EATING DISORDERS
Dr.Sonia Kapur
Clinical Psychologist and Assistant Professor
DEFINITIONS....
Eating disorders are actually
serious and often fatal
illnesses that are associated Eating disorders are
Eating disorders is a
with severe disturbances in associated with increased
psychological condition that
people’s eating behaviors morbidity and mortality
disturbs eating habits. Eating
and related thoughts and (Sullivan, 2002) and are
disorders affect thoughts
emotions. Preoccupation potentially chronic
and emotions, and the
with food, body weight, and conditions associated with a
people with the disease
shape may also signal an range of medical,
become preoccupied with
eating disorder. Common psychological and
food, body shape and
eating disorders include Perspectives, psychosocial
weight.
Anorexia Nervosa, Bulimia consequences.
Nervosa, Female
Athlete Triad
Anorexia Nervosa
TYPES OF Bulimia Nervosa
EATING Female Athlete Triad(FAT)
DISORDE
RS... Anorexia Athletica (AA)
Unspecified Feeding or Eating
Disorder(UFED).
Anorexia Nervosa
Definition- Anorexia nervosa is a Anorexia nervosa can be fatal. It has an
condition where people avoid food, extremely high death (mortality) rate
severely restrict food, or eat very small compared with other mental disorders.
quantities of only certain foods. They People with anorexia are at risk of dying
also may weigh themselves repeatedly. from medical complications associated
Even when dangerously underweight, with starvation. Suicide is the second
they may see themselves as leading cause of death for people
overweight. diagnosed with anorexia nervosa.
Continue...
• Symptoms include:
• Extremely restricted eating
• Extreme thinness (emaciation)
• A relentless pursuit of thinness and unwillingness to
maintain a normal or healthy weight
• Intense fear of gaining weight
• Distorted body image, a self-esteem that is heavily
influenced by perceptions of body weight and shape, or a
denial of the seriousness of low body weight
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Other symptoms may develop over time, including:
• Thinning of the bones (osteopenia or osteoporosis)
• Mild anemia and muscle wasting and weakness
• Brittle hair and nails
• Dry and yellowish skin
• Growth of fine hair all over the body (lanugo)
• Severe constipation
• Low blood pressure
• Slowed breathing and pulse
• Damage to the structure and function of the heart
• Brain damage
• Multiorgan failure
• Drop in internal body temperature, causing a person to feel cold all the time
• Lethargy, sluggishness, or feeling tired all the time
• Infertility
Anorexia patient...
Bulimia nervosa-
• Bulimia nervosa is a condition where people have recurrent and frequent
episodes of eating unusually large amounts of food and feeling a lack of
control over these episodes. This binge-eating is followed by behavior that
compensates for the overeating such as forced vomiting, excessive use of
laxatives or diuretics, fasting, excessive exercise, or a combination of these
behaviors. People with bulimia nervosa may be slightly underweight,
normal weight, or over overweight.
Symptoms include:
• Chronically inflamed and sore throat.
• Swollen salivary glands in the neck and jaw area.
• Worn tooth enamel and increasingly sensitive and decaying teeth as a result of exposure
to stomach acid.
• Acid reflux disorder and other gastrointestinal problems.
• Intestinal distress and irritation from laxative abuse.
• Severe dehydration from purging of fluids.
• Electrolyte imbalance (too low or too high levels of sodium, calcium, potassium, and
other minerals) which can lead to stroke or heart attack.
Female Athlete Triad (FAT)-
• Disordered eating: extreme or harmful methods of weight control
including binge-eating and purging and restricting food intake.
• Amenorrhea: Primary amenorrhea defined as the absence of menstruation
in a girl by age 16 with secondary sex characteristics; Secondary
amenorrhea defined as the absence of 3 consecutive menstrual cycles
after menarche.
• Osteoporosis: Bone mineral density more than 2.5 standard deviations
below the mean for young adults.
Unspecified Feeding And Eating
Disorders (UFED).
