Eating Disorders Flashcards
Anorexia NervosaDiagnostic Criteria - DSM-IV TR (APA, 2000)
- Refusal to maintain body weight over a minimally acceptable weight for age and height (
Bulimia NervosaDiagnostic Criteria - DSM-IV TR (APA, 2000)
- Recurrent episodes of binge-eating.2. Recurrent inappropriate compensatory behaviour in order to avoid weight gain.3. Minimum average of 2 episodes of binge eating and inappropriate compensatory behaviours per week for the last 3 months.4. Self-evaluation unduly influenced by body shape and weight.5. The disturbance does not occur exclusively during periods of anorexia. 2 subtypes: purging & non-purging
Binge Eating DisorderDiagnostic Criteria - DSM-IV TR (APA, 2000)
- Recurrent episodes of binge eating (eating more than others in a discreet time period with a sense of lack of control)2. BE episode associated with 3+ of a) eating more rapidly than usual b) eating until uncomfortably ill c) eating lots when not hungry d) eating alone due to embarrassment e) feelings of guilt disgust or depression after overeating3. Marked distress regarding bingeing4. BE occurs on average on at least 2 days a week for at least 6 mths5. BE not associated with inappropriate compensatory behaviours and does not occur exclusively during episodes AN or BN
Co-morbid Conditions (Davey, 2008)
AN Depression OCD BN Depression BPP Substance abuse BED Associated with depression, impaired work and social functioning, low self-esteem and body shape dissatisfaction
Patient Perspectives on Causes of AN
Nilsson et al (2007) Swedish study; interviewed people who had accessed C & A psychiatric clinics 8 & 16 yrs after initial assessment (median age 15 yrs) Responses subjected to content analysis At 8 yr follow-up recovery rate = 68% At 16 yr follow-up recovery rate = 85%
Attributions
8 yr follow-up 13% had no explanation High own demands/perfectionism most common 16 yr follow-up 1.5% had no explanation High own demands/perfectionism most common More answers related to family causes e.g. illness, expectations, disputes
Other Findings
Frequency of causal attributions to sports requirements, peer relationships, developmental tasks and domestic upheaval stable across follow-ups No differences in causes identified by those who had recovered compared with those who had not
4 Components (Prochaska & DiClemente, 1982)
Stages of change See diagram on previous slide Decisional balance Pros & cons of behaviour and beliefs Self-efficacy Confidence in ability to cope with demands Processes of change Cognitive and then behavioural
Engagement Issues for AN
AN Denial Not entirely deliberate (Vitousek et al, 1998) Resistant to treatment Passive-aggressive (Treasure & Ward, 1997) AN is egosyntonic & increasingly reinforcing (Halmi et al, 2005) TA difficult to establish Risks include premature discharge, punitive treatment and strong helper responses (Vitousek et al, 1998)
Halmi et al (2005)
3 centre study in USA Ss (122) diagnosed AN, aged 14-50 yrs Examined dropout, treatment acceptance and treatment completion rates in 3 conditions; CBT, SSRI (fluoxetine) and both combined Considered predictors Highest rate of attrition occurred in the first 5 weeks of treatment Only predictor of completion was self-esteem Low S-E – 40% completed High S-E – 80% completed Concluded need to increase acceptance and self-esteem to reduce dropout, and medication alone unsuitable treatment option
Engagement Issues BN
BN Usually higher level of motivation 92% BN self-refer vs. 19% AN (Bemis, 1986) Less resistant to treatment as condition is egodystonic However ambivalence about relinquishing ideals and loss of coping strategy likely (Vitousek et al, 1998) Shame acts as a barrier
Motivational Interviewing
Developed by Miller & Rollnick (1991) Effectiveness demonstrated in alcohol abuse settings Linked to TTM in literature However no theoretical or empirical connection exist between the two (Wilson & Schlam, 2004) Some inconsistencies exist e.g. stages & timing Considered as an adjunct to therapy but should be part of CBT anyway (Wilson & Schlam, 2004)
MI Principles
Express empathy Support self-efficacy Roll with resistance Develop discrepancy
MI Approach
Increase awareness of importance of change Increase confidence in ability to deal with change Use socratic method Cognitive strategies before behavioural Be collaborative Be empathic Validate client’s experience (Vitousek et al, 1998)
Double sided reflections
Patient: I am not prepared to let my weight goabove 35 kg.Therapist: You’re terrified about what will happen ifyou start to attend to your nutritionalneeds [empathy with the fear of change]and you know that there are clear signsthat your body is suffering when yourweight is below 40 kg – for example yourblood glucose runs at a dangerously lowlevel and your bones are continuing to dissolve. (Treasure, 2004)
