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Two Main Types Anorexia Nervosa Bulimia Nervosa
Share Strong Drive to be Thin Largely a Westernized, Female Problem Largely an Upper SES Problem
Two Main Types Anorexia Nervosa Bulimia Nervosa
Share Strong Drive to be Thin Largely a Westernized, Female Problem Largely an Upper SES Problem
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InterviewObservationReports from family/friendsObjective Psychological Tests
(e.g., Eating Disorder Inventory)
InterviewObservationReports from family/friendsObjective Psychological Tests
(e.g., Eating Disorder Inventory)
Assessment of Eating Assessment of Eating DisordersDisorders
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Bingeing– Eat Large Amounts of Food– Eating is Out of Control
Bingeing– Eat Large Amounts of Food– Eating is Out of Control
Compensatory Behaviors–Purging via
–Self-Induced Vomiting, Enemas–Laxatives, Diuretics, Exercise, Fasting
Binge-Purge occur, on average, at least 2 X wk for 3 monthsSelf-evaluation is unduly influenced by body shape and weight
Compensatory Behaviors–Purging via
–Self-Induced Vomiting, Enemas–Laxatives, Diuretics, Exercise, Fasting
Binge-Purge occur, on average, at least 2 X wk for 3 monthsSelf-evaluation is unduly influenced by body shape and weight
Bulimia NervosaBulimia Nervosa
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Medical Consequences Medical Consequences
Salivary Gland Enlargement Eroded Dental Enamel Electrolyte Imbalance Intestinal Problems Calluses on Fingers and Hands
Salivary Gland Enlargement Eroded Dental Enamel Electrolyte Imbalance Intestinal Problems Calluses on Fingers and Hands
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Facts and Statistics Facts and Statistics
90-95% are Women Onset 16-19 Years of Age 6-8% of college women About 2.8% Population Overall Chronic if Left Untreated
90-95% are Women Onset 16-19 Years of Age 6-8% of college women About 2.8% Population Overall Chronic if Left Untreated
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Clinical Description Clinical Description Intense fear of
– Gaining weight– Becoming fat
Intense fear of – Gaining weight– Becoming fat
Refusal to maintain body weight– 15% Below Expected Normal
Distorted body imageAmenorrhea (in females)
Refusal to maintain body weight– 15% Below Expected Normal
Distorted body imageAmenorrhea (in females)
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Two Subtypes Two Subtypes
Restricting Type – Excessive Dieting
Restricting Type – Excessive Dieting
Binge-Eating / Purging Type – Rely on Purging– About Half of All Cases
Binge-Eating / Purging Type – Rely on Purging– About Half of All Cases
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Medical Consequences Medical Consequences
Dry Skin, Brittle Hair or Nails Sensitivity to Cold (Lanugo) Risk of death (suicide, starvation, electrolyte imbalance, heart problems)
Dry Skin, Brittle Hair or Nails Sensitivity to Cold (Lanugo) Risk of death (suicide, starvation, electrolyte imbalance, heart problems)
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Associated Features and Facts Associated Features and Facts Begins in adolescence (onset often associated with a stressful life event) Perfectionistic High-Achievers All-or-None Thinking Obsessive and Orderly Comorbid DSM Disorders
– Obsessive-Compulsive Disorder– Substance Abuse
Begins in adolescence (onset often associated with a stressful life event) Perfectionistic High-Achievers All-or-None Thinking Obsessive and Orderly Comorbid DSM Disorders
– Obsessive-Compulsive Disorder– Substance Abuse
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Causes Causes
Social and Cultural Factors–- examples?– Media
– Sets Impossible Idealized Images
Social and Cultural Factors–- examples?– Media
– Sets Impossible Idealized Images
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Causes Causes
Biological InfluencesRuns in FamiliesUnclear What is Inherited The Serotonin-Hypothesis: BN represents an underlying hyposerotonergic condition
Biological InfluencesRuns in FamiliesUnclear What is Inherited The Serotonin-Hypothesis: BN represents an underlying hyposerotonergic condition
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Causes Causes Dieting: When food is restricted, we become preoccupied with it! (The PsychoBiological Impasse)Family Influences (esp. in AN)
– Successful and Driven– Concerned About Appearances– Eager to Maintain Harmony – Deny or Ignore Conflicts– Lack of Open Communication
Dieting: When food is restricted, we become preoccupied with it! (The PsychoBiological Impasse)Family Influences (esp. in AN)
– Successful and Driven– Concerned About Appearances– Eager to Maintain Harmony – Deny or Ignore Conflicts– Lack of Open Communication
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Psychosocial Treatments for BN Psychosocial Treatments for BN Cognitive-behavioral treatments
– Education about eating behavior– Scheduled eating– Exposure / Response prevention
Cognitive-behavioral treatments– Education about eating behavior– Scheduled eating– Exposure / Response prevention
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Psychosocial Treatments Psychosocial Treatments Anorexia Nervosa
– First restore normal weight!– many will gain weight; keeping the weight on is harder– residential treatment– control issues? IPT
Anorexia Nervosa– First restore normal weight!– many will gain weight; keeping the weight on is harder– residential treatment– control issues? IPT
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Biological treatments Biological treatments Bulimia Nervosa
– Because serotonin is thought to play an important role in mediating satiety, SSRIs have been tried– e.g., fluoxetine (Prozac) has demonstrated effectiveness
Anorexia (not effective)
Bulimia Nervosa– Because serotonin is thought to play an important role in mediating satiety, SSRIs have been tried– e.g., fluoxetine (Prozac) has demonstrated effectiveness
Anorexia (not effective)