S O C I A L M O T I VAT I O N : L E C T U R E 5 - 6

H U N G E R M O T I VAT I O N
Thurs day, Se p te mbe r 29 , 20 16

HOMEOSTASIS (see pg. 114, Deckers *not tested on thirst and temperature)

Constant conditions maintained in the body

Disturbances either inside or outside of the body (i.e. environmental conditions) are counteracted by bodily
processes to maintain a stable internal environment
Temperature changes, fluid loss (perspiration, thirst)
Voluntary behaviour aids homeostasis when involuntary physiological reactions are not enough (voluntary
behaviours include drinking water and putting on warmer clothes)
See energy homeostasis (pg. 119, Deckers)
o Eating enough to keep your energy and weight in balance
o When an imbalance occurs (not taking enough, or taking too much energy weight loss/gain)
o Physiological and behavioural mechanisms in body that try to compensate for weight loss/gain
o Hormones: hunger and satiety (fullness)
o Drop in blood glucose triggers search for food
o Fat storage long term processes (amount of leptin corresponds to amount of body fat)
o Diet: less leptin, metabolism gets lower

INTRODUCTION TO HUNGER MOTI VATION

We need both physiologically-based and environmentally-based models to understand hunger and heating
Eating can be strongly determined by incentives and environmental stimuli
Environment is able to override drives, physiological mechanisms and metabolic requirements

Hunger is regulated by short-term and long-term mechanisms:

1. Short-term processes operate under homeostatic mechanisms
o E.g. caloric intake
o Gluclose levels are the short-term energy supply
2. Long-term processes operate under metabolic regulation
o E.g basal metabolism and fat cells
o Body fat is a long-term supply

BASIC PRINCIPLES OF HUNGER MOTIVATION

3 so urce s of e ne rg y are d e rive d f ro m fo od :
1.
2.
3.

Glucose: simple breakdown of carbohydrates (starches and sugars) quick energy source, trigger insulin
response
Lipids (fats): broken down into fatty acids and glycerols (stored in body for future use)
Amino acids (products of proteins): used for growth, repair, energy, and to make neurotransmitters
The CNS can only use glucose
Other cells of the body use glucose (but only in the presence of insulin) and fatty acids
Evolutionarily programmed to eat whenever food is available, and to love the taste of salt, fat, and sugar
o Our ancestors: must eat right away because food may not be available for the next few days
o Sugar is an instant energy source, easily digested and used by our body, distinguish between sweet
edible foods to poisonous foods (e.g. berries)
o Advantageous to be able to attain a lot of food quickly (in case of famine)
o Salt helps us retain water and avoid dehydration
o Foods with more fat also have more energy (calories)
Dopamine system responds to attractive food, makes you want it (e.g. food advertising)

Ene rg y st o rag e and us e

1.
2.
3.

As nutrients are absorbed in the digestive tract, the level of glucose in the blood rises
The pancreas secretes insulin and this allows glucose to be transported into the cells to be used for energy
o All cells are using glucose as fuel at this point
Insulin also allows excess glucose to be converted to glycogen to be stored in the liver and muscles as a shortterm reservoir
a. This energy is easily available to the brain when food is not in the digestive system
b. Several hours after eating, energy in the stomach and intestines is no longer available (resting
metabolism phase) and stored muscle and liver glycogen is now converted to glucose and now used
for energy

4.

If you run out of glycogen (longer period of food deprivation), then fats must be converted to fatty acids for
energy use
5. Fats are not used during the absorptive phase or for short-term use but are stored in case they are ever
needed in the future (e.g. fasting or famine)
Listen to 1:35: chart

Se ns at io ns of hunge r

In stomach: feeling empty, contractions, rumbling (however, stomach contractions not essential for hunger
feelings)
Other sensations: anxiety, weakness, dizziness, tiredness, dry mouth, headache
Insulin surge when you see food in front of you, readily available makes you hungrier
Insulin injection leads to strong hunger feelings
Fasting: normally with food deprivation, youd feel really hungry, but if you go days/weeks without food,
hunger sensations start to disappear
Amount you eat at previous meal affects amount you eat at next meal

Wh at st a rts a me al?
A) Social and environmental cues are powerful determinants of eating

