Eating Disorders

Anorexia Nervosa
Symptoms 1. Starve Themselves
2. Subsisting on little to no food for very long periods of time
3. Remain convinced that they need to lose more weight
 Their body weight is significantly below what is minimally normal for their age and
height
4. In women and girls: The extreme weight loss often causes women and girls who have
begun menstruating to stop having menstrual periods  amenorrhea (Some women still
report some menstrual activity even when qualifying for the DSM-5 Criteria)
5. Emaciated (Shrunk)
6. Distorted image of their body
7. Struggle with an intense fear of gaining weight or of becoming fat
8. Routinely engage in behaviors that interferes with the weight gain
9. Feel good and worthwhile only when they have complete control over their eating and
when they are losing weight
10. Chronically fatigued (from weight loss)
11. Drive themselves to exercise excessively and to keep up an extremely tiring and
demanding schedule at school or work.
12. Develop elaborate rituals around food
DSM – 5 A. Restriction of energy intake relative to requirements  significantly low body weight
Criteria (age, sex, developmental trajectory, physical health).
(same in DSM-IV also! But DSM V explains whether an individual is at significantly low
weight and severity specifiers)
i. Significantly Low Body Weight: Weight that is less than minimally normal or, for
children and adolescents, less than that minimally expected.
B. Intense fear of gaining weight or of becoming fat, or of persistent behaviour that
interferes with weight gain, even though at a significantly low weight.
- Overtly expressed fear of weight gain
- Persistent behaviour that interferes with weight gain. (even if there is use of culturally
sanctioned rationale for dietary restriction involving gastro-intestinal discomfort or
religious reasons)
C. Disturbance in the way in which one’s body weight or shape is experienced, undue
influence of body weight or shape on self-evaluation, or persistent lack of recognition of the
seriousness of the current low body weight.

Subtype:
Restricting Type:
Duration: 3 Months
1. Not engaged in recurrent episodes of binge eating or purging behaviour
- Self-Induced Vomiting
- Misuse of Laxatives, diuretics, or enemas
2. Weight loss is accomplished primarily through dieting, fasting, and/or excessive
exercise.
Binge-Eating/Purging Type:
Duration: 3 Months
1. Engaged in recurrent episodes of binge eating or purging behaviour
- Self-Induced Vomiting
- Misuse of Laxatives, diuretics, or enemas
DSM IV vs DSM IV
DSM V - Stricter
- Required to be at least 15% below normal weight
- women were required to show amenorrhea
DSM V: The prevalence Rates may be higher.
 TYPES - Hornbacher
Restricting 1. Refuse to eat
Type of engage in excessive exercise to prevent weight gain
Anorexia 2. Attempt to go for days without eating anything
Nervosa 3. Consume only small amounts of food each day, to stay alive or as a response to pressure
(RTAN) from others to eat
Binge/Purge 1. Periodically engage in binge eating or purging behaviours
Type of - Self-Induced Vomiting
Anorexia - Misuse of Laxatives, diuretics, or enemas
Nervosa 2. Vs Bulimia Nervosa:
(BPTAN) BPTAN: people continue to be substantially below a healthy body weight
Bulimia: Typically ay normal weight or somewhat overweight
3. Do not engage in binges in which large amounts of food are eaten.
4. If even a small amount of food is eaten, the person feels as if she has hinged and will
purge this food.

