Podcast
Questions and Answers
What is a key characteristic that differentiates normal eating from an eating disorder?
What is a key characteristic that differentiates normal eating from an eating disorder?
- Eating only when hungry
- An obsessive focus on nutritional value (correct)
- Flexibility in food choices
- A variety of foods consumed
Which term describes the type of eating that can occur without fitting into a specific eating disorder diagnosis?
Which term describes the type of eating that can occur without fitting into a specific eating disorder diagnosis?
- Disordered eating (correct)
- Uncontrolled eating
- Habitual eating
- Erratic eating
What is one aspect of normal eating as described in the content?
What is one aspect of normal eating as described in the content?
- Multiple meals and snacks throughout the day (correct)
- Skipping meals to maintain weight
- Consistency in meal timing every day
- Strict adherence to a specific diet plan
Which of the following is NOT mentioned as a goal in understanding eating disorders?
Which of the following is NOT mentioned as a goal in understanding eating disorders?
Which of these is considered an important resource for individuals dealing with eating disorders?
Which of these is considered an important resource for individuals dealing with eating disorders?
What primarily influences food choices in normal eating?
What primarily influences food choices in normal eating?
What is a common emotional response associated with disordered eating?
What is a common emotional response associated with disordered eating?
Which of the following is a characteristic of eating disorders?
Which of the following is a characteristic of eating disorders?
Which eating disorder was first published about in 1873 by Sir William Gull?
Which eating disorder was first published about in 1873 by Sir William Gull?
Which of the following eating disorders was included in the 5th edition of the DSM in 2013?
Which of the following eating disorders was included in the 5th edition of the DSM in 2013?
What is a key difference between disordered eating and eating disorders?
What is a key difference between disordered eating and eating disorders?
How does disordered eating typically affect social eating situations?
How does disordered eating typically affect social eating situations?
What is a prevalent feeling associated with eating disorders?
What is a prevalent feeling associated with eating disorders?
What is the primary recommended treatment for Anorexia Nervosa in Young Adults in the UK?
What is the primary recommended treatment for Anorexia Nervosa in Young Adults in the UK?
Which of the following is NOT a typical treatment method for Bulimia Nervosa?
Which of the following is NOT a typical treatment method for Bulimia Nervosa?
What treatment approach is shared among both Young Adults and Adults for Binge Eating Disorder?
What treatment approach is shared among both Young Adults and Adults for Binge Eating Disorder?
Which factor is crucial for weight restoration in treating Anorexia Nervosa?
Which factor is crucial for weight restoration in treating Anorexia Nervosa?
What is a significant psychological challenge that Charlie might be facing?
What is a significant psychological challenge that Charlie might be facing?
What was a significant issue highlighted regarding patients with eating disorders?
What was a significant issue highlighted regarding patients with eating disorders?
What is emphasized as crucial for increasing adherence in care for eating disorders?
What is emphasized as crucial for increasing adherence in care for eating disorders?
Which model is mentioned as part of culturally appropriate screening tools for eating disorders?
Which model is mentioned as part of culturally appropriate screening tools for eating disorders?
What approach is suggested for improving the identification of eating disorders among Indigenous populations?
What approach is suggested for improving the identification of eating disorders among Indigenous populations?
What challenge is associated with the management and treatment of eating disorders?
What challenge is associated with the management and treatment of eating disorders?
Which of the following is an important factor when considering body image ideals in populations?
Which of the following is an important factor when considering body image ideals in populations?
In the context of improving identification pathways for eating disorders, which question is suggested for reflection?
In the context of improving identification pathways for eating disorders, which question is suggested for reflection?
What is a key question regarding the treatment of eating disorders?
What is a key question regarding the treatment of eating disorders?
What was the primary focus of Ancel Keys' research during the Minnesota experiment?
What was the primary focus of Ancel Keys' research during the Minnesota experiment?
Which of the following changes was observed during the restrictive phase of the Minnesota experiment?
