PSYC1002 Lecture 8 2024 CANVAS.pptx

https://www.wearitpurple.org/ https://www.sydney.edu.au/about-us/vision-and-values/diversity/pride-network.html https://www.sydney.edu.au/students/lgbtiq-pride-network/lgbtiq-support.html Wear it Purple Day is: 30-08-24 PSYC1002: Mental Health Conditio...

https://www.wearitpurple.org/ https://www.sydney.edu.au/about-us/vision-and-values/diversity/pride-network.html https://www.sydney.edu.au/students/lgbtiq-pride-network/lgbtiq-support.html Wear it Purple Day is: 30-08-24 PSYC1002: Mental Health Conditions Lesson 6 Eating Disorders Dr Elizabeth Seeley-Wait (Credit for slides: Dr Rebekah Laidsaar-Powell and Dr Sarah Ratcliffe) Acknowledgement of Country We acknowledge the Traditional Custodians of the land on which we gather, the Gadigal people. We recognise their continued connection to the land and waters of this beautiful place and acknowledge that they never ceded sovereignty. We pay respect all Gadigal Elders and Ancestors, and any First Today’s Lesson Eating Disorders Anorexia Nervosa Bulimia Nervosa Binge Eating Disorder Remember Support is available! Student Counselling Service: Phone +61 2 8627 8433 +61 2 7255 1562 [email protected] Psychology Clinic (provisional psychologists supervised by people like me; you are eligible but you will just need to see if it is the right fit for you through an intake): Phone (02) 9114 4343 These other useful support services are available for you to access: https://insideoutinstitute.org.au https://butterfly.org.au/ https://insideoutinstitute.org.au/resource-library? DSM-IV Eating Disorders DSM-IV classified eating disorders into three categories Anorexia Nervosa Bulimia Nervosa EDNOS Subclinical AN or BN ‘Binge Eating Disorder’ ‘Purging Disorder’ ‘Night Eating Syndrome’ ‘Grazing’ DSM-5 Eating Disorders DSM-5 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 Eating Disorders in Australia Anorexi a Nervos a DSM-5 Anorexia Nervosa A. Restriction of energy intake, leading to a significantly low body weight in the context of age, sex, developmental trajectory and physical health 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. (Body image disturbance) Anorexia Nervosa Severity Mild (BMI >/=17) Moderate (BMI 16-16.99) Severe (BMI 15-15.99) Extreme (BMI restoration of normal weight) Binge Eating Disorde r Binge Eating Disorder (new to DSM V) A Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following: Eating, in a discrete period of time (e.g., within any 2-hour period), an amount of food that is definitely larger than what most people would eat in a similar period of time under similar circumstances. A sense of lack of control over eating during the episode (e.g., a feeling that one cannot stop eating or control what or how much one is eating). B. The binge-eating episodes are associated with three (or more) of the following: Eating much more rapidly than normal. Eating until feeling uncomfortably full. Eating large amounts of food when not feeling physically hungry. Eating alone because of feeling embarrassed by how much one is eating. Feeling disgusted with oneself, depressed, or very guilty afterward. 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 behavior as in bulimia nervosa and does not occur exclusively during the course of bulimia nervosa or anorexia nervosa Binge Eating Disorder A Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following: Eating, in a discrete period of time (e.g., within any 2-hour period), an amount of food that is definitely larger than what most people would eat in a similar period of time under similar circumstances. A sense of lack of control over eating during the episode (e.g., a feeling that one cannot stop eating or control what or how much one is eating). B. The binge-eating episodes are associated with three (or more) of the following: Eating much more rapidly than normal. Eating until feeling uncomfortably full. Eating large amounts of food when not feeling physically hungry. Eating alone because of feeling embarrassed by how much one is eating. Feeling disgusted with oneself, depressed, or very guilty afterward. Binge Eating Disorder - Epidemiology Newer disorder (new in DSM-5) = less is known Prevalence Affects 2.5% (2:1 female/male) Onset Adolescence to early adulthood Course Remission rates higher for BED than AN/BN Associated with higher rates of obesity and  high blood pressure, high cholesterol, type II diabetes, heart disease Epidemiology Theories of causatio n Biological Theories Genetic factors Family and twin studies: moderate heritability for AN and BN Also higher depression, personality disorders, substance use in families of persons with ED Neurotransmitter disturbances Serotonin involved in appetite regulation Mixed findings regarding direction of causation Psychological Theories AN & BN have many features in common: Tendency to base self worth on One disorder which weight/shape is expressed in different ways Intense fear of gaining weight Desire to attain unrealistic levels of thinness Transdiagnostic model (Fairburn et al, 2003) Core low self esteem Perfectionism Distress Tolerance Interpersonal Difficulties High degree of overlap for causes and symptoms Degree of severity BN …………………. AN ? Psycho-social causes Family Factors: Higher parental criticism, control and conflict Lower parental empathy and support Comments on eating behaviours Causation/ Correlation? Peer Factors: Peer Group with ED, Social Approval Socio-cultural factors Appears to have emerged in the latter half of the 20 th century, coinciding with a growing cultural emphasis on thinness “Thin ideal” Internalisation = hypothesised to result in body dissatisfaction, negative affect, low self-esteem, disturbed eating behaviours and even eating disorders (Groesz et al, 2002) Cultural influences BMI trends between 1950-2018 of Miss Universe winners vs. Average American Women Psycho-social causes The idealisation of thinness is seen as a contributing factor to the normative body dissatisfaction females experience in Western culture (Polivy & Herman, 2002) Body dissatisfaction is single strongest predictor of eating disorder symptomotology (Phelps et al, 1999) Eating disorders are more prevalent in subcultures where thin-ideal is amplified (Stice, 1994) Eating disorders more prevalent in occupations / vocations where there is a strong thin-ideal (e.g. modelling, ballet) Treatme nt Biological Medical management “Re-feeding” Dietician Inpatient/outpatient depending on severity Psychological Cognitive-Behavioural Techniques (Adult) CBT-E (Fairburn, 2008); 4 stages (20-40 sessions) Stage 1 Personalised formulation Starting well Psychoeducation Behavioural focus (establishing self monitoring and ‘regular’ eating) Stage 2 Joint review of progress Taking Stock Identify problems still needing addressing and barriers to change Stage 3 Main body of treatment Addressing Address key maintaining factors (weight/shape concerns, Maintaining mood related eating behaviours Factors Stage 4 Ensuring progress is maintained Ending Well Relapse prevention Psychological Maudsley Family Based Therapy (Child-Adoles.) Parental involvement/responsibility in home setting 2/3 are fully weight restored; 75-90% at 5yr follow up Phase 1 Parents in charge of weight restoration “re-feeding” Phase 2 Parents transition control over eating back to the adolescent Phase 3 Discuss adolescent developmental issues, establishing healthy identity Final words of advice Look for reliable Exam sources of information Focus on lesson notes General Practitioner and recordings Australian Psychology Society Use textbook reading to Head2Health supplement learning Beyondblue Blackdog Institute Butterfly Foundation InsideOut MindSpot (ehealth) ThiswayUp (ehealth) Lesson 6: Done