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Eating Disorders
Chapter 7
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Anorexia Nervosa (AN)
A serious condition marked by an
inability to maintain a normal healthy
body weight
-Measured by body mass index (BMI)
Restricting vs. binge eating/purging type
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According to the DSM-IV-TR…
Denial of
illness
Absence of
menstruation,
amenorrhea
Anorexia
Nervosa
Restricting or
binge
eating/purging
subtypes
Also remember being
considered
“underweight” by one’s
BMI
Perception of
body size and
weight is
distorted
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Intense fear of
gaining
weight or
“feeling fat”
Use weight and
shape as a
measure of
self-evaluation
So what does AN really look like?
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Anorexia Nervosa and the Facts…
Affects 1% of the
general population
(1 out of 100)
Begins in
adolescence (usually
after puberty)
Females are 9x
Highest mortality
more likely to
rate of any
develop the disorder
psychiatric
disorder (10.5x more
Low BMIs &
likely)
Osteoporosis
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Who’s Considered at Risk?
Segments of the
Personality traits
-Perfectionism
population where
-Obsessionality
emphasis is placed
-Neuroticism
on body shape and
-Low self-esteem
weight
-Actors, dancers,
models, athletes, etc.
Can you think of any other
populations that would be
considered “at risk” for
Anorexia Nervosa?
-Developmental tasks
(leaving home for
college)
-Worriers
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Comorbidity and AN
80% will suffer from major depression
Up to 75% will suffer from anxiety
disorders
Anxiety as a risk factor in the
development of AN
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Often referred to as the
“invisible eating disorder”
because people tend to be of
normal weight or overweight.
Bulimia Nervosa (BN)
A disorder characterized by recurrent
episodes of binge eating in combination
with some form of compensatory
behavior aimed at undoing the effects of
the binge or preventing weight gain
It’s important to note
that consuming
Compensatory behaviors
-purging subtype vs. non-purging subtype
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1,000 calories is the
minimum to qualify
for a binge session,
but some consume up
to 20,000 calories in
one binge episode.
What one needs to be diagnosed with
BN…
Recurrent episodes of binge eating
Experience a lack of control over eating
Engage in recurrent compensatory
behaviors
-self-induced vomiting
-misuse of laxatives, diuretics, enemas, or other
medications
-fasting or excessive exercise
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So what does BN really look like?
Mortality is rare for those
with BN compared to
those with AN.
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Nine times
more likely in
females.
Some causes of BN…
Westernized societal emphasis on the “thin
ideals,” culture-bound syndrome
Environmental exposure
Social learning
Information sharing (i.e., hearing about it from
friends or reading material on the disorder)
Personality (i.e., low self-esteem, perfectionism,
more impulsive, and have higher rates of novelty
seeking behaviors)
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Comorbidity and BN
80% of people with BN have another
psychiatric disorder
Most common disorders seen in
conjunction with BN: anxiety disorders,
major depression, substance use, and
personality disorders
Examples: Elton John and Princess Diana
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Eating Disorders Not Otherwise
Specified (EDNOS)
A residual diagnostic category for people
who have eating disorders that do not
match the classic profile of anorexia
nervosa or bulimia nervosa
DSM-IV-TR criteria
Binge eating disorder (BED)
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Binge Eating Disorder (BED)
A disorder characterized by regular binge
eating behaviors, but without the
compensatory behaviors that are part of
bulimia nervosa
Still under investigation
Common in people who are overweight
and obese (found in 3.5% of women and 2% of
men in the general population meet criteria)
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What one needs to be diagnosed with
BED…
Recurrent episodes of binge eating
Report of distress over binge eating
Associated with three or more of the
following:
-eating rapidly
-eating past the point of “feeling full”
-eating large amounts of food when not physically hungry
-eating alone due to embarrassment
-feeling disgusted with oneself, depressed, or guilty
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Impact of Gender and Ethnicity
Gender
Ethnicity
 Female prevalence rates 9
to 1
 Reasons
-“Thin ideal”
-Objectification of the
female body
-Influence of female
hormones
 Male athletes
 Stereotypes
 Lack of clear data
 Need for research with
more diverse
populations
 Factors to consider (i.e.,
SES, education level,
familial influence)
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Developmental issues to consider…
Weight problems
Prevalence rates in childhood vs. adolescence
Social
-Leads to social isolation from peers and family
Emotional
-Associated with symptoms of depression and anxiety
Physical
-Onset of menstruation, percentage of body fat, and more
mature “womanly” figures
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And the
Role of the hypothalamus
brain says… Activity-based anorexia
Biological
factors to
consider in the
development
of eating
disorders
Neuroendocrine and
neurohormonal factors
Brain structure and brain
functioning
Family “genetics”
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But my
thoughts tell
me...
Psychological
factors to
consider in the
development of
eating
disorders
Patterns of family dysfunction
(Salvador Minuchin)
-Enmeshment
Distorted cognitions
-Related to body shape,
weight, eating and personal
control
Society and Culture
-Western “thin ideals”
-Culture value on beauty
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The Treatment of Eating Disorders
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Basic Treatment Goals
Anorexia nervosa
-Normalization of eating
behavior and weight
-Increase caloric intake
and weight gain
Bulimia nervosa
-Normalization of eating
-Elimination of binge
eating and purging
Binge eating disorder
-Normalization of eating
-Elimination of binge eating
-Weight stabilization or weight
loss
-Improve psychological factors
(i.e., depression, self-esteem,
and self-efficacy)
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Once hospitalized, then what?
Inpatient treatment
-Multidisciplinary team approach
-Maintenance of healthy weight
-Consideration of other factors (i.e., social supports,
other medical conditions, work, school, suicidal
ideation, etc.)
-Psychotherapy (i.e., individual, group, and family)
-Privileges given as result of compliance with
treatment
-Treatment (comprehensive plan, including “food”)
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Medication: Quick fix or long-term
results?
Biological treatment
-Commonly prescribed
-Need for medication specific to symptoms of
Anorexia Nervosa
-Fluoxetine (Prozac) is an anti-depressant or
Selective Serotonin Reuptake Inhibitor (SSRIs)
used to treat Bulimia Nervosa
-No medications have been FDA approved for Binge
Eating Disorder
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Nutritional Counseling
Nutritional rehabilitation
-Dieticians and nutritionists specializing in the
treatment of eating disorders
-Nutritional needs for someone with anorexia nervosa
-Nutritional needs after assessment of someone with
bulimia nervosa
-Nutritional needs upon evaluation of someone with
binge eating disorder
-Best utilized in conjunction with other treatments
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Changing faulty beliefs one step at a
time…
Cognitive-behavioral therapy
-Focuses on changing one’s perception about body
shape, weight, eating, and sense of control
-Addresses both automatic thoughts and core beliefs
-Replaces negative thoughts and problematic
behaviors
-Use of self-monitoring
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Interpersonal Psychotherapy (IPT)
IPT
-A brief, time-limited therapy approach that focuses
on decreasing eating disorder symptoms by
enhancing social skills in relationships
-Addresses four problem areas (i.e., interpersonal
disputes, role transitions, abnormal grief, and
interpersonal deficits)
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Eating Disorders and the Family Unit
Family-based interventions
-Minuchin’s and Palazzoli’s views of dysfunctional
family system
-Modern approaches to family therapy
-The Maudsley Method
-Effective with adolescents with eating disorders
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