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ED Review Questions

QuestionAnswer
Eating Disorders and the DSM-IV Criteria Anorexia:
CBT Models of Eating Disorders-cognitive and behavioural components Cycle that begins with a pursuit of thinness->leads to restrictive dieting->leads to feeling deprived & hungry->body eventually can no longer handle this deprivation so person engages in a binge->feels bad for binging so purges to compensate->guilt/shame
Model of Anorexia Issue with self-esteem->over-evaluation of weight, shape, eating->strict weight control behaviours->increased checking of weight, body, foods->decrease in rate of weight loss->perceived failure to control weight
Model of Bulimia Self-esteem issue>over-evaluation of weight, body, eating->dietary restraint->binge eating->purging behaviours
Fairburn's Unified CBT Protocol designed to work across many EDs. focus more on behaviours (restricting, binging/purging) & cognitions (over-valuation of shape & weight). Two versions: patients w/ BMI>17.5 (20 sessions in 20 weeks), patients w/ BMI<17.5 (40 sessions in 40 weeks).
Stage 1 of Fairburn's Protocol After medical assessment (EKG, electrolytes, bone density). Twice weekly (7 sessions, 4 weeks). Orient to model & get commitment. Info about weight & weight gain. Complete food logs. Learn to eat regular meals w/o eating in between.
Food Schedule Plan meals at given times, no more than 4 hours in between. Do not eat based on hunger cues. Do not skip meals. Do not eat in between planned meals. Eat whatever, but must eat at scheduled times only.
Stage 2 of Fairburn's Protocol Weekly sessions (2 sessions, 2 weeks). Assess progress. Identify barriers to change. Modify formulation of problem, as needed.
Stage 3 of Fairburn's Protocol Weekly (8 sessions, 7 weeks). Focus on problems that stared ED initially. Target: self-esteem, over-valuation of weight & shape, depression. Reduce checking/comparing. What it means to feel fat. Reduce rule-driven eating.
Stage 4 of Fairburn's Protocol Bi-weekly (3 sessions, 6 weeks). Relapse prevention. How to maintain change. Want patient moving towards BMI of 19-20.
Fairburn's for BMI < 17.5 adds emphasis upfront on regaining weight ->necessary for cognitive work & attendance at therapy. Goal: 1 pound per week = extra 500 calories/day. If BMI<15, refer to inpatient program. DO NOT see outpatient.
Family Based Therapy For Anorexia: Phase 1 Phase 1 Weight Restoration: Assist parents in re-feeding the child. Coach parents to validate ambivalence while insisting starvation is not an option. Externalize symptom: problem isn't the child, it's the disorder. Align child with siblings.
FBT: Phase 2 Return control back to adolescent. Parents help child take control over eating again.Day-to-day issues or family tension can be addressed. Coach on age-appropriate limits.
FBT: Phase 3 Establish healthy adolescent identity. Once adolescent maintains weight above 95% of ideal weight. Focus on impact AN had on establishing healthy identity. Autonomy, parental boundaries, preparation to leave the nest.
Evidence for FBT Best for adolescents who have been sick for <3 yrs. Return to normal weight after tx & maintain at 5 yr follow-up. ED symptoms improved more with FBT than with adolescent-focused tx
CBT vs Meds CBT+meds work better than meds alone. CBT=meds in immediate decrease in binge freq. CBT has greater magnitude & lasts longer than meds. Improved mood, concentration, sense of control, fewer concerns about shape & weight.
Created by: lbord313
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