Eating Disorders
Leccese, MA
WLA
Eating disorders have dramatically
increased as thinness has become
a national obsession.
• Anorexia nervosa
• Bulimia nervosa
Eating
• Binge-eating disorder
Disorders
What do you think contributes to
these increases?
Individual purposely takes in too little nourishment,
resulting in body weight that is very low and below
that of other people of similar age and gender.
Individual is very fearful of gaining weight, or
repeatedly seeks to prevent weight gain despite low
Anorexia body weight.
Nervosa
(part 1) Individual has a distorted body perception, places
inappropriate emphasis on weight or shape in
judgments of herself or himself, or fails to appreciate
the serious implications of her or his low weight.
Anorexia Nervosa (part 2)
´ Two main subtypes
´ Restricting type
´ Lose weight by cutting out sweets and fattening snacks, eventually eliminating nearly all
food
´ Show almost no variability in diet
´ Binge-eating/purging type
´ Lose weight by forcing themselves to vomit after meals or by abusing laxatives or
diuretics
´ May engage in eating binges
´ Incidence and onset
Anorexia ´ 75 percent of reported cases of anorexia nervosa
occur in females
Nervosa ´ Approximately 0.6 percent of all people in Western
(part 3) countries
´ Peak onset age between 14 and 20 years
Anorexia Nervosa (part 4)
´ Progression
´ A normal to slightly
overweight female has
been on a diet.
´ Escalation toward anorexia
nervosa may follow a
stressful event.
´ Most patients recover, but
as many as 6 percent do
not.
Anorexia ´ Clinical picture
´ Key goal is becoming thin.
Nervosa ´ Driving motivation is fear.
(part 5) ´ Preoccupation with food occurs.
´ Thinking is distorted.
´ Usually have a low opinion of their body shape
´ Tend to overestimate their actual proportions
´ Hold maladaptive attitudes and misperceptions
´ Clinical picture
´ Potential psychological problems
´ Depression, anxiety, low self-esteem, sleep disturbances
´ Substance abuse
Anorexia ´ Obsessive-compulsive patterns and perfectionism
Nervosa ´ Medical problems
´ Amenorrhea
(part 6) ´ Lowered body temperature, low blood pressure, body
swelling, reduced bone mineral density, slow heart rate
´ Metabolic and electrolyte imbalances
´ Skin, nail, and hair problems
Bulimia Nervosa (part 1)
Repeated performance
of ill-advised
Repeated binge eating
compensatory behaviors
episodes
(e.g., forced vomiting) to
prevent weight gain
Symptoms take place at
Inappropriate influence
least weekly for a period
of weight and shape on
of 3 months
appraisal of oneself
´ Incidence
´ 1 percent develop bulimia nervosa in their lifetime
Bulimia
´ 75 percent females in reported cases
´ 5 percent of adolescent girls develop full syndrome
Nervosa ´ High rate among college students
(part 2)
Bulimia Nervosa (part 3)
´ Progression
´ Normal to slightly overweight female has been on intense diet
´ Begins in adolescence or young adulthood, lasts for years with periodic letups
´ Weight fluctuates but often stays within normal range
Bulimia Nervosa (part 4)
´ Binges
´ Episodes of uncontrollable eating during which a
person ingests a very large quantity of food
´ May involve 1 to 30 episodes per week and 2,000 to
3,400 calories per episode
Bulimia
Nervosa (part ´ Often carried out in secret, usually with sweet, high-
calorie, soft-texture foods
5) ´ Usually preceded by great tension, which is relieved by
eating
´ Followed by extreme self-blame, shame, guilt,
depression, and weight gain fear
Bulimia Nervosa (part 6)
´ Compensatory behaviors
´ Disorder is also characterized by inappropriate compensatory behaviors
´ Vomiting; purging
´ Laxative or diuretics use
´ Compensatory behaviors effectiveness
´ Some temporary positive effects
´ Caloric bingeing effects not undone
Bulimia Nervosa (part 7)
´ Similarities ´ Differences: Bulimia
´ Distorted body perception ´ More concern about pleasing
others
´ Fear of becoming obese
´ Tend to be more sexually
´ Preoccupation with food, experienced
weight, and appearance
´ Mood swings, frustration and
´ Disturbed eating attitudes boredom, and impulsivity more
´ Feelings of anxiety, depression, likely
obsessiveness, and ´ Different medical
perfectionism complications
´ Heightened risk of suicide ´ Dental problems more likely
attempts and fatalities
´ Amenorrhea less likely
Body dissatisfaction is the single most powerful contributor to
dieting and to the development of eating disorders.
