HC.2.3. Flashcards
(25 cards)
Explain Anorexia Nervosa
A. Underweight
- The individual has a significantly low body weight in the context of age, sex, developmental trajectory, and physical health.
- This is often due to restricted energy intake.
B. Intense fear of gaining weight
- There is an overwhelming fear of gaining weight or becoming fat, even when underweight.
- Individuals may engage in behaviors to prevent weight gain such as restricting food, excessive exercise, or purging.
C. Disturbance in body image
- A distorted perception of body weight or shape.
- The person may not recognize the seriousness of their low body weight and may still see themselves as overweight.
Ernst:
- licht; BMI >/= 17kg/m2
- Matig: BMI = 16-16,99 kg/m2
- Ernstig: BMI =15-15.99 kg/m2
- Zeer ernstig: BMI <15 kg/m2
Name the different subtypes of Anorexia Nervosa
- Restrictive subtype
- Characterized by weight loss primarily through dieting, fasting, or excessive exercise.
- No regular binge-eating or purging behavior is present. - Bing-eating/purging subtype
- The person regularly engages in binge eating or purging behavior (e.g., vomiting, misuse of laxatives or diuretics).
- They still are (very) underweight
Explain Bulimia Nervosa
A. Objective binge eating episodes
- Definition: Eating an unusually large amount of food in a discrete period (e.g., within 2 hours), with a sense of loss of control during the episode.
B. Inappropriate compensatory behaviors
- Definition: Recurrent behaviors aimed at preventing weight gain after binge eating.
- Types include:
— Vomiting (depicted by the person at the toilet)
— Excessive exercise (runner)
— Laxative use (Dulcolax box)
— Extreme dieting/fasting (image with “diet” spelled out)
- These behaviors are inadequate in fully compensating for the calorie intake and are harmful.
C. Self-evaluation is unduly influenced by body shape and weight
- Definition: The individual’s self-worth is overly dependent on body shape and weight.
D. de eetbuien en het compenserende gedrag doen zich gedurende 3 maanden gem. minstens 1x/ week voor
E. De stoornis treedt niet uitsluitend op tijdens episoden van anorexia nervosa.
most people have a normal weight or are overweight.
Ernst:
- licht: 1-3 episoden met inadequaat compensatoir gedrag per week
- matig: gem. 4-7 episoden met inadequaat compensatoir gedrag per week
- Ernstig; gem. 8-13 episoden met inadequaat compensatoir gedrag per week
- zeer ernstig: gem. 14 of meer episoden met inadequaat compensatoir gedrag per week
Explain Binge eating Disorder
A. Recurrent episodes of binge eating
- Individuals regularly consume large quantities of food in a short period, often with a sense of loss of control (same as in Bulimia Nervosa).
B. At least 3 of the following must occur:
1. Eating rapidly (much faster than normal).
2. Eating until uncomfortably full.
3. Eating large amounts when not physically hungry.
4. Eating alone due to embarrassment about the amount consumed.
5. Feeling disgusted, depressed, or guilty afterward.
These reflect the emotional and behavioral patterns of someone with BED.
C. Marked distress caused by the binge eating
- The person experiences significant emotional distress about their binge eating behavior.
- It’s not just the behavior itself but also the psychological impact that is key to diagnosis.
D. No inappropriate compensatory behaviors
- This is what distinguishes BED from Bulimia Nervosa.
- People with BED do not engage in purging, excessive exercise, or fasting to offset binge eating.
E. de eetbuien komen gedurende 3 maanden gem. minstens 1x per week voor
BED is not diagnosed based on body weight. People with BED can be of any weight category, although it is often associated with overweight or obesity.
ERNST:
- Licht: 1 tot 3 eetbui-episoden per week
- Matig: 4-7 eetbui-episoden per week
- Ernstig: 8-13 eetbui-episoden per week
- Zeer ernstig: 14 of meer eetbui-episoden per week
What do all the eating disorders have in common?
the common cause of the eating disorders is the over-evaluation of weight and shape
Explain Avoidant Restrictive Food Intake Disorder (AFRID)
Persistent failure to meet nutritional and/or energy needs, associated with one or more of the following:
1. Weight loss (or failure to gain expected weight in children)
2. Nutritional deficiency
3. Dependence on enteral feeding or supplements
4. Marked interference with psychosocial functioning
- The restriction leads to social, emotional, or daily life difficulties (e.g., avoidance of meals, distress in social eating settings).
