Although many factors have been Implicated in the etiology and maintenance of anorexia nervosa and bulimia, anxiety, particularly in the context of eating, may be critical. Applying the tri-partite model of anxiety, this study was designed to assess anxiety before, during, and after eating in eating disorder and normal control subjects. The experimental eating procedure was preceded by a neutral task. Four groups of ten female subjects each participated: normal-weight females, restricting-anorexics, bulimic-anorexics, and bulimics. Anxiety was assessed by self-report (ratings of pleasure, arousal, and anxiety), psychophysiological (heart rate and skin conductance) and behavioural (food consumption) measures. Controls reported themselves to be non-anxious throughout the study arid ate almost all of the small test meal. Somewhat surprisingly, physiological arousal (especially heart rate) was high during eating. During the neutral task, heart rate declined slightly in all groups. The eating disorder groups indicated a high level of anxiety throughout the study which showed a trend to increase further during eating. In addition, anorexics and bulimics described dysfunctional beliefs regarding the effects of eating on body shape and weight. Similar to controls, physiological arousal was high during eating. Overall, heart rate proved to be a more useful measure of arousal than skin conductance because many anorexics were hyporesponsive. Restricting-anorexics ate the least amount, bulimic-anorexics ate slightly more, and bulimics ate similar amounts to controls. Thus, food consumption was probably associated with weight status. Several conclusions were drawn. Women with eating disorders have a high level of general anxiety probably because of a conflict between biological pressures to eat and fears of weight gain. The high physiological arousal during eating appears to reinforce perceptions of anxiety. The eating disorder groups showed different degrees of concordance among measures of anxiety. Borrowing from the research on phobias, therapeutic procedures such as cognitive therapy, progressive relaxation, and exposure treatments can address the different components of anxiety anorexics and bulimics experience during eating. / Arts, Faculty of / Psychology, Department of / Graduate

This study is a case-study of a patient who was diagnosed as having co-morbid Anorexia Nervosa and Factitious Disorder. It would appear that central to an understanding of both of these disorders is the patient's disturbed relationship to her own body. The existing literature on co-morbid Factitious Disorder and Anorexia Nervosa is rare, with only three cases published. A careful reading of these cases suggests that in all of these cases, Factitious Disorder may have been the primary diagnosis. In this case there was as overidentification with the patient role, and the patient's anorexic symptoms appeared to serve the function of meeting the patient's acute dependency needs. Thus, the patient's Anorexia Nervosa masked the Factitious Disorder and appeared to be secondary to the Factitious Disorder. It is argued that these disorders share several common dynamics, namely the inability to separate from the mother, high parental expectations as well as the use of the body as a transitional or pre-cursor object. In addition there are some common dynamics in the psychotherapy of these patients. All of these factors suggest that in both these disorders the developmental arrest may be located at a pre-verbal level.