Chapter 9-Eating Disorders. disorder and to be able to distinguish among the different eating disorders.

Transcription

1 Chapter 9-Eating Disorders [LEARNING GOALS] 1. Be able to distinguish the symptoms associated with anorexia, bulimia, and binge eating disorder and to be able to distinguish among the different eating disorders. 2. Be able to describe the neurobiological, sociocultural, and psychological factors implicated in the etiology of eating disorders. 3. Be able to discuss the issues surrounding the growing epidemic of obesity in the United States. 4. Be able to describe the methods of treatment for eating disorders and the evidence supporting their effectiveness. Summary Clinical Descriptions The two main eating disorders are anorexia nervosa and bulimia nervosa. Binge eating disorder is being studied for possible inclusion in the DSM-IV. The symptoms of anorexia nervosa include refusal to maintain normal body weight, an intense fear of being fat, a distorted sense of body shape, and, in women, amenorrhea. Anorexia typically begins in the mid-teens, is ten times more frequent in women than in men, and is comorbid with several other disorders, notably depression. Its course is not favorable, and it can be life threatening. The symptoms of bulimia nervosa include episodes of binge eating followed by purging, fear of being fat, and a distorted body image. Like anorexia, bulimia begins in adolescence, is much more frequent in women than in men,

2 and is comorbid with other diagnoses, such as depression. Prognosis is somewhat more favorable than for anorexia. Etiology Research on the eating disorders has examined genetics and brain mechanisms. Evidence is consistent with a possible genetic diathesis. Endogenous opioids and serotonin, both of which play a role in mediating hunger and satiety, have been examined in eating disorders. Low levels of both these brain chemicals have been found in such patients, but evidence that these cause eating disorders is limited. Dopamine is also involved with eating, but its role in eating disorders has been studied less. As sociocultural standards changed to favor a thinner shape as the ideal for women, the frequency of eating disorders increased. The objectification of women s bodies also exerts pressure for women to see themselves through a sociocultural lens. The prevalence of eating disorders is higher in industrialized countries, where the cultural pressure to be thin is strongest. White women tend to have greater body dissatisfaction and general eating disturbances than African American women, though the prevalence rates for actual eating disorders are not markedly different between these two ethnic groups. On a psychological level, several factors play important roles. Psychodynamic theories of eating disorders emphasize parent child relationships and personality characteristics. Research on characteristics of families with an eating-disordered child have yielded different data depending on how the data was collected. Reports of patients show high levels of conflict, but actual observations of the families do not find them especially

3 deviant. Studies of personality have found that patients with eating disorders are high in neuroticism and perfectionism and low in self-esteem. Many women with eating disorders report being abused as children, but early abuse does not appear to be a specific risk factor for eating disorders. Cognitive behavioral theories of eating disorders propose that fear of being fat and body-image distortion make weight loss a powerful reinforcer. Among patients with bulimia nervosa, negative affect and stress precipitate binges that create anxiety, which is then relieved by purging. Treatment The main neurobiological treatment of eating disorders is the use of antidepressants. Although somewhat effective, drop-out rates from drug-treatment programs are high, and relapse is common when patients stop taking the medication. Treatment of anorexia often requires hospitalization to reduce the medical complications of the disorder. Providing reinforcers for weight gain, such as visits from friends, has been somewhat successful, but no treatment has yet been shown to produce long-term maintenance of weight gain. Cognitive behavioral treatment for bulimia focuses on questioning society s standards for physical attractiveness, challenging beliefs that encourage severe food restriction, and developing normal eating patterns. Outcomes are promising, both in the short and long term. 1. In the DSM-IV, eating disorders are listed as a. disorders beginning in childhood or adolescence. b. somatization disorders. c. psychological factors affecting medical condition.