Which of the following changes was observed during the restrictive phase of the Minnesota experiment?
What is a limitation of Cognitive Behavioral Therapy for Eating Disorders (CBT-ED)?
What is a limitation of Cognitive Behavioral Therapy for Eating Disorders (CBT-ED)?
In the Minnesota experiment, what calorie intake was maintained during the semi-starvation phase?
In the Minnesota experiment, what calorie intake was maintained during the semi-starvation phase?
Which of the following does NOT reflect changes experienced by participants during the Minnesota experiment's restrictive phase?
Which of the following does NOT reflect changes experienced by participants during the Minnesota experiment's restrictive phase?
Which factor is NOT included in the psychological and dispositional factors associated with eating disorders?
Which factor is NOT included in the psychological and dispositional factors associated with eating disorders?
What is a significant sociocultural influence on body image and eating disorders?
What is a significant sociocultural influence on body image and eating disorders?
Which age group has the highest prevalence of Bulimia Nervosa (BN)?
Which age group has the highest prevalence of Bulimia Nervosa (BN)?
Which statement regarding the transdiagnostic model of eating disorders is accurate?
Which statement regarding the transdiagnostic model of eating disorders is accurate?
What impact does weight stigma have on individuals with eating disorders?
What impact does weight stigma have on individuals with eating disorders?
What genetic component is associated with the etiology of eating disorders?
What genetic component is associated with the etiology of eating disorders?
Which psychological trait is associated with an increased risk of developing eating disorders?
Which psychological trait is associated with an increased risk of developing eating disorders?
What is the approximate comorbidity percentage of anxiety disorders across eating disorders?
What is the approximate comorbidity percentage of anxiety disorders across eating disorders?
Flashcards
Normal Eating: Regularity
Normal Eating: Regularity
Regular eating involves multiple meals and snacks throughout the day, paying attention to feelings of hunger and fullness.
Normal Eating: Balance
Normal Eating: Balance
A balanced diet includes a variety of foods that offer nutritional value and taste.
Normal Eating: Flexibility
Normal Eating: Flexibility
Flexible eating allows for adjustments based on situations, like different time constraints or available food options.
Eating Disorder vs. Disordered Eating: What's the difference?
Eating Disorder vs. Disordered Eating: What's the difference?
An eating disorder is a serious mental health condition that involves extreme eating behaviors and a distorted body image.
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Eating Disorder vs. Disordered Eating: What's the difference?
Eating Disorder vs. Disordered Eating: What's the difference?
Disordered eating refers to unhealthy eating habits that are not as severe or pervasive as a full-fledged eating disorder.
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Disordered Eating
Disordered Eating
An eating pattern characterized by a strong desire to maintain a specific weight or body shape, often leading to feelings of guilt and shame around food and eating.
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Anorexia Nervosa
Anorexia Nervosa
A serious mental health condition characterized by extreme food restriction, an intense fear of gaining weight, a distorted body image, and persistent thoughts about food.
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Bulimia Nervosa
Bulimia Nervosa
A serious mental health condition characterized by recurrent episodes of binge eating followed by purging behaviors, such as self-induced vomiting, excessive exercise, or misuse of laxatives.
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Binge Eating Disorder
Binge Eating Disorder
A serious mental health condition characterized by recurrent episodes of binge eating, which are marked by eating large amounts of food in a short period of time and a feeling of lack of control over eating.
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Normal Eating
Normal Eating
A pattern of eating that is largely influenced by hunger and preference, without significant guilt or shame.
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Diagnosis and Classification of Eating Disorders
Diagnosis and Classification of Eating Disorders
The official classification and diagnosis of eating disorders, including their symptoms and criteria, is published in the Diagnostic and Statistical Manual of Mental Disorders.
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Eating Disorder
Eating Disorder
A set of criteria and characteristics that define a specific eating disorder.
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Purging
Purging
The act of intentionally removing food from the body after eating, often through self-induced vomiting, excessive exercise, or misuse of laxatives.
