Feeding and Eating Disorders anorexia nervosa obsession w being thin very underweight restriction of energy intake leading to significantly low body weight intense fear of gaining weight or becoming fat or persistently trying to prevent weight gain undue influence of body weight on self evaluation or inability to recognize seriousness of low body weight don t see it as a problem serious enough to get them to eat more perception of what it means to be fat is totally skewed structural brain abnormalities in anorexia probably a result of anorexia rather than a cause insula involved in controlling anxiety regulating disgust feelings communicating feelings of hunger perceptions of taste when viewing images of other people women w and w out anorexia have same lvls of activation but when viewing images of self women w and w out anorexia have diff lvls of activation women w anorexia had little to no activation perception of self is much larger than their actual size serotonin and dopamine reward circuits in response to food women w anorexia don t respond the same way the rest of us to do pleasurable food they don t experience the same biological rewards that the rest of us do when we eat something delicious hunger hormones leptin provides feedback about energy reserves drop in leptin tells us we re hungry we don t see this in anorexia women w anorexia don t have a drop in leptin even if they are hungry ghrelin increase in ghrelin corresponds w increase in hunger however in ppl w anorexia they don t report feeling hungry even when their ghrelin levels increase women w anorexia don t respond in the same way to hunger hormones as normal people do low levels of serotonin associated w impulsivity generally and binge eating specifically women w anorexia can t predict their pulse as well as women w out anorexia misperception of body when we have a sweet taste we want more more blood flow to the insula in women w anorexia there is a slower rate of blood flow to the insula older research indicates anorexia is overwhelmingly predominant among whites but newer research shows less disparity among races mostly female men w anorexia are more likely to be gay or bisexual starting in younger ages could be that we are identifying it in younger ages or could be b c puberty is starting earlier the act of going through puberty hormonally is when biological functioning related to anorexia begins i e activation of hunger hormones your genetic vulnerability to anorexia is activated during this time also affects elderly most show marked disturbance in body image comorbid w mood disorders depressive disorders anxiety disorders esp OCD substance abuse methods of weight loss have life threatening consequences restricting type and binge eating purging type restricting type starvation exercise limiting caloric intake via diet and fasting often develops into binging purging type the binging and purging in anorexia is different than in bulimia b c the individuals binge on relatively small amounts of food and purge more consistently to differentiate btwn binging purging subtype and bulimia look at what s happening most of the time if they are showing all the other symptoms of anorexia most of the time then it s anorexia anorexia has the highest mortality rate compared to any other psychiatric disorder treatment weight restoration is first priority research treatment studies indicate that anorexia is more difficult to treat than bulimia binge eating when someone is at such a low weight they are not functioning at a normal cognitive level starvation impairs cognitive functioning so how can CBT be effective CBT E that focuses on dysfunctional attitudes towards body shape interpersonal disruptions anxiety over becoming fat and losing control over eating and the overemphasis on thinness as a determinant of self worth happiness success is very helpful Maudsley family therapy a type of therapy unique to anorexia parents function as an inpatient unit parents help get teen to eat very hard for parents parents are taught how to deal w the mean things their daughter will say to them also helps deal w underlying family issues and the way the family views and talks about food and body shape helpful for adolescents medication Alanzapene Ziprexa anti psychotic may be helpful but we are newly researching this area SSRIs are sometimes given as of now evidence suggests that drugs don t help virtual reality therapy have them view a body that they can alter to mimic themselves do exercises to help them combat unrealistic body image emotion regulation eating increases anxiety rather than decreases it pro ana websites websites in which people w anorexia post inspirational photos and tips public health question ethical question bulimia nervosa binge eating compensatory behavior purging i e vomiting laxative use exercise or fasting medical consequences of vomiting stomach acids can erode teeth excessive amount of food consumed in a short period feeling a lack of control over eating they can t stop eating even if they want to both of these behaviors occur at least once a week for at least 3 months it s hard to look at someone and tell if they suffer from bulimia based on weight electrolyte imbalance Na and K levels in the body become messed up can lead to kidney failure cardiac arrhythmia heart attack seizures overly concerned w body shape and its effects on overall success fear of gaining weight usually comorbid w anxiety disorders also sometimes comorbid w mood and substance use disorders these patterns of comorbidity may be accounted for by traits of emotional instability and novelty seeking in these individuals treatments SSRIs esp Prozac fluoxetine which is FDA approved and reduces bingeing and purging helpful in long run when combined w psychological treatment like CBT E which teaches patients the physical consequences of binge eating and purging the ineffectiveness of vomiting and laxative abuse and the adverse effects of dieting and has patients eat small amounts of food multiple times a day and not be alone after eating CBT E focuses on altering dysfunctional thoughts and attitudes about body shape weight and eating first focuses on symptoms and then on body image and or relationships CBT E is better than IPT in the long run family therapy is also helpful including integrating family and interpersonal strategies into CBT while adding 2 antidepressants to CBT slightly increased the benefit of CBT CBT remains the preferred treatment