Eating Disorders

Question 1

How has the DSM’s approach to eating disorders evolved over time?

Answer 1

DSM-I: Focused on Bulimia Nervosa.

DSM-IV: Created separate chapters for Anorexia and Bulimia Nervosa.

DSM-5: Renamed the chapter to “Feeding and Eating Disorders” and described these disorders as a persistent disturbance in eating or eating-related behavior that impairs physical health or psychosocial functioning.

Question 2

What does the historical perspective on anorexia suggest about its existence over time?

Answer 2

Versions of anorexia and disordered eating have been around and studied for a long time, with cases described from the Middle Ages to recent centuries.

Question 3

How has the conceptualization of eating disorders evolved over time?

Answer 3

Historically, eating disorders were referred to as “nervous atrophy” or “anorexia hysteria.” Over time, explanations shifted from spiritual causes to factors such as family dynamics, genetics, hormonal influences, and environmental pressures, along with societal ideals like perfectionism and the value placed on thinness.

Question 4

What are three childhood-related eating disorders introduced in DSM-5?

Answer 4

Pica: Persistent eating of non-nutritive substances (e.g., dirt or hair).

Rumination Disorder: Repeated regurgitation of food.

Avoidant/Restrictive Food Intake Disorder (ARFID): Failure to meet appropriate nutritional or energy needs.

Question 5

What are the key features and limitations of DSM-5’s eating disorder chapter?

Answer 5

Disorders include Anorexia Nervosa (AN), Bulimia Nervosa (BN), Binge-Eating Disorder (BED), and Other/Unspecified.

Emphasizes distressing behaviors linked to weight and body shape.

Obesity was not included despite some proposals.

Focuses on grouping childhood disorders with adult presentations for a lifetime perspective.

Question 6

What was the rationale behind the major additions to eating disorders in DSM-5?

Answer 6

Pica, Rumination, and ARFID: Previously in the DSM-IV chapter “Disorders Usually First Diagnosed during Infancy, Childhood, or Adolescence.” DSM-5 integrated them to adopt a lifespan perspective.

Binge-Eating Disorder (BED): Promoted from a condition for further study to reduce reliance on “eating disorder NOS” (not otherwise specified), which was being used as a de facto code for BED.

Question 7

What is the literal meaning of “Anorexia Nervosa”?

Answer 7

The term means a lack of appetite due to nervousness.

Question 8

How is Anorexia Nervosa expressed and misunderstood?

Answer 8

Individuals may not see themselves as underweight, though others might express concern.

Despite being underweight by clinical standards, they may fear gaining weight.

Caloric intake is often restricted, and individuals may perceive themselves as painfully thin.

Severity isn’t always apparent and is specified using subtypes (e.g., restricting or binge-eating/purging types).

Specifiers help interpret how common factors in eating disorders are expressed.

Question 9

What factors are considered for assessing the severity of anorexia nervosa in adults?

Answer 9

BMI score, clinical symptoms, functional disability, and need for supervision are all taken into account.

BMI cutoffs are used by the DSM to specify severity levels.

An average person with anorexia nervosa (AN) is 25-30% below typical body weight.

Question 10

What are some limitations of using BMI as a measure for anorexia diagnosis?

Answer 10

BMI is a crude indicator: Athletes may have low BMI due to low body fat, without having an eating disorder.

BMI < 18.5 alone is not enough for diagnosis; it’s only an indicator.

The severity scale has been criticized by some researchers for lacking consistent value in diagnosis.

Question 11

How does Bulimia Nervosa (BN) relate to Anorexia Nervosa (AN)?

Answer 11

BN and AN can co-occur, and some people with AN may transition to BN.

BN is not about restricting calories but about compensating for food intake through purging, fasting, or exercise.

Unlike AN, individuals with BN are often within a normal weight range and might hide their behaviors related to binge eating.

Question 12

What behaviors characterize Bulimia Nervosa (BN)?

Answer 12

Binge eating: Consuming more food than usual within a short period.

