Abnormal Child Psychology Sixth Edition 14 Feeding and

Abnormal Child Psychology Sixth Edition 14 Feeding and Eating Disorders Eric J. Mash A. 2016 Wolfe ©David Cengage Learning © Cengage Learning 2016

Overview • What is peculiar about eating disorders is that they are linked to Western culture, where food is plentiful and physical appearance is highly valued – In Western society, eating disorders are third most common illness in adolescent females © Cengage Learning 2016

How Eating Patterns Develop • Normal development – Problematic eating habits and picky eating are common in early childhood – Societal norms and expectations affect girls more than boys • Beginning around age 9, girls are more anxious than boys about losing weight • Most important impact on fundamental biological processes is early parent-child relationship • Entering school comes with pressure to conform to perceptions of desirable body type © Cengage Learning 2016

Developmental Risk Factors • Early eating habits, attitudes, and behaviors – Western sociocultural values and preoccupation with weight and dieting • May be internalized and expressed in children as young as age 7 -10 – A constellation of physical and psychological factors are linked to early eating problems and distorted beliefs © Cengage Learning 2016

Developmental Continuum of Eating Habits and Disorders © Cengage Learning 2016

Transition into Adolescence • Anorexia and bulimia typically occur during adolescence • Girls place greater emphasis on selfperceptions of their physical appearance more than boys © Cengage Learning 2016

Transition into Adolescence (cont’d. ) • Contradictory social messages imply that women must be successful in traditional feminine and masculine roles • Changes encourage smoking and other substance use to prevent impulse to binge eat and consequences of weight gain © Cengage Learning 2016

Dieting and Weight Concerns • Restrictive dieting is common in North America, even among elementary school children • Chronic dieting is associated with gender and developmental factors © Cengage Learning 2016

Dieting and Weight Concerns (cont’d. ) • Dieting may lead to a vicious cycle of weight loss and weight gain, overeating, and the “false hope syndrome, ” as well as binge eating and subsequent purging • Many young people diet, but only a small minority develop eating disorders © Cengage Learning 2016

The Binge-Purge Cycle © Cengage Learning 2016

Biological Regulators • Metabolic rate • Body weight • Growth – Major hormonal determinants of physical growth rate during childhood are the growth hormone (GH) and thyroid hormone – Additional gonadal steroids kick in during adolescence to produce a further growth spurt and skeletal maturation © Cengage Learning 2016

Obesity • Approximately one in six children and adolescents (aged 2 -19) in North America are obese • Childhood obesity is a chronic medical condition – Is severely stigmatized in North American society and carries many social and health hazards – Significantly affects children’s psychological and physical development © Cengage Learning 2016

Calculation of a Child’s BMI © Cengage Learning 2016

Prevalence and Development • In U. S. and Canada, obesity rate nearly tripled for boys age 7 -13 and more than doubled for girls between the early 1980 s to mid-2000 s • Worldwide, prevalence of childhood overweight and obesity has increased from 4. 2% in 1990 to 6. 7% in 2010 © Cengage Learning 2016

Risks • Risks include cardiovascular problems, diabetes, and elevated cholesterol and triglycerides – Obesity is a major factor in reducing life expectancy in North America – Preadolescent obesity is a risk factor in the later emergence of eating disorders © Cengage Learning 2016

Prevalence of Obese Children in the U. S. © Cengage Learning 2016

Culture and Socioeconomic Status • Among U. S. children and adolescents – Hispanic boys are significantly more likely to be obese than non-Hispanic White boys – Non-Hispanic black girls are significantly more likely to be obese than non-Hispanic White girls • U. S. has the highest percentage of overweight children in data comparing 15 industrialized countries © Cengage Learning 2016

Culture and Socioeconomic Status (cont’d. ) • Problems for low-income populations – Low cost and availability of fast food and junk food – Diminished physical activities due to living in unsafe neighborhoods © Cengage Learning 2016

Causes • Heritability accounts for a substantial portion of the variance in obesity – Leptin hormone carries instructions to the brain to regulate energy and appetite • Parents determine food availability, and they model an approach to exercise and diet • Family disorganization plays a role – Poor communication, lack of perceived family support, and sexual and physical abuse © Cengage Learning 2016

Treatment • Prevention or intervention of childhood obesity involves the individual’s health and family resources – Restricting diets are not usually recommended • Treatment should: – Address the parents’ knowledge of nutrition – Increase the child’s physical activity – Should instill active, less sedentary routines for both parents and child © Cengage Learning 2016

Feeding and Eating Disorders • Feeding and eating disorders that occur during infancy or early childhood constitute a general diagnostic category – Avoidant/restrictive food intake disorder – Pica © Cengage Learning 2016

