Eating Disorders Flashcards
Anorexia Nervosa
- Restriction of energy intake that leads to a significantly low body weight
- Core psychopathology of an eating disorder: overevaluation of shape, weight, and their control - judging self-wroth and the ability to control shape and weight
- In the cognitive model of the ED’s, that is the structure that is at the center, fueling all the other elements of the ED
Bulimia Nervosa
- Recurrent binge-eating:
- Objective binge: consuming large amount of food at one time (a lot of calorie intake)
- Subjective binge: the person actually ate a similar amount to anyone else, or even less that somebody else but experiences it as “I feel like I lost control while eating”, “this is more than I wanted to eat” - One of more extreme methods of weight control - compensatory behaviours (ex: purging, laxatives, excessive exercising, dietary restriction)
- Core psychopathology of an eating disorder: overevaluation of shape, weight, and their control
Binge-eating Disorder
- Don’t necessarily have the core psychopathology of an eating disorder: overevaluation of shape, weight, and their control
- Have reoccurring binges - eating large amount at one time without the compensatory behaviours
Atypical anorexia
not underweight but have all other elements
“body shape dissatisfaction” vs. “overevaluation of shape/weight” - “normative discontent”
- Body shape dissatisfaction: pretty global experience to have mixed feelings about our body (normative discontent)
- Overevaluation: thinking about shape and weight all of the time - the dominant element of the self-concept and many behaviours are organized around it
treatment manual for anorexia nervosa: main goal
“Establish that there is a crisis in the family and begin the process of defining and enhancing parental authority to manage the crisis”
- Can’t wait eating disorders out - there are physical consequences linked to these disorders
- Eating disorders (anorexia + bulimia): ego syntonic in early stages (this is good about me, I have a lot of self-control - aligns with values)
To parents:
- “You are the people with the biggest investment of love and commitment to your daughter, so you are also the ones most likely to help the most with this problem”
- “Your daughter is desperately ill and something very drastic has to happen for you to save her life” AND “You must be devastated and worn out by this terrible ordeal…”
- therapeutic bind: disorient the family (to initiate the refeeding) AND be kind and containing at same time
treatment manual for anorexia nervosa: parent coaching
- Supervised meals and parents are trained to get the most efficient refeeding
- “You have to provide your daughter, who is starving, the kinds of food that would restore her weight to normal”
- “It is full-cream milk and pasta with a cream sauce that will make the difference, not salad”
CBT-E(nhanced)
A cognitive therapy that is individually focused
it is based on a transdiagnostic cognitive-behavioural theory
Eating Disorders Cycle (bulimia and anorexia)
- core concept of over-evaluation
- strict eating: can include: safe/unsafe food groups, counting calories closely (setting low ceiling), multiday fasts one after another
- binge eating or under-eating
- then compensatory behaviours (bullimia)
What causes a binge with eating disorders:
the more that you delay and restrict eating the more your body will naturally want to replenish the carbs… leading to a binge (but it’s your biggest fear), so then you engage in a compensatory behaviour (very similar to OCD where you have an intrusion and then you neutralize it)
how can an element of eating disorders be linked to anxiety disorders?
there’s an interoceptive element
“my stomach feels gross” interprets a full feeling after dinking water as feeling fat
What happened to the men who did the starvation experiment?
- These men didn’t have the core psychopathology of an eating disorder (overevaluation of shape/weight and control), but they were starved so they had the underweight element
- There were a lot of behavioural, psychological, and physical effects that are also seen in eating disorders, so a lot of elements of an eating disorder is because you are underweight (so the first STEP is to get back to normal weight)
What does CBT-E reccomend for “regular eating”
- 6 meals a day (including snacks)
don’t eat between them, don’t skip them, don’t go more than 4 hours without eating, eat what you like, always know when you’re going to eat next - Benefits of this: not many rules - no “right” and “wrong”, to build a routine to stop bingeing - helps them gain more control over the binge vs. trying to control it by restricting which ultimately causes the bingeing
explain feelings of fatness and an intervention for it
- Feeling of fatness is different than actual weight
- Changes throughout the day
Intervention: scheduled weigh-in or measuring of different body parts
- You have way too much checking or total avoidance of checking (like anxiety disorder, checking the lock on the door 40 times)
- People feel like they’re changing more than they actually are so it shows them they aren’t
to get over safety seeking behaviours what is an example of an exposure we can do?
- clinician and client eat a feared foods together in the session
- Take SUDS ratings at the beginning and as you eat it you experience some distress
Food/eating related exposure:
Eating the food together in the session or mapping out the foods avoided and then facing them on purpose
Body-focused exposure:
To address body image-related fears
Mirror exposures
pure mirror exposure
the client observes themselves in a mirror with the clinician, and during that time they let whatever thoughts that come into their head, com into their head (critical, positive)
- People favor this one - seeing yourself has become a phobic experience so facing that can be helpful
conginitive dissonance mirror exposure
observing yourself but saying positive things about yourself (the person isn’t feeling good when looking at themselves - cognitive dissonance)
Cue exposure for binge-eating:
Mainly for binges in the absence of compensatory behaviours
- Binges are generally cued by locations and times of day, smells, seeing the bag of food that’s a source of the binge, pictures
- You find a food that’s strongly associated with the binge and then look at it, take it and smell it and then taste the food and then throw it out, you’re not allowed to eat for 24 hours after
- Exposing self to all triggers and not following through
checking behaviour exposure: addressing subject bias
Comparison checking
- Sit in a public place
- Examine every 3rd person, roughly your age and gender, and see what you discover
- People realize that everyone is just average, but we always compare ourselves to the extreme best
- Representative sample to compare
checking behaviour exposure: addressing assessment bias
- This one counters what we talked about with looking in the mirror, we don’t usually do that to other people, pick everyone apart
- Go to a change room, look at someone who you would rate as very attractive and then scrutinize that person the same way you would do to yourself
- Even if u find the most attractive person you will find imperfections that you didn’t notice before
- Gets at the idea that you’re not being fair to yourself, everyone has faults