Sight, smell and availability of food triggers eating

Most of the time, humans begin a meal simply because it is time to eat

Variety of foods increases consumption

Social facilitation effects are evident for eating behaviour

o People around you increase arousal
o If its an easy task, that arousal leads to doing more of the behaviour/greater performance (hard task
and increased arousal leads to problems with behaviour)
o Since eating is an easy task, people tend to eat more when there are more people around the table
o Other people may also be setting the norms (e.g. if others eat 3 cookies, you may eat 3 cookies as
well)
o By yourself: tend to eat quickly and not as much

E.g. At friends event there are ham& cheese sandwiches available - Its lunchtime, how many quarter
sandwiches would you eat? (4?)
o Now to go to a luncheon with 7 types of sandwiches: now how many quarter sandwiches would you
eat? (one of each?)
o Were attracted to variety more appetizing increases consumption (buffets encourage people to
eat more)

Social norms and peer influences

Stress: may increase or decrease appetite

B) Depletion of nutrients stimulates hunger
1. Receptors in liver and hypothalamus detect drop in level of glucose available to cells. Hunger increases.
o Liver monitors, signals to hypothalamus
2. A reduced amount of fatty acids in storage (particularly a severe drop) induces hunger
3. If both glucose and lipids (fats) are moderately reduced, consumption is greatly increased

If youre really hungry, satiety signals have to be strong to get you to stop eating
Moderate hunger can be stopped by moderate satiety signals

Why do es f ee d ing st op ?
Issue: feeding stops before nutrients are absorbed. Why?
1. Signals from senses: sight, taste, and odour give meaningful information about calorie intake
o From past eating experiences
2. Stomach distension: feeling full
o Important, but calorie detectors are important as well
o E.g. if you eat food that doesnt have a lot of calories (lettuce, celery) you will have stomach
distension but calorie detectors dont see much energy going in, so you might feel hungry again
sooner
3. Nutrient receptors in stomach: signals that stomach is being filled with food
4. Specificity of satiation:
o Variety increases appetite
o e.g. if youre eating a big plate of pasta: as you continue to eat more of the same food, it starts to
become less palatable, you start to lose your appetite
o But, because of specificity to that particular food, your appetite renews with a new food (thats why
dessert is so appealing)
o Also if you have a lunch out and you have leftovers when you have it again its not as exciting (eating
the same thing for subsequent meals is less appetizing)

5. Satiation of hormones
o CCK hormone
o Secreted by duodenum, fat-rich foods are detected
o Hormone that causes gallbladder to bile (which helps digest fats)
o Suppress feeding in mice (doesnt work as directly in humans)
o If we give CCK injections to humans, it inhibits eating but stomach also has to be some somewhat full
too
o High levels of CCK in bloodstream associated with high degrees of satiety
o Aversion signal to suppress eating, perhaps changing palatability of food
6. Osmotic dehydration: food pulls fluid from body tissues (automatic process)
7. Liver reinforces satiety signals once it starts to receive nutrients (glucose)
o Shutting down feeding, sends signals to brain to reinforce previous satiety signals
8. Memory: brain damage patients whether theyre willing to accept another meal after finishing eating
o Lack of memory (e.g. amnesia, Alzheimers) person may accept 2nd meal soon after 1st meal
o Memory is important in determining whether you accept another meal or not

Ad d it io nal Co ncep t s

Read Deckers: Satiation hormone (CCK)

Insulin

Allows glucose transfer from blood into cells to give energy and fat for storage

Appearance of food or anticipation of eating can trigger release and high levels of circulating insulin associated
with availability of glucose due to ingestion of food
high amounts of insulin means that youve ingested food, and you also get a surge of insulin when you
anticipate food
Hyperinsulinemia

Develops as a result of obesity

Oversupply of insulin resulting in reduced levels of glucose in the blood and greater conversion of glucose to
fat storage

Chronically low blood sugar results in greater feelings of hunger

Summary: oversupply of insulin, drops blood sugar (glucose) levels, leads to greater feelings of hunger
Leptin

Hormone important for satiety

With obesity however, leptin resistance occurs, receptors become less sensitive and the signals are easily
overridden
relative to fat storage
when your leptin levels decrease, maybe you havent eaten much (e.g. sickness, flu, diet), metabolism goes
down (not taking in as much energy), amount of fat you have in your body drops starts to prompt your
appetite
increased leptin means charging up metabolism
o e.g. if youre eating more during Christmas, then the body/brain sense that theres lots of energy
stores, your metabolism might go up a bit during the break
Ghrelin: hunger hormone

prompts you to feel hungry, stimulates thoughts of food

rises with an empty stomach

when youre full, it shuts off

if injected with ghrelin, you would feel more hungry (may even have images of food)
HFCS (High fructose corn syrup)
Sweetener (concentrated form of sugar) in soft drinks, processed foods, and often low fat foods

