PSY2003 W5 Reading

Question 1

What is this paper concerned about?

Answer 1

This paper is concerned with the psychopathological processes that account for the persistence of severe eating disorders.

Question 2

What are the two separate but interrelated lines of argument ?

Answer 2

Evidence based theory of the maintenance of eating disorder; cognitive behavioural thoery of bulimia nervosa.
2- Case of eating disorders shared, but distinctive clincal features tend to be maintained by similar psychopathological processes.

Question 3

What was the evidence based theory ?

Answer 3

Maintenance of eating disorders, the cognitive behavioural theory of bulimia nervosa, should be extended in its focus to embrace four additional maintaining mechanisms.
Specifically, we propose that in certain patients one or more of four additional maintaining processes interact with the core eating disorder maintaining mechanisms and that when this occurs it is an obstacle to change. The additional maintaining processes concern the influence of clinical perfectionism, core low self-esteem, mood intolerance and interpersonal difficulties.

Question 4

What was the second line of argument?

Answer 4

The second line of argument is that in the case of eating disorders shared, but distinctive, clinical features tend to be maintained by similar psychopathological processes.
Accordingly, we suggest that common mechanisms are involved in the persistence of bulimia nervosa, anorexia nervosa and the atypical eating disorders.

Question 5

What is the transdiagnositc thoery?

Answer 5

2 argument lead us to propose a new transdiagnostic theory of the maintenance of the full range of eating disorders, a theory which embraces a broader range of maintaining mechanisms than the current theory concerning bulimia nervosa.

Question 6

What is the new treatment using the transdiagnositc thoery?

Answer 6

Stage 1: intensive initial stage which lasts four weeks, the focus being on engaging and educating the patient, creating an initial personalised formulation and obtaining maximal early behaviour change.

Stage 2: there is a detailed review of progress
so far, as well as the characterisation of any barriers to change.

Stage 4: Largest part of the treatment. Emphasis on modifying the patient’s eating disorder psychopathology (e.g. the over-evaluation of eating, shape and weight and their control, and its various expressions), but it also involves addressing those additional processes identified in the revised formulation. Similar to final stage in CBT BN - ensuring that progress is maintained after treatment ends.

Question 7

What characterised cognitive disturbance?

Answer 7

More specifically, we have suggested that in the great majority of cases there is a central cognitive disturbance characterised by the overevaluation eating, shape and weight and their control, and that in subgroups of these patients one or more of four additional mechanisms also serve to maintain the eating disorder.

Question 8

Are eating disorders similar?

Answer 8

anorexia nervosa, bulimia nervosa and the atypical eating disorders share the same distinctive psychopathology, and patients move between these diagnostic states over time

Question 9

Are anorexia nervosa adn bulimia nervosa similar?

Answer 9

As with the comparison of anorexia nervosa and bulimia nervosa, cross-diagnostic commonalities become even more obvious when a longitudinal perspective is taken. For example, an atypical eating disorder is a common outcome of anorexia nervosa; bulimia nervosa typically starts as anorexia nervosa or an atypical eating disorder; and a particularly common outcome of bulimia nervosa is a chronic atypical eating disorder

Question 10

What are atypical eating disorders?

Answer 10

Some resemble the full syndromes of anorexia nervosa or bulimia nervosa but do not quite meet their diagnostic criteria

Question 11

What does anorexia nervosa and bulimia nervosa have in difference?

Answer 11

Anorexia nervosa and bulimia nervosa have much in common. They share essentially the same core psychopathology.

Major difference lies in the relative balance of the undereating and over-eating, and its effect on body weight.
Bulimia nervosa: 2 forms of behaviour tend to cancel each other out with the result that body weight is usually unremarkable =/=
Anorexia nervosa under-eating predominates—indeed, there may be no binge eating at all—with the result that body weight is extremely low, and symptoms of starvation are prominent

Question 12

What contributes to the maintencance of eating disorders?

Answer 12

perfectionism, self esteem, mood intolerance and interpersonal process

Question 13

What are some interpersonal processes that contribute to maintainence ED?

Answer 13

family tensions often intensify resistance to eating

Obious that certain interpersonal environments magnify concerns about controlling eating, shape and weight. These include families in which there are other members with an eating disorder, and occupations in which there is pressure to be slim.

Longterm interpersonal difficulties undermine self-esteem

Question 14

What is mood intolerance?

Answer 14

Inability to cope appropriately with certain emotional states. Usually this intolerance is of adverse mood states, such as anger, anxiety or depression, but in
some cases there is intolerance of all intense mood states including positive ones

Question 15

What is dysfunctional mood modulatory behaviour?

Answer 15

The dysfunctional mood modulatory behaviour may take the form of self-injury (e.g., cutting, punching or burning themselves) which has the effect of rapidly dissipating the initial mood state, or it may involve taking psychoactive substances (e.g., alcohol, tranquillizers) to directly modify how they feel. Both classes of behaviour are not uncommon among patients with eating disorders

Question 16

What behaviours might be used by bulimia nervosa patients to modulate mood?

Answer 16

Binge eating, self-induced vomiting and intense exercising may also be used as forms of mood modulatory behaviour, binge eating most commonly serving this purpose

Question 17

How is self-esteem linked to ed?

Answer 17

Whilst most patients with bulimia nervosa are self-critical as a result of their failure to achieve their goals, a form of negative self-evaluation that generally reverses with successful treatment, there is a subgroup that has a more global negative view of themselves.

Their negative self-judgements are autonomous and largely independent of performance: in other words, they are less affected by changes in the state of the eating disorder.

Creates hopelessness about their capacity to change, thereby undermining their compliance with treatment, determination achievement in their valued domains.

Question 18

How does perfectionism linked to eds?

Answer 18

Perfectionism is well-known to co-occur with eating disorder. Fear of failure, frequent and selective attention to performance and self-criticism arising from negatively biased appraisals of their performance.

Question 19

What is clinical perfectionism?

Answer 19

over-evaluation of the striving for, and achievement of, personally demanding standards, despite adverse consequences.
System for self-evaluation in which self-worth is judged largely on the basis of striving to achieve demanding goals and success at meeting them.

Question 20

What is the new cogntiive behavioural theory of the maintenance of bulimia nervosa?

Answer 20

The new theory represents an extension of the original theory.

The first of these additional maintaining mechanisms concerns the influence of severe perfectionism; the impact of unconditional and pervasive low self-esteem; difficulty coping with intense mood states; and the fourth is interpersonal and developmental in character

Question 21

What are the effects of CBT BN?

Answer 21

CBT-BN has a substantial effect on the frequency of binge eating and purging, and the full range of the psychopathology of bulimia nervosa. Among treatment completers (typically 80 to 85%), between 40–50% cease binge eating and purging altogether. These patients generally improve in all respects, and it seems that most remain well in the long-term.

CBT-BN is more effective than both delayed treatment and pharmacotherapy.

Question 22

What does the cognitve behavioural thoery underpin?

Answer 22

CBT BN concerned with the processes which maintain bulminia nervosa.
The thoery: maintenance of bulimia nervosa is a dysfunctional system for evaluating self-worth. Whereas most people evaluate themselves on the basis of their perceived performance in a variety of domains of life, people with eating disorders judge themselves largely, or even exclusively, in terms of their eating habits, shape or weight and their ability to control them.
As a result, their lives become focused on their eating, shape and weight, with dietary control, thinness and weight loss being actively pursued whilst overeating, ‘fatness’ and weight gain are assiduously avoided.