2.  Are characterized by severe disturbances in eating behavior  2 spesific diagnoses : (1)Anorexia nervosa : characterized by a refusal to maintain a minimally normal body weight (2)Bulimia nervosa : characterized by repeated episodes of binge eating followed by inappropriate compensatory behavior (such as : self-induced vomitting, misuse of laxatives/diuretics/other medication, fasting, excessive exercise)

3. Anorexia = loss of appetite, nervosa = emotional reasons (misnomer : AN not losing their appetite) Essential features : Refuses maintain normal body weight Intensely afraid of gaining weight Significant disturbances in the perception of the shape or size of his/her body Amenorrhoic in females

4. Diagnostic criteria DSM IV-TR : A. Refusal to maintain body weight at or above minimally normal weight for age and height (e.g : less than 85% that expected) B. Intense fear of gaining weight or becoming fat, even though underweight C. Disturbance in experiencing one’s body weight & shape, undue influence of body weight & shape on self-evaluation, or denial of the seriousness of the current low body weight D. Amenorrhea (e.g. at least 3 menstrual cycles)

5. Subtype AN : 1. Restricting type : during AN, person hasn’t regularly engaged in binge-eating or purging behavior (i.e. self-induced vomiting or misuse of laxatives, diuretics or enemas) 2. Binge-Eating/Purging type : during AN, person has regularly engaged in binge-eating or purging behavior (i.e. self-induced vomiting or misuse of laxatives, diuretics or enemas)

6.  Prevalence : about 10 times more frequent in woman than in man  Course : begins in the early middle teenage years (age 14-18), often after stresstul life event  Differential diagnosis : - Bulimia Nervosa : are able to maintain body weight at or above a minimally normal level (AN binge- eating/purging type can’t)

7.  “Bulimia” from Greek word, meaning : “ox hunger”  Essential features : Binge eating & inappropriate compensatory methods to prevent weight gain, at least 2x seminggu dalam 3 bln Self-evaluation influenced by body shape & weight Binge : eating in discrete period of time (< 2 hours) an amount of food that is definitely large than most individuals would eat in similar circumstances / periof of time

8. Diagnostic criteria DSM IV-TR : A. Recurrent episodes of binge eating. An episode of binge eating characterized by both of the following : 1. eating, in discrete period of time (e.g. with-in 2 hour period), an amount of food that is definitely larger than most people would eat 2. a sense of lack of cotrol over eating during the episode (e.g. a feeling that one can’t stop eating or control what or how much one is eating) B. Recurrent inappropriate compensatory behavior in order to prevent weight gain (such as : self-induced vomitting, misuse of laxatives/diuretics/other medication, fasting, excessive exercise) C. The binge eating & inappropriate compensatory behavior both occur, at least twice a week in 3 months D. Self-evaluation is unduly influenced by body shape and weight E. The disturbance doesn’t occur exclusively during episodes of AN

9. Subtype, ada 2 jenis : 1. Purging type : during BN, person has regularly engaged inself-induced vomiting or misuse of laxatives, diuretics or enemas 2. Nonpurging type : during BN, person has used other inappropriate compensatory behavior, such as fasting or excessive exercise, but hasn’t regularly engaged in self-induced vomiting or misuse of laxatives, diuretics or enemas

10.  Prevalence : 90% of cases are woman, prevalence among woman is about 1-2% of the population  Course : begins in late adolescence or early adulthood, begins often after an episode of dieting  Differential diagnosis : - AN binge-eating/purging type : pada BN weight is normal, menses have become regular

11.  Recurrent episodes of binge eating behavior in the absence of the regular use of inappropriate compensatory behavior characteristic of BN  Indicators of impaired control (3 or more): Eating much more rapidly than normal Eating until feeling uncomfortably full Eating large amounts of food when not feeling physically hungry Eating alone because of being embarrassed by how much one is eating Feeling disgusted with oneself, depressed, or very guilty afer overeating

12. 1. Biological factors : Genetic : both AN & BN run in families. Key features of the eating dis (dissatisfaction with one’s body & strong desire to be thin) appear heritable

13. 2. Sociocultural variables : cultural standards moving in the direction of thinness  dieting to lose weight has become more common  fat = negative connotations (as being unsuccessful & having little self- control)  prevalence of eating disorders increased

14. 3. Gender influences : ◦ Women more heavily influenced than men by cultural standards reinforcing the desirability of being thin ◦ Woman are typically valued more for their appearanece, whereas men for their accomplishments ◦ The risk for women who might be expected to be particularly concerned with their weight (models, dancers, & gymnasts) appear to be especially high 4. Cross cultural studies : industrialized > non indz 5. Racial differences : lbh krn social class

15. 6. Psychodynamic views :  Disturbed parent-child relationship  Personality traits : low self-esteem & perfectionism  Goodsitt : conflict-ridden mother-daughter relationship 7. Family Systems theory : Minuchin – dysfunctional family structure (Enmeshment, Overprotectiveness, Rigidity, Lack of conflict- resolution)

16. 8. Personality & Eating Disorder :  AN : perfectionistic, shy, & compliant. BN : histrionic features, affective instability, outgoing social disposition  AN & BN: high in neuroticism & anxiety, low in self-esteem. Also high on measure of traditionalism (strong endorsement of family & social standards)  AN : depression, social isolation, anxiety. BN : more diffuse & serious psychopathology

17. 9. Cognitive-behavioral Views :  Motivating factor : fear of fatness & body- image disturbance  False behavior is maintain with negative reinforcer (yaitu : reducing anxiety about becoming fat)  Dieting & weight loss positively reinforced by the sense of mastery or self-control they create

18. 1. Biological treatment 2. Psychological treatment :  Two-tiered process : gain weight + avoid medical complication  operant-conditioning behavior therapy : reward for eating & gaining weight  Cognitive behavior therapy : uncover & change false beliefs, altering all-or-nothing thinking, unrealistic thinking  ego-analytic psychotherapy : fokus pada greater autonomy  Family therapy : disorder bsifat interpersonal  Overall goal : develop normal eating patterns