Doesnt trigger satiety signals but adds calories and may trigger hunger instead

Often listed as glucose-fructose in ingredient lists

has become very prevalent in foods in society
drops insulin levels quickly
contrasted to natural fruit: which has fructose and fiber
o fruit has less concentration of these sugars
o your insulin levels may not rise as much when you have fruit
o will give you energy
Agave syrup: also a problematic sweetener

METABOLISM
Ene rg y us e

Resting metabolism: used for body maintenance (60-75%) pumping blood, neural activity, etc.
Thermic effect: energy cost of digesting, storing and absorbing food (10%)
o You need calories to digest calories, continues for several hours after a meal
o Protein takes the most to digest (25% of the protein that you eat)
o 5% of the carbs you digest are used to digest it
o 2% of the fats you digest are used to digest it
Physical activity: voluntary movement (15-30%)
Spontaneous activity: fidgeting, stretching, and maintenance of posture (genetically programmed)
NEAT: Non-Exercise Activity Thermogenesis
o Major cause of individual differences in energy expenditure when physical activity held constant
o Listen to 44:00
o Fidget factor: includes fidgeting, spontaneous activity (nothing to do with the amount we walk/run)
o Goes beyond basic body maintenance to account for individual differences
NEAT Experiment:
o Metabolism varies greatly with age and between individuals
o Resting metabolism slow at approx. 2% per decade
o University age men need avg. of 2900 calories per day and women 2100
o However some people can gain weight if they go over 1300 calories, and others do not gain weight if
they eat an extra 1000 per day even over 8 weeks and do not increase exercise

Metabolism INCREASES:

After we have ingested food (because of thermic

effect)

When we have consumed more calories than

usual (particularly carbohydrates)

After vigorous physical activity (if you are very

physically fit)
o Up to 1 hour after moderate exercise
(jogging)
o Extra calories will be burned if your
exercise is hard and long (e.g. 10km race)
o
o
o

Metabolism DECREASES:

After a long period of food deprivation

With low carbohydrate diets

During night-time sleep

Children have higher resting metabolism, and then it slows down with age
Adults also increase weight with age because theyre often less active than they were as children/teenagers
Body weight is correlated with biological parents (genetics)

SHORT-TERM AND LONG-TERM ENERGY REGULATION

(Did not cover in class)
Short term

Amount of blood glucose is associated with hunger and eating

Decline in blood glucose instigates eating and high level inhibits eating (at least in animal models; note the
environmental factors and incentives relevant to humans)
Depletion of nutrients stimulates hunger.
1. Receptors in liver and hypothalamus detect drop in level of glucose available to cells hunger increases
2. A reduced amount of fatty acids in storage (particularly a severe drop) induces hunger (also relevant to longterm regulation)
3. If both glucose and lipids (fats) are moderately reduced, consumption is greatly increased
Long term

An older model of long-term energy stores is the set point model

Set point model suggests that the body regulates itself around a certain leveland adjusts the resting metabolic
rate to reduce energy consumption if less food is consumed

(in the short term, the body also shows increased thermic effect if eating more calories)
Problems with the set point model:
1. Set point = body weight or fat storage?
2. How does the brain monitor deviation from the set point?
3. How ist eh set point fixed and what changes it?
4. There is no rationale why fuel in reserve should be maintained at a specific amount

