Eating disorders

Eating disorders




Anorexia Nervosa

Bulimia Nervosa

Binge Eating Disorder

Eating Disorder Theory & Treatment




Compared to Anorexia

Anorexia Nervosa

Very low body weight b/c intentionally taking in too little nourishment

Significant fear of gaining weight, preoccupied w/ preventing weight gain (despite low body weight)

Weight-related cognitive distortion:

Distorted body perception

Inappropriate self-worth from weight/shape

Lacks appreciation for implications of current weight


Anorexia Nervosa BMIs

Mild: ≥ 17 Severe: 15

Moderate: 16 Extreme: < 15

Anorexia Nervosa

Goal = thinness

Motivation = fear

Much effort/energy into limiting diet

Planning small meals

Food-filled dreams

Researching food & intake strategies


Case study: karen carpenter (1950-1983)

Singer from 1970s (The Carpenters)

Managed by mother: reports of being overbearing

Age 23: urged to diet (stage outfits getting tight)

Diet & exercise  bulking up; decided food intake was solution

Late 1960s: 145 lbs

1975: 91 lbs


Case study: karen carpenter (1950-1983)

Friend reports: trickery in “emptying plate”

She and mother attributed gaunt look to “stress”

Entered verbally abusive relationship

Entered therapy for eating disorder: mother disapproved

Eventually urged to eat…

Secretly took laxatives (80-90/night)

Several hospitalizations, forced IV feeding  heart damage

Secretly took ipecac (induce vomiting)

Died (32): heart failure worsened by ipecac poisoning


Restricting type

Severe lack of eating

Might go days without eating

Binge/Purge type

Binging or Purging behaviors (e.g., self-induced vomiting, misuse of laxatives)

Determined by last 3 months

Types of Anorexia Nervosa


Bulimia Nervosa

Recurrent binges

Very large amount

Over discrete period

Feels no control during

Repeated, ill-advised compensatory behaviors (to prevent weight gain)

At least weekly, 3 months

Excessive influence of weight/shape on self-appraisal


Etiology: 1-30 binge episodes weekly

Usually in secret

Eaten extremely fast (may barely taste)

Before binge: anxiety/tension

During binge: relief

After binge: shame, guilt, fears of weight gain

Bulimia Nervosa: Binges


Purging type

Self-induced vomiting


Other purging medications (e.g., diuretics)

Non-purging type

Excessive exercise


Bulimia Nervosa: Compensatory techniques


Your turn!

Glenda, a 22-year-old college student, has made negative comments about her weight since age 16. She feels ugly and is worried about academic failure, noting she did not make Dean’s List for the 1st time in four semesters. Since sophomore year, Glenda has “me time gorge fests” on chips and queso at least twice each week. She takes over-the-counter laxatives immediately after eating, which has resulted in significant stomach distress. Glenda is reluctant to break this cycle, saying, “I’ll do what I need to feel good about myself. I need to feel pretty for once.”


Binge-Eating Disorder

Recurrent binges

Binges include 3 of following:

Unusually fast eating

Lack of hunger

Uncomfortably full

Eating in secret (b/c of shame)

Self-disgust, depression, guilt after binge

Causes significant distress

Binges at least weekly, 3 months

No excessive compensatory behaviors


Eating disorder theories


Perceive self as helpless

Eating one of few areas of control  Judge self by weight

Perfectionistic, dichotomous thinking

Links between eating disorders & depressive thoughts

Concordance Rates: Identical Twins
Anorexia Nervosa 70%
Bulimia Nervosa 23%


“I’d just go for days, sometimes 2 or 3 days straight, without eating anything at all. It got quite serious, although at the time I didn’t recognize it for what it was…

I had lost so much weight I had become ill…

I think it was about control. I didn’t feel like I had control over anything else in my life, but food was something I could control, so I did.”

Sociocultural factors

Standards of Beauty: Western ideal shape of women thinner last half century

Gender differences in value of thinness

Fiji Islands & Eating Disorders

Big spike in 1995 & late 2000’s

Enmeshed Family Pattern (over-involved & over-concerned w/ details)

Eating Disorder of one may reflect problem for the group


What theory works best?

They help each other!

Multidimensional Risk Perspective

Risk for Eating Disorder cumulative across theories


Treatments: Anorexia Nervosa

Immediate (restore healthy weight)

Motivational Interviewing


Forced feeding via tube & IV (any concerns?)

Behavioral: Token Economy

Not effective long-term


Treatments: Anorexia Nervosa

Lasting Change


Journals of food intake, hunger, mood

Challenge maladaptive thoughts

Stress coping skills

Family therapy

Identify communication, structure patterns

Help individual individuate

Relapse Rate ≈ 33%

50% recover over 10 years

Death rate = 5-8%


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