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Gap in Care for Moderately Ill Patients
Gap in Care for Moderately Ill Patients
Individuals experiencing moderate illness, falling between outpatient and inpatient care, often struggle to access appropriate treatment due to lack of suitable resources.
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Hui Process
Hui Process
A method for building trust and understanding within a community, particularly among indigenous populations.
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Culturally Appropriate Screening Tools
Culturally Appropriate Screening Tools
Tools designed to identify eating disorders, taking into account cultural backgrounds and specific needs.
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Acculturation
Acculturation
A process of understanding and integrating cultural norms and practices.
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Meihana Model
Meihana Model
A framework that considers the physical, mental, spiritual, and social well-being of individuals.
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Co-design
Co-design
The process of jointly creating interventions or solutions with those directly affected by the issue.
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Conceptualization of EDs by Indigenous Populations
Conceptualization of EDs by Indigenous Populations
The recognition of eating disorders within specific cultural groups, taking into account their unique experiences.
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Translating Interventions Across Cultures
Translating Interventions Across Cultures
The adaptation of an intervention or approach from one context to another, considering cultural and societal differences.
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Anorexia Nervosa Treatment (YA)
Anorexia Nervosa Treatment (YA)
A NICE-recommended treatment for Anorexia Nervosa in young adults involves family therapy, talking therapies like CBT-ED or MANTRA, and weight restoration, which may include inpatient stays and nasal refeeding.
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Anorexia Nervosa Treatment (Adult)
Anorexia Nervosa Treatment (Adult)
In adults with Anorexia Nervosa, NICE recommends talking therapies (CBT-ED, MANTRA) and weight restoration, which might involve inpatient treatment. Psychoeducation is also emphasized.
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Bulimia Nervosa Treatment
Bulimia Nervosa Treatment
NICE recommends guided self-help with cognitive behavioral self-help materials and CBT-ED for adults with Bulimia Nervosa. Family therapy may be used for young adults. Inpatient treatment involving nasal refeeding can be employed if weight is low.
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Binge Eating Disorder Treatment
Binge Eating Disorder Treatment
For Binge Eating Disorder, NICE recommends guided self-help with cognitive behavioral self-help materials and CBT-ED. The treatment approach is the same for both young adults and adults.
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Charlie's Potential Diagnosis
Charlie's Potential Diagnosis
Charlie might have Binge Eating Disorder, experiencing loss of control over eating, guilt and shame around food, low mood, lack of motivation and difficulty engaging in activities.
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Transdiagnostic Approach to EDs
Transdiagnostic Approach to EDs
A transdiagnostic approach to EDs focuses on the common underlying psychological processes, like body image dissatisfaction, dieting, and emotional dysregulation, rather than focusing on specific ED diagnoses.
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Diagnostic Drift in EDs
Diagnostic Drift in EDs
Diagnostic drift refers to the tendency for individuals with EDs to be misdiagnosed or re-diagnosed over time, often due to shifting symptom presentation or diagnostic criteria.
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Genetic Influence on EDs
Genetic Influence on EDs
Genetic factors play a role in the development of EDs. This includes familial risk, meaning those with a family history of EDs are more likely to develop one, and twin studies that have shown higher concordance rates for EDs among identical compared to fraternal twins.
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Neurobiological Factors in EDs
Neurobiological Factors in EDs
Neurobiological factors, particularly serotonin function in the brain, are implicated in EDs. Changes in serotonin levels might affect appetite, mood, and impulse control, potentially influencing ED behaviors.
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Tripartite Model of EDs
Tripartite Model of EDs
The tripartite model of EDs highlights three key factors influencing their development: 1) Biological vulnerability (genetic and neurobiological), 2) Psychological factors (personality traits like perfectionism and low self-esteem), and 3) Social-cultural factors (media influence and societal beauty standards).
