This is a powerpoint presentation for eating disorders based on DSM-IV TR.

1. Eating Disorders
mariacristinajsantos.blogspot.com
http://dlsu.academia.edu/MariaCristinaSantos

2. Eating Disorders
 anorexia - refers to loss of
appetite
 nervosa - indicates that the loss
is due to emotional reasons.

3. Eating Disorders
 The term is something of a misnomer
because most individuals with
anorexia nervosa actually do not
lose their appetite or interest in
food.

4. Eating Disorders
 On the contrary, while starving
themselves, most individuals with the
disorder become preoccupied with
food; they may read cookbooks
constantly and prepare gourmet
meals for their families.

5. True story of Isabel
Anorexia's Childhood Roots
(CBS News)

6. DIAGNOSTIC CRITERIA
FOR ANOREXIA NERVOSA

7.  A. Refusal to maintain body weight at or above a
minimally normal weight for age and height (e.g.,
weight loss leading to maintenance of body
weight less than 85% of that expected; or failure
to make expected weight gain during period of
growth, leading to body weight less than 85% of
that expected).
 B. Intense fear of gaining weight or becoming fat,
even though underweight.
DIAGNOSTIC CRITERIA FOR
ANOREXIA NERVOSA

8.  C. Disturbance in the way in which one's body
weight or shape is experienced, undue
influence of body weight or shape on self-
evaluation, or denial of the seriousness of the
current low body weight.
 D. In postmenarcheal females, amenorrhea,
i.e., the absence of at least three consecutive
menstrual cycles. (A woman is considered to
have amenorrhea if her periods occur only
following hormone, e.g., estrogen,
administration.)
DIAGNOSTIC CRITERIA FOR
ANOREXIA NERVOSA

9. Two Types of Anorexia Nervosa
 Restricting Type: during the current episode of
Anorexia Nervosa, the person has NOT
regularly engaged in binge-eating or
purging behavior (i .e., self-induced vomiting
or the misuse of laxatives, diuretic;, or enemas)
 Binge-Eating/Purging Type: during the current
episode of Anorexia Nervosa, the person has
regularly engaged in binge-eating or
purging behavior (i.e., self-induced vomiting
or the misuse of laxatives, diuretics, or enemas)

10. Eating Disorders Inventory
 The distorted body image that accompanies anorexia
nervosa has been assessed in several ways, most
frequently by a questionnaire such as the EATING
DISORDERS INVENTORY (Garner et al. cited in
Davison et al., 2007).
 Some of the items on this questionnaire are
presented in the table below.

11. Drive for thinness I think about dieting.
I feel extremely guilty after overeating.
I am preoccupied with the desire to be thinner.
Bulimia I stuff myself with food.
I have gone on eating binges where I have felt that I could not stop
I have the thought of trying to vomit in order to lose weight.
Body dissatisfaction I think that my thighs are too large.
I think that my buttocks are too large.
I think that my hips are too big.
Ineffectiveness I feel inadequate.
I have a low opinion of myself.
I feel empty inside (emotionally).
Perfectionism Only outstanding performance is good enough in my family.
As a child, I tried hard to avoid disappointing my parents and teachers.
I hate being less than best at things.
Subscales and Illustrative Items from the Eating
Disorders Inventory

12. Interpersonal
distrust
I have trouble expressing my emotions to others.
I need to keep people at a certain distance (feel
uncomfortable if someone tries to get too close).
Interoceptive
awareness
I get confused about what emotion I am feeling.
I don’t know what’s going on inside me.
I get confused as to whether or not I am hungry.
Maturity fears I wish that I could return to the security of childhood.
I feel that people are happiest when they are children.
The demands of adulthood are too great.
Source: From Garner et al., 1983
Note: Responses use a six-point scale ranging from always to never.
Subscales and Illustrative Items from the Eating
Disorders Inventory

13. Assessment of Body Image
 In another type of
assessment,
individuals with
anorexia nervosa are
shown line drawings of
women with varying
body weights and
asked to pick the
one closes to
their own and the
one that
represents their
ideal shape.

14. Assessment of Body Image
 Individuals overestimate their
own body size and choose a thin
figure as their ideal.
 Despite this distortion in body
size, individuals with anorexia
nervosa are fairly accurate when
reporting their actual weight,
perhaps because they weight
themselves frequently.

