Task 7: The Diet Paradox PDF

Task 7: The diet paradox DSM-5 & Davey (Chapter 10) & Nolen-Hoeksema (Chapter 12) Characteristics of Eating Disorder Anorexia Nervosa → starve themselves, little or no food for long periods, yet remain convinced that they need to lose more weight (A),...

Task 7: The diet paradox DSM-5 & Davey (Chapter 10) & Nolen-Hoeksema (Chapter 12) Characteristics of Eating Disorder Anorexia Nervosa → starve themselves, little or no food for long periods, yet remain convinced that they need to lose more weight (A), → extreme weight loss often causes amenorrhea - stopping menstrual periods, → distorted images of their body (C), → feel good when they have control over eating and weight (B), → weight loss also causes them to be chronically fatigued, yet they drive themselves to exercise or keep up a grueling schedule, → often develop rituals around food, Subtypes: restrictive type of AN - refuse to eat and/or engage in excessive exercise to prevent weight gain, → go days without eating anything, or eat small amounts of food each day to stay alive and in response to pressure from others to eat. binge/purge type of AN - people periodically engage in binge eating or purging behaviors (e.g. vomiting, misuse of laxatives or diuretics), → people typically are at a normal weight or somewhat overweight. Level of Severity/Determination of Low Weight: mild if BMI ≥ 17 kg/m2, moderate if BMI = 16–16.99 kg/m2, severe if BMI = 15–15.99 kg/m2, extreme if BMI < 15 kg/m2, → ! level of severity is not based ONLY on BMI, can be adjusted based on; clinical symptoms, degree of functional disability, need for supervision. Prevalence; 0.9% in adult women, 0.3% in adolescent girls, lower among male with 0.3%, with DSM-5 there were higher 0.8% by 20, 4% woman. Comorbidity; → dangerous disorder with a death rate of 5-9%, → serious consequences: cardiovascular complications, including bradycardia (extreme slowing of heart rate), arrhythmia (irregular heart beat), and heart failure, acute expansion of the stomach, to the point of rupturing, bone strength for women who have amenorrhea, Kidney damage, impaired immune system functioning —> more vulnerable to medical illnesses, → suicide rates is 31 times higher than in the general population. DSM- 5 Criteria Task 7: The diet paradox 1  Bulimia Nervosa → uncontrolled eating, bingeing (A), followed by behaviours intended to prevent weight gain (B), → mild presentation include ˜ 1-3 episodes per week, more extreme forms involve ˜ 14 or more, → variation in size of binges; some consume ˜ 3,000 - 4,000 calories in a sitting, others ˜ 1,200 - 2,000, → self evaluations are heavily influenced by body shape and weight, constantly dissatisfied, → has a more realistic perception of body shape and weight, do not tend to have gross distortions, → often discovered by people around them due to vomiting, also discovered by dentists since frequent vomiting can rot teeth, Prevalence; due to loosened criteria of DSM-5, lifetime prevalence is up to 2.6% among woman, more common in females, more common in westernised cultures, increased significantly in the second half of the 20th century. Onset; often occurs in adolescence. Comorbidity; serious medical complications: electrolyte imbalance that can lead to heart failure, suicide rate is 7.5 times higher than in the general population. DSM-5 Criteria Binge-Eating Disorder → recurrent episodes of binge eating (A), → may eat continuously through the day with no planned mealtimes, → others engage in discrete binges of larger amounts, often in response to stress, anxiety or depression, → may eat rapidly and appear in a daze as they eat (B), Task 7: The diet paradox 2  → often are overweight and think of themselves as disgusted and ashamed of their bingeing (B), → have a history of frequent dieting, memberships in weight-control programs, and family obesity, Prevalence; USA has a rate of 2 - 3.5%, other countries have a lower rate, somewhat more common in women, but gender difference is not significant in many studies. Comorbidity; high rates of depression and anxiety, higher incidence of alcohol abuse and personality disorders. → the whale DSM-5 Criteria Other Specified Feeding or Eating Disorder partial-syndrome eating disorder - syndromes that don’t meet the full criteria for anorexia nervosa or bulimia nervosa. atypical anorexia nervosa - all criteria for anorexia nervosa are met, except significant weight loss, → weight is within or above normal range. bulimia nervosa of low frequency and/or limited duration - all criteria for bulimia nervosa is met, except that bingeing occurs less than once a week and/or for less than 3 months. night eating disorder - regularly eat excessive amounts of food after dinner and into the night. → feel an overwhelming desire to eat at night, → highly distressed since they can’t control their eating, → frequent insomnia, → typically not hungry in the morning & will skip breakfast, → onset in early adulthood, tends to be long-lasting, → often overweight and suffer from depression. Understanding Eating Disorders Biological Factors → many biological