Anorexia Nervosa - Rockhurst

Report
Eating Disorders
307.1 Anorexia Nervosa
Refusal to maintain a normal body weight
An intense fear of gaining weight, and the
fear is not reduced by weight loss
In females, accompanied by amenorrhea
A distorted sense of their body shape
Two subtypes:
– Restricting
– Binge-eating
Associated Features of
Anorexia Nervosa

Symptoms of Depression (e.g., low mood,
social withdrawal, irritability, insomnia,
decreased interest in sex)
 Obsessive-Compulsive Disorder Features both related and unrelated to food
 Others: concerns about eating in public,
feelings of ineffectiveness, a strong need to
control one’s environment, inflexible thinking,
limited social spontaneity.
Physical Effects of Anorexia
Nervosa








Low Blood Pressure
Bradycardia
Reduce Bone Mass
Dry Skin
Brittle Nails
Mild Anemia
Hair Loss
Constipation








Loss of Tooth Enamel
Osteoporosis
Emaciation
Lethargy
Amenorrhea
Abdominal Pain
Cold Intolerance
Altered Electrolytes
(e.g., potassium,
sodium)
307.51 Bulimia Nervosa
Recurrent episodes of binge eating
– eating, in a discrete time, a large amount of food
– a sense of lack of control over eating
Recurrent inappropriate compensatory behavior
in order to prevent weight gain
Binges and compensatory behaviors occur at
least twice a week for 3 months
Self-evaluation is unduly influenced by body
shape and weight
307.51 Bulimia Nervosa
(cont.)
The disturbance does not occur exclusively during
episodes of Anorexia Nervosa
Two subtypes:
– Purging type - during the current episode of Bulimia
Nervosa, the person has regularly engaged in selfinduced vomiting or the misuse of laxatives, diuretics,
or enemas
– Nonpurging type - the person uses other inappropriate
compensating behaviors (e.g., fasting, excessive
exercise)
This Is A Test!
Which is a distinction between anorexia
nervosa and bulimia nervosa?
a Bingeing
b physiological complications common
c pronounced weight loss
d depression
The Societal Impact on Eating
Behaviors, Obesity, and Body
Image
Sociocultural Variables

The cultural ideal for women (especially) and
men has changed dramatically over the years.
 Playboy centerfolds became thinner between
1958 and 1978, now has leveled off. Average
American woman has become heavier.
 1/3 of 10th grade girls feel they are overweight
(most are not).
 Models in women's magazine are becoming
thinner.
Does Society Influence
Eating Behavior?

Have you ever eaten just because everyone else
was?
 Have you ever eaten somewhere you didn’t
particularly want to just because everyone else
wanted to?
 Have you ever eaten alone in a restaurant?
 Do your celebrations and festivities involve
food?
 Have you ever paid $.25 to “supersize” a meal?
Does Society Influence
Body Image?

Do you ever look at a model and wish you
looked like him/her?
 Do you compare yourself to others at the
gym/beach/dance, etc.?
 Have you ever been angry, upset, or depressed
about how your body looks?
 Do you feel ashamed or guilty if you gain a few
pounds?
What messages do we get
from society about weight
related issues?
Cultural Ideals
Cultural Ideals
Advertising and Eating
Disorders
Cultural Ideals
Cultural Ideals
Magazine Ad
The Change over 40 years
Unrealistic Goals:
Average Fashion
Model vs Average Woman
Average
Fashion Model
Average
Woman
Height
5'9"
5'4"
Weight
110 lb
142 lb
16.3
24.3
BMI
Personal communication from Wadden TA, July 1997.
Cognitive-Behavioral
Influences

Fear of fatness and body-image disturbance make
self-starvation reinforcing
 Criticism from peers and parents about being
overweight
 Perfectionism and personal inadequacy
 Portrayals in the media of thinness as ideal, being
overweight as representing lack of willpower or
weakness
 Dieting itself is often the stimulus for binging
Biological Factors in Eating
Disorders

Genetic component - concordance rate of 47%
for monozygotic and 10% for dizygotic pairs
 Although the hypothalamus is a key brain center
for regulating eating, does not seem to be a factor
in eating disorders
 Starvation among anorexic patients may increase
the levels of endogenous opioids, resulting in a
reinforcing euphoric state
 Several studies have found low levels of
serotonin in bulimic patients. Antidepressant
drugs somewhat effective
Biological Treatments

Fluoxetine found to be superior to placebo in
reducing binge eating and vomiting, also lessened
depression and distorted attitudes toward food and
eating
 Attrition in drug trials much higher than that found
in cognitive-behavioral programs (nearly 1/3)
 Most patients relapse when medication is
withdrawn
Treatment of Bulimia
In CBT, patient encouraged to question society’s
standards for physical attractiveness
 Core dysfunctional belief - one’s shape and weight
are of paramount importance for acceptance by
others
 Teach that weight control best accomplished by
eating on a regular basis
 Only about 1/3 of bulimics treated maintain their
gains long-term

Treatment of Anorexia
Nervosa

Immediate goal - help gain weight
 Second goal - long-term maintenance of gains in
body weight.
 Neither medical, behavioral, or traditional
psychodynamic interventions have been very
effective
 Family therapies, despite claims, has not been
adequately studied
The End
Prevalence of NIDDM in Japanese Men
Hara et. al., Diabetes Research & Clinical Practice, (1991)
Ageadjusted %
Men with
Diabetes,
Ages 4070+
20
18
16
14
12
10
8
6
4
2
0
Diabetes
Japan
Hawaii
California
Nutritional Transition and Obesity in China
Popkin et. al., European Journal of Clinical Nutrition (1993)
25
22.33
20
16.44
Percent 15
(%)
10
11.98
10.14
7.73
7.45
4.75
5
2.28
0
Rural
Urban
Region
% Fat in Diet
% with BMI<18.5
% with BMI>25
% with BMI>27
Obesity in Australian Aboriginal People
Jones & White, Annals of Human Biology (1994)
65
55
51
45
Percent
35
Obese
25
(BMI>30)
22
16.7
15
5
4.3
2.4
-5
Least
Most
Degree of Westernization
Women
Men
Indian Migrants and Non-migrant Siblings CHD
Risk Factors
West
London
Punjab
Men
BM I
Cholesterol
26.8(5.2)
6.5(1.4)
22.9(4.7)
4.9(1.1)
Women
BM I
Cholesterol
27.4(4.9)
6.2(1.2)
22.7(4.0)
5.1(1.0)
Bhatnagar et. al., The Lancet (1995)

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