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 periodsTwo 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 OCDBulimia Nervosa:A. Recurrent episodes of binge eatingB. 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 monthsD. Self-evaluation unduly influenced by body shape/weightE. No diagnosis of anorexia (typically average weight, often slightly overweight)- Lifetime prevalence: 4-6%- Up to 20% of college-age women exhibit binge/purge symptomsPossible 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. Genetic predisposition to anorexia (OCD link): h~.50 2. Heritability lower in bulimia (depression link)3. Dieting à reduced serotonin fx à emotion regulation, error detection4. Evidence of reduced D2 receptors in bulimia (addiction model)5. Anorectic starvation à reduced hypothalamus fx à reduced appetiteOther Important Risk Factors:1) Sexual abuse/trauma: general risk factor for many forms of psychopathology, including anorexia and bulimia2) Personality: perfectionism, self-criticism (especially anorexia)3) Development – in anorexia, premature birth, low birth weight, early sleep/feeding problems, early illness4) Family factors – particularly important in bulimia: parental neglect, divorce, criticism of weight Treatment: AnorexiaA. Hospitalization – restore body weight B. Individual therapy/nutritionist (exposure/habituation to food, weight cues)C. Family therapyD. Pharmacotherapy – no solid evidence of efficacy of any medsTreatment: BulimiaA. Pharmacotherapy – SSRI/SNRI: high treatment dropout, but ok outcomes (40-60% response rate); high relapse when drugs withdrawnB. Cognitive-behavior therapy (20 sessions): behavioral component (“4-7plan”), address cognitive distortions (e.g., “all or nothing thinking”, “overgeneralization”); 50-70% response