Restricting Type: during the current episode of Anorexia Nervosa, the person has not regularly engaged in binge-eating or purging behaviour (i.e., self-induced vomiting or the misuse of laxatives, diuretics, or enemas).
Binge-Eating Type or Purging Type: during the current episode of Anorexia Nervosa, the person has regularly engaged in binge-eating OR purging behaviour (i.e., self-induced vomiting or the misuse of laxatives, diuretics, or enemas).
Definition/Review of Anorexia Nervosa:
Anorexia Nervosa is an eating disorder affected by a complex mixture of social, psychological and physical problems.
Characteristics are:
- An intense drive for thinness
- An intense fear of gaining weight or becoming fat
- A disturbance in body image
- In women- a cessation of the menstrual cycle for at least three months
- In men- a decreased sexual drive
There are two types of Anorexia Nervosa:
- Restrictive type
- Binge eating/purging type.
- 90-95% of individuals with Anorexia Nervosa are female.
- It affects about 1 in 2400 adolescents.
- It typically develops in early to mid-adolescents.
- Psychological problems are displaced onto food.
- Dieting behaviour usually precedes it.
- Unusual food behaviours are practiced.
- Need to vicariously enjoy food by cooking it, serving it, or being around it is common.
- Preoccupation with body weight and image.
- Dieting becomes increasingly important.
- Denial of the condition can be extreme.
- Body image disturbance (misperception of body size and shape) is common.
- Pronounced emotional changes are common.
- One-third of anorexics subsequently develop Bulimia Nervosa.
Defining characteristics of Bulimia Nervosa:
Individuals with bulimia nervosa regularly engage in discrete periods of overeating, which are followed by attempts to compensate for overeating and to avoid weight gain. There is variation in the nature of the overeating but the typical episode of overeating involves the consumption of an amount of food that would be considered excessive in normal circumstances. The bulimic is dominated by a sense of a lack of control over the eating. Binge eating is followed by attempts to undo the consequences of the binge though self-induced vomiting, misuse of laxatives, severe caloric restriction, diuretics, enemas, or excessive exercising, etc. The bulimic's self-evaluation is centered on the individual's perceptions of his/her body image. Concerns about weight and shape are characteristic of those with bulimia nervosa. The diagnostic criterion of bulimia nervosa requires that the individual not simultaneously meet criteria for anorexia nervosa. (If an individual simultaneously meets criteria for both anorexia nervosa and bulimia nervosa, only the diagnosis of Anorexia Nervosa, binge-eating/purging type is given.) The formal diagnosis also stipulates minimal frequency and duration cut-offs. The diagnosis requires that individuals must binge eat and engage in inappropriate compensatory behaviour at least twice weekly for three months.
There are also two subtypes of bulimia nervosa. The Purging Type describes individuals who regularly compensate for the binge eating with self-induced vomiting, laxative abuse, diuretics, or enemas. The Non-Purging Type is used to describe individuals who compensate through dietary fasting or excessive exercising.
Definition/Facts: Bulimia Nervosa
There are two types of bulimia nervosa:
- Purging
- Nonpurging
- It occurs in 0.5% to 2.0% of adolescents and young adult women.
- Dieting behaviour usually precedes it.
- Bulimics are usually of average or above average weight.
- Self-evaluation is unduly influenced by size and weight.
- A complex lifestyle develops to accommodate eating disorder behaviours.
- There are ongoing feelings of isolation, self-deprecating thoughts, depression, and low self-esteem.
- There are ongoing feelings of isolation, self-deprecating thoughts, depression, and low self-esteem.
- It typically develops in early to mid-adolescents.
- There is full recognition of the behaviour as abnormal.
- Statistics indicate it is relatively uncommon in men.
Profile: Bulimia Nervosa
Individuals with Bulimia are usually aware they have an eating disorder. Obsessed with food they often focus on and enjoy discussing diet related issues. The Bulimic may engage in self-starvation between binge-purge episodes thus presenting the same dangers as the anorexic, in addition to the ones presented by the binging and purging. Recurring episodes of rapid food consumption followed by tremendous guilt and often purging, a feeling of lacking control over his or her eating behaviours, regularly engaging in stringent diet plans and exercise, the excessive use of laxatives, diuretics, and/or diet pills and a persistent concern with body image can all be warning signs someone is suffering with Bulimia Nervosa.
It is important to realize that those suffering with Bulimia manifest symptoms in different ways. The Bulimic has binge and purge episodes where as purging can be different things to different people. After binging, some will exercise compulsively, in an attempt to burn off the calories of a binge. Others will self-induce vomiting or take laxatives, or to "fast" for days following a binge. Some take diet pills in an attempt to keep from binging or to use diuretics to try to lose weight. Bulimics will often hide food for later binges and often eat in secret.
