Assignment: American Psychiatric
Assignment: American Psychiatric
patients normalize their eating pattern with mealtime feedback provided by a Mandometer
• A scale that rests under a dinner plate, connected to a small computer with a monitor. Allowed patients to:
– compare their rate of eating in real time to that of a typical person eating that meal – develop normal feelings of satiety
• Initially, a behavioral therapist assisted the patients with the use of the Mandometer, but the patients got used to the procedure rapidly and practiced eating without the support of a therapist, including practicing at home.
– patients were provided with warmth, using warm rooms (temperature can be set at 40°C), or thermal blankets, or jackets, to calm them and to avoid the use of calories for thermoregulation.
– physical activity was restricted to calm them and avoid the use exercise for thermoregulation
– A great deal of time was spent convincing and coaxing the patients to start resuming their normal social interactions.
Treatment Research Shows Hopeful Success (Bergh, et. al., 2013)
• Results – The estimated rate of remission for this therapy was
75% after a median of 12.5 months of treatment. – Of those who went in remission, the estimated rate
of relapse was 10% over 5 years of follow-up and there was no mortality.
– These data replicate the outcomes reported in our previous studies and they compare favorably with the poor long-term remission rates, the high rate of relapse, and the high mortality rate reported with standard treatments for eating disorders.
Recovery from BED (APA, 2006) Goal of recovery:
1. Reduce binge eating behaviors 2. facilitate weight loss
• Nutritional rehabilitation and counseling • Psychosocial treatment
– Group and individual psychotherapy, guided self-help and support groups that use a “non-diet” approach and focus on self-acceptance, improved body image, better nutrition and health, and increased physical movement
• Medications – Weight Loss meds
• The appetite-suppressant medication sibutramine is effective for binge suppression, at least in the short term, and is also associated with significant weight loss
Recovery from BED (APA, 2006) • Weight Loss:
– Very-low-calorie diets • have been associated with substantial initial weight
losses – 1 year after treatment: >33% of patients maintaining their
weight loss Greater than 1 year after treatment: weight regain is common
– Medications: • sibutramine was shown to have significant beneficial
effects on binge eating behavior and weight loss – weight decrease 7.4 kg, medication group – weight increase of 1.4 kg, placebo group
Recovery from BED (APA, 2006) • Reduction of binge eating behaviors
– psychotherapy • Has been associated with
– binge frequency reduction rates of 67% or more – significant abstinence rates during active treatment Deterioration during the follow-up period has been observed with all
forms of psychotherapy
– Guided Self-help programs • have been effective in reducing the symptoms of binge eating
disorder in the short run for some patients
– Lifestyle treatment approach • Those focused on self-acceptance and a healthy lifestyle rather
than weight loss may reduce binge eating behavior, depression, anxiety and body dissatisfaction, while improving physical health and quality of life
• http://www.nationaleatingdisorders.org/ • http://www.anad.org/
References • APA. (2013). Eating Disorders. DSM-5-TR® Diagnostic and
Statistical Manual of Mental Disorders 5th Edition. Arlington, VA: American Psychiatric Publishing, Inc.
• APA. (2006) Treatment of Patients With Eating Disorders, 3rd Edition. American Psychiatric Association Practice Guidelines. Arlington, VA: American Psychiatric Publishing, Inc.
• Bergh, C. et. al. (2013). Effective Treatment of Eating Disorders: Results at Multiple Sites. Behavioral Neuroscience. V127; N6, 878 – 889.
• Casiero, D. & Frishman, W.H. (2006). Cardiovascular complications of eating disorders. Cardiol Rev, 14(5), 227-231.
• DeAngelis, T. (2002). Promising treatments for anorexia and bulimia: Research boosts support for tough-to-treat eating disorders. Monitor on Psychology. V33; No. 3.
• Hoek, H. W., & van Hoeken, D. (2003). Review of the prevalence and incidence of eating disorders. International Journal of Eating Disorders, 34(4), 383-396.
References • Hudson J. I., Hiripi E., Pope H. G. Jr., & Kessler R. C. (2007).
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