Prevalence Lifetime Prevalence (America and Europe) – Community Studies

= 0.9 % - Adult Women
= 0.3 % - Adolescent Girls
= 0.3 % - Males (America, none in Europe)
Cultural 1. Caucasians are more likely than African Americans and Hispanic Americans to develop
Differences the disorders.
Reasons
- Caucasians are more likely to accept the thing ideal promoted in the media
2. Cultures that do not value thinness in females  lower rates of anorexia
3. The incidence of Anorexia nervosa has increased substantially since the early part of the
20th Century
4. The Motivations for self-starvation also seem to vary across culture and time
- the stated motivations for excessive fasting have had less to do with weight concerns
than with stomach discomfort or religious considerations
5. Asian Countries + Anorexia Nervosa
- Do not have a distorted body image (readily admit that they are very thin)
- Stubbornly refuse to eat
Onset Begins in Adolescence or Young Adulthood
Course 1. Varies greatly from person to person
2. median number of years from onset to remission of the disorder is 7 years for women and
3 years for men, even among patients in treatment
3. Ten to 15 years after onset of the diagnosis, about 70 percent of patients no longer
qualify for a diagnosis, but many continue to have eating-related problems or other
psychopathology, particularly depression
Comorbidity 1. Individuals with BPTAN tend to have more comorbid psychopathology than people with
RTAN
- Impulsive, suicidal and self-harming behaviours
- More Chronic Course of the disorder
Consequences 1. Dangerous Disorder
- Death Rate: 5-9%
2. Cardiovascular complications
- bradycardia (extreme slowing of heart rate)
- arrhythmia (irregular heart beat)
- heart failure
3. acute expansion of the stomach  to the point of rupturing
4. bone strength is an issue for women who have amenorrhea
- Reasons: Low Oestrogen Levels  low bone strength
5. Kidney Damage
6. Impair immune system functioning  more vulnerable to medical illnesses
 7. Suicide: 31 times the rate in the general population

Bulimia Nervosa
Symptoms 1. Core Characteristic: Uncontrolled Eating or Bingeing; followed by behaviors designed to
prevent weight gain from the binges.
2. Duration:
- Mild Presentation: 1-3 episodes of inappropriate compensatory behaviour per week
- Extreme forms: an average of 14 or more episodes per week.
3. Binge: Occurring over a discrete period of time, such as 1 to 2 hours, and involving an
amount of food definitely larger than most people would eat during a similar period of time
and in similar circumstances.
4. People with eating disorders show tremendous variations in the size of their binges.
- Focus on fats and carbohydrates but sometimes the binge is lesser
- this lesser amount binges is because
- people’s sense that they are violating some dietary rule they have sent for
themselves
- that they have no control over their eating
- But feel compelled to eat even though they are not hungry
5. The behaviours people with bulimia use to control their weight include
- self-induced vomiting
- the abuse of laxatives, diuretics, or other purging medications
- fasting
- excessive exercise
6. Self-evaluations of people are heavily influenced by their body shape and weight
- thin = feel like a good person
7. Vs Anorexia Nervosa
- Bulimians do not show gross distortions in their body images; more realistic
perception of their actual body shape and weight; yet constantly dissatisfied with their
shape and weight and are concerned about losing weight,
- Anorexians: absolutely emaciated, sees themselves as obese (unrealistic body
perception)
8. Bulimians do not show gross distortions in their body images; more realistic perception
of their actual body shape and weight; yet constantly dissatisfied with their shape and
weight and are concerned about losing weight,
DSM – V A. Recurrent episodes of binge eating. An episode of binge eating is characterised by both
Criteria of the following:
1. Eating, in a discrete period of time (within any 2-hour period), an amount of food
that is definitely larger than most people would eat during a similar period of time
under similar circumstances.
2. A sense of lack of control over eating during the episode.
- feeling that one cannot stop eating
- control what or how much one is eating
B. Recurrent inappropriate compensatory behaviours in order to prevent weight gain, such
as
- self-induced vomiting
- misuse of laxatives, diuretics, or other medications
- fasting
- excessive exercise
C. The binge eating and inappropriate compensatory behaviours both occur, on average, at
least once per week for 3 months
D. Self-Evaluation is unduly influenced by body shape and weight
E. The disturbance does not occur exclusively during episodes of anorexia nervosa.
Behaviours that are most often associated with Bulimia Nervosa to control their weight
Self-Inducing 1. Most often associated with Bulimia
Vomiting 2. Bulimia is discovered by family members, roommate, and friends when people are
caught vomiting or leave messes after they vomit.
3. Dentists recognise people with bulimia frequent vomiting can rot teeth  exposure to
stomach acid
4. The cycle of bingeing and then purging or using other compensatory behaviours to
control weight becomes a way of life
Excessive 1. Men with bulimia nervosa are more likely than women with bulimia nervosa to use
Exercise excessive exercising to control their weight.
- Men focused on developing a lean, muscular look rather than on being excessively
thin.
Fasting