15. Anorexia Nervosa
 Women with anorexia nervosa are
frequently diagnosed with
depression, obsessive-
compulsive disorder, phobias,
panic disorder, alcoholism,
and various personality
disorders

16. Anorexia Nervosa
 Men with anorexia nervosa are also
likely to have a diagnosis of a mood
disorder, schizophrenia, or
substance dependence

17. PHYSICAL CHANGES IN
ANOREXIA NERVOSA
 Blood pressure often
falls
 Heart rate slows
 Kidney and
gastrointestinal
problems develop
 Bone mass declines
 Skin dries out, nails
become brittle
 Hormone levels change
 Mild anemia may occur
 EEG abnormalities and
neurological impairments
 Structural brain changes,

18. PREVALENCE
 The lifetime prevalence of Anorexia
Nervosa among females is
approximately 0.5%.
 It is at least 10 times more
frequent in women than in men.
 The incidence of Anorexia Nervosa
appears to have increased in recent
decades.

19. COURSE
 Anorexia Nervosa typically begins in mid- to late
adolescence (age 14-18 years).
 The onset of this disorder rarely occurs in
females over age 40 years.
 Hospitalization may be required to restore weight
and to address fluid and electrolyte imbalances.
 Death most commonly results from starvation,
suicide, or electrolyte imbalance.

20. PROGNOSIS
 About 70% of
patients with
anorexia eventually
recover.
 Recovery often takes
6 or 7 years, and
relapses are common
 Anorexia nervosa is a
life-threatening
illness
 Death rates are 10 times
higher among individuals
with the disorder than
among the general
population and twice as
high as among individuals
with other psychological
disorders.
 Death most often results
from physical
complications of the illness
– for example, congestive
heart failure – and from
suicide

21. BULIMIA NERVOSA

23. Bulimia Nervosa
 Bulimia is from a Greek word
meaning “ox hunger.”
 This disorder involves episodes of
rapid consumption of a large
amount of food, followed by
compensatory behavior, such as
vomiting, fasting, or excessive
exercise to prevent weight gain.

24. Bulimia Nervosa
 The DSM defines a BINGE as eating
an excessive amount of food within
less than 2 hours.

25. Bulimia Nervosa
 ― BULIMIA NERVOSA IS NOT DIAGNOSED IF THE
BINGING AND PURGING OCCUR ONLY IN THE
CONTEXT OF ANOREXIA NERVOSA AND ITS EXTREME
WEIGHT LOSS; THE DIAGNOSIS IN SUCH A CASE IS
ANOREXIA NERVOSA, BINGE-EATING-PURGING TYPE.
INDEED, ONE STRIKING DIFFERENCE
BETWEEN ANOREXIA AND BULIMIA IS
WEIGHT LOSS: INDIVIDUALS WITH
ANOREXIA NERVOSA LOSE A TREMENDOUS
AMOUNT OF WEIGHT WHEREAS
INDIVIDUALS WITH BULIMIA NERVOSA DO
NOT” (Davison, 2007).

26. Diagnostic Criteria
for
Bulimia Nervosa

27. Diagnostic Criteria for
Bulimia Nervosa
A. Recurrent episodes of binge eating. An episode of
binge eating is characterized by
both of the following:
(1) eating, in a discrete period of time (e.g.,
within any 2-hour period). an amount of
food that is definitely larger than most people
would eat during a similar period of time and
under similar circumstances
(2) a sense of lack of (control over eating during the
episode (e.g., a feeling that one cannot stop
eating or control what or how much one is eating)

28. Diagnostic Criteria for
Bulimia Nervosa
B. Recurrent inappropriate compensatory
behavior in order to prevent weight
gain, such as self-induced vomiting;
misuse of laxatives, diuretics, enemas,
or other medications; fasting; or
excessive exercise.
C. The binge eating and inappropriate
compensatory behaviors both occur, on
average, at least twice a week for
3 months.

29. Diagnostic Criteria for
Bulimia Nervosa
D. Self-evaluation is unduly
influenced by body shape and
weight.
E. The disturbance does not occur
exclusively during episodes of
Anorexia Nervosa.

30. Two types of Bulimia
Nervosa
 Purging Type: during the current
episode of Bulimia Nervosa, the
person has regularly engaged
in self-induced vomiting or
the misuse of laxatives,
diuretics, or enemas

31. Two types of Bulimia
Nervosa
 Nonpurging Type: during the
current episode of Bulimia Nervosa,
the person has used other
inappropriate compensatory
behaviors, such as fasting or
excessive exercise, but has not
regularly engaged in self-induced
vomiting or the misuse of
laxatives, diuretics, or enemas

32. Bulimia Nervosa
 In bulimia, binges typically occur in
secret; they may be triggered by
stress and the negative
emotions it arouses, and continue
until the person is uncomfortably full

33. Bulimia Nervosa
 Foods that can be rapidly consumed,
especially sweets such as ice
cream and cake, are usually part of
a binge.
 A recent study found that women with
bulimia nervosa were more likely to
binge while alone and during the
morning or afternoon.

