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CHAPTER 6
EATING DISORDERS
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PPTs t/a Abnormal Psychology 1e by Rieger - Copyright  2009 McGraw-Hill Australia Pty Ltd
AIMS AND OBJECTIVES

Provide overview of historical approaches to eating disorders

Describe current classification system for anorexia nervosa,
bulimia nervosa, and binge eating disorder

Review information regarding prevalence, age of onset,
course, associated problems, and aetiology of these
conditions

Outline main treatment approaches

Discuss key challenges and controversies
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PPTs t/a Abnormal Psychology 1e by Rieger - Copyright  2009 McGraw-Hill Australia Pty Ltd
EATING DISORDERS

Historical and current approaches

Anorexia nervosa

First recognized in the 1870s and conceptualised as a loss of
appetite due to mental causes

In 1970, Gerald Russell proposed formal diagnostic criteria

DSM-IV-TR characterizes anorexia as a relentless pursuit of
thinness

DSM-IV-TR criteria
 1. Maintaining a body weight at a subnormal level (<85%)
 2. Intense fear of becoming fat
 3. A distorted body image
 4. Amenorrhea

Two types: restricting and binge eating / purging
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PPTs t/a Abnormal Psychology 1e by Rieger - Copyright  2009 McGraw-Hill Australia Pty Ltd
EATING DISORDERS

Historical and current approaches

Bulimia Nervosa

Although there are references from ancient Greece / Rome to binge
eating, contemporary descriptions appeared in the 19th century

In 1979, Gerald Russell distinguished bulimia from anorexia


Bulimia nervosa patients had strong urges to overeat and were not
underweight
DSM-IV-TR criteria
1. Recurrent episodes of binge eating with a sense of loss of control over food
intake
2. Inappropriate compensatory behaviour to prevent weight gain
3. Both (1) and (2) occur on average at least 2x per week for 3 months
4. Self-evaluation unduly influenced by body shape and weight
5. Absence of anorexia nervosa

Two types: purging and non-purging
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PPTs t/a Abnormal Psychology 1e by Rieger - Copyright  2009 McGraw-Hill Australia Pty Ltd
EATING DISORDERS

Historical and current approaches

Eating disorder not otherwise specified: binge eating
disorder

DSM-IV- TR provides the category of eating disorder not otherwise
specified (EDNOS) for those who do not meet for anorexia or
bulimia

People with EDNOS may have subjective binges that do not meet
criteria for bulimia nervosa

Binge eating disorder is a subgroup of EDNOS defined by the
occurrence of binge eating episodes without the weight control
behaviours characteristic of those with bulimia nervosa
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PPTs t/a Abnormal Psychology 1e by Rieger - Copyright  2009 McGraw-Hill Australia Pty Ltd
EATING DISORDERS

Anorexia nervosa

Epidemiology



Age of onset and course of the disorder




Affects mainly adolescent girls and young women
0.9% lifetime prevalence, 10x more common in females
Age of onset is usually in early to late adolescence
Mortality rate (5-10%) is the highest of all psychiatric disorders
Substantial portion of patients will fail to make a full recovery
Associated Features and medical problems


Psychological comorbidities include mood and anxiety disorders,
substance use disorders, and personality disorders
Medical problems include irregular heart beats, heart failure, and
severe metabolic disturbance
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PPTs t/a Abnormal Psychology 1e by Rieger - Copyright  2009 McGraw-Hill Australia Pty Ltd
EATING DISORDERS

Anorexia nervosa

Aetiology

Biological factors

Moderate heritability


Higher concordance for monozygotic versus dizygotic twins
Interaction between genetic factors and environment

Environment has been found to influence attitudinal factors, such as body
dissatisfaction

Some research suggesting abnormally high levels of serotonin activity

Neuroendocrine (hormonal systems) are irregular, but this may be a
consequence of the disorder rather than a cause

Possible abnormalities in the structure and function of the brain
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PPTs t/a Abnormal Psychology 1e by Rieger - Copyright  2009 McGraw-Hill Australia Pty Ltd
EATING DISORDERS

Anorexia nervosa

Aetiology

Psychological factors

Low self-esteem


Negative affect


Individuals try to avoid emotional distress by focusing on eating, shape,and
weight
Dysfunctional thinking


Individuals seek to overcome through attainment of extreme thinness
Individuals judge their worth in terms of their eating habits, body shape, and
weight
Perfectionism

Unrealistically high standards pursued in the domain of eating and weight
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PPTs t/a Abnormal Psychology 1e by Rieger - Copyright  2009 McGraw-Hill Australia Pty Ltd
EATING DISORDERS

Anorexia nervosa

Aetiology

Social factors

Family factors



Peer factors


Individuals with anorexia report higher levels of criticism and lower levels
of care and affection from parents, but is a retrospective report and subject
to bias
Parents influence their children through direct comments and through
modelling
Girls in peer groups that emphasize thinness are at increased risk
Cultural values

Anorexia more likely to occur in historical periods/cultures that place a high
value on the control of eating, shape, and weight
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PPTs t/a Abnormal Psychology 1e by Rieger - Copyright  2009 McGraw-Hill Australia Pty Ltd
EATING DISORDERS

Anorexia nervosa

Aetiology

Psychological factors

Low self-esteem


Negative affect


Individuals try to avoid emotional distress by focusing on eating, shape, and
weight
Dysfunctional thinking


Individuals seek to overcome through attainment of extreme thinness
Individuals judge their worth in terms of their eating habits, body shape, and
weight
Perfectionism

Unrealistically high standards pursued in the domain of eating and weight
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PPTs t/a Abnormal Psychology 1e by Rieger - Copyright  2009 McGraw-Hill Australia Pty Ltd
EATING DISORDERS

Anorexia Nervosa

Treatment

Motivational enhancement therapy (MET)