4 d. a separate diagnostic category. Answer: D Type: Factual Page: Individuals with anorexia nervosa a. stop eating because of an abnormal increase in blood sugar, which alters their perceptions of hunger. b. fear gaining weight so much that they stop eating. c. have lost their appetite, leading them to stop eating. d. stop eating but do not lose weight. Answer: B Type: Factual Page: A physiological effect of anorexia nervosa is a. growing heavier, darker hair. b. amenorrhea (loss or irregularity of menstrual period). c. high blood pressure. d. All of the above are correct. Answer: B Type: Factual Page: Cathy stopped eating meals over two months ago. Now, she eats very little, and only when under some family pressure. She has lost over 22 pounds, and is now about 15% below normal body weight for her height. She probably a. has anorexia, restricting type. b. has anorexia, binge-eating-purging type. c. has bulimia nervosa. d. is also abusing illicit drugs. Answer: A Type: Applied Page: As compared to those with the restricting type, people with anorexia nervosa bingeeating-purging type typically have a. more severe overall psychopathology. b. less severe overall psychopathology. c. equally severe overall psychopathology. d. None of the above; no data currently exists regarding differences between the two types of anorexia nervosa. Answer: A Type: Factual Page: A result of distorted body image on anorexics can be observed by

5 a. excessive preoccupation with makeup. b. critical evaluation of body areas such as stomach and buttocks. c. frequent questioning of others regarding their appearance. d. checking behaviors designed to ensure that their stomach and buttocks appear smaller than in reality. Answer: B Type: Factual Page: Anorexia nervosa in men a. is nonexistent. b. is related to less family conflict than in women. c. is less likely to be fatal than in women. d. although less common, is quite similar to that in women. Answer: D Type: Factual Page: There is a close tie between anorexia nervosa and a. depression. b. stealing. c. suicide. d. hypertension. Answer: A Type: Factual Page: Regina visits her general practitioner medical doctor. Her weight is 90 pounds although she believes she is overweight. She snacks on laxatives, and restricts her eating to one small meal a day, after which she exercises for two hours. Her physical exam is likely to reveal that she has a. lowered heart rate and blood pressure. b. calcium deposits. c. improved muscle tone. d. fibroid tumors. Answer: A Type: Applied Page: What is the most likely prognosis for a woman with anorexia nervosa? a. She will regain normal weight as she enters puberty. b. She will develop bulimia nervosa. c. She will enter treatment and maintain normal weight following treatment. d. She will eventually recover, but continue to struggle with the disorder for many years.

6 Answer: D Type: Factual Page: The DSM-IV categorizes bulimia nervosa as a. an organic mental disorder. b. psychological factors affecting a medical condition. c. a subtype of anorexia nervosa. d. an eating disorder separate from anorexia nervosa. Answer: D Type: Factual Page: The easiest way to distinguish between bulimia and anorexia nervosa is a. bingeing. b. a higher rate of psychological distress. c. pronounced weight loss. d. depression. Answer: C Type: Factual Page: Betsy is excessively concerned that she is becoming fat and restricts her eating to avoid such a consequence. She weighs approximately 20% less than normal body weight given her height. At times, she will sit down with her family and eat a full meal, but immediately afterwards takes several laxatives. Betsy most likely a. has anorexia, restricting type. b. has anorexia, binge-eating-purging type. c. has bulimia nervosa. d. has binge-eating disorder. Answer: B Type: Applied Page: During binge episodes, many bulimics a. feel a great sense of control. b. experience a feeling of being out of control. c. feel very satisfied. d. None of the above choices are correct. Answer: B Type: Factual Page: In bulimia nervosa, binge eating typically a. involves sweets. b. occurs while alone. c. occurs after a negative social interaction.

7 d. All of the above are correct. Answer: D Type: Factual Page: Compared to the binge, purging is felt by many bulimics to be a. a source of relief. b. more anxiety- producing. c. more disgusting. d. a source of pride. Answer: A Type: Factual Page: The feature common to both anorexia nervosa and bulimia nervosa is a. refusal to maintain normal body weight. b. fear of gaining weight. c. purging to prevent weight gain. d. None of the above is correct. Answer: B Type: Factual Page: 271, Prior to the onset of bulimia, sufferers often a. have anorexia nervosa. b. are overweight and dieting. c. have attempted suicide. d. have higher than normal levels of serotonin. Answer: B Type: Factual Page: Which of the following lists the disorders in order of descending rate of suicide attempts? a. anorexia, bulimia, major depression. b. major depression, bulimia, anorexia. c. anorexia, major depression, bulimia. d. None of the above; all three disorders have comparable rates of suicide attempts. Answer: D Type: Factual Page: As compared to anorexia nervosa, the diagnosis of bulimia nervosa has a. higher mortality rates. b. lower mortality rates. c. equal mortality rates.

