CHAPTER 10

FEEDING AND EATING

DISORDERS
 FEEDING AND EATING
DISORDERS
• Anorexia nervosa-two subtypes
• Bulimia nervosa
Lesser known
• Binge eating disorder (newest)
• Rumination disorder
• Avoidant/restrictive food intake disorder
• PICA
 PREVALENCE/STATS

• At least 10x more likely in women than men

• Almost half of American women have a negative body image
• Males more concerned with weight and size rather than thinness
• According to the national center for disease control and prevention,
44% of high school females and 15% of HS males are attempting to
lose weight at any given time
• Lets talk about Anorexia….
 ANOREXIA NERVOSA:
SYMPTOMS
• “Significantly” low body weight-used to be below 18.5 BMI in
DSM-IV-TR
• Restriction of energy intake
• Intense fear of becoming or being “fat”
• Disturbance in the way in which one’s body is shaped
• Skin - dry or cracked
• Amenorrhea
• Lanugo
 MORE ANOREXIA SYMPTOMS

• Electrolyte imbalance
• Death risk high

• Medical complications
• Bone loss, kidney failure, cardio problems, dental erosion, infertility,
anemia, abdominal pain, constipation, death, etc.

• Patients typically have a mood disturbance, anxiety, OCPD, or

OCD
• Average patient 25-30% below healthy weight
MEDICAL EFFECTS
 ANOREXIA SUBTYPES

• Restricting Type
• What everyone in here probably knows of
• People who do not regularly engage in binge/purging in the last three
months
• Weight loss primarily through fasting, excessive exercise, dieting

• Binge eating/purging type

• Regularly bingeing/purging for the last three months
• Purging includes laxatives, induced vomiting, diuretics, enemas, etc.
 ANOREXIA NERVOSA:
EPIDEMIOLOGY
• 0.4% 12-month prevalence among young females
• Less is known about males-why?
• Typically begins in late adolescence/early adulthood (rarely in
puberty or over age 40)
• Most prevalent in North America, Western Europe and
industrialized Asian nations than other areas
 SYMPTOMS OF BULIMIA
NERVOSA
• This disorder is characterized by repetitive episodes of binge
eating, followed by purging behaviors (induced vomiting,
laxatives, diuretics)
• Binge eating – consuming an amount of food that is clearly
larger than most people would eat under a similar circumstances
in a fixed period of time (e.g., less than two hours). Up to
clinician to determine what binge eating is.
• Feeling a loss of control during the binge
 MORE SYMPTOMS OF BULIMIA

• Typically “around” a healthy weight

• Weight fluctuates more rapidly than normal
• Binge eating and compensatory behaviors both occurring at least once a
week in a 3 month span
• Self evaluation unduly influenced by body shape/weight
• Over 35% of people who do not have the disorder have reported binge
eating
• Non-clinical people also report fasting (29%), induced vomiting (8%), or
laxatives (5%) to control weight
 BULIMIA: BINGES

• May happen spontaneously, or may be planned

• Usually in secret
• Common after unhappy/unpleasant moods to feel better, usually feels
worse afterward
• Physical discomfort/disgust after
• Eat compulsively/rapidly (lack of control)
• Some describe a dissociative experience
 BULIMIA:
PURGES
• The process of eliminating food from the body
• Most common is self-induced vomiting
• Different examples of hiding behaviors

• Other methods include misusing laxatives, diuretics, enemas

• Purging is not very effective
• Some may exercise excessively or undergo extreme fasting
 BULIMIA

• Highly comorbid with mood disorders, anxiety, personality disorders

(esp. BPD) and substance abuse
• Self-esteem and daily routines centered around weight and diet
• Binge/purging is thought to be a compulsion
• Commonly seen in chaotic, unstable families
• Medical complications – dental erosion, enlarged salivary glands,
electrolyte imbalances, chipping of teeth, rupture of
esophagus/stomach (rare, but deadly)
 EPIDEMIOLOGY OF BULIMIA

• 12-month prevalence is 1-1.5% in young females, less is

known about prevalence in males
• At least 10 times more common in females than males
• Most common in North America, Western Europe and
industrialized Asian nations
 ONSET OF ANOREXIA AND
BULIMIA
• The onset is the same for both disorders
• Late adolescence/early adulthood
• This may be related to:
• Hormonal changes
• Autonomy struggles
• Reactions to normal changes in weight or shape
 BINGE EATING DISORDER

