Eating Disorders (What are some psychological treatments for anorexia…
What are some psychological treatments for anorexia (CBT)
get patients to accept treatment
new eating patterns
operant condition used for weight gain
anorexia is usually treatment inpatient
few treatment affect studies
resistance to treatment
drop out rate
involuntary treatment not uncommon
more death 6-7 years later
no evidence of more positive effects than CBT
What are some demographic risk factors?
binging - males
adolescence / young adulthoof
food is plentiful
sociocultural pressures for idealised body image eg barbie
genetic predisposal - twin studies high concordance
What are some personality risk factors?
What is the development / course of eating disorders?
often follows period of restricted eating
fewer than 50% fully recover
AN can become chronic life threatening problem
An has the highest mortality rate of any psychopathology, 1/5 deaths are suicide
stressful life events (An)
worse for A than B, worse within A with later onset
worse within Bul with childhood trauma / childhood obesity, low self esteem
Inappropriate weight compensatory factors?
must occur weekly over 3 months min
most common is s i v followed by laxative misuse
80% report s i v
30% report lax mis
50% vommit daily
purging temporarily reduces distress of binging
exercise is common but less extreme than anorexia
What is the interpersonal model of bulimia?
therapy focused on resolving difficulties
low self esteem / distress
eating to cope
focus on improving social skills
tolerance of emotions
after 18 weeks: CBT looks best
after 12 months: interpersonal therapy is best
CBT better than IPT
medical problems associated with Anorexia
low bone density
growth of fine hair
What is the DSM criteria for bulimia?
occurs at least weekly for 3 months
recurrent episodes of binge eating
a lot within 2 hrs, sense of lack of control
recurrent inappropriate compensatory behaviours avoiding weight gain eg laxatives
self evaluation based on weight
doesn't better meet criteria for any other eating disorder
What are some facts about binge eating?
intake high as 40,000
average 1.18 hours
emotional turmoil follows
How prevalent is over estimation of weight in A and B
much higher percent in EDNOS
more common in females than males
What factors contribute to low body weight with anorexia ?
intense fear of fat
What is used as an indicator?
refusal to maintain a normal weight
what does this result in?
What are factors within anorexia
self perception of being too fat
unlikely to come forward as weight loss is an achievement
What did Fairburn 00s say about similarities and difference between An and Bul
AN and BN have a lot in common
over evaluation of shape, weight, and its control
binging doesn't separate the two AN subgroup who binge
also purging vs exercising
main difference: bulimia has relative balance of under / over eating and resulting weight can be normal
Describe the cognitive formulation of anorexia
extreme need for self control which becomes eating focused
self control need stems from perfectionism and low self esteem
diet offers evidence of self control and success
adolescence onset could reflect loss of control with puberty
What are the three mechanisms maintaining anorexia
perfectionist standards met
phys / psych of starvation promote it further
intense hunger threatens self control
so does imparied concentration
control of eating = self worth
extreme concerns about shape
culturally specificto where thin = value
always checking = always noticing
rate of weight loss declines
What are maintaining mechanisms of bulimia in some cases?
perfectionism, self worth on success at achieving goals
using binging to cope, mood intolerance
core self esteem
medical problems associated with bulimia
homeo fluid disrup
How does CBT for bulimia work?
establish stable eating pattern
focus on shape / wight concerns
What are the DSM criteria for Anorexia nervosa?
disturbed experience of own body wieght
intense fear of gaining weight
restriction of relative required energy intake resulting in contextually low body weight
What is the cognitive formation of bulimia?
the core maintenance factor is over evaluation of shape and weight (as opposed to self control)
What was new to the DSM 5?
a severity specifier
What is the success rate of CBT
CBT vs waiting list controls
remission 4 weeks later
40% vs 5%
What can be used if the patient also has panic disorder of another cluster c disorder?
the enhanced CBT
What are the four stages of ECBT for BMI 15-40
introduce pattern of regular eating self monitored
relapse prevention by highlighting triggers and strtegies
focus on over evaluation of shape and weight, agree on activities and ensure completion
for underweight phase 1 is different, how?
its longer and about weight gain vs just regulation
also the overall goal is not weight gain
how good is CBT-E at producing desired result?
way better than IPT