abnormal child psychology, 3rd edition, eric j. mash, david a. wolfe chapter 13: eating disorders...

Abnormal Child Psychology, 3rd Edition, Eric J. Mash, David A. Wolfe Chapter 13: Eating Disorders and Related Conditions

Chapter 13

Eating Disorders and Related Conditions


Eating and Normal Development

Problematic eating habits and picky eating are common in early childhood- almost 1/3 of children are described as picky eaters

Societal norms and expectations affect girls more than boys, particularly by late childhood and adolescence


Developmental Risk Factors

Drive for thinness a key motivational factor for dieting and body

image refers to the belief that losing more weight is the

answer to overcoming problems Western sociocultural values and preoccupation with

weight and dieting may be internalized and expressed at a very young age (as young as 7-10)


Developmental Risk Factors (cont.)

Risk factors for development of later eating problems include: early problematic eating behaviors early pubertal maturation high percentages of body fat concurrent psychological problems poor body image

Adolescence brings many changes (including physical maturation) which require major adjustments in self-image; weight concerns intensify, especially for girls



Figure 13.1 A developmental continuum of eating habits and disorders.



Dieting is common, even among elementary school children

Chronic dieting is associated with the onset of adolescent eating disorders

Dieting may lead to “false hope syndrome”, as well as binge eating and subsequent purging


Biological Regulators

Metabolic rate, or balance of energy expenditure, is based on individual genetic and physiological makeup as well as eating and exercise habits

An individual’s natural weight is regulated by his or her own body weight set point, a biologically and genetically determined range of body weight that the body tries to “defend” and maintain

Major hormonal determinants of physical growth rate during childhood are the growth hormone and thyroid hormone, with additional gonadal steroids kicking in during adolescence to produce a further growth spurt and skeletal maturation


Feeding and Eating Disorders of Infancy and Early Childhood

Pica eating inedible, non-nutritive substances for a

period of at least one month affects mostly very young children and those with

MR causes include poor stimulation and poor

supervision in home environment, and genetic factors in some cases of MR

treatments usually based on operant conditioning procedures


Feeding and Eating Disorders of Infancy and Early Childhood (cont.)

Feeding Disorder of Infancy of Early Childhood sudden marked deceleration of weight gain and a

slowing or disruption of emotional and social development prior to age 6

affects up to a third of young children (both boys and girls), particularly those from disadvantaged environments

can lead to or be the result of failure to thrive



Feeding Disorder (cont.) when there is no medical reason, it is often

associated with poor care-giving, including maltreatment

risk factors include family disadvantage, poverty, unemployment, social isolation, parental mental illness, and maternal eating disorders

treatment involves a detailed assessment of feeding behavior and other forms of parent-child interaction



Failure to Thrive characterized by weight below the 5th percentile

for age, and/or deceleration in the rate of weight gain from birth to present of at least 2 standard deviations

associated with social and economic disadvantage, and inadequate or abusive care-giving in early infancy

developmental outcome is highly related to the child’s home environment



Obesity a chronic medical condition characterized by

excessive body fat (usually a BMI above the 95th percentile)

significantly affects children’s psychological and physical health

prevalence is increasing- as of 1990’s, 15% of children were overweight

low correlation between obesity in infancy and obesity later in childhood, but childhood-onset obesity is more likely to persist into adolescence and adulthood


Figure 13.3 U.S. comparison with the next highest countries and the country with the lowest percentage of obese youth.



Obesity (cont.) pre-adolescent obesity a risk factor for later EDs the U.S. has the highest percentage of overweight

children, and rates of obesity seem to increase upon exposure to Western culture and its fast food industries

causes include genetic predisposition (including leptin deficiencies), improper diet, unhealthy lifestyle, as well as family influences, such as poor communication, lack of support, and maltreatment

proper nutrition and less sedentary lifestyle are the recommended treatments- restricting diets not usually recommended


Figure 13.2 Bigger meals, bigger kids. Sources: Centers for Disease Control and Prevention, McDonald’s, and Newsweek.