Prevalence Lifetime Prevalence

= 0.5% in adults
= 0.9% in adolescents
- More common in females than in males
Cultural, 1. More common in Caucasians than in African Americans
Racial / 2. Considerably more common in Westernized cultures than in non-Westernized cultures
Ethnic and 3. Prevalence increased significantly in the second half of the 20th century
Historical
Differences
Onset 1. Most often occurs in adolescence
Course 1. Chronic Condition
2. A long-term study of people seeking treatment found that 15 years after the disorder
about 50 percent showed remission of their symptoms but the other 50 percent still had
symptoms qualifying for a diagnosis
3. frequent use of purging = predictor of a poorer outcome.
Consequences 1. Death rates with bulimia not as high as among people among anorexia
- Double the rate of general population.
2. Serious medical complications
- electrolyte imbalance, from the fluid loss following excessive and chronic vomiting,
laxative abuse, and diuretic abuse.
- Results in heart failure
3. Suicide Rates: 7.5 times higher than in general population.

Binge-Eating Disorders
Symptoms 1. Resembles bulimia nervosa
2. vs Bulimia Nervosa
- does not regularly engage in purging, fasting or excessive exercise to compensate
for binges.
3. May eat continuously throughout the day, with no planned meal-times.
- Engage in discrete binges of large amounts of food, often in response to stress and to
feelings of anxiety or depression
- appear to eat very rapidly
- appear almost in a daze as they eat.
4. Significantly overweight
5. They are disgusted with their body and ashamed if their bingeing
6. Have a history of frequent dieting, membership in weight-control programs, and
family obesity.
- 30% in weight loss programs = binge-eating disorder
DSM – V A. Recurrent episodes of binge eating. An episode of binge eating is characterized by
Criteria both of the following:
 1. Eating, in discrete period of time, an amount of food that is definitely larger than
most people would eat in a similar period of time under similar circumstances.
2. A sense of lack of control over eating during the episode
- a feeling that one cannot stop eating or control what or how much one is eating
B. The binge-eating episodes are associated with three (or more) of the following:
1. Eating much more rapidly than normal
2. Eating until feeling uncomfortably full
3. Eating large amounts of food when not feeling physically hungry
4. Eating alone because of feeling embarrassed by how much one is eating
5. Feeling disgusted with oneself, depressed or very guilty afterward
C. Marked distress regarding binge eating is present
D. The binge eating occurs, on average, at least once a week for 3 months
E. The Binge eating is not associated with the recurrent use of inappropriate
compensatory behaviour and does not occur exclusively during the course of bulimia
nervosa or anorexia nervosa.
Prevalence 1. 2 to 3.5 % of the general population have the disorder
2. More common in women than in men (general community as well as weightloss
programs)
3. No racial or ethnic differences
Consequences 1. Higher rates of depression and anxiety
2. Higher incidence of alcohol abuse and personality disorders
Course 1. Chronic
2. Mean duration of the disorder to be 8 years or 11.4 years

Other Specified Feeding or Eating Disorders – Subclinical symptoms of eating disorders