🔴 Key point (red star):
ARFID is not driven by body image concerns or fear of gaining weight, unlike anorexia nervosa or bulimia nervosa.
Name and explain the 3 subtypes of AFRID
- Sensory-based avoidance
- The individual avoids food due to its texture, taste, smell, or appearance.
- Example: A child who refuses most foods because of their mushy texture or bitter taste. - Arousal or interest-based avoidance
- Lack of interest in eating or low appetite.
- The person simply doesn’t feel hungry or is indifferent to food.
- May “forget to eat” or feel eating is a chore. - Concern or fear-based avoidance
- Avoidance due to a traumatic or fear-based experience, such as:
— Choking
— Vomiting
— Food allergy
- Leads to fear-driven restriction of certain foods or entire food groups.
Explain other specified feeding and eating disorders (OSFED)
A DSM-5 diagnostic category that includes clinically significant eating disorders that do not fully meet the criteria for Anorexia Nervosa, Bulimia Nervosa, Binge Eating Disorder, or ARFID.
1. DSM-IV to DSM-5 Transition
- In DSM-IV, this category was called Eating Disorder Not Otherwise Specified (EDNOS).
- DSM-5 replaced EDNOS with OSFED to provide more specific and clinically useful categories.
2. High Prevalence in Clinical Settings
- Research indicates that 50% of eating disorder patients in treatment settings were diagnosed with EDNOS (now OSFED).
- Suggests that many individuals have serious eating disturbances that don’t fit neatly into one diagnostic box.
3. Overlap of Symptoms
- Most individuals exhibit features of multiple ED subtypes (e.g., someone might restrict and occasionally binge without purging).
- Reflects the complexity and heterogeneity of eating disorders.
4. General Population Impact
- An estimated 75% of people with an eating disorder fall into the OSFED category in community samples
- Highlights how common it is for EDs to present in atypical or mixed ways.
Describe the prevalence of the eating disorders
- AN is the least prevalent. It is the most noticable from the outside.
INCIDENCE OF EDs OVER TIME
Key Takeaways: - Anorexia Nervosa (AN) incidence remains relatively stable over the decades.
- Bulimia Nervosa (BN) shows a notable decline over time (highlighted by the red arrow).
- This could reflect:
— Changing diagnostic criteria or awareness
— Reclassification into other disorders (e.g., OSFED, BED)
— True shifts in behavior patterns
AGE-SPECIFIC INCIDENCE OF AN
- This histogram breaks down incidence of AN by age group and time period.
- Highest rates are in adolescents (10–19 years), with peak detection in 15–19 years, circled in red.
- Detection in younger children (5–9) is rare but present.
- A small but persistent incidence is seen even in adults up to age 64.
Key Insight:
- Anorexia nervosa is most frequently diagnosed in adolescence, but occurs across the lifespan.
- The consistency or increase in adolescent detection suggests increased awareness and screening, not necessarily a true rise in cases.
Diagnoses Are Not Static
- This pie chart shows fluid transitions between different eating disorder diagnoses:
— AN-R = Anorexia Nervosa, Restricting subtype
— AN-BP = Anorexia Nervosa, Binge-Purge subtype
— BN = Bulimia Nervosa
— BED = Binge Eating Disorder
- Arrows between categories indicate that patients often shift diagnoses over time.
Key Message:
- Eating disorders are dynamic and diagnoses can evolve.
- This complicates tracking prevalence, since someone might be counted in different categories at different times.
- Decline in BN may partially reflect reclassification into BED or OSFED.
✅ Overall Interpretation: Are Eating Disorders Increasing?
- AN incidence is relatively stable over time.
- BN appears to be decreasing, but this might be due to diagnostic shifts (e.g., to BED or OSFED).
- Increased detection in adolescents suggests better recognition, not necessarily more cases.
- Diagnoses are fluid, which complicates prevalence data.
📌 Conclusion:
While the total number of people experiencing eating disorders may not have decreased, the types of diagnoses and how we detect them have changed—making it appear as though some disorders are declining when they may just be relabelled or recognized differently.
Explain the psychological mechanisms underlying obesessive thoughts and how they resemble to those in obsessive-compulsive and related disorders.