abnormalities associated with eating disorders which could contribute to disordered eating behavior, heritability; tends to run in families, twin studies found heritability of 56% for AN, and 41% for BED, Task 7: The diet paradox 3  genes; → genes appear to carry a general risk for eating disorders, not for one specific, → genetic risk appears to interact with biological changes of puberty, contributing to the onset of eating disorders in girls, but not in boys, → so, hormone changes in puberty for girls may activate a genetic risk for eating disorders. brain; hypothalamus plays a role in regulating eating, receives messages about recent food consumption and nutrient level, sends messages to cease eating when body’s needs are met, → messages are carried by neurotransmitters - norepinephrine, serotonin, dopamine - and hormones, including; cortisol and insulin, disorder can be caused by imbalance or dysregulation of any of these, or by structural or functional problems in the hypothalamus. → people with AN show lowered functioning in the hypothalamus, abnormalities in levels of hormones, → whether these are causes or consequences of the self-starvation is unclear, → mixed results whether they continue to show abnormalities after weight gain or not, → people with bulimia show abnormalities in system regulating serotonin, this might lead to the body craving carbohydrates, which leads to bingeing. Sociocultural and Psychological Factors Social Pressure and Cultural Norms The Thin Ideal and Body Dissatisfaction → standards of beauty, ideal shape in many nations become thinner, → seen in models, winners of Miss America and Miss Universe pageants, Barbie dolls: all promotion a figure that is physically unattainable by most. → 10 times more diet articles in women’s magazines than in men’s, → more exposure to media, the more dissatisfied one becomes, → media increasingly emphasises muscularity for males, with that, their dissatisfaction has increased, → peers also are effective carriers of appearance related messages, ! ideal remains a strong factor, but evidence suggests that its power may be decreasing, reason could be body-accepting messages in the media, visibility of fuller-sized models, ethnic diversity, but no comparable decrease in men. Athletes and Eating Disorders → certain groups within a culture have standards for appearance that put them at a greater risk, → pressure to maintain a specific weight, → sports classified as “aesthetic” or “weight- dependent,” including diving, figure skating, gymnastics, dance, judo, karate, and wrestling, were most likely to have anorexia nervosa or bulimia nervosa. Cognitive Factors → women who are dissatisfied with their body and have low self-esteem will engage in maladaptive strategies to control weight, → tend to be more concerned with opinions of others, → tend to have a dichotomous thinking style - judging things as either good or bad, e.g. when eating a cookie, they think they have blown their diet and might as well the whole, → obsess over eating routines and plan their days around such, → may be concerned with body size at an unconscious level - will organise perceptions of the world around body size more than others. Task 7: The diet paradox 4  Emotion Regulation Difficulties → may sometimes serve as maladaptive strategies for dealing with painful emotions, → emotional eating - eating when feeling distressed in an attempt to feel better. Family Dynamics → anorexia often occurs in girls who are high achievers, dutiful and compliant, trying to please and by being “perfect”, → tend to have over-invested parents in kid’s compliance and achievements, over-controlling, and will not allow expression of feelings, especially negative ones —> kid’s don’t learn how to identify and accept feelings, instead learn to monitor the needs and desire of others and to comply, → deeply fear separation since they haven’t developed ability to act and think independently, yet recognise the need to separate, → fear involvement with peers, especially sexual involvement, → harbor rage against parents for their overcontrol and become angry, defiant and distrusful, → discover that controlling food intake gives them a sense of control and elicits concern from parents, ! families of girls with eating disorders have high level of conflict, discourage expression of negative emotion, and emphasise control and perfectionism. Treatments for Eating Disorders Anorexia Nervosa Psychotherapy → can be difficult, because they highly value achieved thinness, believe they must maintain control, → can be resistant to therapy and to the therapist’s attempts to change their behaviors and attitudes, → must do lot of work to gain trust and encourage participation: but, gaining trust can be difficult when therapist is forced to hospitalise or forced refeeding, during hospitalisation, therapist will engage the client in facing and solving issues causing them to starve themselves. → can help but it is a long process, often marked by many setbacks, → often continue to have self-esteem issues, family problems, and long periods of depression and