Eating Disorders in Adolescence

Anorexia Nervosa characterized by refusal to maintain minimally

normal body weight, intense fear of gaining weight, and disturbance in perception of body size

denial of thinness a notable feature DSM-IV subtypes:

restricting type - individual loses weight through diet, fasting, or excessive exercise

binge-eating/purging type - individual engages in episodes of binge eating or purging, or both

numerous negative medical consequences


Eating Disorders in Adolescence (cont.)

Bulimia Nervosa primary feature is recurrent binge eating binges are followed by either purging (self-induced

vomiting or misuse of laxatives or diuretics) or by non-purging compensation (fasting, excessive exercise)

as with anorexia, self-evaluation is greatly influenced by body shape and weight


Eating Disorders in Adolescence (cont.)

Bulimia Nervosa (cont.) two subtypes: dietary-depressive subtype show

more eating pathology, social impairment, psychiatric comorbidity, and persistence of symptoms over five years than women with only the dietary subtype

significant medical consequences, but not as severe as those from anorexia

Binge Eating Disorder (BED) similar to bulimia without the compensatory

behaviors 3.1% of girls, and 0.9% of boys


Figure 13.4 Compensatory behaviors of full-syndrome bulimia nervosa among community samples. Data from Garfinkel et al., 1995


Eating Disorders of Adolescence (cont.)

Prevalence among female adolescents, estimated prevalence

of anorexia is 0.3%, and bulimia is 1% both AN and BN are much more common among

females Eating Disorders- Not Otherwise Specified

(EDNOS) is a category of eating disorders that covers problems that do not quite fulfill criteria for AN or BN; prevalence may be much higher than AN and BN



Young men that are affected with eating disorders place more emphasis on athletic appearance or attractiveness than on thinness

Among American minorities, it was found that Hispanics had equal, Blacks and Asians lower, and Native American women higher rates of eating disorders compared to Caucasians



Development onset of anorexia usually between ages 14 and

18, and is sometimes linked to stressful life events; fewer than 1/2 show full recovery; many fluctuate between recovery and relapse

onset of bulimia usually late adolescence to early adulthood; binge eating often develops after a period of restrictive dieting; may follow a chronic course or occur intermittently; between 50%-75% show full recovery

although disordered eating tends to decline in early adulthood, body dissatisfaction remains an issue for many young adults



Causes Biological dimension

neurobiological factors play only a minor role in precipitating anorexia and bulimia, but likely contribute to their maintenance because of effects on appetite, mood, perception, and energy regulation

genetic contribution – inherit a biological vulnerability that interacts with social and psychological factors

imbalances of serotonin may be implicated biochemical similarities found between people

with eating disorders and those with OCD



Causes (cont.) Social dimension

belief in Western culture that self-worth, happiness, and success are determined by physical appearance

sex-role identification and social conformity can contribute to eating problems

possible family influences include family dysfunction, an overemphasis on weight and dietary control, and child sexual abuse



Causes (cont.) Psychological dimension

adolescents with anorexia show a triad of personality features: avoidance of harm, low novelty seeking, and reward dependence

affect disturbance is often comorbid with anorexia

bulimia is associated with mood swings, poor impulse control, obsessive-compulsive behaviors, depression, anxiety, and substance abuse

almost 90% of persons with eating disorders have other Axis I disorders, usually depression, anxiety, or OCD



Treatment for anorexia and bulimia hospitalization in some cases antidepressants and SSRIs may be helpful for

bulimia, but not anorexia psychosocial interventions are proving to be

effective and are generally more effective than medications alone

Resolution of family problems may be crucial Anorexia is generally less responsive to treatment

than bulimia



Treatment (cont.) for anorexia, family-based interventions often

required to restore healthy communication patterns, and cognitive-behavioral methods may be used to modify rigid beliefs, self-esteem, and self-control processes

for bulimia, cognitive-behavioral therapies that focus on attitudes, beliefs, and behaviors supporting problematic eating are effective, as is interpersonal therapy that addresses situational and personal issues contributing to the development and maintenance of the disorder

abnormal child psychology, 3rd edition, eric j. mash, david a. wolfe chapter 13: eating disorders...

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