Download Prevention of an Eating Disorder and Ways to Spread Awareness

Prevention of an Eating
Disorder and Ways to
Spread Awareness
A Presentation by: Sara Mahan (Bird) and Kathleen Verba
Both individuals do not have any conflicts of interest in presenting at the 2014
Zarrow Symposium.
Purpose of the Presentation
 This session will provide information to assist mental health workers to identify
the different diagnostic classifications of eating disorders according to the DSM
V.
 The presenters will also identify different strategies for prevention and
intervention to use with those at risk or suffering from an eating disorder.
 Prevention strategies will range from being developmentally appropriate for preteen to adult.
 The presenters will also discuss societal influences and how eating disorders
are not simply a “woman’s disease.”
 Finally, the presenters will help to provide information to assist in bringing
awareness to the issue and empowering others to advocate.
The Knowledge Gained
 Upon completion of this workshop, the
participant will be able to learn the following:
 The definition of the various eating disorders.
 Strategies for preventions of eating disorders
 How to bring awareness of the prevalence of
eating disorders
Definition of Body Image
 Body image is defined as person’s view of the body (Pruis &
Janowsky, 2010).
 Negative view of body image can sometimes cause a person
to develop a complex in which an eating disorder can
develop.
 There are three types of eating disorders as noted in the
DSM V: anorexia nervosa, bulimia, and binge eating disorder
Definition of Eating Disorders
Anorexia Nervosa
Bulimia Nervosa
Binge-Eating Disorder
Eating Disorder Not Otherwise Specified
Difference Between DSM IV-TR
and DSM V
 Anorexia Nervosa
 The core diagnostic criteria for anorexia nervosa are conceptually unchanged
from DSM-IV with one exception: the requirement for amenorrhea has been
eliminated.
 As in DSM-IV, individuals with this disorder are required by Criterion A to be at a
significantly low body weight for their developmental stage.
 The wording of the criterion has been changed for clarity, and guidance
regarding how to judge whether an individual is at or below a significantly low
weight is now provided in the text.
 In DSM-5, Criterion B is expanded to include not only overtly expressed fear of
weight gain but also incessant behavior that interferes with weight gain.
Difference Between DSM IV-TR
and DSM V
 Bulimia Nervosa
 The only change to the DSM-IV criteria for bulimia nervosa is a
reduction in the required minimum average frequency of binge
eating and inappropriate behavior frequency from twice to once
weekly.
 Binge-Eating Disorder
 The only significant difference from the preliminary DSM-IV
criteria is that the minimum average frequency of binge eating
required for diagnosis has been changed from at least twice
weekly for 6 months to at least once weekly over the last 3
months, which is identical to the DSM-5 frequency criterion for
bulimia nervosa.
Facts
 Approximately 10%-13% of young women meet DSM-IV or
DSM V criteria for eating disorder (Hudson, Hiripi, Pope, & Kessler; Wade,
Bergin, Tiggemann, Bulik, & Fairburn; Stice, Marti, & Rohde as cited in Stice, Butryn, Rohde,
Shaw, & Marti, 2013 ).
 Eating disorders are indicated by chronicity, relapse, distress,
functional impairment, and some risk for future obesity,
depression, suicide attempts, anxiety disorders, substance
abuse, and mortality (Arcelus, Mitchell, Wales, & Nielsen; Crow et al.; Stice et al.;
Swanson, Crow, Le Grange, Swendsen, & Merikangas; Wilson, Becker, & Heffernan as cited
in Stice, et al., 2013).
Facts
 Eating disorders are experienced by individuals who are
obese, average weight, as well as thin.
 The majority of individuals who are obese do not have an
eating disorder. However, the risk of developing binge-eating
disorder increases as obesity increases (Hill, 2007).
 Although considered previously an exclusively White middleclass girl and woman problem, eating disorders cut across
gender, race, class, and affectional orientation (Choate,
2013).
 Thus, it is necessary to develop effective eating disorder
prevention programs, as well as spreading awareness in
order to combat the development of eating disorders.
Prevention
 There are several different prevention programs to combat and
ultimately end the formation of an eating disorder.
 Research supports the utility of cognitive dissonance eating disorder
prevention (Black Becker, Bull, Smith, & Ciao, 2008).
 This intervention targets young women with body dissatisfaction due to
it being an established risk factor for future eating pathology (Johnson &
Wardle; Killen et al., as cited in Stice, et al., 2013).
 Cognitive dissonance is based on the presumption that establishing an
inconsistency between a belief and a behavior will elicit a feeling of
discomfort in an individual (Festinger as cited in Black Becker, et al., 2008).
 To alleviate this discomfort, the individual must create consistency.
 Therefore, ultimately it is changing the belief to coincide with the
behavior
Prevention
 An example of what occurs in a cognitive dissonance prevention program:
 In Stice, Paul, Jeff, and Shaw, (2011) the research team enlisted 306 girls with
eating issues and enrolled half of the girls into the dissonance based program.