People who evaluate their weight and shape negatively are
experiencing body dissatisfaction.
Body
Approximately 83 percent of all girls and women are
Dissatisfaction dissatisfied with their bodies, compared with 74 percent of all
boys and men.
The vast majority of dissatisfied females believe they are
overweight; half of dissatisfied males consider themselves
overweight and half consider themselves underweight.
Recurrent binge eating episodes that include at least three of
these features:
•Unusually fast eating
•Absence of hunger
•Uncomfortable fullness
•Secret eating due to sense of shame
•Subsequent feelings of self-disgust, depression, or severe guilt
Binge Significant distress
Eating Binge-eating episodes take place at least weekly over the
Disorder course of 3 months
(part 1)
Absence of excessive compensatory behaviors
Repeated eating binges during which
people feel no control over their eating
and do not engage in inappropriate
compensatory behavior
• Around 2.8 percent of the population
• At least 64 percent are female
• Later age of onset
Binge • As a result of their frequent binges, half become
overweight or even obese
Eating
Disorder
Many shared features with bulimia nervosa
(part 2) or anorexia nervosa, but not the same drive
to thinness
Successful
Percentage
Percentage Long-Term
One-Year Typical Age Who
Who Are Recovery
Prevalence at Onset Receive
Female After
Treatment
Treatment
Anorexia 0.6-4.0% 75-90% 14-20 years 34% 75%
nervosa
Bulimia 0.5-5.0% 75-90% 15-20 years 43% 75%
nervosa
Binge-eating 2.0-7.0% 64-70% 22-30 years 44% 60%
disorder
Binge Eating Disorder (part 3)
What Causes Eating Disorders? (part 1)
´ Most theorists and researchers use a multidimensional risk
perspective.
´ Several key factors place individuals at risk.
´ More factors = greater likelihood of developing a disorder
´ Leading factors
´ Psychodynamic
´ Cognitive-behavioral
´ Biological
´ Societal pressures
´ Family environment
´ Multicultural
What Causes Eating Disorders? (part 2)
´ Psychodynamic factors: Ego deficiencies
´ Bruch: Psychodynamic theory of eating disorders
´ Disturbed mother–child interactions lead to serious child ego deficiencies and severe
perceptual disturbances.
´ Children of ineffective parents become confused adults who are unaware of their internal
needs.
´ People with eating disorders inaccurately perceive internal cues (alexithymia) and are more
likely to worry about how they are viewed by others.
The dark sites of the Internet
promote behaviors that the clinical
community, and most of society,
consider abnormal and destructive.
• More than 600 pro-anorexia Internet sites,
with names such as “Dying to Be Thin” and
MindTech: “Starving for Perfection”
Dark Sites
of the Besides promoting eating disorders,
in which other ways might pro-Ana
Internet sites be potentially harmful to
regular visitors?
´ Cognitive-behavioral factors
´ Bruch: Several cognitive factors, such as improper labeling
of internal sensations and needs, contribute to eating
disorders
What ´ Little control over life may result in excess control of body size
Causes ´ This contributes to a broad cognitive distortion that lies at the
center of disordered eating—for example, negative self-
Eating judgment based on body shape and weight
Disorders?
(part 3)
´ Depression
What ´ Helps set the stage for eating disorders
Causes ´ Many more people with eating disorder are diagnosed
with major depressive disorder than in the normal
population.
