Eating Disorders

Anorexia (1%) Bulimia (1-3%) Binge-eating disorder (unknown) 10:1 women to men (varies by age) Onset in adolescence Highest mortality rate for any disorder

Clinical Picture - Anorexia Distorted body image Intense fear of weight gain Panic if weight stays same Up to 20% die Resistant to treatment 15% below expected body weight (DSM) Treatment sought 20-30% below

Clinical Picture - Anorexia Denial/lack of insight Perfectionistic/OCD features Preoccupation with food

Medical Consequences - Anorexia Cessation of menstruation Dry skin Brittle hair/nails Sensitivity to cold Cardiovascular problems Low blood pressure Low heart rate

Clinical Picture - Bulimia Normal to average weight May consume 30x normal caloric intake Subjective vs. objective binges A cycle of binging and purging Common on college campuses Depression, shame, guilt

Clinical Picture - Bulimia Out of control (not like anorexia) Rising prevalence Purging is not effective Reduces approx 50% of caloric intake Laxatives have little effect Success in life will be determined by body

Medical Consequences of Bulimia Enlarged salivary glands Puffy face Eroded dental enamel Upset sodium/potassium levels Cardiac arrhythmia Seizures Renal failure Permanent colon damage from laxatives Calluses on fingers/hands

Clinical Picture – Binge Eating Disorder Binges, without compensation 20% of obese individuals 50% among those seeking bariatric surgery Same concerns re: weight/shape 33% binge to alleviate distress

Cross Cultural Considerations Western cultures Recent immigrants increase prevalence after moving Lower rates among African American & Asian Americans Associated with higher social class

What Causes Eating Disorders? Probably multiple sources 1. Social Dimensions 2. Biological Dimensions 3. Psychological Factors

1. Social Dimensions Body image tied (in middle to upper class) with Happiness Self-worth Success Desirable body types change, like fashion (but more slowly)

Societal Pressure to be Thin? 60% of Playboy & Miss America meet weight requirements for anorexia Media portrayal of muscular men Will this have an effect? Overweight men in media Increase on exercise & diet

SATISFACTION WITH BODY SIZE Women rate their body shape as heavier than their ideal and heavier than what they think is attractive Adapted from A.E. Fallon & P. Rozin, “Sex Differences in Perception of Desirable Body Shape.” Journal of Abnormal Psychology, 94 (1985):

SATISFACTION WITH BODY SIZE Adapted from A.E. Fallon & P. Rozin, “Sex Differences in Perception of Desirable Body Shape.” Journal of Abnormal Psychology, 94 (1985): male’s attractive female’s current female’s attractive female’s ideal

SATISFACTION WITH BODY SIZE Men rate their body shape as close to both their ideal and what they think is attractive Adapted from A.E. Fallon & P. Rozin, “Sex Differences in Perception of Desirable Body Shape.” Journal of Abnormal Psychology, 94 (1985):

SATISFACTION WITH BODY SIZE Adapted from A.E. Fallon & P. Rozin, “Sex Differences in Perception of Desirable Body Shape.” Journal of Abnormal Psychology, 94 (1985): male’s current male’s ideal male’s attractive female’s attractive

Family Influences Families of anorexics: Successful Hard-driving Concerned with appearance Eager to maintain harmony (deny conflict or negative feelings) Mothers want daughters to be thin, likely dieting

2. Biological Dimensions Genetic component (4- 5x more likely) Inherited personality (impulsivity, emotional instability)

3. Psychological Dimensions Decreased sense of control and confidence in abilities Perfectionistic Anxiety Relief by purging

Treating Eating Disorders With two types of intervention: 1. Drug Treatments 2. Psychological

Drug Treatments Not effective for anorexia Some evidence for bulimia Antidepressants 47-65% reduction binge/purge (Prozac) Probably not effective alone

Psychological Treatments – Bulimia and BED CBT (Fairburn) Psychoeducation re: medical consequences Eat regular, small meals Dysfunctional thoughts re: shape, weight, food Coping for resisting impulses Interpersonal Therapy Also effective for binge eating Self-help can be useful for BED

IPTCBTBT treatment percent still in remission 10 PSYCHOLOGICAL TREATMENTSposttreatment 1 year 6 Months

Psychological Treatments - Anorexia Restore weight Often inpatient (below 70% or rapid loss) Poor predictor alone of recovery Outpatient CBT to address dysfunctional beliefs Efforts to include family