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					COMPLEXITIES OF EATING
     DISORDERS

             By
       Patti Higgins
                  Prevalence

 Approximately 5-10 million women and 1
  million men struggle with eating disorders,
  such as anorexia, bulimia and binge-eating
  disorder.
 Eating disorders (ED) are complex,
  physiologically and psychologically
  devastating diseases that require professional
  treatment (www.nationaleatingdisorders.org).
             Anorexia Nervosa

   Refusal to maintain a minimum body weight
    (85% of the expected weight).
   Intense fear becoming fat, despite being severely
    underweight (Hall & Ostroff, 1999).
   Abnormal self-perception of body image, denial
    of low weight, and preoccupation with losing
    weight .
   Female patients often develop amenorrhea.
   90% of anorexic cases are female; 10 % are
    males.
                      Bulimia

 Repeated cycles of bingeing (extreme overeating)
  and purging (fasting, vomiting, exercising)
  behaviors.
 After bingeing, the patient attempts to control
  weight gain by inappropriate means such as fasting,
  self-induced vomiting, excessive exercise, abuse of
  laxatives, diuretics, or other drugs.
 90% females; 10 % males.
              ED Assessments

 Eating Disorder          Eating Disorder
  Examination               Inventory (EDI) can
  Questionnaire (EDE-       identify pre-eating
  Q) accurately assess      disorder symptoms.
  and identify females
  with anorexia and
  bulimia.
 Eating Attitudes Test
  (EAT-12) can identify
  pre-eating disorder
  cases.
              Etiology of ED
 Wells and Sadowski (2001) view the etiology
  of bulimia nervosa as highly complex,
  involving various biological, psychological,
  social and family factors.
 Polivy & Herman (2002) noted family
  factors such as dysfunctional
  communication, enmeshment and criticism,
  family attitudes about food, weight, and body
  image were related to development of eating
  disorders.
            Mothers & daughters

 Pike and Rodin (1991) “examined features of 77
  mothers' attitudes and behavior that relate to
  disordered eating among their adolescent
  daughters” (p. 198). Maternal criticism and view of
  daughter’s unattractiveness were related to ED.
 Mother / daughter relationship is a risk factor for
  eating disorders. Study indicated that both
  anorexics’ and bulimics’ descriptions of their
  mothers were generally negative (Johnsson, Smith
  & Amner, 2001).
                Family relationships

 Wonderlich, Klein and Council (1996) found bulimic females
  perceived both parents as hostilely disengaged. Additionally,
  bulimics related their negative self-concepts with perceptions
  of paternal attack/friendliness.
 Humphrey (1989) compared videotapes of 74 family triads
  with anorexic, bulimic-anorexic, bulimic and normal
  daughters. The taped were coded using Benjamin's
  structural analysis of social behavior (SASB).
    Bulimics and their parents were hostilely enmeshed; parents

     undermined daughter's separation and self-assertion.
    Anorexics’ parents gave double messages of nurturant

     affection combined with neglect of their daughter's needs
          Parental relationships

 Wade, Bulik & Kendler (2001) found that
  poorer quality of the marital relationship
  predicted the presence of subclinical bulimia
  nervosa (SBN), generalized anxiety disorder
  (GAD) and alcohol dependence in offspring.
                 Mood factors

   ED may represent a way of coping with
    problems of identity and personal control
    (Polivy & Herman, 2002, p. 187).
   Tachi, Murakami, Murotsu and Washizuka
    (2001) reported binge and purge behaviors may
    be related to attempts to regulate negative
    moods.
   Beebe’s (1994) reported that bulimic behaviors
    are related to both escapism and feelings of
    hopelessness.
     Moods…

 Fassino, Daga, Piero, Leombruni &
  Rovera (2001) used State-Trait
  Anger Expression Inventory
  (STAXI), Temperament and
  Character Inventory (TCI) and
  Eating Disorder Inventory II (EDI-
  II) to discover high impulsivity
  among ED clients. Extreme anger
  was found in bulimic anorexics.
             American culture
 80% of American women are dissatisfied with their
  appearance and body image.
 42% of 1-3 graders want to be thinner (Collins,
  1991).
 81% of 10 year olds are afraid of getting fat
  (Mellin et al., 1991).
 The average American woman is 5'4" tall and
  weighs 140 pounds. The average American model
  is 5'11" tall and weighs 117 pounds.
 Most fashion models are thinner than 98% of
  American women (Smolak, 1996).
     Americans obsess on thinness

