A model of eating disorders

1
A model of eating disorders
Restriction of eating
Bulimia Bingeing Purging Maintain weight
Anorexia Continued restriction Reduced
anxiety Excessive weight loss
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Based on Barlow Durand (1995)
2
Treatments for EDs

• Behaviour therapy
• Cognitive behaviour therapy
• Weight restoration (anorexia only)

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3
CBT

• Treatment based around
• Identifying dysfunctional thinking processes that
  cause maintain disordered eating
• Use of behavioural exercises to test and modify
  maladaptive beliefs

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4
CBT with bulimia nervosa

• Four stages (Fairburn, 1985)
• Education about effects of bingeing, purging,
  dieting
• Modified eating patterns small meals 5-6 times
  a day
• Altering dysfunctional attitudes about food,
  eating the body
• Teaching coping strategies to avoid bingeing
  purging

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5
CBT with bulimia nervosa

• Fairburn et al (1993) comparison of three
  treatments
• CBT (all four parts)
• BT (just the eating habits part)
• IPT (interpersonal therapy)
• Outcome measures cessation of bingeing/purging
  attitudes to body/eating

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6
CBT with bulimia nervosa
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7
CBT with bulimia nervosa

• CBT works fast is more effective than BT
• Not a panacea only 36 had no symptoms at 1
  year follow-up
• Early treatment gains may be lost IPT more
  effective long term
• Drugs may boost effectiveness (Agras et al, 1992)

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8
CBT with anorexia nervosa

• Anorexia involves several cognitive distortions
• Irrational beliefs about food weight gain
• Inaccurate perception of body
• CBT aims to change these thinking patterns, which
  are assumed to maintain anorexia behaviour

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9
CBT with anorexia nervosa

• Treatment goals (Yager, 1994)
• Educate inform about anorexia
• Identify focus on unhelpful thoughts beliefs
• Replace these with more adaptive ways of thinking
• Identify problems develop problem solving
  strategies

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10
CBT with anorexia nervosa

• Improved body image, eating habits at 7-year
  follow up (24 patients Yager, 1994)
• Can be effective in helping maintain weight but
  many continue to have distorted body image
  (Davison Neale, 1994)

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11
CBT with anorexia nervosa

• Highly structured treatments (BT, CBT) most
  effective during initial treatment (lt1 year)
• In longer term, patients may benefit more from
  psychotherapy/IP/family therapy
• Addressing underlying problems? Compare bulimia
  treatment data.

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