Obsessive thoughts:
- Are recurrent, intrusive, and often anxiety-inducing.
- May center on body image, food, numbers, weight, or rituals.
- Are similar across disorders, even if the content varies.
Clinical overlap:
- EDs share traits with OCD (Obsessive-Compulsive Disorder), BDD (Body Dysmorphic Disorder), ASD (Autism Spectrum Disorder).
- High comorbidity: It’s common for patients to have multiple diagnoses across these spectrums.
Common themes: Obsessions with symmetry, control, and perfectionism occur across these disorders.
🔹 Cognitive Traits:
1. Mental inflexibility:
- Difficulty adapting to change or new routines (disturbed set shifting).
- This keeps individuals locked into disordered behaviors even when they know they’re harmful.
2. Detail-focus / weak central coherence:
- A tendency to fixate on minute details (e.g., calorie counts, exact food measurements) while missing the bigger picture.
- Makes it harder to break free from obsessive patterns.
3. Perfectionism & control:
- Many people with EDs have a strong need to feel in control, especially when other life areas feel uncertain.
4. Obsessive-compulsive traits:
- Compulsions and routines may provide temporary relief, reinforcing the behavior
name and explain some controlling behaviors in EDs and why do people with an ED do these behaviors?
controlling behaviors in EDs:
1. Body checking
- Repetitive and compulsive behaviors to monitor weight or body shape:
– Looking in mirrors
– Pinching skin/fat
– Measuring thighs, waist
– Constantly weighing oneself
- These behaviors reinforce obsession with body image.
- Associated with anxiety, low self-esteem, and perfectionism.
2. (Cal.) Counting
- Calorie counting
- Categorizing foods into “safe” and “forbidden”
- Strict monitoring of intake/nutritional data
- Leads to rigid food rules and fear-based avoidance.
- Reinforces a false sense of control over the body and self-worth.
3. Rituals and rules
- Highly specific eating routines, such as:
— Cutting food into tiny pieces
— Eating in a set order
— Using certain plates or utensils
— Only eating at certain times
- These behaviors become compulsive and are difficult to break.
- Serve to reduce anxiety, not necessarily to nourish.
Why do they do these behaviors?
1. Prevention of weight gain
- These behaviors follow restrictive or binge-eating episodes and are compensatory.
- Aim is to eliminate perceived ‘damage’ from eating or to avoid fat gain.
- Motivated by fear of weight gain and distorted body image.
2. Escape from/ suppression of negative emotions
- Binge eating is often used to:
— Cope with feelings of sadness, stress, shame, boredom, or trauma
— Provide temporary emotional relief
- Can become a maladaptive coping strategy for emotional regulation.
- Reinforces a vicious cycle of binging → guilt → restriction → binging.
How does binge eating function as a psychological copings mechanism?
- Binge eating provides temporary escape from:
— Negative emotions (e.g., sadness, shame, anxiety)
— Self-critical thoughts
— Emotional pain or emptiness - It alleviates emotional stress, offering short-term relief.
- The person’s attention is redirected away from painful thoughts or emotions and narrowed down to food and eating.
- This process narrows awareness to the immediate moment (e.g., the texture or taste of food), disconnecting the individual from broader emotional experiences.
People’s experience of binge eating.
- “Feeling numb” or on “auto-pilot” – The binge is often dissociative: not fully conscious or intentional.
- Chewing as a distraction – The physical act of eating can be soothing or help forget emotional pain.
- “Tunnel vision” – Focus becomes so narrow that all that matters is the food.
- Loss of control – People describe feeling like they can’t stop, even if they want to: “I have no choice.”
- Food as the only focus – It becomes a mental escape hatch.
- Self-soothing rationale – Thoughts like “I deserve something nice” are common, reflecting emotional need and self-comfort.
Describe the first stage of an ED
The behaviors initially produce positive psychological consequences for the individual. These early rewards can reinforce the disordered behavior and make it harder to recognize or interrupt.
✅ Perceived Benefits:
1. Sense of Control
- As cited from Shafran et al. (2004), the individual feels more in control of their life, body, or emotions through controlling food intake.
2. Reduction of Anxiety (Short-Term Relief)
- Behaviors such as restriction, purging, or ritual eating temporarily relieve emotional tension or anxiety
💬 Examples of Internal Rewards:
- Increased self-esteem – Feeling accomplished or disciplined through control over food or weight.
