Chapter 7 Chapter 7 Feeding and Eating Disorders Chapter Outline Eating Disorders Anorexia Nervosa AN Eating disorders have been and continue to be a popular topic for debate discussion and research However a variety of causes theories and treatment options surround this quite common disorder especially for females 1 Definition of Anorexia Nervosa a A serious condition marked by an inability to maintain a normal healthy body weight b Extremely visible disorder where people are noticeably thin to the point of emaciation e g severe underweight c Body mass index BMI d Two subtypes e DSM IV TR Clinical features i ii iii i ii i ii iii iv v Measured by weight in kilograms divided by height in meters squared An individual with Anorexia Nervosa may weight 85 less than her ideal body weight Psychologists and other mental health professionals use this calculation to measure thinness Restricting e g the reduction of caloric intake paired with excessive exercise or physical activity Binge eating purging e g eating a large amount of food in a short period of time self induced vomiting or use of laxatives enemas or diuretics Intense fear of gaining weight feeling fat Perceptual distortion e g perceiving bodies as overweight or obese when actually emaciated Emphasis on body shape and weight as a means to measure one s self worth e g self evaluation Deny the seriousness of being drastically underweight Amenorrhea absence of menstruation for at least three consecutive months 2 Epidemiology and Course of Anorexia Nervosa a Clinical features associated with Anorexia Nervosa e g see Table 7 3 b Prevalence rates i ii 0 3 to 1 suffer from Anorexia Nervosa e g meaning 1 in 100 females Many females suffer from a less severe form of Anorexia Nervosa e g subthreshold conditions 1 to 3 Less common in boys and men with females being nine times more likely to develop the disorder e g 3 to 1 females to males iii c Adolescence e g the typical time period for the onset of Anorexia Nervosa but there has been cases of children and older adults suffering from just as severe cases d At risk populations e g segments of the population where emphasis is placed on body shape and weight i Actors dancers models athletes etc e Continued low BMI s even after recovery from Anorexia Nervosa f Osteoporosis e g decreased bone density or brittle bones g Can cause difficulties with fertility and childbirth 1 h Course of AN includes periods of relapse remission and crossover into BN i Mortality i ii 3 Personality and Anorexia Nervosa Highest death rate for any psychiatric disorder 10 5 times more likely Causes of death e g effects of starvation and suicide a Perfectionism e g set high standards for themselves b Obsessionality e g repeated thoughts c Neuroticism e g being hypersensitive and worrying excessively without the ability to shake things off d Low self esteem e Developmental tasks e g leaving home for college dating f People who tend to worry excessively may trigger an underlying biological predisposition 4 Comorbidity and Anorexia Nervosa a It is common for individuals suffering from Anorexia Nervosa to also suffer symptoms from other psychological disorders b Major depression e g 80 of people with Anorexia Nervosa will suffer from depression c Anxiety e g 75 of people with Anorexia Nervosa will also experience anxiety disorders which is often present before the eating disorder d Obsessive Compulsive Disorder An easy way to differentiate Anorexia Nervosa from Bulimia Nervosa is to remember that with AN this is a highly visible disorder because of the extreme underweight and emaciation whereas with BN this disorder can be an invisible eating disorder because individuals are of normal weight or overweight Eating Disorders Bulimia Nervosa BN 1 Definition of Bulimia Nervosa a A disorder characterized by recurrent episodes of binge eating in combination with some form of compensatory behavior aimed at undoing the effects of the binge or preventing weight gain b Unlike Anorexia Nervosa Bulimia Nervosa is an invisible disorder because people tend to be normal weight or overweight c Two subtypes d Inappropriate compensatory behaviors Purging type e g an individual regularly engages in self induced vomiting or the misuse of diuretics enemas and laxatives Nonpurging type e g the individual uses fasting and excessive exercise as a way to control weight but does not regularly purge Any action that is used to counteract a binge or to prevent weight gain Purging subtype uses the following compensatory behaviors self induced vomiting time or misuse of laxatives enemas diuretics or other agents Nonpurging subtype uses excessive exercising and fasting as compensatory behaviors e 2 Epidemiology and Course of Bulimia Nervosa a Clinical features associated with Bulimia Nervosa see Table 7 4 b Prevalence rates i 1 to 3 of women suffer from Bulimia Nervosa e g meaning 1 in 100 to 3 in 100 females Many females suffer from a less severe form of Bulimia Nervosa e g subthreshold conditions 5 to 6 Less common in boys and men with percentage rates of 0 1 to 0 3 i ii i ii iii ii iii c Mid to late adolescence to young adulthood e g the typical time period for the onset of Bulimia Nervosa but there have been cases of even later stages of onset of symptoms 2 d At risk populations e Causes of Bulimia Nervosa Individuals born after 1960 More common in urban areas versus rural areas f Complications associated with Bulimia Nervosa Westernized societal emphasis on the thin ideal a trend that began in 1960s Culture bound syndrome Environmental exposure Social learning Information transfer Physical symptoms e g fatigue lethargy bloating and gastrointestinal problems Bodily symptoms resulting from self induced vomiting e g erosion of dental enamel swelling of the salivary glands and calluses on the backs of the hands Bodily symptoms resulting from abuse of laxatives e g edema fluid loss dehydration electrolyte imbalances serious metabolic problems and permanent loss of normal bowel functioning g Course of BN Approximately one half to two thirds of those diagnosed eventually achieve full or partial remission of symptoms of the disorder h Mortality i 3 Personality and Bulimia Nervosa Rare among people with Bulimia Nervosa with rates as low as 0 5 compared to those of Anorexia Nervosa a Perfectionism e g set high standards for themselves b Low self esteem c d Higher novelty seeking behaviors e g need for stimulus or sensation seeking Impulsive e g inability to
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