Understanding Eating Disorders: Psychopathology PSYC353 Notes

Types of Eating Disorders

Eating disorders come in several forms, each with distinctive patterns and behaviors. Anorexia nervosa involves severely restricting food intake, intense fear of weight gain, and distorted body image—even when dangerously underweight.

There are two subtypes of anorexia: the restricting type (primarily using dieting, fasting, or excessive exercise) and the binge-eating/purging type (engaging in binge eating or purging behaviors).

Bulimia nervosa involves cycles of binge eating (consuming unusually large amounts of food with a feeling of being out of control) followed by compensatory behaviors like self-induced vomiting, misuse of laxatives, fasting, or excessive exercise to prevent weight gain.

💡 The difference between anorexia and bulimia isn't just about weight—it's about patterns of behavior. Someone with anorexia primarily restricts food intake, while someone with bulimia cycles between binging and purging.

More Types and Demographics

With bulimia nervosa, both binge eating and compensatory behaviors occur at least weekly for three months, and self-worth is overly tied to body shape and weight.

Binge eating disorder (BED) involves recurring episodes of consuming unusually large amounts of food with a feeling of loss of control. These episodes typically include eating rapidly, until uncomfortably full, when not hungry, alone due to embarrassment, and feeling disgusted or guilty afterward.

Eating disorders affect different populations in various ways. While they're diagnosed more often in women, the age of onset differs: anorexia typically begins at 16-20, bulimia at 21-24, and BED at 30-50.

Cultural factors play important roles too. Asian and Asian American individuals face higher risk for all eating disorders, while Latinx adults show higher rates of BED. Risk factors include acculturation stress and internalization of Western beauty ideals, while connection to ethnic identity can be protective.

Living with Eating Disorders

People with eating disorders often experience complex emotions including anxiety, shame, denial, and feelings of either lacking control or being overly controlling. These feelings can make it difficult to seek help or acknowledge the problem.

The medical complications of eating disorders can be severe. Anorexia nervosa is potentially deadly, causing cardiac problems, digestive issues, blood count abnormalities, stopped menstrual periods, muscle loss, and bone density reduction.

Bulimia causes its own set of health problems, including dental erosion from stomach acid exposure, throat inflammation, electrolyte imbalances that risk cardiac complications, and irregular menstruation.

Binge eating disorder increases risk for high cholesterol, high blood pressure, diabetes, gallbladder disease, and heart disease.

⚠️ Anorexia nervosa has the highest mortality rate of any psychiatric disorder, primarily due to cardiac complications and suicide.

Causes and Co-occurring Conditions

Eating disorders stem from multiple interconnected factors. Biological factors include genetic predisposition to eating disorders themselves and to co-occurring conditions like depression, OCD, or substance use disorders. Brain differences and neurotransmitter imbalances (serotonin, dopamine) also play roles.

Family dynamics contribute significantly. Anorexia is associated with rigid, less cohesive families with poor communication and high perfectionism. Bulimia often appears in families with high expectations, critical comments about weight/shape, and family members who diet.

Psychological factors like perfectionism, body dissatisfaction, low self-esteem, depression, and impulsivity increase risk for developing eating disorders.

Many people with eating disorders also have other mental health conditions. Common co-occurring diagnoses include anxiety disorders, depression, bipolar disorders, OCD, substance use disorders, PTSD, autism (especially with anorexia), and ADHD (especially with BED and bulimia).

Sociocultural Factors and Treatment

Our culture significantly impacts eating disorder development through beauty standards, diet culture, and media influences. Weight stigma creates psychological distress that can trigger binge eating. Social media platforms often promote unrealistic body ideals and harmful food/fitness messaging.

Getting help for eating disorders remains challenging, with relatively low rates of seeking professional treatment: only 34.5% for anorexia, 49% for BED, and 62.6% for bulimia.

Treatment occurs at different levels of intensity, from outpatient care to partial hospitalization, residential programs, and inpatient treatment for severe cases.

A major treatment challenge is ambivalence—part of the person wants to recover while another part wants to maintain the disorder. This makes simplistic approaches like "just eat food" ineffective because underlying issues remain unaddressed. People may fear weight gain, use the disorder to maintain control, or struggle to cope with emotions in healthier ways.

🔑 Recovery involves more than changing eating habits—it requires addressing the psychological factors and coping mechanisms that maintain the disorder.

Treatment Challenges and Approaches

Treatment settings present unique challenges. People with eating disorders often have competitive tendencies that can manifest in unhelpful ways during group treatment, such as comparing body sizes or disordered eating behaviors.

Medical stabilization becomes necessary in severe cases, especially with very low BMI, irregular heart rates, low blood pressure, organ failure, or electrolyte abnormalities. During refeeding, careful monitoring prevents potentially fatal complications from too-rapid reintroduction of nutrition.

Cognitive Behavioral Therapy for Eating Disorders $CBT-E$ uses a trans-diagnostic framework targeting the over-evaluation of controlling eating, shape, or weight. The model shows how strict dieting, binge eating, and compensatory behaviors create self-reinforcing cycles.

CBT-E treatment follows a structured approach with four stages. Stage 1 focuses on engaging the patient, establishing regular eating patterns, and beginning self-monitoring. Stage 2 reviews progress and addresses barriers to change.

💡 CBT-E is considered the gold standard treatment for bulimia and binge eating disorder, with strong evidence supporting its effectiveness.

Therapeutic Approaches

In Stage 3 of CBT-E—the main treatment phase—therapy focuses on addressing core issues: challenging the over-emphasis on shape and weight, reducing body checking behaviors, examining dietary rules and beliefs, and addressing perfectionism or interpersonal problems.

The final stage (Stage 4) concentrates on maintaining progress and preventing relapse through appointments spaced farther apart, helping transition to independent management.

For Binge Eating Disorder, CBT aims to disrupt the diet-binge cycle by promoting structured eating patterns, improving body image concerns, and using self-monitoring to develop flexible rather than rigid approaches to eating.

Interpersonal Psychotherapy (IPT) offers another effective approach for BED. This model suggests social problems create environments where binge eating develops as a coping mechanism for unexpressed emotions.

IPT focuses on acknowledging feelings directly rather than coping through food. The goal is developing healthy interpersonal skills that promote a positive self-image and better emotional regulation.

Recovery Goals

The ultimate goal of eating disorder treatment is to help people acknowledge and express difficult feelings while developing healthy interpersonal skills. This foundation supports a more positive self-image and reduces reliance on disordered eating as a coping mechanism.

Recovery involves learning to separate self-worth from body size or shape, developing flexible eating patterns, building healthier ways to manage emotions, and creating supportive relationships. Though challenging, with proper treatment, recovery from eating disorders is absolutely possible.