eating disorders n.
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  2. Eating Disorders • Are characterized by severe disturbances in eating behavior • 2 spesific diagnoses : • Anorexia nervosa : characterized by a refusal to maintain a minimally normal body weight • Bulimia nervosa : characterized by repeated episodes of binge eating followed by inappropriate compensatory behavior (such as : self-induced vomitting, misuse of laxatives/diuretics/other medication, fasting, excessive exercise)

  3. Anorexia Nervosa (AN) Anorexia = loss of appetite, nervosa = emotional reasons (misnomer : AN not losing their appetite) Essential features : • Refuses maintain normal body weight • Intensely afraid of gaining weight • Significant disturbances in the perception of the shape or size of his/her body • Amenorrhoic in females

  4. Anorexia Nervosa Diagnostic criteria DSM IV-TR : A. Refusal to maintain body weight at or above minimally normal weight for age and height (e.g : less than 85% that expected) B. Intense fear of gaining weight or becoming fat, even though underweight C. Disturbance in experiencing one’s body weight & shape, undue influence of body weight & shape on self-evaluation, or denial of the seriousness of the current low body weight D. Amenorrhea (e.g. at least 3 menstrual cycles)

  5. Anorexia Nervosa Subtype AN : 1. Restricting type : during AN, person hasn’t regularly engaged in binge-eating or purging behavior (i.e. self-induced vomiting or misuse of laxatives, diuretics or enemas) 2. Binge-Eating/Purging type : during AN, person has regularly engaged in binge-eating or purging behavior (i.e. self-induced vomiting or misuse of laxatives, diuretics or enemas)

  6. Anorexia Nervosa • Prevalence : about 10 times more frequent in woman than in man • Course : begins in the early middle teenage years (age 14-18), often after stresstul life event • Differential diagnosis : - Bulimia Nervosa : are able to maintain body weight at or above a minimally normal level (AN binge-eating/purging type can’t)

  7. Bulimia Nervosa • “Bulimia” from Greek word, meaning : “ox hunger” • Essential features : • Binge eating & inappropriate compensatory methods to prevent weight gain, at least 2x seminggu dalam 3 bln • Self-evaluation influenced by body shape & weight • Binge : eating in discrete period of time (< 2 hours) an amount of food that is definitely large than most individuals would eat in similar circumstances / periof of time

  8. Bulimia Nervosa Diagnostic criteria DSM IV-TR : A. Recurrent episodes of binge eating. An episode of binge eating characterized by both of the following : 1. eating, in discrete period of time (e.g. with-in 2 hour period), an amount of food that is definitely larger than most people would eat 2. a sense of lack of cotrol over eating during the episode (e.g. a feeling that one can’t stop eating or control what or how much one is eating) B. Recurrent inappropriate compensatory behavior in order to prevent weight gain (such as : self-induced vomitting, misuse of laxatives/diuretics/other medication, fasting, excessive exercise) C. The binge eating & inappropriate compensatory behavior both occur, at least twice a week in 3 months D. Self-evaluation is unduly influenced by body shape and weight E. The disturbance doesn’t occur exclusively during episodes of AN

  9. Bulimia Nervosa Subtype, ada 2 jenis : • Purging type : during BN, person has regularly engaged inself-induced vomiting or misuse of laxatives, diuretics or enemas • Nonpurging type : during BN, person has used other inappropriate compensatory behavior, such as fasting or excessive exercise, but hasn’t regularly engaged in self-induced vomiting or misuse of laxatives, diuretics or enemas

  10. Bulimia Nervosa • Prevalence : 90% of cases are woman, prevalence among woman is about 1-2% of the population • Course : begins in late adolescence or early adulthood, begins often after an episode of dieting • Differential diagnosis : - AN binge-eating/purging type : pada BN weight is normal, menses have become regular

  11. Binge Eating Disorder • Recurrent episodes of binge eating behavior in the absence of the regular use of inappropriate compensatory behavior characteristic of BN • Indicators of impaired control (3 or more): • Eating much more rapidly than normal • Eating until feeling uncomfortably full • Eating large amounts of food when not feeling physically hungry • Eating alone because of being embarrassed by how much one is eating • Feeling disgusted with oneself, depressed, or very guilty afer overeating

  12. ETIOLOGY of EATING DISORDER 1. Biological factors : Genetic : both AN & BN run in families. Key features of the eating dis (dissatisfaction with one’s body & strong desire to be thin) appear heritable

  13. ETIOLOGY of EATING DISORDER 2. Sociocultural variables : cultural standards moving in the direction of thinness  dieting to lose weight has become more common  fat = negative connotations (as being unsuccessful & having little self-control)  prevalence of eating disorders increased

  14. ETIOLOGY of EATING DISORDER 3. Gender influences : • Women more heavily influenced than men by cultural standards reinforcing the desirability of being thin • Woman are typically valued more for their appearanece, whereas men for their accomplishments • The risk for women who might be expected to be particularly concerned with their weight (models, dancers, & gymnasts) appear to be especially high 4. Cross cultural studies : industrialized > non indz 5. Racial differences : lbh krn social class

  15. ETIOLOGY of EATING DISORDER 6. Psychodynamic views : • Disturbed parent-child relationship • Personality traits : low self-esteem & perfectionism • Goodsitt : conflict-ridden mother-daughter relationship 7. Family Systems theory : Minuchin – dysfunctional family structure (Enmeshment, Overprotectiveness, Rigidity, Lack of conflict-resolution)

  16. ETIOLOGY of EATING DISORDER 8. Personality & Eating Disorder : • AN : perfectionistic, shy, & compliant. BN : histrionic features, affective instability, outgoing social disposition • AN & BN: high in neuroticism & anxiety, low in self-esteem. Also high on measure of traditionalism (strong endorsement of family & social standards) • AN : depression, social isolation, anxiety. BN : more diffuse & serious psychopathology

  17. ETIOLOGY of EATING DISORDER 9. Cognitive-behavioral Views : • Motivating factor : fear of fatness & body-image disturbance • False behavior is maintain with negative reinforcer (yaitu : reducing anxiety about becoming fat) • Dieting & weight loss positively reinforced by the sense of mastery or self-control they create

  18. TREATMENT ofEATING DISORDER 1. Biological treatment 2. Psychological treatment : • Two-tiered process : gain weight + avoid medical complication • operant-conditioning behavior therapy : reward for eating & gaining weight • Cognitive behavior therapy : uncover & change false beliefs, altering all-or-nothing thinking, unrealistic thinking • ego-analytic psychotherapy : fokus pada greater autonomy • Family therapy : disorder bsifat interpersonal • Overall goal : develop normal eating patterns