Anorexia and bulimia psychology abnormal behavior
The various anorexia behaviors of anorexia can be attributed to genetic factors, after twin studies in which they found
First mentioned in the late 19th century, anorexia nervosa includes attitudes and intentions to make oneself as thin as possible. Indeed, in short, anorexia is a significant weight loss. According to the DSM-IV-TR, the criterion for the diagnosis of anorexia is a bodyweight 15% lighter than the standard weight for the same age and height. In general, there are 2 ways to lose weight and control it. The first way, the classic way: force yourself to eat hungrily and the second way is to eat and drink and then vomit or use bleach. Anorexia is discussed in this chapter mainly in one of the two patterns above.
The diagnostic criteria for anorexia according to the DSM-IV-TR are:
Refuse to keep weight above the minimum normal weight for the same age and height.
Extreme fear of gaining weight despite being underweight.
Disturbance in body perception, being unduly (unreasonably) influenced by weight and physical appearance on self-assessment or denial of the seriousness of a tendency to lose weight.
Stop menstruating when you really lose your appetite.
80%-90% of people with anorexia nervosa are female, with the most common age being puberty between 14 and 18 years old (Pike 1998). Rooney et al. (1995) estimated that about 0.02% of the population and 0.1% of young women have anorexia nervosa. For most people with anorexia, weight control is a long-term problem. Loewe et al. (2001) showed that 21 years after the initial admission, just over half of the women considered anorexia were able to "fully recover", 21% of the women made a partial recovery and 10% were still suffering from anorexia. The diagnosis is full of signs of anorexia. Some tried to seek help or any form of therapy, and 16% died from anorexia-related causes.
Many people with anorexia go on to develop the eating habits of bulimia. That means maintaining a normal weight while eating irregularly and trying to vomit. Unlike many other mental health disorders, anorexia nervosa is more common among women of high socio-economic class, and some have even earned high academic degrees. People with anorexia tend to have low self-assertiveness and self-esteem, and high self-contradiction (Williams et al. 1993).
Due to avoidance of eating, most people with anorexia are often preoccupied with thoughts about food. They probably spend most of their time thinking about food, preparing food for themselves or others, or watching them eat. They may tell dreams about food, experiences with hunger, and suppress cravings. High-intensity exercises or actions to burn calories are very common in weight loss strategies. Most, but not all, people with anorexia nervosa have a distorted image of their body, overestimate their body's proportions, and have negative thoughts about their appearance. Gupta and Johnson 2000). Psychological problems including mild depression, predisposition to obsessive disorders, and anxiety are common in anorexia.
Weight loss and control combined with anorexia can have a number of health consequences. The immediate consequence is amenorrhea. Some of the obvious problems are osteoporosis, low blood pressure, dry cracked skin, dry and brittle hair. Health problems can become serious and metabolically serious, life-threatening. Through research, 0-21% of people with anorexia die, showing that the common cause is starvation and suicide (Steinhausen and Glanville 1983).
According to DSM - IV-TR, diagnostic criteria for bulimia include:
Frequent episodes of binge eating.
Frequent compensatory behaviors such as vomiting after eating prevent weight gain.
Compensatory behaviors occurred on average at least twice a week at regular intervals for 3 months.
Being unduly influenced by weight and appearance on self-esteem.
Many people with bulimia feel unattractive, fear gaining weight, and think they are much heavier than they really are (McKenzie et al. 1993). Their efforts to avoid weight gain were more haphazard than anorexia. Controlling eating is often interrupted by binge drinking sessions. This entails a series of behaviors aimed at “correcting mistakes”. The amount of food consumed during such meals can be very large, about 5000 calories at any one time. Eating is not for enjoyment, actually, it is often a secret, quickly and without time to taste. The warning signs are often psychological and physical stress, and eating is supposed to relieve this stress. During binge eating, individuals experience a loss of control, often followed by guilt, self-accusation, and depression.
About 80-90% of people with bulimia often vomit after eating to try to control their weight, a third abuse laxatives, while others do strenuous exercise (Anderson et al. Maloney 2001). Compensatory behaviors can alleviate feelings of anxiety, frustration, self-loathing, or lack of control over binge eating. Ironically, though, they frequently fail to prevent the extra calorie intake from eating too much food. Binge eating entails several health risks. Continuous vomiting and overuse of laxatives can lead to problems such as abdominal pain, gastrointestinal problems, dehydration, and damage to the lining of the stomach and mouth, where the acid from vomiting occurs. often can damage tooth enamel.
