Developmental psychopathology
Chapter 13 Eating disorder
1) Anorexia nervosa: refusal to maintain body weight, weight gain fair, and denial about
low body weight
Anorexia nervosa restricting type (without binge eating and purging)
Anorexia nervosa with binge eating and purging
2) Bulimia nervosa: uncontrollable eating and compensatory behavior to prevent weight
gain.
3) Binge eating disorder: uncontrollable eating and significant distress.
4) Avoidant/restrictive food intake disorder: refraining from, or lack of interest in, food.
Developmental tasks and challenges related to eating and appearance
The physical development that occurs throughout later childhood and adolescence has
multiple impacts on psychological development and functioning, with the onset of puberty
signaling many of the most dramatic changes.
One of the keys to understanding eating disorders depends on understanding issues related
to body image and body satisfaction
Body image has to do with individuals’ perceptions of their own physical appearance.
Body satisfaction has to do with the degree to which individuals accept or are pleased with
their physical appearance.
Body satisfaction is relatively similar in younger girls and boys, with most children reporting
satisfaction. By early adolescence body dissatisfaction increases. Girls who are underweight
are more satisfied with their bodies. Boys who are dissatisfied are divided between wanting
to lose weight and wanting to gain weight (or muscle). Body dissatisfaction may be
experienced by individuals of all ethnic backgrounds.
Body dissatisfaction and desire for thinness are
more frequently reported in high SES settings.
Media exposure normalizes dieting and excessive
thinness. It encourages young people to evaluate
their bodies, to find them wanting, and to engage in
extreme dieting, overexercising and other health-
compromising behaviors. Media exposure does not
cause, but reinforces, an unhealthy body image
among vulnerable women.
Eating disorders
Eating disorders are psychopathologies characterized by severe disturbances in eating
behaviors, disturbed perceptions of body size and shape, fear of being fat, and
compensatory behaviors to lose weight or to prevent weight gain.
, Childhood body dissatisfaction
predicts negative food-related
cognitions in girls, but only in
boys with high body mass index.
Prevalence of eating disorder has
increased over the past several
decades. Prevalence rates of
2.7% for eating disorders for 13-
to 17 tears old. Girls two and a
half times as likely as boys to
have an eating disorder.
The average duration of an
eating disorder episode was
approximately three months for bulimia and 11 months for anorexia.
Crossover is common:
Individuals who are first diagnoses with bulimia, then cross over to anorexia.
The most frequent pattern is from binge eating disorder to bulimia.
Individuals with avoidant/restrictive food intake disorder often cross over to anorexia.
Depression and anxiety are common comorbid disorders.
Developmental course
Eating disorder onset is most common at two times: early adolescence and late
adolescence.
The first one marks the transition from childhood to adolescence, the second is from
adolescence to adulthood.
Fact: the mortality rate for eating disorders is high.
Etiology
Two of the most well known explanations of eating disorders are related to family factors and
sociocultural factors.
, Genes and heredity
Family and twin research suggests strong heritability for both anorexia end bulimia. The data
are consistent with explanations that highlight common genetic factors underlying eating
disorder symptoms, anxiety and depression. Also nonshared environmental factors (factors
that differentially influence siblings) are much more important than shared environment
factors.
Physiological factors
Physiological studies suggest abnormal activity in various regions of the brain, including the
prefrontal and temporal lobes. Halmi (2009) suggests that individuals diagnosed with
anorexia or bulimia experience a dysregulation of reward circuits with activation of brain and
hormonal stress responses and that these changes in the entire brain-body system underlie
ongoing risk, chronic distress and impairment, and frequent relapses. The onset of puberty is
associated with increased risk. Early maturing girls are at higher risk than later maturing girls.
Child factors
A cluster of biologically influenced personality characteristics have been identified that
increase vulnerability. These include temperament, negative emotionality and emotion
dysregulation, impulsivity, stress reaction and harm avoidance, and reward and punishment
sensitivity. The combination of negative emotionality and impulsivity is connected to binge
eating and purging.