34. Bulimia Nervosa
 Avoiding a craved food on one
day was associated with a binge
episode the next morning
 Other studies show that a binge is
likely to occur after a negative
social interaction, or at least
the perception of a negative
social exchange

35. Bulimia Nervosa
 Patients report that they lose
control during a binge, even to
the point of experiencing something
akin to a dissociative state,
perhaps losing awareness of their
behavior or feeling that it is not really
they who are binging.
 They are usually ashamed of their
binges and try to conceal them.

36. Bulimia Nervosa
 After the binge is over, disgust,
feelings of discomfort, and
fear of weight gain lead to the
second step of bulimia nervosa –
purging to attempt to undo the
caloric effects of the binge.

37. Bulimia Nervosa
 Individuals with bulimia most often
stick fingers down their
throats to cause gagging, but after
a time many can induce vomiting at
will without gagging themselves.
 Laxatives and diuretic abuse
as well as fasting and excessive
exercise are also used to prevent
weight gain.

38. Bulimia Nervosa
 THE DSM DIAGNOSIS OF BULIMIA
NERVOSA REQUIRES THAT THE
EPISODES OF BINGING AND
PURGING OCCUR AT LEAST
TWICE A WEEK FOR 3
MONTHS.

39. Is twice a week a well-
established cut-off point?
 Probably not. Few differences are
found between patients who binge
twice a week and those who do so
less frequently, suggesting that we
are dealing with a continuum of
severity rather than a sharp
distinction

40. PHYSICAL CHANGES IN
BULIMIA NERVOSA
 Although less common than in
anorexia, menstrual
irregularities, including
amenorrhea, can occur, eventhough
bulimia patients typically have a
normal body mass index (BMI)
 The BMI is calculated by dividing weight in
kilograms by height in meters squared and is
considered a more valid estimated of body fat
than many others For women, a normal BMI is
between 20-25.

41. PHYSICAL CHANGES IN
BULIMIA NERVOSA
 Frequent purging can cause
potassium depletion.
 Heavy use of laxatives induces
diarrhea, which can also lead to
changes in electrolytes and
cause irregularities in the
heartbeat.

42. PHYSICAL CHANGES IN
BULIMIA NERVOSA
 Recurrent vomiting may lead to
tearing of tissue in the
stomach and throat and the
loss of dental enamel
 Salivary glands may become
swollen.

43. PREVALENCE
 The lifetime prevalence of Bulimia
Nervosa among women is
approximately 1 %-3%;
 the rate of occurrence of this disorder
in males is approximately one-
tenth of that in females.

44. COURSE
 Bulimia Nervosa usually begins in late
adolescence or early adult life.
 The binge eating frequently begins
during or after an episode of
dieting.
 The course may be chronic or
intermittent

45. PROGNOSIS
 Long-term follow-ups of individuals
with bulimia nervosa reveal that
about 70% recover, although
about 10% remain fully
symptomatic

46. PROGNOSIS
 Individuals with bulimia nervosa who
binge and vomit more, and
have comorbid substance
abuse or a history of
depression, have a poorer
prognosis than patients without
these factors

47. Key Point:
 One striking difference between
anorexia and bulimia is weight
loss; individuals with anorexia
nervosa lose a tremendous
amount of weight whereas
individuals with bulimia
nervosa do not.

48. ETIOLOGY OF EATING
DISORDERS
GENETIC FACTORS
 Both disorders (Anorexia and Bulimia)
tend to run in families, and twin
studies support the role of
genetics in the actual disorders.
 Research findings on the role of
serotonin in anorexia are mixed.

49. ETIOLOGY OF EATING
DISORDERS
GENETIC FACTORS
 Serotonin may play a role in
bulimia, with studies finding a
decrease in serotonin
metabolites, smaller responses to
serotonin agonists, and an increase in
cognitions related to eating disorders, such
as feeling fat, among formerly bulimic
individuals who had their serotonin levels
reduced.

50. ETIOLOGY OF EATING
DISORDERS
GENETIC FACTORS
Newer research suggests
dopamine may play a role
in restrained eating

51. ETIOLOGY OF EATING
DISORDERS
SOCIOCULTURAL
STANDARDS
 As sociocultural
standards changed
to favor a
thinner shape
as the ideal for
women, the
frequency of eating
disorders
increased.

52. ETIOLOGY OF EATING
DISORDERS
PSYCHOLOGICAL LEVEL
 Psychodynamic theories of eating
disorders emphasize parent-child
relationships and personality
characteristics.
 Food becomes a symbol of this failed
relationship. The daughter’s binging
and purging represent the conflict
between the need for the mother
and the desire to reject her.

53. ETIOLOGY OF EATING
DISORDERS
PSYCHOLOGICAL LEVEL
 Studies of personality have found that
patients with eating disorders are high
in neuroticism and perfectionism
and low in self-esteem.
 Many women with eating disorders
report being abused as children,
but early abuse does not appear to be a
specific risk factor for eating disorders.