The prevalence of bulimia ranges from 0.5 to 1% of the population, depending on the population sample studied (Fairburn and Beglin 1994). However, among young women, the rate is higher. Up to 50% of female students surveyed by Schwitzer et al. (2001) reported episodes of binge eating, 6% attempted vomiting, and 8% used laxatives at least once. However, there are also a small number of behaviors that are considered disordered even though they consider themselves appropriate. Some older women visited family planning clinics, Cooper and Fairburn (1983) found that 20% of them reported having at least one bulimia, 3% used it as a method of treatment. Convenient for weight control.
Causes of anorexia and bulimia
Genes may contribute to an increased risk of anorexia and bulimia. For example, Klump et al. (2001) estimated that 74% of the different anorexia behaviors of anorexia could be attributed to genetic factors, after a twin study in which they found 50% of identical twins and no twins. No other egg suffers from anorexia. Similarly, Kendler et al. (1991) found a higher concordance rate for bulimia in identical twins than in fraternal twins, although the concordance rates for both were rather low: 23 and 9%, respectively.
Some studies have shown that people with eating disorders have low serotonin levels. Whether this is a cause or effect of the disorder is unclear and several possible explanations for this finding have been proposed (Kaye et al. 2001) as follows:
Low serotonin levels may result from other conditions, including obsessive-compulsive disorder or depression, with frequent co-occurring eating disorders that are indirectly caused by low serotonin activity.
Low serotonin levels can directly cause an eating disorder because it causes cravings for carbohydrates and thus binge eating.
People with eating disorders may have naturally high serotonin levels that have been reduced by starvation and bowel enema. Distorted eating patterns often drop serotonin below normal.
There is no hypothesis that is strong enough to explain the phenomena.
Successful dieting involves calculating the above processes so that weight loss can be gradual. Individuals with anorexia learn to control their hunger and continue to control their diet regardless of their symptoms. To do so they resist the control of the hypothalamus and continue to lose weight. Binge eaters, on the other hand, enter a persistent battle with those processes: winning and losing. Scoring doesn't stand still and the game is either won or lost over time. when you win and when you lose. Scoring does not stand still and the game is either won or lost over time. when you win and when you lose. Scoring doesn't stand still and the game is either won or lost over time.
"Slim is sexy". People with bulimia and anorexia consider shape and weight to be of primary importance possibly because Western society in general places a high value on appearance. Imagine how the femininity and charm of women have changed since the 1960s, they are thinner and less like hourglasses. The typical figure was drawn in "Playboy" magazine, as evidenced by the thin figure during the 90's, with smaller hip, waist, and bust measurements. (Rubinstein & Caballero 2000). It is not surprising that the proportion of people with low weight and eating disorders is higher in the group of people who need to be attractive such as models, dancers, and athletes. In social groups that advocate for thinness, their rates of eating disorders also increase. in the U.S.A,
The assessment of weight is not only influenced by aesthetics but also by many personal attributes based on physical appearance. Food, eating patterns and weight are also widely regarded as ethical issues and body shape can be the main criterion of self-evaluation and of judging others (Wardle & Marsland 1990); a lot of people hold negative views towards fat people.
More than half of families with an eating disorder seem to emphasize the role of weight and body shape (Haworth-Hoeppner 2000). Mothers in these families were also more likely to be dieters and perfectionists than mothers in families without the disorder (Pike & Rodin 1991). Successful dieting can be a way to gain recognition from demanding parents, especially families, whose children are not very successful in other areas. Skipping meals can make individuals more important in the family, and give them some influence over other family members. ("I'll eat if you..."). It can also be a punishment for them ("I don't eat because of my father...").
Some family therapists may also come up with a completely different pattern of anorexia. In this model, individual anorexia is seen as a symptom of familial dysfunction. Minuchin et al. (1978) describe the characteristics of an "anorexic family" as: easily confused, overprotective, rigid, and avoidant of conflict. So it is possible that there is a conflict between the parents and it is controlled and hidden. According to Minuchin et al. (1978), adolescence is a stressful period in such families, adolescents' attempts to gain their independence in the family increase the risk of parental conflict. The development of anorexia completely prevents family disagreements, and can keep members around the "poor patient". sickness, The need for the care of a young family member provides reassurance of the family's central position and distracts from parental conflicts. The evidence for this theory is firmly based on the family therapy clinical experience of the Minuchin group.
