Explore the lecture notes on eating disorders. Gain insights into the complexities of anorexia nervosa, bulimia nervosa, and binge eating disorder. Delve into diagnostic criteria, symptoms, and contributing factors. Examine psychological, societal, and cultural influences on disordered eating. Disc...
PSYC 300
Chapter 10 – eating disorders
10.1 Clinical Description of Eating Disorders
- Lifetime prevalence estimates of anorexia nervosa 0.9% for women and 0.3% for men.
- Lifetime prevalence estimates of bulimia nervosa 1.5% for women and 0.5% for men.
- Lifetime prevalence estimates of binge eating disorder 3.5% for women and 2.0% for men.
Clear sex difference overall 1 in 3 or 1 in 4 cases involve boys or young men
- Greater heterogeneity in eating disorder symptom expression most common diagnosis (40 to 70% of
clients) is a category called eating disorder not otherwise specified (EDNOS)
Eating disorder not otherwise specified (EDNOS): most common eating disorder diagnosis,
characterized by heterogeneous symptoms and associated features that do not fit the symptoms of
other eating disorders.
This general diagnostic category has been seen as a residual “catch-all” category that underscores
problems inherent in the current diagnostic system.
EDNOS is called a “clinical condition” rather than a category more evidence is needed to
elevate it to a diagnostic category.
Extensive use of EDNOS category reflects the great heterogeneity among individuals deemed to
have an eating disorder
- DSM-5 dropped the EDNOS description in favour of new DSM-5 designations.
One designation unspecified feeding or eating disorder can be used for any condition that
causes clinically significant distress or impairment but does not meet diagnostic thresholds.
Other broad category “other specified feeding or eating disorder.”
o Applies to atypical, mixed, or subthreshold conditions includes various conditions,
including subthreshold bulimia nervosa and subthreshold binge eating disorder.
o Also includes night eating syndrome repetitive tendency to wake up and eat during
the night then get upset about it.
Purging disorder form of bulimia that involves self-induced vomiting or laxative use at least
once a week for a minimum of six months.
o People with purging disorder have levels of disturbed eating and associated forms of
psychopathology that are comparable with patients with other eating disorders
o People with purging disorder have certain distinguishing features.
o One clear feature of purging disorder is high impulsivity.
- Revised DSM-5 descriptions of anorexia nervosa & bulimia nervosa have fewer restrictions that preclude
making a diagnosis should be a lower proportion of EDNOS/other specified diagnoses than in the past.
- Fairburn and Cooper (2011) applied new DSM-5 criteria to their cases and predicted changes will be
only partly successful.
EDNOS cases dropped from 52.7% to 25.1%
With the new diagnostic criteria, 1 in 4 people receiving a diagnosis would still have other
specified feeding or eating disorder diagnosis
o Suggests additional scrutiny and revisions beyond DSM-5 are needed.
A new analysis showed whereas 55 women met lifetime criteria for anorexia nervosa according
to previous work, 37 cases were found using the new criteria (amounts to about a 60% increase)
Anorexia Nervosa
- Anorexia nervosa: disorder in which a person refuses to eat or to retain any food resulting in significantly
low body weight, individual has an intense fear of becoming obese and feels fat even when emaciated.
Anorexia loss of appetite
Nervosa indicates emotional reasons.
- Term is almost a misnomer most people with anorexia nervosa do not lose appetite or interest in food
but are preoccupied with food
, E.g., may read cookbooks, prepare gourmet meals for their families, label foods, etc.
- Some revised criteria in the DSM-5 description for AN:
Person must refuse to maintain a normal body weight and weighs less than 85% of what is
considered normal for that person's age and height.
o Weight loss is typically achieved through dieting, purging (self-induced vomiting, heavy
use of laxatives or diuretics) and excessive exercise
o DSM-5 modified criterion and no longer refers to the 85% guideline.
o Revised criterion looks at restriction of energy intake resulting in significant low body
weight within the context of a person's age, sex, and physical health status.
Person has an intense fear of gaining weight, and the fear is not reduced by weight loss can
never be “thin enough”
People with AN have a distorted sense of their body shape.
o Maintain skewed image even when emaciated, they are overweight or that certain parts
of their bodies, particularly the abdomen, buttocks, and thighs, are too fat.
o To check on body size typically weigh themselves frequently, measure the size of
different parts of the body, and gaze critically at their reflections in mirrors
Females extreme emaciation causes amenorrhea (loss of the menstrual period)
o Criterion has been eliminated from DSM-5 for several reasons.
o Many adolescents/young women have AN but not this symptom
o Amenorrhea occurs in a significant minority of women before any significant weight
loss symptom can persist after weight gain
o Boys and men with anorexia cannot meet the criterion.