Compensatory behaviors: Purging, fasting, exercising, or using laxatives to avoid weight gain.

A sense of loss of control during episodes.

These behaviors typically occur at least once a week for 3 months.

Question 13

What are the specifiers for Bulimia Nervosa (BN)?

Answer 13

Partial or full remission indicates if the individual still meets diagnostic criteria.

Severity is measured by the number of compensatory behaviors per week:
Mild: 1-3 episodes.
Moderate: 4-7 episodes.
Severe: 8-13 episodes.
Extreme: 14+ episodes.

Question 14

Why is it important to distinguish between Anorexia Nervosa (AN) and Bulimia Nervosa (BN)?

Answer 14

There is fluidity between the two conditions, and behaviors can overlap.

BN involves compensating for food intake, while AN focuses more on restriction.

Careful evaluation helps ensure the behavior is correctly attributed to the appropriate disorder, preventing misdiagnosis.

Question 15

What are the specifiers for remission and severity in Bulimia Nervosa (BN)?

Answer 15

Remission:
Partial remission: Some diagnostic criteria for BN are still met, but not all. For example, binge eating or compensatory behaviors may still occur, but with reduced frequency or intensity.

Full remission: No diagnostic criteria for BN have been met for a sustained period, though the individual remains at risk for relapse due to the long-term nature of eating disorders. Monitoring is recommended, as behaviors may reappear over time.

Severity: Measured by the number of inappropriate compensatory behaviors per week:

Mild: 1-3 episodes.
Moderate: 4-7 episodes.
Severe: 8-13 episodes.
Extreme: 14 or more episodes.

Question 16

What are the key differences and similarities between Anorexia Nervosa (AN) and Bulimia Nervosa (BN)?

Answer 16

Differences:

Eating/weight: AN involves extreme dieting with weight below normal, while BN involves binge eating and compensatory behaviors, typically with normal weight.

View of disorder: Individuals with AN often deny the problem and take pride in diet and control, whereas those with BN are aware of their problem but feel ashamed and secretive.

Feelings of control: AN individuals feel comforted by rigid self-control, while BN individuals experience distress from a lack of control.

Similarities:
Self-evaluation: Unduly influenced by body weight and shape in both disorders.

Comorbidity: Individuals with AN may also binge and purge; those with BN may have a history of AN.

SES/age/gender: Both disorders are prevalent in high socioeconomic status (SES), young females.

Question 17

What are the limitations of categorical frameworks when comparing disorders like Anorexia and Bulimia?

Answer 17

Tables can give the appearance of simplicity, but in reality, a continuum may better capture the complexities of these disorders.

Similarities:
Both involve risk factors and self-evaluation concerns about weight and shape.

Dissimilarities:
Whether the person feels pride in their weight.
The level of control they believe they have over their weight.
Whether they mask compensatory actions.

Note: These frameworks are useful but don’t capture the fluid boundaries seen in personality and eating disorders.

Question 18

What is the neurobiological impulse-control model of eating disorders (ED)?

Answer 18

This model frames eating disorders along a spectrum between restrictive and impulsive behaviors.

Restrictive side: Linked to traits like perfectionism, cognitive rigidity, attention to detail, and anxiety (e.g., Anorexia Nervosa).
Impulsive side: Involves high arousal, risky behaviors, and loss of control (e.g., Binge-Eating Disorder, Bulimia Nervosa).

Brain areas involved:
Restrictive: DLPFC, OFC, MPFC, ACC (frontal brain regions).
Impulsive: Dorsal striatum, amygdala, cerebellum, hypothalamus.

Genetic markers: COMT, BDNF, 5HT2A.
Key concept: Anxiety is reframed as pathodysmorphia—a phobia focused on how the body feels and functions.

Question 19

What does the 2012 neurobiological impulse-control model suggest about eating disorders?

Answer 19

Eating disorders exist on a continuum between strong and weak impulse control.

This model emphasizes impulse control as the fundamental issue, influencing both Bulimia Nervosa (BN) and Anorexia Nervosa (AN).