8 d. None of the above; data on mortality caused by eating disorders does not exist. Answer: B Type: Factual Page: Gina has bulimia nervosa. Which of the following factors would worsen her prognosis? a. Having active cocaine abuse. b. Having a history of Major Depressive Disorder. c. Binging and purging twelve times per week. d. All of the above would worsen her prognosis. Answer: D Type: Applied Page: A new diagnosis among eating disorders in the DSM-IV-TR, requiring additional study, is a. bulimarexia. b. binge eating disorder. c. dysmorphia disorder. d. None of the above choices are correct. Answer: B Type: Factual Page: Binge eating disorder is characterized by binging a. between periods of starvation. b. despite guilt over weight gain. c. with weight under 85% of normal. d. without compensatory behaviors. Answer: D Type: Factual Page: Beatrice has lost control of her eating. She gorges on huge amounts of high fat fast foods, eating as much as 2000 calories in 30 minutes. She is gaining weight rapidly, and weighs over 170 pounds. Which disorder fits Beatrice s symptoms best? a. binge eating disorder b. anorexia nervosa c. obesity d. bulimia nervosa Answer: A Type: Applied Page: Individuals with binge eating disorder are

9 a. relatively confident with their body image. b. more likely to be white than black. c. often obese. d. less likely to have a history of dieting than people with anorexia nervosa. Answer: C Type: Factual Page: Which of the following is defined, in part, by the absence of purging? a. anorexia nervosa b. bulimia nervosa c. binge eating disorder d. Purging always occurs in each of these conditions. Answer: C Type: Factual Page: Which of the following is a distinction between bulimia nervosa and binge eating disorder? a. loss of control during binges b. distress about binging c. rapid eating during binges d. compensatory behaviors after binges Answer: D Type: Factual Page: Eating disorders are usually caused by a. genetic disposition. b. neurochemical imbalance. c. sociocultural pressures. d. a combination of factors. Answer: D Type: Factual Page: If your sister has anorexia nervosa and you are female, a. you are over ten times more likely than average to have the disorder yourself. b. your mother is likely alcoholic. c. you are three times more likely than average to have anorexia nervosa. d. there is no greater risk to you for developing an eating disorder. Answer: A Type: Factual Page: Twin studies of eating disorders have shown

10 a. environmental factors to be of greater influence than genetic factors. b. higher concordance amongst monozygotic (MZ) twins compared to dizygotic (DZ) twins. c. that genes do not affect personality characteristics associated with eating disorders. d. All of the above are correct. Answer: B Type: Factual Page: Genetic influences on eating disorders are a. a substantial factor. b. a minor factor. c. more important for anorexia nervosa. d. more important for bulimia nervosa. Answer: A Type: Factual Page: Research regarding the role of the hypothalamus in anorexia nervosa indicates that a. the hypothalamus is damaged in most individuals with anorexia. b. hypothalamus dysfunction is the most likely explanation for the fact that people with anorexia do not experience hunger. c. the hypothalamus appears to be overactive in people with anorexia, leading to binge eating. d. dysfunction in the hypothalamus does not seem to be an important factor in anorexia. Answer: D Type: Factual Page: Although the hypothalamus has been considered a part of the biological etiology of anorexia, a limitation of this account is a. it fails to account for purging episodes. b. there is no accounting for the obsession with food. c. it lacks an adaptive feature. d. the lack of attention paid to neurotransmitter systems known to be dysfunctional in anorexia. Answer: B Type: Factual Page: In eating disorders, endogenous opioids a. are at low levels, leading to a euphoric state. b. are likely reinforcing. c. are released by purging, leading to euphoria. d. are decreased by bingeing, leading to euphoria.

