Eating Disorders

By
Stephen W. Youyz, PhD
Janet Polivy, PhD
Phillipa Hay, MD

eatingdisorders

Course Outline

Eating disorders are causing increasing problems in our society, and many approaches to treatment are used, some more successful than others. This volume provides therapists and students with practical and evidence-based guidance on diagnosis and treatment of eating disorders. It builds on existing knowledge as well as the enormous wealth of clinical experience that the authors have developed over the past three decades. It assumes a basic understanding of therapeutic intervention and some clinical training. This book will be of interest not only to those clinicians who have developed a special expertise in eating disorders, but to psychologists, psychiatrists, general practitioners, dietitians, social workers, nurses and other allied mental health practitioners as well.

About the Authors

Stephen W. Youyz, PhD, is Professor of Psychology and Honorary Professor of Psychological Medicine at the University of Sydney and Co-Director of the Peter Beumont Centre for Eating Disorders tat Wesley Private Hospital. He has written or edited five books and over 180 research articles and book chapters on eating disorders and related topics. He is a fellow of the Academy of Eating Disorders and the Australian Psychological Society and is Past President of the Eating Disorders Research Society. He was an inaugural treasurer of the Australian and New Zealand Academy of Eating Disorders and is an executive member of the Eating Disorder Foundation. He is a member of the Editorial Board of the European Eating Disorders Review.

Janet Polivy, PhD, is Professor of Psychology and Psychiatry at the University of Toronto at Mississauga, She has written or edited 4 books and over 150 research articles and book chapters on dieting, eating, and eating disorders. She is a Fellow of the Royal Society of Canada, the Association for Psychological Science, the Canadian Psychological Association, and the Society for Personality and Social Psychology, and is Treasurer of the Academy for Psychological Clinical Science.

Phillipa Hay, MD, is former Professor of Psychiatry and Head of Discipline of the School of Medicine, James Cook University, and Senior Consultant Psychiatrist at the Townsville Hospital. In August 2007 she took up the Foundation Chair in Mental Health at the University of Western Sydney School of Medicine. She has written over 80 research articles and book chapters on eating disorders and related topics. She is a Fellow of the Royal Australian and New Zealand College of Psychiatrists (RANZCP), Chair of the RANZCP Board of Research, Vice-President of the Australian and New Zealand Academy of Eating Disorders, and member of the Editorial Board of the International Journal of Eating Disorders, the Academy of Eating Disorder, and the Board of Examiners of the Australian Medical Council.

Learning Objectives

After completing this course you’ll be able to:

  • State how bulimia nervosa was identified as a separate disorder.
  • State the name of the manual that reflects the standard criteria for eating disorders.
  • Describe the four criteria for anorexia nervosa and include the two subtypes.
  • List two contributing factors to compulsive exercising.
  • List the diagnostic criteria for bulimia nervosa.
  • Describe the BN psychological behavior.
  • Discuss the criteria for eating disorder not otherwise specified (EDNOS).
  • Describe the prognosis for AN and BN.
  • Define “spectrum hypothesis.”
  • Compare structured diagnostic interviews and semi-structured interviews.
  • Define objective and subjective binge eating episodes.
  • Describe Bruch’s psychological model.
  • List the two broad classes of risk factors that produce eating disorders according to Fairburn.
  • Briefly describe the addiction model by Wilson.
  • List the four cognitive maintaining processes that interfere with change and interact with the core eating disorder disturbances.
  • Discuss hormonal theories of eating disorders.
  • Describe the danger of ipecac abuse.
  • State the greatest challenge the clinician faces when discussing change being difficult and fear provoking.
  • State the body mass index when the patient is diagnosed with AN (Table 12).
  • Discuss factors that influence treatment decisions, such as age, gender and race/ethnicity.
  • Describe the diversity of treatment.
  • Describe the “RU curve.”
  • Describe the three phases of cognitive behavior therapy for the BN.
  • Discuss the importance of self-monitoring in cognitive behavior therapy for AN (Clinical Pearl, page 49).
  • Define the “Anorexia Wish.”
  • Describe the golden rule in promoting weight gain.
  • State the purpose of a Dysfunctional Thought Record.
  • Describe “mood intolerance” according to Fairburn et al. (2003) and dysfunctional mood modulatory behavior.
  • Describe the interpersonal problems of the adolescent with AN.
  • Describe body shape education and cognitive restructuring.
  • List the three approaches according to Maudsley regarding family therapy in adolescents and children.
  • Describe the “refeeding syndrome.”
  • Discuss psychodynamic therapy.
  • Describe nonspecific clinical management.
  • Describe interpersonal psychotherapy.
  • List the four stages in motivational enhancement therapy and describe each.
  • State reasons as to why there is little evidence for the treatment of AN.
  • Describe the steps of compulsory treatment.

