Eating Disorders

March 14, 2013

DSM-IV-TR
Anorexia Nervosa
Bulimia Nervosa

Binge Eating Disorder

Eating Disorder NOS

Anorexia Nervosa (AN)

Symptoms Persistent refusal to maintain normal body weight
(< 85% of what would be expected for age and height)

Intense fear of gaining weight Body image disturbance Amenorrhea

(absence of menstrual period)

Anorexia Nervosa
Subtypes Restrictive
Dieting, fasting, excessive exercise

Binge-eating/Purging
Either one or both Misuse of laxatives

Anorexia Nervosa
More than 90% of cases of AN occur in females Lifetime prevalence: .05% (females) Thought to be more common in developed countries Age of onset: mid- to late adolescence Prognosis: 50-70% recover

Mortality rate: 3-5%

Video http://www.youtube.com/watch?v=y4WqfzN7x CQ

Bulimia Nervosa (BN)

Symptoms
Recurrent episodes of binge eating
Binge: eating in a discrete period of time an amount of food that is definitely larger than most individuals would eat under similar circumstances

Inappropriate compensatory methods to prevent weight gain (purging, laxative use,

excessive exercise)

Self-evaluation excessively influenced by body shape and weight

Bulimia Nervosa
Symptoms
Usually occurs in secrecy or as inconspicuously as possible Triggers: dysphoric mood states, interpersonal stressors, intense hunger following restraint, or feelings related to body image Lack of control Typically within normal weight range Subtypes: Purging Nonpurging

Bulimia Nervosa
More than 90% of individuals with BN are females Lifetime prevalence: 1-3% (females) Thought to be more common in developed countries Age of onset: late adolescence to early adulthood Prognosis: 50-70% recover

Binge Eating Disorder

(DSM-5) Recurrent eating binges Absence of compensatory behaviour to prevent weight gain Linked to obesity Affects men and women about equally
Lifetime prevalence: 3.5% (women) 2% (men)

Age of onset: early to middle adulthood

Comorbidity
Anorexia Nervosa Any DSM-IV disorder 56.2% Bulimia Nervosa 94.5% Binge Eating disorder 78.9% Hudson et al. (2007) National Comorbidity Survey Replication

Mood disorder Anxiety disorder Substance use disorder

42.1% 47.9% 27.0%

70.7% 80.6% 36.8%

46.4% 65.1% 23.3%

Adapted from Hudson et al., 2007

Aetiology of Eating Disorders

Genetic Factors
Relatives of women with AN are 10x more likely to have AN Relatives of women with BN are 4x more likely to have BN

Neurobiological Factors
Abnormal levels of cortisol (hypothalamus) Increased levels of endogenous opioids Low levels of serotonin metabolites

Aetiology of Eating Disorders (contd.)

Sociocultural Factors
The ever increasing thinness of female icons Prevalence of obesity Increase in health consciousness in general dieting Preoccupation with thinness body dissatisfaction Objectification of womens bodies gender differences Culture, ethnicity, SES

Aetiology of Eating Disorders (contd.)

Personality
AN: perfectionistic BN: affective instability

Family
Higher levels of family conflict Higher rates of childhood physical and sexual abuse

Psychological Theories of EDs

Psychodynamic ED is an attempt to gain control in a chaotic environment ED is a way to maintain childhood by avoiding the typical female shape

Psychological Theories of EDs

Cognitive Behavioural
Anxiety about becoming fat increased dieting/other weight loss behaviours temporary relief from anxiety about becoming fat
(Negative reinforcement)

Perfectionistic tendencies and social comparison Criticism from friends & family Perception that controlling wt. will make up for deficits in other areas of life Excessive restraint broken diets and binging

Treatment
Medication
Antidepressants Comorbidity with depression Serotonin Decreases distorted attitudes towards eating Especially helpful with BN

Treatment
Psychotherapy

Family therapy Cognitive Behaviour Therapy:

Encourage clients to question societys standards for physical attractiveness Develop normal eating patterns Challenge unrealistic thoughts about self Relaxation to control the urge to vomit Identify triggers and learn to cope with them Exposure and ritual prevention

Video http://www.youtube.com/watch?v=3wzkKs0TOT s