2.  Two Main Types Until Recently  Anorexia Nervosa  Bulimia Nervosa  Share Strong Drive to be Thin  Largely a Female Problem  Largely a Westernized Problem  Largely an Upper SES Problem  Mortality may result  Binge-eating disorder  Two Main Types Until Recently  Anorexia Nervosa  Bulimia Nervosa  Share Strong Drive to be Thin  Largely a Female Problem  Largely a Westernized Problem  Largely an Upper SES Problem  Mortality may result  Binge-eating disorder

3.  Clinical Description  Binging – Eat Large Amounts of Food – Eating is Out of Control  Binging – Eat Large Amounts of Food – Eating is Out of Control  Belief that popularity and self-esteem are determined by weight and body shape  Compensatory Behaviors – Purging via Self-Induced Vomitting Laxatives, Diuretics, Exercise, Fasting  Belief that popularity and self-esteem are determined by weight and body shape  Compensatory Behaviors – Purging via Self-Induced Vomitting Laxatives, Diuretics, Exercise, Fasting

4.  Subtypes  Purging (most common)  Vomiting, laxatives, or diuretics  Nonpurging  Exercise and/or fasting  6-8% of Bulimics  not in DSM-5 due to low rate  Most are within 10% of normal weight  Subtypes  Purging (most common)  Vomiting, laxatives, or diuretics  Nonpurging  Exercise and/or fasting  6-8% of Bulimics  not in DSM-5 due to low rate  Most are within 10% of normal weight

5.  Medical Consequences Salivary Gland Enlargement  Salivary Gland Enlargement  Eroded Dental Enamel  Electrolyte Imbalance  Intestinal Problems  Calluses on Fingers and Hands  Kidney failure  Cardiac arrhythmia  Seizures  Permanent colon damage Salivary Gland Enlargement  Salivary Gland Enlargement  Eroded Dental Enamel  Electrolyte Imbalance  Intestinal Problems  Calluses on Fingers and Hands  Kidney failure  Cardiac arrhythmia  Seizures  Permanent colon damage

6. 90-95% are Women, 6-8% College Women  90-95% are Women, 6-8% College Women  White; Middle-to-Upper Middle Class  Onset 10-21 Years of Age  About 2.8% Population Overall  Chronic if Left Untreated  Bulimia in men, 5-10% male  Caucasian, middle to upper class  Typically gay or bisexual  Athletes with weight regulations  Onset = older age range 90-95% are Women, 6-8% College Women  90-95% are Women, 6-8% College Women  White; Middle-to-Upper Middle Class  Onset 10-21 Years of Age  About 2.8% Population Overall  Chronic if Left Untreated  Bulimia in men, 5-10% male  Caucasian, middle to upper class  Typically gay or bisexual  Athletes with weight regulations  Onset = older age range

7.  Associated Features  More Severe Form: Purging Type  Most Have Other DSM Disorders  Paradoxically: – Purging is an Inefficient Means to Reduce Weight  A Closely Related Disorder – Binge-Eating Disorder (new to DSM)  More Severe Form: Purging Type  Most Have Other DSM Disorders  Paradoxically: – Purging is an Inefficient Means to Reduce Weight  A Closely Related Disorder – Binge-Eating Disorder (new to DSM)

8.  Marked distress because of binge eating but do not engage in extreme compensatory behaviors and therefore cannot be diagnosed with bulimia  Marked distress because of binge eating but do not engage in extreme compensatory behaviors and therefore cannot be diagnosed with bulimia  Often found in weight-control programs 20%  50% among candidates for bariatric surgery  Better response to treatment  Often found in weight-control programs 20%  50% among candidates for bariatric surgery  Better response to treatment

9.  Associated Features  Many medically obese  Older, and have more psych distress / disorders than non-binging obese  Concerned about shape and weight  Many medically obese  Older, and have more psych distress / disorders than non-binging obese  Concerned about shape and weight

10.  Lifetime prevalence: 2.8%  12-month prevalence: 1.2%  Lifetime prevalence: 2.8%  12-month prevalence: 1.2%

11.  Clinical Description  Relentless pursuit of thinness  Often begins with dieting  Morbid Fear of –  Relentless pursuit of thinness  Often begins with dieting  Morbid Fear of – –  Deliberate Weight Loss  Life-Threatening Consequences  Deliberate Weight Loss  Life-Threatening Consequences

12.  Two Subtypes  Restricting Type – Excessive Dieting  Restricting Type – Excessive Dieting  Binge-Eating-Purging Type Rely on Purging; Eat less during Binges, & purge more consistently than Bulimics About Half of All Cases More Impulsive Behavior  Binge-Eating-Purging Type Rely on Purging; Eat less during Binges, & purge more consistently than Bulimics About Half of All Cases More Impulsive Behavior

13.  Medical Consequences  Amenorrhea  Dry Skin  Brittle Hair or Nails  Sensitivity to Cold  Lanugo  Heart Problems  Electrolyte Imbalance  Amenorrhea  Dry Skin  Brittle Hair or Nails  Sensitivity to Cold  Lanugo  Heart Problems  Electrolyte Imbalance

14.  Associated Features and Facts  Begins Early in Adolescence  Body image disturbance  Pride in diet and control  Rarely seek treatment  Perfectionistic High-Achievers  All-or-None Thinking  Obsessive and Orderly  Comorbid DSM Disorders – Obsessive-Compulsive Disorder – Substance Abuse – Suicide – Anxiety – Mood disorders (71%)  Begins Early in Adolescence  Body image disturbance  Pride in diet and control  Rarely seek treatment  Perfectionistic High-Achievers  All-or-None Thinking  Obsessive and Orderly  Comorbid DSM Disorders – Obsessive-Compulsive Disorder – Substance Abuse – Suicide – Anxiety – Mood disorders (71%)

