comer, abnormal psychology, 8th edition_33600：来的人，心理异常，第八edition_33600

Eating Disorders,Chapter 11,Comer, Abnormal Psychology, 8eDSM-5 Update,Slides & Handouts by Karen Clay Rhines, Ph.D.American Public University System,2,Comer, Abnormal Psychology, 8e DSM-5 Update,Eating Disorders,It has not always done so, but Western society today equates thinness with health and beautyThinness has become a national obsessionThere has been a rise in eating disorders in the past three decadesThe core issue is a morbid fear of weight gainTwo main diagnoses:Anorexia nervosaBulimia nervosa,Eating Disorders,A third disorder binge eating disorder also appears to be on the riseFear of weight gain is not to the same degree as with anorexia or bulimiaPeople with this disorder display many of the other features found in those disorders,3,Comer, Abnormal Psychology, 8e DSM-5 Update,Anorexia Nervosa,The main symptoms of anorexia nervosa are:A refusal to maintain more than 85% of normal body weightIntense fears of becoming overweightDistorted view of weight and shapeAmenorrhea,4,Comer, Abnormal Psychology, 8e DSM-5 Update,5,Comer, Abnormal Psychology, 8e DSM-5 Update,Anorexia Nervosa,There are two main subtypes:Restricting typeLose weight by cutting out sweets and fattening snacks, eventually eliminating nearly all foodShow almost no variability in dietBinge-eating/purging typeLose weight by forcing themselves to vomit after meals or by abusing laxatives or diureticsLike those with bulimia nervosa, people with this subtype may engage in eating binges,6,Comer, Abnormal Psychology, 8e DSM-5 Update,Anorexia Nervosa,About 90%95% of cases occur in femalesThe peak age of onset is between 14 and 18 yearsBetween 0.5% and 3.5% of females in Western countries develop the disorderMany more display at least some symptomsRates of anorexia nervosa are increasing in North America, Europe, and Japan,7,Comer, Abnormal Psychology, 8e DSM-5 Update,Anorexia Nervosa,The “typical” case:A normal to slightly overweight female has been on a dietEscalation toward anorexia nervosa may follow a stressful eventSeparation of parentsMove away from homeExperience of personal failureMost patients recoverHowever, about 2% to 6% become seriously ill and die as a result of medical complications or suicide,Anorexia Nervosa: The Clinical Picture,The key goal for people with anorexia nervosa is becoming thinThe driving motivation is fear:Of becoming obeseOf giving in to the desire to eatOf losing control of body size and shape,8,Comer, Abnormal Psychology, 8e DSM-5 Update,Anorexia Nervosa: The Clinical Picture,Despite their dietary restrictions, people with anorexia nervosa are preoccupied with foodThis includes thinking and reading about food and planning for mealsThis relationship is not necessarily causalIt may be the result of food deprivation, as evidenced by the famous 1940s “starvation study” with conscientious objectors,9,Comer, Abnormal Psychology, 8e DSM-5 Update,Anorexia Nervosa: The Clinical Picture,Persons with anorexia nervosa also think in distorted ways:Usually have a low opinion of their body shapeTend to overestimate their actual proportionsAssessed using an adjustable lens techniqueHold maladaptive attitudes and misperceptions“I must be perfect in every way”“I will be a better person if I deprive myself”“I can avoid guilt by not eating”,10,Comer, Abnormal Psychology, 8e DSM-5 Update,Anorexia Nervosa: The Clinical Picture,People with anorexia nervosa also display certain psychological problems:Depression AnxietyLow self-esteemInsomnia or other sleep disturbancesSubstance abuseObsessive-compulsive patternsPerfectionism,11,Comer, Abnormal Psychology, 8e DSM-5 Update,Anorexia Nervosa: Medical Problems,Caused by starvation:AmenorrheaLow body temperatureLow blood pressureBody swellingReduced bone density,Slow heart rateMetabolic and electrolyte imbalancesDry skin, brittle nailsPoor circulationLanugo,12,Comer, Abnormal Psychology, 8e DSM-5 Update,Bulimia Nervosa,Bulimia nervosa, also known as “binge-purge syndrome,” is characterized by binges:Repeated bouts of uncontrolled overeating during a limited period of timeEat objectively more than most people would/could eat in a similar period,13,Comer, Abnormal Psychology, 8e DSM-5 Update,Bulimia Nervosa,The disorder is also