Eating Disorders

Began to come into the DSM-IV-TR because: Increased prevalence of dieting,

Preoccupation with body, Culturally specific
Bulimia Nervosa
1. Recurrent episodes of binge eating
a. Eating an amount of food that is larger than most people would eat during a
similar period of time
b. A sense of lack of control over eating during the episode
2. Recurrent inappropriate compensatory behavior to prevent weight gain
a. Frequency → 1+/week for 3 months; purging is not effective in
decreasing calories, and has to be immediate. And laxatives are
not effective.
3. Self-evaluation is unduly influenced by body shape/weight
4. Does not occur exclusively within an episode of anorexia
a. Is not reflective or Kleine-Levin syndrome: excessive sleeping, eating, sexuality
Specifiers
- Full or partial remission: none/some of the criteria has been met for a sustained time
- Mild-extreme severity → based on number of compensatory behaviors
1-3+>13/week
- No longer have purging and nonpurging subtypes bc nonpurging is not common
Medical complications
1. Body weight / salivary gland enlargement / dental enamel, chemical imbalance (electro.)
arrhythmia, renal failure, constipation and colon damage (laxative use)
Bulimia epidemiology
- Onset: 15-20y/o – lifetime prevalence 0.28-1% (.46-1.5% women, 0.05-.08% men); high
income countries, a lot of social competition
- If continues for 5 years, will persist – chronic drive for thinness
- Increased risk: childhood obesity, early pubertal maturation, low self-esteem,
mood/social anxiety, physical, sexual abuse
Associated psychological disorders with BN
- Anxiety: 75% – social + GAD – not bi-directional, BN for anxiety, not anxiety for BN
- Substance abuse: 30% – bi-directional, related to the impulsivity aspect
- Mood disorders: 50-90%, ¼-⅓ experience suicidal ideation/attempts
Is BN a way of coping with depression (1) OR is depression a reaction to BN(2)
- 1: sense of control, being able to control weight when can’t control else, low self esteem,
forgetting to eat (could just be anhedonia to eating (depression symptom))
- 2: helplessness, not getting results you want / lack of nutrients, excluding self from social
situations, learned helplessness, lack of fuel in body = low in motivation
Treatment for BN
- Psychoeducation, addressing dysfunctional thoughts about body, weight and eating
- Feeding: 5-6 regular small meals a day
 - Interpersonal therapy: interpersonal problems related to the ED
- Behavior therapy: engaging in alternative activities
Anorexia nervosa
1. Restriction of energy intake relative to requirements, leading to significantly low body
weight in the context of age, sex, developmental trajectory and physical health
a. A ‘refusal to maintain body weight or above a minimally normal weight for age’
2. Intense fear of gaining weight or becoming fat, despite being underweight
3. Self perception (1+)
a. Distorted self-view of body shape or weight
b. Self-evaluation unduly emphasizes body shape weight
c. Denial of the seriousness of the current low body weight
Subtypes
(1) Restricting type (no purging in last 3 months) (2) binge eating/purging // crossover is
common
Medical and psychological comorbidities
- 1. Starvation 2. Amenorrhea (absence/imbalance of menstrual) 3. dry/yellow skin 4.
Lanugo (fine downy fuzzy hair on limbs n cheeks) 5. Sensitive to cold 6. Cardio issues
- Psych: anxiety, mood, substance abuse. (2) OCD (esp with AN-restricting) – compulsion
around the obsession of body, all or nothing belief (labeling foods as good or bad)
- Suicide: 18x more likely
Treatment of AN
- Hospitalization and refeeding for weight gain
- Family approach/therapy: encouraging social support, families may be contributing
- Motivational interviewing: forming things that would provide more motivation for them
Binge eating disorder (came into DSM5 first time)
- Recurrent binge eating (similar to BN)
- A sense of lack of control over eating during episode
- Occur at least 1x/week for 3 months
- The binge-eating episodes are associated with three or more of the following
- Eating Much more rapidly than normal
- Eating until feeling uncomfortably full
- Eating large amounts of foods when not being physically hungry
- Eating alone because of feeling embarrassed by how much one is eating
- Feeling disgusted with oneself, depressed, or very guilty afterward
- Marked distress regarding binge eating: feeling distress after engaging in binge eating
- The binge eating occurs, on average, at least once a week for 3 months
- No recurrent use of inappropriate compensatory behavior
- Does not occur exclusively during the course of BN or AN
BED epidemiology
- Most common ED in males, can occur in late adulthood, Presentation differs across
ethnoracial groups, Dieting tends to follow the development of binge eating – reverse of
 BN, Relapsing course > BN/AN, 20% of people in weight control programs and 50% of
bariatric surgery patients (losing weight via surgery), Suicide - 25%
Is BED the same as an addiction to food or just being a compulsive eater?
- There is stress from the behavior, but still an impulse. There is an impulse and a
compulsion to excessively eat but not addictive.
Treatment for BED
- CBT better than no medication/treatment, combination
- Interpersonal therapy, identifying food difficulties
- Dialectical behavior therapy: focuses on managing negative emotions and controlling
impulsive behavior
Risk factors: check slide 19 for image - table 1 + table 2 (biological)
Gender and ED: 5-10% are males, possibly higher
- Later age of onset, homo/bisexual (BN-not wanting to be in the body you’re in/trauma),
sports that regulate weight (wrestling/aesthetic sports(ballet) – 42% of aes. Athletes have
- Often comorbid with depression, substance disorders, anxiety, excessive exercise
Social/cultural causes of ED
- Prevalent in cultures that place value on thinness, media, beauty standards, parental
factors, food changes
- Spike of ED hospitalizations during covid: seperated from outside, less gym availability,
low self-esteem, comparison with others online, constantly at home
- African americans: less body DISsatisfaction, fewer weight concerns
Dieting and EDs
- Diet in adolescence: 8x more likely to develop ED, 300% greater risk of obesity
- False hope syndrome= low self-esteem + food preoccupation+negative mood = ED
Cognitive causes of ED
- Hilda Bruch: AN is a struggle for autonomy, competence, control, respect
- Perfectionism: ‘i can control what goes in my body if not anything else’
- Low self-esteem, obsessive thinking, black and white/all or nothing thinking
- Trigger – binge eating – purging = more distress
AN-R: emotional eating + fear of losing control
AN-BP: overeating from emotions, not fear of losing control: BN - emotional eating
Treatment of EDs – medication is not very effective
AN: olanzapine - atypical antipsychotic: weight gain is a positive
BN: antidepressant (i.e. prozac) - can reduce binge and purging but not long term (not for AN)