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Summary - 3.5C Basic human needs: Eating, Sex and Sleep (FSWP3085K) $8.00   Add to cart

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Summary - 3.5C Basic human needs: Eating, Sex and Sleep (FSWP3085K)

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Summary of all the content (week 1 to week 4) for 3.5C Basic human needs: Eating, Sex and Sleep + class notes!

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  • March 9, 2024
  • 35
  • 2023/2024
  • Summary

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Week 1

CAMPBELL ET AL. – EATING DISORDERS IN CHILDREN AND ADOLESCENTS

 Eating disorders (ED) are common in younger children, boys and minority groups
o Anorexia Nervosa
 Peak age of onset of 13 to 18 years
 Highest mortality rate of at least 5%
o Bulimia Nervosa
 Peak age of onset of 16 to 17 years
 Mortality rate of 2% but high risk of suicidality and suicide attempts
 Etiology
o Not known - Interplay between genetic and biological predispositions,
environmental and socio-cultural influences and psychological traits
o Heritable (between 30 to 85%)

 Clinical presentation
o Adolescents: Weight loss, growth stunting, abnormal eating behaviors,
recurrent vomiting, excessive exercise, difficulty gaining weight or body
image concerns
o Children: More atypical presentation as failure to gain expected
weight/height (instead that rapid weight loss), without endorsing body
image concerns or engaging in binge eating or purging behaviors
 Boys, overweight or obese children and adolescents → Risk for
delayed diagnosis

 Diagnosis (See DSM-5 for AN, BN & BED)
o Avoidant restrictive food intake disorder
 Common in children, involves restrictive eating behaviors not
driven by fear of weight gain or distorted cognitions
o Other specified feeding and eating disorders
 Atypical AN, subthreshold BN, purging disorder and night eating
syndrome
o Unspecified feeding and eating disorders
 Clinically significant eating disorders that do not fit into other
categories

 Complications
o Cardiovascular system: bradycardia, hypotension, arrhythmias & heart
rate variability
o Gastrointestinal: delayed gastric emptying, constipation and esophagitis
o Electrolytes: electrolytes imbalances caused by vomiting and laxative
abuse
o Endocrine: hormonal imbalances affecting puberty, menstrual cycle and
bone density
o Renal: dehydration and renal insufficiency
o Hematologic: leukopenia and anemia because of low-weight
o Neurologic: structural and cognitive deficits in children and adolescents
(permanent?)

, o Psychiatric: comorbid disorders as depression, anxiety, substance abuse,
OCD and self-injurious behaviors

Treatment modalities

 It is recommended a low threshold for adolescents with ED due to the potential
irreversible effects on growth, mortality risk and evidence supporting improved
outcomes in early treatment
o Adolescents are treated through outpatient, partial hospitalization,
residential or inpatient programs based on severity, duration, safety and
familial preferences
 Family-based treatment (FBT)
o Focuses on nutritional rehabilitation as the primary initial treatment (6 to
12 months)
o Three phases targeting recovery:
 (1) Physical: Coaching parents to refeed their child → Food
exposure
 (2) Behavioral: Developmentally appropriate control of eating
back to the child/adolescent
 (3) Psychological: Relapse prevention
o Effectiveness in adolescents & young adult with AN → Strong evidence of
full remission
 CBT shows promise especially in BN
 Pharmacotherapy
o Limited evidence
o Antidepressants have shown efficacy in BN, while SSRIs seem effective in
BED

Recovery

 Behavioral: Normalizing eating patterns and regaining flexibility in eating habits
 Psychological: Improved self-esteem and age-appropriate functioning in
interpersonal, psychosocial and occupational aspects
 Physical: Full weight restoration, menstrual cycles and/or pubertal progression,
reversal of organ damage and attainment of normal growth and pubertal patterns
 Nutritional: Reaching a goal weight and the ability to maintain a varied and
balanced diet

LIMBERS ET AL. – EATING DISORDERS IN ADOLESCENT AND YOUNG ADULT MALES

 Males: largely underrepresented in the ED literature because of the stigma that
causes them to minimize or deny the presence of symptoms but they are also at
high-risk
o Risk factor: Sexuality → Gay or bisexual exhibits higher rates of ED