characterized by inappropriate compensatory behaviors, including:Forced vomitingMisusing laxatives, diuretics, or enemasFastingExercising excessively,14,Comer, Abnormal Psychology, 8e DSM-5 Update,Bulimia Nervosa,Like anorexia nervosa, about 90%95% of bulimia nervosa cases occur in femalesThe peak age of onset is between 15 and 21 yearsSymptoms may last for several years with periodic letup,15,Comer, Abnormal Psychology, 8e DSM-5 Update,Bulimia Nervosa,Patients are generally of normal weightOften experience marked weight fluctuationsSome may also qualify for a diagnosis of anorexia,16,Comer, Abnormal Psychology, 8e DSM-5 Update,Bulimia Nervosa,Many teenagers and young adults go on occasional binges or experiment with vomiting or laxatives after hearing about these behaviors from friends or the mediaAccording to global studies, 25-50% of students report periodic binge-eating or self-induced vomitingOnly some of these individuals qualify for a diagnosis of bulimia nervosa,17,Comer, Abnormal Psychology, 8e DSM-5 Update,Bulimia Nervosa: Binges,People with bulimia nervosa may have between 1 and 30 binge episodes per weekBinges are often carried out in secretBinges involve eating massive amounts of food very rapidly with little chewingUsually sweet, high-calorie foods with soft textureBinge-eaters commonly consume between as many as 10,000 calories per binge episode,18,Comer, Abnormal Psychology, 8e DSM-5 Update,Bulimia Nervosa: Binges,Binges are usually preceded by feelings of great tensionAlthough the binge itself may be pleasurable, it is usually followed by feelings of extreme self-blame, guilt, depression, and fears of weight gain and being discovered,19,Comer, Abnormal Psychology, 8e DSM-5 Update,Bulimia Nervosa: Compensatory Behaviors,After a binge, people with bulimia nervosa try to compensate for and “undo” the caloric effectsMany resort to vomitingFails to prevent the absorption of half the calories consumed during a bingeRepeated vomiting affects the ability to feel satiated greater hunger and bingeing,20,Comer, Abnormal Psychology, 8e DSM-5 Update,Bulimia Nervosa: Compensatory Behaviors,Compensatory behaviors may temporarily relieve the negative feelings attached to binge eatingOver time, however, a cycle develops in which purging bingeing purging,21,Comer, Abnormal Psychology, 8e DSM-5 Update,Bulimia Nervosa,The “typical” case:A normal to slightly overweight female has been on an intense dietResearch suggests that even among normal participants, bingeing often occurs after strict dieting,22,Comer, Abnormal Psychology, 8e DSM-5 Update,Bulimia Nervosa vs. Anorexia Nervosa,Similarities:Begin after a period of dietingFear of becoming obeseDrive to become thinPreoccupation with food, weight, appearanceFeelings of anxiety, depression, obsessiveness, perfectionismHeighted risk of suicide attemptsSubstance abuseDistorted body perceptionDisturbed attitudes toward eating,23,Comer, Abnormal Psychology, 8e DSM-5 Update,Bulimia Nervosa vs. Anorexia Nervosa,Differences:People with bulimia nervosa are more concerned about pleasing others, being attractive to others, and having intimate relationshipsPeople with bulimia nervosa tend to be more sexually experienced and activePeople with bulimia nervosa are more likely to have histories of mood swings, low frustration tolerance, and poor coping,24,Comer, Abnormal Psychology, 8e DSM-5 Update,Bulimia Nervosa vs. Anorexia Nervosa,Differences:More than one-third of people with bulimia display characteristics of a personality disorder, particularly borderline personality disorderDifferent medical complications:Only half of women with bulimia nervosa experience amenorrhea vs. almost all women with anorexia nervosaPeople with bulimia nervosa suffer damage caused by purging, especially from vomiting and laxatives,25,Comer, Abnormal Psychology, 8e DSM-5 Update,Binge Eating Disorder,Like those with bulimia, individuals with binge eating disorder engage in repeated eating binges during which they feel no control These individuals do not perform inappropriate compensatory behaviorsAs a result of their binges, two-thirds of people with this disorder become overweight or obeseIt is important to recognize, however, that most overweight people do not engage in repeated binges,26,Comer, Abnormal