Psychology 2320A/B Lecture Notes - Lecture 10: Bulimia Nervosa, William Gull, Binge Eating
29 Apr 2018
School
Department
Course
Professor
EATING DISORDERS
TERMS RELEVANT TO ED:
• Anorexia nervosa (AN); bulimia nervosa (BN); binge-eating disorder (BED)
• Binge: during a discrete period of time, eating an amount that is much larger than what an individual
would ordinarily eat during that time frame AND a sense of loss of control over the eating
• Purge: induced vomiting, misuse of laxatives, diuretics, enemas, often occurs in response to binge
EATING DISORDERS: BRIEF HISTORICAL OVERVIEW
– 17th & 18th century (and earlier): Miraculous maids
– Modeled themselves after saints
– Self-denial of food common in saints, the very devout
– Evidence for AN-like syndrome throughout 19th century
– Term anorexia nervosafirst appeared in medical literature, used by William Gull (1874)
– Gull described symptoms similar to DSM-IV
– Late 1800s: differentiation of AN from other psychopathology (hysteria) in women
– Early estimates of prevalence of AN comparable to current
– Unlikely that motivation was weight loss in these historical cases
– Not consistently tied to cultural valuation of thinness
- Absence of accounts of BN prior to 1960
- Russell (1979): BN is a new disorder
- Evidence of a binge-purge syndrome prior to present historical context is rare
- Weight concern focus/exposure to valuation of thinness seems necessary context for BN
WHAT DOES ALL THIS MEAN?
• Are EDs culture-bound syndromes?
– i.e., symptoms linked to a limited number of cultures with specific cultural values; symptom
expression modified by cultural norms
• AN is not; it is present regardless of cultural influences
• BN likely is; it appears to be tied to cultural values of thinness
EATING DISORDERS: DSM- 5 AN
• Restriction of energy intake abnormally low weight
– Guideline given of BMI less than 17.5
• Intense fear of gaining weight/becoming fat
• Undue influence of weight on self-evaluation, disturbance in body image, or denial of seriousness of
low weight
• Severity rating made based on BMI
• Two subtypes:
– Restricting: does not binge or purge
– Binging/purging: regularly binges or purges
• Appx 50% w/ AN binge or purge
find more resources at oneclass.com
find more resources at oneclass.com
EATING DISORDERS: DSM- 5 BN
• ‘eurret i.e., 1X eek for 3 os……
– Binge eating episodes (eating an unusually large amount of food; lack of control over eating
– Inappropriate compensatory behavior (e.g., vomiting, laxatives, fasting, excessive exercise)
• Self-evaluation dependent on body weight/shape
• Severity rating made based on frequency of compensatory behaviors
EATING DISORDERS: DSM- 5 BED
• Recurrent binges (1X/week for 3 mos), along with
– Eating very rapidly, eating until uncomfortably full, eating large amounts when not hungry,
eating alone, self-disgust/guilt about eating
• Marked distress due to binging
• No compensatory behaviors (i.e., purging; excessive exercise) used regularly
• Severity rating made based on frequency of binge-eating episodes
EATING DISORDERS: DSM-5
• Subjective impairment/distress NOT necessary for AN & BN diagnosis
• Diagnostic orphans common (historically)
EATING DISORDERS: PREVALENCE & PHENOMENOLOGY
• AN: .5% prevalence
• 10:1 female-to-male ratio
• BN: 1-3% prevalence
• 10:1 female-to-male ratio
• BED: 1-4% prevalence
• Females only slightly more likely to get diagnosis, 1.5X > males
• AN-underweight; BN-average or overweight; BED-overweight
EATING DISORDERS: ONSET, COURSE, AND OUTCOMES
• AN: two age groups associated w/ onset
– 13/14 years of age; 17/18 years of age
– Onset associated with stressor; diet
• Course of AN is highly variable
– Some recovery fully (<1/2), some improve (1/3), some
show chronic course (1/5)
• Eating/feeding problems in early childhood associated with AN
symptoms in adolescence
• Even w/ recovery from AN, weight remains low
• AN has a 5-20% mortality rate (book figure may be low)
– Highest mortality rate for a psychiatric disorder
– A leading cause of death for women aged 15-24 years old
AN HAS SEVERE MEDICAL CONSEQUENCES
These are primarily effects of starvation; can also have additional
symptoms related to purging, if purging occurs (see next slide)
find more resources at oneclass.com
find more resources at oneclass.com
