Flashcards in Eating Disorders: Bulimia Deck (19)
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1
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
2
What is the difference between BN and BED
Compensatory behaviour must be prevalent for BN, whereas it is an exclusionary criteria for BED
3
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
4
How often must both the binge-eating and inappropriate compensatory behaviour both occur?
At least once a week for 3 months
5
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
6
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
7
Comorbid symptoms
> substance abuse
> depression
> suicidality
> personality disorders
> anxiety disorder
NOT JUST A CASE OF STOPPING PEOPLE BINGING IN MOST CASES
8
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
9
What is Eating Disorder Examination?
> Great reliability and validity
> semi-structured interview
10
What are the 4 subscales of the EDE?
Restraint
Shape concern
Eating concern
Weight concern
11
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
12
What is the treatment of choice for BN
CBT-E (enhanced with interpersonal considerations)
13
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"!
14
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
15
What is stage 2 of CBT (sessions 9-16)
> tackle dieting
> address concerns about shape and weight
> addressing other cognitive distortions
16
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
17
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
18
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
19
