Chapter 9 Eating Disorders PDF

9/27/2024 Copyright Notice Do not remove this notice. 1 CHAPTER 9 EATING DISORDERS Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd...

9/27/2024 Copyright Notice Do not remove this notice. 1 CHAPTER 9 EATING DISORDERS Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 9-2 2 1  9/27/2024 LEARNING OBJECTIVES 9.1 Describe the diagnostic features of eating disorders 9.2 Describe current understandings regarding the epidemiology, aetiology and treatment of anorexia nervosa 9.3 Describe current understandings regarding the epidemiology, aetiology and treatment of bulimia nervosa 9.4 Describe current understandings regarding the epidemiology, aetiology and treatment of binge-eating disorder 9.5 Understand key challenges facing the eating disorders field and evaluate the various responses to these challenges Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 9-3 3 Eating Disorders The DSM-5-TR includes a chapter on ‘Feeding and Eating Disorders’ These are conditions which entail ‘a persistent disturbance of eating or eating-related behavior that results in the altered consumption or absorption of food and that significantly impairs physical health or psychosocial functioning’ Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 9-4 4 2  9/27/2024 Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 9-5 5 DSM-IV versus 5 (and 5-TR) DSM-IV DSM-5 Anorexia Nervosa Anorexia Nervosa Bulimia Nervosa Bulimia Nervosa Eating Disorder NOS Binge-Eating Disorder (including Binge-eating Pica disorder) Rumination Disorder Avoidant/Restrictive Food intake Disorder Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 9-6 6 3  9/27/2024 DSM-5-TR Feeding and Eating Disorders Pica Rumination Disorder Avoidant/Restrictive Food Intake Disorder Anorexia Nervosa Bulimia Nervosa Binge-Eating Disorder Other specified feeding or eating disorder Unspecified feeding or eating disorder. Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 9-7 7 DSM-5-TR Feeding and Eating Disorders Pica Rumination Disorder Avoidant/Restrictive Food Intake Disorder Anorexia Nervosa Bulimia Nervosa Binge-Eating Disorder Other specified feeding or eating disorder Unspecified feeding or eating disorder. Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 9-8 8 4  9/27/2024 Feeding Disorders Pica Rumination Disorder Avoidant/Restrictive Food Intake Disorder Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 9-9 9 DSM-5-TR Feeding and Eating Disorders Pica Rumination Disorder Avoidant/Restrictive Food Intake Disorder Anorexia Nervosa Bulimia Nervosa Binge-Eating Disorder Other specified feeding or eating disorder Unspecified feeding or eating disorder. Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 9-10 10 5  9/27/2024 Eating Disorders As with previous chapter, I will try to cover: – General Description (diagnostic criteria, etc.) – Epidemiology (prevalence, gender differences, etc.) – Aetiology (causes) – Treatment Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 9-11 11 Terminology “Anorexia” and “Bulimia” and “Anorexia Nervosa” and “Bulimia Nervosa” Misnomers Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 9-12 12 6  9/27/2024 DSM-5-TR Feeding and Eating Disorders Pica Rumination Disorder Avoidant/Restrictive Food Intake Disorder Anorexia Nervosa Bulimia Nervosa Binge-Eating Disorder Other specified feeding or eating disorder Unspecified feeding or eating disorder. Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 9-13 13 Anorexia Nervosa Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 9-14 14 7  9/27/2024 Anorexia Nervosa-Clinical Description Persistent energy intake restriction – Historically the DSM has referred to specific weights (e.g.,15% below expected weight or BMI of < 17.5). – Now more vague. Intense fears  Gaining weight  Losing control of eating Body Image Disturbance Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 9-15 15 Anorexia Nervosa - DSM-5-TR Criteria A. Restriction of energy intake relative to requirements, leading to a significantly low body weight in the context of age, sex, developmental trajectory, and physical health. Significantly low weight is defined as a weight that is less than minimally normal or, for children and adolescents, less than that minimally expected. B. Intense fear of gaining weight or of becoming fat, or persistent behaviour that interferes with weight gain, even though at a significantly low weight. C. Disturbance in the way in which one’s body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or persistent lack of recognition of the seriousness of the current low body weight. Restricting Type or Binge-eating/purging type. Copyright © 2022 American Psychiatric Association Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 