eating disorders

feeding and eating disorders

only recently considered mental disorders
obesity- not a psychiatric disorder, not associated w. greater psychopathology,
-is risk in childhood for developing unhealthy dieting patterns often caused by social discrimination, sometimes leading to chronic h

normal development

troublesome eating patterns and limited food preferences- distinguishing characteristic of early childhood- picky eaters
relationship to eating disorders emerging during adolescence or adulthood is unclear
around 9- girls are more anxious than boys about

developmental risk factors

developmental perspective- possibility of continuum of "eating pathology"
-ranges from dieting to clinical syndromes, across all developmental periods
eating problems at young age may contribute to being overweight/obese during childhood
-teased or reject

developmental risk factor: early eating habits, attitudes, and behaviors

1. early eating habits, attitudes, and behaviors
disturbed eating attitudes- describe a person's belief that cultural standards for attractiveness, body image, and social acceptance are closely tied to one's ability to control diet and weight gain

developmental risk factors: transition into adolescence

2. transition into adolescence
unexpected challenges- includes undergoing significant changes in body shape that require considerable adjustments in self-image
onset typically during adolescence
timing of maturation also effects dieting behavior- girls wh

developmental risk factors: dieting and weight concerns

3. dieting and weight concerns
restrictive diet as pastime
survey- students in grades 5-8, 60% had tried to lose weight in past 7 days
-report feeling depressed after overeating and then choose strict diet as form of control
chronic dieting- strongly rela

biological regulators

knowing when and how much to eat- typically natural process controlled by biorhythms that have adapted successfully over time to the stress and strain of our individual lives
normal patterns of eating and growth AND disorders based on disturbance of these

biological regulators: body weight

body resistant to weight change
-each person is biologically and genetically programmed to weight within a certain natural weight range
person's natural weight is regulated around their set point- comfortable range of body weight that the body tries to de

biological regulators: growth

under normal conditions- biological mechanisms of growth as system of feedback loops, messenger signals, and major organs working together to maintain healthy balance
humans- involves manner in which circulating hormones interact w. available nutritional


1 in 6 children and adolescents in North America
childhood obesity- chronic medical condition similar to hypertension or diabetes; characterized by excessive body fat, regulate body weight at elevated set point
85-95th percentile- overweight
above 95t

prevalence and development

past 3 decades- overweight/obese children increasing
5%-17% since mid 1970s
US and Canada- obesity rates for boys tripled 1980s-2000s, rates for girls doubled
some evidence increasing trend is stabilizing
rates still high
obesity during infancy and later

culture and socioeconomic status

significant racial and ethnic disparities in obesity prevalence
US- Hispanic boys significantly more likely to be obese, non Hispanic black girls significantly more likely to be obese
-pressures of familial and cultural influences favoring chubbier childr


function of pedigree
-other individual and family-related factors (dietary and lifestyle preferences)
leptin- hormone carries instructions to brain to regulate energy and appetite
-deficiencies found in severely obese children
-resistant to


prevention and intervention- consider child's health and family's resources
if no medical complications- recommend proper nutrition
-not using a diet
-energy restricted or unbalanced diets risk medical or learning problems
family functioning- instrumental

feeding and eating disorders first occurring in infancy and early childhood

feeding and eating disorders stem from developmental and behavioral problems associated w. eating and growth
1. avoidant/restrictive food intake disorder
2. pica

avoidant/restrictive food intake disorder

characterized by avoidance or restriction of food intake, leading to significant weight loss and/or nutritional deficiency
one or more of 4 key features present:
1. significant weight loss
2. significant nutritional deficiency
3. dependence on enteral fee


ingestion of inedible substances (hair, insects, paint chips)
primarily effects very young children and those w. intellectual disability
one of more common and usually less serious eating disorder found in very young children
-if infant or young child who

eating disorders of adolescence

eating disorders, eating related problems (dieting and bingeing)- most likely to appear during 2 important periods of adolescent development:
1. early passage into adolescence
2. movement from later adolescence to young adulthood
early and middle childhoo


characterized by:
1. refusal to maintain a minimally normal body weight
2. intense fear of gaining weight
3. significant disturbance in individual's perception and experiences of his or her own size
serious physical and mental health consequences if untre