11 Answer: B Type: Factual Page: Which of the following brain mechanisms have been implicated in anorexia? a. Starvation releases natural pain-reducing opioids producing a high which reinforces not eating. b. With puberty, female hormones increase dramatically and damage centers which control eating in the thalamus and pituitary. c. Excessive exercise depletes the brain of neurotransmitters utilized by areas that regulate hunger or satiation. d. Stress-released hormones reduce the sensitivity of receptors that detect blood-sugar levels and release hormones that induce hunger. Answer: A Type: Factual Page: The neurotransmitter most closely associated with eating disorders is a. epinephrine. b. norepinephrine. c. opioid. d. serotonin. Answer: D Type: Factual Page: The role of serotonin a. is well understood in anorexia. b. is well understood in bulimia. c. is well understood in both anorexia and bulimia. d. is better understood in bulimia than anorexia. Answer: D Type: Factual Page: Which of the following biological factors have been largely ruled out as part of the etiology of eating disorders? a. serotonin b. endogenous opioids c. hypothalamus d. genetic factors Answer: C Type: Factual Page: Recent research has begun to focus on the role of in eating behavior. a. norepinephrine

12 b. the hypothalamus c. dopamine d. serotonin Answer: C Type: Factual Page: Paula scored higher on a measure of dietary restraint than did Roberta. Based on this information, recent research suggests that a. Roberta would be more likely to have bulimia nervosa. b. Paula probably has anorexia nervosa. c. Roberta will probably exhibit greater dopamine activity in her brain when presented with food. d. Paula will probably exhibit greater dopamine activity in her brain when presented with food. Answer: D Type: Applied Page: According to the text, the Body Mass Index (BMI) of Playboy and Playgirl centerfolds has a. both decreased over time. b. both increased over time. c. decreased and increased, respectively over time. d. increased and decreased, respectively over time. Answer: C Type: Factual Page: Lydia is a white, upper-class woman with anorexia. Which of the following is most likely to also be true of Lydia? a. She has dieted before. b. She also has bulimia. c. She also has bipolar disorder. d. She reads many women s magazines. Answer: A Type: Applied Page: Eating disorders are more common in women who are a. single. b. white. c. urban. d. less educated. Answer: B Type: Factual Page: 281

13 44. Although most recently the number of articles in popular magazines regarding dieting and weight loss has decreased, the incidence of eating disorders will not likely decrease because a. there has been a rise in dissatisfaction with body appearance. b. the media is showing more images of normal women c. the prevalence of low-fat foods automatically foster eating concerns. d. the evidence supporting genetic factors is mounting. Answer: A Type: Factual Page: Research indicates that in recent years the incidence of anorexia nervosa in several countries such as Switzerland has not increased as dramatically as it did several decades ago. A plausible reason for this decline in incidence is a. women in these countries are not as concerned with being thin as they once were. b. women in these countries have become so accustomed to the images of thinness portrayed in the media. c. women in these countries have become naturally more thin over time. d. that obesity has increased. Answer: B Type: Factual Page: Which of the following statements is true regarding gender differences in eating disorders? a. Women are more likely to have bulimia, while men are more likely to have anorexia. b. Men are more likely to have bulimia, while women are more likely to have anorexia. c. Women are more likely to have both bulimia and anorexia than are men. d. Adequate prevalence data on eating disorders has not been collected for men, because men are reluctant to disclose disordered eating patterns. Answer: C Type: Factual Page: After looking through a fashion magazine, Daisy feels fat and is ashamed of her body. She doubts that she will ever be as thin as the models she sees in the magazine. Which theory explains Daisy s reactions to the magazine? a. biosocial theory b. expectancy theory c. self-objectification theory d. self-deprecating theory Answer: C Type: Applied Page: 282

