Eating disorders Flashcards
Classification of anorexia nervosa
3months +
- restriction of food leading to significantly lower body weight (below 17.5MBI sometimes 15% below expected weight)
- intense fear of gaining weight, persistent behaviour that interferes with weight gain
- disturbance in view of the body, lack of recognition of the seriousness of current low body weight
> restrcting type
bing-eating/purging type
- Mild: BMI ≥ 17 kg/m2
- Moderate: BMI 16–16.99 kg/m2
- Severe: BMI 15–15.99 kg/m2
- Extreme: BMI < 15 kg/m2
Anorexia and low weight?
- Atypical anorexia nervosa: All criteria for AN are met, except that despite significant weight loss, the individual’s weight is within or above the normal range. (could be just as unwell and distressed and severe but weight is higher)
Classificaiton of Bulima Nervosa
recurrent episodes of binge eating (eating a lot more than usual person in a small amount of time -2hrs) AND feeling a sense of lack of control over eating
recurrent inappropriate compensatory behaviours in order to prevent weight gain
3x a week for 3 months
Binge eating disorder
recurrent episodes of binge eating (eating a lot more than usual person in a small amount of time -2hrs) AND feeling a sense of lack of control over eating
at least 3 of
- eating faster than usual
- eating until uncomfortably full
- eating large amounts when not hungry
- eating alone because feeling embarrassed
- feeling disgusted with oneself, gauility, depressed afterwards
- Excessive concern with weight or shape may or may not be present (not required but usually there)
at least 1 a week for 3 months
Differentials
Borderline PD (impulsive binges),
Body dysmorphic disorder,
emotion dysregulation,
mood (coping),
Medical
BN + AN
Differences from anorexia nervosa in mouth, dental, throat = due to bulimia nervosa
Those with BN are typically within the normal to slightly overweight range, whereas those with AN are significantly underweight
Risk factors
- Genetics:
- Biological: Female, Low serotonin, Hormones ( ghrelin, leptin)
- Developmental
o Bulimia nervosa: Childhood obesity, teasing, early prepubertal maturation
o Anorexia nervosa: Adverse prenatal, perinatal, and neonatal events e.g. dysmaturity, prematurity. Feeding and sleeping difficulties during infancy, Childhood personality traits – anxiety, depression, perfectionism, ASD, trauma - Cultural: Caucasian, Media portrayals:
- Family conflict; Critical comments about weight and shape; modelling of abnormal eating behaviour
- Abuse
- Psychological factors
o Internalisation of a thin ideal; body dissatisfaction;
o Perfectionism;
o Mood intolerance;
o Low self-esteem;
o Impulsivity
o Low sense of personal control - Dieting
Dieting risk factor
STUDY:
- During periods of restricted food intake, people become preoccupied with food and eating.
o Classic study conducted during WWII: Conscientious objector “volunteers” placed on strict diets
o Healthy men, with normal eating patterns, didn’t starve for body related purpose but just because they were enrolled in the experiment.
o They then became became dissatisfied with bodies (once they lost weight), started thinking, writing, and reading more about food, many moved into food-related work, started collective cooking, cooking books etc
o Therefore, when people are starved by behave differently.
Assessment
Eating behaviour
Physical (height, eight, what they ideal would be)
Body shape and weight perception
comorbidity
Impulsive behaviours
Other psychological problems
General health
Family structure
Check subjective v objective binge
Food & fluid intake
Body checking behaviours (scales, pinching etc)
Rules/rituals and markers
Compensatory behs
Functional analysis (what’s driving the beh)
Assess family factors
Medical check up (any health risk) & menstruation
Understand possible reinforcers
- social factors, e.g., attention, praise
- psychological factors, e.g., mastery, achievement, pride, control
- Physical factors, e.g., endorphins
- Functional avoidance, e.g., relief from difficult decisions re relationships, education
- Physiological factors e.g., body feeling of wanting to restrict
Understand negative experiences (shame)
Psychometrics
Eating Disorders Inventory (perfectionism, drive for thinness, bulimia, self esteem)
Body Shape and Weight Questionnaire
Model
Transdiagnostic model of ED’s
Cognitions
Automatic thought: “I must control my eating, ill feel better if I binge, I’m fat and ugly”
Intermediate beliefs: if I’m thin people will like me better, no one likes me because I’m fat
Core beliefs: I’m, * I’m never going to recover from this. I’ll always be damaged goods. It’s my own fault. (Worthless)
How could anyone be attracted to me when I’m this fat and ugly? (Unlovable)
Cognitive themes in EDs
* Overvaluation of eating, weight, shape and their control
* Mood intolerance
* Core low self-esteem
* Perfectionism
* Interpersonal problems
Treatment
** Long haul process – takes time and patience
Therapist stance:
Foster self-acceptance−ED is understandable – “makes sense that ED developed to feel in control when things were out of control” but also showing things are not helping them achieve what they would like
Consider where they are:
* Precontemplation (“not ready”)
* Contemplation (“thinking about it”)
* Preparation (“getting ready for change”) * Action (“ready, set, go”)
* Maintenance (“hanging in there”)
Motivational Interviewing
- Often don’t want to be there
- “miracle Qs”
- Pros and cons of current eating in the short-term and long term
- Pros and cons of staying the same in the short term and long term
Technique/foster understanding early
* Client writes two letters
* One to the eating disorder as a friend
* One to the eating disorder as an enemy
* Allows client to reflect on both sides of the ED
* Can enhance alliance, as the therapist acknowledges aspects of the ED that are valued by the client
- Risk – get to normal weight
Family-Based Therapy
DBT
- Emotional regulation/distress intolerance – self compassion,
Mindfulness
Good for binge eating, maybe for other ED’s
**Aim for acceptance rather than satisfaction for body image
CBT
Early
- Self monitoring (food intake + situation, thought, feeling, body - careful not reinforce check behs)
- Psychoeducation (normal/healthy food intake and weight range, nutrients for brain and impact of nutrient restriction, why dieting doesn’t work – food preference vs food restriction)
- Normalise eating (planning food instead of counting calories), emphasise nutrition, recommend 3 meals 2-3 snacks – introduce variety of food give checklist of different kinds and they pick how much they ate in the week can be motivating for them to try and get more ticked off)
- Identify emotions (emotional intelligence (naming, recognising cues – self-awareness) use emotional chart to make it easier
Middle
- Evaluating cognitions (eg on low self esteem, perfectionism, thin ideal, fears of weight gain)
- Behavioural (family meal times, beh exps eg perfectionism)
- Emotion regulation - skills for relaxation/coping (not using binge eating as coping strategy)
- Chaining/dominos - Stimulus control – avoid high risk chain ones
- Other CBT interventions if required (assertiveness, problem solving, relaxation, anxiety management)
- Problem solving - communication within families
- Focus on co-occurring mood/anxiety difficulties
Later
- Relapse prevention/self-therapy
Sheets to fill in
Cue > body response thought, feelings > behaviour > short-term and long-term consequences
then think what could I have done differently and go through it again and see how it would change
Y model
Have Y model (pathway of thought and where it led and then an alternate thought and where it would have led – the immediate consequence may not matter but the long-term consequences are huge
