Download Child and Adolescent Psychopathology

Chapter 15:
Evidence Based Interventions for
Eating Disorders
Peter M. Doyle
Catherine Byrne
Angela Smyth
Daniel Le Grange
Overview: DSM-5
 Anorexia Nervosa: failure to achieve or maintain a minimum
weight for age and height, fear of gaining weight although
underweight, and disturbance of self-perception of body weight
or shape or denial of seriousness of low body weight
 Bulimia Nervosa: normal weight, but engaging in regularly
occurring episodes of binge eating coupled with compensatory
behaviors
 Binge Eating Disorder: binge eating but not engaging in any
compensatory behaviors
 Feeding and Eating Disorder Not Elsewhere Classified:
engaging in some sort of disordered eating
Eating Disorder Rates
 At age of 20, 0.8% of people in United States will
have anorexia
 2.6% bulimia
 3.0% binge eating disorder
 4.8–11.5% feeding and eating disorder not elsewhere
classified
 Typical age for onset: 16 to 20 years old
 Increasingly younger cases are being seen in the
United States
Anorexia: Family Based
Treatment
 Family-Based Treatment for Anorexia Nervosa (FBT-AN)
 Focus: weight restoration and aiming to empower parents and families
to elicit change
 Primary therapist coordinates treatment team
 Team: family, therapist, medical provider, psychiatrist
 Three phases:
 1) Engage the entire family in the eating disorder
 2) Control over food decisions is gradually handed back to child/adolescent
 3) Help patient and his or her family navigate a return to normal trajectory of
adolescent development
 Only treatment that has well-established empirical evidence
Behavioral Family Systems
Therapy
 Parental involvement and initial control over eating to help
patients overcome anorexia
 Unlike FBT-AN, BFST does not focus on empowering parents to
use their own intuition to facilitate changes to meals and food
choice
 Parents work with a nutritionist
 Three phases:
 1) Parent training related to implementation of behavioral weight gain
program
 2) Parents maintain control over eating, but sessions turn to identify
cognitions that are underlying eating disorder
 3) Patient assumes responsibility for his/her own eating and weight
 Evidence indicates this is a promising therapy
Adolescent Focused
Psychotherapy (AFP)
 Individual psychotherapy from a self-psychology model
 Focus: helping patients to identify, tolerate, and more
effectively manage their emotions
 Three phases:
 1) Building rapport between therapist and patient and developing a
mutually understood conceptualization of anorexia
 2) Enhancing individualization and independence from parents
 3) Developing appropriate coping strategies to deal with the tasks of
adolescence and engage in independent behaviors
 RCT indicated that FBT was significantly superior to AFP
CBT for Bulimia
 Cognitive behavioral therapy for bulimia nervosa
(CBT-BN)
 Three stages
 1) Establish rapport, increase motivation for treatment
 2) Address distorted cognitions surrounding food, eating,
weight, shape
 3) Consolidate treatment gains and develop a relapse
prevention plan
 RCT compared CBT to family therapy: CBT showed
improvements over family therapy at 6 months, but not
12
Family Based Treatment for
Bulimia
 Relies on family involvement to address eating
disorder symptoms
 Three Phases
 1) Shifts control of eating over to the parents
 2) Shifting control of eating and food-related decisions back to
adolescent in gradual fashion
 3) Addresses developmental issues and encourages
communication between parents and adolescents
 Two RCTs have provided empirical evidence for FBT-
BN
Binge Eating Disorder
 No RCTs have been published examining the
efficacy of treatment for adolescents with binge
eating disorder
 In adults, interpersonal psychotherapy, cognitive
behavioral therapy, and dialectical behavior
therapy are efficacious for binge eating
Parental Involvement: Family
Based Treatment of Anorexia
 Parent involvement critical and central to this approach
 Parents can:
 Get frustrated with refusal to eat
 Misinterpret refusal to eat
 Blame their child for bringing stress on the family
 Retreat from role and become overly permissive
 To be most effective: aligned with one another and
sending consistent messages regarding decisions
about the child’s meals and activity level
Parental Involvement: Bulimia
 Adolescents with bulimia are less likely to need
parents
 Often more motivated during treatment
 Involvement varies based on the case and family
dynamics
 Can assist with CBT
 Younger patients can benefit from reminders to use
rational responses to automatic thoughts
Adaptations and Modifications
 FBT: age of child/adolescent needs to be taken
into consideration, and adaptations made for
developmental level
 Bulimia: common for adolescents to have a
comorbid psychiatric disorder; treatments can
include additional mental health professionals to
treat these comorbid disorders
 Binge Eating Disorder: developmental concerns
Measuring Treatment Effects
 Weight: measured weekly
 Frequency of binge eating and purging: assessed via
self-report
 CBT self-monitoring: cognitions about food, weight,
shape, or mood state
 Gold standard: Eating Disorder Examination
 Semi structured interview conducted by a clinician
 Measures disordered eating over 28-day period
 Four subscales: eating concern, shape concern, weight concern,
dietary restraint
 Global score
Clinical Case: Annalise
 15-year-old Caucasian female
 Assessment: weight started at 115 lbs and at assessment
weighed 92 lbs; BMI 2nd percentile; consumes fewer than 1,000
calories per day most days; fears of “becoming fat again”
 Diagnosis: GAD, anorexia
 Treatment plan: FBT-AN, medication to treat preexisting anxiety
symptoms
 Outcome: continued to gain weight weekly with help of parents;
improvements in eating restraint, eating concern, weight
concern, and shape concern; reductions in anxiety