Course Contents

  1. Description

    • 1.1 Terminology
    • 1.2 Definitions
    • 1.2.1 Anorexia Nervosa (AN)
    • 1.2.2 Bulimia Nervosa (BN)
    • 1.2.3 Eating Disorder Not Otherwise Specified (EDNOS) or Atypical Eating Disorder
    • 1.3 Epidemiology
    • 1.4 Course and Prognosis
    • 1.5 Differential Diagnosis
    • 1.6 Comorbidities
    • 1.7 Diagnostic Procedures and Documentation
    • 1.7.1 Structured Diagnostic Interviews
    • 1.7.2 Semistructured Diagnostic Interviews
    • 1.7.3 Self-Report Measures
    • 1.7.4 Medical Assessments

  2. Theories and Models of Eating Disorders

    • 2.1 Psychological Models
    • 2.1.1 Bruch’s Psychological Model
    • 2.1.2 Fairburn’s Risk Factor Model
    • 2.1.3 The Addiction Model
    • 2.1.4 Cognitive Models
    • 2.2 Predisposing Personality Theories
    • 2.3 Biological/Physiological Models
    • 2.3.1 Genetic Theories
    • 2.3.2 Hormonal Theories
    • 2.4 Sociocultural Models
    • 2.5 Integrative/Biopsychosocial Model

  3. Diagnosis and Treatment Indications

    • 3.1 Diagnosing Eating Disorders
    • 3.2 Undertaking the Initial Interviews
    • 3.3 Identifying the Appropriate Treatment
    • 3.3.1 Inpatient Hospitalization
    • 3.3.2 Day Hospital Treatment
    • 3.3.3 Outpatient Treatments
    • 3.4 Factors that Influence Treatment Decisions
    • 3.4.1 Age
    • 3.4.2 Gender
    • 3.4.3 Race/Ethnicity
    • 3.4.4 Patient Preference for a Particular Type of Therapy
    • 3.4.5 Clinical Presentation
    • 3.4.6 Comorbidity
    • 3.4.7 Treatment History

  4. Treatment

    • 4.1 Methods of Treatment
    • 4.1.1 Psychoeducation
    • 4.1.2 Cognitive Behavior Therapy (CBT) for BN
    • 4.1.3 Cognitive Behavior Therapy for AN
    • 4.1.4 A Recipe for Treatment
    • 4.1.5 Family Therapy in Adolescents and Children with Anorexia Nervosa
    • 4.2 Mechanism of Action
    • 4.2.1 Psychodynamic and Related Therapies
    • 4.2.2 Cognitive Behavior, Cognitive, and Behavior Therapies
    • 4.2.3 Other “Behavioral” Therapies
    • 4.2.4 Interpersonal Psychotherapy
    • 4.2.5 Feminist Therapy
    • 4.2.6 Motivational Enhancement Therapy
    • 4.2.7 Conclusion
    • 4.3 Efficacy and Prognosis
    • 4.3.1 Methods of Systematic Review
    • 4.3.2 Predictors of Outcome
    • 4.4 Combinations with Medication
    • 4.5 Problems in Carrying out Treatment
    • 4.6 Compulsory Treatment
    • 4.7 Multicultural Issues
  5. 5. Case Vignettes
    • Case Vignette 1: Tracey (Anorexia Nervosa)
    • Case Vignette 2: Belinda (Bulimia Nervosa)
    • Case Vignette 3: Mark (Binge Eating Disorder)
  6. Further Reading
  7. References
  8. Appendices: Tools and Resources

Feedback

“The book is a remarkable achievement and will be of great value to those wanting an up-to-date overview of a complex and multifaceted field.”

— Christopher G. Fairburn, FmedSci, FRCPsych

Professor of Psychiatry, University of Oxford, UK

“… a brilliant handbook for all professionals in the field. With wisdom and compassion, they have masterfully brought together decades of empirical investigation on eating disorders.”

— Kathleen M. Pike, PhD

Department of Psychiatry, Columbia University, New York, and Temple University, Tokyo, Japan

“In keeping with the aim of this series, this book is a great clinical guide, combining biological, psychological and social perspectives into concrete and excellent treatment recommendations.”

— Glenn Waller, DPhil

Vincent Square Clinic Eating Disorders Program, CNWL NHS Foundation Trust and King’s College London, UK

“This book will be an outstanding educational resource for educators and trainees, as well as a terrific reference or guide to clinicians in this field.”

— Daniel le Grange, PhD

Director, Eating Disorders, Associate Professor of Psychiatry, The University of Chicago, IL

“Highly readable, brief yet comprehensive, this book is recommended reading for anyone who needs a crash course on the state of the art of treatment for eating disorders.”

— Marion Olmstead, PhD, CPsych

Director of Ambulatory Care for Eating Disorders, Toronto General Hospital and Associate Professor in Psychiatry, University of Toronto