The last sociocultural model indicates that both anorexia and bulimia can also result from sexual abuse (Oppenheimer et al. 1985). According to this model, the consequence of abuse among adolescent girls is to make them have a strongly negative view of femininity. The result is a rejection of the feminine type and tries to resist it. This most often shows up during puberty. The evidence for this is not very strong. Although sexual abuse is high among people with eating disorders, it is not a key feature because it is not higher than in people with anxiety disorders or other psychological disorders.
Social factors manifest behavior through cognitive processes. Despite the differences in problem presentation, Fairburn's (1977) cognitive model suggests that both anorexia and bulimia share a common psychological disturbance: a set of beliefs and distorted views of body shape and weight. Being thin and losing weight is a priority, perhaps because of the high desire to look leaner and more attractive, individuals work to combat weight gain and obesity. The scheme that consists of assessing someone's worth on the basis of achieving a thin and light body is called a "weight-related self-schema".
Once weight-related patterns are identified, it distorts the way individuals perceive and interpret their experiences. Others judge not on personal qualities but on the extent of being thinner or fatter than other individuals. All activities are viewed from the perspective of weight control, and any situation leads to a self-assessment that entails a strong focus on weight and shape. Any fluctuations in weight have a profound effect on thoughts and emotions.
For some people, their concern and preference for control over their weight indicate a lack of self-love and a desire to control weight gain as an aspect of their lives. They hope to feel better about themselves if they get thinner – a process that leads them to never be satisfied with their appearance and continue to lose weight. Depression appears to be the result of anorexia behavior, low self-esteem, and increased reliance on weight control as a way to maintain self-worth.
At first, trying to lose weight can be triggered by a few factors including criticism, comments about weight or body shape, teasing or the role of the crisis transition from a child to a woman. . Dietary changes are sustained by multiple reinforcement processes. Positive reinforcement at first can be the experience of being complimented on looking slim. When that becomes a concern, they can continue to create positive reinforcement as the individual gains the family's attention. One form of feedback can be very important: the daily or weekly reinforcement of the bathroom scale. These provide solid feedback on results. For people with low self-esteem, weight loss can provide an element of control and success in their lives. Losing weight becomes equal to self-worth, self-esteem, and perhaps more than any other factor in life. Anorexia behavior can be driven by negative reinforcement.
People with anorexia experience an intense fear of gaining weight. To avoid this fear, restricting food intake also provides relief from the fear.
Both anorexia and bulimia reflect different ways of solving problems, but they share a common cognitive background. According to Fairburn (1997), people with anorexia may over a period of time control their eating better than bulimia nerds who are chaotic and less consistent. He observes that because of restrictive dietary habits, individuals with both anorexia and bulimia are under considerable psychological and physiological pressure to binge eat. In response to these demands, both groups had to create rules to control the diet: what they could and couldn't eat when they needed to. These principles are perfect but difficult to implement. Even so, people with anorexia often have enough self-control to follow the rules they set. Whereas foodies often fail to do so.
When an eater starts to eat, they often split their thoughts ("I ate, the diet plan went bust. What's the point of trying to diet...?") and get started. bulimia. Binge eating also often tends to improve negative moods, and is, therefore, a reinforcement in itself. This is due to a variety of causes, including the lethargy resulting from eating large amounts of food and for people who try to vomit feeling less stressed. Initial positive feelings are often followed by feelings of disgust and shame with overeating, which add to the real effort to follow the diet plan, but dieting can be very beneficial. risked eating innocents again, and so the vicious cycle continued.
The distorted image of yourself
The second cognitive model, only available to people with anorexia, refers to a distorted self-image. That is, people with anorexia feel "fat" even when their weight is not clinically normal (Bruch 1982). In a review of an overwhelming number of studies, Gupta and Johnson (2000) suggest that many anorexic people have an extreme overestimation of their body proportions, specifically underestimating their appearance and think it's unattractive. In contrast, Slade and Brodie (1994) suggest that many of these comments represent an emotional response rather than a feeling. They claim that people with eating disorders are often not confident in their body measurements and appearance and that only when they are forced to do so, they often make the mistake of overestimating their body measurements. Epstein et al. (2001) also agree with the same statement when experimentally,
The dietary restriction also has other biological consequences that have nothing to do with body size and appearance and also lead to persistent cognitive distortions. Hunger affects a number of cognitive processes, causing poor concentration, slow thinking, rigidity, withdrawal, obsessive-compulsive behavior, depression. As a result, hunger can suppress positive feedback, and anorexia people become more rigid in their beliefs and unable to escape seeing their problems differently (Whittal and Zaretsky). 1996).
