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After studying this chapter you will be able to understand: The eating disorder continuum, no simple causes, anorexia nervosa, bulimia nervosa, binge-eating disorder, body dysmorphic disorder, night-eating syndrome, males: an overlooked population, anorexia athletica, the female athlete triad.
Spotlight on Eating Disorders Eating Disorders • Eating disorders ≠ disordered eating – Eating disorder: Serious illness affecting daily activities – Disordered eating: Usually temporary or mild change in eating patterns The Eating Disorders Continuum • DSM-5 assigns eating disorders to categories across a continuum – Self-starvation at one end – Binge-eating disorder on the other No Simple Causes • Predisposition • Social factors – Expectations for body size and shape • Psychological factors – Peer relationships – Family expectations – Emotional trauma No Simple Causes • Biological factors – Neurotransmitter levels • Genetic factors – Synthesis and release of leptin and orexin Anorexia Nervosa • Diagnostic criteria – Body weight < 85% of expected (BMI ≥ 17.5 kg/m2) – Intense fear of weight gain – Distorted body image – Amenorrhea • Causes • Warning signs Anorexia Nervosa • Treatment – Goals • Stabilize physical condition • Convert patient into participant • Restore nutritional status • Gradual weight gain – Psychotherapy • Individual • Group • Family Bulimia Nervosa • Diagnostic criteria – Recurrent binge eating – Recurrent purging, excessive exercise, or fasting – Excessive concern about weight and shape – Absence of anorexia nervosa • Causes Bulimia Nervosa • Binge: large amount of food, short period of time – High-calorie, highfat foods • Purge – Affects fluid and electrolyte balance – Can be life threatening Bulimia Nervosa • Treatment – Medical – Nutritional – Psychotherapy • Antidepressant medications Binge-Eating Disorder • Diagnostic criteria – Recurrent binge eating – Distress over eating behaviors – No recurrent purging – Absence of anorexia nervosa • Triggers of binge eating – Stress – Conflict Binge-Eating Disorder • Treatment – Psychotherapy • Antidepressant medications – Long-term support Body Dysmorphic Disorder • Preoccupied with an imagined or slight defect in appearance • Often coexists with – Obsessive-compulsive disorder – Major depression – Delusions – Social phobia Night-Eating Syndrome • Habitual pattern of interrupting sleep to eat • Indications – Eats more than half of daily calories during and after evening meal – Wakes up at least once a night to eat – Feels tense or guilty while eating – Persists in behavior for 3+ months Males: An Overlooked Population • Fewer instances than females • Most affected men are overweight, unlike women • Men involved in sports, modeling, entertainment – Pressure for certain weight or shape Anorexia Athletica • Sports-related eating disorders • Body size/shape important in competition • Pressure from coaches The Female Athlete Triad • Disordered eating • Amenorrhea • Premature Osteoporosis Other Issues • Pregorexia – Pregnant women who reduce calories and exercise in excess • Infantile anorexia – Severe feeding difficulties beginning with introduction of solid foods Combating Eating Disorders • Promote self-esteem • Focus on size acceptance • Celebrate the diversity in all sizes and shapes • Discourage meal skipping • Encourage eating in response to hunger, not emotions ... Eating Disorders Continuum • DSM-5 assigns eating disorders to categories across a continuum – Self-starvation at one end – Binge -eating disorder on the other No Simple Causes • Predisposition.. .Eating Disorders • Eating disorders ≠ disordered eating – Eating disorder: Serious illness affecting daily activities – Disordered eating: Usually temporary or mild change in eating patterns... medications Binge -Eating Disorder • Diagnostic criteria – Recurrent binge eating – Distress over eating behaviors – No recurrent purging – Absence of anorexia nervosa • Triggers of binge eating