- Among Adolescent and young adult women
- Partial syndrome eating disorders
o syndromes that don't meet the full criteria for anorexia nervosa or bulimia nervosa
o Adolescents with partial-syndrome eating disorders may binge a couple of times a month but
not every week.
o They may be underweight but not severely so.
o They tend to be highly concerned with their weight and judge themselves on the basis of their
weight, but their symptoms don't add up to a full-blown eating disorder
o Prevalence:
 Girls
o Several Psychological problems – Adolescence and in their 20s
 Anxiety disorder
 Substance abuse
 Depression
 Attempted suicide
 90%: diagnosable psychiatric disorder – early 20s
 Lower self-esteem
 Poorer social relationships
 Poorer physical health
 Lower levels of life satisfaction
 Less likely to have earned a bachelor’s degree
 More likely to be unemployed
- Other Specified Feeding or Eating Disorder
o DSM-5
o Capture presentations of an eating disorder that cause clinically significant distress or
impairment but do not meet the full diagnostic criteria for any of the eating disorders
 o Partial syndrome eating disorders
o DSM IV: eating Disorders not Otherwise Specified
 Prevalence: 5% of the general population
 As severe and persistent as major eating disorders

Other Specified Feeding or Eating Disorder Categories

Atypical Anorexia 1. All criteria for anorexia nervosa are met, except that despite significant weight loss,
Nervosa the individual’s weight is within or above the normal range.
Bulimia Nervosa 1. Involves meeting all of the criteria for bulimia nervosa, except that the binge eating
of low frequency and inappropriate compensatory behaviours occur, an average, less than once a week,
and/or limited and/or for less than 3 months
duration
Night Eating 1. NEW DISORDER!!!!
Syndrome 2. Regularly eat excessive amounts of food after dinner and into the night
3. Not part of cultural or social norms
4. Feel an overwhelming desire to eat at nights, most nights of the week
5. Highly distressed that they cannot control their eating behaviour
6. frequent insomnia
7. may believe that they cannot control their eating behaviours.
8. typically not hungry in the morning and skip breakfast
9. Onset: early adulthood
10. Course: long-lasting
11. overweight
12. suffer from depression
13. vs sleep eating
- Sleep eating: occurs in sleep disorders, not awake or aware when they are
eating
- night eating: awake and aware when they are eating

Obesity
 NOT IN DSM-V
 Fun facts about obesity!
o Common among people with binge-eating disorder
o Greatest public health concerns internationally
o Highly associated with numerous mental disorders
o A risk factor for the development of some mental disorders (depression)
o Result of psychotropic medication side effects (atypical antidepressants)
 Obesity is defined as a body mass index (BMI) of 30 or over, with BMU calculated as your
weight in pounds multiped by 703, then divided by the square of your height in inches.
o Obesity = excess body fat
 Increase in rates, all age groups
o African Americans have highest obesity rates
 Consequences associated with Obesity
o Increased risk of coronary heart disease, hypertension and stroke, type 2 diabetes, and some
kinds of cancer!
o Financial burden from health care costs
o More physical illnesses
o Lower quality of life
 o More emotional problems
o Stigmatization of obese people
o Workspace problems (lesser work opportunities and promotions)
o Victim f teasing and bullying  skip school!!
 Note: such stigmatization could serve as motivation for obese people to lose weight, experimental
studies show that exposure to stigmatizing media portrayals leads obese people to eat more rather
than less
 Causes
o Environmental causes
 Toxic environment of high-fat, high-calorie, inexpensive food and advertisers who
promote the consumption of large quantities of this food
 Super-size Me culture: reduction in the amount of physical activity people engage in.
 Increased consumption of fast-food which is high in calorie
 There is increased ultra processed foods sold by fast food restaurants can create
addictions similar to those created by drugs of abuse.
 Manipulated fat, sugar, salt, food additives, flavour enhancers, and caffeine 
increase flavour, quick absorption of ingredients (sugar) in bloodstream,
increasing the foods’ addictive properties.
 Rats fed with this type of food Endure more shocks to get more high fat, high
sugar foods; show changes in the brain similar to those seen in people addicted
to substances (cocaine).
 More activity in the reward areas of the brains associated with drug abuse
when exposed to photos of such foods.
 Obese people show less activity in certain reward areas of the brain when they
actually consume such food, however, suggesting that changes in the brain
similar to those seen in drug addicts occur after chronic exposure to
ultraprocessed foods
 people who show behavioral signs of food addiction, such as craving,
tolerance, and withdrawal from high-fat, high-sugar ultraprocessed foods,
have brain activity in response to viewing food photos and consuming
processed foods similar to that of obese people
 Immigrant studies
o Genes
 Affect the number of fat cells and the likelihood of fat storage, the tendency to
overeat, and the activity level in the brain in response to food.
 Interact with the toxic environment
 Weight loss programs = modest weight loss
 Weight loss drugs
o Sibutramine (meridian), orlistat (Xenical) and rimonabant (acomplia)
o Suppress appetite
o Help people lose weight
o Side effects
 Gastrointestinal upset (orlistat)
 Increased blood pressure and heart rate (sibutramine)
 Negative mood changes (rimonabant)
 BMI between 30 and 39
o Low calorie diets are recommended
 Pre-packaged, portion-controlled servings
o Increase their level of physical activity.
 BMI of 40 or over + at least one severe health problem (diabetes)
 o Bariatric Surgery is an option
 A small pouch is created at the base of the esophagus, severely limiting food intake,
and the stomach may be stapled, banded, or bypassed
 Substantial weight loss
 Difficult to weight loss + maintain it
o Reasonably modest goals for weight loss
o Focus on increasing their physical activity
o Improvement in cardiac functioning and diabetes risk
 Proven methods
o Eat more nutrient-dense foods and fewer foods with empty calories
o Aim for a minimum of 30 minutes of physical activity daily.
o Structure your environment so that healthy choices are easier to make
o Be more active throughout the day

