Eating Disorders Presentation 1 and 2 Notes
Eating Disorders Presentation 1 and 2 Notes PSYC 2250
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This 8 page Class Notes was uploaded by AmberNicole on Saturday September 3, 2016. The Class Notes belongs to PSYC 2250 at East Carolina University taught by Dr. Greg Neimeyet in Fall 2016. Since its upload, it has received 7 views. For similar materials see Eating Disorders in Psychology at East Carolina University.
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Date Created: 09/03/16
Introduction to Eating Disorders Categories include anorexia, anorexia nervosa, bulimia, bulimia nervosa, or not otherwise specified disorder (EDNOS) General Facts About 10% of Americans are thought to have eating disorders (90-95% of these are women) o Eating disorders in men is growing o Conservative element because it is self report and many people don’t want to report this or in a disease like anorexia, many people do not even realize it or see themselves as medically compromised or having an eating disorders, therefore, they do not report it. 85% of American women are dissatisfied with their weight or body o Difference be the nonclinical forms of disorder and body dissatisfaction and clinical forms (bulimia, anorexia, and not otherwise specified) is known as the eating disorder spectrum rd th Over 70% of girls have dieted by the age of 10 (3 -4 grade) Americans spend over 30 billion dollars a year on weight-loss products o Tendency to object individuals to their size of bodies and how they look Anorexia Nervosa Recognized in the first edition of DSM Weight and body size are more or less normally distributed and can be caused by something such as genetics Medical conditions can cause an individual to look Anorexic Anorexia means loss of appetite Nervosa suggests that the loss of appetite is due to nervous conditions Misnomer on both accounts because they are famished and continuously hungry not a loss of appetite so hunger is like a success. Secondly, it is not a nervous condition like an anxiety disorder. It has to do with the concept of a nervous breakdown in the psychological area. Anorexia Nervosa: DSM IV Criteria 1) Refusal to maintain a normal body weight (weight loss leading to weight of 15% or more below expected norm for age and weight or failing to reach expected weight if prepubescent) o Example: A young woman who is 5"4' is expected to weigh about 120 pounds, instead, she weighs only 102. 2) Intense fear of gaining weight o Terrified of even half a pound or even ounces o Will wear bulky clothes to avoid attention 3) Distorted perception of body size, shape (I.e., thinking that you are overweight even if extremely thin) and self-esteem being greatly influenced by weight/body shape o There is a distortion of perception (they think they are fat when they are extremely thin) o Self-worth is tied to weight loss and it is never enough o The more you lose, the more you want to lose and there is always a haunting of potential gains 4) For post-pubertal women, the absence or cessation of regular periods (missing 3 consecutive menstrual cycles or failing to ever have a menstrual cycle if prepubescent) o Feel guilty when they have a period because they are not starving themselves enough Two Subtypes of Anorexia Restricting Type o During the current episode of anorexia, the person does not engage in binge-eating or purging behaviors, but relies on fasting, consuming very little food, and/or excessive exercise o Most common type of anorexia Binge-eating/Purging Type o The person regularly engages in binge-eating or purging behaviors o Much less common but does occur o Meets all criteria of anorexia but also regularly engage in binge-eating or purging o Both quality and quantity of binge is different in bulimia and anorexia Definitions Binge-eating o Eating more than a normal person would within a discrete period of time (I.e., two hours) o Could be 10,000-20,000 calories Purging behaviors o Engaging in vomiting (either self-induced or by drinking a toxic substance such as Ipecac to induce vomiting), laxative use, and/or diuretic (water pill) use, in order to compensate for calories consumed during a binge o Purging usually occurs after binge eating Bulimia Nervosa: DSM IV Criteria 1) Recurrent episodes of binge eating 2) A feeling of lack of control over eating during binges 3) The regular use of purging behaviors to prevent weight gain (at least twice a week for 3 months or longer) 4) Self-evaluation is unduly influenced by body shape and weight 5) The binge eating and purging does not occur exclusively during episodes of Anorexia Nervosa, binge/purge type o Important because it occurs in the rule out criteria because you can only diagnose with one and anorexia trumps bulimia The Binge The average bulimic binges about 14 times a week (twice a day) o Highest number recorded in a day is 40 times a day. During a binge, a bulimic can consume between 1,000 and 20,000 calories in one sitting Binges are often triggered by emotional issues or chronic dieting (not by hunger issues) Binge-eating: A Vicious Cycle Many bulimics can no longer distinguish feelings of hunger and fullness (satiety) and often mistake emotions such as anger, fear, loneliness, sadness, etc... for hunger. The bulimic may experience a negative event such as getting a bad grade, this leads to emotional upset which triggers eating. After the binge, the bulimic feels ashamed which leads to the purging behavior. Purging may temporarily relieve the shame, but often leads to guilty feelings itself, or, another binge is triggered by some other emotional event Emotional Event --> Negative emotion --> Binge-Eating --> shame/Guilt --> <-- Purging (inversely related with shame/guilt Bulimic Irony No matter what the bulimic does to try to "get rid of" calories consumed during a binge, many calories are still digested: o At least 1,100-1,200 calories are retained from purging by vomiting o Laxatives only decrease calories consumed by 12% That is why bulimics are usually normal-weight to slightly overweight. o Purging is an ineffective and very dangerous means of weight loss Two Subtypes of Bulimia Purging Type (Active) o Use of vomiting, laxatives, diuretics, or diet pills to compensate for the calories from a binge o Compensates for calories consumed within binge Non-purging type (Passive) o Use of excessive exercise or fasting to compensate for the calories from a binge Bulimia is much more common than anorexia because anorexia is only about 1% of the overall population and bulimia is 10x greater Bulimia is usually later developed than anorexia o Bulimia is usually in the early 20s o Anorexia