• UFED is diagnosed when an individual’s symptoms do not line up with those of another
disorder, or when there is simply not enough information to determine a more specific
diagnosis. This UFED label can change once more information is gathered, or as symptoms
change over time.
• The presence of disordered thoughts and behaviors regarding food and body image is not
enough to warrant an eating disorder diagnosis. These thoughts and behaviors must be
severe enough to cause significant distress to the individual.
• The exact prevalence of UFED is unknown, though it is not believed to be common among the
eating disorder community. As Jennifer J. Thomas, Ph.D., confirms, “In her study of DSM-5
changes at the Klarman Eating Disorders Center, just 1 of 150 patients had UFED. This patient
struggled with bingeing and purging but didn’t have the intense shape and weight concerns
that are required for a bulimia diagnosis.
Disordered Eating Behaviors
• Symptoms of UFED include disordered eating behaviors that cause significant distress or impairment.
Disordered behaviors can vary greatly. Common behaviors include restriction, bingeing, and/or purging.
• Restriction is characterized by limiting caloric intake to an extreme. This is one of the primary symptoms of
anorexia nervosa, though it is a common facet of many eating disorders.
• Binge eating occurs when an individual consumes a large quantity of food, typically in secret and until
uncomfortably full. Bingeing is often uncontrollable and leaves the individual feeling guilty and shameful. In
some cases, this leads to compensatory behaviors, such as self-induced vomiting or laxative abuse.
• An individual can engage in compensatory behaviors, otherwise known as purging, regardless of the size of the
meal. Bingeing and purging is characteristic of bulimia nervosa, and bingeing without the use of compensatory
behaviors would likely be diagnosed as BED. Purging following a small or “normal” meal might fall under the
category of anorexia nervosa or purging disorder. This is dependent on the other symptoms and their severity.
• Purging can take many forms, including compulsive exercise. This occurs when an individual has an obsession
with burning calories recently consumed, and does so through excessive exercise. Compulsive exercise is a
common symptom present in many eating disorders.
Lesser-known Behaviors
• There are many disordered behaviors that are less common and therefore not as openly
discussed within the eating disorder community.
• Chewing and spitting is a behavior in which individuals chew their food to get the sensation of
eating, then spit it out to avoid the caloric intake or feeling full. This is different than
rumination disorder, in which an individual swallows, then regurgitates and typically re-chews
the food.
• Pica is an eating disorder characterized by eating non-food substances, such as carpeting or
paper products. The ingestion of hair is known as trichophagia, closely connected to the hair-
pulling disorder trichotillomania.
Prevalence Symptoms-
Eg- In the competitive sport
environment, an athlete risks
It has traditionally been difficult to get an being dropped from a program or team if
accurate assessment of eating disorders his eating problem is discovered.
in any population. Because there are Therefore athletes with
doubts about the validity of many of the these types of disorders are often very
questionnaires used to measure eating secretive, and they are not willing to
problems share information until the problem
becomes almost catastrophic and
professional help is necessary.
Various researches have summarized the
prevalence of eating disorders in sport-
• Female athletes, in general, reported higher frequencies of eating disorders than male athletes,
which is similar to the general population. Male athletes with eating disorders are less prevalent
and thus have not been studied as extensively as female athletes.
• A significant percentage of athletes engage in disordered eating or weight loss behaviors (e.g.,
binge eating, rigorous dieting, fasting, vomiting, use of diuretics), and these behaviors are
important to examine even though they are subclinical in intensity.
• Eating disorders among athletes and their use of pathogenic weight loss techniques tend to have a
sport-specific prevalence (e.g., they occur more among gymnasts and wrestlers than in archers or
basketball players).
• Up to 66% of female athletes may be amenorrheic compared with approximately 2% to 5% of
nonathletes. These data (along with higher levels of disordered eating by female athletes) suggest
that female athletes may eventually develop osteoporosis, which can result in increased bone
fractures, increased skeletal fragility, and permanent bone loss.