Interpretation from a Psychoanalytic Perspective
The classical psychoanalytic theory offers several explanations for anorexia (Zerbe 2001). One of the explanations is the unconscious confusion between eating and sexual instinct. Some women may avoid eating as a symbol of avoiding sex.
Some other possible explanations are that anorexic women fantasize about oral conception and mistake obesity for pregnancy. Fasting reduces the risk of pregnancy. Another possible explanation is that anorexia reflects regression to earlier stages of development. The individual shrinks himself in the truest sense of the word. This and the cessation of menstruation is an unconscious desire to reject adulthood and wish to return to a childhood-like state. Finally, anorexia is the result of delayed psychosexual development. If the child is attached to the oral period, the anxiety and gender obsession will most likely manifest in the eating disorder.
Combining psychoanalysis and cognitive processes, Bruch (1982) concluded that anorexia is the result of disturbances in the mother-child interaction process, which leads to a lack of self-esteem including poor self-esteem. ownership and control, manifesting as eating disorders. According to Bruch (1982), some mothers make mistakes in caring for and meeting the needs of their young child, possibly as a result of prioritizing their own needs over the needs of the child or misunderstand their behavior. They may offer food or hug the child when they like, but it is unlikely that the child has liked or misinterpreted the child's feelings or needs. As a result, the child may be confused or unaware of his or her true needs, not knowing when they are hungry or full, and not knowing how to express their feelings. Fukunishi (1997) points out that many binge eaters mistakenly perceive emotions such as anxiety and confusion as signs of hunger and respond with eating. Finally, Walter and Kendler (1995) conclude that people with eating disorders tend to over-trust the opinions of others and worry about how they will see themselves.
Interventions for anorexia
There are many causes of anorexia, so the best treatment depends on the individual. Types of interventions that may be used include cognitive behavioral therapy, family therapy, and depth psychotherapy, each of which is performed as praise, encouragement rather than competitive intervention. painting. The intervention can be divided into 2 phases.
The following is the confession of the bulimia nerd and anorexic. Although both are eating disorders, their observations are actually very different. The perspective of people with bulimia focuses on eating and the guilt and discomfort that accompanies it. People with anorexia focus on broader issues, namely revenge, and control. The path to the disorder is different for each person, so although there are some typical ways, it is only approximate. The same disorder but the way it leads to it can be completely different in different people.
I think it's easier not to drink or take medicine than not to eat as usual. You may or may not use it. If you don't want them just avoid them. But eating is different. You eat....you feel good you keep eating and it's hard to stop. I want to be slim and good-looking. And I love my food. So I said to myself OK. Today you will not eat until 6 o'clock and you will only eat for health. And I start the day with good intentions.
But then I live for food, I can't help but eat lunch - for everyone around me it's easy. But as time goes on, I want to eat, I don't feel hungry. But what happens when I get home, I just want to eat. it's in my head and I know there's food in the fridge - delicious ice cream and great chocolates. God, I love chocolate. Why can't I like something healthy that's low in calories? I sit and watch TV but I think about food, right now. anyway, a few nights I can get through, cooking myself something just right for the night when I'm busy or absorbed in the TV or something. but other nights, I just go straight to the fridge and get the food. Unfortunately, it never lacks, How does it work for you? 2 biscuits is not enough for you so you continue to snack on something bigger and higher in calories. It's still better if you stop there. But you keep thinking "I'll just eat a little more..." and you start eating, what can stop you now. Then I forgot my original good intentions, I believe I gave in to eating. So I eat and eat, I don't stop until I'm full. I ate until my stomach burst. I feel uncomfortable and I know I will gain weight. I felt really guilty the next day. So I made myself suffer. Then I feel better. At least I can rest and know I won't gain weight. It really comforts me. And I swore to myself that tomorrow I would control my eating.
My anorexia started when I was 13 years old. I had a food problem from years before. My mom was always on a diet - and I was often a dieter with her, sometimes a diet contest with her. Now I've noticed that our food struggles are over. distract the family's attention from the unrest that pervades the entire house. I became the right place to vent my parents' anger. I have no safety...I have been beaten a lot and often humiliated.
When I was 13, my parents were very outspoken and they tried to have complete control over my life, my friends, my boyfriend, and everything. This control has pushed me to the abyss... Dieting has become an obsession for me. I lost more than 10 kg in just 1 month! The hunger is still there. There are days when I mostly think about food. But I was destined to tame it. I have struggled to fully control it, perhaps the only control I have. I feel that if I fail if I eat, that means I will lose myself, lose my control.