Eating ´ Close relatives with eating disorder have higher rates of
depressive disorders.
Disorders? ´ Similar brain circuit abnormalities are involved in those
with eating disorders and depression.
(part 4) ´ Antidepressant drugs sometimes help persons with
eating disorders.
´ Biological factors
What ´ Certain genes may cause susceptibility to eating
disorders.
Causes ´ Relatives of people with eating disorders are six times
more likely to develop eating disorders themselves.
Eating ´ Brain circuit dysfunction is linked to interconnectivity
problems.
Disorders? ´ Larger and more active insula, orbitofrontal cortex, and
striatum; smaller prefrontal cortex
(part 5) ´ Abnormal activity levels of serotonin, dopamine, and
glutamate
´ Biological factors
´ Other biological theorists focus on the hypothalamus.
What ´ Lateral hypothalamus (LH): Produces hunger
Causes ´ Ventromedial hypothalamus (VMH): Reduces hunger
´ Hypothalamus and related brain structures activate
Eating chemicals from brain and body: GLP-1
´ Weight set point
Disorders? ´ Hypothalamus, related brain structures, and chemicals
such as GLP-1 work together
(part 6) ´ Responsible for keeping an individual at a particular
weight level and triggering bodily changes that make
weight loss more difficult
What Causes Eating Disorders? (part 7)
´ Societal pressures
´ Western standards for female attractiveness
´ Socially accepted prejudice against overweight people
´ Higher risks for eating disorders within certain subcultures (e.g., models, actors, dancers, and
certain athletes)
´ Economic and racial differences in eating disorders prevalence rates
´ Social networking, Internet activity, and television browsing
´ Fashion and music websites; gossip- and leisure-related TV
What Does Teenage Eating Look Like?
´ Family environment
´ Families may impact and maintain eating disorders.
What ´ History of emphasis on thinness, appearances, or dieting
Causes ´ Dieting and perfectionistic mothers
´ Enmeshed family patterns (overinvolvement;
Eating overconcern) (Minuchin)
Disorders?
(part 8)
´ Multicultural factors: racial and ethnic differences
´ Prior to this century
What ´ Eating behaviors, values, and goals of women in
Causes minority groups in the United States were
considerably healthier than those of non-Hispanic
white American women.
Eating ´ Lower weight and body shape dissatisfaction; different
Disorders?
ideal girl belief
´ More attainable body dimensions for African American
(part 9)
teens
Multicultural factors: racial and ethnic
differences
Research over past two decades
• Young women of color in the United States
What • Express body dissatisfaction to the same
degree as young non-Hispanic white
Causes American women
Eating • Are even more likely to engage in disordered
eating behaviors (particularly binge eating)
Disorders? • May actually have a higher prevalence of
(part 10) eating disorders, including binge-purge
disorder
´ Multicultural factors: gender differences
´ Men are as likely as women to eat in unhealthy ways
but account for only 25 percent of all people with
reported anorexia nervosa and bulimia nervosa.
´ Double standard for attractiveness
What Causes ´ Different methods of weight loss: men = exercise; women =
dieting
Eating ´ Causes for men
Disorders?
´ Link to requirements and pressures of job or sport
´ Body image
(part 11) ´ Different patterns of dysfunctional eating (muscularity-
oriented disordered eating behaviors; muscle dysmorphia,
reverse anorexia nervosa)
How Are
Eating ´ Eating disorder treatment goals
Disorders ´ Correct dangerous eating patterns
´ Address broader psychological and situational factors
Treated? that have led to and maintain the eating problem
(part 1)
How Are Eating
Disorders Treated?
(part 2)
´ Treatments for anorexia
nervosa
´ Immediate aims of
treatment for anorexia
nervosa
´ Regain lost weight
´ Recover from
malnourishment
´ Eat normally again
How Are Eating Disorders Treated?
(part 3)
´ Restoring weight and normal eating methods
´ Nutritional rehabilitation
´ Intravenous feedings
´ Behavioral weight-restoration approaches
´ Combination of supportive nursing care, nutritional counseling, and high-calorie
diet
´ Motivational interviewing
How Are Eating Disorders Treated?
