😵Abnormal Psychology Unit 13 – Eating Disorders

What Are Eating Disorders?

• Eating disorders are serious mental health conditions characterized by persistent disturbances in eating behaviors and thoughts about food, weight, and body image
• Involve abnormal eating habits that negatively impact physical and mental health, such as severely restricting food intake, binging on large amounts of food, or engaging in purging behaviors (self-induced vomiting, misuse of laxatives or diuretics)
• Often co-occur with other mental health disorders, such as anxiety, depression, and substance abuse
• Can affect people of all ages, genders, and backgrounds, although they are more common among adolescents and young adults, particularly females
• Eating disorders have the highest mortality rate of any mental illness due to medical complications and suicide
• Individuals with eating disorders often experience significant distress and impairment in daily functioning, including social, occupational, and academic difficulties
• Eating disorders are not a choice or a lifestyle preference, but serious illnesses that require professional treatment and support

Types of Eating Disorders

• Anorexia Nervosa: characterized by severe restriction of food intake, intense fear of gaining weight, and distorted body image
  • Restrictive type: involves limiting food intake and engaging in excessive exercise or fasting
  • Binge-eating/purging type: involves episodes of binge eating followed by purging behaviors
• Bulimia Nervosa: characterized by recurrent episodes of binge eating followed by compensatory behaviors to prevent weight gain, such as self-induced vomiting, misuse of laxatives or diuretics, fasting, or excessive exercise
• Binge Eating Disorder (BED): characterized by recurrent episodes of consuming large amounts of food in a short period, often accompanied by feelings of loss of control, shame, and distress
• Other Specified Feeding or Eating Disorder (OSFED): includes eating disorders that do not meet the full diagnostic criteria for anorexia, bulimia, or BED, but still cause significant distress and impairment
• Avoidant/Restrictive Food Intake Disorder (ARFID): involves persistent failure to meet appropriate nutritional or energy needs, often due to sensory sensitivities, fear of adverse consequences, or lack of interest in food
• Pica: characterized by persistent eating of non-food substances (clay, dirt, paper) that is inappropriate for the individual's developmental level
• Rumination Disorder: involves repeated regurgitation of food, which may be re-chewed, re-swallowed, or spit out

Causes and Risk Factors

• Eating disorders have a complex and multifaceted etiology, involving a combination of biological, psychological, and sociocultural factors
• Genetic predisposition: research suggests that eating disorders have a strong genetic component, with individuals who have a family history of eating disorders or other mental health conditions being at higher risk
• Neurobiological factors: abnormalities in brain structure and function, particularly in areas involved in reward processing, emotion regulation, and impulse control, may contribute to the development of eating disorders
• Personality traits: certain personality characteristics, such as perfectionism, impulsivity, and low self-esteem, have been associated with an increased risk of developing eating disorders
• Trauma and adverse life events: experiences of abuse, neglect, bullying, or significant life stressors can increase vulnerability to eating disorders
• Family dynamics: dysfunctional family relationships, such as enmeshment, rigidity, or excessive criticism, may contribute to the development of disordered eating behaviors
• Sociocultural influences: exposure to media messages that promote a thin ideal, as well as cultural pressures to conform to certain body standards, can contribute to body dissatisfaction and disordered eating
• Peer pressure and social comparison: negative experiences with peers, such as teasing or bullying related to weight or appearance, as well as social comparison and competition, can increase risk for eating disorders

Signs and Symptoms

• Behavioral signs:
  • Preoccupation with food, calories, and dieting
  • Skipping meals or making excuses to avoid eating
  • Engaging in secretive or ritualistic eating behaviors
  • Excessive exercise or rigid exercise routines
  • Frequent checking of body weight or appearance
  • Wearing baggy or layered clothing to conceal weight loss
• Physical signs:
  • Significant weight loss or fluctuations in weight
  • Gastrointestinal problems (constipation, acid reflux, abdominal pain)
  • Menstrual irregularities or amenorrhea in females
  • Dizziness, fainting, or fatigue
  • Dry skin, brittle hair and nails, and fine hair growth on the body (lanugo)
  • Cold intolerance and low body temperature
  • Dental problems, such as enamel erosion or tooth sensitivity
• Emotional and cognitive signs:
  • Intense fear of gaining weight or becoming fat
  • Distorted body image or dissatisfaction with appearance
  • Mood swings, irritability, or difficulty concentrating
  • Feelings of shame, guilt, or worthlessness related to eating or body image
  • Perfectionism and rigid thinking patterns
  • Social withdrawal and isolation
• It is important to note that not all individuals with eating disorders will display all of these signs and symptoms, and the severity and presentation may vary depending on the specific type of eating disorder and individual factors