- Self-affirming thoughts – “This is what I do best, better than others” suggests pride or superiority derived from the behavior.
- Enhanced identity – A sense of uniqueness or importance can develop around the ED behavior (feeling ‘special’).
- Behavior becomes part of self-concept – Eating habits or body image may begin to define the person’s identity.
- Avoiding weight gain – Reinforces the belief that these behaviors are necessary or effective.
- Emotional escape – Using food-related behaviors to suppress or avoid negative feelings.
Recognizing this stage helps explain why early intervention is often difficult—because the behavior initially feels like it’s working.
Describe the second stage: psychological consequences
While disordered eating may begin with feelings of control or relief, over time it causes worsening mental health and cognitive functioning.
❗ Key Psychological Effects:
1. Negative Mood Increases
- Individuals become more depressed, anxious, and emotionally distressed.
- This stage is often marked by:
— Loneliness
— Guilt, shame
— Disgust with oneself or the body
2. Stress
- The ongoing demands of maintaining restrictive rules or rituals around food lead to chronic stress.
3. Obsessive Behaviors Intensify
- Food- and body-related obsessions increase:
— More frequent body checking
— Constant calorie tracking
— Heightened food fears
4. More Rules
- As anxiety escalates, individuals often create additional rules around eating or exercise to try to regain control, which only fuels the disorder.
5. Cognitive Impairments
- Problems with concentration and focus are common, often due to malnutrition, sleep disruption, or emotional exhaustion.
6. Emotional Numbness
- People may begin to feel disconnected from their emotions or others.
- This emotional blunting is both a symptom and a coping mechanism.
7. Body Avoidance
- Some individuals become so distressed by their body image that they avoid mirrors, photos, or physical intimacy.
- This reflects the deepening disconnect and distress around body perception.
This stage shows how initially “rewarding” ED behaviors turn toxic, causing significant psychological harm and making recovery more complex. It’s often when motivation for treatment grows, but also when the illness is more entrenched.
Describe the second stage: physical consequences
- Malnutrition
- Results from inadequate intake of calories and nutrients.
- Leads to:
— Fatigue
— Weakness
— Dizziness or fainting
— Brittle hair and nails
— Dry skin - Cardiovascular Issues
- Slow heart rate (bradycardia) and low blood pressure due to calorie restriction.
- Electrolyte imbalances (e.g., low potassium from purging) can cause:
— Irregular heartbeat
— Heart failure
— Sudden cardiac death - Gastrointestinal Problems
- Constipation and bloating from restricted intake.
- Delayed gastric emptying (“feeling full quickly”).
- Acid reflux, stomach rupture, or esophageal tears from bingeing and purging.
- Laxative abuse can damage the colon and disrupt natural bowel function. - Hormonal and Reproductive Effects
- Loss of menstruation (amenorrhea) in females due to low body fat and hormonal disruption.
- Infertility or reduced libido.
- In adolescents, stunted growth and delayed puberty. - Bone Health
- Osteopenia and osteoporosis due to low estrogen and poor calcium/vitamin D intake.
- Increased risk of fractures and long-term bone damage. - Dental and Oral Issues (especially in bulimia)
- Stomach acid from vomiting erodes tooth enamel.
- Increased tooth decay, gum disease, and mouth sores.
- Swollen salivary glands (“chipmunk cheeks”).
- teeth erosion - Muscle Wasting
- The body begins breaking down muscle (including heart muscle) when not enough nutrients are available.
- Weakness and loss of strength. - Skin and Extremities
- Lanugo: fine hair growth on the body to conserve warmth.
- Cold intolerance and blue-tinted fingers/toes due to poor circulation. (acrocyanosis)
- Skin bruises easily and wounds heal slowly.
- Erythema ab igne: a skin condition caused by prolonged and repeated exposure to heat, typically without burning the skin
- Russell’s sign: It refers to calluses, scars, or abrasions on the knuckles or backs of the hands. Caused by repeatedly using the hands to induce vomiting—as the fingers come into contact with the teeth, friction and trauma to the skin occur.
Describe the second stage: social consequences
🔴 Key Social Consequences of EDs:
1. Social Isolation
- Individuals often withdraw from social contact, either due to shame, fear of judgment, or the need to maintain disordered behaviors in secrecy.