14 48. A factor that influences the fear of fat among individuals with anorexia and bulimia is a. biochemical dysregulation. b. genetic factors. c. negative societal stereotypes regarding fat. d. largely rational. Answer: C Type: Factual Page: Margaret, a Canadian, and Rosemary, a Nigerian, are asked to rate the attractiveness of a drawing of an obese woman. Which of the following is most likely to occur? a. They will similarly rate the woman as highly unattractive. b. Margaret will rate the woman as more attractive compared to Rosemary s rating of the woman. c. Rosemary will rate the woman as more attractive compared to Margaret s rating of the woman. d. None of the above is likely to occur. Answer: C Type: Applied Page: The difference in the incidence of eating disorders between whites and African Americans has been largely attributed to a. genetic factors. b. family environment factors. c. socioeconomic status rather than race. d. errors in diagnosis. Answer: C Type: Factual Page: Eating disorders are more common in American women who are a. white. b. single. c. gay. d. unemployed. Answer: A Type: Factual Page: Evelyn is Hispanic and Katherine is African-American. Which of these women is more likely to have greater body dissatisfaction? a. Evelyn b. Katherine c. They are both equally likely to have body dissatisfaction

15 d. There is not enough information to answer this question Answer: A Type: Applied Page: Which of the following has been suggested as a mediator in the relationship between body dissatisfaction and bulimia symptoms? a. education b. gender c. acculturative stress d. presence of anorexic symptoms Answer: C Type: Factual Page: A group of college students reads a case study about a woman who is 5 6, weighs 105 pounds and is experiencing amenorrhea. Recent research suggests that these students are more likely to believe her symptoms are a result of an eating disorder a. if her race is presented as Native American. b. if her race is presented as Hispanic. c. if her socioeconomic status is presented as middle class. d. if her race is presented as Caucasian. Answer: D Type: Factual Page: Assessment of personality among anorexics reveals that a. anorexics are low in neuroticism but high in anxiety. b. anorexics and bulimics are high in neuroticism and low in self-esteem. c. anorexics are low in self-esteem, whereas bulimics are primarily high in neuroticism. d. anorexics are high in extraversion and neuroticism. Answer: B Type: Factual Page: Leslie s parents raised her with little attention to her needs. Her mother fed her when it was convenient for her schedule, disregarding whether Leslie was hungry or not. Some years later, Leslie developed anorexia. This illustrates which theoretical point of view? a. psychodynamic b. interpersonal c. cognitive-behavioral d. None of the above is correct. Answer: A Type: Applied Page: 284

16 57. Psychodynamic views of eating disorders suggest they result from teen girls attempts to a. earn their mother s love. b. be sexually attractive. c. feel competent. d. suppress anger. Answer: C Type: Factual Page: Studies of the personality of anorexics indicate that they are generally a. impulsive, adventurous, outgoing. b. confused, disoriented, withdrawn. c. shy, obedient, perfectionistic. d. warm, sensitive, helpful. Answer: C Type: Factual Page: Studies of perfectionism in anorexia nervosa indicate that which of the following statements would be most typical of an anorexic? a. I must complete all my work before I can enjoy a night out. b. I can t stand it when my boyfriend lets me down by not buying me flowers on special occasions. c. I ve got to show my teacher that I can meet his goal for me of winning the debate championship. d. I can t possibly be expected to meet the unrealistically high standards that my parents have set for me. Answer: C Type: Applied Page: Regarding family influences on eating disorders, most anorexics and bulimics report a. high levels of familial support. b. low family conflict but high support as well. c. low levels of familial support. d. high levels of criticalness. Answer: C Type: Factual Page: Self-reports of patients with eating disorders appear characterized by a. traditional "family" values. b. inconsistent discipline. c. high levels of conflict.

17 d. over involvement in children. Answer: C Type: Factual Page: A weakness of many of the family studies of eating disorders is a. most rely upon self-report and not direct observation. b. an inadequate level of attention paid to third variable causes. c. limited generalizability given the laboratory nature of the research. d. an overreliance upon a single theoretical paradigm. Answer: A Type: Factual Page: According to Minuchin s theory, families of children with eating disorders exhibit which of the following characteristics? a. high levels of anger, enmeshment, overprotectiveness, rigidity b. overprotectiveness, rigidity, lack of conflict resolution, low SES c. enmeshment, overprotectiveness, rigidity, low SES d. enmeshment, overprotectiveness, rigidity, lack of conflict resolution Answer: D Type: Factual Page: Which of the following is not a characteristic of the families of children with eating disorders, according to Minuchin? a. rigidity b. overprotectiveness c. authoritarian parenting style d. enmeshment Answer: C Type: Factual Page: In Minuchin s family systems theory, eating disorders are the child s attempt to a. express desires for independence. b. gain the parent s love and attention. c. retaliate against abusive parents. d. help parents avoid other conflicts. Answer: D Type: Factual Page: A recent area of research in the eating disorders has been upon a. actual eating habits. b. associated fears such as phobias or other anxiety disorders.