- Self-esteem of people with AN is closely linked to maintaining thinness.
Overevaluation of appearance: tendency to link thinness with positive self-esteem & self-
evaluations.
Investigation found increased self-esteem in people with acute AN low body weight
association wasn’t found among control participants or people recovered from anorexia
Tendency for weight loss to be associated with better self-esteem reflects clinical observations
o Young people with anorexia strive for bodily perfection through starvation due to a
misguided sense that attaining the goal of being ultra-thin will make them feel better
about themselves and their lives.
- Distorted body image that accompanies AN has been assessed most frequently by questionnaires
E.g., Eating Disorders Inventory (EDI) developed in Canada, widely used measures to assess
self-reported aspects of eating disorders.
Questionnaire respondents use a six-point scale ranging from “always” to “never” for these:
Drive for - I think about dieting.
thinness - I am preoccupied with the desire to be thinner.
Bulimia - I have thought of trying to vomit to lose weight.
- I have gone on eating binges where I have felt that I could not stop
Body - I think that my thighs are too large.
dissatisfaction - I think that my buttocks are too large.
- I feel inadequate.
Ineffectiveness - I feel empty inside (emotionally).
Perfectionism - Only outstanding performance is good enough in my family.
- I hate being less than best at things.
Interpersonal - I have trouble expressing my emotions to others.
distrust - I need to keep people at a certain distance.
Interoceptive - I get confused about what emotion I am feeling.
awareness - I don't know what's going on inside me.
Maturity fears - I wish that I could return to the security of childhood.
, - The demands of adulthood are too great.
- AN begins in early to middle teenage years often after an episode of dieting and exposure to life stress.
- Halmi (2009) data from five continents concluded rates among younger people are on the rise
Presence of anxiety disorder is a significant risk factor among younger people.
- Comorbidity is very high
Both men and women at risk for eating disorders are also prone to depression, panic disorder,
and social phobia
Some gender differences women are at substantially greater risk for mania, agoraphobia, and
substance dependence.
- Meta-analysis found no link between anorexia nervosa and illicit drug use, but a clear link between
bulimia nervosa and drug use
Canadian investigators specifically tied drug use to the bingeing and dieting cycle
Eating Disorder and Addiction Clinic outlined various ways eating and appearance-related
concerns become barriers to recovery among women with extreme forms of addiction.
There is a need for sophisticated treatment approaches for individuals with comorbid conditions.
Physical Changes in Anorexia Nervosa
- Self-starvation and use of laxatives produce numerous undesirable biological consequences in people
with anorexia nervosa. Some symptoms include:
Blood pressure often falls
Heart rate slows
Kidney and gastrointestinal problems develop
Bone mass declines
Skin dries out
Nails become brittle
Hormone levels change
Mild anemia may occur.
- Some people also lose hair from the scalp may develop laguna (fine, soft hair on bodies)
- Levels of electrolytes (potassium and sodium) are altered.
These ionized salts (present in bodily fluids) are essential for the process of neural transmission
lowered levels can lead to tiredness, weakness, cardiac arrhythmias, and even death.
- Brain size declines EEG abnormalities and neurological impairments are frequent
Research in Canada found deficits in white-matter volumes are restored upon recovery from AN,
but deficits in grey-matter volumes appear irreversible (at least short term)
Prognosis
- About 70% of clients with AN eventually recover
Often takes 6 or 7 years
Relapses are common before a stable pattern of eating and maintenance of weight is achieved
- Changing distorted views of the self is very difficult, particularly in cultures that value thinness.
- Anorexia Nervosa is a life-threatening illness
Death rates are about 10x higher among clients with the disorder than among general population
Death rates are about 2x higher among clients with other psychological disorders.
There is no other disorder that matches the mortality risk inherent in anorexia nervosa
Bulimia Nervosa
- Bulimia nervosa: a disorder characterized by episodic uncontrollable eating binges followed by purging
either by vomiting or by taking laxatives.
Bulimia Greek word meaning “ox hunger.”
- Disorder involves episodes of rapid consumption of a large amount of food, followed by compensatory
behaviours, such as vomiting, fasting, or excessive exercise, to prevent weight gain.
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