Abnormal Psychology- Ch 11 (Comer)

-Refusal to maintain body weight above a minimally healthy normal weight for age and height.
-Intense fear of gaining weight
-Disturbed body perception, undue influence of weight or shape on self-perception, denial of the seriousness of condition
-Amenorrhea

Preoccupation with food. Thinking, talking, dreaming and reading about food, excessive planning of meals.

Maladaptive thoughts. (Must be perfect, deprivation makes me a better person, excessive guilt after eating)
Poor self-esteem.
Warped body image. Typically perceive themselves as upwards of 20% larger than they actually are.

Depression
Anxiety
Insomnia
Substance abuse
OCD (typically food related, but can be broader)

Lowered body temp
Low blood pressure
Body swelling
Reduced bone mineral density
Slow heart rate
Rough, dry and cracked skin
Brittle nails
Lanugo on the trunk (fine silky hairs)

Recurrent binge eating
Recurrent compensatory behavior to prevent weight gain (response to binge)
Symptoms presenting twice a week for three months
Undue influence of weight or shape on self-image

90-95% females
15-21 years of age
Weight stays within a normal range, but fluctuates wildly inside those parameters

Purging type- Forced vomiting. Misuse of laxatives, diuretics or enemas.
Non-purging type- Fasting or exercising frantically
Binge-eating- Binge eating with no compensatory behavior.

Bulimic have 1-30 binges per week, most in secret.
Food is typically sweet, with soft texture. Highly caloric.
Binges are preceded by significant tension, with the person feeling irritable and unable to control an overwhelming need to eat.
Post-binge, there are feelings of self-recrimination, shame, guilt and depression. Also the fear of weight gain and being discovered.

Vomiting only prevents about half of the caloric absorption. Repeated vomiting impairs the ability to feel satiated, which can lead to greater hunger and more frequent binges.
The purging may alleviate much of the anxiety and self-loathing. However, this may open the door for increased binges, which then necessitate purges.

More antisocial
More trusting of those trying to help
Intense hunger experienced (vs denied)
Recognize behavior is abnormal
More Impulsive
Dramatic
More sexually experienced

Ineffective parenting is the root cause. The parent misattributes the child’s needs and incorrectly responds. Child is afraid and cries, thinking the child is hungry, the parent feeds them.
This leads to the child’s inability to interpret their own needs and appropriate responses. Unable to ‘trust’ their own feelings, the children feel they aren’t in control of themselves.
Manipulating their body-shape/eating habits provides the needed sense of control.

Impaired ability to describe internal emotions, often being unable to distinguish between feelings and bodily sensations resulting from emotional arousal.
Impaired ability to describe emotions to others.
Impaired imaginative functions.
Cognitive functioning which is highly external and stimulus oriented.

Eating disorders have an underlying maladaptive process in which the person believes their worth is based EXCLUSIVELY on their body shape/weight and their ability to control these factors.

Genes may lead some to be predisposed to eating disorders. Arguments in support of this: Relatives of those with eating disorders have shown a significantly greater probability of developing it themselves. Twins: One identical twin is far more likely to develop the disorder if the other does than in the case of fraternal twins.

Lateral Hypothalamus: When stimulated, causes hunger.
Ventromedial Hypothalamus: When stimulated, suppresses hunger.
Along with two chemicals (CCK, GLP-1) these areas produce a weight-based homeostasis. When fasting, GLP-1 is suppressed and metabolism slows to encourage weight gain. When full, metabolism increases and GLP-1 is produced.

When a culture values a particular body type, people will try to attain it. Those people prone to maladaptive behaviors will pursue the ideal in maladaptive ways.

Tube and intravenous feedings.
Hospital stay, in which patients are rewarded for gaining weight.
Supportive nursing care, nutritional counseling and a high-calorie diet.

Clients keep a diary of their feelings, hunger levels and food intake and encouraged to find connections between them.
They are also taught to identify their core belief that they SHOULD be judged based on their shape.weight and their control of those features.
Alternative coping behaviors (rather than restrictive eating) are taught.

20% remain troubled for years.
Recovery recurs in 1/3 of recovered patients, typically triggered by new life stressors.
Individuals with psych or sexual issues prior to anorexia are less likely to recover.
The more weight lost and/or the longer before treatment begins, the less recovery is likely.

Diary (as for anorexics) and exposure and response prevention.
Having the client eat ‘forbidden’ foods, then staying with them until the desire to ‘purge’ has passed, to show that eating is not an activity that needs undoing.
The client is taught to identify and challenge the maladaptive thinking that precedes a binge.

Antidepressant drugs have been used in the past 10-15 years. Unlike anorexia, bulimia patients respond to the medication.
Improvement has been shown in 40% of patients, reducing their binges by 67% and purges by 56%. Works best when concurrent with other therapies.

89% of those treated recover. (70% complete, 19% partial)
40% respond immediately to treatment, with significant improvement. A further 40% respond moderately.
Relapse occurs in 1/3 of patients within 2 years, but typically within six months. Those who experienced it longer are more likely to relapse.