Psychological of Eating Disorders

Psychological of Eating Disorders

Eating disorders are a group of serious conditions in which you’re so preoccupied with food and weight that you can often focus on little else. The main types of eating disorders are anorexia nervosa, bulimia nervosa and binge-eating disorder. Eating disorders can cause serious physical problems and, at their most severe, can even be life-threatening. Most people with eating disorders are females, but males can also have eating disorders. An exception is binge-eating disorder, which appears to affect almost as many males as females. Treatments for eating disorders usually involve psychotherapy, nutrition education, family counseling, medications and hospitalization.

Eating disorders are classified as Axis I disorders in the Diagnostic and Statistical Manual of Mental Health Disorders (DSM-IV). Published by The American Psychiatric Association. There are various other psychological issues that may factor into eating disorders, some fulfill the criteria for a separate Axis I diagnosis or a personality disorder which is coded Axis II and thus are considered comorbid to the diagnosed eating disorder. Axis II disorders are subtyped into 3 “clusters”, A, B and C.The causality between personality disorders and eating disorders has yet to be fully established. Some people have a previous disorder which may increase their vulnerability to developing an eating disorder. Some develop them afterwards. The severity and type of eating disorder symptoms have been shown to affect comorbidity. The DSM-IV should not be used by laypersons to diagnose themselves, even when used by professionals there has been considerable controversy over the diagnostic criteria used for various diagnoses, including eating disorders. There has been controversy over various editions of the DSM including the latest edition DSM-V due in May 2013.

Comorbid Disorders
Axis I Axis II
depression obsessive compulsive personality disorder
substance abuse, alcoholism borderline personality disorder
anxiety disorders narcissistic personality disorder
obsessive compulsive disorder histrionic personality disorder
Attention-Deficit-Hyperactivity-Disorder avoidant personality disorder

Personality traits

There are various childhood personality traits associated with the development of eating disorders. During adolescence these traits may become intensified due to a variety of physiological and cultural influences such as the hormonal changes associated with puberty, stress related to the approaching demands of maturity and socio-cultural influences and perceived expectations, especially in areas that concern body image. Many personality traits have a genetic component and are highly heritable. Maladaptive levels of certain traits may be acquired as a result of anoxic or traumatic brain injury, neurodegenerative diseases such as Parkinson’s disease, neurotoxicity such as lead exposure, bacterial infection such as Lyme disease or viral infection such as Toxoplasma gondii as well as hormonal influences. While studies are still continuing via the use of various imaging techniques such as fMRI; these traits have been shown to originate in various regions of the brain such as the amygdala and the prefrontal cortex Disorders in the prefrontal cortex and the executive functioning system have have been shown to affect eating behavior.

Personality Traits
The Big Five personality traits
The “Big Five” also referred to as the “Five-Factor Model” are five broad factors (dimensions) of personality, that are based upon empirical research. A mnemonic device to remember them is the acronym “OCEAN”. Two of the tests to measure the Big Five are the “Big Five Inventory” and the IPIP (International Personality Item Pool ) an abbreviated form is the “IPIP-NEO”. The BFI and the IPIP-NEO are available free online for noncommercial purposes. ”Online test”
1.Openness to Experience/Intellect
Composed of two related but separable traits, Openness to Experience and Intellect. Behavioral aspects include having wide interests, and being imaginative and insightful, correlated with activity in the dorsolateral prefrontal cortex. Considered primarily a cognitive trait.
2.conscientiousness
Scrupulous, meticulous, principaled behavior guided or conforming to one’s own conscience. Associated with the dorsolateral prefrontal cortex. Anorexics are noted to have higher levels of conscientiousness.
3.extroversion
amygdala
Gregarious, outgoing, sociable, projecting one’s personality outward. The opposite of extroversion is introversion. Extroversion has shown to share certain genetic markers with substance abuse. Extroversion is associated with various regions of the prefrontal cortex and the amygdala.
4.agreeableness
Refers to a compliant, trusting, empathic, sympathetic, friendly and cooperative nature.
5.neuroticism
thalamus
“Refers to an individual’s tendency to become upset or emotional” (Hans Eysenck) “Neuroticism is the major factor of personality pathology” (Eysenck & Eysenck, 1969). Neuroticism has a been linked to serotonin transporter (5-HTT) binding sites in the thalamus: as well as activity in the insular cortex.
self esteem (low)
A “favorable or unfavorable attitude toward the self (Rosenberg, 1965).”An individual’s sense of his or her value or worth, or the extent to which a person values, approves of, appreciates, prizes, or likes him or herself” (Blascovich & Tomaka, 1991).
harm avoidance
A tendency towards shyness, being fearful and uncertain, tendency to worry. Neonatal complications such as preterm birth have been shown to affect harm avoidance. Those with BED, AN, and BN exhibit high levels of harm avoidance. The volume of the left amygdala in girls was correlated to levels of HA, in separate studies HA was correlated with reduced grey matter volume in the orbito-frontal, occipital and parietal regions.

novelty seeking

Impulsive, exploratory, fickle, excitable, quick-tempered, and extravagant. Associated with addictive behavior.
perfectionism
“I don’t think needing to be perfect is in any way adaptive” (Paul Hewitt, PhD)Socially prescribed perfectionism-“believing that others will value you only if you are perfect.”

