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Chapter 11 - Eating Disorders (Theories # (Hilde Bruch Developed a …
Chapter 11 - Eating Disorders
DSM-5
Bulimia Nervosa
Characterized by binges
Key Diagnosis Features
Repeated bouts of uncontrolled overeating during a limited period of time
Eat objectively more than most people would
Out of control of ones eating
Once a week for at least 3 months
Fluctuating healthy weight
vs anorexia
Binge Eating Disorder
Engage in repeated eating binges during which they feel no control
Comments
2/3 become overweight or obese
Binges range from 1300 - 3500 calories
Key Diagnosis Features
Recurrent episodes of binge eating
Guilt afterwards
1-2 binges (mild) // 14+ (extreme)
Eating alone because guilt
Eating large amounts when not hungry
Eating more rapidly than normal
Anorexia Nervosa
Key Diagnosis Features
Refusal to maintain more than 85% of normal body weight
Intense fears of becoming overweight
Distorted view of weight and shape
Amenorrhea (loss of menstrual cycle)
Comments
Most dangerous out of all 3
Like the attention it brings
Peak age is 14-15
Mostly women
Distorted thought process about image
Must be "perfect in every way"
I can avoid feelings if I starve myself
2 Types
Restricting Type
Lose weight by cutting out sweets and fattening snacks, eventually eliminating all foods
Show no variability in diet
Binge-Eating/Purging Type
Lose weight by forcing themselves to vomit by abusing laxatives
May engage in eating binges
Clinical Picture (Psychological)
Depression
Anxiety
Low Self-Esteem
Insomnia
Substance Abuse
Obsessive-compulsive Disorder
Perfectionism
Medical Problems
Amenorrhea
Low body temp
Low blood pressure
Body swelling
Reduced bones density
Slow heart rate
Metaolic and electrolyte imbalance
Dry skin, brittle nails
Poor ciruclation
Lanugo
Bulimia vs Anorexia
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Bulimia
More concerned about pleasing others, being attractive
Tend to be more sexually experienced and active
Alcohol abuse
More keep it in the closet
1/2 women experience amenorrhea
1/3 of people with bulimia display characteristics of a personality disorder
Anorexia
Obsessive-compulsive behaviors
3x more common
Need for social approval before the development
Can see it from their looks and personalities
All women experience amenorrhea
Similarities
Relationship with food
Substance abuse
Fear of becoming obese
High female to male ratio
Causes
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Leading Factors
Psychological Problems
ego, cognitive, and mood disturbances
Biological Factors
Sociocultural Conditions
family, societal, multicultural
Theories
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Hilde Bruch
Developed a psychodynamic theory
Assumption that eating disorder symptom are the overty pathological manifestations of underlying conflicts that the client has been unable to resolve
Bruch's theory also contains several cognitive factors... Tension states = "need to eat"
Validating and Listening
Self-soothe
Self-efficacy
Strengthen their ego
Argued that eating disorders are the results of disturbed mother-child interactions. Lead to serious ego deficiencies in the child
Cognitive Theories
Emphasize the biases in people's beliefs pertaining to body size and eating
Perfectionism, feeling of ineffectiveness, reduced sensitivity, obsessive thoughts, all or nothing thinking
Biological Theories
Relatives of people with eating disorders are up to 6x more likely to develop the disorder themselves
Low serotonin levels relations
Puberty seems to be a critical period
Brain Control of Hunger
Hypothalamus
Lateral: involved in "turning on" eating
Ventromedial: involved in "being satisfied" with eating
Societal Pressures
Western standards of female attractiveness
Media, sex role, economic, racial and ethnic context
Miss America & Playboy
Family Environment
Abnormal interactions and forms of communication within a family may set the stage for an eating disorder
Salvador Minuchin cites "enmeshed family patterns"... family that doesn't understand boundaries
Gender Differences
Western society's double standard
Men are more likely to exercise
Women are more likely to diet
Depression
mood disorders set the stage for eating disorders
Treatment
2 main goals
Correct dangerous eating patterns
Address broader psychological and situational factors that have led to, and are maintaining, the eating problem
Anorexia Nervosa
Regain lost weight
Eat normally again
CBT usual orientation
Most Popular Weight Resoration
Combination of supportive nursing care, nutrition counseling, and normal-calorie diets
Most Popular Treatment
Helper to achieve success and fulfillment from pursuits unrelated to weight and shape
Attempts to treat anorexia with pills have not been successful
Family Therapy
Treatment of separation and boundaries
Overcome high parental expectations
Bulimia Nervosa
Eliminate binge-purge patterns
Establish good eating habits
Eliminate the underlying cause of bulimic patterns
CBT
Limit eating behavior and thoughts about food, weight, and shape
Interpersonal Therapy (IPT); seeks to improve interpersonal functioning
Antidepressant Medication
Helps as many as 40% of patients
Relapse
Triggered by stress
More likely in
Longer history
Vomited frequently
Histories of substance abuse
Lingering interpersonal problems
Binge Eating Disorder
Similar with Bulimia Nervosa's treatment goals
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Exercise plans
Individual experiences
Sigmuend Frued... Psycodynamic View