APPLICATION OF PHYSIOLO GY OF HUNGER AND MOTIVATIONAL THEORIES TO

WEIGHT CONTROL

Understand and accept the limitations of your metabolism

o In the short term, your body forgives you if you overeat every now and then. Over long term, watch
out!
Dieting must be directed to permanent changes in eating habits or weight will eventually be regained as you
return to usual eating habits with your newly reduced metabolism
Engaging in only one of (a) increased physical activity or (b) reducing calories, is far less effective as a weight
loss strategy than the two factors combined
Yo-yo dieting (weight cycling) has significant long-term consequences in reducing metabolism
o Weight cycling is the repeated loss and regain of body weight
o Dieting trains body to become more efficient at making due with less calories
Do not eat rushed meals. Allow enough time for the stop eating signals to take effect before you consume
more than you need.
o Fast food restaurants: bright lighting, lots of stimulation encourages people to eat quickly and get
out of there
o People eat less and slower under a nicer restaurant environment (dim lighting, etc.)
Do not skip meals when dieting.
o The powerful combination of strong hunger drive due to empty digestive system plus food incentives
means that you are at risk of consuming more calories than if you had eaten regularly
Dieters become more susceptible to eating disinhibition
o Be aware of the effects of stress, alcohol, depression, and exposure to high calorie foods on loss of
control of food intake
o Effects of bad moods and good moods: people start to lose control of food intake (even if they try to
put cognitive controls on)
o E.g. Stress eating

(Listen to 1:04)

Co g nit ive Re st r aint

Dieting: substituting cognitive controls to override unconscious physiological processes

Cognitive controls are fragile
o Situations and emotions can easily interfere with cognitive inhibitions
E.g. Restraint release (eating disinhibition) occurs with stress, anxiety, depression, alcohol, exposure to high
calorie foods
o Or have incentives (people wanting to eat when they see their favourite foods, even though youre not
particularly hungry)
Conscious processes and voluntary behaviours can be directed to exercise motivation, mindfulness and self
regulation (e.g. Goal setting & self monitoring)

Table 5.1: Revised Restraint Scale (see Deckers for examples)

Restrained eaters: dieters

Gives an idea whether youre a restrained eater or not

BOUNDARY MODEL OF HUNGER AND SATIETY

Comfort zone exists between an upper satiety boundary and lower hunger boundary

If you fall below the lower boundary, you have feelings of hunger and the further you fall below (e.g. empty
stomach, weakness), the greater the impetus to eat

If you reach the satiety boundary (e.g. feelings of fullness), you stop eating

Between the two biological boundaries is the zone of biological indifference where social factors and
palatability of food determine eating

Normal eaters are assumed to be more responsive to physiological boundaries to determine when to start and
stop eating
Ex. Taste test ice cream
Before we give you the ice cream, heres a milkshake
Predict: if theres a difference between restrained and nonrestrained eaters amount of ice cream they eat
What the hell effect: I had the milkshake, might as well enjoy the ice cream! Tomorrow is another day.
o Or: Im under a lot of stress, so I will have a cheat day and try again tomorrow.
Zone of biological indifference varies between normal eaters, restrained eaters, and people with anorexia or bulimia

Dieters impose a cognitive boundary that often falls short of the satiety boundary
o This diet boundary is under fragile cognitive control and can be easily breached (What the hell
effect)

Diet boundaries can also be removed due to positive moods, negative moods, and stress in restrained eaters

Binge eaters have a higher satiety boundary and/or are unable to stop eating at the usual satiety boundary
o They may only stop when they reach physiological capacity or when interrupted

People with anorexia have a very low diet boundary and feel full easily
o They may be unresponsive to or ignore hunger signals and their zone of biological indifference is
shifted downwards

Bulimia: emotional distress, eating is a distraction, and binging is a distraction

o Feeling guilty after binging then purge to deal with the guilt

FOOD PSYCHOLOGY: REDUCING MINDLESS EATING

Make food life mindful. Remove the cues that cause overeating: size bias, priming, distraction, fast eating
In sight, in mind (priming effect):
o When seeing or imagining food temptation, and impulsiveness increases
o Salivation increases and pancreas secretes insulin
o You can keep fruits and vegetables in clear containers, and unhealthy in opaque containers to help
use this to heat healthier

The bigger the package, the more people eat

Popcorn experiment: free stale popcorn in movie theatre

o Half people got medium sized bucket, and half got large bucket (no sharing)
o Large bucket: people ate more
Refillable soup bowl:
o People come into restaurant, 4 people at a table, 2 people with regular soup bowl but other 2 have
secret refillable bowl
o Measured the amount that people consumed with refillable bowl ate about 73% more
Chicken wing experiment:
o People who had the pile of bones increasing ate 28% less, while people who had waitresses clean
away their plates ate more
Applying mindfulness: suggestions can reduce or increase consumption as needed

Variations of the 20% rule:

o
Eat until 80% full (no longer hungry)
o Dish 20% less than you think you might want before you eat
o Increase fruits and vegetables by 20%, reduce carbohydrates by 20%