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Media & Diet Industry Influence on EDs
Media & Diet Industry Influence on EDs
The media and diet industry often promote unrealistic beauty standards, promoting thinness for women and muscularity for men. Weight stigma, or the prejudice against overweight individuals, further contributes to disordered eating and body dissatisfaction.
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Weight Stigma and EDs
Weight Stigma and EDs
Weight stigma is the negative attitude and prejudice towards people who are overweight or obese. It can lead to shame, discrimination, and social isolation, which contribute to body dissatisfaction, unhealthy dieting, and the development of EDs.
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Psychological Factors in EDs
Psychological Factors in EDs
Psychological and dispositional factors, including personality traits like perfectionism, low self-esteem, and high introspective awareness, can contribute to the development of EDs.
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Minnesota Starvation Experiment
Minnesota Starvation Experiment
A research study conducted in the 1950s by Ancel Keys at the University of Minnesota that investigated the effects of severe starvation and subsequent rehabilitation on human subjects. It involved a group of healthy young men who were deliberately subjected to semi-starvation for six months and then re-fed for another three months. The study revealed how profound starvation can affect physical, psychological, and social aspects of individuals.
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Semi-starvation
Semi-starvation
A period of extreme food restriction that deliberately reduces caloric intake significantly, often to a point where the body enters a state of starvation. It's characterized by a dramatic decrease in energy levels, weight loss, and a wide range of psychological, physiological, and social consequences. Experimentally, it allows investigating the impact of starvation on the human body and mind.
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CBT-ED (Cognitive Behavioral Therapy for Eating Disorders)
CBT-ED (Cognitive Behavioral Therapy for Eating Disorders)
A type of therapy used to address eating disorders by focusing on the interplay between thoughts, feelings, and behaviors. It involves identifying and challenging distorted thinking patterns, learning coping mechanisms, and developing healthier behaviors around eating. It also helps individuals develop a more positive body image and improve their self-esteem.
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Psychoeducation
Psychoeducation
The provision of information and education about a particular condition, in this case, eating disorders. It aims to increase understanding of the disorder, its causes, symptoms, and treatment options. This information empowers individuals with knowledge and skills to manage their condition and make informed decisions about their care.
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Long-Term Effectiveness of CBT-ED
Long-Term Effectiveness of CBT-ED
A limitation of CBT-ED, referring to the effectiveness of the therapy over a prolonged period. It raises questions about how well the positive effects of CBT-ED hold up in the long run.
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Eating Disorders Lecture Notes
- Eating disorders are covered in Introduction to Clinical Psychology (PSY1204) - Lecture 6.
- Dr Fidan Turk's contact details and office hours are given.
- Stella Kozmér's contact details and office hours are provided.
- A visual image of an apple is included.
Lecture Outline
- Definitions of eating disorders
- Historical landmarks in eating disorders study
- Classification of eating disorders
- Risk factors and etiology of eating disorders
- Epidemiology and prevalence of eating disorders
- Identification of eating disorders
- Management and treatments for eating disorders
Learning Outcomes
- Understanding eating disorders
- Identifying differential characteristics of eating disorders diagnoses.
- Understanding risk factors and prevalence of eating disorders.
- Gaining knowledge of available treatments for eating disorders (EDs).
Reminder
- Take care of your well-being.
- Well-being services, support channels, and a contact are available at University of Exeter.
- BEAT (Beating Eating Disorders) and GP services are mentioned as resources.
What Does Normal Eating Look Like?
- Eating regularly with multiple meals and snacks
- Feeling hunger and fullness
- Eating a balanced diet with variety of foods and nutrients
- Adapting to situations and foods as needed.
Differences Between Normal and Disordered Eating
- Normal Eating: Food choices primarily motivated by hunger and preference; no guilt or shame associated with eating; no difficulty eating in social situations.
- Disordered Eating: Food choices strongly influenced by weight or body image goals; guilt or shame often associated with eating; avoidance or difficulty eating in social situations.