Causes of Knowing these factors might help you prevent or reduce
the probability that an eating disorder (or disordered
eating) will occur in someone—or yourself.
eating 1. Weight Restrictions and Standards
disorders 2. Coach and Peer Pressure
3. Sociocultural Factors
in sports- 4. Judging Criteria
5. Critical comments about body, weight and shape
6. Genetic and biological factors
7. Mediating factors
8. Recognition and Referral of an Eating Problem
Weight
• Sports such as weightlifting, wrestling, and boxing commonly
use weight classifications to subdivide competitor groups.
Restrictio
• Often athletes try to “make weight” so they can compete at a
lower weight classification, which presumably would give them
an advantage against a lighter opponent. This can result in their
ns and trying to drop up to 10 or even 15 pounds immediately before
weigh-ins, usually resulting primarily in rapid dehydration.
Standard • Techniques to achieve this rapid weight loss include fasting; fluid
restriction; and the use of diuretics, laxatives, and purging. But
weight loss and dieting are not limited to athletes, because
s- these behaviors are a common problem among young people.
• Coaches, trainers, and parents should discourage these weight
loss methods, even those that are embedded in the sport
culture.
• Researchers (Sedula, Collins, & Williamson, 1993) investigating
more than 11,000 high school students found that more than
40% of the females were attempting to lose weight through
some type of diet.
Coach and
Peer
Pressure-
• Coaches and peers can play
an important role in shaping
the attitude and behaviors of
athletes. Unfortunately,
coaches sometimes
knowingly or unknowingly
exert pressure on athletes to
lose weight, even when they
have information about safe
and effective weight
management procedures.
• Although genetics can certainly influence disordered
eating, the current thinking is that the condition has more
to do with the cultural emphasis on thinness, which can
lead to widespread body dissatisfaction (especially in
women).
Sociocultural • Eg- the American Society for Aesthetic Plastic Surgery
reported that more than 200,000 cosmetic surgeries were
Factors- done in 2007 on children under 18 years of age so they
could look a certain way (Marcus, 2009).
• Our culture values thinness, and according to some
figures, up to 95% of women overestimate their body size
as 25% larger on average than it actually is. In essence, the
media constantly tell us that we should look thin and
beautiful like the models we see on billboards and
television.
• The last 20 years have seen an increased focus on the
relationship between body weight or body fat and
Performa performance.
nce • In fact, research has indicated that there is a correlation
between a low percent body fat and high levels of
Demands performance in a number of sports (Wilmore, 1992). This
has led many coaches and athletes to focus on weight
- control for the purpose of reaching optimal weight.
However, lower body fat does not always mean better
performance.
• In sports in which physical attractiveness, especially for
Judging females, is considered important to success (gymnastics,
figure skating, diving), coaches and athletes may perceive
that judges tend to be biased toward certain body types.
Criteria- • When athletes do not conform to these images, they may
stand out among their teammates and experience
incredible pressure to achieve unrealistic and unhealthy
body weights and shapes.
Critical • Although there has long been anecdotal evidence that
comments critical comments about body shape and weight (e.g., “fat
cow,” “Pillsbury dough boy,” “tubby”) particularly
about
negatively affect female athletes, little empirical research
was conducted.
body, • In 2008, Muscat and Long found that athletes who recalled
more critical comments and more severely critical
weight comments than others reported greater disordered eating
as well as more intense negative emotions (shame,
anxiety).
and • . In addition, females at the highest level of competition
shape- (i.e., international) were more likely to remember critical
comments than athletes performing at lower competitive
levels.
Genetic and biological
factors-
• “Why do only a small fraction of individuals (mostly
females) go on to develop an eating disorder?” In an
excellent review article, Striegel-Moore and Bulik
(2007) discuss a number of studies investigating
biological as well as sociocultural predictors of eating
disorders. There seems to be ample evidence that
biology plays a role in the development of eating
disorders from the findings of twin studies and
molecular-genetic studies.
• The personality factors of
asceticism,
submissiveness, and
conformity were all
Mediating
related to eating
pathology among athletes.
