PSY240H1 Lecture 7: lecture 7 pt 2
Biological Theories
Genetics
• – Family history of anorexia nervosa increases one’s risk 4x (Could be in part due to
modelling by family members, disordered eating structures, etc.)
compared with the general population
• – Heritability estimate for anorexia nervosa may be as high as 56%
• – Underlying genetic mechanisms are poorly understood
Endogenous opioids
Substances produced by the body that reduce pain, enhance mood, suppress appetite
In anorexia nervosa, released during starvation, euphoric state, reinforcing (which may explain
why people can continue through the torture).
In bulimia nervosa, levels may be low, promote craving, ingestion of food creates euphoric state,
reinforcing.
Serotonin deficit in bulimia nervosa
Cognitive Behavioral Theories
Fairburn, Cooper, & Shafran’s (2003) transdiagnostic model on slide.
The central concept of all eating disorders (except binge-eating disorder) is self-evaluation based
on control over eating, shape, or weight. And what happens when you have this self-evaluation
based on these beliefs is you will restrict and restrain calories/behave in a way which interferes
with weight gain. This leads to binge-eating episodes (because you have to adhere to extreme
and specific dietary rules but then you break these rules and you feel really badly about it, and
then they decide to abandon it cuz like fuck it im not doing well anyway may as well binge (all
or nothing thinking which is common amongst almost all mental illnesses)). This in turn
maintains the self-evaluation/concern over eating which sort of restarts the cycle. The other issue
is that when people who have these concerns often experience stressors (especially because
mental health usually exacerbates it), then there are the physical/social consequences of under-
eating and the reinforcement of loosing weight which plays back and re-starts the cycle.
CBT Theories and Perfectionism slides online
Treatment Approaches:
• Multi-disciplinary treatment team should ideally include medical doctor, psychiatrist,
dietitian and therapist.
• Education and involvement of the family and other support network is crucial
• Psychological treatments are not generally sufficient for severely malnourished patients
• Value of therapy prior to refeeding stage is uncertain (Starving patients are often
negativistic, obsessional, or mildly cognitively impaired
• Therapy can be helpful for patients once malnutrition has been corrected and weight gain
has begun (Typically required for at least a 1-year period).
• General consensus regarding the efficacy of a combined psychotherapeutic/medication
approach
The Ethics of Refeeding in Anorexia Nervosa
Difficult questions to consider:
Are patients competent to make decisions about their treatment?
Should patient’s wish not to be fed be respected?
Is it medically appropriate to impose nutrition on a patient’s who has been treated this way
before and has relapsed?
(Others on slides).
Treatment for Eating Disorders:
(CBT)
Stage one:
Engage patient in treatment and change
Jointly create formulation
Establish self-monitoring
Establish collaborative “weekly weighing”
Provide education
Establishing “regular eating”
Involving significant others
Stage two:
Review progress,
identify problems still to be addressed and any barriers to change
Revise formulation if necessary
Stage three
• – Addressing over evaluation of shape and weight
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PSY240H1 Full Course Notes
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Document Summary
Substances produced by the body that reduce pain, enhance mood, suppress appetite. In anorexia nervosa, released during starvation, euphoric state, reinforcing (which may explain why people can continue through the torture). In bulimia nervosa, levels may be low, promote craving, ingestion of food creates euphoric state, reinforcing. Fairburn, cooper, & shafran"s (2003) transdiagnostic model on slide. The central concept of all eating disorders (except binge-eating disorder) is self-evaluation based on control over eating, shape, or weight. And what happens when you have this self-evaluation based on these beliefs is you will restrict and restrain calories/behave in a way which interferes with weight gain. This in turn maintains the self-evaluation/concern over eating which sort of restarts the cycle. Multi-disciplinary treatment team should ideally include medical doctor, psychiatrist, dietitian and therapist: education and involvement of the family and other support network is crucial.