I want to look good, I want to fit the image of a woman. But the biggest part is revenge! I look forward to seeing my parents' reaction to my starvation. Dieting is no longer a good thing, there must be something to do with my mother...it has to be a weapon. Put all her behavior on herself. They were somewhat angry because they couldn't control this part of me, worry and fear. But I got it under control. They cursed, screamed, and tried to get me to eat. But I don't eat- not for them.
I started to lose my emotions. I want to starve to have control, to prove I can, also because I deserve it...because I hate myself! The initial phase is usually a hospital stay, focusing on weight gain, and the latter is a prolonged period of outpatient therapy that focuses on cognitive and behavioral changes.
Encourage weight gain:
Patients should be hospitalized in case of severe weight loss, less than 75% of normal weight. Hospital interventions often focus on improving the underweight. This process is based on observable conditioning that includes pre-determining a specific reward for weight gain, the most valuable of which may be discharged from the hospital after achieving the weight gain goal. Need to avoid the risk of stuffing food in and then vomiting it up, nullifying the cure.
A few years ago, such rewards might have been talking on the phone or watching TV. However, these are still considered fundamental rights today, and changing them would be an infringement on civil rights. Thus the 'reward' for eating is often self-determined and must be out of the ordinary for inpatients. It could be increasing social privileges, talking to guests, and performing social favors. Calorie intake must increase slowly over time: if you take in too many, calories may not be consumed at first. Nurses can also educate individuals about anorexia and provide prevention and encouragement information. The key point here is to make sure that gaining weight during this time doesn't translate to being overweight in the long run.
While the majority of people in therapy gained weight initially, others continued to lose weight, and in some cases, it was even life-threatening. This has created both clinical and ethical challenges for those involved in such a program. The key question now is whether it is necessary to provide nutrition to the sick even if they do not want it? The debate focuses on anorexic people's ability to make decisions about what their real life is or decide to die. Some clinicians (eg, Russon and Alison 1998) argue that most anorexic people have the mental capacity to make decisions to eat or not to eat. Therefore, therapy that goes against their wishes is not appropriate, even if it may lead to their death. Others (eg, Treasure 2001),
Treasure (2001) identifies four general principles for determining when legally competent individuals decide to choose or refuse treatment. That is:
Understand and remember the information needed for their decisions, being aware of the possible consequences of having or not getting treatment.
Trust the information.
Consider information as part of the decision-making process.
Acknowledge that they have health problems and seek remedies for their condition.
According to Treasure (2001), individuals with anorexia nervosa often do not meet the above criteria and are therefore often illegally accused of incompetent decision-making for medical treatment and that may endanger their lives. So doctors have the right to treat them without their consent. This view is also consistent with previous legal practices (Dyer 1997) that required forced treatment of people with anorexia including forced foster care, all of which are legal and in the case of anorexia. necessary.
The second stage in therapy is interventions aimed at changing behavior and maintaining the change in the long term. Possibly the most widely used cognitive-behavioral approach is that of Garner and Bemis (1985). It is divided into several stages, the first stage being the establishment of a working relationship with the individual. Garner and Bemis say that at this point, the most critical issue is that their basic beliefs are not shaken, resulting in their refusal to receive therapy. Therefore, the therapist must understand the individual, recognize their weight control strategies, and appreciate how successful those strategies are. This may be related to the question of when it is possible to achieve all that the individual intended and to appreciate the emotional and physical costs of extreme dieting. Early sessions may be used only to establish outcomes and costs for anorexia behaviors. This could also be the exploration of the underlying scheme of these behaviors. Homework assignments can also be used to collect data on how events affect emotional thinking and provide an opportunity to experiment with different ways of unraveling relationships. between events with eating and weight. Only when a good working relationship is established and the individual is motivated to change, at least with this in mind, does cognitive therapy begin? Homework assignments can also be used to collect data on how events affect emotional thinking and provide an opportunity to experiment with different ways of unraveling relationships. between events with eating and weight. Only when a good working relationship is established and the individual is motivated to change, at least with this in mind, does cognitive therapy begin? Homework assignments can also be used to collect data on how events affect emotional thinking and provide an opportunity to experiment with different ways of unraveling relationships. between events with eating and weight. Only when a good working relationship is established and the individual is motivated to change, at least with this in mind, does cognitive therapy begin?
Cognitive interventions can have many purposes including changing misperceptions and developing self-control. May emphasize false feelings and attitudes. While it may not change their desire to be thin, being aware of the deviance and accepting the fact that they are exaggerated can help them eat better. Self-control can be fostered by confronting negative perceptions and encouraging individuals to trust their intuition and feelings. The cognitive challenge encourages individuals to pay attention to the strong emotions brought about by the behavior, helping them probe some of the underlying patterns of those behaviors, such as the belief that Bodyweight or appearance may be the sole criterion for self-worth, and complete self-control is essential.