Psychology, 8e DSM-5 Update,Binge Eating Disorder,Between 2 and 7% of the population display binge eating disorderThe binges and many other symptoms that characterize this pattern are similar to those seen in bulimiaOn the other hand, those with binge eating disorder are not driven to thinness, the disorder doesnt start following a diet, and there are not large gender differences in the prevalence of this disorder,27,Comer, Abnormal Psychology, 8e DSM-5 Update,What Causes Eating Disorders?,Most theorists and researchers use a multidimensional risk perspective to explain eating disorders:Several key factors place individuals at riskMore factors = greater likelihood of developing a disorderLeading factors:Psychological problems Biological factorsSociocultural conditions,28,Comer, Abnormal Psychology, 8e DSM-5 Update,What Causes Eating Disorders? Psychodynamic Factors: Ego Deficiencies,Hilde Bruch developed a largely psychodynamic theory of eating disordersBruch argued that eating disorders are the result of disturbed motherchild interactions, which lead to serious ego deficiencies in the child and to severe perceptual disturbances,29,Comer, Abnormal Psychology, 8e DSM-5 Update,What Causes Eating Disorders? Psychodynamic Factors: Ego Deficiencies,Bruch argues that parents may respond to their children either effectively or ineffectivelyEffective parents accurately attend to a childs biological and emotional needsIneffective parents fail to attend to childs needs; they feed when the child is anxious, comfort when the child is tired, etc.Such children may grow up confused and unaware of their own internal needs and turn, instead, to external guides Clinical reports and research have provided some empirical support for this theory,30,Comer, Abnormal Psychology, 8e DSM-5 Update,What Causes Eating Disorders? Cognitive Factors,Bruchs theory also contains several cognitive factors, like improper labeling of internal sensations and needsAccording to cognitive theorists, these deficiencies contribute to a broad cognitive distortion that lies at the center of disordered eating (e.g., negative self-judgment based on body shape and weight),31,Comer, Abnormal Psychology, 8e DSM-5 Update,What Causes Eating Disorders? Depression,Many people with eating disorders, particularly those with bulimia nervosa, experience symptoms of depressionTheorists believe depressive disorders may “set the stage” for eating disorders,32,Comer, Abnormal Psychology, 8e DSM-5 Update,What Causes Eating Disorders? Depression,There is empirical support for the claim that mood disorders set the stage for eating disorders:Many more people with an eating disorder qualify for a clinical diagnosis of major depressive disorder than do people in the general populationClose relatives of those with eating disorders seem to have higher rates of depressive disordersPeople with eating disorders, especially those with bulimia nervosa, have serotonin abnormalitiesSymptoms of eating disorders are helped by antidepressant medications,33,Comer, Abnormal Psychology, 8e DSM-5 Update,What Causes Eating Disorders? Biological Factors,Biological theorists suspect certain genes may leave some people particularly susceptible to eating disordersConsistent with this idea:Relatives of people with eating disorders are up to 6 times more likely to develop the disorder themselvesIdentical (MZ) twins with anorexia: 70%Fraternal (DZ) twins with anorexia: 20%Identical (MZ) twins with bulimia: 23%Fraternal (DZ) twins with bulimia: 9%These findings may be related to low serotonin,34,Comer, Abnormal Psychology, 8e DSM-5 Update,What Causes Eating Disorders? Biological Factors,Other theorists believe that eating disorders may be related to dysfunction of the hypothalamusResearchers have identified two separate areas that control eating:Lateral hypothalamus (LH) Ventromedial hypothalamus (VMH),35,Comer, Abnormal Psychology, 8e DSM-5 Update,What Causes Eating Disorders? Biological Factors,Some theorists believe that the hypothalamus, related brain areas, and chemicals together are responsible for weight set point a “weight thermostat” of sortsSet by genetic inheritance and early eating practices, this mechanism is responsible for keeping an individual at a particular weight levelIf weight falls