Eating Disorders
Psych 347
(12-5-13)

Problems with amount eaten:

Obesity

overeating/inadequate exercise leads to unhealthy body weight

Anorexia Nervosa

a. morbid fear of being overweight

often distortions in perception of body and in body image seen

b. self-starvation to unhealthy body weight

Bulimia Nervosa

a. episodic loss of control over eating [binge]

b. inappropriate/dangerous weight control mechanisms [purge]

(1) self-induced vomiting

(2) abuse of emetics, laxatives, diuretics

(3) excessive exercise

Eating Disorder Not Otherwise Specified

eating problems which do not clearly fit either AN or BN patterns are probably the most common eating disorders

Body dissatisfaction is the single strongest predictor of eating disorder symptoms (Phelps, Johnston, Augustyniak, 1999)

Severity may be a more useful variable than diagnostic pattern

severity is associated with response to treatment and outcome results

longitudinal studies find reoccurence is common but patterns may shift

Problems with substance eaten:

Pica: "persistent eating of nonnutritive substances" (DSM-IV-TR, 2000, p. 103)

Pica (L for magpie: the old Romans thought the bird would eat anything. Pica referred to eating nonfood substances, but usually excluded behavior motivated by starvation or belief system. Current use of the term is often synonymous with the more general expression: scavenging behavior.

Scavenging Behavior: generic term for eating nonfood substances, regardless of reason.

Pica/scavenging behavior is common in very young children, usually outgrown.

Major concern is risk of lead poisoning if child consumes paints, plaster, or similar material.

patterns may be "named" based on substance consumed:

a. Geophagia: eating earthy substances

b. Trichlophagia: eating hair

c. Corprophagia: eating feces

d. etc.

mouthing and eating nonfood substances developmentally common in infants between approximately 8 and 24 months and is not considered Pica

"not part of a culturally sanctioned practice" (DSM-IV-TR, 2000, p. 103)

scavenging behavior

 

Anorexia nervosa

First off, the name of this syndrome is a misnomer: "anorexia" refers to loss of appetite, "anorexia nervosa" would suggest a "nervous loss of appetite", but most individuals with AN have not lost their appetite--they have developed a consuming fear of become obese, usually associated with a distorted body image, a strong desire for additional weight loss, refusal to maintain a minimal healthy body weight, and (in postmenarchealfemales) amenorrhea (loss of menstruation)

"The essence of anorexia nervosa (AN) is a relentless pursuit of thinness (presumably driven by a central disturbance in bodily experience) and a phobia of the consequences of eating (usually expressed as a dread of weight gain or obesity)." (Steiger & Seguin, 1999, p. 365)

prevalence rates vary with the methods used to identify index cases

occurs more frequently in industrialized/Western nations

occurs more frequently in females, possibly 10 to 1 prevalence

"The disorder is eight to eleven times more common in females than males" (Kendall, 2000, p. 106)

but males and females with AN appear similar (Olivardia & Pope, 1995)

onset usually in adolescence

high risk of onset between the ages of 14 to 18, average age onset 17 (Kendall, 2000, p. 106)

course is often cyclical and chronic

serious mobidity (inpairment) and motality (death is a possible outcome)

Bulimia nervosa

"the main feature of bulimia nervosa (BN) is dyscontrol over eating." (Steiger & Seguin, 1999, p. 366)

occurs more frequently in females, approximately 10 to 1 ratio

onset somewhat later than AN, usually in late adolescence/early adulthood

serious mobidity (inpairment) and motality (death is a possible outcome)

the major patterns of eating disorders

both AN and BN patterns are believed to be linked to excessive or compulsive dieting (Steiger & Seguin, 1999, p. 366)

both AN and BN occur more frequently in subclinical or "partial" presentations

both AN and BN are frequently comorbid with other difficulties: mood disorders, anxiety disorders, substance abuse disorders, dissociative disorders, personality disorders

both AN and BN have serious physical side-effects and can lead to death

Maxmen & Ward (1995) (and many other authors) draw clear distinctions between AN and BN and the disorders can be objectively differentiated (patients with AN are below normal body weight, patients with BN maintain normal weight); nevertheless, the usefullness and validity of this common distinction remains under question. While patients with AN and BN can be differentially diagnosed with good reliablity at a given point in time, longitudinal studies often have found that a patient with one eating disorder pattern at the origin of the study has another at a later point in time.

Eating Disorder Not Otherwise Specified (EDNOS)

Binge Eating Disorder

[obesity in the absence of binge eating is not classified as an eating disorder in DSM-IV-TR; "DSM-IV suggests that when psychological forces promote obesity, they should be indicated as 'psychological factors affecting physical condition' in the section entitled, Other Conditions That May Be a Focus of Clinical Attention." (Maxmen & Ward, 1995, p. 333)]

Feeding Disorder of Infancy or Early Childhood (not in Eating Disorders group)

"persistent failure to eat adequately" (DSM-IV-TR, 2000, p. 107)

"failure to thrive"

alternative classifications of eating disorders

Restrictor: eating disorder patients (AN) who restrict food intake but do not binge or purge

Binger: eating disorder patients (BN and some AN) who binge and purge

Comorbidity of eating disorders with other psychopathology

mood disorders: affective symptoms are common in eating disorders

approximately 25 to 50 % of patients with AN meet concurrent criteria for a major depression; 75% will experience a depression during their life span (Steiger & Seguin, 1999); elevated rates have also been reported for BN

many patients with eating disorders who do not show full mood disorder syndromes will show significant depressive symptoms

both AN and BN patients are at risk for suicide attempts and completions

BN (but not usually AN) patients are at risk for self-injurious behavior

anxiety disorders: anxiety symptoms are common in eating disorders

rates of comorbid anxiety disorder in AN are reported between approximately 20 and 75 % (Steiger & Seguin, 1999); and in BN between approximately 13 and 60 % (Steiger & Seguin, 1999)

phenomenonological similarity between eating disorders and OCD (intrusive thoughts, compulsive behavior) has focused attention on obsessive-compulsive disorders in particular; heightened concurrences have been reported for OCD in eating disorders populations, and for eating disorders in OCD populations; both may share common neurobiologial features (serotonergic anomalies) (Steiger & Seguin, 1999)

substance abuse disorders

substance abuse difficulties have been reported in bulimic (but not restrictive) eating disorders (Steiger & Seguin, 1999)

hypothesis of a common personality patter--"addictive personality": prone to the misuse of substances--has been advanced by some authors but has not been cleared supported to date (Steiger & Seguin, 1999); similarly, no "disorder-specific" family pattern has been empirically established; neither have biological hypotheses of shared neurobiological factors been convincing demonstrated for comorbid eating disorders and substance abuse (Steiger & Seguin, 1999)

dissociative disorders

dissociative symptoms have been reported to be common among BN patients (Steiger & Seguin, 1999)

personality disorders

comorbidity with personality disorders are reported in clinical samples of patients with eating disorders, this association appears to go beyond the well documented tendency of eating disorders to exacerbate personality trait tendencies although the best understanding of this relationship has not been resolved (Steiger & Seguin, 1999)

personality disorder diagnoses should be made very cautiously in the context of active eating disorders (the same caution holds for diagnosing personality disorders in the presence of active mood disorders and substance abuse)

.