Eating Disorders: Bulimia Flashcards
(19 cards)
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?
Partial:
> after full criteria for BN met, some, but not all, of the criteria have been met for a sustained period of time
Full:
> 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
Comorbid symptoms
> substance abuse > depression > suicidality > 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) > ineffectiveness > body dissatisfaction > interpersonal distrust > perfectionism > impulse regaulation
What is Eating Disorder Examination?
> Great reliability and validity
> semi-structured interview
What are the 4 subscales of the EDE?
Restraint
Shape concern
Eating concern
Weight concern
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
cost-effectiveness
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
What are the two types of diaries that should be used
Food Diary for behavioural modification Thought Diary for cognitive restructuring > situation > dysfunctional thought > challenge to dysfunctional thought
