abnormal lecture ch09
TRANSCRIPT
1Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 9Slides & Handouts by Karen Clay Rhines, Ph.D.
Chapter 9Chapter 9
Eating DisordersEating Disorders
2Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 9
Eating DisordersEating Disorders
Although not historically true, current Western beauty standards equate thinness with health and beauty Thinness has become a national obsession!
There has been a rise in eating disorders in the past three decades
Two main diagnoses: Anorexia nervosa
Bulimia nervosa
3Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 9
4Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 9
Anorexia NervosaAnorexia Nervosa
There are two main subtypes: Restricting type
Lose weight by restricting “bad” foods, eventually restricting nearly all food
Show almost no variability in diet
Binge-eating/purging type Lose weight by vomiting after meals, abusing
laxatives or diuretics, or engaging in excessive exercise
Like those with bulimia nervosa, people with this subtype may engage in eating binges
5Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 9
Anorexia NervosaAnorexia Nervosa
About 90%–95% of cases occur in females The peak age of onset is between 14 and
18 years Between 0.5% and 2% of females in
Western countries develop the disorder Many more display some symptoms
Rates of anorexia nervosa are increasing in North America, Japan, and Europe
6Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 9
Anorexia NervosaAnorexia Nervosa
The “typical” case: A normal to slightly overweight female has been on
a diet
Escalation to anorexia nervosa may follow a stressful event
Separation of parents
Move or life transition
Experience of personal failure
Most patients recover However, about 2% to 6% become seriously ill and die as
a result of medical complications or suicide
7Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 9
Anorexia Nervosa: The Anorexia Nervosa: The Clinical PictureClinical Picture
The key goal for people with anorexia nervosa is becoming thin The driving motivation is fear:
Of becoming obese
Of giving in to the desire to eat
Of losing control of body shape and weight
8Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 9
Anorexia Nervosa: The Anorexia Nervosa: The Clinical PictureClinical Picture
Despite their dietary restrictions, people with anorexia are preoccupied with food This includes thinking and reading
about food and planning for meals
This preoccupation may be the result of food deprivation rather than its cause
Famous 1940s “starvation study” with conscientious objectors
9Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 9
Anorexia Nervosa: The Anorexia Nervosa: The Clinical PictureClinical Picture
People with anorexia nervosa also think in distorted ways: Often have a low opinion of their body shape
Tend to overestimate their actual proportions Adjustable lens assessment technique
Hold maladaptive attitudes and misperceptions “I must be perfect in every way”
“I will be a better person if I deprive myself”
“I can avoid guilt by not eating”
10Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 9
Anorexia Nervosa: The Anorexia Nervosa: The Clinical PictureClinical Picture
People with anorexia may also display certain psychological problems: Depression (usually mild) Anxiety Low self-esteem Insomnia or other sleep disturbances Substance abuse Obsessive-compulsive patterns Perfectionism
11Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 9
Anorexia Nervosa: Medical Anorexia Nervosa: Medical ProblemsProblems
Caused by starvation: Amenorrhea
Low body temperature
Low blood pressure
Body swelling
Reduced bone density
Slow heart rate
Metabolic and electrolyte imbalances
Dry skin, brittle nails
Poor circulation
Lanugo
12Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 9
Bulimia NervosaBulimia Nervosa
Bulimia nervosa, also known as “binge-purge syndrome,” is characterized by binges: Bouts of uncontrolled overeating during
a limited period Eats more than most people would/could eat
in a similar period
13Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 9
Bulimia NervosaBulimia Nervosa
The disorder is also characterized by compensatory behaviors, such as: Vomiting
Misusing laxatives, diuretics, or enemas
Fasting
Exercising excessively
14Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 9
15Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 9
Bulimia NervosaBulimia Nervosa
Like anorexia nervosa, about 90%–95% of bulimia nervosa cases occur in females
The peak age of onset is between 15 and 21 years
Symptoms may last for several years with periodic letup
16Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 9
Bulimia NervosaBulimia Nervosa
Patients are generally of normal weight Often experience weight fluctuations
Some may also qualify for a diagnosis of anorexia
17Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 9
18Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 9
Bulimia NervosaBulimia Nervosa
“Binge-eating disorder” may be a related diagnosis Symptoms include a pattern of binge
eating with NO compensatory behaviors (such as vomiting)
This condition is not yet listed in the DSM-IV-TR
19Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 9
Bulimia NervosaBulimia Nervosa
Teens and young adults have frequently attempted binge-purge patterns as a means of weight loss, often after hearing accounts of bulimia from friends or the media
In one study: 50% of college students reported periodic binges 6% tried vomiting 8% experimented with laxatives at least once
Surveys suggest that as many as 5% of women develop the full syndrome
20Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 9
Bulimia Nervosa: Bulimia Nervosa: BingesBinges
For people with bulimia nervosa, the number of binges per week can range from 2 to 40 Average: 10 per week
Binges are often carried out in secret Binges involve eating massive amounts of food
rapidly with little chewing Usually sweet foods with soft texture
Binge-eaters commonly consume more than 1000 calories (often more than 3000 calories) per binge episode
21Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 9
Bulimia Nervosa: Bulimia Nervosa: BingesBinges
Binges are usually preceded by feelings of tension and/or powerlessness
Although the binge itself may be pleasurable, it is usually followed by feelings of extreme self-blame, guilt, depression, and fears of weight gain and “discovery”
22Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 9
Bulimia Nervosa: Bulimia Nervosa: Compensatory BehaviorsCompensatory Behaviors
After a binge, people with bulimia nervosa try to compensate for and “undo” the caloric effects
The most common compensatory behaviors: Vomiting
Fails to prevent the absorption of half the calories consumed during a binge
Affects ability to feel satiated greater hunger and bingeing
Laxatives and diuretics Also almost completely fail to reduce the number of
calories consumed
23Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 9
Bulimia Nervosa: Bulimia Nervosa: Compensatory BehaviorsCompensatory Behaviors
Compensatory behaviors may temporarily relieve the negative feelings attached to binge eating Over time, however, a cycle develops in
which purging bingeing purging
24Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 9
Bulimia NervosaBulimia Nervosa
The “typical” case: A normal to slightly overweight female has
been on an intense diet
Research suggests that even among normal subjects, bingeing often occurs after strict dieting
For example, a study of binge-eating behavior in a low-calorie weight loss program found that 62% of patients reported binge-eating episodes during treatment
25Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 9
Bulimia Nervosa vs. Bulimia Nervosa vs. Anorexia NervosaAnorexia Nervosa
Similarities: Onset after a period of dieting Fear of becoming obese Drive to become thin Preoccupation with food, weight, appearance Elevated risk of self-harm or attempts at suicide Feelings of anxiety, depression, perfectionism Substance abuse Disturbed attitudes toward eating
26Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 9
Bulimia Nervosa vs. Bulimia Nervosa vs. Anorexia NervosaAnorexia Nervosa
Differences: People with bulimia are more worried about
pleasing others, being attractive to others, and having intimate relationships
People with bulimia tend to be more sexually experienced
People with bulimia display fewer of the obsessive qualities that drive restricting-type anorexia
People with bulimia are more likely to have histories of mood swings, low frustration tolerance, and poor coping
27Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 9
Bulimia Nervosa vs. Bulimia Nervosa vs. Anorexia NervosaAnorexia Nervosa
Differences: People with bulimia tend to be controlled by
emotion – may change friendships easily
People with bulimia are more likely to display characteristics of a personality disorder
Different medical complications: Only half of women with bulimia experience
amenorrhea vs. almost all women with anorexia
People with bulimia suffer damage caused by purging, especially from vomiting and laxatives
28Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 9
What Causes Eating What Causes Eating Disorders?Disorders?
Most theorists subscribe to a multidimensional risk perspective: Several key factors place individuals at risk
More factors = greater risk
Leading factors: Sociocultural conditions (societal and family
pressures)
Psychological problems (ego, cognitive, and mood disturbances)
Biological factors
29Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 9
What Causes Eating What Causes Eating Disorders? Disorders?
Societal PressuresSocietal Pressures Many theorists believe that current
Western standards of female attractiveness have contributed to increases in eating disorders Standards have changed throughout history
toward a thinner ideal Miss America contestants have declined in weight
by 0.28 lbs/yr; winners have declined by 0.37 lbs/yr
Playboy centerfolds have lower average weight, bust, and hip measurements than in the past
30Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 9
What Causes Eating What Causes Eating Disorders? Disorders?
Societal PressuresSocietal Pressures Certain groups are at greater risk
from these pressures: Models, actors, dancers, and certain
athletes Of college athletes surveyed, 9% met full
criteria for an eating disorder while another 50% had symptoms
20% of surveyed gymnasts met full criteria for an eating disorder
31Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 9
What Causes Eating What Causes Eating Disorders? Disorders?
Societal PressuresSocietal Pressures Societal attitudes may explain economic
and racial differences seen in prevalence rates In the past, white women of higher SES
expressed more concern about thinness and dieting
These women had higher rates of eating disorders than African American women or white women of lower SES
Recently, dieting and preoccupation with food, along with rates of eating disorders, are increasing in all groups
32Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 9
What Causes Eating What Causes Eating Disorders? Disorders?