Avoidant/Restrictive Food Intake Disorder • Characterized by a sudden or marked deceleration of weight gain and a slowing or disruption of emotional and social development prior to age 6 • Prevalence and development – Affects up to one-third of young children – Equally common among boys and girls – Many factors lead to the initial problem • There is no typical developmental outcome © Cengage Learning 2016

Causes and Treatment • Many interacting risk factors influence a child’s adaptation to a certain level of caloric intake • Failure to thrive (FTT) may result from deprivation of maternal stimulation and love © Cengage Learning 2016

Causes and Treatment (cont’d. ) • Avoidant/restrictive food intake disorder is associated with: – Family disadvantage, poverty, unemployment, social isolation, parental mental illness, and maternal eating disorders (specific risk factor) • Treatment involves detailed assessment of feeding behavior and parent-child interactions, while allowing parents to play a role in the infant’s recovery © Cengage Learning 2016

Pica • Ingestion of inedible, nonnutritive substances (e. g. , hair, insects, and paint) for a period of at least one month • Affects mostly very young children and those with intellectual disability • May be life-threatening if it continues into adolescence © Cengage Learning 2016

Prevalence and Development • Pica is more prevalent among institutionalized children and adults – Especially those with severe impairments and mental retardation • Affects 0. 3 -14. 4% of children and adults with intellectual disabilities – 9 -25% of those in institutions © Cengage Learning 2016

Causes and Treatment • • Specific causes have not been isolated Vitamin or mineral deficiency No evidence of genetic factors Can be a serious and substantial problem – Risk of lead poisoning or intestinal obstruction • Treatments are based on operant conditioning procedures and teaching caregivers to keep the child’s environment tidy and removing dangerous substances © Cengage Learning 2016

Eating Disorders of Adolescence • Two important periods of adolescence for eating disorders – Early passage into adolescence – Transition from later adolescence to young adulthood • Childhood risk factors (eating problems, dieting patterns, and negative body image) – May cause teens to exert excessive control over their eating as a way to manage stress and physical changes © Cengage Learning 2016

Anorexia Nervosa • Characterized by refusal to maintain minimally normal body weight; intense fear of gaining weight; and significant disturbance in perception and experiences of body size • DSM-5 subtypes – Restricting type - individual loses weight through diet, fasting, or excessive exercise – Binge-eating/purging type © Cengage Learning 2016

Diagnostic Criteria for Anorexia Nervosa © Cengage Learning 2016

Bulimia Nervosa • Much more common than anorexia • Primary feature is recurrent binge eating • Binges are followed by compensatory behaviors (intended to prevent weight gain) in the form of two subtypes: – Purging – Non-purging © Cengage Learning 2016

Diagnostic Criteria for Bulimia Nervosa © Cengage Learning 2016

Diagnostic Criteria for Bulimia Nervosa (cont’d. ) © Cengage Learning 2016

Bulimia Nervosa (cont’d. ) • Thinking is rigid and absolutistic (all or nothing attitude) – The individual either feels completely in control or completely out of control • Medical consequences are severe, but not as severe as consequences resulting from anorexia © Cengage Learning 2016

Binge Eating Disorder • Similar to bulimia without the compensatory behaviors – Involves periods of eating more than other people would, accompanied by feeling of loss of control – Affects 1. 5%-3% of adolescents – Has negative health correlates © Cengage Learning 2016

Diagnostic Criteria for Binge Eating Disorder © Cengage Learning 2016

Prevalence and Development • Prevalence of anorexia nervosa and bulimia among adolescents is 0. 3% and 0. 9%, respectively • Persons with anorexia are 15% or more below normal weight and engage in binge eating only occasionally • Those with bulimia are within 10% of normal weight and binge frequently; then purge to control their weight © Cengage Learning 2016

Prevalence and Development (cont'd. ) • Eating disorders among boys – More common than originally believed – Young men place emphasis being muscular • Sexual orientation and eating disorders – Gay men are at greater risk for behavioral symptoms of eating disorders compared to heterosexual men © Cengage Learning 2016

Ethnic and Cross-Cultural Considerations • Anorexia occurs around the world, although it may manifest differently • Bulimia is a culture-bound syndrome – Arising predominately in Western regions of the world • Higher SES for women was considered a risk factor in the past – Upon reaching a certain level of affluence, the association between high SES and eating disorders may no longer exist © Cengage Learning 2016

