3.5C
Basisbehoeften van de mens
, Lecture week 1: eating disorders
Basic human needs (eating, sex and sleep) survival. We have built in
mechanisms to remind us to engage in them.
They drive our behaviour. Common brain physiology among the basic human
needs. Eating, sexual, and sleep disorders are very common.
Guest lecture – Jeffrey van der Starre & Marijke Ottervanger- CBT-
E(nhanced) in the treatment of eating disorders.
See DSM-V for full lists of criteria
Anorexia nervosa (definition: a loss of eating due to nervous symptoms) - The
hallmark of anorexia nervosa is that a person is underweight.
Bulimia nervosa – binges combined with compensatory purging. You cannot be
underweight with bulimia nervosa, you can be overweight though. Most of the
time people have a healthy BMI.
Binge eating disorder – binges without purging. You typically are overweight with
BED, but this is not necessarily a condition for a diagnosis.
ARFID (avoidant restrictive food intake disorder) – a patient avoids types of foods
because they fear these foods with unwanted consequences. They can
sometimes be underweight (due to a lack of nutrients), but quite often they have
a regular appearance)
Pica – a patient who eats things not usually considered food. Most often this
appears in children or patients with cognitive retardation.
OSFED (other specified feeding- or eating disorders) – people who do not fully
meet the criteria for one of the eating disorders.
CBT-E cycle
1. Make a transdiagnostic formulation (Maintenance cycle)
2. Stage 1: bi-weekly appointments. Motivate & engage your patient to work
on food goals or treatment in general. Food diary: Asterix column stands
, for when people think that they have eaten too much. V/D column stands
for compensating behaviour after eating.
3. Stage 2: weekly appointments. Identify problems with the therapy, remove
barriers and adjust treatment if needed. Identify the maintaining factor of
the ED. After stage 2 the treatment will become more personalized.
4. Stage 3: this is the main body of treatment. These are weekly
appointments. You address main mechanisms that are supposed to
maintain the patient’s ED. How this is done precisely varies from patient to
patient.
5. Stage 4: appointments every other week. focus on relapse prevention.
, Literature week 1: eating disorders
DSM-V
Anorexia nervosa
A. Restriction of energy intake relative to requirements, leading
to a significantly low body weight in the context of age, sex,
developmental trajectory, and physical health. Significantly low weight is
defined as a weight that is less than minimally normal or, for children and
adolescents, less than that minimally expected.
B. Intense fear of gaining weight or of becoming fat, or persistent behaviour
that interferes with weight gain, even though at a significantly low weight.
C. Disturbance in the way in which one’s body weight or shape is
experienced, undue influence of body weight or shape on self-evaluation,
or persistent lack of recognition of the seriousness of the current low body
weight.
Restricting type: During the last 3 months, the individual has not engaged in
recurrent episodes of binge eating or purging behaviour (i.e., self-induced
vomiting or the misuse of laxatives, diuretics, or enemas). This subtype describes
presentations in which weight loss is accomplished primarily through dieting,
fasting, and/or excessive exercise.
Binge-eating/purging type: During the last 3 months, the individual has engaged
in recurrent episodes of binge eating or purging behaviour (i.e., self-induced
vomiting or the misuse of laxatives, diuretics, or enemas).
Subtypes
1. Binge-Eating/Purging Type – Individuals engage in binge eating followed by
purging through vomiting, laxatives, diuretics, or enemas. Some purge
after consuming small amounts of food without bingeing.
2. Restricting Type – Characterized by severe restriction of food intake
without regular bingeing or purging.
Crossover between subtypes is common, and classification should be based on
current symptoms rather than long-term patterns.
Diagnostic Features
Three key features define AN:
Persistent energy intake restriction leading to significantly low body
weight.
Intense fear of gaining weight or behaviors that prevent weight gain.
Distorted self-perception of weight or body shape.
Weight assessment is challenging as normal ranges vary.
Associated Features Supporting Diagnosis
AN can lead to severe medical complications, including: Malnutrition-related
organ dysfunction, Hormonal changes, such as amenorrhea, Depression, anxiety,
Basisbehoeften van de mens
, Lecture week 1: eating disorders
Basic human needs (eating, sex and sleep) survival. We have built in
mechanisms to remind us to engage in them.