Societal PressuresSocietal Pressures The socially accepted prejudice
against overweight people may also add to the “fear” and preoccupation about weight About 50% of elementary and 61% of
middle school girls are currently dieting
33Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 9
What Causes Eating What Causes Eating Disorders? Disorders?
Family EnvironmentFamily Environment Families may play an important role in
the development of eating disorders As many as half of the families of those
with eating disorders have a long history of emphasizing thinness, appearance, and dieting
Mothers of those with eating disorders are more likely to be dieters and perfectionistic themselves
34Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 9
What Causes Eating What Causes Eating Disorders? Disorders?
Family EnvironmentFamily Environment Abnormal family interactions and forms of
communication within a family may also set the stage for an eating disorder Minuchin cites “enmeshed family patterns” as
causal factors of eating disorders These patterns include overinvolvement in, and
overconcern about, family member’s lives
35Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 9
What Causes Eating Disorders? What Causes Eating Disorders? Ego Deficiencies and Cognitive Ego Deficiencies and Cognitive
DisturbancesDisturbances Bruch argues that eating disorders
are the result of disturbed mother–child interactions, which lead to serious ego deficiencies in the child and to severe cognitive disturbances
36Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 9
What Causes Eating Disorders? What Causes Eating Disorders? Ego Deficiencies and Cognitive Ego Deficiencies and Cognitive
DisturbancesDisturbances According to Bruch, parents may respond
to their children either effectively or ineffectively Effective parents accurately attend to a child’s
biological and emotional needs Ineffective parents fail to attend to child’s
internal needs; they feed when the child is anxious, comfort when the child is tired, etc.
There is some empirical support for Bruch’s theory from clinical reports
37Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 9
What Causes Eating What Causes Eating Disorders? Disorders?
Mood DisordersMood Disorders Many people with eating disorders,
particularly those with bulimia nervosa, experience symptoms of depression Theorists believe mood disorders may
“set the stage” for eating disorders
38Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 9
What Causes Eating What Causes Eating Disorders? Disorders?
Mood DisordersMood Disorders There is empirical support for the claim that
mood disorders set the stage for eating disorders: Many more people with an eating disorder qualify
for a clinical diagnosis of major depressive disorder than do people in the general population
Close relatives of those with eating disorders seem to have higher rates of mood disorders
People with eating disorders, especially those with bulimia nervosa, have low levels of serotonin
Symptoms of eating disorders are helped by antidepressant medications
39Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 9
What Causes Eating What Causes Eating Disorders? Biological Disorders? Biological
FactorsFactors Biological theorists suspect certain genes
may leave some people particularly susceptible to eating disorders Consistent with this model:
Relatives of people with eating disorders are 6 times more likely to develop the disorder themselves
Identical (MZ) twins with bulimia: 23% Fraternal (DZ) twins with bulimia: 9%
These findings may be related to low serotonin
40Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 9
What Causes Eating What Causes Eating Disorders? Biological Disorders? Biological
FactorsFactors Other theorists believe that eating
disorders may be related to dysfunction of the hypothalamus Researchers have identified two
separate areas that control eating: Lateral hypothalamus (LH)
Ventromedial hypothalamus (VMH)
41Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 9
What Causes Eating What Causes Eating Disorders? Biological Disorders? Biological
FactorsFactors Some theorists believe that the LH and VMH
are responsible for weight set point – a “weight thermostat” of sorts Set by genetic inheritance and early eating
practices, this mechanism is responsible for keeping an individual at a particular weight level
If weight falls below set point: hunger, metabolism binges
If weight rises above set point: hunger, metabolism
Dieters end up in a fight against themselves to lose weight
42Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 9
Treatments for Eating Treatments for Eating DisordersDisorders
Eating disorder treatments have two main goals: Correct abnormal eating patterns
Address broader psychological and situational factors that have led to and are maintaining the eating problem
This often requires the participation of family and friends
43Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 9
Treatments for Anorexia Treatments for Anorexia NervosaNervosa
The initial aims of treatment for anorexia nervosa are to: Restore proper weight
Recover from malnourishment
Restore proper eating
44Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 9
Treatments for Anorexia Treatments for Anorexia NervosaNervosa
In the past, treatment took place in a hospital setting; it is now often offered in an outpatient setting
In life-threatening cases, clinicians may need to force tube and intravenous feedings on the patient This may breed distrust in the patient and create a
power struggle
Most common technique now is the use of supportive nursing care and high-calorie diets Necessary weight gain is often achieved in 8 to 12
weeks
45Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 9
Treatments for Anorexia Treatments for Anorexia NervosaNervosa