Developmental Course • Onset of anorexia is usually between ages 14 and 18 – Often begins with dieting - gradually leads to life-threatening starvation (5% mortality rate) – Fewer than one-half show full recovery; onethird show fair improvement, and one-fifth continue on a chronic course • Worse outcomes are correlated with: – Longer illness duration; bingeing and purging; and comorbid affective or anxiety disorders © Cengage Learning 2016

Developmental Course (cont’d. ) • Onset of bulimia is in late adolescence and young adulthood • Binge eating often develops during or after a period of restrictive dieting • May follow a chronic course or occur intermittently © Cengage Learning 2016

Developmental Course (cont’d. ) • Between 50 -75% of patients with bulimia show full recovery over several years • Disordered eating tends to decline in early adulthood – Body dissatisfaction remains an issue for many young adults © Cengage Learning 2016

Causes • Single best predictor or risk for developing an eating disorder is being an adolescent female • Biological and environmental variables are inextricably linked • Biological dimension - may contribute to the maintenance of the disorder • Genetic and constitutional factors – Eating disorders run in families © Cengage Learning 2016

Causes (cont’d. ) • Neurobiological factors – Imbalances of serotonin, which regulates hunger and appetite, may be implicated – Biochemical similarities have been found between people with eating disorders and those with OCD • Social dimension – Features of contemporary Western culture may be implicated in eating disorders © Cengage Learning 2016

Causes (cont’d. ) • Sociocultural factors – Western culture self-worth, happiness, and success are determined primarily by physical appearance – Teenage girls - weight loss and being skinny are more important than sexual issues, alcohol and drug abuse, mental health, disease, and environmental issues – Mass media influences perceptions of body dissatisfaction © Cengage Learning 2016

Causes (cont’d. ) • Family influences – Teen’s eating disorder may be functional • Directing attention away from basic family conflicts – Family processes may contribute to an overemphasis on weight and dietary control – Child sexual abuse may be a risk factor for eating disorders, especially bulimia • General risk factor for psychopathology, rather than specific risk factor for eating disorders © Cengage Learning 2016

Causes (cont’d. ) • Psychological dimension – Hilda Bruch stated that eating disorders are related to struggle for autonomy, competence, control, and self-respect – Arthur Crisp considers anorexia to be a type of phobic avoidance disorder, in which the phobic objects are normal adult body weight and shape – Mood disorder is often comorbid with anorexia © Cengage Learning 2016

Psychological Dimension (cont'd. ) • Bulimia is associated with: – Mood swings, poor impulse control, obsessive -compulsive behaviors, major depression, anxiety disorders, and substance abuse • Almost 90% of persons with eating disorders have other Axis I disorders – Usually depression, anxiety, or OCD © Cengage Learning 2016

Psychological Dimension (cont'd. ) • Discrepancy between one’s actual self and one’s ideal self increases the likelihood of eating problems, especially among women • The adolescent with bulimia or anorexia feels: – Efforts to restrict diet and lose weight are ways of gaining control over her life and of becoming a better person © Cengage Learning 2016

A Dynamic Perspective on the Determinants of Eating Disorders © Cengage Learning 2016

Treatment • Psychological interventions: individual and/or family-based psychotherapy, sometimes accompanied by medical interventions – Effectiveness is weak, especially for anorexia nervosa – Efficacy of cognitive-behavioral approaches focusing on modifying abnormal eating behaviors underlying bulimia – Most can be managed as outpatients © Cengage Learning 2016

Treatment (cont'd. ) • Hospitalization (usually brief) is necessary for those who: – Have serious complications due to comorbid diagnosis or – Are at high physical and/or psychiatric risk • Pharmacological antidepressants (not for initial treatment) and SSRIs may be helpful for bulimia, but not anorexia – Should be used in conjunction with CBT, not just medication by itself © Cengage Learning 2016

Treatment (cont’d. ) • Psychosocial interventions – Comprehensive treatment plans with an internist, a psychotherapist, a nutritionist, and a psychopharmacologist are more effective than medications alone – Resolution of family and interpersonal problems are crucial to recovery from an eating disorder © Cengage Learning 2016

Treatment (cont’d. ) • Anorexia is generally less responsive to treatment than bulimia – Initial phase - restoring weight and monitoring of any medical complications – In a study comparing CBT and specialist supportive clinical management treatments • Both groups reported improvements in quality of life and social adjustment – Family interventions are often required to restore healthy communication patterns © Cengage Learning 2016

Treatment (cont’d. ) • Bulimia – Individual or family oriented CBT works to change eating behaviors with rewards and modeling • Helps patients change distorted or rigid thinking patterns • Addresses underlying interpersonal issues – Interpersonal therapy addresses situational and personal issues contributing to the development and maintenance of the disorder © Cengage Learning 2016