It was proposed before DSM-5, advocating that neurobiological findings should be interpreted through this lens.

Question 20

How do impulse control levels influence eating disorders in the neurobiological model?

Answer 20

Lack of Impulse: Leads to loss of control over eating, resulting in BN or binge eating at the extreme.

Strong Impulse Control: Leads to rigid control over appetite and physiological responses, contributing to AN or binge-purge behaviors.

Question 21

What other features and ongoing debates are associated with the neurobiological impulse-control model?

Answer 21

Perfectionism is linked to restricted eating in AN.

Alcohol overconsumption may reflect poor impulse control or excessive food consumption.

The model highlights pathodysmorphobia, a phobia about how the body feels, as an important anxiety-related feature.

There is debate about viewing eating disorders as a continuum, which the DSM framework does not fully accommodate.

Question 22

What are the diagnostic criteria for Binge Eating Disorder (BED) in DSM-5?

Answer 22

Recurrent episodes of binge eating: Eating a large amount of food within 2 hours with a loss of control (similar to Bulimia, Criteria A).

At least 3 associated symptoms, such as:
Eating more rapidly.

Eating until uncomfortably full.

Eating when not hungry.
Feeling embarrassed, disgusted, depressed, or guilty afterward.

Occurs weekly for 3 months, without compensatory behaviors (unlike BN).

Specifiers: Partial or full remission, and severity levels (similar to BN).

Question 23

What are the controversial views regarding the inclusion of BED in DSM-5?

Answer 23

Agree: BED needs formal recognition with clinical utility backed by sufficient evidence.

Disagree: Critics argue that the diagnosis is too broad, potentially overpathologizing normal eating.

Impact: In the US and Australia, BED has become the most commonly diagnosed eating disorder since its inclusion in DSM-5.

Question 24

What are the prevalence rates of BED across demographics?

Answer 24

3.5% of women: Most common in early adulthood.

2% of men: Most common in midlife.

1.6% of adolescents.

2014 Study: Raised concerns about overdiagnosing normal eating behaviors through the inclusion of BED, but ultimately argued against this concern.

Question 25

How is Binge Eating Disorder (BED) described from the perspective of lived experience?

Answer 25

A binge is not pleasurable but mindless and repetitive, with hands moving from mouth to food.

Afterward, individuals feel awful, confronted by empty food packets and a sense of shame that can be overwhelming.

Question 26

What is Allen Frances’ criticism of BED as a diagnosis?

Answer 26

Frances argues that BED represents “gluttony” being redefined as a treatable disorder.

He believes it is a “fake diagnosis”, criticizing the overpathologizing of behaviors and the lowering of diagnostic thresholds.

Frances contends that expanding diagnostic categories diminishes their clinical usefulness.

Question 27

How did Amy Pershing respond to Allen Frances’ criticism of BED?

Answer 27

Pershing argues that BED is not about gluttony or overindulgence but reflects a deeper issue.

BED, like other eating disorders, is shaped by biology, genetics, environment, trauma, family dynamics, and weight stigma.

Pershing emphasizes that BED is not primarily about food but about a complex interplay of factors.

Question 28

Should DSM-5 have included obesity as a mental disorder?

Answer 28

Key questions:
Does obesity cause subjective distress or impairment?

Are biological factors a reason to exclude it, given their significant role?

If not classified as an eating disorder, could obesity fit under addictive disorders or body dysmorphic disorder?

Conceptual concern: Including obesity in DSM could alter how we conceptualize mental illness, challenging the idea of “abnormal” behavior being rare.

Historical consideration: In a male-dominated world, a woman’s body was historically viewed as a key survival tool and source of power.

Question 29

What is the epidemiology of eating disorders like BED and AN?

Answer 29

BED:
Most common eating disorder in Australia and internationally, affecting 2-3.5% of the general population.
Rates are higher in individuals with obesity.

