Slide 1Eating Disorders on a ContinuumAnorexia Nervosa – DSM criteriaBulimia NervosaWhat’s the difference?Slide 6Sociocultural factorsBiological FactorsFamilial FactorsEmotional and personality risk factorsTreatmentTreatmentHelpful resourcesEATING DISORDERS Causes, Risk, Assessment and TreatmentEating Disorders on a ContinuumHealthy eating habitsOccasional dieting, skipping meals, binge-eatingFrequent dieting, compensatory behaviors, extreme exerciseDisordered eating habitsAnorexia Nervosa – DSM criteria•Significantly low body weight•Consider context•BMI < 17 – 18.5•Intense fear of gaining weight or persistent bx that interferes with weight gain •Distorted experience of one’s shape/weight•Restricting •Binge-PurgingBulimia Nervosa•Recurrent episodes of binge-eating•Lack of control over eating•Eating larger portion than most (3000-4500 calories) in discrete time period •Recurrent bx to prevent weight gain (vomiting, laxatives, excessive exercise)•Occur approx 1x/wk for 3 months•Body shape and weight are unduly important in self-evaluationWhat’s the difference?ANOREXIA•Body weight•Significantly low•Severely distorted body image•Personality traits•Controlling•Treatment•Harder to treat•More deadly BULIMIA•Body weight•Normal•Realistic body image, but dissatisfaction•Personality Traits•Lack of control •Treatment•More amenable to txETIOLOGYSociocultural factors•Unrealistic media ideals•Thinness/Muscularity Body DissatisfactionDietingCulturePressure to be ThinReinforced behaviorsBiological Factors•Heritability•First-Degree relations at higher risk •Genetics (33-84%; ~ 50%)•Body systems that regulate appetite/satiety/cessation of eating•Hypothalamus – regulates eatingDisruptions in serotonin/dopamineFamilial Factors•Learned behaviors •Dieting, weight monitoring, self-confidence •Family dynamics•Enmeshed, Lack of Conflict Resolution•AbuseEmotional and personality risk factors •Bulimia and Anorexia:•Low self-esteem•Neuroticism•Depression•Anorexia –•Perfectionism •Bulimia - •Impulsivity, lack of controlTreatmentTreatment•Hard to get/engage in treatment•Two-tiered Process •1. Immediate goal of gaining weight (refeeding)•2. Long-term goal to address underlying causes and maintain weight•CBT•Cognitive restructuring (All-Or-Nothing Thinking)•Establish normal eating behaviors•Eat forbidden food and then don’t allow to vomit*•Identify triggers for binge/purge cyclesHelpful resources•Counseling and Psychological Services•(919) 966-2281•More info:•www.eating-disorder.com•Your