15.  More female than males  Caucasian, middle to upper class  Onset = age 13 to 18  Chronic  Resistant to treatment  Lifetime prevalence:.6%  More female than males  Caucasian, middle to upper class  Onset = age 13 to 18  Chronic  Resistant to treatment  Lifetime prevalence:.6%

16.  Causes  Social and Cultural Factors – Thinness Equals Success – Has Increased Over Time  North American minority populations  Immigrants to western cultures  Increase in eating disorders  Increase in obesity  Cultural values  Standards for body image  Media – Sets Impossible Idealized Images – Promotes body image and weight as frequent issues  Social and Cultural Factors – Thinness Equals Success – Has Increased Over Time  North American minority populations  Immigrants to western cultures  Increase in eating disorders  Increase in obesity  Cultural values  Standards for body image  Media – Sets Impossible Idealized Images – Promotes body image and weight as frequent issues

17.  Causes  When Food is Restricted… –  When Food is Restricted… –

18.  Causes  Family Influences – Successful and Driven – Concerned About Appearances – Eager to Maintain Harmony – Deny or Ignore Conflicts – Lack of Open Communication  Family Influences – Successful and Driven – Concerned About Appearances – Eager to Maintain Harmony – Deny or Ignore Conflicts – Lack of Open Communication

19.  Causes Biological Influences  Biological Influences – Runs in Families – Unclear What is Inherited – Modeling Mommies??  Psychological Influences – Diminished Sense of Control –Family, interpersonal issues of control – Low Self-Esteem Biological Influences  Biological Influences – Runs in Families – Unclear What is Inherited – Modeling Mommies??  Psychological Influences – Diminished Sense of Control –Family, interpersonal issues of control – Low Self-Esteem

20.  Anorexia  No demonstrated efficacy  Bulimia  Antidepressants  May enhance psychological treatment  No long-term efficacy  Anorexia  No demonstrated efficacy  Bulimia  Antidepressants  May enhance psychological treatment  No long-term efficacy

21.  Cognitive-behavior therapy (CBT)  Treatment of choice  Target problem eating behaviors  Target dysfunctional thoughts  Interpersonal psychotherapy  Improve interpersonal functioning  Similarly effective, long-term  Cognitive-behavior therapy (CBT)  Treatment of choice  Target problem eating behaviors  Target dysfunctional thoughts  Interpersonal psychotherapy  Improve interpersonal functioning  Similarly effective, long-term

22.  Cognitive-behavior therapy (CBT)  Interpersonal psychotherapy  As effective as CBT  Medications  Prozac  No benefit  Meridia  Possible benefits  Cognitive-behavior therapy (CBT)  Interpersonal psychotherapy  As effective as CBT  Medications  Prozac  No benefit  Meridia  Possible benefits

23.  Family involvement  Communication about eating/food  Attitudes about body shape  Long-term prognosis  Poorer than bulimia  Weight restoration  May require hospitalization  Target dysfunctional attitudes  Body shape  Control  Thinness = worth  Family involvement  Communication about eating/food  Attitudes about body shape  Long-term prognosis  Poorer than bulimia  Weight restoration  May require hospitalization  Target dysfunctional attitudes  Body shape  Control  Thinness = worth

24.  ---------------------------------------------------- ---------------------------------------------------- ------------------------------------------------------ ------------------------------------------------------  ---------------------------------------------------- ---------------------------------------------------- ------------------------------------------------------ ------------------------------------------------------

25. Rapid increases in prevalence –U.S. adults 1991 = 12% 2000 = 30.5% 2002 = 30.6% 2004 = 32.2% 2008 = 33.8% 2010 = 35.7% –Developing nations –Health Risks –70% of U.S. adults overweight –BMI versus weight Obesity—Statistics

26.  Spread of modernization  Inactive, sedentary lifestyle + high fat foods  Genetics  30% of the cause  Biological factors  Initiation and maintenance of eating  Psychosocial factors  Impulse control, affect regulation, attitudes Causes of Obesity

27. Disordered Eating Patterns in Cases of Obesity  Night eating syndrome  Associated with obesity  1/3 of daily calories consumed  Patients are awake  No binge eating

28.  Progression from least to most intrusive  Self-directed weight loss programs  Commercial self-help programs  Behavior modification programs  Bariatric surgery  15% of patients who have bariatric surgery fail to lose significant weight  Efficacy  Moderate for adults  Higher for children and adolescents  Family involvement Obesity Treatment

29. Are Eating Disorders Are Eating Disorders a Form of Addiction? a Form of Addiction?

30. v Severe Craving v Loss of Control v Used to Cope With Negative Feelings v Preoccupied with Substance v Unsuccessful Attempts to Quit v Denial v Adverse Psychosocial Consequences v Severe Craving v Loss of Control v Used to Cope With Negative Feelings v Preoccupied with Substance v Unsuccessful Attempts to Quit v Denial v Adverse Psychosocial Consequences

31.  Rumination Disorder  Regurgitating and Reswallowing Food  Disorder of Infancy--Adolescence  Can Occur With Bulimia  “Failure to Thrive Syndrome”  Regurgitating and Reswallowing Food  Disorder of Infancy--Adolescence  Can Occur With Bulimia  “Failure to Thrive Syndrome”

32.  Infants and MR Populations  Eating Non-Nutritive Substances – paint, string, hair, feces,  Infants and MR Populations  Eating Non-Nutritive Substances – paint, string, hair, feces,  Pica