A.P. Chapter 16

• 1.
• AN- refusal to maintain minimum body weight for healthy functioning
• BN-underweight, normal weight, near-normal weight, or over weight
• 2.
• AN- hunger and disorder denied; proud of weight management; more satisfied with body
• BN- intense hunger experienced; binge-purge experienced as abnormal; greater body dissatisfaction
• 3.
• AN- less antisocal behavior
• BN- greater tendency to antisocial behavior and alcohol abuse
• 4.
• AN- mistrust of others, especially professionals
• BN- more trusting of persons wishing to help
• 5.
• AN- tend to be obsessional (OCD)
• BN- tend to be dramatic
• 6.
• AN- Greater self-control, but emotionally over-controlled
• BN- more impulsivity and emotional instability; greater levels of depression
• 7.
• AN- more likely sexually immature and inexperienced
• BN- more sexually experienced and active
• 8.
• AN= females more likely to reject traditional role
• BN- females more likely to accept traditional role; concerned about others' opinion
• 9.
• AN- age of onset usually around 14-18yrs
• BN- Age of onset usually around 15-21yrs
• 10.
• AN-less familial predisposition to obesity
• BN- greater familial predisposition to obesity
• 11.
• AN- greater tendency toward pre-disorder compliance w/ parents
• BN- greater tendency toward pre-disorder conflict w/parents
• 12.
• AN- tendency to deny family conflict
• BN- tendency to perceive intense family conflict

• 1. lateral hypothalamus (LT=eat)
• 2. Ventromedial hypothalamus (VT= STOP)
• 3. Paraventricular nucleus ( cluster of cells in hypothalamus. Food preferences)

• Glucostatic theory
• lipostatic theory

monitoring glucose levels, when those drop, it says eat, when they are back to normal, stop eating

longterm weight, hypothalamus monitoring size and number of fat cells in body, if you have more cells the body will urge to eat more, if you have less cells, you can eat less

• (adipose)
• determined by genetics, metabolism, early feeding, average weight person = 30-40 billion

• -not in the DSM
• if 2 binges per week, for at least 6 months without compensatory behavior, may be diagnosed with eating disorder NOS

20% above ideal weight for women, 24% for men. may also use body mass index

• type 2 diabetes
• hypertension
• cardiovascular disease
• CVAs (strokes)
• colorectal cancer

greater number of fat cells

tolerance, withdrawal, ingest more than intended, much time thinking about food and its consumption, overeat despite attempts or promises to cut back, overeat despite adverse consequences

Anorexia Nervose (AN)

• refusal to maintain minimum body weight
• intense fear of gaining weight or becoming obese
• disturbance in body image (cognitive distortion)
• in postmenarcheal females, ammenorrhea for at least 3 cycles

• restricting type
• binge eating/purging type

fasting only (starve, and when finally give in only eat something so small like 1 kernal of popcorn)

fasting with occasional bingeing and purging (usually starves, but once in awhile gives in so binge, then purge)

• low bone density
• lanugo (long silky hair on their bodies, bc losing body fat, which is insulation to bodies, so hair acts as insulation)
• dry skin, brittle nails
• hypotension; cardia arrhythmia
• confused thinking (brain needs glucose, can get to point where they have delusions)

• many OCD quailities
• highly perfectionistic, intelligent
• depressed, anxious, introverted
• perceives little personal control
• "thinness = happiness"
• strange food- related behavior

Anorexia Nervosa

muscle dysmorphobia

Bulimia Nervosa (BN)

• recurrent episodes of binge eating
• recurrent inappropriate compsensatory behavior
• behaviors both occurr, on average 2+ times per week for 3 months
• self-evaluation unduly influenced by body shape and weight

• purging type: 75% use vomiting
• non-purging type: after binge person might sleep "hibernate" for days at a time

2-40 per week (10 average); rarely longer than 2 hours, loss of control; triggered by stress, emotions, mood. hoard food/steal food. after binge, much guilt and self-blame so compensatory behaviors used for "purification"; extremely secretive

• cardiac problems (postassium loss); heart failure
• esophageal ulcerations (internal bleeding)
• decay of tooth enamel
• speeded-up metabolism ( this why you dont actually recognize a person who purges, bc they can be fat, skinny or normal)
• puffy glands (paraotoid glands swell) chipmunk cheeks
• stomach ruptures

• very secretive
• much shame, self-blame, low self-esteem
• excessive concern with body image
• intelligent, extroverted, perfectionistic
• OCD traits, compliant to norms, people-pleasers
• high rates of substance abuse may be "cutters"

because it is a mindset, once a BN always BN

• genetics (triggered at puberty?)
• disregulation of glp-1 (peptide from fat cells)
• disregulation of metabolic rates
• low serotonin levels (5-HT) esp. in BN

• this is OLDEST THEORIES FOR EDs
• Anorexia- fear of oral impregnation; oral (nurturance), anal (self-control), phallic (Electra Complex) fixations
• Bulimia- oral (nurturance), anal (OCD qualities fixatiions; binging allows avoiding anger felt towards others; purging is purification by superego to atone for id's binge

attention for thinness, weight loss is self-reinforicing (AN); rewarded by stress release and learned not thinking when bingeing (BN)

distored image of self and body; perfectionism; perceptions of low personal control; alexithymia (difficulty finding words to talk about their feelings)

• AN: family enmeshment; over-controlling parents; norms provided no outlet for women's anger; slim role models and prejudice against large people
• BN: family enmeshment: over protectiveness; family worried about appearances; norms stress high perfectionism in women but limited access or prestige and power

• restore physical health first
• then deal with psychological/family issues
• 8-phase approach

• deal with purging first
• then address binges
• antidepressants help in 50-60% of cases
• 8-phase treatment program

• most effective is exercise and reducing eating
• other methods include medications
• surgical procedures