can start even before adolescence Bulimia is not visible Eating Disorder NOS NOS is an abbreviation for "Not Otherwise Specified" Disorders of eating that do not meet all of the criteria for either anorexia or bulimia – the "catch-all" or "leftover" category for problematic eating patterns Examples o A female meets all criteria for Anorexia but has regular periods o Binge-eating without engaging in any purging or compensatory behaviors to get rid of calories o Compulsive eating: Always needing to eating NOS is a larger category with more people qualifying than anorexia and bulimia combined o 2/3 of eating disorders are placed into this Transdiagnostic considerations (dimensional view of eating disorders): people come in and out of these dementias Binge Eating, Compulsive Eating, Chronic Dieting, and Obesity Not yet an "official" disorder in the Diagnostic and Statistical Manual of Mental Disorders, version IV (DSM IV-TR) Currently would be categorized as Eating Disorder NOS EDNOS: Eating disorder not otherwise specified Binge Eating Disorder Recurrent episodes of binge eating (at least 2 days out of the week for six or more months) Feelings of impaired control over eating Significant distress over binge-eating Absence of regular compensatory behavior (vomiting, exercising, etc...) Symptoms do not occur exclusively during episodes of Anorexia or Bulimia More recurrent than anorexia or bulimia Isn't officially recognized yet in the DSM but is under study Distressed over binge but cannot control it Anorexia and bulimia trump a binge eating disorder because you cant qualify for anorexia or bulimia and have an eating disorder Impaired Control Indicators o Eating very rapidly o Eating until feeling uncomfortably full o Eating large amounts of food when not hungry o Eating alone out of embarrassment of being seen eating large quantities in public o Feeling disgust, guilt, or depression after overeating Associated Features of BED Eating is often emotionally triggered (not out of hunger) Feeling a dissociative quality during binges (feeling like you aren't really there or are watching yourself eat without feeling like you are doing it: automatic pilot) Often, have a history of dieting and obesity On average, more likely to be obese than the normal population May have significant weight fluctuation Experience impairment in social and/or work activities due to ED (eating disorder) o Example: not going to a party in fear of overeating there Higher rates of self-loathing, depression, anxiety, bodily concern, and interpersonal sensitivity than the normal population Prevalence of BED 0.7-4% in non-patient community samples 15-50% of those in weight control programs Women have 1.5 times higher prevalence than men The onset of the disorder is usually in late adolescence or the early 20's Often, the disorder begins after experiencing significant weight loss from dieting o This is because restrictive eating increases the body's hunger signals and increases the likelihood of binge-eating Medical Problems Associated with BED Higher serum cholesterol levels High blood pressure Stroke Diabetes (induced by intaking too much glucose/sugar) Heart disease Depression (between 15-50% of those in weight loss programs were depressed) o We don't know cause and effect here: Does depression cause BED or does BED cause depression Over release in insulin to compensate for all the sugar so the person is stressing out the metabolism as well as the rest of the body Compulsive Overeating (different than binge eating) Not yet officially recognized Continuous "grazing" More positive relationship to food Gourmet vs. Gourmand o Gourmet is someone who has a fine taste and can appreciate various foods and flavors o Someone who loves to eat anything: does not matter how good it is: gormand Obesity A National Health and Nutrition Examination Survey found that 50.7% of American women and 59.4% of American men are overweight or seriously overweight Body Mass Index Definitions o Overweight Women: 27.3-32.3 Men: 27.8-31.1 o Obese Women: >32.3 Men: >31.1 Men tend to gain weight in their early 20's, whereas women gain weight after menopause Standards of what "overweight" means have changed over time o Originally, overweight was arbitrarily set as 20% above the norm BMI doesn’t take into account a lot of factors Chronic Dieting and Obesity Set-Point Theory o Each person's body has a "set-point" or a genetically programmed desired weight range When a person binges or restricts food intake, the body either slows or increases metabolic rate to compensate Think of a thermostat: when the temperaature falls below the temperature you set, the heat comes on to warm things up. When the temperature gets too hot, the AC comes on. Chronic Dieting When the body is deprived of food, it increases feelings of hunger and changes metabolism to weigh more on less food until its original set-point is regained However, now the body stores more fat to protect itself against future restrictive eating That is why those who diet to lose weight quickly usually regain the weight they lost or even more weight Of those losing 25+ pounds, 90% regain within 2 years and 98% regain the weight within 5 years (set-point theory) 80-90% of those on diets are women even though men more likely to be overweight! A 1969 American Cancer Society longitudinal study followed 800,000 men and women over 6 years and found that only weight loss dramatically increased the risk of premature death by heart disease or stroke Starvation/malnutrition from dieting may really be the cause of the heart disease, atherosclerosis, hypertension, and diabetes that we usually associate with obesity Yo-yo dieting is really bad for the body because of the weight fluctuations Obesity: Power and Stereotypes Non-obese Americans tend to have a higher SES, are more educated, and have greater access to dietary and health information Weight stereotypes: We tend to believe that the overweight are "weak-willed" "eat too much" and are "lazy" Truth: In 12/13 studies, obese people ate the same or less than non-obese people and made similar food choices Truth: studies show that genetics highly influence weight (25-70% of weight in adults) Obesity Quiz T or F Weight is a reliable predictor of health o False; most predictive is yoyo dieting There are significant differences between the eating habits of normal and obese people o False When it comes to weight, genetics may be more important than environment or learned behavior o True The health problems associated with obesity may actually be a result of dieting o True Fat on the body is always a predictor of dangerous fat in the body like clogged arteries o False