Solving the Anorexia Puzle: A Scientific Approach 0920887201, 3456818653

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SolvingtheAnorexiaPuzzle AScientificApproach

W.FrankEpling,Ph. D. W.DavidPierce,Ph. D. OFGLAMORGAN UNIVERSITY CENTRE RESOURCES LEARNING CF371DL MidGlamorgan, Pontypridd, 480480 ( 01443) Pontypridd Telephone:

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LibraryofCongressCataloging-in-Publication Data Epling,W.Frank. SolvingtheAnorexia Puzzle:AScientific Approach / byW.Frank Epling,W.DavidPierce. p. cm. Includes bibliographical references. ISBN0-88937-034-6: $29.50(U.S.) 1. Anorexia nervosa.2. Exercise addiction.[1. Anorexia Nervosa.2. EatingDisorders.]I.Pierce,W.David. II. Title. [DNLM:WM175E64s] RC552.A5E651991 616.85'262--dc20 DNLM/DLC forLibraryofCongress 90-4426 CIP CanadianCataloguing inPublication Data Epling,W.Frank Solvingtheanorexia puzzle Includes bibliographical references. ISBN0-88937-034-6

1. Anorexia. 2. Anorexianervosa. I. Pierce,W. David. II. Title.

RCS552.A5E7 1991

616.85'262 C90-093866-8

Copyright ©1992byHogrefe &HuberPublishers, Inc. 14BruceParkAvenue Toronto,OntarioM4P2S3

P.O.Box51 Lewiston, N.Y.14092 Nopartofthisbookmaybereproduced, storedinaretrieval system, ortransmitted, inany formorbyanymeans,electronic, mechanical, photocopying, microfilming, recording or

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ISBN0-920887-20-1Hogrefe&HuberPublishers *Toronto*Lewiston, NY«Bern« Stuttgart ISBN3-456-81865-3HansHuberPublishers «Bern«Stuttgart»Toronto*Lewiston, NY wrt

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SolvingtheAnorexiaPuzzle: AScientific Approach

AbouttheAuthors

W.FrankEpling,Ph.D.is a professor ofbehavioral psychologyinthe

Department ofPsychology attheUniversityofAlberta.Heisalsoaclinical

psychologist in StudentCounselling Serviceat theUniversity andhas extensive experience inthefieldofabnormal behavior. Aftercompleting his Ph.D.degreeat Washington StateUniversity, Dr.Eplingtravelledto England. Duringthe1970’s, hewasaconsulting psychologist atRainhill Hospitalin Prescot,a lecturerat the Universityof Southampton,and a

clinicalpsychologist Whitecroft Hospital ontheIsleofWight.Following hisstayinBritain, Dr.Eplingtookanappointment asChiefPsychologist at YorktonUnionHospital,Yorkton,Saskatchewan, Canada.In 1977,he

joinedtheUniversity ofAlbertawherehehashada successful research career.Hehaspublished numerous scientific articlesandbookchapters in thefieldsofbehavioralpsychology, nutrition,andanorexia.

W.DavidPierce,Ph.D.is a professor ofbehavioral psychology in the Department of Sociology at theUniversity ofAlberta.Heis currently Director oftheCentreforExperimental Sociology, aresearch facility forthe experimental analysis ofhumanbehavior. In1975,Dr.Piercereceived his Ph.D.degreefromYorkUniversity inToronto, Canadaandsubsequently

tookafaculty appointment attheUniversity ofAlberta. Heisamember of

theAmerican Psychological Association andtheAssociation forBehavior Analysis. Hisresearch isfocusedontheinterplay ofbehavior principles, biology,and culture.Dr. Piercehas conductedscientificresearchwith

animalsandhumanson theallocation of behaviorin complex-choice settings— aswellasresearchontheinterrelations betweeneatingand running, anorexia andnutrition. Hehaspublished morethan40scientific articlesandbokchapters,andiscurrentlywritingabookonContemporary

Behavior Analysis—tobepublished withDr.Eplingascoauthor.

Tableof Contents

ForewordbyDr.P.J. V.Beumont

Preface

Xvii

Introduction: AScientificApproachto Anorexia Physicalactivityandanorexia nervosa Activityanorexia inanimals Thebiological basisofactivity-anorexia Thesocialcontextofactivityanorexia Summary andoverview References

PARTONE:ANOREXIA NERVOSA ChapterOne:AnorexiaAsAMentalIllness

15

ChapterTwo:Non-Medical PerspectivesofAnorexia

27

Themedicalmodelofanorexia nervosa Physicalandmentalcausesofanorexia Diagnosis ofanorexia nervosa Psychoanalysis andanorexia nervosa Anorexia asneurosis Mentalillnessasamyth References Thesocial-cognitive model Thebehavioral model

vi

EPLING &PIERCE Sociallabelingandanorexia nervosa References

ChapterThree:Incidence,RiskandRecovery

43

ChapterFour:Psychologicaland PhysicalSymptoms Psychological symptoms ofanorexia nervosa Distortion ofbodyimage Bulimia Weightphobia Explanation ofpsychological symptoms Behavioral symptoms ofanorexia nervosa Eating,hungerandbodyweight Activity, sleepandnutrition Physiological symptoms ofanorexia nervosa Amenorrhea andexercise Otherphysiological symptoms References

95

ChapterFive:IndirectTreatmentofAnorexiaNervosa

45

Incidence ofanorexia nervosa Geographical location Sex,ageandsocioeconomic status Riskfactorsandanorexia nervosa Obesity, bulimiaanddieting Familycharacteristics Eatingattitudes Menses,exerciseandanorexia Recovery anddeath References

Criteriaforevaluating treatment Psychoanalysis Evaluation ofpsychoanalysis Insightpsychotherapy Contemporary psychoanalysis Client-centred psychotherapy Evaluation ofinsighttherapies Familytherapy Treatment withfamilytherapy Evaluation offamilytherapy

Cognitive psychotherapy

Rational-emotive psychotherapy Cognitive therapy Evaluation ofcognitive therapy References

ChapterSix:DirectTreatmentsofAnorexiaNervosa Medicaltherapy Medical regulation ofanorexia

93

Evaluation ofmedical therapy

Behavior therapy Principles ofbehavior Behavior therapyandanorexia nervosa Evaluation ofbehavior therapy Wheretofindhelp Anorexia nervosa Depression andsuicide References

PARTTWO:ACTIVITY ANOREXIA ChapterSeven:Behavioral FoundationsofActivity Anorexia

111

ChapterEight:Motivational BasisofActivity Anorexia

131

ChapterNine:Biological BasisofActivityAnorexia

149

Activityanorexia inanimals Activityandanorexia Adaptation effects Effectsofmealfrequency Modification ofactivityanorexia Implications ofanimalexperiments Activityanorexia inhumans References

Effectsoffoodsupplyonphysicalactivity Deprivation, foodsupplyandactivity Mealschedules andphysicalactivity Effectsofphysicalactivityonfoodintake Exerciseandcaloricintake Appetite andsatiety Motivational interaction ofeatingandexercise Reinforcement valueofexercise Reinforcement valueoffood Conclusion References Principles ofevolution Naturalselection Evolution andbehavior Evolution andanorexia Evolution andactivityanorexia Physiological basisofactivityanorexia Activityandendogenous opiates Anorexia, exerciseandfertility

viii EPLING &PIERCE Conclusion References

ChapterTen:TheSocialContextofActivityAnorexia Cultureandactivityanorexia Thevalueoffitness Thinness asabeautystandard

169

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