Clinical Psychology: Eating Disorders

EATING DISORDERS
 Present in 2% of the population, females > males
 Dieting and ED
- Dieting is often the 1st step
- Nevonen & Broberg (2000) - interview study, 70% of anorexics said dieting had been the first step
- Dieting predicts new cases (Patton et al., 1999) and the onset of binging and purging
- But: Stice (2002) : the evidence is equivocal
 Long term issue: 21 years after initial admission, 50% are fully recovered, 21% partially recovered, 10%
still met criteria, 16% dead of causes related to anorexia (Loewe et al., 2001)
 Keel et al. (1999): Bulimia: 222 people followed for 11 years. 11% still met criteria, 70% full or partial
remission
 Difficult to detect in primary care settings
 Bennett: in contrast to many mental health disorders, prevalence of Anorexia Nervosa (AN) highest
among high SES groups and among those with high academic achievement

ANOREXIA: FEATURES OF DEVELOPMENT

 Initial diets and weight loss
 Family ‘dysfunction’
 Relationship difficulties
 Low self esteem and confidence
 Emotional suppression (alexthymia)

BULIMIA: FEATURES OF DEVELOPMENT

 Previous diets / AN
 Impulsivity
 Can’t tolerate negative emotions - eating is a coping mechanism for dealing with it
 Attachment issues
 Self-worth - guilt for pursuing own needs

Common to both: abuse, responsibilities of the world /guilt

Stice (2002) evaluates the evidence for risk factors:

 Sexual abuse: no empirical support
 Consistent support for thin-real idealisation = increases in body dissastisfaction, dieting and negative
affect
 Pressure to be thin predicted increases in body dissatisfaction, dieting and negative affect, onset of binge
eating, some null effects
 Modelling (of others) did not predict increases in body dissatisfaction or dieting but did predict onset of
binge eating and bulimic symptoms
 Body dissatisfaction is a risk factor for dieting, negative affect and eating pathology and a maintenance
factor for bulimic symptoms

,  Dieting = increased negative affect, bulimic symptoms and eating pathology, although some mixed
evidence
 Concludes dieting is a risk factor for bulimic pathology but rather attenuates overeating tendencies
 Perfectionism – mixed results, collectively findings support perfectionism as a risk factor for bulimic
pathology and a maintenance factor for eating pathology
 Prevention programmes should focus on reducing malleable risk factors like thin-ideal internalisation,
body dissatisfaction and negative affect and also strive to increase protective factors like self esteem and
social support
 Risk factors can be used to identify high risk groups
 Need better research


Genetics - Strober et al (2000): female relatives with AN were 11x more likely than relatives of controls to get
AN. BN: 3.7 x more likely for relative of those with BN

ANOREXIA NERVOSA (AN)

 “nervous appetite”
 The criteria:
- Refusal to maintain body weight over minimally normal weight (85% generally)
- Intense fear of gaining weight
- Disturbance of body-size evaluations
- Amenorrhoea (if post-pubertal) for at least 3 cycles ( no period)
- Distinguish: a) restricting type (starvation - much more common), b) binge-purging type (less
common, more like bulimia)
 The stats:
- William Gull (1873) first described and named
- Average age of onset 16-18
- As young as 7 reported
- Females > males - for every 10-12 females there is one male (Lucas, 1999)
- Highest mortality rate of any psychiatric disorder - 10% long term (e.g. Battle & Brownwell, 1996)
- Suicide risk x 23 higher than normal (Harris and Barraclough, 1997)
- Comorbidity with depression 63% (Herzog et al., 1992), OCD 35% (Rastam, 1992)
- Reduced brain volume (Swayze et al., 1996)



BULIMIA NERVOSA

 The criteria
- Recurrent binge eating - more than usual plus sense of loss of control - usually on really strict diet
then if have a slip up will think it’s all over and will binge, then have to compensate
- Inappropriate compensatory behaviour - vomiting, laxatives, exercise, fasting
- Both occurring as least twice a week for at least 3 months
- Self esteem influenced by weight
- No evidence of AN
- Purging subtype (vomiting, laxatives)
- Non-purging (fasting , exercise)
 The stats:
- Gerald Russell (1979) first described and named