Perfectionism, involving setting impossibly high goals and experiencing a sense of
failure and worthlessness when those goals are not met, appears to run in families
and may lead to the ‘relentless pursuit of the tin ideal’.
Body-related characteristics and attitudes are another set of risk factors, with body
dissatisfaction at the nexus. Body dissatisfaction is the most consistent and strongest
predictor of eating disorders later in life.
Parent and family factors
One basic risk variable involves general family dysfunction. The relationship of mothers and
daughters are a frequent clinical focus. Mothers’ critical comments about weight and shape
and the frequency of such comments appear to be more influential than family conflict.
Encouragement of dieting is also related to body dissatisfaction and drive for thinness.
Paternal rejection is an especially poignant risk factor. There are also protective family
factors as well. Family connectedness, positive family communication, and parental
monitoring all decrease the risk of eating disorders in adolescents.
Environmental factors
Negative life evens increase the risk for eating disorders and may trigger the onset of an
eating disorder. Media influences are also important risk factor. Media exposure clearly plays
a role in increasing body dissatisfaction and internalization of the thin ideal. Beyond media
influence, a variety of culture-related factors likely influence the development of eating
disorders.
Assessment and diagnosis
The assessment and diagnosis of eating disorder involves the developmentally informed
evaluation of a complicated mix of somatic and psychological symptoms. Assessment may
be especially problematic because most adolescents with eating disorder deny difficulties
and avoid contact with medical or mental health professionals. There are a number of well-
validated structured interview and self-report measures for screening and diagnosis,
although instruments need to be designed and interpreted with regard for differences in the
clinical presentation of adolescents versus adults and with respect to ethnicity and gender.
Because several of the diagnostic criteria for eating disorders involve cognitive symptoms,
the diagnostic process must take into account age-related and cultural considerations. Given
the different perspectives of adolescents and parents, particularly related to family
Chapter 13 Eating disorder
1) Anorexia nervosa: refusal to maintain body weight, weight gain fair, and denial about
low body weight
Anorexia nervosa restricting type (without binge eating and purging)
Anorexia nervosa with binge eating and purging
2) Bulimia nervosa: uncontrollable eating and compensatory behavior to prevent weight
gain.
3) Binge eating disorder: uncontrollable eating and significant distress.
4) Avoidant/restrictive food intake disorder: refraining from, or lack of interest in, food.
Developmental tasks and challenges related to eating and appearance
The physical development that occurs throughout later childhood and adolescence has
multiple impacts on psychological development and functioning, with the onset of puberty
signaling many of the most dramatic changes.
One of the keys to understanding eating disorders depends on understanding issues related
to body image and body satisfaction
Body image has to do with individuals’ perceptions of their own physical appearance.
Body satisfaction has to do with the degree to which individuals accept or are pleased with
their physical appearance.
Body satisfaction is relatively similar in younger girls and boys, with most children reporting
satisfaction. By early adolescence body dissatisfaction increases. Girls who are underweight
are more satisfied with their bodies. Boys who are dissatisfied are divided between wanting
to lose weight and wanting to gain weight (or muscle). Body dissatisfaction may be
experienced by individuals of all ethnic backgrounds.
Body dissatisfaction and desire for thinness are
more frequently reported in high SES settings.
Media exposure normalizes dieting and excessive
thinness. It encourages young people to evaluate
their bodies, to find them wanting, and to engage in
extreme dieting, overexercising and other health-
compromising behaviors. Media exposure does not
cause, but reinforces, an unhealthy body image
among vulnerable women.
Eating disorders
Eating disorders are psychopathologies characterized by severe disturbances in eating
behaviors, disturbed perceptions of body size and shape, fear of being fat, and
compensatory behaviors to lose weight or to prevent weight gain.
