discussion topic

Weight Concerns, Body Dissatisfaction, and Eating Disorders

Eating Disorders: Features and Epidemiology

Eating Disorders: Stigma Associated with Eating Disorders

Eating Disorders: Causes and Prevention

Eating Disorders: Assessment and Treatment

Weight Concerns, Body Dissatisfaction, & Eating Disorders

Eating Disorders: Causes & Prevention

Eating Disorders: Assessment & Treatment

Weight Concerns, Body Dissatisfaction, and Eating Disorders

• 1) Weight Concerns – Feeling overweight much of the time – Viewing one’s weight negatively

• 2) Body Dissatisfaction – Distress with one’s appearance

• 3) Eating Problems – Restricted Eating or Dieting – Lack of Control over Eating

The Continuum of Body Dissatisfaction to Eating Behavior

Eating Disorders: Causes & Prevention

Eating Disorders: Assessment & Treatment

Eating Disorders: Features and Epidemiology

The Continuum of Body Dissatisfaction to Eating Behavior (cont’d.)

Eating Disorders: Causes & Prevention

Eating Disorders: Assessment & Treatment

Eating Disorders: Features and Epidemiology

DSM-5: Anorexia Nervosa

Eating Disorders: Causes & Prevention

Eating Disorders: Assessment & Treatment

Eating Disorders: Features and Epidemiology

• Refusal to maintain body weight

• Intense fear of gaining weight

• Perceptual disturbance of body image

• Extreme dissatisfaction with body

• Dehydration • Hypotension • Anemia • Kidney dysfunction • Heart problems • Dental problems • Electrolyte imbalance • Osteoporosis

Features of Anorexia Nervosa

Eating Disorders: Causes & Prevention

Eating Disorders: Assessment & Treatment

Eating Disorders: Features and Epidemiology

DSM-5: Bulimia Nervosa

Eating Disorders: Causes & Prevention

Eating Disorders: Assessment & Treatment

Eating Disorders: Features and Epidemiology

• Binge-eating episodes • Inappropriate methods

to prevent weight gain • Self-evaluation greatly

influenced by body shape & weight

• Episodes often triggered by depression, stress or low self-esteem

• Dental Problems • Swelling of salivary

glands • Esophageal

problems • Chronic diarrhea • Bowel problems

Features of Bulimia Nervosa

Eating Disorders: Causes & Prevention

Eating Disorders: Assessment & Treatment

Eating Disorders: Features and Epidemiology

Misuse of laxatives

Misuse of enemas

Excessive exercise

Misuse of diuretics

Behaviors used to prevent weight gain after binge eating are called

compensatory behaviors. They include:

Fasting

Self-induced vomiting

Bulimia Nervosa

Eating Disorders: Causes & Prevention

Eating Disorders: Assessment & Treatment

Eating Disorders: Features and Epidemiology

DSM-5: Binge-Eating Disorder

Eating Disorders: Causes & Prevention

Eating Disorders: Assessment & Treatment

Eating Disorders: Features and Epidemiology

Eating Disorders: Causes & Prevention

Eating Disorders: Assessment & Treatment

Recurrent episodes of binge eating. A binge eating episode involves both:

Symptoms of Binge-Eating Disorder

Eating, in a specified period of time, an amount of food that is larger than what most would eat in the same period of time and in similar circumstances

Feeling a lack of control over one’s eating (inability to stop eating or control how much is eaten)

Binge-Eating Disorder

Eating Disorders: Features and Epidemiology

• Binge-eating episodes without compensatory behaviors

• Eating more rapidly than the “normal person

• Eats despite often uncomfortable full feeling

• Eating when not hungry • Eating alone • Feeling disgusted,

depressed or guilty

• Varying level of obesity • Enroll in weight control

programs

Features of Binge-Eating Disorder

Eating Disorders: Causes & Prevention

Eating Disorders: Assessment & Treatment

Eating Disorders: Features and Epidemiology

Eating Disorder Women Men

Anorexia nervosa 0.30.9

Bulimia nervosa 0.51.5

Binge eating disorder 2.03.5

Source: Hudson, J.I., Hiripi, E., Pope, H.G., & Kessler, R.C. (2007). The prevalence and correlates of eating disorders in the National Comorbidity Survey Replication. Biological Psychiatry, 61, 348-358.

