San Jose State University
Etiology & PathophysiologyThomas & Schaefer: Ch. 3Chavez & Insel pp. 6-8OutlineSocietal-culturalPsychosocialBiological3 elements of self-perceptionPhysiologyEffect of genetics & environmentRisk promoters & protectorsEtiology & Risk FactorsInability to cope & express feelings related to:RejectionLossInsecurityRidiculeDiscriminationAbuseFamily crisisSocietal-cultural influences:Thin/muscular = beauty, happy, good, success, loved & powerReinforced by media do some develop EDs while others do not?Psychosocial FactorsPerfectionist, achievement-orientedIndependent & persistentTolerant of pain & discomfortHigh self-expectation yet low self-esteemDysfunctional familiesOverbearing/controlling parentsPhysical or sexual abuseParental alcohol or drug abuseFood, Body Shape & Body WeightUse food as a:Substitute for loveCompanionBuffer against stressFriend/enemyObsession w/ food & shape divert energy from feeling:Low self-esteemShameHelplessnessIncompetenceSocial Anxiety Biological influenceImbalance in hormones & neurotransmittersSerotoninMelatonin (precursor is serotonin)NorepinephrineEndorphinsCholecystokinin (CCK)Early onset of menarche (< 12yr)Males: late onset of pubertyPredisposition for obesity or thinnessThose most prone:Believe the cultural myth that thinness/muscularity is necessary to be taken seriously, to have success, clout & to fit inNot self-acceptingBarely like who they areOften feel like “losers”Additional risks for athletesPersonality traitsTolerant of discomfort & painWeight loss & weight cyclingSudden increase in training volumeDecrease appetite leading to wt lossTraining intensity correlated to EDPressure from coaches, teammates, parentsStress & injury may feel helpless, vulnerable & out-of-controlInjury or illnessChange or loss of coachMoving away from family/friendsChange in training load: off-season3 elements of self-perceptionSelf-image = your sense of identityBody image = what you see when you look in the mirror & how comfortable or satisfied you are w/ your shape, size and appearanceSelf-esteem = feelings you have about yourselfSelf-image - 1st linkImage of who you are and who you want to become - your identitySelf-image changes:Influences, outside pressures, values & beliefsTakes time to develop an underlying self-image that results in a feeling of balance & contentmentMany ups & downs: adjust to external pressures and internal desires & arrive at a comfortable matchBody image - 2nd linkHow comfortable you are w/ the size, shape & appearance of your bodyChangeableWhat you see when you look in the mirror may be different than what others seeBI is inaccurate: what you think you see may not be realMood affects BI and BI affects moodWhen “ideal” body image clashes w/ what you think you see when you look in the mirrorTakes time to develop - changes w/ adolescenceInfluenced by the 3 P’sParents, peers & pressSelf-esteem - 3rd linkFeelings you have about your self and linked closely to self-image & body-imageClash when you can’t look the way you think you’re supposed to, no matter how hard you try -> self-doubt, feelings of inadequacyLow self-esteem makes it hard to acknowledge & express feelings - both risk factorsDifficult to develop, even harder during adolescenceKeep emotions to selfDoubt validity of emotions you do feelQuestion the right to have such feelingsSay/wonder “who could like/love me?” or “I don’t deserve to be liked/loved.”Elements of self-esteemLiking yourselfHaving a body image you can appreciate (even if it is not “model-perfect”)Being able to take some risk & not be overwhelmed w/ the thought of failureGiving self credit when you deserve itHaving a realistic self-image based on fact not fantasyPathophysiologyGenes -> Cells -> Systems -> BehaviorsGenesCode for mRNAs -> code for proteins w/i cellsAltered systems in the brain:Altered brain activation as seen by MRIAltered behavior:Outward expressionNature vs. NurtureEDs run is familiesTwin studies demonstrate significant genetic factors Nurture:Sociocultural factors: pursuit of unrealistic thinness ideal, promotion of body dissatisfaction that precedes disorderAll people exposed but only some develop EDsGene-Environment interactionSame people who give us our genes also create our environmentEx: IQ = “double advantage”Pass down genes & model disordered eating/attitudes = “double disadvantage”Genes may drive us to seek out environments that emphasize appearance and thinnessBallet or gymnastics: culture of thinness combined with genetic predispositionGene x EnvironmentGenes influence vulnerabilityFour types of factors:Genetic risk promotersGenetic protective factorsEnvironmental risk promotersEnvironmental protective factorsAnnaAnna’s aunt has ANFather is tall & naturally thin HS high jumperAnna did not go on diets when all friends were, as she was naturally thinHS Anna starts running track coach encourages everyone to lose weight to improve performance. Put everyone on a diet.Anna tried dieting, but got too hungry - stopped after 1 dayFamily regularly eats breakfast and dinner together – an environment for open discussion of coach’s unrealistic expectations ................
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