Diagnosis and Assessment

• Eating disorders are diagnosed based on a comprehensive evaluation by a mental health professional, such as a psychiatrist or psychologist, using criteria from the Diagnostic and Statistical Manual of Mental Disorders (DSM-5)
• The assessment process typically involves:
  • Clinical interview to gather information about the individual's eating behaviors, thoughts, and emotions related to food and body image
  • Medical history and physical examination to assess the individual's overall health status and rule out any underlying medical conditions
  • Psychological assessment tools, such as self-report questionnaires or structured interviews, to evaluate the presence and severity of eating disorder symptoms and co-occurring mental health conditions
• Specific diagnostic criteria for each type of eating disorder:
  • Anorexia Nervosa: restriction of energy intake leading to significantly low body weight, intense fear of gaining weight, and disturbance in the way one's body weight or shape is experienced
  • Bulimia Nervosa: recurrent episodes of binge eating and inappropriate compensatory behaviors occurring at least once a week for three months
  • Binge Eating Disorder: recurrent episodes of binge eating occurring at least once a week for three months, accompanied by marked distress and lack of regular compensatory behaviors
• Differential diagnosis: eating disorders must be differentiated from other conditions that may present with similar symptoms, such as medical conditions (gastrointestinal disorders, endocrine disorders), other mental health disorders (depression, anxiety, obsessive-compulsive disorder), or normal variations in eating behaviors
• Assessment of co-occurring conditions: individuals with eating disorders often have co-occurring mental health conditions, such as anxiety disorders, depressive disorders, or substance use disorders, which should be assessed and addressed in treatment planning
• Ongoing monitoring: regular assessment of the individual's progress in treatment, including changes in eating behaviors, weight, and psychological symptoms, is essential for evaluating the effectiveness of interventions and making necessary adjustments to the treatment plan

Treatment Approaches

• Eating disorders require a multidisciplinary treatment approach that addresses the complex interplay of biological, psychological, and social factors contributing to the disorder
• Treatment goals: the primary goals of treatment are to restore healthy eating patterns, achieve and maintain a healthy body weight, address underlying psychological and emotional issues, and prevent relapse
• Levels of care: treatment may be provided in various settings depending on the severity of the disorder and the individual's needs, including outpatient, intensive outpatient, partial hospitalization, residential, or inpatient settings
• Nutritional rehabilitation: a key component of treatment involves developing a structured meal plan and gradually reintroducing a balanced and adequate diet to restore nutritional health
  • Registered dietitians or nutritionists work with individuals to establish healthy eating habits and address any nutritional deficiencies
  • Meal support and monitoring may be provided in higher levels of care to ensure adherence to the meal plan and prevent compensatory behaviors
• Psychotherapy: various forms of psychotherapy are used to address the psychological and emotional aspects of eating disorders
  • Cognitive-behavioral therapy (CBT): focuses on identifying and modifying dysfunctional thoughts and behaviors related to eating, weight, and body image
  • Interpersonal psychotherapy (IPT): addresses interpersonal difficulties and role transitions that may contribute to or maintain eating disorder symptoms
  • Family-based treatment (FBT): involves the family in the treatment process and emphasizes parental control over the child's eating in the early stages of recovery
  • Dialectical behavior therapy (DBT): teaches skills for emotion regulation, distress tolerance, and interpersonal effectiveness, which can be helpful for individuals with co-occurring borderline personality disorder or self-harm behaviors
• Medications: while there are no medications specifically approved for the treatment of eating disorders, certain medications may be used to address co-occurring conditions or specific symptoms
  • Antidepressants (SSRIs) may be prescribed for individuals with co-occurring depression or anxiety disorders
  • Antipsychotics (olanzapine) have been studied for the treatment of anorexia nervosa, particularly in the weight restoration phase
• Multidisciplinary team approach: effective treatment requires collaboration among professionals from various disciplines, including psychiatrists, psychologists, primary care physicians, registered dietitians, and social workers
• Long-term follow-up and relapse prevention: recovery from eating disorders is a gradual and ongoing process that requires continued support and monitoring to prevent relapse and maintain progress