- Eating Disorders: Food choices are driven by weight loss goals and concerns associated with restricted eating, binging, or purging. Guilt, shame, avoidance, or attendance of social situations involving food.
Historical Landmarks
- 15th Century: Anorexia nervosa was first noted.
- 1873: Sir William Gull described anorexia nervosa.
- 1979: Bulimia nervosa was formally recognized.
- 2013: Binge eating disorder was added to the DSM-5.
- Other figures/dates: Gerald Russell described the "ominous course" of anorexia, a phrase included in the DSM-5.
Diagnosis and Classification of EDs
- Information regarding the differences between DSM-IV and DSM-5 criteria for eating disorders.
- Information about ICD-11 will be taught.
- Relevant information about diagnostic drift may be discussed
Types of Eating Disorders
- DSM-V: Binge Eating Disorder (BED), Bulimia Nervosa (BN), Anorexia Nervosa (AN), Pica, Rumination disorder, Avoidant/restrictive food intake disorder, Other specified feeding or eating disorder (OSFED)
- Additional conditions: Orthorexia nervosa (under consideration), Bigorexia (muscle dysmorphia), Emotional overeating, Diabulimia, and Obesity.
Specific Types of Eating Disorders
- Anorexia Nervosa: Characterized by refusal to maintain a minimally healthy body weight.
- Restricting or Binging/Purging subtypes.
- Bulimia Nervosa: Marked by repeated episodes of binge eating followed by compensatory behaviors.
- Self-induced vomiting, laxative or diuretic use.
- Binge Eating Disorder: Repetitive episodes of uncontrolled eating followed by feelings of guilt, distress, or shame.
Transdiagnostic Approach
- Presentation of a circular graphic illustrating the relationship between eating disorders and no eating disorders.
- No eating disorders versus other eating disorders with specific percentages.
- Information about the inter-dependency.
- Information about eating disorders are discussed.
- Overview and different approaches will be given.
Etiology of Eating Disorders
- Risk factors and onset timeline
- Ethnic background and gender, and cultural differences
- Biological and psychological risk factors
- Sexual abuse and physical neglect
- Gastrointestinal difficulties, picky eating, and pica eating
- Discussion about timelines and potential risk factors
Genetic Influence
- Genetic components influence eating disorders
- Familial risk involved in eating disorders
- Interaction of genetic dispositions and individual experiences
Neurobiological Factors
- Brain and serotonin function relate to changes in appetite, mood, and impulse control in eating disorders.
- Discussion of tryptophan depletion.
Sociocultural Influences
- Impact of social groups
- Thin ideal internalization, appearance comparison, and body dissatisfaction can lead to eating disorders.
- Media influence on sociocultural impacts
Tripartite Model of Eating Disorders
- Diagram illustrating the interplay of peer influences, partner influences, familial influences, thin ideal internalization, appearance comparison, body dissatisfaction, and disordered eating.
Influence of Peers on Body Image and Eating Disorders
- Peer group pressure to tease others that have weight issues
- Friends who are on diets
- Peer group pressures to conform to body and eating habits
- Discussion about weight-related teasing, fat talk, and peers being on diets
Diet Industry and Media
- Unrealistic appearance ideals in media
- The association of thinness ideals with eating disorders
- Weight Stigma and the societal perception of ideal body types
Weight Stigma
- The idea that being "fat" is harmful
- Leads to severe body dissatisfaction to address the discomfort/shame associated with being "fat"
- Leads to long-term dieting behaviours
Psychological and Dispositional Factors
- Perfectionism, shyness, neuroticism
- Low self-esteem
- High introspective awareness of bodily sensations
- Negative or depressed affect
- Dependence and non-assertiveness
Dysfunctional Scheme for Self-Evaluation
- Model illustrating the relationship between over-evaluation of eating, shape, and weight, perfectionism, low self-esteem, and eating disorders
- Diagram shows mood intolerance and its relationship to behaviors, compensatory behaviours, dieting and other weight control behaviours, and feelings.
