Summary: 3.5 Basic Human Needs: Eating, Sex & Sleep
Lectures
Lecture 1
CBT-E in treatment of eating disorders
Diagnostics
• AN
• BN
• BED
o OSFED
• ARFID
o Most often seen in children / patients w/ mental retardation
• Pica
Preliminary differential diagnosis
• Core psychopathology of all 3 is the same
Transdiagnostic formulation of the eating disorder
àmaintenance cycle
1. Where would you start-goals?
2. Which factors are most important to address in therapy?
a. Weight
b. Function: Relation w/ food – restricting or overeating
c. Lack of-/feeling of control
d. Perception of oneself
e. Social circle – promoting Eds or not
• E.g., binges – perpetuated by feelings of loneliness à leads to isolating
oneself à shame
,Cognitive behavioral therapy enhanced in the treatment of eating disorders
• Stage 1 (sessions 1-7) → intensive initial stage, twice per week, setting up a formulation
of the underlying maintaining factors (base for the rest of the treatment) → engaging
the patient in treatment
• Stage 2 (sessions 8-9)→ weekly appointments → brief stage, patients take stock, review
progress, identify barriers to change, modify the formulation and plan stage 3.
Important to identify problems with the therapy, to remove barriers and adjust treatment
if needed. After stage 2 the treatment will become more personalized
• Stage 3 (session 10-17) → main body of treatment, weekly appointments, addressing
the main mechanisms that are supposed to maintain the patient’s ED. varies patient to
patient. The therapist chooses which factors to focus on.
o often over-evaluation of shape and weight is an important maintaining
mechanism that will be addressed in this stage
• Stage 4 (session 18-20)→ final stage, once every 2 weeks, first aim : ensure that the
changes are maintained and the second : minimize risk of relapse in the long term,
personalized maintenance plan is made
o personalised maintenance plan is made
• After 20 weeks a review session
àObjective vs subjective binges
, Plenary Meeting Week 1
Misconceptions
o ED is not a lifestyle choice, a diet gone bad, or a phase – it’s disturbed self-perception
o cannot tell if someone has ED by looking at them
o social media cannot be the only to blame
Characteristics
AN:
o Persistent food restriction leading to significantly low body weight
o Fear of weight gain
o Disturbance in how body weight/ shape is experienced
o purging type – it’s not objectively large amount of food (could be one apple for them
and then they binge)
BN:
o Binge eating = Overeating + Loss of Control
o Compensatory behaviours - vomiting, misuse laxatives, fasting
o Self-worth is based on body shape/ weight
BED:
o Binge eating = Overeating + Loss of Control WITHOUT compensatory behaviours
o Eating quickly, uncomfortably full, eating alone, feeling disgusted
o Distress
Similarities
o all eating/-related disturbances
o AN & BN overlap in way body weight/ shape experienced
o Body weight BN>AN
o BN & BED overlap in overeating + LOC eating, except for compensatory behaviours
o Both usually have no long-term dietary restrictions to influence their weight between
BE episodes
o Dieting may precede BN, while attempting to diet begins after BED
Differences
o Remission: BED> AN & BN
o BED patients rarely switch from BED to other ED
Prevalence
• can happen to everyone
• some people may be more susceptible than others and at different times on their lives
Presentation in males
o EDs may present differently to females (where weight concerns and drive for thinness
is typically seen)
o Less typical compensatory behaviours (vomiting and using laxatives) and body/ weight
concerns compared to women
o Lack of awareness of eating behaviours that are pathological (and stereotypically
'female)
o May be at risk for delayed diagnosis (and therefore significant complications)
o Muscle dysmorphia (subtype of body dysmorphic disorder) can be common in men and
could also be linked to EDs (incl. usage of steroids drug use, weightlifting, dieting)
o Often comorbid substance abuse (could negatively impact treatment course)
o Possibly better prognosis than women
Lectures
Lecture 1
CBT-E in treatment of eating disorders
Diagnostics
• AN
• BN
• BED
o OSFED
• ARFID
o Most often seen in children / patients w/ mental retardation
• Pica
Preliminary differential diagnosis
• Core psychopathology of all 3 is the same
Transdiagnostic formulation of the eating disorder
àmaintenance cycle
1. Where would you start-goals?
2. Which factors are most important to address in therapy?
a. Weight
b. Function: Relation w/ food – restricting or overeating
c. Lack of-/feeling of control
d. Perception of oneself
e. Social circle – promoting Eds or not
• E.g., binges – perpetuated by feelings of loneliness à leads to isolating
oneself à shame
,Cognitive behavioral therapy enhanced in the treatment of eating disorders
• Stage 1 (sessions 1-7) → intensive initial stage, twice per week, setting up a formulation
of the underlying maintaining factors (base for the rest of the treatment) → engaging
the patient in treatment
• Stage 2 (sessions 8-9)→ weekly appointments → brief stage, patients take stock, review
progress, identify barriers to change, modify the formulation and plan stage 3.
Important to identify problems with the therapy, to remove barriers and adjust treatment
if needed. After stage 2 the treatment will become more personalized
• Stage 3 (session 10-17) → main body of treatment, weekly appointments, addressing
the main mechanisms that are supposed to maintain the patient’s ED. varies patient to
patient. The therapist chooses which factors to focus on.
o often over-evaluation of shape and weight is an important maintaining
mechanism that will be addressed in this stage
• Stage 4 (session 18-20)→ final stage, once every 2 weeks, first aim : ensure that the
changes are maintained and the second : minimize risk of relapse in the long term,
personalized maintenance plan is made
o personalised maintenance plan is made
• After 20 weeks a review session
àObjective vs subjective binges
, Plenary Meeting Week 1
Misconceptions
o ED is not a lifestyle choice, a diet gone bad, or a phase – it’s disturbed self-perception
o cannot tell if someone has ED by looking at them
o social media cannot be the only to blame
Characteristics
AN:
o Persistent food restriction leading to significantly low body weight
o Fear of weight gain
o Disturbance in how body weight/ shape is experienced
o purging type – it’s not objectively large amount of food (could be one apple for them
and then they binge)
BN:
o Binge eating = Overeating + Loss of Control
o Compensatory behaviours - vomiting, misuse laxatives, fasting
o Self-worth is based on body shape/ weight
BED:
o Binge eating = Overeating + Loss of Control WITHOUT compensatory behaviours
o Eating quickly, uncomfortably full, eating alone, feeling disgusted
o Distress
Similarities
o all eating/-related disturbances
o AN & BN overlap in way body weight/ shape experienced
o Body weight BN>AN
o BN & BED overlap in overeating + LOC eating, except for compensatory behaviours
o Both usually have no long-term dietary restrictions to influence their weight between
BE episodes
o Dieting may precede BN, while attempting to diet begins after BED
Differences
o Remission: BED> AN & BN
o BED patients rarely switch from BED to other ED
Prevalence
• can happen to everyone
• some people may be more susceptible than others and at different times on their lives
Presentation in males
o EDs may present differently to females (where weight concerns and drive for thinness
is typically seen)
o Less typical compensatory behaviours (vomiting and using laxatives) and body/ weight
concerns compared to women
o Lack of awareness of eating behaviours that are pathological (and stereotypically
'female)
o May be at risk for delayed diagnosis (and therefore significant complications)
o Muscle dysmorphia (subtype of body dysmorphic disorder) can be common in men and
could also be linked to EDs (incl. usage of steroids drug use, weightlifting, dieting)
o Often comorbid substance abuse (could negatively impact treatment course)
o Possibly better prognosis than women
