stomach in the first half of the 20 century, then the best way to a man's heart was through control of her stomach in the second half of the century  alexithymia is the inability to read emotional stages  Nonorganic failure to thrive is a condition in which children do not gain adequate weight, and no medical reason can be found for low weight  Three types of antecedents were identified and coded by blind raters o The infant indicated a desire to feed itself, while the mother indicated a desire to feed the infant o The mother expressed concern over the manner of the infant's eating (usually about the mess) o The infant refused offered food  Three potential responses that might prevent conflict were also coded o The mother acknowledges the infant's cues o The mother puts aside her own desires o The infant disengages o  Finally, three types of episodes were coded o Antecedents end in conflict in the index group o Antecedents do not end in conflict in the index group o Antecedents do not end in conflcit in the control group  No control infant disengaged in response to an antecedent  Developed a family systems model to explain eating disorders as a manifestation of disturbed family relationships  Boundaries between subsystems can range from enmeshed (too weak) to disengaged (too strong)  Somaticized – expressed as physical conditions  Intrapsychic conflict Eating Disorders Review May/June 2014 Breaking down barriers to coverage for eating disorders treatment  Only about a third of those with anorexia nervosa (AN) and only 6% with bulimia nervosa (BN) receive mental health care  Insurance companies use a number of tactics to avoid or minimize the costs of covering eating disorders treatment  Under the FREED Act, coverage would be available not only to patients who meet the strict criteria for AN and BN but also to those with other eating disorders. Thus, patients with binge eating disorder (BED) would also be eligible for coverage  The individual states can require private insurers to cover eating disorders on the same basis as other health conditions  Beginning this year, mental illness and substance abuse services must be included in the essential benefits packages sold to individuals and small businesses  Early partial symptomatic response can be a very useful predictor of long term treatment outcome  Studies have shown this pattern with cognitive behavioral therapy for bulimia nervosa  While inpatient treatment for anorexia nervosa (AN) often successfully restores body weight, too many patients have relapses after discharge from the treatment unit  The enhanced CBT approach is designed to address some of the key mechanisms that help maintain eating disorders, such as restricting intake and promoting underweight, life events and mood, and overvaluing shape and weight  The new approach was used in 27 adolescent patients 13 to 17 years of age who had severe AN  The authors believe that three particular strategies may help reduce relapse risk o The inpatient unit is open so patients are exposed to stimuli that may provoke the return of eating disorder psychopathology o Possible triggers for relapse are identified and addressed in the individual CBT-E sessions o The parents and significant others work to develop a more positive and stress free home environment o The changes in BMI and eating disorders cognitions made while the teens were inpatients were well maintained at 6 month and 1 year follow ups o The authors speculate that the good outcome could be traced to several factors  CBT-E may have addressed key mechanisms that maintain eating disorder psychopathology, including inclusion of parents and the open nature of the unit  Results from some studies indicate that bod image concerns are equally important among adolescent boys and girls and around 2/3 of adolescent boys are dissatisfied with their bodies  For young adult males, body image concerns can be equally divided between losing weight and a desire to gain muscle mass  Cross cultural differences among young adult males may affect the incidence of body image disorders  Young men with higher body dissatisfaction scores were more open to the use of doping in sports  Cognitive remediation therapy (CRT) is a behavioral treatment that uses drill and practice,and compensatory and adaptive strategies to improve targeted cognitive areas like memory, attention, and problem solving  Oxytocin is a hormone produced by the hypothalamus that is stored by and releasd from the pituitary gland  Oxytocin is released naturally during social recognition, bonding, sex, childbirth, and breastfeeding, and in its synthetic form has been tested as a treatment for numerous psychiatric disorders  Because it is digested in the gastrointestinal tract when taken orally, oxytocin is usually administered as a nasal spray  After receiving a dose of oxytocin, patients with AN were less likely to focus on the expressions of disgust and were less likely to avoid angry faces; instead, they became more vigilant to the angry faces  In a separate survey, the authors also examined the methylation status of the oxytocin receptor gene (OXTR) in patients with AN  Methylation is a common epigenetic mechanism that diminishes gene expression  Researchers found that individuals with aN had methylation at 5 of 6 sites within the OXTR gene  Normal healthy women had low or intermediate levels of methylation  Authors suggest that epigenetic mechanisms in the OXTR gene may play a role in the pathophysiology of AN  Male children of women with BN were taller than control group children, while male children of women with a history of AN and BN and female children of women with AN were shorter  While some prior studies have suggested that children of women with BN may be at risk of becoming overweight or obese, in this study higher weight was observed for male children in all maternal ED diagnosis. Conversely, female children of women with AN grew more slowly in early childhood  Early adolescence is a time of major changes and transitions  Girls were more than twice as likely as boys to restrict their food intake  More boys than girls were using more intensive exercise to lose weight  Purging and binge eating were rare in both girls and boys  At age 15, binge eating or overeating were associated with impairment at school and home for the girls. Among boys, binge eating or overeating was similarly associated with impairment but also with burden on their parents.  Binge eating/overeating was associated with emotional and behaivoral disorders across genders  These results emphasize the importance of disordered eating behaviors in early adolescence for later disordered eating, overweight, and obesity  The interface between food intake, weight, eating behavior, and addiction has been a topic of increasing interest in recent years  Anorexia nervosa (AN) is still the most deadly psychiatric disease, with mortality rates reaching 20% in some studies  Adult women with AN that is not too severe can be successfully treated on an outpatient basis, according to early results from a large scale German trial  Focal psychodynamic therapy addressed the associations of interpersonal relationships, and the working relationship of the therapist and patient (therapeutic alliance)


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