Health Consequences

• Eating disorders can have severe and potentially life-threatening physical and psychological consequences, particularly if left untreated
• Malnutrition: restrictive eating disorders (anorexia nervosa, ARFID) can lead to malnutrition, which can affect every organ system in the body
  • Electrolyte imbalances, such as hypokalemia or hyponatremia, can cause cardiac arrhythmias, seizures, or other neurological complications
  • Anemia, leukopenia, and thrombocytopenia can result from nutritional deficiencies and increase the risk of infections and bleeding
  • Osteoporosis and increased risk of fractures due to decreased bone mineral density
• Gastrointestinal problems: eating disorders can cause a range of gastrointestinal issues, including:
  • Delayed gastric emptying and constipation due to slowed gastrointestinal motility
  • Gastroesophageal reflux disease (GERD) and esophageal inflammation or rupture from frequent vomiting
  • Pancreatitis, particularly in individuals with bulimia nervosa who misuse laxatives or diuretics
• Cardiovascular complications: eating disorders can affect the heart and circulatory system, leading to:
  • Bradycardia (slow heart rate) and hypotension (low blood pressure) due to malnutrition and electrolyte imbalances
  • Mitral valve prolapse and other structural heart abnormalities
  • Increased risk of sudden cardiac death, particularly in individuals with severe anorexia nervosa
• Endocrine and reproductive issues: eating disorders can disrupt the endocrine system and reproductive function
  • Amenorrhea (absence of menstrual periods) and infertility in females due to hormonal imbalances
  • Decreased testosterone levels and sexual dysfunction in males
  • Impaired growth and development in children and adolescents with eating disorders
• Neurological and cognitive effects: malnutrition and electrolyte imbalances can affect brain function and structure
  • Difficulty concentrating, memory impairment, and executive dysfunction
  • Structural brain changes, such as decreased gray and white matter volume, particularly in individuals with anorexia nervosa
  • Increased risk of seizures, particularly in individuals with severe electrolyte imbalances
• Psychological and social consequences: eating disorders can have a profound impact on an individual's mental health and social functioning
  • Increased risk of depression, anxiety disorders, and suicide
  • Social isolation and withdrawal due to preoccupation with food and body image
  • Impaired academic or occupational functioning and decreased quality of life
• Mortality: eating disorders have the highest mortality rate of any mental illness, with anorexia nervosa having a particularly high risk of premature death due to medical complications or suicide

Prevention and Support Strategies

• Primary prevention: aims to prevent the development of eating disorders by addressing risk factors and promoting protective factors
  • Promoting media literacy and critical thinking skills to help individuals resist unrealistic and unhealthy body ideals portrayed in the media
  • Encouraging positive body image and self-esteem through education and empowerment programs, particularly in schools and youth organizations
  • Providing education about healthy eating habits and the dangers of dieting and disordered eating behaviors
  • Addressing sociocultural factors that contribute to the development of eating disorders, such as weight stigma and discrimination
• Secondary prevention: focuses on early identification and intervention for individuals who are at high risk or showing early signs of eating disorders
  • Screening for eating disorder symptoms in primary care settings, particularly among adolescents and young adults
  • Training healthcare professionals, educators, and parents to recognize the signs and symptoms of eating disorders and provide appropriate referrals for assessment and treatment
  • Implementing evidence-based prevention programs, such as the Body Project or the Healthy Weight Intervention, which have been shown to reduce risk factors for eating disorders
• Tertiary prevention: involves providing support and resources for individuals who have been diagnosed with an eating disorder to prevent relapse and promote long-term recovery
  • Ensuring access to evidence-based treatment services, including multidisciplinary care and specialized eating disorder programs
  • Providing ongoing support and monitoring after the completion of formal treatment to prevent relapse and maintain progress
  • Connecting individuals with peer support groups and recovery communities, such as the National Eating Disorders Association (NEDA) or the Alliance for Eating Disorders Awareness
  • Encouraging the involvement of family members and significant others in the recovery process and providing education and support for caregivers
• Reducing stigma and increasing awareness: promoting a greater understanding of eating disorders as serious mental health conditions that require professional treatment and support
  • Educating the public about the signs, symptoms, and consequences of eating disorders through media campaigns and community outreach programs
  • Encouraging individuals who are struggling with eating disorders to seek help and emphasizing that recovery is possible with appropriate treatment and support
  • Advocating for policies and legislation that improve access to care, protect the rights of individuals with eating disorders, and promote research and prevention efforts
• Research and innovation: continued research is essential for improving our understanding of the causes, consequences, and most effective treatments for eating disorders
  • Investigating the genetic, neurobiological, and environmental factors that contribute to the development of eating disorders
  • Developing and evaluating new prevention and treatment approaches, such as technology-based interventions or novel pharmacological agents
  • Studying the long-term course and outcomes of eating disorders to inform relapse prevention and recovery support strategies