more common than anorexia
DSM5- primary hallmark is binge eating
1. binge- episode of overeating that must involve
a. objectively large amount of food
b. lack of control over what or how much is eaten
-context must be considered
attempt to conceal binge e

binge eating disorder

increasingly widespread during age of abundant fast food and obesity
similar to bulimia w. binge eating, no compensatory behaviors
periods of eating more than other people, accompanied by feeling of loss of control
overeating defined by- amounts and types

eating disorder overview

key diagnostic criteria
1. anorexia
-food restriction leading to significantly low body weight
-fear of or interference w. weight gain
-disturbance in self-perceived weight or shape
2. bulimia
-recurrent binge eating
-recurrent compensatory behaviors to p

prevalence and development

distinguishing between major eating disorders of adolescence and young adulthood difficult because disorders share many features
can overlap w. other mental disorders- depression, schizophrenia
-obscures some features, leads to misdiagnosis

eating disorders and young men

increased recognition
also subjected to powerful media images
increasingly muscular male body ideal may contribute to dissatisfaction, disordered eating, harmful weight-control or body-building behaviors
some of same clinical features as young women

sexual orientation and eating disorders

gay men- greater risk for behavioral symptoms of eating disorders, more susceptible to media images promoting thinness, more likely to experience poor body image and body dissatisfaction and symptoms related to eating disorders
studies suggest gay men mor

ethnic, cross-cultural, socioeconomic considerations

anorexia observed in western and non-western regions- suggests not "culture-bound" syndrome as once thought
eating disorders don't manifest same way in different cultures
-Hong Kong- studies suggest anorexia divided into fat-phobic and non-fat-phobic subt

developmental course

anorexia- typically appears during adolescence (14-18)
-occasionally older women, men, prepubertal children
often begins w. dieting that gradually leads to starvation
-sometimes onset of dieting and starvation linked to stressful events (teased about weig


dramatic effects on physical and psychological well-being have inspired many theories
no single factor isolated as major cause for any type
*do neurobiological processes disrupt eating patterns, or do eating problems lead to changes in neurobiology?

biological dimension

neurobiological factors play minor role in precipitating anorexia and bulimia
-factors may contribute to maintenance of disorder because of effects on appetite, mood, perception, and energy regulation
makes sense biological mechanisms acting together or a

genetic and constitutional factors

tend to run in families
relatives of patients, esp. female relatives, 4-5X more likely to develop disorder
Swedish twin study- indicates anorexia and bulimia moderately overlap in genetic and environmental contributors
-heritability as larger role in both

neurobiological factors

serotonin regulates hunger and appetite- studies focus on it as possible cause
-presence of serotonin leads to feeling of fullness and desire to decrease intake
-decrease in serotonin leads to continuous hunger and greater food consumption at one time- co

social dimension

features of western culture as prerequisites for eating disorders
personal freedom, emphasis on instant gratification, availability of food, lack of supervision, cultural ideal of diet and exercise for weight loss- powerful influences
-contribute to drive

sociocultural factors

most white women in middle-upper class- self-worth, happiness, success determined by physical appearance
-eating disorders represent an attempt to feel good w. respect to personal appearance and self-control
fashion models and media images- women becoming

family influences

role of family, parental psychopathology
-alliances, conflicts, interactional patterns family may play causal role
-eating disorder may be functional to detract attention away from basic conflicts in family
-families w. members w. eating disorders- w

psychological dimension

external pressures interact w. certain psychological characteristics to increase risk, esp. during transitions
*complex interactive process embedded in multiple layers of biological, familial, personality, and environmental factors
-makes causation diffic


psychological interventions often include some form of individual and/or family-based psychotherapy
-sometimes with medical intervention
evidence for any form modest
-increasing support for family-based intervention for adolescents w. anorexia
-benefits o


gaining recognition for assistance in management of eating disorders
-not considered to be initial treatment of choice
SSRIs- most studied and used
-because of strong association between anorexia and bulimia and the affective disorders
-only treatment app


presence of emotional and physiological problems requires comprehensive treatment plan
-usually consists of treatment team
-internist, nutritionist, psychotherapist, psychopharmacologist
once diagnosed and other illnesses ruled out- decide if can be treat