A.P. Chapter 16
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What are some Characteristic of Anorexia VS Bulimia
- AN- refusal to maintain minimum body weight for healthy functioning
- BN-underweight, normal weight, near-normal weight, or over weight
- 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
- AN- less antisocal behavior
- BN- greater tendency to antisocial behavior and alcohol abuse
- AN- mistrust of others, especially professionals
- BN- more trusting of persons wishing to help
- AN- tend to be obsessional (OCD)
- BN- tend to be dramatic
- AN- Greater self-control, but emotionally over-controlled
- BN- more impulsivity and emotional instability; greater levels of depression
- AN- more likely sexually immature and inexperienced
- BN- more sexually experienced and active
- AN= females more likely to reject traditional role
- BN- females more likely to accept traditional role; concerned about others' opinion
- AN- age of onset usually around 14-18yrs
- BN- Age of onset usually around 15-21yrs
- AN-less familial predisposition to obesity
- BN- greater familial predisposition to obesity
- AN- greater tendency toward pre-disorder compliance w/ parents
- BN- greater tendency toward pre-disorder conflict w/parents
- AN- tendency to deny family conflict
- BN- tendency to perceive intense family conflict
what is the Hunger-drive homeostatic process 3 components
- 1. lateral hypothalamus (LT=eat)
- 2. Ventromedial hypothalamus (VT= STOP)
- 3. Paraventricular nucleus ( cluster of cells in hypothalamus. Food preferences)
name the theories of hunger
- Glucostatic theory
- lipostatic theory
describe the glucostatic theory
monitoring glucose levels, when those drop, it says eat, when they are back to normal, stop eating
describe lipostatic theory
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
describe fat cells
- determined by genetics, metabolism, early feeding, average weight person = 30-40 billion
what is obesity
- -not in the DSM
- if 2 binges per week, for at least 6 months without compensatory behavior, may be diagnosed with eating disorder NOS
what is the operation definition
20% above ideal weight for women, 24% for men. may also use body mass index
what health risks are linked to obesity?
- type 2 diabetes
- cardiovascular disease
- CVAs (strokes)
- colorectal cancer
when you have lower metabolic rates there are
greater number of fat cells
describe equate with a food addiction
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
voluntary self-starvation; goal is to be thin but motivation is intense fear of becoming fat/obese
Anorexia Nervose (AN)
what is the diagnostic criteria for Anorexia Nervosa?
- 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
what are the 2 types of Anorexia Nervosa?
- restricting type
- binge eating/purging type
describe the restricting type of AN
fasting only (starve, and when finally give in only eat something so small like 1 kernal of popcorn)
describe the binge eating/purging type of AN
fasting with occasional bingeing and purging (usually starves, but once in awhile gives in so binge, then purge)
what are the physiological symptoms of AN?
- 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)
what are some psychological features of AN?
- many OCD quailities
- highly perfectionistic, intelligent
- depressed, anxious, introverted
- perceives little personal control
- "thinness = happiness"
- strange food- related behavior
20% mortality rate, highest among all psychiatric disorders; affects about 1% of women age 12-40 years. most deadly psychiatric disorder!
reverse anorexia in males; extremely muscular but perceive selves as underdeveloped. exercise fanatically, use steroids
hunger of an ox; gorge up to 60k calories in binge episode, then compensation by purging or fasting
Bulimia Nervosa (BN)
what is the diagnostic criteria for Bulimia Nervosa
- 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
what are the two types of Bulimia Nervosa?
- purging type: 75% use vomiting
- non-purging type: after binge person might sleep "hibernate" for days at a time
what are binge episodes ?
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
what are physiological symptoms of BN
- 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
what are the psychological features of BN
- 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"
why do they consider BN a chronic couse that waxes and wanes ?
because it is a mindset, once a BN always BN
what are the biological etiologies for eating disorders?
- genetics (triggered at puberty?)
- disregulation of glp-1 (peptide from fat cells)
- disregulation of metabolic rates
- low serotonin levels (5-HT) esp. in BN
what are the psychodynamic etiologies for eating disorders
- 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
what are the behavioral etiologies for Eating disorders?
attention for thinness, weight loss is self-reinforicing (AN); rewarded by stress release and learned not thinking when bingeing (BN)
what are the cognitive etiologies for eating disorders?
distored image of self and body; perfectionism; perceptions of low personal control; alexithymia (difficulty finding words to talk about their feelings)
what are the social/sociocultural etiologies of eating disorders?
- 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
what are the treatments for AN?
- restore physical health first
- then deal with psychological/family issues
- 8-phase approach
what are the treatments for BN?
- deal with purging first
- then address binges
- antidepressants help in 50-60% of cases
- 8-phase treatment program
what are the treatments for obesity?
- most effective is exercise and reducing eating
- other methods include medications
- surgical procedures
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