See before you eat; see while you eat

o Visual cues help monitor consumption: e.g. pour refills into fresh glasses
o Never eat from large package (people eat at least 20% more)
o Preplate and leave all dishes on the stove not table
o Most people eat until plate is clean (the usual cue to stop). Leave something on plate
o Distraction of all kinds makes us eat more
o The faster we eat, the more we eat
o Pause to ask if still hungry
o Eat slowly. Drink water during meal to slow down. It takes 20 minutes for body and brain to signal
satiation
o The longer you stay at the table, the more you eat. Be the last to start and pace yourself with the
slowest eater.

Overcome the size bias

o Size of the popcorn bucket, the package or the plate suggests how much to eat and influences
consumption
o Use tall skinny glasses and moderate size plates
o Repackage large boxes into small Ziplocs or Tupperware (portion control)

Make snacking a hassle not a habit

o Remove all snacks from sight and make hard to reach
o Create a pause between seeing and eating. Pause points and portion control packages reduce mindless
consumption
o Snack only at the table on a clean plate
o Limiting variety at a party slows you down and increases sensory specific satiety
o Identify cravings when not hungry: Im not hungry but Im going to eat this anyway prevents
mindless indulging or reduces consumptions to taste
o Split fast food meal combo with a friend
Slim by design: Mindless eating solutions for everyday life (by Brian Wansink)
Its easier to change your eating environment than to change your mind
How can you make healthy eating decisions even when your brain is on autopilot?

The history of mini package foods (100 calorie snack pack)

Slim diners have different strategies at buffets (e.g. sit facing away from food, have a look at all foods first
and choose your favourites)

Eating

Redesigning your kitchen: make healthier foods more visible than tempting, unhealthy foods; dont make
kitchen too comfortable with chairs (dont spend as much time there), smaller serving utencils
Never snack and multitask
Half plate rule: way to have consciousness of what youre eating half of your plate has to be filled with fruit,
veggies, or salad (and other half anything you want), and have to do this with each new plate you get as well
Dont bring bread, bring water: when restaurants bring bread, people overindulge
Kids: What would Batman [superhero/best friend/favourite teacher] pick?, then now what do you want?
making them more conscious about their choice (being specific between two choices, and non-judgmental)
Thinking about what a well-liked person would do makes us less indulgently compulsive
Disorders:
Sociocultural pressures on people
75% of women are weight preoccupied
Social values: people associate acceptance, willpower, and maturity with visual appearances
Men: pressures are on body form, musculature, time at the gym
Certain sports: visual appearance is important, or body weight/size is important (categories, competitions,
etc.)
o Gymnastics (women): highest rate of dieting
o Ballet dancers, body builders, wrestlers, diving, figure skating, synchronized swimming, etc.
o Exercise-induced anorexia: less incentive to eat

Anorexia

Diagnostic Criteria:
o Restricting calorie intake leading to weight loss or failure to gain weight
o Significantly low body weight for age, sex, and height
o Intense fear of weight gain (even though underweight) and persistent behaviour that interferes with
weight gain
o Distortion of body image and of their condition

Prevalence:
o 1-2% of general population
o women comprise 90% of cases
o 2.5% of students; young white middle/upper class families

Health consequences
o Cardiac problems including heart failure
o Kidney failure
o Osteoporosis and bone fractures
o Long term digestive problems
o Brain abnormalities: enlarged ventricles and grooves suggesting loss of brain tissue

Prognosis
o 6-18% fatality rate
o 25-50% experience reoccurrence after treatment
o Follow-up after long term therapy shows 29% had good recovery
o Recovery better if caught earlier

Treatment
o Combination of therapies including behaviour modification, cognitive therapy, nutritional counseling,
anti-anxiety drugs or antidepressants
o Periodic checks and long term follow-up necessary
o Family based treatment (Maudsley approach)

Quite successful in children

One of the issues for families is guilt, blame this approach steps back from that

Severity of illness treat it as a disease, similar to how youd treat a child with cancer (were
there for you, we support you, I know the medicine makes you sick but I need you to take this
medicine) dont blame the child, everyone working together to support

Family therapy, coaching the parents

2/3 of patients regained normal weight without having to be admitted to hospital, better family
dynamics, etc.