anxiety. Cognitive-Behavioral therapy → most researched for AN, → clients overvaluation for thinness is confronted, → rewards are made contingent on the person’s gaining weight, → if hospitalised, privileges (e.g. going out, shopping trip, receiving vists) are used as rewards, → taught relaxation techniques, → can lead to weight gains and reduces symptoms, → many drop out and return to anorexic behaviors. Family Therapy = person with anorexia and family is treated as one unit, best studied is Maudsley model - involved 10 - 20 session over 6 - 12 months, parents are initially coached to take control over eating, as therapy progresses, child gains greater autonomy. Biological Therapies → Antidepressants are often used for AN, as they result in reduction of symptoms, → Olanzapine, an atypical antipsychotic, leads to increase in weight. Bulimia Nervosa Cognitive-Behavioral Therapy → received most support for successful treatment, → based on the view that extreme concerns about shape and weight are central features of the disorder, → therapist teaches client to monitor cognitions that accompany eating, → therapist helps confront such cognitions and develop more adaptive attitudes, → involves introducing forbidden foods and helping client to confront irrational thoughts about these, Task 7: The diet paradox 5  → clients is taught to eat three meals a day and to challenge thoughts, → usually lasts about 3 - 6 months, 10 - 20 sessions, → more effective than drug therapies, Interpersonal Therapy = client and therapist discuss interpersonal problems related to the client’s eating disorder, and the therapist works actively with the client to develop strategies to solve these problems. Supportive-expressive Psychodynamic Therapy = therapist also encourages the client to talk about problems related to the eating disorder - especially interpersonal problems - but in a highly nondirective manner. Behavioral Therapy = client is taught how to monitor her food intake, is reinforced for introducing avoided foods into her diet, and is taught coping techniques for avoiding bingeing. ! all of these resulted in improvement, but, cognitive-behavioral therapy & interpersonal therapy showed greatest and most enduring improvements. Biological Therapies → selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine (trade name Prozac), appear to reduce binge-eating and purging behaviors, but often they fail to restore the individual to normal eating habits. Binge-Eating Disorder Cognitive-Bejavioral Therapy → shown to be more effective than other psychotherapies or medications, → reduces binges as well as concern with weight, shape, and eating in people with binge-eating disorder. Biological Therapies → Number of drugs, including SSRIs, antiepileptic medications (such as topiramate), and obesity medications (such as orlistat), all are better than a placebo in reducing binge eating but do not tend to reduce concerns about body shape or weight. Articles Fairburn, (2003). Cognitive behaviour therapy for eating disorders: a “transdiagnostic” theory and treatment. concerned with the psychopathological processes that account for persistence of severe eating disorders, two arguments: 1. cognitive behavioural theory of bulimia nervosa should be extended in its focus to embrace four additional maintaining mechanisms: → influence of clinical perfectionism, core low self-esteem, mood intolerance and interpersonal difficulties. 2. shared but distinctive clinical features tend to be maintained by similar psychopathological processes, those arguments lead to proposal of a new transdiagnostic theory that explains the persistence of eating disorders; = model of eating disorders that argues that a dysfunctional system of self-evaluation is central to the maintenance of all eating disorders, and that self-worth is defined in terms of control over eating, weight and shape, which in turn leads to dietary restraint. → central issue is over evaluation of eating, shape, weight, and control, → this leads to extreme behaviors (dietary restraint, binge eating, purging), → other mechanisms that contribute the maintenance of eating disorders include: low self-esteem, perfectionism, interpersonal problems, and mood intolerance. Task 7: The diet paradox 6  proposed a transdiagnostic treatment based on this expanded theory; → suitable for all eating disorders, regardless the diagnosis, → focuses on addressing maintaining mechanism. Polivy, (2002). Causes of eating disorders. reviews development of these disorders, including: sociocultural factors culture, ideals that are difficult to achieve, media representation of idealised slim physiques, dissatisfaction, peer influence, family factors reinforcement by praising slenderness, family dynamics enmeshed, intrusive, hostile, and negating of the patient’s emotional needs, or overly concerned with parenting, critical family environment, parental control, mothers, worry about their daughters attractiveness, those who themselves have an ED tend to have a negative influence. individual risk factors personality traits, low self-esteem, interpersonal