Week 7 Eating Disorders PSYC 376 Fall 2024 St. FX University PDF

Week 7: Eating Disorders PSYC 376 Fall 2024 Dr. Laura Lambe St. FX University Housekeeping Exams are graded – class average 70% Available for review during student hours or by appointment General feedback on the case study… Just saying “she’s Black” for a predisposing factor = 0 poin...

Week 7: Eating Disorders PSYC 376 Fall 2024 Dr. Laura Lambe St. FX University Housekeeping Exams are graded – class average 70% Available for review during student hours or by appointment General feedback on the case study… Just saying “she’s Black” for a predisposing factor = 0 points Must link to something like minority stress theory! Remember that current symptoms are often perpetuating factors Many people forgot to describe the psychosis symptoms here Housekeeping For Thursdays class… Small group activity involving a short article on the “Minnesota Starvation Experiment” Will have time to read in class, but may be helpful to review in advance (short paper is available on Moodle) Learning Objectives Differentiate bulimia nervosa, binge-eating disorder, and anorexia nervosa (including subtypes) as outlined in the DSM-5-TR through case examples. Understand the medical severity associated with eating disorders. Describe the etiology and maintenance on eating disorders, with a focus on transdiagnostic factors and the role of culture. Explain evidence-based treatment approaches for eating disorders across the lifespan. Our ideas about eating disorders… A movie that you know is going to be about a person with an eating disorder starts. The opening scene is going to set the stage and introduce the main character. What do you see? Eating disorders come in all shapes and sizes!! Diet culture We (the Western world) are obsessed with food, nutrition, body size/shape, and weight loss 2/3 of Canadians are currently trying to lose weight 40% of which have tried a diet that involves eliminating entire food groups We are all exposed to this culture to varying degrees. And yet – only The weight loss industry is a a small proportion will develop an $73B industry in the US eating disorder Diagnostic criteria What are the diagnostic criteria for eating disorders in the DSM-5-TR? What is under-eating? Restriction: undereating (too few calories/day) Restraint: extreme and rigid rules about what one eats Typically around what kinds of foods, amounts of certain foods, times of day, combinations of food and exercise What is a binge? Binge (objective): A discrete ( more physical complications Bulimia A. Recurrent binges. B. Recurrent compensatory behaviors. Nervosa C. A and B occur ~1x/week for 3 months. (BN): D. Self-evaluation is unduly influenced by body weight/shape/size. Diagnostic E. Does not occur exclusively during AN. criteria BN: Core Features Binges are the most distressing; often presenting concern. Binges are often done in secret and can Often occur in the evening even be “planned”. Usually the foods being restricted or avoided Binges are often triggered by strong emotions or stressful events. Still may be numbers focused; still have food rules/avoided foods, dietary restraint – sense of “failure” w/ binges.  A. Recurrent episodes Eating more rapidly Binge Eating of binge eating. than normal Disorder B. Associated with 3+ Feeling uncomfortable full. (BED): of: Eating large amounts without feeling Diagnostic C. Distress. physically hungry. D. Occurs 1x week for Eating alone due to criteria 3m. embarrassment. Feeling disgusted, E. No compensatory depressed, or guilty behaviors, does not afterwards. occur within the context of AN or BN.  Many are “over weight”, in weight-control programs Up to 50% of candidates for bariatric surgery. Dieting often a precursor to binging. BED: Core Typically have the same body Features weight/shape/size concerns as other EDs. But this isn’t diagnostic? Later age of onset, more even gender distribution, better prognosis relative to other EDs.  Masculine gender norms emphasize muscles, so presentation is different. Is this captured by ED diagnostic criteria? Eating disorders Higher levels of body dissatisfaction, dieting, and binging among BGT+ men and athletes 7% of male athletes vs 2.3% of general population among boys and men Related constructs “Orthorexia” = pathological obsession with “clean eating”, “health”, and ”fitness” (not currently in the DSM) Body dysmorphic disorder related to muscles (muscle dysmorphia) Nagata et al., 2020 Small group activity Make a flow chart of differential diagnoses for AN (both subtypes, atypical), BN, BED yes Prescence of disordered eating behavior (E.g., Significantly low weight restriction, binging, purging) no Case Study 1 Jamie is a 21-year-old college student. Jamie's concerns about body image and weight began to escalate in high school, when she began intensive dieting and exercising to lose weight. Despite being underweight, Jamie is preoccupied with the fear of gaining weight. She has started avoiding social gatherings, especially those involving food, leading to isolation from her peers. Recently, Jamie has begun eating all of her roommates’ snack foods in secret, often when they are sleeping. These leads to intense feelings of guilt and shame. Jamie attempts to eliminate the calories associated with these foods through an intensive running regimen. What is your diagnosis? Why? Case Study 2 Alex is a 24-year-old non-binary individual who presents for treatment in your private practice office. They started experiencing binge-eating episodes under the stress of law school, which evolved into a cycle of overeating and self-induced vomiting. The cycle happens multiple times a week, causing significant disruptions in Alex's professional and personal life. Psychologically, Alex grapples with body image issues, self-esteem problems, and increased anxiety and depression. What is your diagnosis? Why?  