below set point: hunger, metabolic rate bingesIf weight rises above set point: hunger, metabolic rateDieters end up in a battle against themselves to lose weight,36,Comer, Abnormal Psychology, 8e DSM-5 Update,What Causes Eating Disorders? Societal Pressures,Many theorists believe that current Western standards of female attractiveness are partly responsible for the emergence of eating disordersWestern standards have changed throughout history toward a thinner idealMiss America contestants have declined in weight by 0.28 lbs/yr; winners have declined by 0.37 lbs/yrPlayboy centerfolds have lower average weight, bust, and hip measurements than in the past,37,Comer, Abnormal Psychology, 8e DSM-5 Update,What Causes Eating Disorders? Societal Pressures,Members of certain subcultures are at greater risk from these pressures:Models, actors, dancers, and certain athletesOf college athletes surveyed, 9% met full criteria for an eating disorder while another 50% had symptoms20% of surveyed gymnasts appear to have an eating disorder,38,Comer, Abnormal Psychology, 8e DSM-5 Update,What Causes Eating Disorders? Societal Pressures,Societal attitudes may explain economic and racial differences seen in prevalence ratesHistorically, women of higher SES expressed more concern about thinness and dieting These women had higher rates of eating disorders than women of the lower socioeconomic classesRecently, dieting and preoccupation with thinness, along with rates of eating disorders, are increasing in all groups,39,Comer, Abnormal Psychology, 8e DSM-5 Update,What Causes Eating Disorders? Societal Pressures,The socially accepted prejudice against overweight people may also add to the “fear” and preoccupation about weightAbout 50% of elementary and 61% of middle school girls are currently dietingA recent survey of adolescent girls tied eating disorders and body dissatisfaction to social networking, Internet activities, and television browsing,40,Comer, Abnormal Psychology, 8e DSM-5 Update,What Causes Eating Disorders? Family Environment,Families may play an important role in the development of eating disordersAs many as half of the families of those with eating disorders have a long history of emphasizing thinness, appearance, and dietingMothers of those with eating disorders are more likely to be dieters and perfectionistic themselves,41,Comer, Abnormal Psychology, 8e DSM-5 Update,What Causes Eating Disorders? Family Environment,Abnormal interactions and forms of communication within a family may also set the stage for an eating disorderInfluential family theorist Salvador Minuchin cites “enmeshed family patterns” as causal factors of eating disordersThese patterns include overinvolvement in, and overconcern about, family members lives,42,Comer, Abnormal Psychology, 8e DSM-5 Update,What Causes Eating Disorders? Multicultural Factors: Racial and Ethnic Differences,A widely publicized 1995 study found that eating behaviors and attitudes of young African American women were more positive than those of young white American women Specifically, nearly 90% of the white American respondents were dissatisfied with their weight and body shape, compared to around 70% of the African American teensThe study also suggested that the groups had different ideals of beauty,43,Comer, Abnormal Psychology, 8e DSM-5 Update,What Causes Eating Disorders? Multicultural Factors: Racial and Ethnic Differences,Unfortunately, research conducted over the past decade suggests that body image concerns, dysfunctional eating patterns, and eating disorders are on the rise among young African American women as well as among women of other minority groupsThe shift appears to be partly related to acculturation,44,Comer, Abnormal Psychology, 8e DSM-5 Update,What Causes Eating Disorders? Multicultural Factors: Racial and Ethnic Differences,Eating disorders among Hispanic American female adolescents are about equal to those of white American womenEating disorders also appear to be on the increase among Asian American women and young women in several Asian countries,45,Comer, Abnormal Psychology, 8e DSM-5 Update,What Causes Eating Disorders? Multicultural Factors: Gender Differences,Males account for only 5% to 10% of all cases of eating disordersThe reasons for this striking differe