Although the problem is life-threatening and permanent, some authors have conducted controlled effects trials to investigate the effectiveness of cognitive-behavioral interventions on anorexia (Pike 1998). It is possible that because of the chronic nature of the condition, there are people who participate in many different treatment programs and it is difficult to determine which intervention their behavior change is due to. Non-therapeutic status carries a long-term risk of serious injury, and the risk of discontinuing therapy is also very high, making the design of standard trials very difficult.
Regardless of the evidence, cognitive behavioral therapy is considered an effective intervention. In an early trial, Channon et al. (1989) compared the behavioral approach and the cognitive-behavioral approach. Behavioral therapy involves slowly confronting avoidant foods. Cognitive-behavioral therapy identifies unusual beliefs about eating. There was some difference between the two interventions at both 6 and 12 months, although the authors suggest that a more acceptable cognitive process links better therapy to outcomes for both. interventions are better. Since there was no 'no therapy' group in the study because it would be unethical, it is difficult to determine the exact effectiveness of the intervention. In a similar comparison, Treasure et al. (1995) compared the effectiveness of cognitive therapy and combined cognitive-analytic therapy. After 1 year of intervention, both therapies proved equally effective, with 63% of participants having good results or "immediate" recovery.
Access to family therapy:
Many different family therapies have been used to treat anorexia, but all seek to change the power structure in the family by strengthening the parents, preventing communication. cross-generational intelligence and reduce stress and parental problems. It should be noted that this approach contrasts sharply with the cognitive-behavioral intervention described above, which promotes self-control and control over the individual's eating.
Structural family therapy:
One of the first family approaches to the treatment of anorexia was reported by Minuchin et al. 1978 (see chapter 4). They report that the success rate is 85%.
This has, however, been viewed with some caution as it is based on case studies with relatively young and intact families rather than data from controlled trials. More recently, Russell et al. (1978) continued a similar therapeutic approach, focusing on family stressors. The approach has 3 tasks. The first includes arranging for the family to enter therapy. The second stage is the feeding period. This is the time when families begin to eat together to strengthen family ties, provide support, and prescribe food and eating habits. During this time, the "patient" and their siblings are encouraged to band together to reinforce reasonable family boundaries. The final stage includes a change in the family system,
Russell et al. (1987) compared the effectiveness of this approach with personal support techniques in treating both anorexia and bulimia. Their results are not very optimistic. Although many people with anorexia show signs of gaining a little bit of weight, it is only modestly compared to the general population. After 1 year of study, 23% of participants had good results, 16% had good results, and 61% had poor results. Family therapy improved more than individual therapy in weight regulation, menstrual function, and psychosocial adaptation for participants whose problems were present before age 19 and those with that lasted less than 3 years. Individual therapy improved outward appearance more effectively than family therapy in older participants.
Family behavioral therapy:
Family behavioral therapy (Robin et al. 1995) combines a systemic approach and behavioral therapy. The goal of therapy begins with weight loss. Strategies to achieve the goal include changing eating habits, cognitive therapy to reduce body image bias, fear of fat, and feelings of inadequacy. Family interaction patterns such as conflict avoidance, awkwardness, and overprotection are also introduced. Treatment in three stages. First, control of eating will be transferred from children to parents to restore order in the family. Parents are guided and encouraged to implement a weight gain behavior program for their child, which includes meal preparation, regular exercise, and a follow-up or non-follow-up chart. When weight gain occurs, the treatment is moved to phase 2. It combines 3 elements:
Reform the body's false representations and wasteful beliefs about food.
Work with families to correct awkwardness, alliances, and inappropriate order in the family.
Slowly transition to eating control for the person with the disorder.
Finally, families can be taught problem-solving, and communication skills. Robin et al. (1995) evaluated the effectiveness of their approach, compared with individual encouragement therapy, in a group of adolescent girls aged 12-19 years. After a year of study, both types of therapy had a positive effect, although there was no difference between the two groups.