Factors that affect the development of an eating disorder

Biological Factors
Genetics 1. Run in Families
2. Heritability is seen in these disorders.
3. Genes appear to carry a general risk for eating disorders rather than a specific risk
for one type of eating disorders
4. Genetic Risk + Interact with Biological Changes of puberty  contribute to the
onset of eating disorders in girls (not in boys)
a. Girls: Changes in hormones at puberty may activate a genetic risk for eating
disorders
b. Biological changes of puberty + changes in girls’ social worlds  risk for
eating disorders
Bodily Systems 1. Hypothalamus
that regulate a. Central role in regulating eating
appetite, hunger, b. Receives messages about the body’s recent food consumption and nutrient
satiety, initiation level and sends messages to cease eating when the body’s nutritional needs are
of eating, and met.
cessation of eating 2. Neurotransmitters
a. Messages from hypothalamus are carried by neurotransmitters
b. Norepinephrine, serotonin, dopamine
3. Hormonal
a. Messages from hypothalamus are carried by hormones
b. Cortisol and insulin
4. Imbalance in or dysregulation of any of the neuro-chemicals involved in this
system or by structural or functional problems in the hypothalamus  disordered
eating behaviours.
a. Anorexia Nervosa: Lowered functioning of the hypothalamus and
abnormalities in the levels of several hormones important to its functioning,
including serotonin and dopamine.
b. Bulimia Nervosa: Abnormalities in the systems regulating the neurotransmitter
serotonin
i. Deficiency in serotonin  crave carbohydrates  bulimians binge on high
carbohydrate foods, engage in self-induced vomiting or other types of
purges; avoid gaining weight from carbohydrates.
Biological abnormalities in eating disorders  crave a certain kind of food or by making it difficulty for a
person to read the body’s signals regarding hunger and fullness.
 Socio-Cultural and Psychological Factors
Social Pressures 1. Differences in prevalence of eating disorders = differences in the standards of
and Cultural beauty for women (times and cultures)
Norms 2. Groups within Culture (athletes): standards of appearance that put them at a
greater risk for developing an eating disorder
3. Thin Ideal and Body Dissatisfaction:
a. Thinner and thinner ideal shape (models, icons, dolls)
b. Women who internalise the thing ideal promoted in the media are at risk
for eating disorders.
c. More exposure young females have to media pressure to be thin  more
dissatisfied they become with their bodies.
d. More in Females than Males: Thinness is valued and encouraged in
females than males.
e. Body dissatisfaction fed by pressures to be thin is one of the strongest
predictors of risk for the development of eating disorders in young women.
f. Reality TV Shows, Cosmetic surgery makeovers – adults under 50
i. Greater perceptions of pressures to be thin
ii. Greater beliefs that they could control their body’s appearance
g. Peer pressure (effective carriers of appearance-related message): Amount
of media exposure (TV and Internet)girls friends had (Fiji, confederate –
19yr thin complains)
4. Athletes and Eating Disorders
a. Additional pressure to maintain a specific weight and body shape
b. Especially those participating in Sports in which Weight is considered an
important factor in competitiveness (gymnastics, ice skating, dancing,
horse racing, wrestling, and body building)
c. Aesthetic or weight dependent sports (diving, figure skating, gymnastics,
dance, judo, karate, and wrestling): more likely to have anorexia nervosa
or bulimia nervosa.
d. Women athletes with eating disorders: physical changes of puberty had
decreased their competitive edge  started dieting severely to try to
maintain their pre-pubescent figure.
i. Female Body Builders: Anorexic at some time in their life, terrified of
being fat, obsessed with food; abused ephedrine (stimulant that helps
to reduce body fat, esp if there was symptoms of eating disorders)
e. Men: Body Building is an increasingly popular sport
i. Body Builders have substantial weight fluctuations as they shape their
bodies for competition and then binge during the off-season.
ii. Have a pattern of eating and exercising as obsessive as that of men
with eating disorders
iii. Focus on gaining muscle rather than losing fat.
iv. Bingeing after most competitions, gaining significant weight in off-
season, heavy dieting to lose lot of weight for the competition.
f. Mixed results with amateurs athletics: varsity athletes >> club athletes
and independent exercisers >> non-exercisers; elite >> non-elite (esp