experiences, abuse, trauma, teasing, negative affect, negative emotionality (stress, mood, self-directed hostility), body dissatisfaction. cognitive aspects obsessive thoughts, inaccurate judgments, perfectionism, dissociation, cognitive bias, rigid thinking patterns. Task 7: The diet paradox 7  biological aspects genetics, neuroendocrine factors, other factors, lack of internal awareness. Treasure, (2010). Eating disorders. → reviews eating disorders, → focuses on diagnosis, epidemiology, pathogenesis, treatment, prognosis. Herman, (1975). Restrained and unrestrained eating. (This paper describes the very first experimental study of binge eating.) hypothesis; normal weight college age females, differing in the extent of their concern about weight and restraint in their eating habits, will correspondingly differ m their reaction to the experimental removal of restraint, → high restraint were expected to consume more ice cream in the 2 milkshake conidtion. method; 45 female university students, in the first phase they were required to consume 0, 1 or 2 milkshakes (”preliminary taste”, “milkshake preload”), then a “sample” of three containers of ice cream: chocolate, vanilla, strawberry, → subject was allowed to taste as much of each flavor she wanted, then rated them all, → then was allowed to help herself to any remaining ice cream, after tasing period, experimenter returned a questionnaire (diet, weight, attitudes towards food. results & discussion; high restraint subjects consumed more ice cream after the milkshake preload than after no preload at all, Low restraint subjects consumed decreasing amounts of ice cream as a function of preload size. Howard, (1999). The role of dieting in binge eating disorder: Etiology and treatment implications. introduction; examines whether dieting is a casual factor in the development of binge eating disorder (BED), analysing retrospective studies, dietary restraint levels, prospective studies. theoretical frameworks; restraint theory = assumes that people have “set points”, which is thought to be higher for obese individuals, “restraint” was thus a process of self-imposed food deprivation used to achieve a weight below one’s physiological set point. → people who want to lose weight go against normal biological processes, → hypothesised that eaters impose a diet boundary to regulate their eating in order to achieve weight-loss goals, → boundary consists of rigid cognitive rules & beliefs about allowed levels of food intake that override the physiological controls over food intake. → This places an artificial limit on eating, which eventually causes feelings of physiological & psychological deprivation. → When the boundary is transgressed, the attempt at dietary restraint is undermined and this leads to feelings of failure. → At this point the individual loses control until he/she is uncomfortably full. lowe’s three-factor model differentiates between: frequency of dieting and overeating - cycles of dieting and overeating, current dieting - active efforts to restrict intake, Task 7: The diet paradox 8  weight suppression - maintaining weight loss over time. dietary restraint in BED; dieting plays a causal role in the development of binge eating problems in individuals with bulimia nervosa. measurement tools Restraint Scale: Positive correlation with binge severity but may reflect past dieting rather than current restraint. Three-Factor Eating Questionnaire (TFEQ): Low correlation, suggesting BED individuals are not currently dieting. Eating Disorder Examination (EDE): Low scores in BED populations, possibly reflecting more general food avoidance strategies. Cognitive Factors Scale (CFS): Indicates unrealistically high dieting standards among BED individuals. conclusion BED individuals demonstrate heightened food-related concerns, even when not actively dieting. prospective studies; Studies analyzing the effect of dieting on binge behavior show mixed results: Severe dieting (e.g., very low-calorie diets) temporarily suppresses binge eating but often results in increased binge episodes once normal eating resumes. Loss of control over eating, rather than caloric intake alone, may contribute to binge episodes. discussion; Dieting likely contributes to BED for some but not all individuals. Past unsuccessful dieting may impair hunger and satiety cues, increasing binge vulnerability. BED patients often report rigid, unrealistic dieting standards. research needs; Consistent definitions of "dieting" and better differentiation between past and current dieting behaviors. Longitudinal studies to assess the long-term relationship between dieting and binge eating. treatment implications; Current cognitive-behavioral treatments prioritize reducing binge eating before addressing weight loss. Concerns: Neglecting obesity and its health risks. Undermining patient motivation to address primary concerns like weight loss. Recommendations: Integrate appetite awareness training to restore hunger and satiety sensitivity. Individual assessments to tailor interventions addressing unique dieting histories and behaviors. Jansen, (2016). Eating disorders