PSYC 407 1st Edition Lecture 13 Outline of Last Lecture I. The Bipolar DisorderII. What is Bipolar II?III. What is Cyclothmia?IV. What are Mood Disorders?V. What is An Integrative Theory?Outline of Current Lecture II. Types of Eating DisorderA. Anorexia NervosaB. Bulimia NervosaC. Eating Disorders D. Binge-Eating DisordersCurrent LectureTYPES OF EATING DISORDERS- Anorexia Nervosa- Bulimia Nervosa- Eating Disorder NOS- Binge-Eating DisorderAnorexia Nervosa (AN)The essential features of anorexia nervosa:1. Refusal to maintain a minimally normal body weight (15 % below expected weight)2. Intense fear of gaining weight and losing control over eating.3. Significant disturbance in the perception of the shape or size of one's body4. AmenorrheaThese notes represent a detailed interpretation of the professor’s lecture. GradeBuddy is best used as a supplement to your own notes, not as a substitute.-Previously a requirement, not in DSM 5- Patients commonly lack insight into the problem and are brought to professional attention by a family member.- Comorbid psychiatric symptoms include depressive symptoms such as depressed mood, social withdrawal, irritability, insomnia, and decreased sexual interest- Many depressive features may be secondary to the physiologic ramifications of semistarvation.- Obsessive-compulsive features—thoughts of food, hoarding food, picking or pulling apart small portions of food, or collecting recipes—are common- Anxiety symptoms and concerns of eating in public are also common.Anorexia: Two TypesDSM IV-TR identifies two subtypes of anorexia nervosa: 1. Restricting type limiting calories by diet and fasting2. Binge eating–purging type. During current episode of AN the person has regularly engaged in binge eating or purging behavior.Personality Characteristics of AN- Diminished sense of personal controlo Feel “out of control”o Body is controllableo Perfectionistic attitudes in relation to distorted body imageo Often are perfectionistic in other realms as wello ObsessionalityCourse of ANSignificant numbers of AN individuals switch from restricting type to binge-purge type.As a general guideline, it appears that one third+ of patients fully recover, one third retain sub-threshold symptoms, and one third (or less) maintain a chronic eating disorder.Mortality is over 10 % with deaths occurring from starvation, suicide, medical complicationHighest mortality rate of all mental illnessesDifferential DiagnosisDepressive disorder:1. Generally do not have an intense fear of obesity or body image disturbance2. Usually have a decreased appetite, whereas anorexia nervosa patients claim to have a normal appetite and to feel hungrySomatization-Patients with somatization disorder do not generally express a morbid fear of obesity-Severe weight loss and amenorrhea longer than 3 months are unusual in somatization disorder.Schizophrenia-Schizophrenic patients might have delusions about food being poisoned but rarely are they concerned with caloric content. They also do not express a fear of gaining weight.Bulimia Nervosa- Recurrent episodes of binge eating characterized by both:o Eating, in a discrete period of time (e.g., within any 2-hour period), an amount of food that is definitely larger than most people would eat during a similar period of time and under similar circumstanceso A sense of lack of control over eating during the episode, defined by a feeling that one cannot stop eating or control what or how much one is eatingCompensatory Behaviors• Recurrent inappropriate compensatory behavior to prevent weight gain• Self-induced vomiting (purging)• Fasting• Excessive exercise• Misuse of laxatives, diuretics, enemas, or other medicationsThe binge eating and inappropriate compensatory behavior both occur, on average, at least twice a week for 3 months.Bulimia Nervosa- Self evaluation is unduly influenced by body shape and weight.o The disturbance does not occur exclusively during episodes of anorexia nervosa.o Often discovered by dentists due to erosion of enamelBinge Eating in BNBinge eating is typically triggered by:-Distressed or melancholic mood states-Interpersonal stressors-Intense hunger following dietary restraints-Negative feelings related to body weight, shape, and food. Patients are typically ashamed of their eating problems, and binge eating usually occurs in secrecy. Unlike anorexia nervosa, bulimia nervosa patients are typically within normal weight range and restrict their total caloric consumption between binges.Bulimia Subtypes Purging type: During the current episode of bulimia nervosa, the person has regularly engaged in purging behavior self-induced vomiting or the misuse of laxatives, diuretics, or enemas. Non-purging type: During the current episode of bulimia nervosa, the person has used inappropriate compensatory behavior (such as fasting or exercise) but has not regularly engaged in self-induced vomiting or misused laxatives, diuretics, or enemas.CO-MORBIDITY of BNDepressive Disorders consistently diagnosedAnxiety Disorders 50% (esp. OCD)BPD occurs in 34%23% have alcohol dependenceCourse of BNShort-term success is 50% to 70%,-Relapse rates between 30% and 50% after 6 months. These patients have an overall better prognosis as compared with anorexia nervosa patientsPoor prognostic factors are:-hospitalization, -higher frequency of vomiting, -poor social and occupational functioning, -poor motivation for recovery, -severity of purging, -presence of medical complications, -high levels of impulsivity, -longer duration of illness, -delayed treatment, and -premorbid history of obesity and substance abuse.Eating Disorder Not Otherwise Specified (EDNOS)Eating disorder not otherwise specified includes disorders of eating that do not meet the criteria for any specific eating disorder. Ex: Repeatedly chewing and spitting out, but not swallowing, large amounts offood. Pro-Ana & Pro-Mia WebsitesPro-Ana – promotion of Anorexia, “ana”Pro-mia – Pro-bulimiaEndorse Anorexia or Bulimia as desirableLifestyle choices, not a diseaseRapidly spread with advent and accessibility of the internetChange sites oftenThinspiration or “Thinspo”Characteristics of these groupsShare crash dieting techniques, recipes-Give advice for how to refuse food in public or with family-How to hide weight loss from parents or doctorsCompete with each other at losing weight, or fast together in displays of solidarityPost their