DSM-IV-TRAnorexic Nervosa Bulimia Nervosa Binge Eating Disorder Refusal to maintain Recurrent episodes Eating normal body weight of binge eating misappropriate Recurrent and amount of food Intense fear of gaining weight (even inappropriate Lack of control over though under weight) compensatory eating behaviors Distorted perception Marked distress of body shape & size Self evaluation is dependent on weight Amenorrhea and body shape
DSM-IV-TRCategoriza*onEmphasis on outwardly observable facetsEa*ng disorder = obsession with body image and control?
Intervention Onset of Illness Prevention Treatment*note: the rationale behind these t wo types ofinter vention should not be much different
PreventionOnset of ED typically during adolescenceor early adult lifeEasier to treat ED early before itbecomes chronicPreventing it before it starts will evenbe better
Prevention ObjectivesIncrease knowledgeDiscourage calorie-restrictive dietingand promote healthy eating and exerciseDevelop skills to resist social pressure toeatPromote self-acceptance and developmentof positive image Smolak, 1999
Middle School Primary Prevention Program for Eating DisordersA controlled study with a Twelve-Month Follow-up Grave et al., 2001
Prevention Program Grave et al., 2001Evaluate efﬁcacy of a new school-basedeating disorder prevention programdesigned to reduce dietary restraint, and the level of preoccupation with regard to shape and weight
Prevention Program Grave et al., 2001N= 106 (M age: 11 - 12 years old)61 girls, 45 boys (Universal-selective program*) (McVey et al., 2007) Experimental group = 55 Control group = 51 These groups were formed by randomly selecting classesThe experimental group went through the program devised by the authors;nothing was administered to the control group (it was just for comparison).
Methods Grave et al., 2001 Program (6 weeks)1 week 1 week 6-month 2 booster 12-month before after follow-up sessions follow-upprogram program
Methods Program Grave et al., 2001 (6 weeks)1 week 1 week 6-month 2 booster 12-month before after follow-up sessions follow-upprogram programQuestionnaires- Eating disorder Examination (EDE-Q)- Eating Attitude Test (EAT)- Rosenberg Self-Esteem Scale (RSES)- 35-item knowledge questionnaire (KQ) by the authors- demographic and background info*
Methods Program Grave et al., 2001(6 weeks) 2 hour-long sessions 30 mins: educational materials Remaining: practical activities, group discussions, revision of homework
Methods Program Grave et al., 2001(6 weeks)increase knowledgeinteractive rather than didacticfriendly approach to cognitive restructuringHW: to encourage students to apply the preventionprogram in their livesRole playing: teach how to deal with adversecomments about shape and weight
Methods Program Grave et al., 2001(6 weeks) 2 booster sessions2-hour longsimilar to program
Results & Conclusion Grave et al., 2001led to increase in knowledge anddecrease in some attitudesthese effects were maintained at 12-month follow-upsigniﬁcant reduction obser ved on EATand global EDE-Q scores in bothexperimental and control group
Results & Conclusion Grave et al., 2001increase in knowledge did not triggerimmediate effect on attitudes, butdelayed positive effect
Results & Conclusion Grave et al., 2001no signiﬁcant changes on the levels of restraint, shape and weight concern self-esteemAuthors conclude: difﬁcult to statistically achieve signiﬁcant decrease in the behavior and attitudes more intensive inter vention is necessary to modify these attitudes
Finally, a Question!What do you think of this pilot study?Also, what is the assumption behindsuch inter vention method? changing attitude towards body shape and weight maintain habits of healthy living style increase knowledge of aversive impact of weight management
Discussion Grave et al., 2001general aim of the program to create a counter-culture in which the pupils helped each other to discourage dieting and to challenge media messages about thinness and beauty
Disease-Speciﬁc Pathways approachSocial Cognitive Theory (SCT) sociocultural factors that create/maintain disordered eating Decrease risk factors associated with disordered eating (e.g. idealization of slenderness, drive for thinness, or fear of fatness) Foster protective factors (e.g. healthy eating)
Non-Speciﬁc VulnerabilityStressor (NSVS) Approach Foster generic life-skills e.g. stress management, assertion, decision- making, social competency & resiliency
Feminist Empowerment Relational (FER) modelEmphasizes developing critical thinkingtowards the gendered issuescontributing to negative body imagepromote new norms of relating,acceptance, support and powerparticipatory approach
She felt that she had not been “successful”as an anorexic because she did not reach an extremely low weight.She believed that truly successful anorexics die of star vation and that somehow they should be revered for their accomplishments. Ms A, Bulik & Kendler,,2000
Every time I felt guilty, painful, angry, hate, fearful, embarrassed, I would start to eat because every time I ate, I would feel so happy and “high”.All the stress and worries just disappeared and I would feel like I have escaped into another world. Jenn, (Not just surface damage)
"I had a very complicatedchildhood, very difﬁcult, very painful. My mothers bigphobia was that I would grow.She spent her time measuringmy height. She wouldnt let mego outside because shed heardthat fresh air makes children grow, and thats why I was kept at home. It was completely traumatic." Isabelle Caro, model Died 17 Nov 2010 (aged 28)
Mere Obsession of Body Image? Long-standing patterns of interpersonal discomfort (Kaye et al., 2004) Sustained pattern of interpersonal deﬁcit
Mere Obsession of Body Image? Disruption of attachment process during adolescence (O’Kearney, 1996) Ambivalent attachment scores were positively correlated with Drive for Thinness and Bulimia subscale scores of EDI-2 Consistent with empirical studies linking anxious- ambivalent attachment with ED Suldo & Sandberg, 2000
Mere Obsession of Body Image? Poor interoceptive awareness (Fassino et al., 2004) an anorexic is disconnected from her internal experiences and thus does not use internal signals of hunger, fatigue or affective state to guide behavior effectively Zucker and colleagues (2007) instead suggest that we study social cognition in anorexia
Social Cognition in EDZucker and colleagues (2007) propose following reasonsto study interpersonal interaction in an AN: Improvements in social acceptance and interpersonal proﬁciency are the areas which individuals with AN are motivated to improve Only effective treatment for youths to date rely on the involvement of the family (Lock & le Grange, 2005) Social cognition indices such as social perception have been reported to be crucial mediators bet ween neurocognitive impairment and functional status
Final ThoughtsIs there more to mere body imageperception?How should we then devise the efﬁcientpreventive inter vention method?Is EVERYONE with the ED having such acomplicated causes for ED?Strengths?
Although core behavioral features are often constant across patients, the underlyingcomplexity of biological and environmental factors that converge to create an eating disorder are unique to each individual.
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