 The girls were involved in four 1 hour weekly sessions. The groups of girls were
encouraged to critique thin ideal body types in exercises where they used written,
verbal and behavioral responses.
 These counter-attitudinal activities result in reduced confirmation of the thin-ideal
because inconsistent cognitions create psychological discomfort that encourages
individuals to alter their cognitions to restore consistency.
Prevention
 The goal of these activities were to produce cognitive dissonances that
motive the individuals to reduce their pursuit of thin ideals, produce the
individuals to have more satisfaction with their bodies, manage their
weight control behaviors that are unhealthy, reduce negative affect, and
reduce eating disorder symptoms.
 The control group was given a two page leaflet developed by the
National Eating Disorder Association, that pointed out behaviors that
were positive and negative body image and eating issues.
 At the end of the treatment, both groups were interviewed. They were
also interviewed again at six months, one, two and three years after.
 The results revealed that the dissonance based group had less body
dissatisfaction at the end of the treatment through the third year followup.
Prevention
 Neumark-Sztainer, Butler, and Palti (as cited in Stice & Presnell, 2007)
evaluated a 10-hour universal intervention, which was offered
to all female students in the participating school.
 This intervention focused on information on healthy weight
control behaviors, body image, eating disorders, causes of
eating disorders, and social pressure resistance skills.
 This intervention produced significant improvements in those
with eating disorder symptoms at 1-month follow-up; in those
who were dieting and binge eating at 6-month follow-up; and
individuals who binge eating at 24-month follow-up.
Prevention
 Stewart, Carter, Drinkwater, Hainsworth, and Fairburn (2001) evaluated a 5hour universal program that focused on individuals resisting cultural pressures
for thinness, focused on body weight, body acceptance, effects of cognitions
on the individual’s emotions, nature and consequences of eating disorders,
self-esteem enhancement, stress management, and healthy weight control
behaviors.
 This program produced significant improvements in dieting and eating disorder
symptoms at termination and 6-month follow-up, and decreases in body
dissatisfaction at termination, relative to assessment-only controls.
Prevention
 Bearman, Stice, and Chase, (2003) evaluated a 4-hour
cognitive-behavioral intervention intended to promote body
satisfaction among high-risk women with body image concerns.
 This intervention was used so the individuals replaced negative
appearance of self statements with positive statements and by
using systematic desensitization to reduce body image anxiety.
 This intervention produced significant reductions in body
dissatisfaction, negative affect, and bulimic symptoms at
termination and 3-month follow-up, and in body dissatisfaction at
6-month follow-up relative to the control group.
Prevention
 There is also evidence that
print, broadcast, and
electronic media can be an
aid to promote the ideal
view of body image as well
as be an asset to provide
prevention (Yager & O’Dea, 2008).
 The media showcases that
muscular anatomy is ideal
for men and thin is ideal for
women (Shulze & Gray; Heinberg &
Thompson; Agliata & Tantleff-Dunn as cited in
Yager & O’Dea, 2008).
Prevention
 Reality weight-loss shows depict individuals who are obese
and their struggles to lose weight.
 A study examined how exposure to The Biggest Loser
impacted levels of weight bias by assigning participants to
either an episode of The Biggest Loser or a nature reality
show (Domoff et al., 2012).
 Participants in The Biggest Loser condition had significantly
higher levels of dislike of overweight individuals and more
strongly believed that weight is controllable.
 The results indicate that anti-fat attitudes increased after brief
exposure to weight-loss reality television.
Prevention
 A way to provide prevention is developing programs based
on media literacy.
 Teach the individual to promote a critical evaluation of the
media, which in turn creates the person to doubt the
credibility and influence the media has (Irving & Berel as cited in Yager &
O’Dea, 2008).
 This technique can help reduce cultural body image norms
and reduce the internalization of the thin ideal.
 Which creates the individual to view their body in a healthy
way and reduce body dissatisfaction, dieting, and the
formation of an eating disorder (Shaw & Waller, as cited in Yager & O’Dea, 2008).
Prevention
 Self-esteem is a key piece in prevention of eating disorders
and skewed body image.
 Self-esteem approach is highly used in working with young
children and adolescents (Yager & O’Dea, 2008).
 This approach is based on the self-efficacy component of
Bandura's Social Learning Theory and Social Cognitive
Theory (Bandura as cited Yager & O’Dea, 2008).
 This technique is based on that the thought that to change
healthy behavior, individuals must have the required personal
skills and self-efficacy to maintain this healthy behavior.
 The individual will also excel if it is able to grow in a positive
environment with social support (Yager & O’Dea, 2008).
Prevention
 Low self-esteem is linked with a risk factor for body
dissatisfaction, dieting, and eating disorders among men and
women of all ages (Button et al.; Croll et al.; Stice as cited in Yager & O’Dea, 2008).
 Health education and health promotion programs that have
been based on improving the individuals self-esteem has
been noted to decrease body dissatisfaction, dietary restraint
and the formation of disordered eating. (O’Dea; O’Dea & Abraham; McVey
et al., as cited in Yager & O’Dea, 2008).