Not easily translatable to adults

Problems can last a long time, even a lifetime

High death rate for eating disorders
Anorexia: 10-15% death rate, 50% recovery, and 40% have chronic/long term problems
Often a turn-around point is when women want to start a family, and need to increase weight to have a baby
Approach: assure survival first, and can respond to both cognitive and drug treatment (SSRI doesnt work until
they come to closer weight range) must do a follow-up

Some are so resistant to treatment that they have to be hospitalized (treatment programs, intensive therapy)

Bulimia

Diagnostic Criteria

Prevalence: more than anorexia

Health consequences

Prognosis

Treatment
o Cognitive behavioural therapy: tends to work quickly but interpersonal therapy and family dynamics is
also often effective after a year or so
o Sometimes SSRI used in treating bulimia
Anorexia notes?

Due to extreme food deprivation the body loses ability to digest and absorb food

Intestines starved of food: when you try to get person to eat, food becomes classically conditioned as aversive
makes patient sick and uncomfortable (low incentive for food)

Phosphorus deprivation essential when eating occurs

Uptake of phosphorous and serotonin causes breathing problems, heart problems, feelings of distress

Dont want to eat food but are still preoccupied with food (e.g. may prepare snacks and bake food for friends
but wont eat it themselves)

Serotonin (important): in people that dont have an eating disorder makes you calm and happy
o People with anorexia: serotonin linked with anxiety, rigidity, obsessive compulsive disorder
o Abnormally low in people who are suicidal, depressed
o Abnormally high with people who have anxiety, obsessive compulsive disorders
o Paradoxical effect for people with anorexia: not sure if its an overproduction or if its an oversensitivity
to serotonin, or increased number of serotonin receptors SSRIs when given to people with anorexia, it
lowers the number of postsynaptic receptors over time, because theres lots of serotonin available
o Brain then starts to regulate itself (number of serotonin receptors), but takes about 2 weeks for the
SSRI to work, until weight is closer to normal level
o Restricting food intake seems to be a way for people with anorexia to reduce levels of serotonin
(reduce anxiety, calming themselves, feeling that theyre in control)
Causes and associated factors
Genes vs.
environment

Family
issues

Social
pressures

Personality
issues
Potential
triggers

Anorexia

Genetic predisposition to psychological

disorders (e.g. anxiety, depression)

Cascading biological effects that inhibit

recovery/treatment

Losing neurotransmitters, brain function is

impaired due to starvation

Family dysfunction/interaction issues (e.g

emotional neglect, abuse, sexual assault,
sibling rivalry)

Family history of depression, anxiety,

substance abuse or eating disorders

Societal messages and pressures, coachs

demands

Thinness demand/body image sports or

activities (e.g. dance, modeling)

Obsessive, perfectionist, anxious,

overachiever, needing control, need for
approval

Stress and coping problems, parents divorce,

diet

Bulimia

Environmental, learning, peer modeling,

socially rewarded behaviour

Non-supportive or hostile family, chaotic

Family history of depression, alcoholism,
weight problems

Body image concerns, low self-esteem, peer

pressure
Weight cycling, sports with weight
categories
Impulsive, low sense of self-control, low
frustration tolerance, need for approval and
fear of disapproval
Diet, weight control technique that becomes
compulsive, stress, depression, low
serotonin levels
Possible eating more food to increase
serotonin levels
Later teen years, college age

Age of onset

Early to mid-teens

How can you help a person with an eating disorder?

1. Dont make comments/criticism about food or weight

2.

Dont nag about eating or not eating. Dont spy. People with eating disorders are extremely self-conscious
about their eating habits

Dying to be thin: eating disorders

Types of Therapy
o Individual therapy
o Group therapy
o Art therapy
o Nutritional therapy
o Drug therapy
o Cognitive behavioural therapy

Anorexia
o Dancers: during anorexia, got more attention, got more parts, nurtured

Exercise-induced anorexia:
o Exercised more than she could consume
o Anxiety is a common trait/disorder (sometimes from childhood)
o Patient took drug that affects serotonin
o Medications like prozac doesnt work on underweight patients

Bulimia: binge eating and purging

o Medication
o Psychotherapy: cognitive behavioural therapy

Traits:
o Wanting to be in control
o Worry about consequences of behaviour

Lack of food stop menstruation

o Important for bone density growth
o Risks: bone loss, injuries, osteoporosis, inability to reproduce