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Eating Disorders 2


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Characteristics of anorexia nervosa
Refusal to maintain normal body weight

Intense fear of gaining weight

Disturbance in the way one’s body weight or shape is experienced

Characteristics of bulimia
Recurrent episodes of binge eating

Inappropriate compensatory behavior (i.e., self-induced vomiting, misuse of laxatives)

Self-evaluation unduly influenced by body shape and weight
Age of onset

Recovery rates

Ego syntonic vs. ego dystonic
Binge Eating Disorder
CBT (similar to CBT for BN)

Interpersonal Therapy (IPT)

Nutritional Counseling

Weight loss programs
Related disorders to eating disorders
Body Image Dissatisfaction

“Reverse Anorexia” / Muscle Dysmorphia

Body Dysmorphic Disorder
Co-morbid Issues with EDs
Self-harm behaviors
Substance abuse
Anxiety and OCD spectrum disorders
Trauma history
Personality disorders
The role of the toxic environment on EDs
Epidemic of obesity
Poor food choices available to children
Unhealthy foods marketed to children, even in schools
Sedentary communities
Difficulty of managing weight
Risk factors for EDs
Childhood obesity

Parental criticism of weight and shape

Perfectionism and “All or none” thinking

Participation in appearance focused activities
Precipitating Events with EDs
Major life transitions

Family / Social / Romantic problem

Failure (school, work, competition)

Traumatic event
Why do symptoms develop with EDs?
Body dissatisfaction leads to extreme dietary restraint, which leads to binge-eating

Symptom behaviors relieve low mood/anxiety

Symptom behaviors help manage interpersonal difficulties
Theoretical Approaches to Treatment for EDs
Cognitive-behavioral therapy
Interpersonal therapy
Psychodynamic therapy
Family Systems therapy
Maudsley Model
Cognitive Behavioral Therapy for Bulimia Nervosa
Self monitoring/assessment
Structured meal plan
Coping skills for managing distressing emotions
Substitute healthier behaviors
Work on identifying and altering cognitive distortions
Treating Anorexia: An Evolution
The early years: Psychoanalytic models, separation of child and family

The middle years: long hospitalizations, family systems models

Currently: Maudsley model, working collaboratively with families
Treatment of Obesity in Children
A family affair

Modification of the food environment

Creating opportunities to be active

Extremely difficult to treat
When to hospitalize for EDs...
Trend toward fewer and shorter hospitalizations
Insurance driven vs data driven
Medical vs psychiatric issues
Generalizability of treatment
Ego-syntonic nature of anorexia
Characteristics of an Effective Prevention Program
Targets girls age 15+
Of longer duration (3+ sessions)
Targets girls with one or more risk factors
Is interactive rather than didactic
Does not focus on psychoeducation
Focuses on building self-esteem, efficacy, self-confidence
What hormones control hunger and satiety ?
Leptin - Suppresses appetite
Ghrelin – Enhances appetite
What is the biology of hunger?
Hypothalamus regulates hunger and satiety in separate centers
Hunger is mostly controlled by glucose level
Satiety is regulated by cholecystokinin
Produced in fat cells In direct proportion to the amount of stored energy
Provides feedback to hypothalamic appetite centers
Regulates body weight
Promotes satiety
Decreases appetite
Decreases the synthesis of fat
Increases the body's ability to burn fat
Obese people
A surplus of leptin, but unresponsive to effects
Stimulates feeding
Produced in stomach and hypothalamus
Increased levels with:
Weight loss
Reduced caloric intake
Stimulates reward pathway in VTA
Anorexia- Analytic Theory
Mother - Child is extension of ego
Father - Seeks nurturing from daughter
Patient is exerting independence and punishing parents simultaneously
Makes others feel greedy and helpless
Bulimia- Pathogenesis
Child Sexual Abuse
Parents described as rejecting and neglectful
More distant with more conflict than anorexia
Cognitive Distortions
Selective abstraction

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