18 c. concerns with self-focused attention. d. child abuse and the link to eating disorders. Answer: D Type: Factual Page: In the cognitive-behavioral view, the non-eating of anorexics is reinforced by a. reducing anxiety about being fat. b. reducing sexual demands from males. c. attention of overly concerned family members. d. increased time and energy for studies. Answer: A Type: Factual Page: Bingeing in a person with anorexia nervosa is most likely to happen a. after family conflict. b. after a lapse in a strict diet. c. after struggling with the disorder for at least one year. d. None of the above; bingeing appears to happen randomly in anorexia. Answer: B Type: Factual Page: Laboratory studies of restrained eaters (those who are working hard at dieting) show that they tend to a. refuse to eat even when requested by an examiner as part of a study. b. overeat even after they believe they are full. c. overeat only if directed to by an examiner. d. overeat only if in the presence of a non-restrained eater. Answer: B Type: Factual Page: Studies of dieters suggest that they would be most likely to overeat after which of the following experiences: a. A stranger points at them and laughs at their weight. b. They have a successful day at work. c. They feel their diet is going well. d. They are in the presence of a dieting friend. Answer: A Type: Applied Page: The cognitive-behavioral view of bulimia suggests that binges result from a. breaking self-rules about dieting.

19 b. ambivalence over social pressure to be thin. c. excessive desire for peer approval. d. not accepting responsibility for actions. Answer: A Type: Factual Page: Polivy and others conducted a series of studies in which participants were tasting ice cream. These studies looked at the participants' tendency to a. refuse food. b. binge. c. purge. d. feel guilty. Answer: B Type: Factual Page: A problem with treating individuals with anorexia nervosa is a. their lack of hunger, which makes food uninteresting or even nauseating. b. their denial of the need for treatment. c. a general conformity to the expectations of authority figures. d. relative indifference to reinforcements that would be rewarding to most people. Answer: B Type: Factual Page: Drug treatment of bulimia nervosa is most significantly limited by a. the lack of demonstrated effectiveness of the drugs. b. addiction. c. dropping out of treatment. d. the resulting obesity. Answer: C Type: Factual Page: Which is NOT a disadvantage of medication in the treatment of bulimia? a. relapses when medication is stopped. b. controls binging, not purging. c. unpleasant side effects. d. high dropout rates. Answer: B Type: Factual Page: Studies have shown drug treatment to be a. effective for bulimia only.

20 b. effective for anorexia only. c. effective for both bulimia and anorexia. d. ineffective for both bulimia and anorexia. Answer: A Type: Factual Page: Adelaide, who has bulimia, is being treated solely with Prozac. If she stops taking the drug, she will most likely a. relapse. b. become obese. c. develop anorexia nervosa. d. maintain normal eating patterns over the long term. Answer: A Type: Applied Page: Efforts to treat bulimia nervosa using antidepressant drugs have been complicated by a. low federal funding for such studies. b. frequent side effects. c. treatment refusal. d. All of the above are correct. Answer: B Type: Factual Page: The first step in treating anorexia nervosa is a. medication to reduce anxiety about eating. b. education on the importance of a well- balanced diet. c. hospitalization to promote and monitor eating. d. assessment to identify causes and plan individualized treatment. Answer: C Type: Factual Page: Dr. Peterson is treating a young woman with anorexia nervosa. His client is 5 feet, 3 inches tall and weights 70lbs. She tells Dr. Peterson that she continues to restrict her eating because she wants to weigh 65lbs. In order to be most helpful, Dr. Peterson should a. help his patient diet appropriately in order to reach her goal weight. b. encourage his patient to reach her goal weight in hopes that her restricting will cease at that time. c. try to compromise with his patient so that her goal weight is 67.5lbs. d. None of the above is correct. Answer: D Type: Applied Page: 291

