PROBLEM 5: YOU ARE WHAT YOU EAT
Learning Goals:
Case 1:
What eating disorders exist and what are their features? (DSM / epidemiology/ clinical prognosis)
Can you diagnose an eating disorder based solely on weight/BMI?
Case 2:
What theories can explain the origin of eating disorders?
Are the aetiological theories the same for the different eating disorders?
Case 3:
Which therapies are used to treat eating disorders, and which are effective?
Is mirror exposure an effective treatment for eating disorders, and if so, for which disorder?
Eating Disorder
Characterised by
- Persistent disturbance in eating behaviour
ANOREXIA NERVOSA
• Lack of appetite induced by nervousness
• Intense fear of gaining weight or becoming fat combined with behaviours that result in a
significantly low body weight
CRITERIA
1. Restriction of energy intake relative to requirements, leaning to low body weight in the
context of age, sex, developmental trajectory and physical health. Significantly low weight
is weight that is less than minimally normal for children, adolescents less than that
minimally expected
2. Intense fear of gaining weight or becoming fat. Persistent behaviour that interferes with
weight gain even though at significantly low weight
3. Disturbance in the way in which ones body weight or shape is experienced, undue influence
of body weight of shape of self-evaluation, or persistent lack of recognition of the
seriousness of the current low body weight.
Change from DSM-4 – DSM-5
- Amenorrhea (cessation of menstruation) no longer required for a person to be given
the diagnosis
o Women who continue to menstruate but meet all the other diagnostic criteria for
anorexia nervosa are similar psychologically to women who have amenorrhea and
have ceased menstruating
o Can’t be used for males
, o Can’t be assessed in prepubescent girls or women who use hormonal
contraceptives
Centuries old
- Extreme fasting that were signs of anorexia can be found in early religious literature
- First medical account = 1689
Some people may feel fulfilled by their weight loss
Others make efforts to conceal their thinness by wearing baggy clothes or carrying hidden objects so
that they weigh more when measured by others
2 types
Difference: the way in which patients maintain their low weight
1. Restricting: limit the quantity of food consumed
o Caloric intake is controlled
o Avoid eating in presence of others
o Eat slow, cut it in small pieces, or dispose of it secretly
2. Binge-eating:
o Binge: out of control consumption of food that is far greater than what most people
would eat
o Purge: efforts to remove it from the body (vomiting, laxatives, diuretics, enemas)
§ Excessive exercise
§ Fasting
Distorted values of eating disorders
- Restricting type of anorexia: greatly admired by others with eating disorders
- Hallmark of truly successful person with anorexia nervosa was death from starvation
BULIMIA NERVOSA
• Characterized by uncontrollable binge eating and efforts to prevent resulting weight gain by
using inappropriate behaviours (self-induced vomiting, excessive exercise)
• Recent diagnosis
• Usually normal weight (slightly overweight)
CRITERIA
1. Recurrent episodes of binge eating
- Eating in discrete period of time, an amount of food that is definitely larger than what
most individuals would eat in a similar period of time under similar circumstances
- A sense of lack of control over eating during the episode
2. Recurrent inappropriate, compensatory behaviours in order to prevent weight gain
- Self- inducing vomiting
- Misuse of laxatives
, - Diuretics or Other medications
- Fasting
- Excessive exercise
3. Occurs at least once a week for 3 months
4. Self-evaluation is unduly influenced by body shape and weight
5. Disturbance does not occur exclusively during episodes of anorexia nervosa
Difference between person with bulimia nervosa and binge-eating/purging = weight and those with
bulimia purge
- Person with anorexia is severely underweight – not the case for bulimia
- Share common fear about becoming fat
o Those with bulimia are typically of normal weight (slightly overweight)
BINGE EATING DISORDER
• After a binge, the person does not engage in any form of inappropriate compensatory
behaviour
o Include purging, laxatives, exercise
• Less dietary restrain
• Being overweight or obese
CRITERIA
1. Recurrent episodes of binge eating
- Eating in discrete period of time, an amount of food that is definitely larger than what
most individuals would eat in a similar period of time under similar circumstances
- A sense of lack of control over eating during the episode
2. Associated with 3 or more of the following:
- Eating more rapidly
- Eating until uncomfortably full
- Eating large amounts when not feeling physically hungry
- Eating alone because embarrassed about how much one eats
- Feeling disgusted with oneself, depressed or guilty after
3. Marked distress regarding eating
4. Occurs on average at least once a week for 3 months
5. Not associated with recurrent use of inappropriate compensatory behaviour. Does not
occur exclusively during the course of bulimia or anorexia
, Epidemiology
AGE OF ONSET
- Children as young as 7 have been known to develop eating disorders
o Especially anorexia nervosa
- Anorexia nervosa: most likely to develop in 15-19 year olds
- For bulimia nervosa: age group at highest risk is young women (20)
- Binge eating: 30-50
Learning Goals:
Case 1:
What eating disorders exist and what are their features? (DSM / epidemiology/ clinical prognosis)
Can you diagnose an eating disorder based solely on weight/BMI?
