1.6 Problem 4 Summary

1.6 Problem 4
You Are What You Eat
Eating disorders- persistent disturbance in eating behaviour

Differences
Anorexia- v. underweight, higher mortality rate,

Anorexia Nervosa
Anorexia nervosa- intense fear of gaining weight or becoming fat, combing with
behaviours that result in significantly low body weight
DSM-5 For Anorexia Nervosa
A. Restricting energy intake relative to requirements, causing v. low body weight for age, sex,
developmental trajectory, physical health. Significantly low weight is weight less than minimally
normal, or for children/adolescents, less than minimally expected
B. Intense fear of gaining weight/becoming fat, or persistent behaviour that interferes with weight
gain, even though at v. low weight
C. Disturbance to way one’s body weight/shape is experienced, undue influence of body
weight/shape on self-evaluation, or persistent lack of recognition of seriousness of current low
body weight

 Patients often deny having any problem
 Feel fulfilled by weight loss, yet feel unsure about their weight
 Efforts sometimes made to conceal thinness eg. baggy clothing
 May drink much water to increase their weight temporarily
 Severely underweight
 Greater mortality than bulimia
2 types:
1. Restricting type
-limit quantity of food consumed
-caloric intake tightly controlled
-often avoid eating in presence of others
-may eat v. slowly, cut food into small pieces, dispose of food secretly
-admired by others with eating disorders
2. Binge-eating/purging type
-binge, purge, or binge and purge
-binge- out-of-control consumption of amount of food far greater than most
would eat in same amount of time and circumstances
-purge- remove food eaten from their bodies
Inc. self-induced vomiting vomiting, laxatives, diuretics, enemas
-excessive exercise or fasting

DSM-5 For Bulimia Nervosa
A. Recurrent episode of binge eating. Episode of binge eating has both the following
1. Eating, in discrete period of time, amount that’s larger than what most individuals would eat in similar
time period and circumstances
2. Sense of lack of control overeating during episode
B. Recurrent inappropriate compensatory behaviours to prevent weight gain, inc. self-induced vomiting, misuse
of laxatives, diuretics, mediation, fasting, excessive exercise
C. Binge eating and inappropriate compensatory behaviours both occur, on average, once a week for 3 months
D. Self-evaluation unduly influenced by body shape/weight
E. Disturbance doesn’t occur exclusively during episodes of anorexia nervosa


Bulimia Nervosa
Bulimia nervosa- uncontrollable binge eating and efforts to prevent the weight gain
using behaviours inc. self-induced vomiting and excessive exercise
 Clinical binge-eating anorexia nervosa v similar
o Anorexia nervosa must be severely underweight, bulimia- not a
requirement
 =if binge/purge AND meet criteria for anorexia, diagnosis anorexia
not bulimia
 Typically, normal weight, sometimes slightly overweight

,  Desire to be slender
o Early stages- eats low calorie-foods
o Restriction on foods dissolves, eat “forbidden foods”
o Consume up to 4,800 calories in binge
o To manage breakdown of self-control, vomit, fat, exercise excessively or
abuse laxatives
 Efforts made to conceal behaviour

Binge Eating Disorder
 No inappropriate “compensatory” behaviour following a binge
 Less dietary restraint than bulimia or anorexia
 Associated with obesity/over-weight
 Likelier to have overvalued ideas on important of weight & shape than
overweight/obese patients
DSM-5 For Binge-Eating Disorder
A. Recurrent episode of binge eating. Episode of binge eating has both the following
1. Eating, in discrete period of time, amount that’s larger than what most individuals would eat in similar
time period and circumstances
2. Sense of lack of control overeating during episode
B. Binge-eating episodes associated with 3+ of following:
1. Eating much more rapidly than normal
2. Eating until feeling uncomfortably full
3. Eating much food when not feeling physically hungry
4. Eating alone as embarrassed by how much they’re eating
5. Feeling disgusted with oneself, depressed, or v. guilty
C. Marked distress regarding binge eating in present
D. Binge eating occurs, on average, at least once a week for 3 months
E. Binge eating isn’t associated with recurrent use of inappropriate compensatory behaviour as in bulimia
nervosa and doesn’t occur exclusively during course of bulimia or anorexia

Onset and Gender Differences
 Anorexia/bulimia uncommon before adolescence but can happen
 Anorexia likeliest between 15-19 years
 Bulimia, likeliest women between 20-24 years
 Binge eating, likeliest 30-50 years
 Primarily in women
o Potentially as disorders in men underdiagnosed as stereotypes that they’re
female disorders
o DSM emphasise shape and body weight regulation methods (eg. dieting),
but males often express it by over-exercising to be more muscular
 Gay/bisexual men likelier than heterosexual men as more dissatisfied with bodies
 Wrestlers, jockeys, ballet dancers, models all at higher risk due to weight required
for their professions

Prevalence
 Binge-eating most common- 2%
USA lifetime prevalence 3.5% women, 2% men
 B.E.D. likelier in obese people, 6.5-8%
 Bulimia- 1%
USA lifetime prevalence 1.5% women, 0.5% men
 Anorexia- 1.2% women, 0.29% men
USA lifetime prevalence 0.9% women, 0.3% men
 Peak in cases in 20th century, now decrease in prevalence

Eating Disorder Medical Complications
 Anorexia has highest mortality rate of all psychiatric disorders
 Anorexia usually causes death from medical complications
o 3% die from self-imposed starvation
o Symptoms: thin hair, brittle nails, dry skin, downy hair on
face/neck/arms/back/legs, yellowish tinge to skin