CHAPTER 10 – EATING DISORDERS
Preoccupation with weight and body dimensions or reliance on food as a coping mechanism can
become extreme and lead to eating disorders
Disorder DSM-5 Criteria
Anorexia nervosa types - Restricted caloric intake resulting in body weight significantly
below the minimum normal weight for one’s age and height
- Intense fear of gaining weight or becoming fat, which doesn’t
diminish even with weight loss
- Body image distortion or self-evaluation unduly influenced by
weight
Bulimia nervosa - Recurrent episodes of binge eating behaviour and compensatory
behaviours (1 or more times per week for 3 or more months)
- Loss of control over eating behaviour when bingeing
- Use of vomiting, exercise, laxatives, or fasting to control weight
- Self-evaluation unduly influenced by weight or body shape
Binge-eating disorder (BED) - Recurrent episodes of binge eating (1 or more binges a week for 3
or more months)
- Loss of control when bingeing
- Eating until uncomfortably full or when not hungry
- No regular use of inappropriate compensatory activities to control
weight
- Marked distress over bingeing
Anorexia Nervosa:
Extreme thinness
Starve themselves, relentlessly pursue thinness, and detest weight gain
Occurs primarily in adolescent girls and young women
Continue to insist they are overweight
Cognitive distortion – regarding their body, shape, and weight results in behaviours such as
excessive mirror and weight checking
Subtypes of anorexia nervosa:
o Restricting type
Pursue weight loss through severe dieting or exercising
More introverted and tend to deny psychological distress or feelings of hunger
o Binge-eating/purging type
Binge eat and then use self-induced vomiting, laxatives, or diuretics to avoid weight
gain
More extroverted and impulsive
Report more anxiety, depression, and guilt
Often have a strong appetite
Tend to be older
Physical complications
o Anorexia is associated with serious medical complications
o Irregular heart rate
o Low blood pressure
o Extreme fatigue
o Dry skin
o Brittle hair
o Low body temperature
o Kidney disease
o Bone loss
o Cirrhosis of the liver
Course and outcome
o Can range from full recovery after 1 episode to a fluctuating pattern of weight gain and
relapse to a chronic and deteriorating course ending in death
Bulimia Nervosa:
Characterised by:
o Recurrent episodes of binge eating that occur at least once a week for 3 months or more
o A loss of control over eating during the binge episode
Vomiting, laxatives, diuretics, or enemas, restricting food intake, engaging in excessive exercise
Realise their eating patterns aren’t normal, and are distressed by that knowledge
Physical complications and associated characteristics:
o Erosion of tooth enamel from vomited stomach acid, dehydration, swollen salivary glands,
and lowered potassium, which can weaken the heart and cause heart irregularities and
cardiac arrest
o Inflammation of the oesophagus, stomach and rectal area
o Often use eating as a way of coping with distressing thoughts or external stressors
Course outcome:
o Page 328
Binge-Eating Disorder:
Similar to bulimia that it involves bingeing, an accompanying feeling of loss of control, and marked
distress over eating during the episodes
An individual must have a history of binge-eating episodes at least once a week for a period of 3
months
Exhibit at least 3 of the following with binge eating episodes
o Eating more rapidly than normal
o Uncomfortable feeling of fullness
o Eating large amounts of food even when not hungry
o Eating alone due to embarrassment about the quantity eaten
o Feeling depressed or guilty after bingeing
Do not use compensatory behaviours
Physical complications and associated characteristics:
o Often overweight
o Obesity
o Type 2 diabetes
o High blood pressure
o High cholesterol levels
o Bingeing is often preceded by distressing emotions such as guilt, depression, or disgust
Course and outcome:
o Page 329
Other Specified Feeding or Eating Disorders:
This category includes seriously disordered eating patterns that don’t fully meet the criteria for the
above
Examples of people who fit in this category include:
o Individuals of normal weight who meet the other criteria for anorexia nervosa
o Individuals who meet the criteria for bulimia nervosa or binge-eating disorder except that
binge eating occurs less than once a week or has been present for less than 3 months
o Individuals with night-eating syndrome
o Individuals who don’t binge but frequently purge as means to control weight
Aetiology of Eating Disorders:
Biological dimension
o Moderate heritability
o Pubertal weight gain
o Appetitive neural circuitry
o Dopamine
o Ghrelin and leptin
Psychological dimension
o Appetite variations
o Emotional eating
o Body dissatisfaction
o Personality characteristics
o Mood or anxiety disorders
Social dimension
o Parental attitudes and behaviours
o History of being teased about size or weight
o Peer pressure regarding weight/eating
o Fat talk
o Social media
Sociocultural dimension
o Social comparison
o Media presenting distorted images
o Cultural definitions of beauty
o Objectification – female and male bodies evaluated through appearance
Treatment of Eating Disorders:
Remission is most likely to occur when there is a reduction in symptoms early in the treatment
process
Treatment of Anorexia Nervosa:
Initial goal is to restore weight and address the medical complications associated with starvation
Physical condition of the person is carefully monitored because sudden and severe physiological
can occur during re-feeding
Psychological interventions
o Provide emotional support and help the client
Understand and cooperate with nutritional and physical rehabilitation
Identify and question the dysfunctional attitudes related to the eating disorder
Improve interpersonal and social functioning
Address other psychological disorders or conflicts that reinforce disordered eating
behaviour
Family therapy is an important and effective component in the treatment of anorexia nervosa
Treatment of Bulimia Nervosa:
Physical conditions are identified and treated
Cognitive-behavioural approaches can help individuals develop a sense of self-control and reduce
binge-purge symptoms
o Involves encouraging the consumption of 3 balanced meals a day, reducing rigid food rules
and body image concerns, identifying triggers for bingeing, and developing strategies for
coping with emotional distress
Adding exposure and response prevention procedures to therapy appears to improve long-term
outcomes for individuals with bulimia
SSRIs are sometimes helpful
Treatment of Binge-Eating Disorder:
Similar to those for bulimia nervosa
Do differ in some ways as most are overweight and have to deal with societal prejudices
Due to the health consequences of excessive weight, many therapy programmes also focus on
healthy approaches to weight loss
Antidepressant medications
Obesity:
Having a BMI greater than 30
o Estimate of our body fat
Not the result of being lazy or lacking self-control
More accurate to consider obesity as a disease with specific symptoms, abnormal physiological
processes and associated health risks
Increases risk of high cholesterol and triglyceride levels, type 2 diabetes, cancer, coronary heart
disease, stroke, gallbladder disease, arthritis, sleep apnoea, and respiratory problems
Biological dimension
o Genetic influence on appetite
o “Thrifty genotype”
o Dopamine receptors and pleasure in eating
o Ghrelin, leptin and cortisol levels
o Weight-promoting intestinal bacteria
o Slower metabolism
Psychological dimension
o Physical and sexual abuse
o Emotional eating
o Internalised weight stigma
o Exercise avoidance
o Negative mood states
Social dimension
o Bullying
o Social contagion
o Stressful family relationships
o Teasing from family members or peers
Sociocultural dimension
o Racism and discrimination
o Cultural influences on body preference
o Poorer neighbourhoods, less access to healthy foods
o Advertising of high-calorie foods
Treatment for Obesity:
Dieting
Lifestyle changes
Medications
Surgery
o Gastric banding or gastric bypass
Contemporary Trends and Future Directions:
Pages 351-352