Case 2:
What theories can explain the origin of eating disorders?
Are the aetiological theories the same for the different eating disorders?
Case 3:
Which therapies are used to treat eating disorders, and which are effective?
Is mirror exposure an effective treatment for eating disorders, and if so, for which disorder?
Eating Disorder
Characterised by
- Persistent disturbance in eating behaviour
ANOREXIA NERVOSA
• Lack of appetite induced by nervousness
• Intense fear of gaining weight or becoming fat combined with behaviours that result in a
significantly low body weight
CRITERIA
1. Restriction of energy intake relative to requirements, leaning to low body weight in the
context of age, sex, developmental trajectory and physical health. Significantly low weight
is weight that is less than minimally normal for children, adolescents less than that
minimally expected
2. Intense fear of gaining weight or becoming fat. Persistent behaviour that interferes with
weight gain even though at significantly low weight
3. Disturbance in the way in which ones body weight or shape is experienced, undue influence
of body weight of shape of self-evaluation, or persistent lack of recognition of the
seriousness of the current low body weight.
Change from DSM-4 – DSM-5
- Amenorrhea (cessation of menstruation) no longer required for a person to be given
the diagnosis
o Women who continue to menstruate but meet all the other diagnostic criteria for
anorexia nervosa are similar psychologically to women who have amenorrhea and
have ceased menstruating
o Can’t be used for males
, o Can’t be assessed in prepubescent girls or women who use hormonal
contraceptives
Centuries old
- Extreme fasting that were signs of anorexia can be found in early religious literature
- First medical account = 1689
Some people may feel fulfilled by their weight loss
Others make efforts to conceal their thinness by wearing baggy clothes or carrying hidden objects so
that they weigh more when measured by others
2 types
Difference: the way in which patients maintain their low weight
1. Restricting: limit the quantity of food consumed
o Caloric intake is controlled
o Avoid eating in presence of others
o Eat slow, cut it in small pieces, or dispose of it secretly
2. Binge-eating:
o Binge: out of control consumption of food that is far greater than what most people
would eat
o Purge: efforts to remove it from the body (vomiting, laxatives, diuretics, enemas)
§ Excessive exercise
§ Fasting
Distorted values of eating disorders
- Restricting type of anorexia: greatly admired by others with eating disorders
- Hallmark of truly successful person with anorexia nervosa was death from starvation
BULIMIA NERVOSA
• Characterized by uncontrollable binge eating and efforts to prevent resulting weight gain by
using inappropriate behaviours (self-induced vomiting, excessive exercise)
• Recent diagnosis
• Usually normal weight (slightly overweight)
CRITERIA
1. Recurrent episodes of binge eating
- Eating in discrete period of time, an amount of food that is definitely larger than what
most individuals would eat in a similar period of time under similar circumstances
- A sense of lack of control over eating during the episode
2. Recurrent inappropriate, compensatory behaviours in order to prevent weight gain
- Self- inducing vomiting
- Misuse of laxatives
, - Diuretics or Other medications
- Fasting
- Excessive exercise
3. Occurs at least once a week for 3 months
4. Self-evaluation is unduly influenced by body shape and weight
5. Disturbance does not occur exclusively during episodes of anorexia nervosa
Difference between person with bulimia nervosa and binge-eating/purging = weight and those with
bulimia purge
- Person with anorexia is severely underweight – not the case for bulimia
- Share common fear about becoming fat
o Those with bulimia are typically of normal weight (slightly overweight)
BINGE EATING DISORDER
• After a binge, the person does not engage in any form of inappropriate compensatory
behaviour
o Include purging, laxatives, exercise
• Less dietary restrain
• Being overweight or obese
CRITERIA
1. Recurrent episodes of binge eating
- Eating in discrete period of time, an amount of food that is definitely larger than what
most individuals would eat in a similar period of time under similar circumstances
- A sense of lack of control over eating during the episode
2. Associated with 3 or more of the following:
- Eating more rapidly
- Eating until uncomfortably full
- Eating large amounts when not feeling physically hungry
- Eating alone because embarrassed about how much one eats
- Feeling disgusted with oneself, depressed or guilty after
3. Marked distress regarding eating
4. Occurs on average at least once a week for 3 months
5. Not associated with recurrent use of inappropriate compensatory behaviour. Does not
occur exclusively during the course of bulimia or anorexia
, Epidemiology
AGE OF ONSET
- Children as young as 7 have been known to develop eating disorders
o Especially anorexia nervosa
- Anorexia nervosa: most likely to develop in 15-19 year olds
- For bulimia nervosa: age group at highest risk is young women (20)
- Binge eating: 30-50