(part 4)
´ Achieving lasting changes
´ Cognitive-behavioral therapy
´ Identification of core pathology and alternative stress and problem-solving strategies
´ Monitoring ties between feelings, hunger levels, and food intake
´ Changing attitudes about weight and eating; need for independence and control
mechanisms
´ Most successful when continued for at least a year beyond recovery and
supplemented by other approaches
How Are Eating Disorders Treated?
(part 5)
´ Long-term success linked to overcoming underlying psychological
problems
´ Combination of education, psychotherapy, and family therapy used;
psychotropic drugs
´ More effective in anorexia nervosa than other therapies; most effective
prevention when continued beyond one year
´ Best results when supplemented by other approaches, especially family family
therapy
How Are Eating Disorders Treated?
(part 6)
´ Changing family interactions
´ Valuable treatment part, especially for children and adolescents
´ Involvement of whole family
´ Separation of feelings and needs from those of other family members
How Are Eating Disorders Treated?
(part 7)
´ Treatment aftermath
´ Lifetime duration is six years.
´ Weight is quickly restored and continued improvement is evident for the majority
of clients.
´ Medical improvements mean fewer deaths.
´ At least 20 percent experience continued difficulties.
´ Psychological problems may persist.
How Are Eating Disorders Treated?
(part 8)
´ Treatments for bulimia nervosa
´ Treatment is frequently offered in eating disorder clinics; 43 percent receive
treatment
´ Eliminate binge-purge patterns and establish good eating habits
´ Eliminate the underlying cause of bulimic patterns; combination of therapies
´ Programs emphasize education and therapy
´ Antidepressant drug therapy
How Are Eating Disorders Treated?
(part 9)
´ Treatments for bulimia nervosa
´ Cognitive-behavioral therapy
´ Behavioral techniques tailored to unique features of bulimia nervosa
´ Diaries
´ Exposure and response prevention (ERP)
´ Cognitive techniques
´ Help clients recognize and change maladaptive attitudes toward food, eating, weight, and
shape
´ Typically teach individuals to identify and challenge negative thoughts that precede the urge
to binge
How Are Eating Disorders Treated?
(part 10)
´ Treatments for bulimia nervosa
´ Other forms of psychotherapy in individual or group formats
´ Interpersonal psychotherapy
´ Psychodynamic therapy
´ Family therapy
´ Antidepressant medications
´ Cognitive-behavioral, interpersonal, and psychodynamic therapy may
each be offered either an individual or a group therapy format.
How Are Eating Disorders Treated?
(part 11)
´ Treatment aftermath
´ Untreated bulimia nervosa can last for years.
´ Treatment provides immediate, significant improvement in about 40 percent of
cases; 40 percent show moderate response.
´ Ten years after treatment, about 75 percent of patients are fully or partially
recovered.
´ Relapses are often triggered by stress.
Trending: Shame on
Body Shamers
´ Body shaming has been noted since
mid-nineteenth century.
´ Today’s Internet and media provide a
larger platform for cruel comments.
´ 94 percent of teen girls and 64 percent
of boys have experienced body
shaming.
´ A countertrend led by influential
celebrities is raising awareness.
How Are Eating Disorders Treated?
(part 12)
´ Treatments for binge-eating disorder
´ Treatments are often similar to those for bulimia nervosa.
´ Lifetime duration is 14 years.
´ Around 60 percent no longer fit criteria by treatment end; one one-third show total
improvement.
´ African Americans have better treatment outcomes than non-Hispanic white
Americans.
How Are Eating Disorders Treated?
(part 14)
´ Treatments for binge-eating disorder
´ Reduction or elimination of binge-eating patterns
´ Cognitive-behavioral therapy
´ Other forms of psychotherapy
´ Antidepressant medications
´ Short-term effectiveness; high relapse risk
´ Additional weight management interventions are often needed