AN (Anorexia Nervosa):
Initially considered a culturally specific disorder, thought to be confined to Western or economically developed countries.
Now observed in other regions, such as Hong Kong, raising questions about cultural prevalence.

At-risk groups:
Young females from high socioeconomic status (SES) backgrounds.
Individuals in sports emphasizing weight control (e.g., gymnastics, dance).

Question 30

What are the key epidemiological points about Anorexia Nervosa (AN) and Bulimia Nervosa (BN) worldwide?

Answer 30

AN incidence is stable, but BN incidence is declining.

AN is being diagnosed earlier, with increasing cases in younger age groups (<15 years).

During their lifetime, up to 4% of females and 0.3% of males experience AN, while up to 3% of females and more than 1% of males experience BN.

Both disorders are found not only in young Western females but also across males, all age groups, and non-Western countries.

Mortality risk for both AN and BN is five times or more higher than the general population.

Question 31

What trends have been identified in the diagnosis of AN and BN?

Answer 31

Diagnoses of AN are increasingly seen in younger individuals.

These disorders can occur at any age and in both boys and men, as well as across diverse populations worldwide.

Even if not clinically disordered, behaviors like body dissatisfaction and related beliefs remain highly prevalent in the community, potentially at a subclinical level.

Question 32

What are the key points about eating disorders in men?

Answer 32

Eating disorders are 10 times more common in women than men, but specific subgroups of men are at risk, including:

Wrestlers (pressure to “make weight”).

Athletes (e.g., AFL players) and some female athletes as well.

Certain sexual orientations.

Age of onset of eating disorders is similar for men and women.

Critical focus: The DSM may miss cases in men due to its emphasis on thinness (low BMI) rather than bulk, which can be relevant for some men.

Question 33

How do age and gender act as risk factors for eating disorders (EDs)?

Answer 33

Both Anorexia Nervosa (AN) and Bulimia Nervosa (BN) typically begin in adolescence or early adulthood.

Weight concerns and dieting tend to decrease as adolescent girls transition into adulthood, especially after marriage and parenthood.

Women are more likely to be affected by EDs, but men can also experience them.

Question 34

What are the medical complications of Anorexia Nervosa (AN)?

Answer 34

Amenorrhea (loss of menstrual cycle).

Dry skin, brittle hair, and nails.

Increased sensitivity to cold.

Downy hair growth (lanugo) on the face and limbs.

Cardiovascular problems (e.g., low blood pressure).
If purging:
Electrolyte imbalance, dehydration, dental problems, and a sensitized gag reflex.

Osteopenia (low bone density), potentially leading to osteoporosis or stress fractures.

Death due to starvation or increased suicide risk.

Question 35

What is the comorbidity of eating disorders (EDs) with other mental health disorders?

Answer 35

EDs often co-occur with anxiety, mood, substance use, and personality disorders.

OCD is commonly seen in both AN (Anorexia Nervosa) and BN (Bulimia Nervosa).

Between 50-70% of people with AN, BN, or BED also meet criteria for another DSM diagnosis.

Question 36

How do eating disorders demonstrate high diagnostic crossover?

Answer 36

BN can cross over to AN or BED, but BED only overlaps with BN, not AN.

The BN-Binge/Purge subtype (BN-BP) can transition into BN.

Boundaries between EDs are fluid, and crossover between subtypes is common.

It’s essential to consider how symptoms are attributed and how diagnostic boundaries are applied.

Question 37

What biological factors contribute to the aetiology of Anorexia Nervosa (AN)?

Answer 37

Study: Queensland scientists identified genes linked to AN, showing strong connections to metabolism.

Genetic component: Possible but complex to interpret.

Neurotransmitter role in eating regulation:
Serotonin abnormalities detected.
Issues with hypothalamic function.
Altered dopaminergic systems impacting reward sensitivity.

The body may try to maintain a set point weight, contributing to the disorder.

Question 38

What psychological factors contribute to the etiology of eating disorders?

Answer 38

Cognitive factors: Distorted perception of body size or weight.