 Differences with females:
o Less shape and weight concerns
o Less body dissatisfaction
o Less drive for thinness → Concerns of being “bigger” and more muscolar
(AN excluded)
 Muscle dysmorphic disorder (dysmorphic disorder proposed as type
of ED)

,  Enhance muscolarity including dieting, weifhtlifting and
steroids
o Less likely to eat in response to negative emotions, sense of loss of control
when binge eating and restricting their food because of body
dissatisfaction
o Less likely to engage in dieting, laxative use and self-induced vomiting in
bulimic cases

 Assessment
o Eating Disorder Examination (EDE) assess frequency and intensity of
behavioral and cognitive symptoms associated with ED and its frequently
used
 It was created and normed for female populations → Caution is
necessary when applying it to diagnose adolescent and
young adult males
o Eatin Disorder Assessment for Men (EDAM) created but more research
needed

 Treatment
o Adolescents: Family-based treatment is the only well-established
o Young adults: CBT and intepersonal psychotherapy are well-established
and there is preliminary evidence for family-based treatment

 Males less likely to seek treatment (-minority groups - low SES)
o Misconception that ED affects females
o Shame and stigma
o Physician less likely to recognize symptoms due to lower rates of incidence
and differences in symptoms presentation
 Critical factors: Improving interpersonal interaction, therapist
characteristics and quality of the therapeutic relationship
 Attention should be given to a heightened prevalence of comorbid
substance abuse disorders and the role that competitive sports play

WILSON – COGNITIVE-BEHAVIORAL THERAPY FOR EATING DISORDERS

Bulimia nervosa (BN): Abnormal overevaluation of the importance of body
shape/weight → Dysfunctional dieting and other extreme, unhealthy weight-control
behaviors (purging) → Binge-eating

 CBT: Replace dysfunctional dieting with a regular and healthy pattern of eating,
ceasing purging and other extreme forms of weight control and decreasing
overevaluation of body shape/weight
o Risk factor and maintaining mechanisms: dysfunctional dieting
 Reducing the strict control helps overcoming the disorder
 CBT-E (enhanced-behavioral therapy): Revised version which is personalized to
the patient
o CBT-Ef (focused): Address overevaluation of body weight/shape and treats
the “mood intolerance” → Trigger of binge eating and purging
o CBT-Eb (broad): Address comorbid disorders that maintain/complicate
eating disorder → Perfectionism, low self-esteem and interpersonal
difficulties
 CBTgsh (guided self-help)

, o Guided self-help based on the principles and procedures of CBT
o Effective first-level treatment: rapid reduction in binge eating, greater
acceptability and lower cost than family therapy
 Treatment efficacy
o CBT is more effective than either antidepressants or other psychological
treatments as interpersonal psychotherapy (IPT)
o Predictors of improved outcome: Early response to CBT
o Predictors of poorer outcome:
 No responders in the early course of therapy
 Longer history of eating disorder
 Overevaluation of the importance of body shape/weight

Binge-eating disorder (BED):

 CBT: Reduce frequency of binge eating at follow up and high rates of remission
o CBT is more effective than either antidepressants or behavioral weight
loss (BWL)
 Combining medication with CBT produced superior outcomes to
pharmacotherapy only but does not enhance the outcome yielded
by CBT only
 CBTgsh
o Effective as IPT in maintain improvements at follow-up and both superior
to BWL
o More effective than treatment-as-usual (TAU) in remission rates
 Treatment efficacy
o Predictors of improved outcome: Early response to CBT
 CBT + IPT can be used when there is a failure in finding rapid
response since IPT its efficacious with both rapid and nonrapid
responders
o Predictors of poorer outcome:
 Overevaluation of the importance of body shape/weight

Anorexia nervosa (AN):

 CBT-E
o Support for the treatment of anorexia nervosa
 Improvement in eating disorder psychopathology and increased
weight
 As effective as TAU → Probably related to the study’s design

Effectiveness and scalability of CBT

 Evidence-based treatment for all eating diagnoses for both adolescents and
adults
 More effective in the long-term compared to IPT and pharmacological treatment
 No significant differences among different ethnic and racial groups in treatment
outcome
 Cost-effective
o Brief CBTgsh is as effective as lengthier manual-based CBT for BN and
BED
o Guided-self-help is more effective than pure self-help without support from
a counselor

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