Child Psychopathology

Normal eating behavior

Eating disorders

Reading: Chapter 13

Normal eating development

Troublesome eating habits and limited food preferences are common in early childhood among boys and girls

Family rituals surround eating, e.g., getting children to eat new foods

Societal norms and expectations affect girls more than boys, particularly at adolescence

Continuity in eating behavior and later problems

Pica Bulemia

Picky eating, Digestive problems

Anorexia

Other risk factors: Early pubertal maturation, high body fat, concurrent psychological problems, poor body image

What is wrong with this billboard?

1. Glamorizes anorexia, a deadly physical and mental illness, as "cute"

2. Sends the message that starving oneself leads to beauty and approval

3. Insults eating disorders sufferers, their loved ones and women everywhere who

are tormenting themselves to meet an unattainable beauty ideal

Anorexia nervosaRefusal to maintain weight, intense fear of gaining weight, disturbance in perception of body size

Denial of thinness

Menstrual cycle stops due to low body fat

Restricting type: Diet, fasting or excericise

Binge-eating/Purging type

Dx Criteria

Refusal to maintain body weight at or above a minimally normal weight for height and age

Intense fear of gaining weight or becoming fat Disturbance in how body weight or shape is

experienced, denial of seriousness of current weight

Ammenorrhea in post-menarchal females– Types: Restricting – Binge-Eating purging type

Bulimia nervosa

Binge eating follows change in mood, stress, or hunger

Purging involves self-induced vomiting, diuretics, laxative abuse, or by other compensation (e.g., exercise)

Weight is usually average or slightly above average

Dx Criteria

Recurrent episodes of binge eating– Large amount of food, lack of control

Compensatory behavior such as vomitting, exercise, laxative abuse, enemas

Binge/compensatory cycle twice a week for 3 months

Self-evaluation unduly influenced by boddy weight

Disturbance does not occur exclusively during episodes of anorexia– Types: Purge (vomit, laxative, enemas, diuretics)– Non-purge (fasting or exercise)

Prevalence1-2% of population, more common than 30 years ago

More common in females than males (approximately 10:1 ratio); Purgative behaviors may differ

Usually strikes between age 14 - 18, but exists in adulthood and even late childhood

50% show complete recovery, others may continue irregular eating and body dissatisfaction

Etiology Neurobiology and genetic contributions

– addiction models have looked at endogenous opiods released when hungry

Sociocultural factors– belief that self-worth, happiness, and success are

determined by appearance– dieting/ nondieting cycle– prevalence of social models (e.g., 90120)

Family interaction patterns– Enmeshment, alliances, conflicts, victimisation, parental

pressure

Psychological factorsAutonomy, competence, and control are themes

Phobic avoidance of normal adult body weight or sexual maturity in anorexia

Binge/Purge cycle becomes addictive

Unattainable standards of perfectionism

Bulimia related to poor impulse control , sexual acting out, borderline or histrionic personality disorders

Treatment is difficult:Anorexia Bulimia Hospitalisation, i.v.

feeding at “set point” may be necessary

Contracting for weight gain to earn privileges (e.g., access to family) & avoid food battles

Family therapy to deal with autonomy and control

Individual counselling Dietary education

Hospitalisation may be necessary if electrolytes are “out of whack” (siezures) or purging must be monitored

Cognitive Behavioral approaches to address self control

Antidepressants have been helpful

Dietary education

Behavioral Treatments

Reinforcing involvement in exercise as well as appropriate eating

Positive reinforcement: Attention, token economy, point system

Change in family eating habits – purchasing food, where do you eat, high calorie snacks, avoiding fast food