 51% of 9 and 10 year old girls feel better about
  themselves if they are on a diet (Mellin et al.,
  1991).
 46% of 9-11 year olds are sometimes or very
  often on diets, and 82% of their families are
  sometimes or very often on diets (Gustafson-
  Larson & Terry, 1992).
 91% of women surveyed on a college campus
  had attempted control their weight by dieting.
                 Media factors
   Guerro-Prado, Barjau-Romero, Chinchilla, &
    Moreno (2001) found an “undeniable influence of
    mass media in the genesis and maintenance” (p.
    403) of eating disorders.
   Researchers also speculate that more males may
    develop the disorder as the media continues to
    pressure men and boys to strive for ideal body
    image (Polivy & Herman, 2002).
   Polivy and Herman (2002) propose that
    sociocultural factors including the media contribute
    to the increase of eating disorders among young
    women.
     Ethnicity and cultural factors

 Kuba and Harris (2001) studied 115 Mexican
  American women and found that contextual
  variables such as level of acculturation,
  socioeconomic status (SES), peer
  socialization, family structure, and
  immigration status influence the occurrence
  of eating disorders in women of color.
                    Males

 Eliot & Baker (2001) collected
  comprehensive descriptions of 40 eating
  disordered males and surveyed others.
  Indications are that many males do have
  extreme concerns about body image and
  weight.
                    Treatments

 Wells & Sadowski (2001) suggest comprehensive,
  individualized and multifaceted therapy, including
  both pharmacological and behavioral treatment
  components.
 Little (2002) suggests hospitalization to stabilize
  the patient, behavior modification, family
  counseling, group counseling, drug therapy and
  individual psychotherapy.
              Family Therapy

 Minuchin and Fishman (1981) emphasized that
  the anorexic or bulimic patient exhibits these
  symptoms as a response to the dysfunctional
  family system. Suggest reestablishing parental
  heirarchy through structural family therapy.
 Enhancing parenting skills and communication
  processes have been helpful with anorexic
  families (DeAngelis, 2002; Cierpka, Reich &
  Kraul, 1998).
           More family therapy…
 Milan trained therapists may view eating disorders
  such as anorexia and bulimia as “family
  games”(Goldenberg & Goldenberg, 2000).
 Narrative therapists engage in externalizing
  conversations to demonstrate that the family or client
  is not the problem: “the problem is the problem”
  (Goldenberg & Goldenberg, 2000, p. 316).
 McDaniel, Hepworth and Doherty (1992) proposed
  medical family therapy, which refers to “the
  biopsychosocial treatment of individuals and families
  who are dealing with medical problems” (p. 2).
             Multi-modal options
 Goals of therapy include promoting understanding,
  improving intrapersonal and interpersonal
  functioning, restoring normal exercise patterns, and
  addressing comorbid psychopathology and
  psychological conflicts (Muscari, 2002, p. 22).
 Bean and Weltzin (2001) suggest multidimensional
  residential treatment that has cognitive-behavioral,
  interpersonal, experiential and family therapies.
 Riess (2002) recommends cognitive-behavioral
  therapy (CBT), psychoeducation, interpersonal
  therapy (IPT), and relational therapy (RT).
                 Physical Exercise

   Sundgot-Borgen, Rosenvinge, Bahr and Schneider
    (2002) examined the effect of physical exercise as an
    experimental treatment condition against the well-
    documented effect of cognitive-behavioral therapy
    (CBT). Exercise helped reduce drive for thinness,
    improved change in body composition, enhanced
    aerobic fitness, and reduced frequency of bingeing,
    purging and laxative abuse.
            Pharmacological options

 Research demonstrated the efficacy of fluoxetine
  treatment as statistically superior to the placebo
  treatment. Bulimic patients who received fluoxetine
  exhibited reduction in frequency of vomiting
  episodes and frequency of binge eating episodes
  (Romano, Halmi, Sarkar, Koke & Lee, 2002, p.
  671).
      “Continued treatment with fluoxetine in patients with
       bulimia nervosa who responded to acute treatment with
       fluoxetine improved outcome and decreased the
       likelihood of relapse” (Romano et al., 2002, p. 671).
                   Conclusion
 ED are complex disorders requiring thorough review
  of diagnoses, etiologies, family issues, assessment
  methods, family therapy treatment models and other
  treatment approaches of eating disorders.
 The prevalence and seriousness of eating disorders,
  such as anorexia, bulimia, binge eating disorder
  warrant improvements in public awareness,
  psychoeducational techniques and media
  responsibility.
 Furthermore, family prevention and intervention have
  been indicated as highly beneficial.

				
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