- This leads to loneliness, which may further worsen the eating disorder.
2. Difficulties in Social Engagement
- People with EDs may struggle with conversations, intimacy, or group settings, especially those involving food or appearance-related topics.
3. Conflicts with Parents or Spouses
- Tension may arise as loved ones express concern or attempt to intervene.
- Family members may not fully understand the disorder, leading to miscommunication or frustration.
4. Avoidance of Eating or Body-Related Situations
- Common examples:
— Avoiding restaurants, family meals, holidays, or public eating
— Skipping activities like beach trips or swimming, due to body image distress or exposure fears
5. Avoidance of Physical Activities
- Activities like playing with children, sports, or exercise may be avoided due to:
— Body shame
— Low energy or physical weakness
— Fear of how the body appears while moving
6. Impact on School or Work
- EDs can impair cognitive function, mood, and energy—making it hard to focus, attend, or perform at work or school.
- Severe cases may result in dropping out or being unable to maintain employment.
Describe and explain the course and mortality of EDs
Based on long-term studies, the course of AN and BN is variable:
- 50% recover fully
– Individuals no longer meet diagnostic criteria and resume healthy functioning.
- 30% recover only partly
– These individuals may improve but still struggle with residual symptoms, such as food rituals or body image issues.
- 20% become chronic
– The disorder persists for many years, often becoming resistant to treatment.
This highlights that early detection and intervention are critical for improving outcomes.
EDs have the highest mortality rate of all psychiatric disorders.
- Causes of death include:
— Medical complications (e.g., cardiac arrest, organ failure)
— Suicide, particularly in anorexia nervosa
📊 Meta-analysis by Arcelus et al. (2011)
This study pooled data from multiple sources and found:
- Standardized Mortality Ratios (SMRs):
— Anorexia Nervosa (AN): 5.86 → individuals with AN are nearly 6 times more likely to die than age-matched peers.
— Bulimia Nervosa (BN): 1.93
— EDNOS (now OSFED): 1.92
- Suicide risk:
— 1 in 5 people with AN who die, die by suicide.
— This underscores the extreme psychological suffering and comorbidity with depression and anxiety.
Explain some barriers to help seeking
🔴 Key Barriers to Help Seeking:
1. Lack of Knowledge About the Illness
- Affects both individuals suffering from EDs and health professionals.
- Many do not recognize the symptoms as serious or even part of a mental illness.
- Misconceptions about what an eating disorder “looks like” (e.g., that someone must be underweight) prevent recognition.
2. Difficulty Acknowledging the ED
- Individuals may not fully realize or accept they have a problem.
- Denial and minimization are common psychological defenses in EDs.
3. Shame, Stigma, and Disclosure Issues
- Fear of being judged, misunderstood, or labeled as “vain” or “attention-seeking.”
- Embarrassment or guilt about behaviors (e.g., bingeing, purging) can make it hard to open up.
- Social stigma deters many from speaking out or seeking professional help.
4. Lack of Knowledge About Treatment
- Even when someone recognizes they need help, they may not know:
— What treatments are available
— Where to go
— Whether treatment is effective or safe
5. Delayed Help-Seeking
- On average, there is a 3–5 year gap between onset of symptoms and seeking professional help
- During this time, the disorder can become more entrenched and harder to treat.
6. Low Treatment Rates
- More than 50% of people with an ED never receive treatment at all.
- This highlights systemic and personal obstacles that prevent recovery.
Explain the stepped care disease management model
- Shows a progressive model of care from low-threshold digital interventions to inpatient treatment.
- Starts with platforms like Proud2Bme and Featback (e-health/peer support).
- Moves up to support groups, respite houses, nurses, outpatient therapy, day treatment, and inpatient treatment.
- Emphasizes the role of prevention, early identification, and community-based care.
- Includes peer and parent support along the way, which helps bridge gaps.
Dit model goed leren!! dia 54.
Explain the E-health interventions Featback & Proud2Bme
With the E-health interventions we can close the gap between illness onset and getting treatment (now4-5 jaar).
FEATBACK:
- what: A web-based or mobile self-help system.
- Aims to reduce barriers to care, such as shame, stigma, and lack of knowledge.