Unlike most disorders, people with anorexia are attached to their disorder
MET aims to help patients increase their motivation to change
Cognitive behaviour therapy

Conducted in 3 stages:
1. Establish supportive and collaborative relationship and meal plan
2. Target dysfunctional beliefs about weight and food
3. Prepare for the end of treatment and prevent relapse

Family therapy


Maudsley Model – promotes re-feeding and weight gain by encouraging
parents to take responsibility for health eating in the home
Family therapy may be preferable to individual treatment for younger patients
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PPTs t/a Abnormal Psychology 1e by Rieger - Copyright  2009 McGraw-Hill Australia Pty Ltd
EATING DISORDERS

Bulimia nervosa

Epidemiology

Prevalence



Age of onset and course of the disorder



Primarily affects females
1-3% lifetime prevalence
Age of onset is later than anorexia nervosa, late adolescence and
young adulthood
Can become chronic for some
Associated medical and psychological problems


Depletion of electrolytes from purging behaviours in 50%
Depression, anxiety, and substance use disorders are common
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PPTs t/a Abnormal Psychology 1e by Rieger - Copyright  2009 McGraw-Hill Australia Pty Ltd
EATING DISORDERS

Bulimia nervosa

Aetiology

Biological factors




Moderate heritability
Family predisposition to obesity and family histories of substance use and
mood disorders
Reduced serotonergic function
Social factors

Individuals with bulimia report:



more critical comments and teasing about shape, weight, or eating
poorer family functioning
more negative interpersonal interactions before binge eating episodes
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PPTs t/a Abnormal Psychology 1e by Rieger - Copyright  2009 McGraw-Hill Australia Pty Ltd
EATING DISORDERS

Bulimia nervosa

Aetiology


Psychological factors
Dual Pathway Model – binge eating episodes are triggered by
dietary restriction, negative affect, or both
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PPTs t/a Abnormal Psychology 1e by Rieger - Copyright  2009 McGraw-Hill Australia Pty Ltd
EATING DISORDERS

Bulimia nervosa

Treatment

Motivational enhancement therapy (MET)



Self-help approaches


Like anorexia, some individuals with bulimia are not motivated to recover
MET has been shown to increase recovery and treatment response
Little support for pure self-help approaches, but guided self-help may be
effective
Cognitive behaviour therapy
1. Educate patient about bulimia and self-perpetuating cycle of dieting
2. Eliminate all dieting and target dysfunctional cognitions
3. Focus on relapse prevention

Interpersonal psychotherapy


Help individuals identify and change interpersonal problems
Pharmacological approaches

Antidepressant medication is more effective than placebo
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PPTs t/a Abnormal Psychology 1e by Rieger - Copyright  2009 McGraw-Hill Australia Pty Ltd
EATING DISORDERS

Binge eating disorder

Epidemiology

Prevalence



Age of onset and course of the disorder



2/3 female
3-5% lifetime prevalence
Age of onset is unknown, estimated to be late adolescence and
young adulthood
Course is controversial, some suggest it is a short-term condition
while others argue it is more chronic
Associated medical and psychological problems


The most prominent physical problem is overweight or obesity
Mood disorders, anxiety disorders, substance use and personality
disorders are common
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PPTs t/a Abnormal Psychology 1e by Rieger - Copyright  2009 McGraw-Hill Australia Pty Ltd
EATING DISORDERS

Binge eating disorder

Aetiology

Biological factors




Psychological factors



Preliminary support for moderate heritability
May entail dysfunction in serotonin system
Hormonal disturbances may also play a role
Strong support for the role of negative affect
Emotional eating is associated with binge eating disorder
Social factors


Poorer family functioning
Obesity stigma
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PPTs t/a Abnormal Psychology 1e by Rieger - Copyright  2009 McGraw-Hill Australia Pty Ltd
EATING DISORDERS

Binge eating disorder

Treatment

Self-help approaches


Pure self-help and guided self-help approaches both may be efficacious
Cognitive behaviour therapy (CBT)

Targets of treatment are




Interpersonal psychotherapy


Highly effective in reducing binge eating and as effective as CBT
Behavioural weight loss


develop a moderate eating plan
increase physical activity, and
achieve greater acceptance of body shape/weight
Emphasis is on weight loss by restricting caloric intake and increasing
activity
Pharmacological approaches

Antidepressant medications have been supported, although not as effective
as CBT
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PPTs t/a Abnormal Psychology 1e by Rieger - Copyright  2009 McGraw-Hill Australia Pty Ltd
EATING DISORDERS

Current challenges and controversies

Limitations of current treatment approaches





Involuntary treatment


More large controlled trials of psychotherapy are needed
While CBT is effective for bulimia, much room for improvement
Approaches to eating disorders and obesity need to be integrated
Large gap between presence of eating disorder and diagnosis and
treatment
Many clinical and ethical dilemmas related to imposing treatment on
patients who are at risk of death (e.g, in serious cases of anorexia)
Prevention of eating disorders

Can focus on general or specific risk factors depending on whether
individuals are beginning to display symptoms
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PPTs t/a Abnormal Psychology 1e by Rieger - Copyright  2009 McGraw-Hill Australia Pty Ltd
SUMMARY

Historical and Current Approaches to Eating Disorders

Anorexia Nervosa




Bulimia Nervosa




Epidemiology, Onset, Course, and Associated Problems
Aetiology
Treatment
Binge Eating Disorder




Epidemiology, Onset, Course, and Associated Problems
Aetiology
Treatment
Epidemiology, Onset, Course, and Associated Problems
Aetiology
Treatment
Current Challenges and Controversies
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PPTs t/a Abnormal Psychology 1e by Rieger - Copyright  2009 McGraw-Hill Australia Pty Ltd