Researchers have found that people with anorexia must overcome their underlying psychological problems to achieve lasting improvement
46Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 9
Treatments for Anorexia Treatments for Anorexia NervosaNervosa
Therapists use a mixture of therapy and education to achieve this broader goal, using a combination of individual, group, and family approaches One focus of treatment is building autonomy
and self-awareness
Therapists help patients recognize their need for independence and control
Therapists help patients recognize and trust their internal feelings
47Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 9
Treatments for Anorexia Treatments for Anorexia NervosaNervosa
Another focus of treatment is correcting disturbed cognitions, especially client misperceptions and attitudes about eating and weight Using cognitive approaches, therapists
correct disturbed cognitions and educate about body distortions
48Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 9
Treatments for Anorexia Treatments for Anorexia NervosaNervosa
Another focus of treatment is changing family interactions Family therapy is important for
anorexia
The main issue is often separation
49Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 9
The use of combined treatment approaches has greatly improved the outlook for people with anorexia nervosa But even with combined treatment,
recovery is difficult
The course and outcome of the disorder vary from person to person
Treatments for Anorexia Treatments for Anorexia NervosaNervosa
50Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 9
Treatments for Anorexia Treatments for Anorexia NervosaNervosa
Positives of treatment: Weight gain is often quickly restored
83% of patients still showed improvements after several years
Menstruation often returns with return to normal weight
The death rate from anorexia is declining
51Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 9
Treatments for Anorexia Treatments for Anorexia NervosaNervosa
Negatives of treatment: Close to 20% of patients remain troubled
for years Even when it occurs, recovery is not
always permanent Anorexic behaviors recur in at least one-third of
recovered patients, usually triggered by stress Many patients still express concerns about
body shape and weight
Lingering emotional problems are common
52Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 9
Treatments for Bulimia Treatments for Bulimia NervosaNervosa
Treatment is frequently offered in specialized eating disorder clinics
53Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 9
Treatments for Bulimia Treatments for Bulimia NervosaNervosa
The initial aims of treatment for bulimia nervosa are to: Eliminate binge-purge patterns
Establish good eating habits
Eliminate the underlying cause of bulimic patterns
Programs emphasize education as much as therapy
54Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 9
Treatments for Bulimia Treatments for Bulimia NervosaNervosa
Several treatment strategies: Individual insight therapy
The insight approach receiving the most attention is cognitive therapy, which helps clients recognize and change their maladaptive attitudes toward food, eating, weight, and shape
As many as 65% stop their binge-purge cycle
55Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 9
Treatments for Bulimia Treatments for Bulimia NervosaNervosa
Several treatment strategies: Individual insight therapy
If cognitive therapy isn’t effective, interpersonal therapy (IPT), a treatment that seeks to improve interpersonal functioning, may be tried
A number of clinicians also suggest self-help groups or self-care manuals
56Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 9
Treatments for Bulimia Treatments for Bulimia NervosaNervosa
Several treatment strategies: Behavioral therapy
Behavioral techniques are often included in treatment as a supplement to cognitive therapy
Diaries are often a useful component of treatment
Exposure and response prevention (ERP) is used to break the binge-purge cycle
57Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 9
Treatments for Bulimia Treatments for Bulimia NervosaNervosa
Several treatment strategies: Antidepressant medications
During the past decade, antidepressant drugs have been used in bulimia treatment
Most common is fluoxetine (Prozac), an SSRI
Drugs help as many as 40% of patients
Medications are best when used in combination with other forms of therapy
58Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 9
Treatments for Bulimia Treatments for Bulimia NervosaNervosa
Several treatment strategies: Group therapy
Provides an opportunity for patients to express their thoughts, concerns, and experiences with one another
Helpful in as many as 75% of cases, especially when combined with individual insight therapy
59Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 9
Treatments for Bulimia Treatments for Bulimia NervosaNervosa
Left untreated, bulimia can last for years
Treatment provides immediate, significant improvement in about 40% of cases An additional 40% show moderate
improvement
Follow-up studies suggest that 10 years after treatment about 90% of patients have fully or partially recovered
60Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 9
Treatments for Bulimia Treatments for Bulimia NervosaNervosa
Relapse can be a significant problem, even among those who respond successfully to treatment Relapses are usually triggered by stress
Relapses are more likely among persons who: Had a longer history of symptoms
Vomited frequently
Had histories of substance use
Have lingering interpersonal problems
61Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 9
Treatments for Bulimia Treatments for Bulimia NervosaNervosa
Finally, treatment may also help improve overall psychological and social functioning