Case Study 3 Dan, a 22-year-old man and varsity athlete, has been involved in sports and physical fitness since his childhood. He is known among his peers for his dedication to staying fit, often spending over two hours at the gym six days a week. His Instagram is filled with pictures of his workout routines, and he frequently offers advice on how to achieve specific fitness goals. Over the past year, friends and family began to notice that Dan's dedication to fitness was bordering on obsession. While he had always been meticulous about his diet, he began eliminating entire food groups from his diet, weighing all his food, and frequently talking about "clean eating.” On occasions when he did indulge, he'd express extreme guilt and increase his workout duration the next day. What is your diagnosis? Why?  Diagnostic A migration transdiagnostic approach to eating disorders Milos et al. 2005 Biopsychosocial factors What causes and maintains eating disorders? Etiology of eating disorders Over-evaluation of size and Genetics shape Exercise induced Fear of weight gain/fatness appetite suppression Drive for thinness Starvation effect/ Bio Psycho Body dissatisfaction dieting Perfectionism Puberty Impulsivity Low emotion regulation Low self-esteem Social Culture ideals on beauty Social environments that emphasize performance and appearance (e.g., sports teams, high achieving families) Stressful life events The psychology of hunger: The Minnesota Starvation Experiment (1944) 36 healthy adult men volunteered for the study Goal: learn more about starvation + how to refeed people after WWII Starvation phase ~1500 calories Small group activity: Minnesota Starvation Experiment Read the attached article summarizing the effects of this study with a small group and discuss/answer these questions: 1. This research study was not conducted to study eating disorders. Why is it relevant for understanding these disorders? 2. What are the implications of this research for treating eating disorders? 3. What are the limitations of this research?  Genetic heritability ~0.56 Hard to separate from learned environment Other Puberty Time during which girls tend to gain weight biological Dysregulated patterns of eating/hormones factors No/poor hunger cues Food lacks “positive incentive value” Low levels of serotonin Psychological factors Perfectionism x low self-esteem Distorted body image Mood intolerance Rigidity/obsessionality Fairburn et al., 2003 Social: Cultural Garner et al. 1980 Expectations of 20 years of weight data on Playboy centrefolds and Miss Amercia Pageant Thinness contestants Cultural context Protective effects in African American girls and women African American girls and women tend to be more satisfied with their bodies than White women, less likely to experience eating disorders Why? (Parker et al., 1995) Family and cultural appreciation of a fuller body size Black girls described success/ideal girl in terms of personality traits – smart, funny, friend, etc Black body ideal focused on other features – hair, eyes, lips, etc, and having a “sense of pride” Eating Disorders during COVID-19 CBC Podcast While Coat Black Art with Dr. Brian Goldman – RJs’s story – Eating disorders, kids, and COVID-19 https://www.cbc.ca/listen/live- radio/1-75-white-coat-black-art /clip/15825702-rjs-story-eating -disorders-kids-and-covid-19 Why the increase? Eating disorders during the COVID-19 pandemic and quarantine: an overview of risks and recommendations for treatment and early intervention (Cooper et al. 2022) Transdiagnosti c model (Fairburn et al., 2003)  Transdiagnosti c model (Fairburn et al., 2003) Minnesota Starvation Experiment (1945) Starvation has DRAMATIC impacts on physiological, psychological, cognitive, and social functioning Medical consequences + Treatment Medical severity of Eating Disorders Purging… Being underweight… Dental complications Brain atrophy (brain fog, poor Swelling of parotid glands (salivary concentration) gland) GI problems Damage to GI tract Amenorrhea Electrolyte imbalance 🡪 can be fatal! Dry skin, brittle nails, sensitivity to cold Cardiovascular problems 🡪 This will get you admitted to the hospital Electrolyte imbalance 🡪 can be fatal Bone density 🡪 long term impacts  If underweight… Inpatient hospitalization may be required First goal = weight gain and stabilization Treatment Medication options SSRIs more effective for BN than AN Why? Antipsychotics (olanzapine) sometimes used for AN  20 sessions over 20 weeks! 40 if underweight! Treatment components CBT-E Transdiagnosti Psychoeducation 🡪 medical consequences, ineffectiveness of compensatory strategies, etc c approach Regular eating + self monitoring Weekly weight monitoring Exposure Distress tolerance/coping strategies Cognitive restructuring Staying motivated  Gold standard Tx for children and adolescents Especially with comorbid depression Phase 1: Weight restoration Family Based Parents in charge of all nutrition – how much is eaten, when, content, Treatment monitoring completion, limited physical activity “Family meal” with support from a therapist (FBT) Phase 2: Gradual return of developmentally appropriate independence with food E.g., choose snacks with approval, then able to make own lunch, etc Phase 3: Back to “normal” life More individual work with you on getting back into typical tasks for their age/stage Summary Eating disorders occur in all types of bodies but are most prevalent among women and girls in Western contexts. AN and atypical anorexia are defined by overevaluation of weight/shape/size and dietary restriction/restraint. BN is characterized by recurrent binging and purging, whereas BED is characterized by binging only. Treatment involves medical stabilization + interruption of maintaining factors (e.g., starvation syndrome, distress intolerance).  Resources: For next NEDIC: National Eating Disorder time… Information Centre Eating Disorders Nova Scotia Peer support groups + clinicians Quiz 8 suggested due date Nov 21st Essay suggested due date Nov 21 Final due date Nov 28 Submit on Moodle “Week 0”