They drive our behaviour. Common brain physiology among the basic human
needs. Eating, sexual, and sleep disorders are very common.
Guest lecture – Jeffrey van der Starre & Marijke Ottervanger- CBT-
E(nhanced) in the treatment of eating disorders.
See DSM-V for full lists of criteria
Anorexia nervosa (definition: a loss of eating due to nervous symptoms) - The
hallmark of anorexia nervosa is that a person is underweight.
Bulimia nervosa – binges combined with compensatory purging. You cannot be
underweight with bulimia nervosa, you can be overweight though. Most of the
time people have a healthy BMI.
Binge eating disorder – binges without purging. You typically are overweight with
BED, but this is not necessarily a condition for a diagnosis.
ARFID (avoidant restrictive food intake disorder) – a patient avoids types of foods
because they fear these foods with unwanted consequences. They can
sometimes be underweight (due to a lack of nutrients), but quite often they have
a regular appearance)
Pica – a patient who eats things not usually considered food. Most often this
appears in children or patients with cognitive retardation.
OSFED (other specified feeding- or eating disorders) – people who do not fully
meet the criteria for one of the eating disorders.
CBT-E cycle
1. Make a transdiagnostic formulation (Maintenance cycle)
2. Stage 1: bi-weekly appointments. Motivate & engage your patient to work
on food goals or treatment in general. Food diary: Asterix column stands
, for when people think that they have eaten too much. V/D column stands
for compensating behaviour after eating.
3. Stage 2: weekly appointments. Identify problems with the therapy, remove
barriers and adjust treatment if needed. Identify the maintaining factor of
the ED. After stage 2 the treatment will become more personalized.
4. Stage 3: this is the main body of treatment. These are weekly
appointments. You address main mechanisms that are supposed to
maintain the patient’s ED. How this is done precisely varies from patient to
patient.
5. Stage 4: appointments every other week. focus on relapse prevention.
, Literature week 1: eating disorders
DSM-V
Anorexia nervosa
A. Restriction of energy intake relative to requirements, leading
to a significantly low body weight in the context of age, sex,
developmental trajectory, and physical health. Significantly low weight is
defined as a weight that is less than minimally normal or, for children and
adolescents, less than that minimally expected.
B. Intense fear of gaining weight or of becoming fat, or persistent behaviour
that interferes with weight gain, even though at a significantly low weight.
C. Disturbance in the way in which one’s body weight or shape is
experienced, undue influence of body weight or shape on self-evaluation,
or persistent lack of recognition of the seriousness of the current low body
weight.
Restricting type: During the last 3 months, the individual has not engaged in
recurrent episodes of binge eating or purging behaviour (i.e., self-induced
vomiting or the misuse of laxatives, diuretics, or enemas). This subtype describes
presentations in which weight loss is accomplished primarily through dieting,
fasting, and/or excessive exercise.
Binge-eating/purging type: During the last 3 months, the individual has engaged
in recurrent episodes of binge eating or purging behaviour (i.e., self-induced
vomiting or the misuse of laxatives, diuretics, or enemas).
Subtypes
1. Binge-Eating/Purging Type – Individuals engage in binge eating followed by
purging through vomiting, laxatives, diuretics, or enemas. Some purge
after consuming small amounts of food without bingeing.
2. Restricting Type – Characterized by severe restriction of food intake
without regular bingeing or purging.
Crossover between subtypes is common, and classification should be based on
current symptoms rather than long-term patterns.
Diagnostic Features
Three key features define AN:
Persistent energy intake restriction leading to significantly low body
weight.
Intense fear of gaining weight or behaviors that prevent weight gain.
Distorted self-perception of weight or body shape.
Weight assessment is challenging as normal ranges vary.
Associated Features Supporting Diagnosis
AN can lead to severe medical complications, including: Malnutrition-related
organ dysfunction, Hormonal changes, such as amenorrhea, Depression, anxiety,