Prevalence and Epidemiology
- Statistical data on the evolution of prevalence of eating disorders, including an increase in rates for Anorexia Nervosa (AN), Bulimia Nervosa (BN), Atypical AN, Atypical BN, Binge Eating Disorder (BED), EDNOS, and All ED categories.
- Galmiche et al., 2019's work
Special Issues for Men
- Drive for muscularity
- Eating different to bulk up
- Exercise, including bradycardia
Community Study Prevalence in the UK
- Community study of eating disorders in the UK (Solmi et al., 2016)
- Reported prevalence figures for Eating Disorders (EDs), Binge Eating Disorder (BED) and Bulimia Nervosa (BN) and specific age groups
Comorbidity
- Anxiety and mood disorders are common in individuals with eating disorders
- Impulsivity, including substance use disorders and borderline personality disorder, frequently co-occurs with bulimia nervosa (BN).
- Obsessive-compulsive disorder (OCD) is more common in anorexia nervosa (AN) in comparison to individuals with bulimia nervosa (BN).
- Relationship between eating disorder (EDs) and mood and anxiety disorders.
- Impulsivity and other diagnoses like substance use disorders and borderline personality disorder in relation to Eating disorders.
- Relationship between OCD and Anorexia Nervosa and Bulimia Nervosa
Identification of EDs
- Discussion point on Case studies and identification of eating disorders in patients (Alex)
- Focus on what clinicians do in different situations, and identifying EDs.
Case Study 1
- Describes a patient experiencing anxiety and their concerns about weight and eating.
Case Study 2
- Presents Charlie, a 27-year-old seeking support due to disordered eating behaviours and their link to low mood and lack of motivation.
Importance of Tackling Eating Disorders Holistically
- Minnesota experiment (Keys, 1950): Illustrates how harmful starvation is on the mind, body, and personality.
- Overview of the experiment
Changes During Restrictive Phase
- Preoccupation with food, changes in eating behavior, emotional and cognitive changes, and social and physical changes
- Explanation of these factors
Back to Charlie... CBT-ED
- Goal-focused talking therapy (NICE) for eating disorders
- Addresses how thoughts influence behaviours.
- Explains Cognitive Behavioral Therapy and its stages.
Etiology Model
- Diagram showing the relationship between low self-esteem and high negative affect, dieting, bingeing, and compensatory behaviours in bulimia nervosa.
Example of Psycho-education
- InsideOut eClinic
- Online psychological support materials are available
- Graphic illustrating fluctuations in feelings about weight
Limitations of CBT-ED
- Discusses the long-term effectiveness and suitability
- Common comorbidities, lack of focus on interpersonal relationships, dietary restraint, and service delivery can limit the impact during treatment
Future Directions
- Collaborative and integrated care of multiple conditions.
- Improving digital systems and technology to help individuals with food and other health-related support.
- Using data and digital health tools.
- Discussion about improving accessibility, early intervention, and mixture of techniques in relation to Eating disorder care.
Collaborative and Integrated Care
- Pathways for eating disorders co-occurring with autism and ADHD
- Discussion of communication strategies
- Focus on incorporating wellbeing and collaborative care
Psychedelics and EDs
- Use of psychedelics across the globe for eating disorders
- Primarily Anorexia Nervosa (AN)-focused trials
- Limitations in generalizability
FoodT App
- App-based food-specific inhibitory control training
- Useful tool in treating binge-type eating disorders
- Discusses digital health use in eating disorder treatment
Recovery Record
- Online tool/record to log daily activities and feelings about eating
- The tool aids in recording eating behaviors for individuals seeking recovery.
Practical Steps for Weight Management
- Discussion about obesity-related medical help and dietary adjustments.
- Ozempic/Wegovy and calorie labelling in eating disorder treatments
- Discussion about HAPIFED- obesity management for BED /BN
Questions?
- Encourages questions
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