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Psychology of Abnormal Behavior Samenvatting
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Abnormal Psychology8. Disorders of Eating and Sleeping
Major Types of Eating Disorders
- Several types of eating disorders
o Bulimia nervosa: out-of-control eating episodes or binges are followed by self-
induced vomiting, excessive use of laxatives, or other attempts to purge (get rid
of) food
o Anorexia nervosa: the person eats nothing beyond minimal amounts of food,
so body weight sometimes drops dangerously
o Binge-eating disorder: individuals may binge repeatedly and find it
distressing but do not attempt to purge the food
- The chief characteristic of these related disorders is an overwhelming, all-
encompassing drive to be thin. Of the people with anorexia nervosa who are followed
over a sufficient period, up to 20% die as a result of their disorder, with slightly more
than 5% dying within 10 years.
- As many as 30% of anorexia-related deaths are suicides, which is 50 times higher than
the risk of death from suicide in the general population
- Until recently, eating disorders were not found in developing countries, where access
to sufficient food is so often a daily struggle; only in the West, where food is generally
plentiful, have they been rampant. Not this is changing; evidence suggests that eating
disorders are going global
- Obesity is not considered an official disorder in the DSM, but we consider it here
because it is thought to be one of the most dangerous epidemics confronting public
health authorities around the world today
Bulimia Nervosa
Clinical Description
- The hallmark of bulimia nervosa is eating a larger amount of food – typically, more
junk food than fruits and vegetables – than most people would eat under similar
circumstances
- Just as important as the amount of food eaten is that the eating is experienced as out of
control. Another important criterion is that the individual attempts to compensate for
the binge eating and potential weight gain, almost always by purging techniques
o Techniques include self-induced vomiting immediately after eating, and using
laxatives and diuretics
- Some people use both, others attempt to compensate in other ways like excessive
exercise
- Purging is not a particularly efficient method of reducing caloric intake. Vomiting
reduces approximately 50% of the calories just consumed, less if it is delayed; laxatives
and related procedures have little effect, acting, as they do, so long after the binge
- A lot of people feel like their popularity and self-esteem would largely be determined
by the wright and shape of their bodies
Pagina 1 van 51
,Medical Consequences
- Chronic bulimia with purging has a number of medical consequences
o Salivary gland enlargement caused by repeated vomiting, which gives the face a
chubby appearance
o It may erode the dental enamel on the inner surface of the frond teeth as well as
tead the esophagus
o Continued vomiting may upset the chemical balance of bodily fluids, including
sodium and potassium levels. This ‘electrolyte imbalance’ can result in serious
medical complications including cardiac arrhythmia, seizures, and renal failure
Associated Psychological Disorders
- An individual with bulimia usually presents with additional psychological disorders,
particularly anxiety and mood disorders
- Most evidence indicates that depression follows bulimia and may be a reaction to it
- Substance abuse also commonly accompanies bulimia nervosa
- In summary, bulimia seems strongly related to anxiety disorders and somewhat less so
to mood and substance use disorders
Anorexia Nervosa
- The overwhelming majority of individuals with bulimia are within 10% of their normal
weight. In contrast, individuals with anorexia nervosa differ in one important way from
individuals with bulimia. They are so successful at losing weight that they put their
lives in considerable danger
- People with anorexia of proud of both their diets and their extraordinary control
Clinical Description
- Anorexia nervosa is less common than bulimia, but there is a great deal of overlap
- Many individuals have a history of anorexia; that is, they once used fasting to reduce
their body weight below desirable levels
- Many people lose weight because of a medical condition, but people with anorexia
have an intense fear of obesity and relentlessly pursue thinness. The disorder most
commonly begins in an adolescent who is overweight or who perceives herself to be
- DSM-IV specifies two subtypes of anorexia nervosa
o Restricting type: individuals diet to limit calorie intake
o Binge-eating-purging type: individuals rely on purging
- Unlike individuals with bulimia, binge-eating-purging anorexics binge on relatively
small amounts of food and purge more consistently, in some cases each time they eat
- Individuals with anorexia are never satisfied with their weight loss. Only continued
weight los every day for weeks on end is satisfactory
- Although the DSM-IV criteria specify body weight 15% below that expected, the
average is approximately 25% to 30% below normal by the time treatment is sought.
Another criteria is a marked disturbance in body image
Medical Consequences
- One common medical complication of anorexia nervosa is cessation of menstruation
(amenorrhea), which also occurs relatively often in bulimia
- Other medical signs and symptoms include dry skin, brittle hair or nails, and sensitivity
to or intolerance of cold temperatures
- It is relatively common to see lanugo, downy hair on the limbs and cheeks
Pagina 2 van 51
, - Cardiovascular problems can also result
Associated Psychological Disorders
- As with bulimia nervosa, anxiety disorders and mood disorders are often present in
individuals with anorexia, with rates of depression occurring at some point during
their lives in as many of 71% of cases
- One anxiety disorder that seems to co-occur often with anorexia is obsessive-
compulsive disorder
Binge-Eating Disorder
- Individuals with a binge-eating disorder experience marked distress because of binge
eating but do not engage in extreme compensatory behaviors and therefor cannot be
diagnosed with bulimia
- Individuals who meet preliminary criteria for BED are often found in weight-control
programs
- About half of individuals with BED try dieting before bingeing and half start with
bingeing and then attempt to diet; those who begin bingeing first become more
severely affected by BED and are more likely to have additional disorders
Statistics
- Clear cases of bulimia have been described for thousands of years, but bulimia nervosa
was recognized as a distinct psychological disorder only in the 1970s
- Among those who present for treatment the overwhelming majority (90-95%) of
individuals with bulimia are women; most are white and middle to upper-middle class
- Among women, adolescent girls are most at risk.
- Once bulimia develops, it tends to be chronic if untreated. Similarly, once anorexia
develops, its course seems to be chronic – although not so chronic as bulimia
Cross-Cultural Considerations
- The disorders develop in immigrants who have recently moved to Western countries.
- Surveys reveal that African American adolescent girls have less body dissatisfaction,
fewer weight concerns, a more positive self-image, and perceive themselves to be
thinner than they are compared to Caucasian adolescent girls
- There is a relatively high incidence of purging behavior in some minority groups. In
most cases, the purging seems to be associated with obesity
- In Japan, the prevalence of anorexia nervosa among teenage girls is still lower than the
rate in North America, but, it seems to be increasing
Developmental Considerations
- Because the overwhelming majority of cases begin in adolescence, it is clear that
anorexia and bulimia are strongly related to development.
- After puberty, girls gain weight primarily in fat tissue, whereas boys develop muscle
and lean tissue. As the ideal look in Western countries is tall and muscular for men and
thin and prepubertal for women, physical development brings boys closer to the ideal
and takes girls further away
- Eating disorders (anorexia) occasionally occur in children under the age of 11. In those
rare cases they are likely to restrict fluid intake, as well as food intake, perhaps not
understanding the difference
- Negative attitude toward being overweight emerges as early as 3 years of age, and
more than half of girls age 6-8 would like to be thinner
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