Anorexia Nervosa A Body weight less than 85 of expected Body Mass Index 17 5 B Intense fear of becoming fat gaining weight even though thin C Disturbance of body image e g sees self as grossly overweight D Amenorrhea absence of at least 3 consecutive periods Two subtypes 1 Restricting 2 Binge Eating Purging Anorectic individuals rarely seek treatment referred by family Onset commonly age 12 18 recently trending younger Prevalence 1 About 1 10 die of starvation medical complications or suicide Prominent medical difficulties include malnutrition dry yellow skin cold sensitivity slow heartbeat dehydration loss of potassium risk of heart or kidney failure Frequently require hospitalization to recover from malnutrition refeeding syndrome 35 co morbidity with OCD Bulimia Nervosa A Recurrent episodes of binge eating B Recurrent compensating behavior s to prevent weight gain vomiting laxative use diuretics enemas exercise C Binges purges occur at least twice a week for 3 months D Self evaluation unduly influenced by body shape weight E No diagnosis of anorexia typically average weight often slightly overweight Lifetime prevalence 4 6 Up to 20 of college age women exhibit binge purge symptoms Possible medical complications Electrolyte imbalance heart kidney failure Gastric ulcer esophageal rupture Tooth decay Swollen salivary glands Permanent colon damage laxative use Medical Model Considerations in Eating Disorders 1 2 3 4 5 Genetic predisposition to anorexia OCD link h 50 Heritability lower in bulimia depression link Dieting reduced serotonin fx emotion regulation error detection Evidence of reduced D2 receptors in bulimia addiction model Anorectic starvation reduced hypothalamus fx reduced appetite Other Important Risk Factors 1 Sexual abuse trauma general risk factor for many forms of psychopathology including anorexia and bulimia 2 Personality perfectionism self criticism especially anorexia 3 Development in anorexia premature birth low birth weight early sleep feeding problems early illness 4 Family factors particularly important in bulimia parental neglect divorce criticism of weight Treatment Anorexia A Hospitalization restore body weight B Individual therapy nutritionist exposure habituation to food weight cues C Family therapy D Pharmacotherapy no solid evidence of efficacy of any meds Treatment Bulimia A Pharmacotherapy SSRI SNRI high treatment dropout but ok outcomes 40 60 response rate high relapse when drugs withdrawn B Cognitive behavior therapy 20 sessions behavioral component 4 7 plan address cognitive distortions e g all or nothing thinking overgeneralization 50 70 response rate