1. Eating Disorders

2. 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

3. 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

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

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

6. 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

7. 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

8. 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

9. 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

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

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

12. 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)

13. 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

14. 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): 102-105 2.02.53.03.54.04.55.0

15. 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): 102-105 2.02.53.03.54.04.55.0 male’s attractive female’s current female’s attractive female’s ideal

16. 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): 102-105 2.02.53.03.54.04.55.0

17. 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): 102-105 male’s current male’s ideal male’s attractive female’s attractive 2.02.53.03.54.04.55.0

18. 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

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

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

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

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

23. 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

24. 50 40 30 20 IPTCBTBT treatment 60 70 percent still in remission 10 PSYCHOLOGICAL TREATMENTSposttreatment 1 year 6 Months

25. 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