Lack of interoceptive awareness: Difficulty recognizing internal body signals (e.g., hunger).

Perfectionism and desire for control.

Dysphoria, low self-esteem, and depression.

Anxiety about how others perceive their appearance.

Association between weight/appearance and self-worth or success.

Question 39

What social factors contribute to the etiology of eating disorders?

Answer 39

Cultural specificity: Eating disorders are considered one of the most culturally specific psychological disorders in the DSM.

Perceptions of attractiveness influence body image.

Dietary restraint is accepted and emphasized in certain occupations or cultures.

Religious and cultural practices may promote dietary restraint.

Family influences:
Mothers who diet may influence children.

Individuals with AN may avoid conflict but desire control.

Upbringing is an ongoing area of investigation

Question 40

How does body dissatisfaction act as a risk factor for eating disorders? think about the gendered aspect of this question and what people from various genders rated as “desirable”

Answer 40

Individuals show varying levels of satisfaction with different body parts.

Nearly half of the women in the survey reported mid-torso dissatisfaction.

Body dissatisfaction can begin in childhood, with females often experiencing it earlier than males.

Dissatisfaction can lead to dietary control behaviors, increasing the risk of eating disorders.

Question 41

What assessment tools are used to study body dissatisfaction?

Answer 41

Researchers use body figure images to explore body perception.

Participants are asked to select:
Ideal body.
Body they think their partner desires.
Their actual body.

This method helps researchers analyze discrepancies in body perception, revealing potential links to eating disorders.

Question 42

What gendered patterns emerge from body image research?

Answer 42

Women: The ideal body is often thinner than the actual body, and the partner’s ideal is somewhere between the two.

Men: The actual body is often smaller, with the ideal being a middle size, and the partner’s ideal being the largest.

These discrepancies highlight gendered patterns in body dissatisfaction and may contribute to eating disorder development.

Question 43

How can family factors influence the development of eating disorders?

Answer 43

An affected parent may increase the risk.

Family dysfunction:
Families that are rigid, less cohesive, and have poor communication.

Correlation studies make it unclear if the family environment causes the disorder or if the disorder shapes the family dynamics, posing a causality issue.

Question 44

What individual differences and risk factors contribute to eating disorders?

Answer 44

Demographic factors such as low mood (negative affectivity) and perfectionism.

A strong desire for control and high or unrealistic standards.

Researchers are exploring common characteristics within families to understand how these patterns could contribute to the etiology of eating disorders.

Question 45

What are the potential risk factors for eating disorders?

Answer 45

Physical size

Eating patterns

Pubertal status

Personality characteristics

Attitudes about eating and self

Family dynamics/functioning

Family history
Interoceptive awareness:

Ability to recognize internal cues, including emotional states and hunger.

Question 46

What is the integrative biopsychosocial model of eating disorders?

Answer 46

Biological influences:
Inherited vulnerabilities (e.g., neurobiological response to stress, impulsive eating).

Psychological influences:
Anxiety focused on appearance and distorted body image.

Social influences:
Cultural pressures to be thin, family dynamics, and social expectations regarding appearance.

Question 47

How do eating disorder behaviors relate to the need for control?

Answer 47

Purging in BN and binge-purging in AN are attempts to regain control.

Restricting food intake allows individuals to feel in control of weight gain.

Cultural pressures linking thinness with success and attractiveness can exacerbate these behaviors.

Comments from peers and family on body weight can reinforce disordered eating patterns.

Question 48

What are the treatment differences for AN, BN, and BED?

Answer 48

Anorexia Nervosa (AN):

May require force-feeding or hospitalization.
Can become a medical emergency with severe weight loss and cardiac complications.

Nasogastric feeding may be necessary to stabilize the physical state before psychological therapy.
Bulimia Nervosa (BN) and Binge Eating Disorder (BED):

More responsive to psychological treatments than AN.

May also be treated with weight-loss drugs.
Source: Australian Psychological Society 2018 review of evidence-based interventions.

