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Prof. Janet Treasure eatingresearch

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Prof. Janet Treasure eatingresearch

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    2. Overview Introduction-the range of eating disorder. Update on Aetiology. Evaluating risk. Vocational and social functioning. A summary evidence about change.

    3. Spectrum of EDs

    5. Anorexia Nervosa Illness defined 1860 Teenage onset Avoid eating Excess exercise High mortality (up to 20%) & disability

    6. Bulimia nervosa 1979: Defined by Russell Core Behaviours: Binge >1000cal out of control Compensatory Behaviours eg Vomit, laxatives, exercise, drugs Teenage onset 2-4% of population

    7. Binge Eating Disorder: History 1994 DSM-IV: category deserving further study Recurrent distressing binges No food restriction No compensatory behaviours Obesity Prevalence: 1-6% Men & women affected equally Peak age onset: 13-15 and early 20s

    8. Lifetime prevalence of BN in 3 cohorts of twins

    11. Four Maintaining Factors AN

    12. Four Maintaining Factors AN

    14. Poor Social comparison

    15. Four Maintaining Factors AN

    16. Information processing biases

    19. Translating New Science into Treatment: Cravings & Desire

    21. How can desire for food be disrupted?

    22. Animals models of binge eating A period of under nutrition. Divert food stomach Intermittent availability of highly palatable food Stress. Breeding (Rada et al 2005, Lewis et al 2005, Avena et al 2005, Corwin 2006, Corwin & Hajnal 2005, Boggiano et al 2005; Avena & Hoebel 2003, Avena & Hoebel 2007, Boggiano et al 2007).

    23. Animals models of binge eating (these animals also become addicted to other substances eg amphetamine) A period of under nutrition. Divert food stomach Intermittent availability of highly palatable food Stress. Breeding (Rada et al 2005, Lewis et al 2005, Avena et al 2005, Corwin 2006, Corwin & Hajnal 2005, Boggiano et al 2005; Avena & Hoebel 2003, Avena & Hoebel 2007, Boggiano et al 2007).

    24. Human models of binge eating A period of under nutrition (Size 0 culture & promotion of dieting). Divert food stomach (Vomiting as compensatory method) Intermittent availability of highly palatable food (Easy access to food disembedded from social eating)

    27. Opening Moves Normalise ambivalence about attendance. Who is the prime mover, peers, self, line manager? Elicit readiness to change. Elicit concerns: physical, psychological, spiritual, family, social, education/career, forensic. Assess medical risk. Ethical responsibility: Discuss issues of confidentiality. If high risk need to involve others, professionals.

    28. Opening Moves Normalise ambivalence about attendance. Who is the prime mover, peers, self, line manager? Elicit readiness to change. Elicit concerns: physical, psychological, spiritual, family, social, education/career, forensic. Assess medical risk. Ethical responsibility: Discuss issues of confidentiality. If high risk need to involve others, professionals.

    29. Matching Process to Readiness. The Cycle of Change

    30. Opening Moves Normalise ambivalence about attendance. Who is the prime mover, peers, self, line manager? Elicit readiness to change. Elicit concerns: physical, psychological, spiritual, family, social, education/career, forensic. Assess medical risk. Ethical responsibility: Discuss issues of confidentiality. If high risk need to involve others, professionals.

    32. What is the Health and Psychosocial Burden? ? Morbidity (Johnson et 2002, Striegel Moore et al 2003,Patton et al 2008). Education: interruptions and lower level for AN. (Byford et al 2007). Vocational: 21% on state benefits (Hjern et al 2006). Social networks small (Tiller et al 1997). Communication Skills impaired (Takahasi et al 2006). Carers high burden and distress (Treasure et al 2001).

    33. Opening Moves Normalise ambivalence about attendance. Who is the prime mover, peers, self, line manager? Elicit readiness to change. Elicit concerns: physical, psychological, spiritual, family, social, education/career, forensic. Assess medical risk. Ethical responsibility: Discuss issues of confidentiality. If high risk need to involve others, professionals.

    34. Is there binge eating? There is often secrecy about the pattern of food intake and the various compensatory strategies. Other addictive and antisocial behaviours can also be present.

    35. Physical Signs Parotid or submandibular gland enlargement. Eroded teeth. "Russell's sign" callus on back of hand. Cold blue hands, nose and feet. Lanugo hair.

    36. What is the Risk? The Brief Medical Risk Assessment www.eatingresearch.com Skeletal power to examine for myopathy which is a good marker of severity. Blood pressure and HR to measure cardiac function and circulation. The fall in BP between sitting & standing & dizziness is a measure of dehydration. Core temperature- level of metabolism.

    38. Opening Moves Normalise ambivalence about attendance. Who is the prime mover, peers, self, line manager? Elicit readiness to change. Elicit concerns: physical, psychological, spiritual, family, social, education/career, forensic. Assess medical risk. Ethical responsibility: Discuss issues of confidentiality. If high risk need to involve others, professionals.

    40. How to Manage Eating Disorders: 1. Help move the patient into the position where they are interested in considering change eg discussing the pros and the cons of their behaviour. A motivational interviewing approach can help with patient's ambivalence about change Guide the patient to an expert resource outlining the long-term effects of starvation, nutrition advice and general information about eating disorders. Counseling about other issues -e.g., relationship problems, perfectionist, rigid and anxious traits. Target the risk & maintaining factors: information processing traits, interpersonal factors, pro- ED beliefs

    41. Cochrane systematic reviews: AN

    42. Cochrane systematic reviews: BN

    43. Technology: Guided Self Help Education and skills based self help. Books DVDs Web based programmes offer interactive element

    44. Conclusion A spectrum of eating disorders now exist. The risk of binge eating disorders has increased for cohorts born after 1950. Cognitive, emotional and physical factors can impact on vocational functioning. Engagement into treatment can be difficult for AN. Guided self care is a useful first step. Good results for psychotherapy BN majority AN now manage out of hospital.

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