Abnormal Psychology

470 CHAPTER 10

Summary of Anorexia

Nervosa

The hallmark of anorexia nervosa is a refusal to

maintain a healthy weight; DSM-IV-TR defi nes

the weight cutoff as less than 85% of expected

body weight. Other criteria include an intense

fear of becoming fat or gaining weight,

distortions in body image, and amenorrhea.

DSM-IV-TR includes two types of anorexia:

restricting and binge-eating/purging.

Anorexia can lead to significant medical

problems, most importantly muscle wasting

(particularly of heart muscle), low heart rate,

low blood pressure, loss of bone density, and

decreased metabolism. Other symptoms in-

clude irritability, headaches, fatigue, and rest-

lessness. All methods of purging—vomiting,

diuretics, laxatives, and enemas—can cause

dehydration. Starvation also leads to various

psychological and social problems.

Critics of the DSM-IV-TR diagnostic criteria

for anorexia point out that the criteria of low

weight and amenorrhea are not highly associ-

ated with general medical status, prognosis,

or outcome. Also, the two types of anorexia—

restricting and binge-eating/purging—may

better represent stages of the disorder rather

than distinct paths it can take.

Thinking like a clinician

Since the age of 12, Lee has been very thin,

in part because of hours of soccer practice

weekly. Now, at the age of 17, Lee eats very

little (particularly staying away from foods

high in fat), continues exercising, and gets

angry when people comment about weight.

What would you need to know to determine

whether Lee has anorexia nervosa? If Lee

does have anorexia, what would be some pos-

sible medical problems that might arise? What

if Lee were male—would it change what you’d

need to know to make the diagnosis? Explain

your answer.

Summary of Bulimia

Nervosa

Bulimia nervosa is characterized by recurrent

episodes of binge eating followed by inappro-

priate efforts to prevent weight gain. DSM-IV-TR

specifies two types of bulimia: the purging

type (which is characterized by vomiting or the

use of diuretics, laxatives or enemas) and

SUMMING UP

Key Concepts and Facts About Treating Eating Disorders

• The treatments that target neurological and other biological fac-
  tors include:
  
  
  • nutritional counseling to improve eating (and can also correct
    erroneous information about food and weight);
  
  
  • medical hospitalization for significant medical problems
    related to the disorder; and
  
  
  • medication to address some symptoms of the eating disorder
    and of anxiety and depression. Specifically, SSRIs may help
    prevent relapse in those with anorexia and can decrease symp-
    toms of bingeing and purging in those with bulimia.
  
  
  
  


• The primary treatment that targets psychological factors is CBT,
  which is the treatment of choice for eating disorders. CBT addresses
  maladaptive thoughts, feelings, and behaviors that impede normal
  eating, promote bingeing and purging, and lead to body image dis-
  satisfaction. CBT may include exposure with response prevention
  and help patients develop new coping strategies.
  
  
  • Treatments that target social factors include:
    
    
    • interpersonal therapy, which is designed to improve the
      patient’s relationships; as relationships become more satisfying,
      the eating disorder symptoms diminish;
    
    
    • family therapy, particularly the Maudsley approach, which can
      be helpful for adolescents with anorexia who live at home. Par-
      ents fi gure out how to feed their child, despite her protests,
      until she eats normally and without a struggle;
    
    
    • psychiatric hospitalization, which provides supervised meal-
      times to increase normal eating, and a range of therapeutic
      groups to address various psychological and social factors
      (such as irrational beliefs about food and weight and social
      problems), plus individual therapy and possibly medication;
    
    
    • prevention programs, which have the goal of preventing
      eating disorders from developing, particularly in high-risk
      individuals.
    
    
    
    
  
  
  
  

Follow-up on Marya Hornbacher

Marya Hornbacher’s fi rst memoir, Wasted, was written when she was 23 years old.

Within a year of its publication, she was diagnosed with a rapid cycling form of bipo-

lar disorder (see Chapter 6 for a discussion of bipolar disorder). Hornbacher spent the

next 10 years struggling with alcohol dependence and bipolar disorder; her struggles

are recounted in her subsequent memoir, Madness: A Bipolar Life (2008). Although

the flagrant symptoms of eating disorders were mostly behind her at the close of

Wasted, in her later memoir she reported occasional periods of restricting or purg-

ing as she struggled with manic episodes and mixed episodes. She recounts that these

periods of disordered eating were attempts to regulate her extreme moods. Her

experiences highlight the frequent comorbidity among people with eating disorders.