9-16 16 8  9/27/2024 Anorexia Nervosa - DSM-5-TR Criteria Severity BMI Mild: GE 17 Moderate: 16-16.99 Severe: 15-15.99 Extreme: LT 15 Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 9-17 17 Anorexia Nervosa - DSM-5-TR Criteria Anorexia Nervosa-Subtypes Restricting Type: No bingeing or purging – rigid adherence to diet or exercise – tend toward obsessive-compulsive personality – inflexible; strict about rules and morals Binge-eating / Purging Type: Bingeing OR purging – tend toward impulsiveness and substance abuse – Validity here is fairly well established Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 9-18 18 9  9/27/2024 Anorexia Nervosa PLAY VIDEO Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 9-19 19 Anorexia Nervosa PLAY VIDEO Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 9-20 20 10  9/27/2024 DSM-5-TR Feeding and Eating Disorders Pica Rumination Disorder Avoidant/Restrictive Food Intake Disorder Anorexia Nervosa Bulimia Nervosa Binge-Eating Disorder Other specified feeding or eating disorder Unspecified feeding or eating disorder. Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 9-21 21 Bulimia Nervosa Binge eating – Excess amounts of food – Perceived as ‘out of control’ Compensatory behaviors – Purging (i.e., vomiting or laxatives) – Excessive exercise – Fasting Self-esteem determined by weight and body shape Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 9-22 22 11  9/27/2024 Bulimia Nervosa - DSM-5-TR Criteria A. Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following: 1. Eating in a discrete period of time, an amount of food that is definitely larger than what most individuals would eat in a similar period of time under similar circumstances. 2. A sense of lack of control over eating during the episode. B. Recurrent in appropriate compensatory behaviours in order to prevent weight gain, such as self-induced vomiting; misuse of laxatives, etc. C. The binge eating and compensatory behaviours both occur, on average, at least once a week for 3 months. D. Self-evaluation is unduly influenced by body shape and weight. E. Does not occur exclusively during episodes of anorexia nervosa. Copyright © 2022 American Psychiatric Association Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 9-23 23 Bulimia Nervosa DSM-IV had subtypes – Purging (most common)  Ineffective – Nonpurging (6-8%) – Questionable validity of sub-types – Nonpurging similar to BED – Eliminated in DSM-5 More on body image in BN Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 9-24 24 12  9/27/2024 Body Image and Bulimia Nervosa Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 9-25 25 Body Image and Bulimia Nervosa Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 9-26 26 13  9/27/2024 Body Image and Bulimia Nervosa Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 9-27 27 Body Image and Bulimia Nervosa Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 9-28 28 14  9/27/2024 DSM-5-TR Feeding and Eating Disorders Pica Rumination Disorder Avoidant/Restrictive Food Intake Disorder Anorexia Nervosa Bulimia Nervosa Binge-Eating Disorder Other specified feeding or eating disorder Unspecified feeding or eating disorder. Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 9-29 29 Binge-Eating Disorder Food binges No compensatory behaviors In DSM-III would have been called Bulimia Appendix of DSM-IV-TR - Experimental diagnostic category Full diagnostic status in DSM-5 Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 9-30 30 15  9/27/2024 Binge-Eating Disorder- DSM-5-TR Criteria A. Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following 1. Eating in a discrete period of time, an amount of food that is definitely larger than what most individuals would eat in a similar period of time under similar circumstances. 2. A sense of lack of control over eating during the episode. B. The binge-eating episodes are associated with three (or more) of the following. 1. Eating much more rapidly than normal. 2. Eating until feeling uncomfortably full. 3. Eating large amounts of food when not feeling physically hungry. 4. Eating alone because of feeling embarrassed by how much one is eating. 5. Feeling disgusted with oneself, depressed, or very guilty afterward. Copyright © 2022 American Psychiatric Association Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 9-31 31 Binge-Eating Disorder- DSM-5-TR Criteria C. Marked distress regarding binge eating is present. D. The binge eating occurs, on average, at least once a week for 3 months. E. The binge eating is not associated with the recurrent use of inappropriate compensatory behaviour as in bulimia nervosa and does not occur exclusively during the course of bulimia nervosa or anorexia nervosa. Copyright © 2022 American Psychiatric Association Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 9-32 32 16  9/27/2024 DSM-5-TR Feeding and Eating Disorders Pica Rumination Disorder Avoidant/Restrictive Food Intake Disorder Anorexia Nervosa Bulimia Nervosa Binge-Eating Disorder Other specified feeding or eating disorder Unspecified feeding or eating disorder. Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 9-33 33 Prior to DSM-5 was called Eating Disorder Not Otherwise Specified “The Eating Disorder Not Otherwise Specified category is for disorders of eating that do not meet the criteria for any specific eating disorder” Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 9-34 34 17  9/27/2024 EDNOS – The Neglected Problem From Fairburn & Bohn, 2005 Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 9-35 35 EDNOS – The Neglected Problem From Fairburn & Bohn, 2005 Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 9-36 36 18  9/27/2024 Eating Disorders As with previous chapter, I will try to cover: – General Description (diagnostic criteria, etc.) – Epidemiology (prevalence, gender differences, etc.) – Aetiology (causes) – Treatment Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 9-37 37 The Epidemiology of Anorexia Nervosa Believed to affect mainly adolescent girls and young women, but??? Lifetime prevalence rate of 0.9 per cent Mortality rate is 5–10 per cent. The highest of all psychiatric disorders Age of onset is usually early to late adolescence (earlier than other eating disorders) Recovery is typically a lengthy process Associated with significant medical complications of starvation, e.g., irregular heartbeat, heart failure, and metabolic disturbances Associated with psychological complications, e.g., depression, anxiety Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 9-38 38 19  9/27/2024 Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 9-39 39 The Epidemiology of Anorexia Nervosa Medical Consequences Amenorrhea Dry skin Brittle hair and nails Sensitivity to cold temps Lanugo Cardiovascular problems Electrolyte imbalance Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 9-40 40 20  9/27/2024 The Epidemiology of Anorexia Nervosa Associated Psychological Disorders – Anxiety  OCD – Mood disorders (33-60%) – Substance abuse – Suicide As noted, the mortality rate (5–10%) is the highest of all psychiatric disorders. Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 9-41 41 The Epidemiology of Bulimia Nervosa Believed to primarily affect females, – 90-95% female? – Caucasian, middle to upper class? a 1–3 per cent lifetime prevalence. – Females = 1.1% – College/university women= 6-8% Age of onset is probably later than anorexia. – Onset = age 16 to 19 Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 9-42 42 21  9/27/2024 The Epidemiology of Bulimia Nervosa Possibly fewer medical complications compared to anorexia, but still: – Salivary gland enlargement – Erosion of dental enamel – Electrolyte imbalance – Kidney failure – Cardiac arrhythmia – Seizures – Intestinal problems – Permanent colon damage Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 9-43 43 The Epidemiology of Bulimia Nervosa Associated Psychological Disorders – Anxiety (75%)  Social phobia and GAD – Mood disorders (50-70%) – Substance abuse (36.8%) – Personality Disorders (Borderline) Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 9-44 44 22  9/27/2024 The Epidemiology of Bulimia Nervosa Bulimia Nervosa in men – 5-10% male  Caucasian, middle to upper class  Gay or bisexual  Athletes with weight regulations – Onset = older Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 9-45 45 Bulimia Prevalence may be Decreasing From KEEL , HEATHERTON, DORER , JOINER, & ZALTA, 2005 Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 9-46 46 23  9/27/2024 The Epidemiology of Binge-Eating Disorder 3-5% of the adult population 8% of the obese population Some research - 20-40% of the population of obese persons seeking treatment. More conservative estimates are in the range of 5-10% Affects more females but probably only 1.5/1 female to male ratio. Age of onset estimated to be late adolescence and young adulthood. In only around 50% does dieting precede bingeing. Mood disorders, substance abuse and anxiety are common. Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 9-47 47 Eating Disorders As with previous chapters, I will try to cover: – General Description (diagnostic criteria, etc.) – Epidemiology (prevalence, gender differences, etc.) – Aetiology (causes) – Treatment Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 9-48 48 24  9/27/2024 Aetiology (causes) of Eating Disorders Disorder-Specific Approach Transdiagnostic Approach Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 9-49 49 Transdiagnostic Model of Eating Disorders Proposed by Fairburn et al., a diagnostic approach that focuses on the similarities between various types of eating disorders – Views overvaluation of eating, shape, and weight as the core pathology underlying all eating disorders – Hypothesises that overvaluation leads to restriction/dieting that, in turn, leads to disordered eating – May explain the high rate of diagnostic crossover in eating disorders Limitations of the transdiagnostic model: – Many individuals with BED report onset of binge eating before development of weight concerns Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 9-50 50 25  9/27/2024 The Aetiology of Anorexia Nervosa Biological factors: – A moderate heritability but may depend on what aspect of the disorder is being studied – Interaction between genetic factors and the environment – Serotonin activity may play a role, but exactly how is not clear. – May have abnormal function of neuroendocrine (hormonal) systems involved in the regulation of hunger and fullness Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 9-51 51 The Aetiology of Anorexia Nervosa Psychological factors: – Low self-esteem – Negative affect – Negative emotions and mood – Dysfunctional thinking – Perfectionism—unrealistically high standards Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 9-52 52 26  9/27/2024 The Aetiology of Anorexia Nervosa Social factors: – Family factors  Individuals with anorexia report higher levels of criticism and lower levels of care from parents.  Parents may influence their children through direct comments and modelling. Peer group pressure and cultural values play a role. Concerning rise in pro-anorexia websites – ‘Thinspiration’ Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 9-53 53 The Aetiology of Bulimia Nervosa Biological factors: – A moderate hereditability – Familial predisposition to obesity, substance use and mood disorders – Possible reduced serotonin function, but may be related to dietary restraint Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 9-54 54 27  9/27/2024 The Aetiology of Bulimia Nervosa Psychological factors: – Dual Pathway Model: binge eating episodes triggered by dietary restriction, negative affect or both. Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 9-55 55 The Aetiology of Bulimia Nervosa Social factors: – Individuals with bulimia nervosa report higher levels of critical comments about their eating, shape and weight. – Individuals with bulimia nervosa report a history of poor family functioning compared to healthy individuals. – Negative interpersonal interactions may trigger binge eating. Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 9-56 56 28  9/27/2024 The Aetiology of Binge-Eating Disorder Biological factors: – A moderate hereditability – May entail dysfunction in the serotonin system – Possible role of hormonal disturbances Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 9-57 57 The Aetiology of Binge-Eating Disorder Psychological factors: – Strong support for role of negative affect. – Emotional eating is associated with binge eating disorder. – High percentage of individuals report experiencing major depression in the period before they developed the disorder. Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 9-58 58 29  9/27/2024 The Aetiology of Binge-Eating Disorder Social factors: – Poorer family functioning – Elevated levels of criticism – Reduced levels of affection Obesity stigma  Negative attitudes and behaviours of others towards obese individuals Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 9-59 59 Transdiagnostic Factors and Eating Disorders Sociocultural Dimensions – Cultural imperatives  Thinness = success, happiness – Ideal body size standards  Change rapidly – Media standards – Social and gender standards  Internal and perceived Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 9-60 60 30  9/27/2024 Transdiagnostic Factors and Eating Disorders Cross-Cultural Considerations – North American minority populations – Immigrants to Western cultures  Increase in eating disorders  Increase in obesity – Cultural values – Standards for body image Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 9-61 61 Transdiagnostic Factors and Eating Disorders Standards for Body Image – Body Image Research – Different Ideals/Standards for men versus women Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 9-62 62 31  9/27/2024 Women’s and Men’s Ratings of Ideal, Attractive, and Current Body Size Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 9-63 63 Women’s Ratings of Ideal, Attractive, and Current Body Size Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 9-64 