Ch 21
Role of Culture:
•Eating behaviors are influenced by
•Society
•Culture
•Historically, society and culture also have influenced what is considered desirable in
the female body.
Epidemiological Factors:
● Lifetime prevalence for an episode of anorexia nervosa is 2.4% to 4.3%.
● Men account for 25% of those with anorexia and bulimia and 36% of those with
binge eating disorders.
● Bulimia nervosa is decreasing in recent years, with a lifetime prevalence of 2%
among women.
● The onset of bulimia nervosa occurs in late adolescence or early adulthood.
● It occurs primarily in societies that
emphasize thinness. Binge eating disorder consists of recurrent episodes of
eating significantly more than most people would in a similar period of time under
similar circumstances.
● Obesity has been defined as a body mass index (B M I) of 30 or greater.
● 68.5% of adult Americans are overweight, and 35% of these are in the obese
range.
Anorexia Nervosa:
● Characterized by a morbid fear of obesity
● Symptoms include gross distortion of body image, preoccupation with food, and
refusal to eat.
● Weight loss is extreme, usually more than 15% of expected weight.
● Other symptoms include hypothermia, bradycardia, hypotension, edema, lanugo,
and a variety of metabolic changes
● Amenorrhea is typical and may even precede significant weight loss.
● There may be an obsession with food.
● Feelings of anxiety and depression are common.
, Bulimia Nervosa:
● episodic, uncontrolled, compulsive, rapid ingestion of large quantities of food
over a short period (binging).
● The episode is followed by inappropriate compensatory behaviors to rid the body
of the excess calories (purging: self-induced vomiting or the misuse of laxatives,
diuretics, or enemas).
● Usually binging episodes are terminated by uncomfortable full feeling’
● Weight fluctuations can be seen
s/s:
● Fasting or excessive exercise may also occur.
● Most patients with bulimia are within a normal weight range; some are slightly
underweight, and some are slightly overweight.
● Depression, anxiety, and substance abuse are not uncommon.
● Excessive vomiting and laxative or diuretic abuse may lead to problems with
dehydration and electrolyte imbalances
● Russell’s sign
● Eroded tooth enamel
Common comorbidities:
- Mood disorders
- Anxiety disorders
- Substance abuse
-
Binge Eating Disorder
● The D S M-5 identifies binge eating disorder (BED) as an eating disorder that
can lead to obesity.
○ The individual binges on large amounts of food, as in bulimia nervosa.
○ B E D differs from bulimia nervosa in that the individual does not engage
in behaviors to rid the body of the excess calories.
○ No purging
Predisposing Factors:
● Biological
● Genetics: A hereditary predisposition to eating disorders has been hypothesized.
● Anorexia nervosa is more common among sisters and mothers of those with the
disorder than it is among the general population.
Role of Culture:
•Eating behaviors are influenced by
•Society
•Culture
•Historically, society and culture also have influenced what is considered desirable in
the female body.
Epidemiological Factors:
● Lifetime prevalence for an episode of anorexia nervosa is 2.4% to 4.3%.
● Men account for 25% of those with anorexia and bulimia and 36% of those with
binge eating disorders.
● Bulimia nervosa is decreasing in recent years, with a lifetime prevalence of 2%
among women.
● The onset of bulimia nervosa occurs in late adolescence or early adulthood.
● It occurs primarily in societies that
emphasize thinness. Binge eating disorder consists of recurrent episodes of
eating significantly more than most people would in a similar period of time under
similar circumstances.
● Obesity has been defined as a body mass index (B M I) of 30 or greater.
● 68.5% of adult Americans are overweight, and 35% of these are in the obese
range.
Anorexia Nervosa:
● Characterized by a morbid fear of obesity
● Symptoms include gross distortion of body image, preoccupation with food, and
refusal to eat.
● Weight loss is extreme, usually more than 15% of expected weight.
● Other symptoms include hypothermia, bradycardia, hypotension, edema, lanugo,
and a variety of metabolic changes
● Amenorrhea is typical and may even precede significant weight loss.
● There may be an obsession with food.
● Feelings of anxiety and depression are common.
, Bulimia Nervosa:
● episodic, uncontrolled, compulsive, rapid ingestion of large quantities of food
over a short period (binging).
● The episode is followed by inappropriate compensatory behaviors to rid the body
of the excess calories (purging: self-induced vomiting or the misuse of laxatives,
diuretics, or enemas).
● Usually binging episodes are terminated by uncomfortable full feeling’
● Weight fluctuations can be seen
s/s:
● Fasting or excessive exercise may also occur.
● Most patients with bulimia are within a normal weight range; some are slightly
underweight, and some are slightly overweight.
● Depression, anxiety, and substance abuse are not uncommon.
● Excessive vomiting and laxative or diuretic abuse may lead to problems with
dehydration and electrolyte imbalances
● Russell’s sign
● Eroded tooth enamel
Common comorbidities:
- Mood disorders
- Anxiety disorders
- Substance abuse
-
Binge Eating Disorder
● The D S M-5 identifies binge eating disorder (BED) as an eating disorder that
can lead to obesity.
○ The individual binges on large amounts of food, as in bulimia nervosa.
○ B E D differs from bulimia nervosa in that the individual does not engage
in behaviors to rid the body of the excess calories.
○ No purging
Predisposing Factors:
● Biological
● Genetics: A hereditary predisposition to eating disorders has been hypothesized.
● Anorexia nervosa is more common among sisters and mothers of those with the
disorder than it is among the general population.
