Anorexia Nervosa

Anorexia Nervosa • Refusal to maintain wt. at or above minimally normal wt. for age or height (e.g., wt. less than 85% of expected wt. Or failure to gain during period of growth) • Intense fear of gain wt. or becoming fat even tho’ underwt.

Anorexia Nervosa (cont.) • Body image distortion or undue influence of wt. on self-evaluation or denial of consequences of wt. • Amenorrhea (at least 3 consecutive cycles) • Restricting vs. binge/purging types

Bulimia Nervosa • Recurrent episodes of binging w/ both: • Eating in discrete time period a larger-than-average amt. of food • Sense of lack of control overeating • Recurrent inappropriate compensatory beh. to prevent wt. gain such as self-induced vomiting; misuse of laxatives, diuretics, enemas, etc.; fasting; excessive exercise

Bulimia Nervosa (cont.) • Binging & purging occur at least 2x per wk. for 3 mo. • Self-evaluation unduly influenced by wt. & shape

Bulimarexia Bulimia-Bulimarexia-Anorexia Continuum

Overcontrol Compulsive Anxiety Perfectionism (“Best Little Girl in the World”) Family enmeshment Undercontrol (loss of control) Impulsivity Depression Substance abuse Family disengagement Correlates of Anorexia-Bulima (pure types)

Garner & Garfinkel • Determinants of eating disorders sociocultural as well as ind. & familial • Study - Miss Americas & contestants, Playboy centerfolds, life ins. tables from ‘59-’79 - real-ideal discrepancy increased • Similar results from ‘80-’90, ‘90’s

Garner & Garfinkel (cont.) • Pressures to be thin • Cultural norms of attractiveness • Culture of thinness, thinness as requirement for beauty (& beauty emphasized) • Thin = white = attractive = successful = middle-upper class • Influences people to extent they internalize cultural ideal for beauty

More on Sociocultural Determinants • More common in cultures w/ plenty of food, thin beauty ideals • Women of color less susceptible unless internalize cultural emphasis on thinness, risk lowered by distance from young, white, heterosexual, middle-class ideal

Research on Sociocultural Determinants • 3 min. exposure to thin images from fashion mags increased depression, shame, guilt, stress, insecurity, body dissatisfaction • Those who had largest increases in negative emotion showed increased bulimic symptoms • Chronic exposure in 13-17 y/o’s increased deprssion, esp. w/ low social support • Half of women report frequent dissatisfaction w/ apperance (1/3 of men)

Biological Factors • Genetic predisposition to eating disorders. inc. kind of purging • Genetic predisposition to depression • Dysregulation of hypothalamus • Serotonin imbalances • Poor nutrition leads to negative emotions

Individual Factors • Food used to cope w/ negative emotions • Overconcern w/ others’ opinions • Rigid, dichotomous thinking, perfectionism • Sexual abuse hx

Familial Factors • Anorexia - enmeshment • Bulimia - disengagement • Success- & image-oriented, “All American” families

Dangers of Dieting • Restriction starts food preoccupation • Restricted eaters eat more after preload (abstinence violation effect) • Restricted eaters also more responsive to external cues

Binge-purge cycle • Negative affect - binging - fear of fatness, shame, guilt - purge - relief, shame (______ conditioning) • Target behavior is purging, which maintains binging

More on Treatment of Eating Disorders • Monitor purging, trace to negative emotions & thoughts that mediate those (& are also depressogenic) • Replace purging w/ healthier strategies to cope w/ negative emotions • Challenge perfectionism & internalization of beauty standards, focus on other sources of self-worth (feminist therapy)

Binge Eating Disorder • In appendix of DSM, being considered for inclusion in future editions as full-fledged disorder • Similar criteria to bulimia nervosa in terms of binging or may eat often throughout day • Often results in being overweight (obesity not in DSM, on the rise) as well as depression, anxiety, personality disorders • May be more common in African-American than European-American women

Anorexia Nervosa