Anorexia Nervosa Disorder
You will be responsible for writing a brief paper about a fictional person with a mental illness. Your job is to present a realistic, accurate, and comprehensive portrayal of what a person with a certain mental illness may look like: how the mental illness developed, the symptoms, how it was diagnosed, and how it was treated. The case must be fictional; do not base any elements of the paper on yourself or someone you know (directly or indirectly)! By the end of your paper, I should be able to tell that you have a thorough, accurate, and realistic understanding of the mental illness you selected and how it can present itself in the real world (as supported by research). Make sure to provide enough information to not only illustrate what the mental illness is, but also show why other similar diagnoses would not be accurate (e.g., if writing about someone with Anorexia Nervosa, make sure to provide information that shows why this person does not have Bulimia). We will discuss the paper more in class. In general, students with strong papers cover all the necessary information in 4-5 pages (double spaced). Papers should be generally consistent with APA style (e.g., 12-point font, one-inch margins).
Your paper will be graded in part on the quality and clarity of your writing.
Eating disorders
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overview
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Anorexia Nervosa
Bulimia Nervosa
Binge Eating Disorder
Eating Disorder Theory & Treatment
Complications
Types
Types
Compared to Anorexia
Anorexia Nervosa
Very low body weight b/c intentionally taking in too little nourishment
Significant fear of gaining weight, preoccupied w/ preventing weight gain (despite low body weight)
Weight-related cognitive distortion:
Distorted body perception
Inappropriate self-worth from weight/shape
Lacks appreciation for implications of current weight
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Anorexia Nervosa BMIs
Mild: ≥ 17 Severe: 15
Moderate: 16 Extreme: < 15
Anorexia Nervosa
Goal = thinness
Motivation = fear
Much effort/energy into limiting diet
Planning small meals
Food-filled dreams
Researching food & intake strategies
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Case study: karen carpenter (1950-1983)
Singer from 1970s (The Carpenters)
Managed by mother: reports of being overbearing
Age 23: urged to diet (stage outfits getting tight)
Diet & exercise bulking up; decided food intake was solution
Late 1960s: 145 lbs
1975: 91 lbs
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Case study: karen carpenter (1950-1983)
Friend reports: trickery in “emptying plate”
She and mother attributed gaunt look to “stress”
Entered verbally abusive relationship
Entered therapy for eating disorder: mother disapproved
Eventually urged to eat…
Secretly took laxatives (80-90/night)
Several hospitalizations, forced IV feeding heart damage
Secretly took ipecac (induce vomiting)
Died (32): heart failure worsened by ipecac poisoning
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Restricting type
Severe lack of eating
Might go days without eating
Binge/Purge type
Binging or Purging behaviors (e.g., self-induced vomiting, misuse of laxatives)
Determined by last 3 months
Types of Anorexia Nervosa
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Bulimia Nervosa
Recurrent binges
Very large amount
Over discrete period
Feels no control during
Repeated, ill-advised compensatory behaviors (to prevent weight gain)
At least weekly, 3 months
Excessive influence of weight/shape on self-appraisal
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Etiology: 1-30 binge episodes weekly
Usually in secret
Eaten extremely fast (may barely taste)
Before binge: anxiety/tension
During binge: relief
After binge: shame, guilt, fears of weight gain
Bulimia Nervosa: Binges
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Purging type
Self-induced vomiting
Laxatives
Other purging medications (e.g., diuretics)
Non-purging type
Excessive exercise
Fasting
Bulimia Nervosa: Compensatory techniques
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Your turn!
Glenda, a 22-year-old college student, has made negative comments about her weight since age 16. She feels ugly and is worried about academic failure, noting she did not make Dean’s List for the 1st time in four semesters. Since sophomore year, Glenda has “me time gorge fests” on chips and queso at least twice each week. She takes over-the-counter laxatives immediately after eating, which has resulted in significant stomach distress. Glenda is reluctant to break this cycle, saying, “I’ll do what I need to feel good about myself. I need to feel pretty for once.”
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Binge-Eating Disorder
Recurrent binges
Binges include 3 of following:
Unusually fast eating
Lack of hunger
Uncomfortably full
Eating in secret (b/c of shame)
Self-disgust, depression, guilt after binge
Causes significant distress
Binges at least weekly, 3 months
No excessive compensatory behaviors
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Eating disorder theories
Cognitive
Perceive self as helpless
Eating one of few areas of control Judge self by weight
Perfectionistic, dichotomous thinking
Links between eating disorders & depressive thoughts
| Concordance Rates: Identical Twins | |
| Anorexia Nervosa | 70% |
| Bulimia Nervosa | 23% |
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“I’d just go for days, sometimes 2 or 3 days straight, without eating anything at all. It got quite serious, although at the time I didn’t recognize it for what it was…
I had lost so much weight I had become ill…
I think it was about control. I didn’t feel like I had control over anything else in my life, but food was something I could control, so I did.”
Sociocultural factors
Standards of Beauty: Western ideal shape of women thinner last half century
Gender differences in value of thinness
Fiji Islands & Eating Disorders
Big spike in 1995 & late 2000’s
Enmeshed Family Pattern (over-involved & over-concerned w/ details)
Eating Disorder of one may reflect problem for the group
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What theory works best?
They help each other!
Multidimensional Risk Perspective
Risk for Eating Disorder cumulative across theories
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Treatments: Anorexia Nervosa
Immediate (restore healthy weight)
Motivational Interviewing
Hospitalization
Forced feeding via tube & IV (any concerns?)
Behavioral: Token Economy
Not effective long-term
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Treatments: Anorexia Nervosa
Lasting Change
CBT
Journals of food intake, hunger, mood
Challenge maladaptive thoughts
Stress coping skills
Family therapy
Identify communication, structure patterns
Help individual individuate
Relapse Rate ≈ 33%
50% recover over 10 years
Death rate = 5-8%
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Next Class
Schizophrenia & Related-Disorders (3/19)
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