Chapter 32: Eating Disorders
Psychological characteristics r/t eating disorders
Anorexia Nervosa BULIMIA NERVOSA
Sexuality conflict or fears Impulsivity
Maturity fears Boundary problems
Ritualistic behaviors Limit-setting difficulties
Perfectionism
Emotional Dysregulation
ANOREXIA NERVOSA AND BULIMIA NERVOSA
Difficulty expressing anger
Low self-esteem
Body dissatisfaction
Powerlessness
Ineffectiveness
Perfectionism
Dietary restraint
Obsessiveness
Compulsiveness
Non-assertiveness
Cognitive distortions
Anorexia nervosa
Restricting subtype:
- no binge eating/ purging or misuse of laxatives, diuretics, or enemas for > 3
months
- Weight loss achieved by dieting/fasting or excessive exercise
Binge eating/purging subtype:
- Recurrent binge eating/ purging or misuse of laxatives, diuretics, or enemas in
the last 3 months
Clinical course
- Occurs early in adolescence
- Slow onset, with serious dieting occurring before an emaciated body. Starvation
noticed. Aids in diagnosis.
o Many women may not be severe enough to use diagnosis and receive early
treatment for s/s or no treatment at all.
, o Refusal to maintain normal weight because of distorted body image and
intense fear of becoming fat makes it difficult to identify and treat.
- Can be chronic condition with relapses characterized by significant weight loss.
o Even if recovered they may still have distorted body images and be
preoccupied with weight and food; and develop bulimia nervosa and
continue to have anxiety disorders or other psych illnesses.
Body distortion
- Severely distorted body image from reality
o They see themselves as obese and undesirable even when they are
emaciated.
o Unable to accept objective reality and perceptions of the outside world
o Body image distortion→ individual perceives their body disparately from
how the world or society views it.
Drive for thinness
- Intense desire for thinness because they see themselves as fat, fear becoming
fatter, and “driven” to work towards “undoing” this fear.
- They ignore body cues like hunger or weakness and concentrate ALL efforts on
controlling food intake.
o Entire mental focus is the goal of weight loss= ALL OR NOTHING mindset
o Organized around food-related activities: preparing food, counting calories,
reading cookbooks
▪ Emotional dysregulation: difficulty regulating expression of
emotions. Inability to accept one’s emotional responses, to
accomplish goals in midst of distress, to be aware of and
acknowledge the significance of developing and implementing coping
strategies to influence and manage emotions effectively.
Guilt and anger
- Avoid conflict and have difficulty expressing negative emotions like anger. An
overwhelming sense of guilt and anger leading to conflict avoidance.
o All-encompassing focus on food and weight, feelings of inadequacy, social
contacts gradually reduced, becoming isolated.
o More severe weight loss associated with apathy, depression, and even
mistrust of others.
Perfectionism
, - Make sure everything is symmetrical, or objects placed at the same distance from
each other, or in performance-based tasks.
o Risk factor for eating disorders.
o The more severe the disorder the more perfectionistic.
▪ As symptoms resolve, perfectionism may decrease.
Diagnostic criteria
- Made when there is a restriction of intake, leading to significantly low body weight.
BMI measures severity. Intense fear of gaining weight, or becoming fat, and body
image issues like undue influence of body weight on self-concept and lack of
recognition of seriousness of low body weight.
- DSM-5 criteria
o Restriction of energy intake leading to significantly LBW in context of age,
sex, development trajectory, and physical health
o Intense fear of gaining weight or behavior that interferes with weight gain
o Disturbance in experience of body weight or shape or influence on self-
evaluation. Lack of recognition of severity.
- Specify whether:
o Restricting type
o Binge eating/purging type
- Specify if
o In partial remission
▪ After full criteria for anorexia nervosa were previously met, Criterion A
(low body weight) has not been met for a sustained period, but either
Criterion B (intense fear of gaining weight or becoming fat or behavior
that interferes with weigh gain) or Criterion C (disturbances in self-
perception of weight and shape) is still met.
o In full remission
▪ After full criteria for anorexia nervosa were previously met, none of the
criteria have been met for a sustained period of time.