thinness is not emphasised in sports)
Cognitive Factors 1. Body dissatisfaction (social pressures to achieve a certain shape or weight) +
low self-esteem + perfectionism  toxic mix of cognitive factors  predict
the development of an eating disorder.
2. (Women) dissatisfied with their body + low self esteem  maladaptive
strategies to control their weight (excessive dieting and purging)
3. More concerned with the opinions of others
4. More conforming to others wishes
5. More susceptible to social pressures to be thin.
6. Dichotomous thinking style – judging things as ether all good or all bad
 a. Not break from their rigid eating routines or they will completely lose
control over their eating
b. Obsess over their eating routines
c. Plan their days around these routines (smallest detail)
7. Concerned with body size at an unconscious level
a. Attend to body size than information about facial structure (bulimia)
even classification
b. Unconsciously organise their perceptions around body size
Emotional 1. ED behaviours may sometimes serve as maladaptive strategies for dealing
Regulation with painful emotions.
Difficulties 2. Suffering depressive symptoms, negative affect  development of anorexic
and bulimic symptoms
3. engaged in emotional eating-eating when they felt distressed in an attempt to
feel better were significantly more likely to develop chronic binge eating
4. Sub-types
a. Connected to excessive attempts to lose weight – dieting subtype
i. Women with this dieting subtype are greatly concerned about their
body shape and size
ii. Try to maintain a strict low calorie diet
iii. Frequently abandon their regimen
iv. Engage in binge eating
v. Use vomiting or exercise to try to purge themselves of the food or of
the weight it puts on their bodies.
b. Depressive Subtype
i. Are concerned about their weight and body size
ii. They are plagued by feelings of depression and low self-esteem
iii. Often eat to quell these feelings
iv. Suffer greater social and psychological consequences over time than
the other subtype
v. Face more difficulties in their relationships with family and friends
vi. Are more likely to suffer significant psychiatric disorders (anxiety
disorders)
vii. Less likely to respond well to treatment
viii. Major depression or anxiety disorder over time
ix. More likely to continue to engage in severe binge eating
Family Dynamics 1. Hilde Bruch
2. Anorexia Nervosa often occurs in girls who have been unusually “good girls”
a. High Achievers, Dutiful, Compliant Daughters, Trying to please parents
and others by being perfect
b. Parents who are overinvested in their daughters’ compliance and
achievements, overcontrolling, will not allow the expression of feelings
(esp negative feelings)
c. Do not learn to identify and accept their own feelings and desires; learn to
monitor closely the needs and desires of others
d. Comply to others’ demands
e. Separation and Individuation from one’s family
i. girls from overcontrolling families deeply fear separation because they
have not developed the ability to act and think independently of their
family.
ii. Fear involvement with peers (esp sexual) - neither understand their
feelings nor trust their judgement.
iii. Yet want to separate
iv. Rage against parents for their overcontrol and become angry, defiant
and distrustful
v. Discover that controlling their food intake  sense of control over
 their life + elicits concern from their parents
vi. Rigid control of their body  sense of power over sense and the
family (unlike before); a way to avoiding peer relationships (sickly,
distant, untouchable and superior in her self-control)
3. Families of girls with eating disorders
a. High levels of conflict
b. Discourage expression of negative emotion
c. Emphasize control and perfectionism
d. Similar features are prevalent in families of children with depression,
anxiety disorders and other psychopathology.
e. ED: mothers in these families believe their daughters should lose more
weight, criticize their daughters’ weight, and are themselves more likely to
show disordered eating patterns
4. A lack of awareness of their bodily sensations  ignore even the most severe
hunger pangs; ones who cannot completely ignore their hunger may fall into
the binge/purge type of anorexia or bulimia
5. Binge-Eating
a. Low parental warmth + high parental demands or controls  Binge eating
vs psychopathology
b. History of binge eating among other family members
c. individuals who develop the tendency to binge may come from families
that modeled and reinforced bingeing behavior