Lifetime Prevalence Rates (%) for Major Eating Disorders

Epidemiology of Eating Disorders

Eating Disorders: Causes & Prevention

Eating Disorders: Assessment & Treatment

Eating Disorders: Features and Epidemiology

Male Body Ideal

Eating Disorders: Features and Epidemiology

Eating Disorders: Causes & Prevention

Eating Disorders: Assessment & Treatment

Female Body Ideal

Eating Disorders: Features and Epidemiology

Eating Disorders: Causes & Prevention

Eating Disorders: Assessment & Treatment

Focus on College Students: Eating Disorders

Eating Disorders: Features and Epidemiology

Eating Disorders: Causes & Prevention

Eating Disorders: Assessment & Treatment

Gender and Eating Disorders

Eating Disorders: Features and Epidemiology

Eating Disorders: Causes & Prevention

Eating Disorders: Assessment & Treatment

Stigma Associated with Eating Disorders

• Research suggests many blame those with eating disorders for their problems

• Eating disorders are self-inflicted and related to “willpower”

• Factors for anorexia nervosa are lack of social support, lack of discipline and poor parenting

• Stigma associated with perceptions that those with anorexia nervosa are responsible for these problems

Eating Disorders: Causes & Prevention

Eating Disorders: Assessment

& Treatment

Stigma Associated with Eating Disorders

Eating Disorders: Causes & Prevention

Eating Disorders: Assessment

& Treatment

Statement Eating Disorders Alcoholism

19981998

Danger to others 657

Unpredictable

Depression

1998

23

2003

7

2003

64

2003

19

Hard to talk to

Feel different from us

0.7-4.0They are to blame

Could pull themselves together

Treatment wouldn’t help

Will never fully recover

7129 5627 70 53

5938 6233 55 56

3549 4333 25 30

6034 1333 54 11

5238 1935 50 17

119 1610 12 15

2411 2315 29 25

Stigmatizing Statements

Stigma Associated with Eating Disorders

Weight Concerns, Body Dissatisfaction, & Eating Disorders

Eating Disorders: Causes & Prevention

Eating Disorders: Assessment & Treatment

Amygdala

Prefrontal cortex

Nucleus accumbens

Thalamus

Somatosensory cortex

Hypothalamus

© William Howard/Stone/Getty Images

Biological Factors for Eating Disorders

Biological Factors for Eating Disorders (cont’d.)

• Neurochemical Features – Serotonin

• Satiety

– Dopamine – Endogenous Opioids

• Personality Traits – Perfectionism – Impulsivity

Weight Concerns, Body Dissatisfaction, & Eating Disorders

Eating Disorders: Causes & Prevention

Eating Disorders: Assessment & Treatment

Environmental Risk Factors for Eating Disorders

• Family Factors – Reinforcement on weight loss

• Media Exposure to the “Thin Ideal” • Cognitive Factors

– Body Dissatisfaction – Body Image Disturbance

• Cultural Factors

Weight Concerns, Body Dissatisfaction, & Eating Disorders

Eating Disorders: Causes & Prevention

Eating Disorders: Assessment & Treatment

Weight Concerns, Body Dissatisfaction, & Eating Disorders

Eating Disorders: Causes & Prevention

Eating Disorders: Assessment & Treatment

Environmental Risk Factors for Eating Disorders (cont’d.)

Weight Concerns, Body Dissatisfaction, & Eating Disorders

Eating Disorders: Causes & Prevention

Eating Disorders: Assessment & Treatment

Causes of Eating Disorders

Weight Concerns, Body Dissatisfaction, & Eating Disorders

Eating Disorders: Causes & Prevention

Eating Disorders: Assessment & Treatment

Prevention of Eating Disorders

Prevention of Eating Disorders (cont’d.)