54. COGNITIVE BEHAVIORAL
THEORIES
 Cognitive behavioral
theories of eating
disorders propose
that fear of
being fat and
body-image
distortion make
weight loss a
powerful reinforcer.

55. COGNITIVE BEHAVIORAL
THEORIES
 Among patients with bulimia nervosa,
negative affect and stress
precipitate binges that create
anxiety, which is then relieved by
purging.

56. PSYCHOLOGICAL TREATMENT
OF ANOREXIA NERVOSA
 Therapy for anorexia is generally
believed to be a two-tiered
process.
 Immediate goal is to help the patient
gain weight in order to avoid
medical complications.
 Second goal of treatment—long
term maintenance of weight
gain.

57. PSYCHOLOGICAL TREATMENT
OF ANOREXIA NERVOSA
 Family
therapy
 The therapist
sees the family
at a family
lunch
session.

58. Family Therapy
 One strategy is to instruct each parent
to try individually to force the
child to eat. The other parent may
leave the room. The individual
efforts are expected to fail.
But through this failure, the mother
and father may now work
together to persuade the child
to eat.

59. Family Therapy
 Thus, rather than being a focus of
conflict, the child’s eating
will produce cooperation
and increase parental
effectiveness.

60. PSYCHOLOGICAL TREATMENT
OF BULIMIA NERVOSA
 The overall goal of treatment in
bulimia nervosa is to develop
normal eating patterns.
 Patients need to learn to eat 3 meals
a day and even some snacks in
between meals without sliding
back into binging or purging.

61. PSYCHOLOGICAL TREATMENT
OF BULIMIA NERVOSA
 Cognitive behavior therapy (CBT) is
the best validated and most current standard
for the treatment.
 Cognitive behavioral treatment for bulimia
focuses on questioning society’s
standard for physical attractiveness,
challenging beliefs that encourage
severe food restriction, and
developing normal eating patterns.

62. PSYCHOLOGICAL TREATMENT
OF BULIMIA NERVOSA
 One intervention that is sometimes used
in the cognitive behavioral treatment
approach asks the patient to bring
small amounts of forbidden food
to eat in the session.
 Relaxation is employed to control the
urge to induce vomiting.

63. PSYCHOLOGICAL TREATMENT
OF BULIMIA NERVOSA
 To improve on CBT, some investigators are
examining one important aspect –exposure
and ritual prevention (ERP – aspect of CBT of
obsessive-compulsive disorder). This ERP
component involves discouraging the patient
from purging after eating foods that usually
elicit an urge to vomit.
 Patients with bulimia nervosa are also taught
assertiveness skills to help them cope with
unreasonable demands placed on them by others.

64. ANTIDEPRESSANTS
 Although somewhat effective, drop-out
rates from drug-treatment
programs are high and relapse is
common when patients stop taking the
medication.
 Treatment of anorexia often requires
hospitalization to reduce the medical
complications of the disorder.


65. Eating Disorder
Not Otherwise Specified

66. Eating Disorder
Not Otherwise Specified
The Eating Disorder Not Otherwise Specified
category is for disorders of eating that
do not meet the criteria for any specific Eating
Disorder.
1. For females, all of the criteria for Anorexia
Nervosa are met except that the individual has
regular menses.
2. All of the criteria for Anorexia Nervosa are met
except that, despite significant weight loss, the
individual 's current weight is in the normal range.

67. Eating Disorder
Not Otherwise Specified
3. All of the criteria for Bulimia Nervosa are met except
that the binge eating and inappropriate compensatory
mechanisms occur at a frequency of less than twice a
week or for a duration of less than 3 months.
4. The regular use of inappropriate compensatory
behavior by an individual of normal body weight after
eating small amounts of food (e.g., self-induced
vomiting after the consumption of two cookies).
5.Repeatedly chewing and spitting out, but not
swallowing, large amounts of food.
6.Binge-eating disorder: recurrent episodes of binge
eating in the absence of the regular use of
inappropriate compensatory behaviors characteristic of
Bulimia Nervosa.

68. PREVENTIVE INTERVENTIONS
FOR EATING DISORDERS
 Psychoeducational Approaches.
The focus is on educating children and
adolescents about eating disorders to prevent
them from developing the symptoms;
 De-emphasizing Sociocultural
Influences. The focus here is on helping
children and adolescents resist or reject
sociocultural pressures to be thin;

69. Society’s Preoccupation with
Thinness
 After winning Miss
Universe (1996),
she gained a few
pounds, some
people became
outraged and
suggested she give
up her crown.

70. PREVENTIVE INTERVENTIONS
FOR EATING DISORDERS
 Risk Factor Approach. The
focus here is on identifying
individuals with known risk
factors for developing eating
disorders (e.g., weight and body
concern, dietary restraint) and
intervening to alter these
factors.

71. Thank You!!!