64 32  9/27/2024 Body Image Ratings by Women who Scored High on Distorted Attitudes Toward Eating Rate: ideal shape, current shape, and shape most attractive to the opposite sex (actual ratings by men shown as “other attractive”) Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 9-65 65 Body Image Ratings by Women who Scored Low on Distorted Attitudes Toward Eating Rate: ideal shape, current shape, and shape most attractive to the opposite sex (actual ratings by men shown as “other attractive”) Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 9-66 66 33  9/27/2024 Body Image and Distorted Eating Attitudes Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 9-67 67 Beauty Standards Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 9-68 68 34  9/27/2024 BMIs for “Miss America” Winners Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 9-69 69 Beauty Standards Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 9-70 70 35  9/27/2024 Beauty Standards Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 9-71 71 Beauty Standards Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 9-72 72 36  9/27/2024 Dieting and Eating Disorders Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 9-73 73 Dieting and Eating Disorders Dieting seems to reliably precede onset of AN and BN (less so for BED) Prospective studies of dieting typically suggest something similar Experimental research is mixed Animal research often ignored. Conclusions not totally clear Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 9-74 74 37  9/27/2024 Dieting and Eating Disorders Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 9-75 75 Eating Disorders and Addiction Severe Craving Loss of Control Used to Cope With Negative Feelings Preoccupied with Substance Unsuccessful Attempts to Quit Denial Adverse Psychosocial Consequences But an issue of partial similarity (can abstain from drugs but not food). Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 9-76 76 38  9/27/2024 Eating Disorders As with previous chapters, I will try to cover: – General Description (diagnostic criteria, etc.) – Epidemiology (prevalence, gender differences, etc.) – Aetiology (causes) – Treatment Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 9-77 77 The Treatment of Bulimia Nervosa Motivation enhancement therapy – May be motivated to stop binge eating but unwilling to give up pursuit of unrealistic and unhealthy levels of thinness Self-help approaches – Good for those who are motivated – Manualised and based on CBT techniques Cognitive-behaviour therapy (CBT) Interpersonal psychotherapy (IPT) – Help individuals identify and change interpersonal problems that are assumed to be maintaining the eating disorder Pharmacological approaches – Antidepressants Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 9-78 78 39  9/27/2024 Psychological Treatments of Bulimia Nervosa Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 9-79 79 Psychological Treatments of Bulimia Nervosa Cognitive-behaviour therapy (CBT) – Treatment of choice – Target problem eating behaviors – Target dysfunctional thoughts – More recently “Enhanced CBT (CBT-E)” Interpersonal psychotherapy – Improve interpersonal functioning – Similarly effective, long-term CBT may work quicker Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 9-80 80 40  9/27/2024 Psychological Treatments of Bulimia Nervosa Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 9-81 81 Treatment of Binge-Eating Disorder Self-help approaches – Self-help may be a useful first step – Guided self-help most useful approach Cognitive behaviour therapy (CBT) Interpersonal psychotherapy (IPT) Behavioural weight loss (BWL) – Focus on weight loss, secondary focus on binge eating Pharmacological approaches – SSRIs – Anticonvulsants, with some adverse effects Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 9-82 82 41  9/27/2024 Psychological Treatments of Binge-Eating Disorder Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 9-83 83 Treatments for Anorexia Nervosa Harder to study because of severity of disorder. Gaining weight not that hard; maintenance is the challenge. Early behavioural treatments viewed as coercive. Cognitive behaviour therapy targets dysfunctional beliefs about weight and food. Particularly useful for those who are motivated to change. Motivational enhancement therapy aims to increase the motivation to change. CBT and family-based treatments viewed as the standard now. CBT-E being studied too. Family therapy is particularly considered a treatment of choice for younger patients. Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 9-84 84 42  9/27/2024 Any Questions? If so, post them online Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 9-85 85 43