need more experimental psychopathology. argues that the lack of understanding the cause, maintain and change in eating disorder is the biggest problem, which makes treatment effectiveness limited, so treatments could benefit from experimental studies. Milo, (2005). Instability of eating disorder diagnoses: prospective study. introduction; there’s a close relationship between the different diagnoses, emphasised by the diagnostic crossover over time, study examines diagnostic change across eating disorders. method; 192 participants with a DSM-IV diagnosis were followed up 12 months and 30 months after baseline evaluation. Task 7: The diet paradox 9  results; stability of diagnosis was highest for AN; followed by BN, and then EDNOS. discussion; study notes movement between diagnoses, three main findings: diagnostic stability was low - only a third retained their original diagnosis, this was only in part due to remission, considerable flux between the three, all showed this tendency. strengthens the view that these disorders have much in common, limits current diagnostic scheme and treatment (changes in weight or eating behavior could simply be due person receiving an entirely different diagnosis). Murray, (2016). Dissecting the Core Fear in Anorexia Nervosa. → treatment of AN involves weight restoration, which directly confronts core fear, → article examines whether traditional exposer therapy can be optimised, exposure to feared stimuli is insufficient in ensuring long-term fear reduction: → fear reduction is achieved through inhibitory learning, an active learning process in which fear outcomes are disproven, creating non-threat associations with originally feared stimulus. → exposure therapies now focus on maximally violating fear expectancies rather than aiming for habituation. Disentangling Feared Stimuli and Feared Outcomes this bring challenges: → it is unclear whether the fear of weight gain is a feared stimulus (cue) or a feared outcome (consequence), → effective treatment requires identifying and targeting the specific fear association. Food consumption as Feared Stimulus → may associate eating with weight gain, leading to avoidance of “fear foods”, → small weight gain can evoke fear of uncontrollable weight gain. Task 7: The diet paradox 10  Weight Gain as Feared Cue → may fear that weight normalisation will violate their self-concept. ! fear associations differ among patients, that makes individualised approaches so important. Impact on Treatment → traditionally emphasises weight restoration, → depending on the specific fear association: Food-Focused fears: → introducing avoided foods might reinforce fear-food-weight link, Self-concept fears: → solely addressing food and weight may fail to address fears regarding identity and emotional states. ! treatment has to avoid “one size fits all” approach, instead focusing on tailoring interventions to patients fears. Roth, (2012). Can we live longer by eating less? A review of caloric restriction and longevity. → caloric restriction has been shown to prolong life of species and to prevent age-related diseases, → evidence that restriction could prevent age-related diseases in humans is emerging, → further research needs to be done, especially on the downstream effects. Stice, (2006). Relation of Successful Dietary Restriction to Change in Bulimic Symptoms: A Prospective Study of Adolescent Girls. → theorists suggest that dieting increases the risk of bulimic symptoms, → experimental studies challenge this, showing that diets may reduce binge eating, → in this study, primary aimed to test wether diets in real-world was accompanied by a decrease in bulimic symptoms, as suggested by experimental studies. methods; 496 adolescent girls (ages 11-15) were recruited, measurement of BMI for diet success, structured interviews for symptoms. results & discussion; group with successful diet: significant reduction in binge eating, group with no weight change: no significant improvement. ! effective diet can be associated with decreasing bulimic symptoms, aligning with experimental findings. depressive symptoms: no difference, this challenges the belief that dieting harms mental health. Stice, (2005). Effects of a Weight Maintenance Diet on Bulimic Symptoms in Adolescent Girls: An Experimental Test of the Dietary Restraint Theory. → dietary restraint model - posits that dieting increases risk of bulimic symptoms, → experimental findings are incompatible with those findings, → conducted an experience to test this. methods; Task 7: The diet paradox 11  188 adolescent girls, randomly assigned to a healthy weight intervention or an assessment only control group. results & discussion; weight maintenance showed greater decrease in bulimic symptoms, reductions in binge frequency, compensatory behaviors and overvaluation of weight, experienced a short-term decrease in negative emotions, effect diminished over the follow up period, intervention maintained body weight and reduced risk of obesity, ! findings challenge dietary restraint theory, suggesting that diets reduce bulimic symptoms. Task 7: The diet paradox 12