• Researchers (de Bruin,
Bakker, & Oudejans, 2009)
factors-
have found that athletes
who are ego-oriented
tend to display more
disordered eating, and
thus they recommend
that coaches emphasize a
mastery-oriented climate
focusing on improvement
Recognition and referral of an
eating problem-
• Practitioners are in an excellent position to spot individuals with eating disorders (Thompson,
1987). Thus, they must be able to recognize the physical and psychological signs and
symptoms of these conditions.
• People with anorexia often pick at their food, push it around on their plate, lie about their
eating, and frequently engage in compulsive or ritualistic eating patterns such as cutting food
into tiny morsels or eating only a very limited number of bland, low calorie foods.
• People with bulimia often hide food and disappear after eating (so they can purge the food
just eaten) or simply eat alone. Whenever possible, fitness educators should observe the
eating patterns of students and athletes, looking for abnormalities.
Treatme • Treatments for eating disorders vary depending on the
type and your specific needs. Even if you don’t have a
nts of diagnosed eating disorder, an expert can help you address
and manage food-related issues. Treatments include:
eating • Psychotherapy
disorder • Maudsley approach
• Medications
s- • Nutrition counseling
• Psychotherapy: A mental health professional can determine the best psychotherapy
for your situation. Many people with eating disorders improve with
cognitive behavioral therapy (CBT). This form of therapy helps you understand and
change distorted thinking patterns that drive behaviors and emotions.
• Maudsley approach: This form of family therapy helps parents of teenagers with
anorexia. Parents actively guide a child’s eating while they learn healthier habits.
• Medications: Some people with eating disorders have other conditions, like anxiety
or depression. Taking antidepressants or other medications can improve these
conditions. As a result, your thoughts about yourself and food improve.
• Nutrition counseling: A registered dietitian with training in eating disorders can
help improve eating habits and develop nutritious meal plans. This specialist can
also offer tips for grocery shopping, meal planning and preparation.
Prevention of Eating
Disorders-
• Some suggestions for being proactive in reducing eating disorders in athletes and exercisers.
• Promote proper nutritional practices- Research indicates that many sport participants have limited information or
have incorrect views about proper sport nutrition. Many individuals turn to coaches, trainers, and peers for
nutritional advice, and these exercisers and athletic personnel should therefore become educated about good
nutrition and methods of weight control (Coaches’ Guide to Nutrition and Weight Control [Eisenman, Johnson, &
Benson, 1990] is one good source of nutritional information.)
• Focus on fitness, not body weight- We must move away from obsessing about weight to focusing on health and
fitness itself. There is no ideal body composition or weight for an athlete or exerciser, because weight and body
composition fluctuate greatly, depending on the type of sport, body build, and metabolic rate. Rather, an ideal range
might better be targeted, with input from professionals such as nutritionists and exercise physiologists.
• Be sensitive to weight issues- Athletic personnel should be made aware of the issues athletes contend with regarding
weight control and diet, and they should act with sensitivity in these areas. Coaches and fitness leaders often exert
powerful influence on individuals, and they should exercise care when making remarks about weight control.
Practices such as repeating weigh-ins, associating weight loss with enhanced performance, setting arbitrary weight
goals, and making unfeeling remarks must be avoided at all costs.
• Promote healthy management of weight- As the incidence of and focus on disordered eating
practices in sport and exercise have increased in recent years, so too has the availability of
educational material. For example, the NCAA produced an informative set of three videos along
with supportive educational material on eating disorders in sport (National Collegiate Athletic
Association, 1989). Sport and exercise science professionals need to keep up with the latest
information regarding weight loss and eating disorders.
• Use a cognitive-dissonance intervention- Recent research (Smith & Petrie, 2008) has
demonstrated that cognitive dissonance may be helpful in reducing some of the negative feelings
and thoughts typically held by athletes with disordered eating.In their study, Smith and Petrie had
female athletes (who described themselves as having disordered eating) engage in a variety of
exercises (in three sessions), which called into the question the ideal thin female body type to
create dissonance. Results revealed that the intervention produced some positive effects,
particularly with respect to decreases in sadness and depression and in internalization of a
physically fit and in-shape body type and increases in body satisfaction.
Assessment tools-
Thank you