Self-oriented perfectionism-“an internally motivated desire to be perfect.

Perfectionism is one of the traits associated with obsessional behavior and like obsessionality is also believed to be regulated by the basal ganglia..

Alexithymia
insular cortex
The inability to express emotions.”To have no words for one’s inner experience”(Rený J. Muller Ph. D).In studies done with stroke patients, alekithymia was found to be more prevalent in those who developed lesions in the right hemisphere following a cerebral infarction. There is a positive association with Post Traumatic Stress Disorder (PTSD), childhood abuse and neglect and alekithymia. Utilizing psychometric testing and fMRI, studies showed positive response in the insula, posterior cingulate cortex (PCC), and thalamus.
rigidity frontal lobe
Inflexibility, difficulty making transitions, adherence to set patterns. Mental rigidity arises out of a deficit of the executive functions. Originally termed frontal lobe syndrome it is also referred to as dysexecutive syndrome and usually occurs as a result of damage to the frontal lobe. This may be due to physical damage as in the famous case of Phineas Gage, or due to the effects of a disease such as Huntington’s disease or an hypoxic or anoxic insult
impulsivity
inferior frontal gyrus
Risk taking, lack of planning, and making up one’s mind quickly (Eysenck and Eysenck). A component of disinhibition. Abnormal patterns of impulsivity have been linked to lesions in the right inferior frontal gyrus and in studies done by Antonio Damasio author of Descartes Error, damage to the ventromedial prefrontal cortex has been shown to cause a defect in real-life decision making in individuals with otherwise normal intellect. Those who sustain this type of damage are oblivious to the future consequences of their actions and live in the here and now..:
disinhibition
orbitofrontal cortex
Behavioral disinhibition is an inability or unwillingness to constrain impulses, it is key component of executive functioning. Researchers have emphasized poor behavioural inhibition as the central impairment of ADHD. May be symptomatic of orbitofrontal lobe syndrome a subtype of frontal lobe syndrome which may be an acquired disorder as a result of traumatic brain injury, Hypoxic Ischaemic Encephalopathy (HIE), anoxic encephalopathy, degenerative diseases such as Parkinson’s, bacterial or viral infection such as Lyme disease and neurosyphilis. Disinhibition has been consistently associated with substance abuse disorders, obesity, higher BMI, excessive eating, an increased rate of eating, and perceived hunger.
obsessionality
basal ganglia
Persistent often unwelcome and frequently disturbing ideas, thoughts, images or emotions, rumination, often inducing an anxious state. Obsessionality may result as a dysfunction of the basal ganglia

Psychologists play a vital role in the successful treatment of eating disorders and are integral members of the multidisciplinary team that may be required to provide patient care. As part of this treatment, a physician may be called on to rule out medical illnesses and determine that the patient is not in immediate physical danger. A nutritionist may be asked to help assess and improve nutritional intake.

Once the psychologist has identified important issues that need attention and developed a treatment plan, he or she helps the patient replace destructive thoughts and behaviors with more positive ones. A psychologist and patient might work together to focus on health rather than weight, for example. Or a patient might keep a food diary as a way of becoming more aware of the types of situations that trigger bingeing.

Simply changing patients’ thoughts and behaviors is not enough, however. To ensure lasting improvement, patients and psychologists must work together to explore the psychological issues underlying the eating disorder. Psychotherapy may need to focus on improving patients’ personal relationships. And it may involve helping patients get beyond an event or situation that triggered the disorder in the first place. Group therapy also may be helpful.

Some patients, especially those with bulimia, may benefit from medication. It’s important to remember, however, that medication should be used in combination with psycho-therapy, not as a replacement for it. Patients who are advised to take medication should be aware of possible side effects and the need for close supervision by a physician.

References

  • Steinhausen, H.C. (2009). “Outcomes of eating disorders.” Child and Adolescent Psychiatric Clinics of North America, 18 (1): 225-242.
  • Hudson, J.I., Hiripi, E., Pope, H.G., & Kessler, R.C. (2007). “The prevalence and correlates of eating disorders in the National Comorbidity Survey Replication.” Biological Psychiatry, 61 (3): 348-358.
  • National Institute of Mental Health. (2007). “Eating disorders.”

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Clinical – Editor in Chief :

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