Question 49

What are the key challenges and outcomes in the treatment of Anorexia Nervosa (AN)?

Answer 49

Inpatient admission may be required to establish safe weight gain in severe cases.

20% of individuals with AN may die from complications, with suicide accounting for half of these deaths.

After reaching normal weight, treatments shift focus to improving self-worth and other psychological factors.

Compliance is challenging due to conflicts between medical goals (weight gain) and the individual’s desire for weight loss.

Question 50

What are the key treatment approaches for Anorexia Nervosa (AN)?

Answer 50

Enhance self-esteem by focusing on internal, not external evaluations.
Provide education on normal body weight and address maladaptive thoughts related to control.

Family therapy may be part of the treatment.
Weight gain promotion:
Behavioral therapy programs.

Maudsley method: Temporarily assume control over eating until it can be returned to the patient.

Question 51

What are the implications of labeling and terminology in the treatment of Anorexia Nervosa (AN)?

Answer 51

DSM-5 does not code specific AN stages, though stages have been proposed in the literature.

An Australian study found that individuals preferred the term “severe and enduring” over “chronic” to describe their experience with AN.
Treatment adjustments may be needed based on comorbidity, severity, and illness duration.

Language matters:
Some participants found “chronic” to be damning and felt it implied “no hope.”
The term “severe and enduring” was preferred for better reflecting the ongoing struggle without the negative connotations.

Question 52

What are the key components and effectiveness of CBT for Bulimia Nervosa (BN) treatment?

Answer 52

CBT is aimed at:
Education and behavioral strategies to normalize eating patterns.
Addressing cognitions that contribute to disordered eating.
Relapse management and preparation for realistic weight/shape expectations.

Effectiveness:
70-80% success rate in stopping binge-purge behavior.
Can be used in individual, group, or self-directed formats.

Question 53

What is the role of Interpersonal Therapy (IPT) in treating Bulimia Nervosa (BN)?

Answer 53

Focus:
Improves interpersonal relationships rather than targeting eating behaviors directly.

Initially studied as a placebo:
Ongoing research is needed.
Raises the question: When one therapeutic approach works, how do we decide which to apply next?
Follow-up analyses showed promise.

Mechanism:
Works on self-esteem and negative affectivity.
Addresses relationships, potentially leading to improved self-esteem and indirect appetite management.

Question 54

What are the treatment options for Binge Eating Disorder (BED)?

Answer 54

Evidence-based treatments are available, including:
Cognitive Behavioural Therapy (CBT)
Interpersonal Therapy (IPT)

Medications that may help:
Antidepressants (e.g., SSRIs) – can improve mood and impact eating behavior, especially if comorbid depressive disorder is present.
Anticonvulsants or other medications – can help reduce body weight.

Important consideration:
All treatments should be evaluated within the matrix of risks, benefits, and alternatives.

Question 55

Please list the NHMRC levels of evidence hierarchy: That is, different study types produce different levels of evidence, guiding treatment recommendations.

Answer 55

Levels of Evidence:

Level I: Meta-analysis or systematic review of Level II studies with quantitative analysis.

Level II: Study with independent, blinded comparison against a valid reference standard.

Level III-1: Pseudorandomised controlled trial (e.g., alternate allocation).

Level III-2: Comparative study with concurrent controls (non-randomised trial, cohort study, case-control study).

Level III-3: Comparative study without concurrent controls (historical control study, single-arm study).

Level IV: Case series with pretest/post-test outcomes or post-test outcomes alone.

Application to Eating Disorders:
Treatments for BN and BED show the highest level of evidence supporting CBT as an effective approach.

Question 56

the NHMRC created a list of levels of evidence (level I - V) for various EDs; Level I being “strong evidence” and Level IV being “weak evidence”. What was found at each level of evidence to be effective in treating various EDs?

