Eating Disorders & Obesity

ANOREXIA NERVOSA

BULIMIA NERVOSA

BINGE-EATING DISORDER

OBESITY

diagnostic criteria

prevalence

treatments

relentless pursuit of thinness; involves behaviors that result in clinically low body weight

change from DSM IV: amenorrhea is no longer a diagnostic criterion

intense fear of gaining weight or becoming 'fat'

disturbance in the way in which one's body weight or shape is experienced, persistent lack of recognition of the seriousness of the low body weight

look painfully emaciated, deny having any problem, feel fulfiled by their weight loss / ambivalent

two types:

restricting type

binge-eating / purging type

making every effort to limit the quantity of the food consumed, tightly controlled caloric intake

restrictive eating + binging & purging

out-of-control consumption of an amount of food & removing the food they have eaten from their bodies (self-induced vomiting, misuse of laxatives, diuretics, and enemas; excessive exercise or fasting)

greatly admired by others with eating disorders; distorted values

diagnostic criteria

prevalence

treatments

uncontrollable binge eating and efforts to prevent gaining weight by self-induced vomiting or excessive exercise

recurrent episodes of binge eating, recurrent inappropriate compensatory behaviors

both must occur, on average, at least once in a week for 3 moths (more relaxed criteria compared to the DSM-IV)

self-evaluation is heavily influenced by body shape and weight

difference between bulimia nervosa & binging/purging type of anorexia nervosa

weight: anorexia = severely underweight, bulimia = normal weight/slightly overweight (the diagnosis of anorexia trumps the diagnosis of bulimia because of the far greater mortality rate!)

disgusted w/ their behavior (diff from anorexia); shame, guilt, self-depreciation (so they conceal their behaviors)

diagnostic criteria

prevalence

treatments

NEW addition to the DSM-5

similar to bulimia, BUT the person does not engage in any form of inappropriate compensatory behaviors

recurrent episodes of binge eating (rapid eating, uncomfortably full, eating when not feeling hungry, feelings of guilt and embarrassment after)

on average once a week for 3 months (same as bulimia)

16- to 20-year-olds

21 to 24 years old (a bit later)

30 to 50 year olds (latest)

females most likely (men could be underdiagnosed because of the stereotype that these are 'female' disorders)

men: dissatisfaction often involves a wish to become more muscular (overexercising as a means of weight control)

also: gay and bisexual men have higher rates of eating disorders (they value, like heterosexual men, attractiveness and youth in their partners)

most common: 2% lifetime (higher in obese people)

1% lifetime

1% lifetime (in its severe form is as common as shizophrenia)

medical complications

5x higher mortality rate; 3% of people die from consequences

look extremely unwell, lanugo (hair on face, neck, arms, back, and legs), thin hair, yellow toned skin (esp palms and feet)

purplish-blue tinge due to problems w/ temp regulation (cold)

low blood pressure, feeling tired, weak, dizzy, fainting, vitamin B deficiency (could account for the cognitive changes), increased risk for osteoporosis later in life

can die from heart arrhythmias (caused by imbalances in electrolytes such as pottasium -- can also result in kidney damage and renal failure)

laxtative abuse = dehydration, electrolyte imbalances, kidney disease, damaged bowels and gastrointestinal tract

medical complications

2x higer mortality rate

electrolyte imbalances (pottasium), damage to the heart (using ipecac syrup -- vomit-inducing poison), calluses on hands (from sticking them down their throat), tears to the throat

damaged teeth (acidic stomach contents), brushing teeth damages them even more, mouth ulcers, dental cavities, small red dots around the eyes (pressure of throwing up), swollen salivary glands, puffy cheeks...

over the very long term, recovery is possible (62.8% recovered)

still harbor residual food issues even after recovery

high rates of attempted / completed suicide

in the long term, prognosis looks quite good

high rates of clinical remission

causal factors

genetics (family increased risk), heritable (strong genetic component -- ab as strong as in bipolar disorder and shizophrenia)

every eating disorder : major depressive disorder in relatives

anorexia : OCD and OC personality disorder

causal factors

alcohol and drug dependence in relatives

genetics; heritable (strong genetic component -- ab as strong as in bipolar disorder and shizophrenia)

chromosome 12 (associations to shizophrenia and neuroticism, metabolic factors (pshychiatric & metabolic underpinnings)

brain abnormalities: hypothalamus, frontal (monitoring the pleasantness of stimuli) and temporal (body image perception) cortex

biological weight 'set point'

neurotransmitters: disruption in the serotonergic system (good w/ antidepressants) leads to disruptions in other systems (dopamine)

social pressures toward thinness (ex: Fiji)

family influences: family dysfunction (rigid, less cohesive, poorer communications, perfectionist tendencies, dieting, high expectations, critical comments!, parent-child conflict..)

individual risk factors: gender, internalizing the thin ideal, perfectionism, negative body image, dieting, negative emotionality

medical attention for short-term improvement; successful

medications: antidepressants (not esp effective), antipsychotic olanzapine (may be beneficial + weight gain)

family therapy: three phases (refeeding, new pattern of family relationships, and development of healthy relationships), relatively good approach

CBT: very effective, not so much for those with more long-standing problems

CBT: leading treatment; best alone without medications, behavioral and cognitive components

medications: antidepressants (good)

dialectical behavior therapy: more individualized CBT

transdiagnostic approaches: IPT, CBT-E (works more quickly)

medications: antidepressants, appetite suppressants, anticonvulsants

IPT, CBT > behavioral treatments

increased risk for many health problems: high cholesterol, hypertension, heart disease, arthritis, diabetes, and cancer, reduction in life expectancy (5-20 years)

less than third of the population is at a health weight (2/3 are overweight)

with the exception of Asians, more prevalent in ethnic minorities

higher in men than in women (exception of African Americans)

not in the DSM-5; although the inability to restrain eating despite the wish to do so is similar to symptoms of substance abuse and drug dependence AND both may concern problems in motivation, reward, and inhibitory control

genetics highly associated, inability to produce leptin (but mostly resistant to its effects), disruptions in ghrelin (appetite stimulator), Prader-Willi syndrome (high levels of ghrelin)

sociocultural factors: fast life, culture of supersizing, overconsumption of ultraprocessed foods (needs more to get the same amount of 'high'), issue of accessibility, food advertising

family influences: eating as showing love, mothers smoking while pregnant, attitudes toward food ,overfeeding infants, obesity in someone close to us (depends on the closeness of the relationship)

treatments

lifestyle modifications

medications

bariatric surgery

behavioral intervention: low-calorie diet, exercise

positive benefits, but modest (weight loss w/ dieting is not very well maintained in the long run)

obesity is resistant to psychological methods of treatment? -- importance of early intervention

orlistat (xenical) = reducing fat that can be absorbed once it enters the gut

lorcaserin (Belviq) = targets serotonin

naltrexone + bupropion (COntrave) = drug and alcohol addiction + depression + smokers

modest clinical benefits

sibutramine (Meridia) = withdrawn after widespread use for many years bc of safety concerns

most effective long-term treatment for the morbidly obese

reducing stomach storage capacity and shortening the intestine length