Diagnostic Criteria: Bulimia Nervosa
The following definition of Bulimia Nervosa is used to assist mental health professionals in making a clinical diagnosis. The clinical definitions are usually not representative of what a victim feels or experiences in living with the illness. It is important to note that you can still suffer from Bulimia even if one of the below signs/symptoms is not present. If you think you have Bulimia, it is dangerous to read the diagnostic criteria and think if you do not have one of the symptoms; you therefore, must not be Bulimic.
1. Recurrent episodes of binge eating.
Purging Type: during the current episode of Bulimia Nervosa, the person has regularly engaged in self-induced vomiting or the misuse of laxatives, diuretics, or enemas
No purging Type: during the current episode of Bulimia Nervosa, the person has used other inappropriate compensatory behaviours, such as fasting or excessive exercise, but has not regularly engaged in self-induced vomiting or the misuse of laxatives, diuretics, or enemas
The medical model believes infections, genetics, biochemistry and nuero-anatomy to be the causes of eating disorders.
Infection:
Germs or micro-organisms such as bacteria or viruses are known to prodce disease states e.g. measles & influenza .Micro-organisms are linked to mental illnesses such as general paresis. Barr et al (1990) found increase of disease schizophrenia in children whose mothers had flu when pregnant.
Genetics:
Illnesses can be carried in genes hence inherited by the parents. Kendler masterson & Davis (1985) found that relatives of schizophrenics were 18 times more likely to be diagnosed with schizophrenia than we would normally expect. Gene-mapping studies by sherrington et al (1988) found evidence of a link between schizophrenia & a gene located on chromosome 5.
Biochemisrty:
Possible cause of abnormality lies in the patients biochemistry e.g. theorist think schizophrenia is cause by excess dopamine a substance in the brain . it can be looked upon so that its because of the abnormality causes anxiety, causing increase in hormones due to stress which produces excess chemicals.
Neuroanatomy:
The structure of the nervous system can affect mental disorders leading to eating disorders.
Research by Holland et al. (1988) suggested there was some genetic vulnerability to anorexia. Fava et al. (1989) found seratonin and noradrenaline to be related to anorexia, and research into the ventromedial and lateral hypothalamus has shown malfunctions in this area of the brain could also be related to eating disorders. However, a lot of this evidence is correlational and it is unlikely that the causes of eating disorders are purely biological.
The psychodynamic approach offers several psychological explanations. According to Freud, eating disorders could be caused by conflicts in sexual development. This enables the individual to keep a child-like figure and prevent development of puberty. Also the explanation to prevent pregnancy as no period means that it becomes impossible to become pregnant. This theory fails to account for males or bulimics. Another suggestion is that sufferers of eating disorders come from families that are enmeshed, or in high states of conflict. Bruch (1971) suggested anorexics were caught in a struggle for autonomy.
The behavioural approach maybe due to mimic their idols which tend to be super models. The increase in anorexia super models sends the impression that it is normal to be so under weight
A cognitive behavioural theory of anorexia nervosa.
Fairburn CG, Shafran R, Cooper Z.
A cognitive behavioural theory of the maintenance of anorexia nervosa is proposed. It is argued that an extreme need to control eating is the central feature of the disorder, and that in Western societies a tendency to judge self-worth in terms of shape and weight is superimposed on this need for self-control. The theory represents a synthesis and extension of existing accounts. It is 'new', not so much because of its content, but because of its exclusive focus on maintenance, its organisational structure and its level of specification. It is suggested that the theory has important implications for treatment.
Childhood obesity is one of the risk factors for the later development of bulimia nervosa and binge eating disorder. It has also been associated with the development of anorexia nervosa.
Investigation to prove so:
OBJECTIVES: To investigate concerns about weight, shape and eating, dietary restraint, self-esteem and symptoms of depression in overweight girls. To investigate the relationship between concerns and self-esteem and depressive symptoms in this group.
METHOD: Eighteen overweight girls and 18 average-weight girls completed the child version of the Eating Disorders Examination, the Harter Self-Perception Profile and the Short Moods and Feelings Questionnaire.
RESULTS: Overweight girls had more concerns about weight, shape and eating and attempted dietary restraint more often. They had more negative self-esteem related to their athletic competence, physical appearance and global self-worth and more symptoms of depression. There was an association between concerns and self-esteem based on physical appearance in the overweight group.
CONCLUSION: Overweight girls show some of the psychological features associated with the development of eating disorders, including a link between concerns and self-esteem based on physical appearance. This may help to explain why childhood obesity increases the risk of a later eating disorder.
The cognitive approach is mainly stresses on the the body image distortion. Individuals see a large difference in actual size and desired body size. This leads to eating disorders to get to desired body size.