, Childhood body dissatisfaction
predicts negative food-related
cognitions in girls, but only in
boys with high body mass index.
Prevalence of eating disorder has
increased over the past several
decades. Prevalence rates of
2.7% for eating disorders for 13-
to 17 tears old. Girls two and a
half times as likely as boys to
have an eating disorder.
The average duration of an
eating disorder episode was
approximately three months for bulimia and 11 months for anorexia.
Crossover is common:
Individuals who are first diagnoses with bulimia, then cross over to anorexia.
The most frequent pattern is from binge eating disorder to bulimia.
Individuals with avoidant/restrictive food intake disorder often cross over to anorexia.
Depression and anxiety are common comorbid disorders.
Developmental course
Eating disorder onset is most common at two times: early adolescence and late
adolescence.
The first one marks the transition from childhood to adolescence, the second is from
adolescence to adulthood.
Fact: the mortality rate for eating disorders is high.
Etiology
Two of the most well known explanations of eating disorders are related to family factors and
sociocultural factors.
, Genes and heredity
Family and twin research suggests strong heritability for both anorexia end bulimia. The data
are consistent with explanations that highlight common genetic factors underlying eating
disorder symptoms, anxiety and depression. Also nonshared environmental factors (factors
that differentially influence siblings) are much more important than shared environment
factors.
Physiological factors
Physiological studies suggest abnormal activity in various regions of the brain, including the
prefrontal and temporal lobes. Halmi (2009) suggests that individuals diagnosed with
anorexia or bulimia experience a dysregulation of reward circuits with activation of brain and
hormonal stress responses and that these changes in the entire brain-body system underlie
ongoing risk, chronic distress and impairment, and frequent relapses. The onset of puberty is
associated with increased risk. Early maturing girls are at higher risk than later maturing girls.
Child factors
A cluster of biologically influenced personality characteristics have been identified that
increase vulnerability. These include temperament, negative emotionality and emotion
dysregulation, impulsivity, stress reaction and harm avoidance, and reward and punishment
sensitivity. The combination of negative emotionality and impulsivity is connected to binge
eating and purging.
Perfectionism, involving setting impossibly high goals and experiencing a sense of
failure and worthlessness when those goals are not met, appears to run in families
and may lead to the ‘relentless pursuit of the tin ideal’.
Body-related characteristics and attitudes are another set of risk factors, with body
dissatisfaction at the nexus. Body dissatisfaction is the most consistent and strongest
predictor of eating disorders later in life.
Parent and family factors
One basic risk variable involves general family dysfunction. The relationship of mothers and
daughters are a frequent clinical focus. Mothers’ critical comments about weight and shape
and the frequency of such comments appear to be more influential than family conflict.
Encouragement of dieting is also related to body dissatisfaction and drive for thinness.
Paternal rejection is an especially poignant risk factor. There are also protective family
factors as well. Family connectedness, positive family communication, and parental
monitoring all decrease the risk of eating disorders in adolescents.
Environmental factors
Negative life evens increase the risk for eating disorders and may trigger the onset of an
eating disorder. Media influences are also important risk factor. Media exposure clearly plays
a role in increasing body dissatisfaction and internalization of the thin ideal. Beyond media
influence, a variety of culture-related factors likely influence the development of eating
disorders.
Assessment and diagnosis
The assessment and diagnosis of eating disorder involves the developmentally informed
evaluation of a complicated mix of somatic and psychological symptoms. Assessment may
be especially problematic because most adolescents with eating disorder deny difficulties
and avoid contact with medical or mental health professionals. There are a number of well-
validated structured interview and self-report measures for screening and diagnosis,
although instruments need to be designed and interpreted with regard for differences in the
clinical presentation of adolescents versus adults and with respect to ethnicity and gender.
Because several of the diagnostic criteria for eating disorders involve cognitive symptoms,
the diagnostic process must take into account age-related and cultural considerations. Given
the different perspectives of adolescents and parents, particularly related to family