Answer 56

Level I:
CBT for BN and BED (not for AN)

Level II:
AN: CBT (eating-disorder focused), Online CBT, Family Interventions, Psychodynamic therapy
BN: Online CBT, Bibliotherapy, DBT
BED: Online CBT (guided), Bibliotherapy (Guided), DBT, IPT, MBSR, Psychoeducation

Level III:
AN: N/A
BN: IPT
BED: EFT

Level IV:
AN: DBT
BN: Psychoeducation
BED: ACT

Note:
For AN, there is no Level 1 evidence, but Level 2 evidence exists for an eating-disorder-focused version of CBT, family interventions, and psychodynamic therapy.

Question 57

In an umbrella Review (a meta-analysis of meta-analyses” What were the findings and limitations of the study in relation to all EDs?

Answer 57

Key Findings & Limitations:

Most conclusions relate to outcomes up to the end of treatment, but follow-up data is limited.
In AN, remission and long-term courses require more research to capture what happens over time.
The review measures disordered outcomes and general markers like quality of life.

Conclusions:
AN: Family-based interventions show the most support for remission and weight gain, especially for new cases and adolescents.

BN: Individual CBT outperforms other treatments for behavior and remission outcomes, with some drug therapies also providing support.

BED: General psychotherapy or manualized therapies are more effective than active controls for ED psychopathology and dropout but less effective for weight loss.

Behavioral treatments, like weight loss programs and CBT, are more effective for behaviors and psychopathology.

Question 58

In a study titled “Pilot Randomised wait-list control trial”, the focus was on emotional focused therapy for BED. What was the design, how was BED measured, and the key findings?

Answer 58

Study Design:
12 one-hour EFT sessions provided to 20 individuals with BED.

Group data were analyzed separately and combined once wait-listed participants received treatment.

Results offer preliminary evidence supporting EFT’s feasibility for BED and call for larger randomized control trials.

Measure:
EDEQ: Eating Disorders Examination Questionnaire – measures binge eating psychopathology through items like: “I feel capable to control my eating urges when I want to.”

Key Findings:
CBT Limitation: High dropout rates in treatment.

Emotional Factors: Negative emotions are a reliable predictor of BED, highlighting the need for psychological interventions focused on emotions.

Half the participants were initially treated, while the rest were assigned to a wait-list control.

Both groups reported on their emotional experiences and eating behaviors throughout treatment.

Outcome: Over time, all treatments led to a decline in episodes, with the EFT group performing better than controls by the study’s end.

Question 59

In a study that looked at different prevention programs against young females and HCT - please name the four programs and the results of the programs, comment on efficacy and how this relates to prevention efforts.

Answer 59

a. Cognitive Dissonance
b. Education on Healthy Weight
c. Expressive Writing
d. Assessment Only (ED Presence Check)
Results:

Healthy Weight Education was the most effective intervention, showing significant improvements at 6 months and 1 year in reducing binge eating episodes.

Cognitive Dissonance showed promising trends toward significance, but further replication studies are required to confirm its effectiveness.
Conclusion:

Prevention efforts should focus on educational programs that promote understanding of healthy weight to prevent the onset of eating disorders.

Question 60

What are some social considerations that could reduce the socially constructed idea of bodies?

Answer 60

If eating disorders are socially constructed, there could be a need for transparency.

Disclaimers on photoshopped images could promote awareness about body ideals.

Transparency might help people recognize what is real versus what is constructed, fostering healthier body image ideals.

Question 61

What do prevention efforts need to consider when being created?

Answer 61

Prevention programs can serve as interventions, but they should also address societal influences.

Key questions:
Are eating disorders a result of individual or societal issues, or a combination of both?

Do these disorders reflect individual weaknesses, or do they suggest a need for ‘big-picture’ social responsibility and change?

Question 62

What did Paxton say about Creating a Culture of Dissonance?

Answer 62

“While extremely rigid weight and shape body image ideals prevail, a large proportion of the population will compare themselves with these ideals, find themselves wanting, engage in disordered eating, and develop subclinical and clinical eating disorders…psychologists can play very positive roles in guiding prevention and providing evidence-based interventions for body dissatisfaction and disordered eating.”
— Paxton, 2011