Eating Disorders

• Eating disorders


  Persistent disturbance of eating or eating-related behavior that results in altered consumption or absorption of food and significantly impairs physical health or psychosocial functioning
• Specific diagnoses


  • Anorexia Nervosa
  • Bulimia Nervosa
  • Binge-Eating disorder
  • Pica
  • Rumination Disorder
  • Avoidant/restrictive food intake disorder

  
• Anorexia Nervosa


  • Restriction of energy intake leading to significantly low body weight
  • Intense fear of gaining weight or becoming fat, or persistent behavior that interferes with weight gain
  • Disturbance in the way in which one's body weight or shape is experienced

  
• Anorexia Nervosa Specifiers


  • Restricting type: Weight loss is accomplished primarily through dieting, fasting, and/or excessive exercise
  • Binge-eating/purging type: Engaged in recurrent episodes of binge eating or purging behavior

  
• Anorexia Nervosa Severity


  • Mild: BMI >/= 17 kg/m2
  • Moderate: BMI 16-16.99 kg/m2
  • Severe: 15-15.99 kg/m2
  • Extreme: < 15kg/m2

  
• Anorexia Nervosa


  • Persistent energy intake restriction
  • Fear of becoming fat or behaviors that interfere with gain
  • Experience of body shape/weight are distorted
• Anorexia Nervosa


  • Self-esteem often based on weight
  • Individuals often brought in by family members/friends
  • Can lead to life-threatening medical conditions
• Anorexia Nervosa Prevalence
• Anorexia Nervosa is a very dangerous disorder
• Bulimia Nervosa


  Recurrent episodes of binge eating and recurrent inappropriate compensatory behaviors in order to prevent weight gain

  
• Bulimia Nervosa Severity


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

  
• Bulimia Nervosa


  • Loss of control may not be absolute
  • Tend to crave foods they would otherwise avoid
  • Typically ashamed of the behavior

  
• Bulimia Nervosa Compensatory Behaviors


  • Most common is vomiting
  • Others include laxatives, diuretics, enemas, thyroid hormone, reducing insulin, fasting, and exercise
• Bulimia Nervosa Prevalence
• Binge-Eating Disorder


  Recurrent episodes of binge eating with a sense of lack of control, associated with 3+ specific behaviors, and marked distress

  
• Binge-Eating Disorder Severity


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

  
• Binge-Eating Disorder Prevalence

  
• Family-Based Treatment for AN (Maudsley Approach)


  • Strong Research Support (div 12 of APA)
  • For adolescents with AN
• How does Family-Based Treatment for AN work?

  1. Weight Restoration

  2. Returning control over eating to the adolescent

  3. Establishing healthy adolescent identity
• Weight Restoration


  Therapist helps parents to take a more active role in getting their child to eat more. Starvation is not an option. This is done with empathy and understanding while still maintaining that the child eat
• Returning control over eating to the adolescent

  Therapist helps parent encourage the child to take back control over their eating once the child has accepted phase 1, is eating, and the family system is working more functionally
• Establishing healthy adolescent identity

  • Initiated when the child is able to maintain weight above 95% ideal weight
  • Focuses on central issues of the adolescent and work to support personal autonomy, appropriate parental boundaries, and parent's working on their own life after the child's prospective departure
• Cognitive-Behavioral Therapy for Anorexia Nervosa

  • Modest Research Support for Post-Hospitalization Relapse Prevention
  • Designed for late adolescents and adults
  • Conducted in individual format
  • Biweekly is recommended until weight is stable
  • Focused on: Behavioral strategies, Exposure to forbidden foods, Addressing cognitive aspects, Motivation for change, Disturbance in experience of shape and weight
• Interpersonal Psychotherapy for Bulimia Nervosa


  • Strong Research Support
  • Based on treatment originally created for depression
  • Focus on interpersonal difficulties in individual's life
  • Roughly 20 weekly sessions in 3 phases: 1. Identify interpersonal problems, 2. Individual encouraged to take the lead in facilitating change, 3. Maintenance of gains and relapse prevention
  • Slower symptoms improvement and resolution than CBT
• Other supported treatments for Bulimia Nervosa


  • Family-based therapy (Modest Research support)
  • Healthy-weight program (Controversial research support)
• Cognitive-Behavioral Therapy for Binge-Eating Disorder


  • Strong Research Support
  • Dietary restraint promotes and maintains binge eating pathology
  • Treatment is designed to reduce dietary restraint through behavioral strategies: Self-monitoring of behaviors, Normalizing patterns of eating, Modifying dysfunctional thoughts and beliefs about shape and weight
• Interpersonal Psychotherapy for Binge-Eating Disorder


  • Strong Research Support
  • Focus on interpersonal difficulties that lead to binge-eating behaviors