Prevention
 Self-compassion is described as treating oneself kindly in the
midst of struggling with painful events or emotions.
 The relationship between self-compassion, shame and body
image dissatisfaction were examined and the results
indicated self-compassion was negatively associated with
shame and eating disorder symptomology (Ferreira, PintoGouveia, & Duarte, 2013).
 In a study examining the contributions of self-compassion,
fear of self-compassion, and self-esteem in eating disorder
pathology, fear of self-compassion was the strongest
predictor of eating disorder pathology (Kelly, Vimalakanthan,
& Carter, 2014).
Prevention
 Therefore, the use of prevention programs are highly
effective when working with individuals with an eating
disorder.
 These programs can consist of working with an individual in
creating a cognitive dissonance, working with individuals in
creating body satisfaction using cognitive-behavioral
treatment, an information intervention that works with
individuals in understanding facts of eating disorders and the
effects it has as well as ways to promote body acceptance.
 These programs are just a few in helping prevent eating
disorders developing in individuals.
Awareness
 Knowledge of this issue
 NEDA Week
 Operation Beautiful
 Use of social media
 Standing with those who embrace positive body views rather
than promote unhealthy body views. Like actresses such as
Demi Lovato, Jennifer Hudson, Jennifer Lawrence, and
more.
Experiment
 Operation Beautiful
References
 American Psychiatric Association. (2000). Diagnostic and statistical manual of mental
disorders (4th ed., text revision). Washington, DC: Author.
 American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA:
American Psychiatric Publishing.
 Bearman S.K., Stice, E, Chase, A. (2003).. Effects of body dissatisfaction on depressive and bulimic symptoms: A
longitudinal experiment. Behavior Therapy, 34(1), 277–293.
 Black Becker, C., Bull, S., Smith, L. M., & Ciao, A. C. (2008). Effects of Being a Peer-Leader in an Eating Disorder
Prevention Program: Can We Further Reduce Eating Disorder Risk Factors?. Eating Disorders, 16(5), 444-459.
doi:10.1080/10640260802371596
 Domoff, S.E., Hinman, N.G., Koball, A.M., Storfer-Isser, A., Carhart, V.L., Baik, K.D, & Carels, R.A. (2012). The effects of
reality television on weight bias: An examination of The Biggest Loser, Obesity, 20, 993-998. do: 10.1038/oby.2011.378.
 Ferreira, C., Pinto-Gouveia, J., & Duarte, C. (2013). Self-compassion in the face of shame and body image dissatisfaction:
Implications for eating disorders, Eating Disorders, 14, 207-210. doi: 10.1016/j.eatbeh.2013.01.005
 Hill, A.J. (2007). Obesity and eating disorders, Obesity Reviews, 8(Suppl. 1), 151-155.
 Kelly, A.C., Vimalakanthan, K., & Carter, J.C. (2014). Understanding the roles of self-esteem, self-compassion, fear of selfcompassion in eating disorder pathology: An examination of female students and eating disorder patients.
 Pruis, T. A., & Janowsky, J. S. (2010). Assessment of body image in younger and older women. Journal of General
Psychology, 137(3), 225. Retrieved from http://www.tandf.co.uk/journals/titles/00221309.asp
 Shaw, H. E., Stice, E., & Springer, D. W. (2004). Perfectionism, body dissatisfaction, and self-esteem in predicting bulimic
symptomatology: Lack of replication. International Journal of Eating Disorders, 36(1). doi:10.1002/eat.20016
 Stewart, D.A., Carter, J.C., Drinkwater, J., Hainsworth, J., Fairburn, C.G. (2001). Modification of eating attitudes and
behavior in adolescent girls: A controlled study. International Journal of Eating Disorders 29(1), 107–118.
 Stice, E., & Presnell, K. (2007). The body project: Promoting body acceptance and preventing eating disorders. Oxford, NY:
Oxford University Press.
 Stice, E., Paul R., Jeff G., & Shaw, H. (2011). An effectiveness trial of a selected dissonance-based eating disorder
prevention program for female high school students: Long-term effects. Journal of Consulting and Clinical
Psychology 79(4), 500-08.
 Stice, E., Butryn, M. L., Rohde, P., Shaw, H., & Marti, C. (2013). An effectiveness trial of a new enhanced dissonance
eating disorder prevention program among female college students. Behaviour Research & Therapy, 51(12), 862-871.
doi:10.1016/j.brat.2013.10.003
 Yager, Z., & O'Dea, J. A. (2008). Prevention programs for body image and eating disorders on University campuses: a
review of large, controlled interventions. Health Promotion International, 23(2), 173-189. doi:10.1093/heapro/dan004
 Yanover, T., & Thompson, J. (2008). Eating problems, body image disturbances, and academic achievement: Preliminary
evaluation of the eating and body image disturbances academic interference scale. International Journal of Eating
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