Is he mentally ill?

May be over or underweight, typically about average

Family hx often includes obesity or alcoholism

Prevalence about 1-3 %, higher rates when we look at # with behaviors

>90% are female

Preoccupied with food, eating, and vomiting so that concentration on other subjects is impaired. May steal food (increased food costs assoc. with binging)

Less time socializing, more time alone than non-bulimics

• Less time socializing, more time alone than non-bulimics

• Terrified of losing control over eating—all or none thinking

• Lots of shame, guilt, self-deprecation, and efforts at concealment

• More extroverted

• More likely to abuse ETOH, steal, attempt suicide

• More affectively unstable than depressed

• Difficulty with self-regulation

• Some evidence of hx of pica

• More sexually active than controls, but less interested in sex and enjoy it less

• Hx of childhood maladjustment; alienated from family

• Higher rates of borderline

50-75% show full recovery

• 50-75% show full recovery

• Health risks: Electrolyte imbalances, hypokalemia (low potassium) leading to heart problems, damage to heart muscle, calluses on hands, tears to the throat, mouth ulcers and cavities, small red dots around eyes, swollen salivary glands

Risk of anorexia for relatives is 11.4X greater than controls—concordance for MZ twins is about 50%, DZ twins about 5%

• Risk of anorexia for relatives is 11.4X greater than controls—concordance for MZ twins is about 50%, DZ twins about 5%

• Risk of bulimia is 3.7x greater

• Some linkage to chromosome 1 for anorexia, chromosome 10 for bulimia

• Serotonin—neurotransmitter linked to obsessionality, mood disorders, impulsivity—also modulates appetite and feeding behavior

• Link is still not entirely clear

• Set point—90-95% of those who lose weight regain it

Peer and media influences

• Peer and media influences

• Fiji—Becker

• Objectification theory (Frederickson and Roberts, 1997)

• --women’s bodies are sexually objectified

• --use observer perspective when viewing selves

• --leads to habitual body monitoring-increased shame and anx, fewer peak states, increased depression and eating disorder

• Hebl et al 2004—swimsuit vs. sweater paradigm

1/3 of pts report that family dysfunction contributed to dev of anorexia

• 1/3 of pts report that family dysfunction contributed to dev of anorexia

• No typical family profile with anorexia

• associated family behaviors—rigidity, parental overprotectiveness, excessive control, marital discord
• triangulation
• double message of nurturant affection and neglect of dtr’s need to express her own feelings

• Many parents have same issues—preoccupied with desirability of thinness, dieting, good physical appearance

• Bulimia—high parental expectations, other family members’ dieting, critical comments about shape, weight, or eating

Fat spurt—more associated with increased body dissatisfaction than age

• Fat spurt—more associated with increased body dissatisfaction than age

• Girls who are underweight are most satisfied with weight

• Internalizing the thin ideal is associated with

• Body dissatisfaction, dieting, negative affect

• Perfectionism—more common in women

• Sexual abuse in bulimia and binge-eating

Anorexia Nervosa

• Anorexia Nervosa

• Treatable but motivation is a big issue
• Many have been tried (nutritional counseling, individual and group tx, 12 step, meds, beh. contracts)—most have weak evidence
• Best results—cog-beh approaches and response prevention; family tx for adolescents
• Most are outpt-inpt for brief periods
• Meds—not initial tx of choice, SSRIs used 1st—none has consistently improved wt. maintenance or prevented relapse of anorexia

SSRIs are more helpful for bulimia—seem to decrease frequency of binges as well as improving mood and preoccupation with shape and weight

• SSRIs are more helpful for bulimia—seem to decrease frequency of binges as well as improving mood and preoccupation with shape and weight

• Cog-beh is tx of choice—multiple controlled studies show CBT superior to meds and interpersonal tx.

• Behavioral components focus on meal planning, nutritional education, ending binging and purging cycles by teaching person to eat small amts more frequently

Obesity is a widespread epidemic

• Obesity is a widespread epidemic

• 2/3 of adult population in US, 31% of those are obese
• WHO –obesity is one of top 10 global health problems

• BMI: below 18.5 underweight

• 18.5-24.9—normal
• 25-29.9—overweight
• 30 or above—obese

• To calculate: (weight in pounds*703)/ht in in sq

• In US—6x more common in lower SES adults, 9x more common in lower SES children

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