Abnormal Psychology

462 CHAPTER 10

Treating Eating Disorders

One important goal when treating a patient with anorexia is to help the patient

attain a medically safe weight through increased eating or decreased purging; if that

safe weight cannot be reached with outpatient treatment, then inpatient treatment

becomes imperative. Marya Hornbacher describes one aspect of her treatment for

anorexia and how she felt about it:

Denied food, your body and brain will begin to obsess about it. It’s the survival instinct,

a constant reminder to eat, one that you try harder and harder to ignore, though you

never can. Instead of eating, you simply think about food all the time. You dream

about it, you stare at it, but you do not eat it. When you get to the hospital, you have

to eat, and as truly terrifying as it is, it is also welcome. Food is the sun and the moon

and the stars, the center of gravity, the love of your life. Being forced to eat is the most

welcome punishment there is.

(1998, p. 151)

When someone with an eating disorder isn’t underweight enough to require inpa-

tient treatment, many different factors can be the initial targets of treatment. In

this section we examine specifi c treatments that target neurological (and biological,

more broadly), psychological, and social factors and the role of hospitalization.

Like treatment for other disorders, the intensity of treatment for eating disor-

ders can range from hospitalization, day or evening programs, residential treatment,

to outpatient treatment. In all these forms of treatment, cognitive-behavior therapy

Key Concepts and Facts About Understanding Eating Disorders

• It is particularly difficult for researchers to establish cause-
  and-effect relationships among the factors associated with
  eating disorders. This diffi culty arises because the symptoms
  themselves—restricting, bingeing, purging, excessive exercise,
  malnourishment—create neurological (and other biological),
  psychological, and social changes.


• Neurological factors associated with eating disorders include:
  
  
  • unusually low activity in the frontal, temporal, and parietal
    lobes, as well as the anterior cingulate cortex, the basal
    ganglia, and the cerebellum. However, these neural pat-
    terns may vary for specifi c types of anorexia, and may be
    affected by dieting. Patients with anorexia also have re-
    duced gray and white matter;
  
  
  • reduced responsiveness to serotonin, a neurotransmitter
    involved in mood, anxiety, and binge eating. One theory about
    the role of serotonin in bulimia involves tryptophan, a building
    block of serotonin;
  
  
  • a tendency for eating disorders tend to run in families, as well
    as evidence of substantial heritability, which indicates that
    genes play a role.
  
  
  
  


• Psychological factors related to eating disorders include:
  
  
  • irrational thoughts and excessive concerns about weight,
    appearance, and food;
  
  
  • binge eating as a result of the abstinence violation effect;
    
    
    • positive and negative reinforcement of symptoms of eating dis-
      orders (restricting, bingeing, and purging);
    
    
    • certain personality traits: perfectionism, harm avoidance, neu-
      roticism, and low self-esteem;
    
    
    • disinhibited eating, triggered by the last supper effect, espe-
      cially in restrained eaters; and
    
    
    • comorbid psychological disorders in female adolescents, par-
      ticularly depression.
    
    
    
    
  
  
  
  


• Social factors related to eating disorders include:


• family members and friends who provide a model for eating,
  concerns about weight, and focus on appearance through their
  own behaviors and responses to others;


• cultural factors, which play a key role, as evidenced by
  the increased prevalence over time of bulimia and con-
  cern about weight that is part of anorexia. Specifi c cultural
  factors include a cultural ideal of thinness and repeated
  exposure—through the media—to this ideal, as well as the
  individual’s assimilation of this ideal. People in Western and
  Westernized countries are more likely to develop eating dis-
  orders than are people from non-Western and developing
  countries;


• confl icting gender roles in Western societies and a tendency
  to view women’s bodies as objects and search for bodily fl aws
  (objectifi cation theory).