Treatment
Psychotherapy for 1. Difficult: Highly value the thinness they have achieved and believe they must
Anorexia Nervosa maintain absolute control over their behaviours  hence, they are resistant to
therapy and the therapists attempts to change their behaviours or attitudes in
particular
2. What therapists should do (irrespective of type psychotherapy)?
a. Step 1: Work to win the trust and encourage participation in therapy;
i. Difficult if the therapist has to hospitalise the client due to excessive
weight loss
ii. Hospitalisation and re-feeding is essential
iii. During Hospitalization: try to engage the client in facing and solving
the psychological issues causing her to starve herself.
b. Step 2: maintain their trust and participation as the client beings to regain
the dreaded weight.
3. About Client
a. Do not seek treatment themselves
b. Do not come to the attention of a therapist until they are so malnourished
that they have a medical crisis (cardiac arrest) or family fear for their life.
4. Psychotherapy
a. Help many people with anorexia (esp adolescents)
b. Typically a long process – often marked by setbacks
c. Along the way, many people with anorexia who have an initial period of
recovery- with restoration of normal weight and healthy eating patterns-
relapse into bulimic or anorexic behaviors
d. continue to have self-esteem issues, family problems, and periods of
depression and anxiety.
5. Cognitive Behavioural Therapies
a. Client’s over-valuation of thinness is confronted
b. Rewards are made contingent on the person’s gaining weight
c. Hospitalised: certain privileges in hospitals are used as rewards (going
outside, shopping, family visits)
 d. Taught relaxation techniques – useful when they become extremely
anxious about ingesting food.
e. Results: weight gains, reductions in symptoms; but there is drop outs or
relapses.
6. Family Therapy
a. Person with anorexia and her family are treated as an unit
b. Maudsley model
i. 10-20 sessions
ii. Duration: 6-12 months
iii. Parents are coached to take control of their child’s eating and weight
iv. Child’s autonomy is linked explicitly to the resolution of the eating
disorder
Psychotherapy for 1. Cognitive Behavioural Therapy (CBT)
Bulimia Nervosa a. based on the view that the extreme concerns about shape and weight are
the central features of the disorder
b. Teaches the client to monitor the cognitions that accompany their eating,
particularly the binge eating and purging episodes.
c. Helps the client confront these cognitions and develop more adaptive
attitudes toward weight and body shape.
d. Behavioral Components
i. Involve introducing forbidden food back into the clients diet
ii. Helping client confront her irrational thoughts about these foods
iii. Taught to eat three healthy meals a day
iv. To challenge the thoughts they have about these meals and the
possibility of gaining weight
e. Duration: 3-6 Months – 10-20 Sessions
f. Results
i. 50% stop the binge/purge cycle
ii. Decrease depression and anxiety
iii. Increase in social functioning
iv. Lessening of concern about dieting and weight
g. More effective than drug therapies in producing complete cessation of
binge eating and purging and in precenting relapse over long term
h. CBT + address emotional regulation difficulties  effective for
depression + ED
i. CBT vs Interpersonal Therapy (IPT), Supportive Expressive
Psychodynamic Therapy, and behavioural therapy (minus focus on
cognitions)
i. IPT:
1. Discuss interpersonal problems relating to client’s ED
2. Actively work to develop strategies to solve these problems
ii. Supportive Expressive Psychodynamic Therapy
1. Encourages the client to talk about problems related to the ED
(esp interpersonal Problems)
2. Highly non-directive manner
iii. Behavioral Therapy
1. the client is taught how to monitor her food intake
2. is reinforced for introducing avoided foods into her diet,
3. is taught coping techniques for avoiding bingeing
iv. Results:
1. Improvement in clients Eating behaviours and emotional well-
being
2. CBT and IPT: greatest improvements (enduring); CBT >> IPT
(better, quicker, more effective; prevent relapse duration: 3-6
weeks)
Psychotherapy for 1. CBT >> Psychotherapy / anti-depressant medications
Binge Eating 2. Effects
Disorders a. Reduces binges
b. Reduces overconcern with weight, shape, and eating in people
Biological 1. Bulimia Nervosa
Therapies a. Selective Serotonin Reuptake Inhibitors (SSRIs) [Fluoxetine – Prozac]
i. Reduce the binge-eating and purging behaviours
ii. Fail to restore the individual to normal eating habits
iii. CBT + anti-depressants = increase rates of recovery.
2. Anorexia Nervosa
a. Anti-depressants
i. Reduction of symptoms
ii. Olanzapine (atypical anti-depressant) – leads to increase in
weight in people with AN
3. Binge-Eating Disorders
a. SSRIs
b. Anti-epileptic medications (topiramate)
c. Obesity Medications (orlistat)
i. Reduce binge eating
ii. Not reduce concerns about body shape or weight

