PSYC 407 1st Edition Lecture 14 Outline of Last Lecture I. Types of Eating Disordera. Anorexia Nervosab. Bulimia Nervosac. Eating Disorders d. Binge-Eating DisordersOutline of Current Lecture I. Dietary Restraint ModelII. Emotion and Binge EatingIII. Co-morbidity of Eating DisordersIV. Factors V. The Nature of SuicideVI. Sleep Disordersa. Dyssomniasb. ParasomniasCurrent LectureEtiologyDietary Restraint Model-Restricting caloric intake results in increased internal cues to consume food-However, bingeing often occurs before dieting.-Dieting may mediate the relationship between another factor and binge eatingEmotion and Binge Eating- Depression is nonspecific risk factor, negative affect may trigger binges.- Pre-binge emotions more distressing than post-binge.- Heatherton and Baumeister’s ESCAPE THEORYo Binge eating allows escape from negative self-awareness (cognitive narrowing)Co-morbidity of Eating DisordersThese 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.Common comorbid conditions include:Major --depressive disorder or dysthymia (50%-75%), Sexual abuse (20%-50%), Obsessive-compulsive disorder (25% with anorexia nervosa), Substance abuse (12%-18% with AN and 30%-37% with BN)Bipolar disorder (4%-13%)Culture, Age, Gender- Eating disorders are more common in industrialized societies where there is an abundance of food and being thin, especially for women, is considered attractive.- Most common in the United States, Canada, Europe, Australia, New Zealand, and South Africa. However, rates are increasing in Asia, especially in Japan and China, where women are exposed to cultural change and modernizationSociocultural- In the United States, eating disorders are common in young Latin American, Native American, and African American women, but the rates are still lower than in white women.- Both anorexia nervosa and bulimia nervosa are most commonly seen in girls and women. Estimates of female-to-male ratio range from 6 : 1 to 10 : 1.GenderFemale athletes involved in running, gymnastics, or ballet and male body builders or wrestlers are at increased risk.Estimated 10-15% of those with eating disorders are male AN in males associated w/being “too small” May engage in extreme behaviors to gain weight and muscle mass (perhapssteroids)  Sometimes called reverse anorexia or muscle dysmorphia.Also see AN in some male athletes -Usually in sports revolving around “weigh-ins”Ex. Jockeys, WrestlersDisorder OnsetEating disorders have been reported in up to 4% of adolescents and young adults. The most common age at onset for anorexia nervosa is the mid-teens.-In 5% of the patients, the onset of the disorder is in the early twenties. The onset of bulimia nervosa is usually in adolescence but may be as late as early adulthoodPrevalence in young- Prevalence of eating disorders in young children is unknown. However, children as youngas 5 years have reported awareness of dieting and know that inducing vomiting can produce weight loss. - Children and adolescents with anorexia may experience retarded growth due to low growth hormone levels- Eating disorder not otherwise specified is the most prevalent eating disorder.Prognostic Factors Factors that predict good outcome include:-admission of hunger, -lessening of denial, and-improved self esteem.  Factors that predict poor outcome include: -initial lower minimum weight, -presence of vomiting or laxative abuse, -failure to respond to previous treatment, -disturbed family relationships, and -conflicts with parents.Familial Pattern- First-degree female relatives and monozygotic twin offspring of patients with anorexia nervosa have higher rates of anorexia nervosa and bulimia nervosa.- Children of patients with anorexia nervosa have a lifetime risk for anorexia nervosa that is tenfold that of the general population- Families of patients with bulimia nervosa have higher rates of substance abuse, particularly alcoholism, affective disorders, and obesityBiologic FactorsDenial of Hunger in Anorexia Nervosa patientsEndogenous opiods may be contributing to this denialSome hypothesize that dieting can increase the risk for developing an eating disorder. Increased endorphin levels have been described in patients with bulimia nervosa after purging and may be likely to induce feelings of well being.-Provides a feeling of “relief” after a purgePsychosocial FactorsHigh levels of hostility, chaos, and isolation and low levels of nurturance and empathy are reported in families of children presenting with eating disordersAnorexia has been postulated as a reaction to demands on adolescents to behave more independently or to respond to societal pressures to be slender. Anorexia nervosa patients are usually high achievers, and two thirds live at home with parentsFamily dynamics alone, however, do not cause anorexia nervosa. Self-starvation may be an effort to gain validation as a unique person.Patients with bulimia nervosa have been described as having difficulties with impulse regulation.Psychodynamic Factors Extreme discipline over biological urges compensates for perceived lack of identity and perceived loss of control. Also, may be seen as phobic avoidance disorder in which feared object is adult weight, adult shape, aging, death, fear of succeeding as an adult, and adult sexuality. May avoid fears by preventing puberty and regressing back to pre-pubertal state.Treatment- A comprehensive treatment plan including a combination of nutritional rehabilitation, psychotherapy, and medication is recommended.- The patient's weight and cardiac and metabolic status determines the acuteness of the illness and the need for hospitalizationReasons for HospitalizationWeight <75% of individually estimated healthy weightRapid, persistent decline in oral intake or weight despite maximally intensive outpatient interventions.Electrolyte or metabolic abnormalities. Hematemesis – vomiting blood Vital sign changes including orthostatic hypotension and heart rate <40 bpm or >110 bpm Inability to sustain body core temperature Comorbid psychiatric illness (suicidal, depressed, unable to care for self, etc.)Aims of TreatmentRestore the patient's nutritional status Establish healthy eating patternsTreat medical complicationsCorrect core dysfunctional thoughts related to the eating disorderEnlist family