Flashcards in Eating Disorders: Bulimia Deck (19)
What constitutes a binge-eating episode?
> Eating, in a discrete period of time, an amount of food that is definitely larger than socially acceptable
> A sense of lack of control over eating during the eating episode - they are desperate to stop eating but can't
What is the difference between BN and BED
Compensatory behaviour must be prevalent for BN, whereas it is an exclusionary criteria for BED
What are the criteria for bulimia nervosa?
> Recurrent episodes of binge-episodes
> Recurrent inappropriate compensatory behaviour
> Self-evaluation is unduly influenced by body shape and weight - it influenced who they are!
> the disturbances does not occur exclusively during episodes of anorexia nervosa
How often must both the binge-eating and inappropriate compensatory behaviour both occur?
At least once a week for 3 months
What classifies partial and full remission?
> after full criteria for BN met, some, but not all, of the criteria have been met for a sustained period of time
> after full criteria for BN met, none of the criteria have been met for a sustained period of time
Severity levels of BN (average inappropriate compensatory behaviours per week)
Mild: 1-3 episodes
Moderate: 4-7 episodes
Severe: 8-13 episodes
Extreme: 14+ episodes
> substance abuse
> personality disorders
> anxiety disorder
NOT JUST A CASE OF STOPPING PEOPLE BINGING IN MOST CASES
What are the scales of assessment for the Eating Disorder Inventory (EDI-3)
> drive for thinness
> bulimia (eating like an Ox)
> body dissatisfaction
> interpersonal distrust
> impulse regaulation
What is Eating Disorder Examination?
> Great reliability and validity
> semi-structured interview
What are the 4 subscales of the EDE?
What should you consider when selecting a treatment?
> acceptability - are the people going to do it
> attrition rates - how many people drop out etc.
> clinical effectiveness
> speed of action - will it work quick enough
> breadth of effects - stop binging, lift mood and raise self-esteem
> durability of effects - continue after treatment
What is the treatment of choice for BN
CBT-E (enhanced with interpersonal considerations)
What does CBT involve for BN
> concerned with present and future - rather than past
> needs BOTH cognitive restructuring AND behavioural modification
"talk the talk" and "walk the walk"!
What is stage 1 of CBT (sessions 1-8)
> establish a sound therapeutic relationship
> educate them on the cognitive maintenance of BN to explain the need for both behavioural and cognitive change
> establish regular weekly weighing
> educate on adverse consequences of compensatory behaviours
> introduce a regular pattern of eating
> start keeping a food diary record (FDR)
> reduce secrecy and increase support from others
What is stage 2 of CBT (sessions 9-16)
> tackle dieting
> address concerns about shape and weight
> addressing other cognitive distortions
What is stage 3 of CBT (sessions 17-19
> aim is to ensure that progress is maintained
> try to prevent relapse
> plan for dealing with setbacks
What is the cognitive view of the maintenance of BN
Low self-esteem - > extreme concerns about shape or weight - > strict dieting - > binge-eating - > self-induced vomiting - > LOOPS AROUND TO START
Why shouldn't you use Overeaters Anonymous
> With eating, the abstinence model doesn't work - Keys et al. (1950) study on starving
> You need to introduce forbidden foods and get accustomed to them