Several case studies and uncontrolled studies have shown that the psychoanalytic approach to the treatment of anorexia is effective in adolescents with minor problems. However, there are not many studies comparing the effectiveness of this approach with other approaches. One of them is by Dare et al. (2001). Psychoanalytic interventions were performed over a relatively limited period, averaging 24 sessions over a one-year period. In it, the therapist does not act as a guide, does not give advice on eating or other issues in symptom management. Instead, they interpret the unconscious and conscious meaning of symptoms in relation to personal history, the consequences of symptoms and their effect in their current relationships, the manifestation of such influences in relation to the therapist. Dare et al. (2001) compared the effectiveness of these approaches with the family therapy approach of Russell et al. (1987), the intervention on an individual basis has elements of both psychoanalytic and cognitive approaches and a loosely supportive state in which participants receive no systemic therapy. The study participants had a relatively poor prognosis. The age of onset is late, the problem persists for a long time, and the condition does not improve with other therapies. However, after a long year of intervention, one-third of the women no longer met the diagnostic criteria for anorexia. Only 5% of those in the control group showed improvement. Thus, no intervention is more effective than the other. individual-based interventions have elements of both psychoanalytic and cognitive approaches and a lax support state in which participants receive no systemic therapy. The study participants had a relatively poor prognosis. The age of onset is late, the problem persists for a long time, and the condition does not improve with other therapies. However, after a long year of intervention, one-third of the women no longer met the diagnostic criteria for anorexia. Only 5% of those in the control group showed improvement. Thus, no intervention is more effective than the other. individual-based interventions have elements of both psychoanalytic and cognitive approaches and a lax support state in which participants receive no systemic therapy. The study participants had a relatively poor prognosis. The age of onset is late, the problem persists for a long time, and the condition does not improve with other therapies. However, after a long year of intervention, one-third of the women no longer met the diagnostic criteria for anorexia. Only 5% of those in the control group showed improvement. Thus, no intervention is more effective than the other. the problem persists for a long time and the situation does not improve with other therapies. However, after a long year of intervention, one-third of the women no longer met the diagnostic criteria for anorexia. Only 5% of those in the control group showed improvement. Thus, no intervention is more effective than the other. the problem persists for a long time and the situation does not improve with other therapies. However, after a long year of intervention, one-third of the women no longer met the diagnostic criteria for anorexia. Only 5% of those in the control group showed improvement. Thus, no intervention is more effective than the other.
Pharmacological interventions have not been particularly effective in the treatment of anorexia. Jimerson et al. (1993) conducted a meta-analysis of all controlled studies in the treatment of anorexia with antidepressants and psychotropic drugs to see efficacy. They show little evidence of effectiveness. After this review, the pilot studies also did not change the overall picture. Although treatment with SSRIs may be effective in treating depression associated with anorexia, there is no evidence of a definitive change in the baseline symptoms of anorexia (Ferfuson et al. 1999). However, there are some exceptions in this study. Kaye et al. (2001b) showed that the intervention was administered to women with anorexia treated with either fluoxetine or placebo-controlled. For those receiving fluoxetine, 63% had good responses such as weight gain, maintenance of adequate weight, improvement of obsessions, underlying eating disorder symptoms, and mood. Only 16% of the placebo group achieved significant weight gain. The effectiveness of a drug intervention may depend on the patient's willingness to take the drug, which is generally low. In a meta-analysis of comparisons between psychotherapy and medication, Bacaltchuk et al. (2002) found overall remission rates to be 20% for those treated with antidepressants compared with 39% for psychotherapy. The dropout rate was higher in antidepressant users than in psychotherapists. The effectiveness of a drug intervention may depend on the patient's willingness to take the drug, which is generally low. In a meta-analysis of comparisons between psychotherapy and medication, Bacaltchuk et al. (2002) found overall remission rates to be 20% for those treated with antidepressants compared with 39% for psychotherapy. The dropout rate was higher in antidepressant users than in psychotherapists. The effectiveness of a drug intervention may depend on the patient's willingness to take the drug, which is generally low. In a meta-analysis of comparisons between psychotherapy and medication, Bacaltchuk et al. (2002) found overall remission rates to be 20% for those treated with antidepressants compared with 39% for psychotherapy. The dropout rate was higher in antidepressant users than in psychotherapists.