- Describes Featback as an automated monitoring & feedback system.
- Tailored to:
— Body image concerns
— Disordered eating
— Binge eating
— Compensatory behaviors
- Helps assess:
— Whether behavior is functional or dysfunctional
— Whether the person is improving or deteriorating
🧠 Core Features
1. Automated Monitoring & Feedback
- Users fill in brief weekly questionnaires about:
— Body image concerns
— Eating behaviors (binge eating, restriction, purging)
— Emotional well-being
- Based on responses, they receive tailored feedback—automatically generated and personalized.
2. Psychoeducation
- Provides structured information about:
— Healthy eating and nutrition
— Triggers and risk factors for disordered eating
— Coping strategies and self-awareness tools
3. Behavioral Evaluation
- Helps users reflect on their behavior over time:
— Is this behavior functional or dysfunctional?
— Am I improving or deteriorating?
- Encourages early recognition of negative patterns before they escalate.
4. Anonymous & Accessible
- No referral needed.
- Can be used completely anonymously, reducing shame and increasing openness.
- Suitable for teens and adults; also offers support to parents and peers.
📱 User Interface & Structure
Friendly, app-like interface with:
- Informational pages
- Self-tests
- Feedback tracking
- Options for online help or chat
🎯 Who Is It For?
People with:
- Early signs of disordered eating
- Mild to moderate eating problems
- Ongoing concerns about food, weight, or body image
Also useful for those waiting for treatment, or as a supplement to therapy.
PROUD2BME:
- Created by and for people with lived experience.
- Active across Instagram, YouTube, TikTok, and receives ~9,000 visits/day.
- Emphasizes anonymity, peer connection, and recovery focus.
- Proud2Bme is an online community-based intervention designed to support individuals—especially teens and young adults—who are struggling with eating problems, body image issues, and related mental health concerns. It offers a positive, recovery-focused, and stigma-free environment that encourages open discussion, peer support, and self-empowerment
- what:
— A digital e-community launched in 2009 as a healthy alternative to pro-anorexia (“pro-ana”) websites.
— Created by and for people with lived experience of eating disorders.
— Supported by mental health professionals, including the Dutch center GGZ Rivierduinen.
— Known internationally (e.g., partnered with NEDA in the U.S. in 2011).
🧠 Core Elements of the Intervention
1. Peer Support & Social Connection
- Users share stories, struggles, and recovery journeys.
- Community members support each other through comments, blogs, forums, and live chats.
- Helps reduce shame, isolation, and stigma.
2. Positive Identity Formation
- Promotes self-acceptance, confidence, and individuality with the motto:
“Don’t be afraid to be you.”
- Encourages healthy body image and realistic beauty standards.
3. Moderated & Safe Space
- Unlike dangerous “pro-ana” spaces, Proud2Bme is professionally moderated to ensure safety and discourage harmful behavior.
- It is recovery-oriented, meaning it actively promotes getting better—not staying sick.
4. Multimedia Approach
- Offers content across multiple platforms:
— Website (articles, personal blogs)
— Instagram, YouTube, TikTok (educational and engaging content)
- Reaches thousands daily (e.g., 9,000 visits/day at its peak).
5. Anonymity & Accessibility
- Users can engage anonymously, lowering the threshold for help-seeking.
- Available 24/7 online, making it highly accessible.
🎯 Target Audience
- Primarily teens and young adults, but also suitable for:
— Individuals unsure if they have an eating disorder
— Those waiting for formal treatment
— People in recovery who want ongoing support
Describe the dutch guidelines for Anorexia Nervosa and Bulimia Nervosa
- First-line treatment: Outpatient Cognitive Behavioral Therapy (CBT).
— Goals: Weight restoration, reducing binge/purge behaviors, correcting distorted thoughts. - Inpatient or day treatment only if outpatient fails.
- For youth: Multi-family therapy is preferred.
- Medication: Limited to cases of therapy resistance or comorbidity.
Describe the dutch guidelines for binge eating disorder
- First-line: Outpatient CBT, potentially followed by weight loss interventions.
- May be supplemented by antidepressants.
- Encourages self-help tools based on CBT (e.g., digital options like Featback).
Explain CBT for Anorexia/Bulimia more
🧠 1. Anorexia Nervosa (AN)
✅ Guideline Recommendations:
- First-line treatment: Outpatient CBT-ED (CBT for Eating Disorders), especially for adults.
