Chapter 8 Online Book Notes Abnormal Psychology Began to increase during the 1950 s or early 1960 s Bulimia Nervosa An eating disorder involving recurrent episodes of uncontrolled excessive binge eating followed by compensatory actions to remove the food for example deliberate vomiting laxative abuse and excessive exercise Binge a relatively brief episode of uncontrolled excessive consumption usually of food or alcohol Anorexia Nervosa an eating disorder characterized by recurrent food refusal leading to dangerously low body weight Binge Eating Disorder BED a pattern of eating involving distress inducing binges not followed by purging behaviors being considered as a new DSM diagnostic category 20 percent die as a result of these diseases and 5 percent die 10 years later 30 percent of anorexia related deaths are suicides which is 50x higher than the risk of death from suicide in the general population Bulimia rose dramatically between 1975 and 1986 Eating disorders are culturally specific Until recently eating disorders were only found in the West where food was plentiful and readily available 90 percent with eating disorders are female Obesity an excess of body fat resulting in a body mass index a ratio of weight to height of 30 or more 70 percent of adults in the US are overweight and 30 percent meet the criteria for obesity The more overweight someone is at a given height the more they are at risk to their health 8 1a Bulimia Nervosa Bulimia s eating is out of control Purging techniques in the eating disorder bulimia nervosa the self induced vomiting or laxative abuse used to compensate for excessive food ingestion Techniques include self induced vomiting immediately after eating using laxatives drugs that relieve constipation and diuretics drugs that result in loss of fluids through greatly increase frequency of urination Vomiting only reduces approximately 50 percent of the calories just consumed less if it is delayed Psychologic characteristic despite accomplishments and success you feel that your e g popularity and self esteem would be largely determined by the weight and shape of your body Medical Consequences Salivary gland enlargement caused by repeated vomiting which gives the face a chubby appearance Erode the dental enamel on the inner surface of the front eth and tear the esophagus Upsets the chemical balance of bodily fluids including sodium and potassium levels Electrolyte imbalance can result in serious medical complications if unattendtion including cardiac arrhythmia disrupted heartbeat seizures and renal kidney failure all of which can be fatal Develop more body fat than age and weight matched healthy controls even though they are trying to avoid just this Associated Psychological Disorders 75 percent of the patients with bulimia also presented with an anxiety disorder such as social phobia or generalized anxiety disorder 80 6 percent of those with bulimia had an anxiety disorder at some point in their lives Mood disorders such as depression also commonly co occur with those who have bulimia Depression follows bulimia and may be a reaction to it 8 1b Anorexia Nervosa Those with bulimia are within 10 percent of their normal weight However those with anorexia are not Those with anorexia are proud of both their diets and self control while those with bulimia tend to be ashamed at their eating issues and lack of control Clinical Description Anorexia is less common than bulimia but there is a great deal of overlap People with anorexia have an intense fear of obesity and relentlessly pursue thinness Most commonly begins in adolescence Two subtypes of anorexia nervosa Restricting type individuals diet to limit calorie intake Binge eating purging type they rely on purging Binge on relatively small amounts of food and purge more consistently then those who have bulimia Subtypes often overlap Individuals with anorexia are never satisfied with their weight loss Marked disturbance in body image After seeing doctors those with anorexia become good at saying what the doctors want to hear Medical Consequences Amenorrhea cessation of menstruation Dry skin brittle hair or nails sensitivity to or intolerance of cold temperatures lanugo downy hair on the limbs and cheeks Cardiovascular problems chronically low blood pressure and heart rate Associated Psychological Disorders Anxiety and mood disorders are often present in individuals with anorexia Depression 71 percent 8 1c Binge eating Disorder OCD often seems to co occur with anorexia nervosa especially experience marked distress because of binge eating but do not engage in extreme compensatory behaviors and therefore cannot be diagnosed with bulimia Greater likelihood of occurring in males and at a later onset of age Greater likelihood of remission and better response to treatment Those who meet criteria are often found in weight control programs occurs in those who are obese especially 1 2 of the individuals with BED trying dieting before bingeing and 1 2 start bingeing and then attempt to diet Those who begin bingeing first become more severely affected by BED 8 1d Statistics Bulimia was not distinguished until the 1970 s but has been described for thousands of years 90 95 percent with bulimia are women Males who have bulimia are predominately gay or bisexual and have a later age of onset Males in sports that require weight regulation wrestling are another large group of males with eating disorders Adolescent girls are most at risk Lifetime prevalence was 2 to 3 times greater in females with the exception of BED The median age of onset for all eating disorders was a range from 18 21 years old With anorexia this onset is fairly consistent Once bulimia develops it tends to be chronic if untreated Even when those with anorexia no longer meet the criteria for it they still tend to restrict their eating Those with bulimia who have had treatment tend to go into remission more so than those with anorexia nervosa Cross Cultural Considerations Eating disorders develop in immigrants who have recently moved to Western countries The prevalence of eating disorders is lower among African American and Asian American females and equally common among Hispanic females and more common among Native Americans Anorexia rarely occurs among North American African American women Developmental Considerations Differential patterns of physical development in girls and boys interact with cultural influences to create eating disorders After puberty