o Specify current severity
▪ Mild: BMI ≥17 kg/m2
▪ Moderate: BMI 16 to 16.99 kg/m2
▪ Severe: BMI 15 to 15.99 kg/m2
▪ Extreme: BMI <15 kg/m2
Across the lifespan
Psychological characteristics r/t eating disorders
Anorexia Nervosa BULIMIA NERVOSA
Sexuality conflict or fears Impulsivity
Maturity fears Boundary problems
Ritualistic behaviors Limit-setting difficulties
Perfectionism
Emotional Dysregulation
ANOREXIA NERVOSA AND BULIMIA NERVOSA
Difficulty expressing anger
Low self-esteem
Body dissatisfaction
Powerlessness
Ineffectiveness
Perfectionism
Dietary restraint
Obsessiveness
Compulsiveness
Non-assertiveness
Cognitive distortions
Anorexia nervosa
Restricting subtype:
- no binge eating/ purging or misuse of laxatives, diuretics, or enemas for > 3
months
- Weight loss achieved by dieting/fasting or excessive exercise
Binge eating/purging subtype:
- Recurrent binge eating/ purging or misuse of laxatives, diuretics, or enemas in
the last 3 months
Clinical course
- Occurs early in adolescence
- Slow onset, with serious dieting occurring before an emaciated body. Starvation
noticed. Aids in diagnosis.
o Many women may not be severe enough to use diagnosis and receive early
treatment for s/s or no treatment at all.
, o Refusal to maintain normal weight because of distorted body image and
intense fear of becoming fat makes it difficult to identify and treat.
- Can be chronic condition with relapses characterized by significant weight loss.
o Even if recovered they may still have distorted body images and be
preoccupied with weight and food; and develop bulimia nervosa and
continue to have anxiety disorders or other psych illnesses.
Body distortion
- Severely distorted body image from reality
o They see themselves as obese and undesirable even when they are
emaciated.
o Unable to accept objective reality and perceptions of the outside world
o Body image distortion→ individual perceives their body disparately from
how the world or society views it.
Drive for thinness
- Intense desire for thinness because they see themselves as fat, fear becoming
fatter, and “driven” to work towards “undoing” this fear.
- They ignore body cues like hunger or weakness and concentrate ALL efforts on
controlling food intake.
o Entire mental focus is the goal of weight loss= ALL OR NOTHING mindset
o Organized around food-related activities: preparing food, counting calories,
reading cookbooks
▪ Emotional dysregulation: difficulty regulating expression of
emotions. Inability to accept one’s emotional responses, to
accomplish goals in midst of distress, to be aware of and
acknowledge the significance of developing and implementing coping
strategies to influence and manage emotions effectively.
Guilt and anger
- Avoid conflict and have difficulty expressing negative emotions like anger. An
overwhelming sense of guilt and anger leading to conflict avoidance.
o All-encompassing focus on food and weight, feelings of inadequacy, social
contacts gradually reduced, becoming isolated.
o More severe weight loss associated with apathy, depression, and even
mistrust of others.
Perfectionism
, - Make sure everything is symmetrical, or objects placed at the same distance from
each other, or in performance-based tasks.
o Risk factor for eating disorders.
o The more severe the disorder the more perfectionistic.
▪ As symptoms resolve, perfectionism may decrease.
Diagnostic criteria
- Made when there is a restriction of intake, leading to significantly low body weight.
BMI measures severity. Intense fear of gaining weight, or becoming fat, and body
image issues like undue influence of body weight on self-concept and lack of
recognition of seriousness of low body weight.
- DSM-5 criteria
o Restriction of energy intake leading to significantly LBW in context of age,
sex, development trajectory, and physical health
o Intense fear of gaining weight or behavior that interferes with weight gain
o Disturbance in experience of body weight or shape or influence on self-
evaluation. Lack of recognition of severity.
- Specify whether:
o Restricting type
o Binge eating/purging type
- Specify if
o In partial remission
▪ After full criteria for anorexia nervosa were previously met, Criterion A
(low body weight) has not been met for a sustained period, but either
Criterion B (intense fear of gaining weight or becoming fat or behavior
that interferes with weigh gain) or Criterion C (disturbances in self-
perception of weight and shape) is still met.
o In full remission
▪ After full criteria for anorexia nervosa were previously met, none of the
criteria have been met for a sustained period of time.
o Specify current severity
▪ Mild: BMI ≥17 kg/m2
▪ Moderate: BMI 16 to 16.99 kg/m2
▪ Severe: BMI 15 to 15.99 kg/m2
▪ Extreme: BMI <15 kg/m2
Across the lifespan