• New to the DSM-5, characterized by frequent episodes of

bingeing without compensatory behaviors
• Also associated with psychological difficulties and physical
complications

• Stress/Comfort Foods
• Typically overweight/obese
• BMI>30
BINGE
EATING
DISORDE
R&
OBESITY
CYCLE
 TREATMENT: ANOREXIA

• Treatment facilities
• In-patient/out-patient

• Goals
• 1st-Weight gain
• 2nd-Broader issues

• Challenges
• $$$/Location
• Severity/Willingness
 METHODS OF ANOREXIA
TREATMENT
• Antidepressants or other medications (Prozac, atypical antipsychotics)
• Maudsley method of family therapy
• Intense parental involvement

• Cognitive-behavioral therapies
• Psychodynamic/Feminist therapies…
• Not much success, more research needs to be done
 LONG-TERM OUTCOME OF
ANOREXIA
• Poor prognosis, partially due to treatment methods
• 10-20 year follow-up
• 5% die of starvation/medical complications/suicide
• Never satisfied with weight loss
• Early intervention is key
• Most do not seek treatment right away
 TREATMENT: BULIMIA

• Higher success rate

• More approaches to treatment-Mostly group therapy
• CBT
• Interpersonal Therapy (IPT)
• Antidepressants
• Dialectical-behavioral therapy (DBT)
• Similar challenges to Anorexia
TREATMENT: BED

• Lifestyle changes
• Social/Family support
• IPT
• Weight management medications, if obese
• Bariatric surgery, if obese
 CAUSES OF ANOREXIA/BULIMIA

• Genetics/Environment
• Age/Gender
• Controlling (AN) / Chaotic family (BN)
• Psychological Factors/Personality
• Diets/Negative body image
• Perfectionism/Struggle for control
 SOCIAL FACTORS, MEDIA,
GENDER, AND CULTURE
• Media standards
• Ideals for thinness (females)
• Ideals for muscular/fitness (males)

• Today’s standards of beauty in western/industrialized nations

• Greater risk if born after 1960 for bulimia
• Assumptions
• Appearance = Approval = Acceptance

• Men endorsing thinner ideals for women

• Pro-ANA, pro-MIA websites
FIGURE 10.1 PERCENTAGE OF FEMALES REPORTING THAT THEY WERE “VERY OR MOSTLY DISSATISFIED” WITH
SPECIFIC PHYSICAL ATTRIBUTES IN A NATIONAL SAMPLE OF WOMEN AGED 18 TO 70.
SOURCE: CASH, THOMAS AND PATRICIA HENRY. 1995. WOMEN’S BODY IMAGES: THE RESULTS OF A NATIONAL
SURVEY IN THE U.S.A. SEX ROLES; 33: 19–28.
 EATING DISORDERS IN MALES &
LGBTQ+ POPULATIONS
• “Reverse Anorexia” or “Adonis Complex”
• Focus more on weight shape/size rather than thinness

• Underreporting due to gender norms and shame

• LGBTQ+ populations are at greater risk beginning at age 12
• Fear of rejection or actual experiences of rejection
• Internalized negative beliefs/messages related to orientation or gender
identity
• Inability to meet body image ideals within some LGBTQ+ cultures
• Experience of bullying due to orientation/gender identity
 PREVENTION OF EATING DISORDERS

Education about deception in the media

• E.g., airbrushing and Photoshop
https://www.youtube.com/watch?v=xKQdwjGiF-s
 PREVENTION OF EATING
DISORDERS
• Better social marketing techniques
• Ads promoting body norms
• Better awareness for eating disorders for both men and women
• Information for unrealistic norms
• Information about consequences of eating disorders

• Improve family cohesion, parenting methods, psychoeducation

• Dissonance intervention
• Complete tasks inconsistent with thinness ideals, prevent young girls from
becoming obsessed with appearance
RESOURCES

• NEDA
• Nationaleatingdisorders.org
• 1-800-931-2237 Helpline

• Student Counseling Center in UC 3400

THOUGHTS/QUESTIONS?