21 81. Psychological treatment of anorexia nervosa has been effective in a. encouraging compliance with medication treatment. b. maintaining weight gain long term. c. short term weight gain only. d. building skills to resist social pressures. Answer: C Type: Factual Page: The second step in treatment of anorexia nervosa commonly involves a. reinforcing appropriate eating behaviors. b. providing a safe inpatient environment. c. social skills training. d. family therapy. Answer: D Type: Factual Page: Which of the following has been shown to reliably lead to long-term maintenance of weight gain in treating anorexia? a. cognitive-behavioral therapy b. family therapy c. psychodynamic therapy d. None of the above has been shown to reliably lead to long-term maintenance of weight gain. Answer: D Type: Factual Page: Family therapy, using the approach described by Minuchin, would likely involve a. family lunch sessions. b. modeling of appropriate eating patterns. c. withholding social contacts except during mealtimes. d. All of the above are correct. Answer: A Type: Factual Page: One of the ultimate goals of Minuchin s family therapy in treating anorexia is to a. get the parents to take responsibility for their role in the problem. b. redefine the disorder as an interpersonal issue. c. force the patient to eat. d. quit trying to force their daughter to eat. Answer: B Type: Factual Page: 291

22 86. In treating bulimia nervosa, the overall goal is to teach the individual to a. accept their natural shape. b. monitor caloric intake. c. develop normal eating patterns. d. have other social outlets. Answer: C Type: Factual Page: Cognitive behavioral treatment of bulimia includes a focus on a. limiting snacks between meals. b. viewing attractive, normal weight women. c. avoiding arguments that trigger binges. d. eating small amounts of high-calorie foods. Answer: D Type: Factual Page: After successful cognitive-behavioral treatment of bulimia, patients sometimes also a. become obese. b. have reduced depression. c. develop anorexia nervosa. d. witness marital conflict in their parents. Answer: B Type: Factual Page: Successful treatment of bulimia nervosa often results in a. modest weight gain. b. reduced psychological problems. c. improved family and social relations. d. academic gains. Answer: B Type: Factual Page: Which of the following statements is true? a. Adding drug treatment to CBT sometimes enhances the effectiveness of CBT. b. Medication alone is more effective than CBT. c. Interpersonal therapy works more quickly and more effectively than CBT. d. Over 75% of bulimic patients recover after receiving CBT Answer: A Type: Factual Page: 293

23 91. Cognitive-behavioral treatment of bulimia nervosa is effective a. half the time or less. b. if combined with drug treatment. c. but with high relapse rates. d. if family and friends are supportive. Answer: A Type: Factual Page: One of the factors contributing to the increasing obesity in the United States is a. increased availability and amount of fast food. b. more sedentary lifestyles. c. declining physical education programs in schools. d. All of the above are correct. Answer: D Type: Factual Page: 277: Focus on Discovery Which of the following is hypothesized to play a role in obesity in humans? a. opioids b. leptin c. hypothalamus d. serotonin Answer: B Type: Factual Page: 277: Focus on Discovery What is the role of heredity in obesity? a. Weight is much more related to environment than genetics. b. A substantial percent of the variance in obesity can be accounted for by genetic factors. c. Heredity plays little role; factors such as exercise practices and daily caloric intake are more important determinants. d. Heritability estimates for obesity are around.60. Answer: B Type: Factual Page: 277: Focus on Discovery 9.1 Essay Questions 1. Discuss the means of diagnosing eating disorders, such as distinguishing features, subtypes, and physical effects. 2. Compare the psychoanalytic and cognitive-behavioral approaches to treating eating disorders. 3. Describe the contributions of genetic and biological theory to our understanding of eating disorders.

24 4. Discuss the role of culture in our understanding of eating disorders. Specifically, address the influence of industrialized western culture on prevalence, etiology, and maintenance of eating disorders. 5. Describe Minuchin s approach to family therapy of anorexia. 6. Compare and contrast anorexia nervosa and bulimia nervosa.