• National Eating Disorders Awareness Week – A media campaign to educate & screen for eating disorders – Approximately 51% of prevention programs reduce risk factors – Approximately 29% reduce current & future risk factors

• Student Bodies – An 8 week program administered via the internet – Combines a structured cognitive-behavioral curriculum with a

discussion group

– Primary goals are to reduce weight concerns & body dissatisfaction – Each week they can log onto the website with updated content

Weight Concerns, Body Dissatisfaction, & Eating Disorders

Eating Disorders: Causes & Prevention

Eating Disorders: Assessment & Treatment

Weight Concerns, Body Dissatisfaction, & Eating Disorders

Eating Disorders: Causes & Prevention

Eating Disorders: Assessment & Treatment

Assessment of Eating Disorders

Assessment of Eating Disorders (cont’d.)

• Interviews • Self–Report Questionnaires

– The Eating Disorder Diagnostic Scale

• Self-Monitoring – Diaries

• Physical Assessment – Monitor & record daily symptoms & behavior

Weight Concerns, Body Dissatisfaction, & Eating Disorders

Eating Disorders: Causes & Prevention

Eating Disorders: Assessment & Treatment

Weight Concerns, Body Dissatisfaction, & Eating Disorders

Eating Disorders: Causes & Prevention

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Treatment of Eating Disorders

Eating Disorders: Assessment & Treatment

Weight Concerns, Body Dissatisfaction, & Eating Disorders

Eating Disorders: Causes & Prevention

Eating Disorders: Assessment & Treatment

Controlled weight gain

Medication

Biological Treatment of Eating Disorders

Weight Concerns, Body Dissatisfaction, & Eating Disorders

Eating Disorders: Causes & Prevention

Low self esteem

Negative affect

Diet to feel better about self

Restrict food intake too much

Diet brokenBinge

Compensatory behaviors (e.g., vomiting to reduce fear of weight gain)

Psychological Treatment of Eating Disorders

Eating Disorders: Assessment & Treatment

• Family Therapy – Helpful for adolescents with anorexia nervosa – The Maudsley Model Approach

• Cognitive-Behavioral Therapy (CBT) – Dominant approach to treat eating disorders – Conducted with a nutrition program & medication – Episodes are negatively reinforcing – Focuses on the binge & purge cycles

Psychological Treatment of Eating Disorders (cont’d.)

Weight Concerns, Body Dissatisfaction, & Eating Disorders

Eating Disorders: Causes & Prevention

Eating Disorders: Assessment & Treatment

Bulimia Nervosa: The Binge Purge Cycle

Weight Concerns, Body Dissatisfaction, & Eating Disorders

Eating Disorders: Causes & Prevention

Eating Disorders: Assessment & Treatment

Cognitive Behavioral Therapy (CBT)

• CBT try to interrupt the binge-purge cycle – Question social standards for physical

attractiveness

– Challenge beliefs that encourage severe food restriction

– Develop “normal” eating patterns & habits – Lasts approximately 18 weeks in a stage-like

treatment plan

Weight Concerns, Body Dissatisfaction, & Eating Disorders

Eating Disorders: Causes & Prevention

Eating Disorders: Assessment & Treatment

Cognitive Behavioral Therapy (CBT) (cont’d.)

Weight Concerns, Body Dissatisfaction, & Eating Disorders

Eating Disorders: Causes & Prevention

Eating Disorders: Assessment & Treatment

Weight Concerns, Body Dissatisfaction, & Eating Disorders

Eating Disorders: Causes & Prevention

Are you constantly thinking about your weight and food?

Are you dieting strictly and/or have you lost a lot of weight?

Are you more than 10% below your healthy weight?

Are people concerned about your weight?

Sample Screening Questions for Eating Disorders

Is your energy level down?

Do you constantly feel cold?

Long-Term Outcome for People with Eating Disorders

Eating Disorders: Assessment & Treatment

Chapter Reflections

• Which assessment techniques do you think are most effective for each of the major types of eating disorders?

• What treatments appear to be most effective for specific eating disorders?

• What is the long-term outcome for individuals with eating disorders?