- For adolescents, Family-Based Therapy (FBT) or multi-family therapy is often preferred.
🧩 CBT Focus:
- Weight restoration and normalizing eating behavior.
- Challenging rigid beliefs about weight, control, and self-worth.
- Reducing rituals, perfectionism, and body checking.
- Building motivation for change (as patients may be ambivalent).
- Coping skills for managing anxiety, distress, and transitions.
🍽️ 2. Bulimia Nervosa (BN)
✅ Guideline Recommendations:
- CBT is the gold standard (CBT-BN), supported by NICE and Dutch guidelines.
- Recommended as first-line outpatient treatment for most individuals.
🧩 CBT Focus:
- Breaking the binge–purge cycle.
- Identifying and modifying triggers for binge eating.
- Restructuring all-or-nothing thinking (e.g., “I ate one cookie, I ruined the day”).
- Addressing body dissatisfaction and low self-esteem.
- Developing regular, balanced eating patterns (e.g., 3 meals, 2 snacks).
Explain CBT for BED, AFRID and OSFED
🍔 3. Binge Eating Disorder (BED)
✅ Guideline Recommendations:
- CBT is the first-line treatment, either individually or in group format.
- May be supplemented with antidepressants, especially if depression is present.
🧩 CBT Focus:
- Reducing binge eating episodes.
- Normalizing eating routines and reducing emotional eating.
- Challenging beliefs like “I have no control over food”.
- Addressing shame, guilt, and body image concerns.
- Managing triggers (stress, boredom, emotional distress).
MAIN FEATURES:
1. Psychoeducation
- Educates the individual about:
— What BED is and how it develops
— The binge-restrict cycle
— How dieting, perfectionism, and emotional distress contribute to bingeing
2. Self-Monitoring
- Patients keep detailed records of:
— Food intake
— Thoughts, emotions, and situations before and after eating
— Binge episodes and triggers
- Helps build awareness and identify patterns.
3. Establishing Regular Eating Patterns
- A structured eating plan: 3 meals + 2–3 snacks/day at regular intervals.
- Prevents extreme hunger, which reduces the urge to binge.
- Reduces chaotic or impulsive eating.
4. Cognitive Restructuring
- Identifies and challenges unhelpful thoughts, such as:
— “I’ve already blown it, I might as well keep eating.”
— “I have no control over food.”
- Replaces them with realistic, compassionate thinking.
5. Addressing Dietary Restraint and Food Rules
- CBT challenges rigid food rules (e.g., “I can’t eat carbs”).
- Encourages flexibility and moderation instead of “all-or-nothing” thinking.
6. Emotion Regulation
- Recognizes emotional triggers for bingeing (e.g., sadness, boredom, stress).
- Teaches non-food coping strategies, such as:
— Problem-solving
— Relaxation techniques
— Assertiveness or journaling
7. Body Image Work
- Addresses body dissatisfaction and overvaluation of weight/shape.
- May involve:
— Mirror exposure
— Body neutrality exercises
— Reducing checking and avoidance behaviors
8. Relapse Prevention
- Plans for long-term maintenance by:
— Identifying high-risk situations
— Creating coping strategies
— Reinforcing progress and flexibility over perfection
🌀 4. Other Specified Feeding or Eating Disorders (OSFED)
✅ Guideline Recommendations:
- Use the CBT model that aligns with the individual’s symptom pattern (e.g., CBT-BN or CBT-BED).
- Treatment is individualized, since OSFED includes mixed symptoms.
🧩 CBT Focus:
Same core principles apply:
- Identify triggers
- Modify unhelpful thoughts
- Normalize eating
- Reduce avoidance and body checking
- Extra attention to flexibility, since symptoms vary.
👶 5. Avoidant/Restrictive Food Intake Disorder (ARFID)
✅ CBT Use Is Emerging:
- Not yet standard everywhere, but CBT-ARFID is being developed.
- Focuses on gradual exposure to feared foods, reducing avoidance, and addressing sensory sensitivity or fear of choking.
🧩 CBT Focus:
- Identifying and challenging fear-based or sensory avoidance.
- Behavioral exposure to non-preferred or feared foods.
- Involving family to support structured eating and safety learning.