Intervention for bulimia
In contrast to the intervention in anorexia, for bulimia, there is more texture and better prognosis (Anderson and Maloney 2001). One of the pioneering cognitive-behavioral therapies in bulimia is the three-stage approach (Fairburn 1997). The first phase has two goals: to demonstrate the need for therapy, and the second is to change binge eating habits to a more regular form of eating. Eating is strictly focused on 3 main meals plus 2 to 3 pre-planned snacks, without vomiting or other similar behaviors. This usually does not lead to weight gain. Conversely, reducing the frequency of binge eating can help with weight loss. Energy-draining activities such as bathing and meeting friends can be used to reduce the risk of binge eating. Once meals are regularly taken, the urge to vomit will naturally decrease. There is a further problem, however, in that it may be necessary to continue using behaviors to suppress eating for an hour or more after eating. The use of laxatives and diuretics should cease at this stage with tapering by programs introduced for those unable to do so right away. To help with this process, make it known to individuals that strategies are not intended to inhibit the attractiveness of food. Later in this phase, therapy sessions may involve both the client and close friends and relatives, with the aim of providing an environment that can support behavior change. The use of laxatives and diuretics should cease at this stage with tapering by programs introduced for those unable to do so right away. To help with this process, make it known to individuals that strategies are not intended to inhibit the attractiveness of food. Later in this phase, therapy sessions may involve both the client and close friends and relatives, with the aim of providing an environment that can support behavior change. The use of laxatives and diuretics should cease at this stage with tapering by programs introduced for those unable to do so right away. To help with this process, make it known to individuals that strategies are not intended to inhibit the attractiveness of food. Later in this phase, therapy sessions may involve both the client and close friends and relatives, with the aim of providing an environment that can support behavior change.
The second stage involves using both behavioral and cognitive processes to combat shape and weight stereotypes and other distorted perceptions. Behavioral interventions may include eating previously avoided foods and, if necessary, increasing energy input. This is done hierarchically, starting with foods that are acceptable to those that can cause severe anxiety or the desire to binge eat or take an enema. At the same time, clients are encouraged to identify negative perceptions of their shape and weight and to seek evidence to support or counteract them using cognitive challenge techniques. awake. Fairburn (1997) points out that many clients have a very limited portfolio of such thinking, caused by a variety of situations. By revisiting those thoughts and the situations that caused them, the potency and automaticity of these thoughts are gradually reduced. Next, testing the behavioral hypothesis involves gradually engaging in previously avoidant and fearful behaviors such as exposing one's body by wearing tight clothing, undressing at the pool, or even don't wear clothes in the dark.
The third phase involves maintaining the progress made in the first two phases, considering strategies to prevent recurrence once therapy has ended.
Cognitive-behavioral therapy is seen as the psychotherapy of choice for bulimia (Anderson and Maloney 2001). This treatment usually gives good results quickly as well as long term. For example, Wilson (1996) reported that on average, about 55% of people who attend cognitive behavioral therapy do not have bowel movements by the end of therapy and that those people continue to be in great remission. Those who continued to use bleach also experienced a significant reduction in the number of laxatives used: an average of 86% reduction in laxative use. The long-term follow-up data are also encouraging. Fairburn et al. (1995) reported that 63% of their cases did not recur after nearly 6 years. A comparison of behavioral therapy and cognitive behavioral therapy showed that both were equally effective in reducing binge-eating disorder shortly after initiating therapy.
Another psychotherapeutic approach is also quite effective in treating bulimia. Interpersonal psychotherapy (IPT) focuses primarily on strategies that improve interpersonal relationships in the absence of any other therapeutic problems. Fairburn et al. found that it was less effective than cognitive therapy in short courses. However, the results after 1 year were no longer different and the IPT participants continued to improve. The remission rate at this point was 46% with IPT and 39% with cognitive therapy. The authors attribute the good outcomes of IPT to improvements in self-worth and relationships, which makes body shape and weightlessness important to the individual. Because the effectiveness of IPT is more indirect than cognitive methods, it takes longer to manifest.
Overall, antidepressants for bulimia reduced the frequency of binge eating by an average of 56%, compared with 11% for placebo. (Jimerson et al. 1993). However, many people with antidepressant therapy quit midway because of their dependence on the drug. In addition, the recurrence rate in this group is up to 30%-45% after about 4-6 months of discontinuation of treatment. Jimerson et al. (1993) summarizing data showed that about 50% of people taking prescription antidepressants had an improvement, yet only a third of them maintained remission.
Three out of five studies comparing cognitive behavioral therapy with pharmacological intervention showed no difference ineffectiveness. (Bacaltchuk et al. 1999). Two studies showed better cognitive-behavioral interventions. Overall, rates of sustained remission in the antidepressant group were 20%, and in the cognitive approach 39%. Dropout rates were also higher among people taking antidepressants than with cognitive therapy: 40% versus 18%. In one of these studies, Agras et al. (1994) randomly assigned women with bulimia to some form of therapy, including a brief course of antidepressant, cognitive behavioral therapy, or combination therapy. After 4 months, both cognitive therapy and the combination were more effective than drugs alone in treating bulimia and ileus. These results were maintained for the next year.