Eating Disorders: Bulimia

Question 1

What constitutes a binge-eating episode?

Answer 1

> Eating, in a discrete period of time, an amount of food that is definitely larger than socially acceptable
A sense of lack of control over eating during the eating episode - they are desperate to stop eating but can’t

Question 2

What is the difference between BN and BED

Answer 2

Compensatory behaviour must be prevalent for BN, whereas it is an exclusionary criteria for BED

Question 3

What are the criteria for bulimia nervosa?

Answer 3

> Recurrent episodes of binge-episodes
Recurrent inappropriate compensatory behaviour
Self-evaluation is unduly influenced by body shape and weight - it influenced who they are!
the disturbances does not occur exclusively during episodes of anorexia nervosa

Question 4

How often must both the binge-eating and inappropriate compensatory behaviour both occur?

Answer 4

At least once a week for 3 months

Question 5

What classifies partial and full remission?

Answer 5

Partial:
> after full criteria for BN met, some, but not all, of the criteria have been met for a sustained period of time

Full:
> after full criteria for BN met, none of the criteria have been met for a sustained period of time

Question 6

Severity levels of BN (average inappropriate compensatory behaviours per week)

Answer 6

Mild: 1-3 episodes
Moderate: 4-7 episodes
Severe: 8-13 episodes
Extreme: 14+ episodes

Question 7

Comorbid symptoms

Answer 7

> substance abuse
> depression 
> suicidality
> personality disorders
> anxiety disorder

NOT JUST A CASE OF STOPPING PEOPLE BINGING IN MOST CASES

Question 8

What are the scales of assessment for the Eating Disorder Inventory (EDI-3)

Answer 8

> drive for thinness
> bulimia (eating like an Ox)
> ineffectiveness
> body dissatisfaction
> interpersonal distrust
> perfectionism
> impulse regaulation

Question 9

What is Eating Disorder Examination?

Answer 9

> Great reliability and validity

> semi-structured interview

Question 10

What are the 4 subscales of the EDE?

Answer 10

Restraint
Shape concern
Eating concern
Weight concern

Question 11

What should you consider when selecting a treatment?

Answer 11

> acceptability - are the people going to do it
attrition rates - how many people drop out etc.
clinical effectiveness
speed of action - will it work quick enough
breadth of effects - stop binging, lift mood and raise self-esteem
durability of effects - continue after treatment
cost-effectiveness

Question 12

What is the treatment of choice for BN

Answer 12

CBT-E (enhanced with interpersonal considerations)

Question 13

What does CBT involve for BN

Answer 13

> concerned with present and future - rather than past
needs BOTH cognitive restructuring AND behavioural modification
“talk the talk” and “walk the walk”!

Question 14

What is stage 1 of CBT (sessions 1-8)

Answer 14

> establish a sound therapeutic relationship
educate them on the cognitive maintenance of BN to explain the need for both behavioural and cognitive change
establish regular weekly weighing
educate on adverse consequences of compensatory behaviours
introduce a regular pattern of eating
start keeping a food diary record (FDR)
reduce secrecy and increase support from others

Question 15

What is stage 2 of CBT (sessions 9-16)

Answer 15

> tackle dieting
address concerns about shape and weight
addressing other cognitive distortions

Question 16

What is stage 3 of CBT (sessions 17-19

Answer 16

> aim is to ensure that progress is maintained
try to prevent relapse
plan for dealing with setbacks

Question 17

What is the cognitive view of the maintenance of BN

Answer 17

Low self-esteem - > extreme concerns about shape or weight - > strict dieting - > binge-eating - > self-induced vomiting - > LOOPS AROUND TO START

Question 18

Why shouldn’t you use Overeaters Anonymous

Answer 18

> With eating, the abstinence model doesn’t work - Keys et al. (1950) study on starving
You need to introduce forbidden foods and get accustomed to them

Question 19

What are the two types of diaries that should be used

Answer 19

Food Diary for behavioural modification
Thought Diary for cognitive restructuring
> situation
> dysfunctional thought
> challenge to dysfunctional thought