10.7 SUMMING UP

Anorexia Nervosa

• The hallmark of anorexia nervosa is a significantly low body weight along with an intense fear of gaining weight or using various methods to prevent weight gain, plus distortions in body image. DSM-5 specifies two types of anorexia: restricting and binge eating/purging.
• Anorexia can lead to significant medical problems: muscle wasting (particularly of heart muscle), low heart rate, low blood pressure, loss of bone density, and decreased metabolism. Other symptoms include irritability, headaches, fatigue, and restlessness. All methods of purging—vomiting, diuretics, laxatives, and enemas—can cause dehydration because they primarily eliminate water, not calories, from the body.

Bulimia Nervosa

• Bulimia nervosa is characterized by recurrent episodes of binge eating followed by inappropriate efforts to prevent weight gain.
• All purging methods can cause dehydration, which leads to electrolyte imbalances and possibly death. Chronic vomiting can lead to enlarged parotid and salivary glands and can erode dental enamel. Chronic laxative use can lead to permanent loss of intestinal functioning.

Binge Eating Disorder and “Other” Eating Disorders

• Binge eating disorder is characterized by a pattern of feeling out of control during episodes of eating in which the person eats more than most people would eat in the same period of time and circumstances, without subsequent purging.
• Binge eating disorder is more common that anorexia and bulimia combined.
• People with significantly disturbed eating who do not meet the criteria for the other eating disorders may be diagnosed with a nonspecific “other” eating disorder.

Understanding Eating Disorders

• Cause-and-effect relationships among the factors associated with eating disorders are difficult to establish. This difficulty arises because the behaviors and their immediate consequences create neurological (and other biological), psychological, and social changes.
• Neurological factors associated with eating disorders include:
  • unusually low activity in the frontal and temporal lobes as well as reduced gray and white matter;
  • reduced responsiveness to serotonin, a neurotransmitter involved in mood, anxiety, and binge eating; and
  • a tendency for eating disorders to run in families, as well as evidence of substantial heritability, which indicates that genes play a role.
• Psychological factors related to eating disorders include:
  • irrational thoughts and excessive concerns about weight, appearance, and food;
  • binge eating as a result of the abstinence violation effect;
  • positive and negative reinforcement of symptoms of eating disorders;
  • certain personality traits, such as perfectionism and low self-esteem;
  • disinhibited eating, especially in restrained eaters; and
  • comorbid psychological disorders in female adolescents, particularly depression.
• Social factors related to eating disorders include:
  • family members and friends who provide a model for eating, concerns about weight, and focus on appearance through their own behaviors;
  • cultural factors, which play a key role, as evidenced by the increased prevalence over time of bulimia and concern about weight that is part of anorexia; and
  • conflicting gender roles in Western societies and a tendency to view women’s bodies as objects and search for bodily flaws (objectification theory).

Treating Eating Disorders

• The treatments that target neurological and other biological factors include:
  • nutritional counseling to improve eating (and correct erroneous information about food and weight);
  • medical hospitalization for significant medical problems related to the disorder; and
  • medication, in particular SSRIs, to address some symptoms of the eating disorder and of anxiety and depression.
• The primary treatment that targets psychological factors is CBT, which is the treatment of choice for eating disorders. CBT addresses maladaptive thoughts, feelings, and behaviors that impede normal eating, promote bingeing and purging, and lead to body image dissatisfaction. CBT may include exposure with response prevention and help patients develop new coping strategies.
• Treatments that target social factors include:
  • interpersonal therapy, which is designed to improve the patient’s relationships;
  • family therapy, particularly the Maudsley approach, which can be helpful for adolescents with anorexia who live at home;
  • psychiatric hospitalization, which provides supervised mealtimes to increase normal eating, and a range of therapeutic groups to address various psychological and social factors, plus individual therapy and possibly medication;
  • prevention programs.