8. Eating disorders Flashcards
AN
persistent energy intake restriction
intense fear of weight gain/becoming fat/ persistent behaviour that interferes with weight gain
disturbance in self perceived weight or shape
BN
recurrent episodes of binge eating
recurrent inappropriate compensatory behaviours to prevent weight gain
self evaluation that is unduly influenced by shape and weight
BED
recurrent episodes of binge eating that must occur on average at least once per week for 3 MO
body image disparagement
view that one’s body is loathsome or repulsive
commonly accompanied by body shape avoidance
debting
creation of an energy deficit or ‘debt” typically through exercising to accomodate subseqeuent eating
core transdiagnostic psychopathology of eating disorders
over evaluation of shape, weight and their control
assessment
clinical interview- unstructured, semi/structured (EDE)
informant perspectives (sometimes not appropriate for adults)
self report questionnaires (EDE-Q, CIA, EDI-III)
medical/health assessment and contact
NICE guidelines first line treatment for adults with AN
individual eating disorder CBT (CBT-E, CBT-ED)
MANTRA
SSCM (specialist supportive clinical management)
if one unacceptable, contraindicated or ineffective, try one of the others or ED focused psychodynamic therapy
NICE guidelines first line treatments for children/young people with AN
AN focused family therapy (FT-AN), options for single and family sessions
if unacceptable, contraindicated or ineffective, try CBT-ED or adolescent focused psychotherapy for AN (AFP-AN)
NICE guidelines first line treatment for adults with BN
guided self help
IF U/A: CBT-ED
NICE guidelines first line treatment for children/young people with BN
FT-BN options for single and family sessions throughout
IF U/A: CBT-ED
NICE guidelines first line treatment for adults/children/young people with BN
guided self help
IF U/A: CBT-ED
When to include other HPs
weight low
dietary restrictions
health complications (diabetes)
other mental health comorbidities
Formulation- CBT theory of restricting AN
overevaluation of shape and weight and their control
strict dieting- non compensatory weight control behaviour
significantly low weight- preoccupation with eating, social withdrawal, heightened fullness, heightened obsessionality
Formulation- CBT theory of BN
over evaluation of shape and weight and their control
strict dieting, non-compensatory weight control behaviour
events and associated mood change
binge eating
compensatory vomiting/laxative misuse
transdiagnostic theory of EDs
over evaluation of shape and weight and their control
strict dieting- non compensatory weight control behaviour
significantly low weight
events and associated mood change
AND/OR might lead to binge eating
compensatory vomiting/laxative misuse
Formulation- extended transdiagnostic theory of EDs
refer to slide 22
CBT-E
usually 20 sessions over 20 W, if bm <17.5 recommend 40 sessions
Core (ED psychopathology and mood intolerance) or broad (adds in modules on clinical perfectionism, core low self-esteem and interpersonal difficulties
versions for younger (adolescent) patients
intensive inpatient and group versions as well
principle of parsimony
heavy behavioural focus, limited use of cog strategies
de-centering from the eating problem
may involve significant other sessions
caution again combining with eclectic approaches
contraindications to CBT-E
compromised physical health
suicide risk
severe clinical depression
persistent substance misuse
major life events or crises
inability to attend treatment/any planned absence of therapist
CBT-E phase 1A
sessions 1-2, twice weekly
establish therapeutic relationship
assessment
goals
instilling hope, enthusiasm, ownership
formulation and formulation feedback (diagram)
preparation for treatment
initiation of self monitoring and rationale for homework
education about weight checking
CBT-E phase 1B
sessions 3-8, twice weekly
in session weighing 5 mins
reviewing monitoring records and homework assignments 10 mins
collaboratively setting agenda 3 mins
working through agenda and agreeing on homework tasks 30 mins
summarising, confirming homework, setting next appt 3 mins
CBT-E phase 1 goals
education of eating problems- guided reading
establish a pattern of regular eating
involve significant others if helpful
CBT-E Phase 2
sessions 9-10 weekly
transitional phase
CBT-E Phase 2 goals
conduct a joint review of progress
identify barriers to change
review the formulation
deciding whether to use core or broad CBT-E
Design phase 3
CBT-E phase 2 designing stage 3- ordering your maintaining mechanisms
overevaluation of shape and weight
over evaluation of control over eating
dietary restraint
dietary restriction
being underweight
event or mood triggered changes in eating
CBT-E phase 3- overevaluation of shape, weight and control
identifying the over evaluation and its consequences
enhancing the importance of other domains for self evaluation
addressing shape checking and avoidance
addressing feeling fat
exploring origins of the over evaluation
learning to control the eating disorder mindset
self evaluation pie chart
CBT-E phase 3- dietary restraint/restriction
helping patients view their dieting as a ‘problem’
identifying and addressing dietary rules
addressing over evaluation of control
CBT-E phase 3- events, mood and eating
proactive problem solving
development of functional methods of mood modulation
CBT-E Phase 4
ending treatment 3-4 sessions 2-3 weeks apart
addressing concerns about ending treatment
ensuring progress is maintained
phasing out treatment procedures
minimising risk of relapse
review
adaptations/broad CBT-E
core low self esteem
interpersonal problems
clinical perfectionism
CBT-E for adolescents
group CBT-E