Societal
Pressures for Biological Factors Personality Traits Maintainance
thinness

Children whose
more likely to engage in extreme parents are lacking Weight
in affection and Reinforced loss
Development of unhealthy attitudes Make some people more likely than others to develop an eating measures to control their weight in
nurturance and who by societal reinforced
towards eating disorders pursuit
are controlling and images by family
of an ideal of attractiveness demanding of and peers
Anorexia: Bulimia +
perfectionism
Reinforced Binge:
by sense Greatly
of control desire
they gain control
- To over their but are
achieveing Ideal weight for women dysregula lives by unable to
All or
a healthy promoted by beauty tion of the highly mainin it --
Genetic nothing
weight standards <<< what is hormone Tendency toward anxeity or mild Low Self- Perfectioni restricing > fall into
Predisposi thinkig
considered healthy and or depression Esteem sm diets binges to
- tion (dichotono
normal for the average neurotran espcae the
maintainin mous)
woman smitter negative
g fitness system emotions.
Bulimia
engage in
compensa
tory
behaviour
Negative Bulimia: s to help
Not regain
body often Mood Problems
dangerous fragile
image depressed
and eat sense of
impulsivel control
y in and
response reinforced
to moods .

Environme
Stresses of
Excessive ntal
the
dieting Circumsta
disorder
nces

Conditions
for
impulsive
binge
eating

negative
emotions
+ lower
self-
esteem