Treatment of Eating Disorders by Emotion Regulation

Valerija Sipos, Ulrich Schweiger

• Publisher: Kohlhammer Verlag
• Year: 2017
• eBook ISBN: 9783170332911
• Edition: 1
• Topic: Psychology
• Subtopic: Abnormal Psychology
• Index: Psychology

Eating disorders belong to the leading causes of lost life years in young adult women. Current behavioral treatments are efficacious but reach only part of the affected women. The treatment presented in this book differs from many prior treatment approaches in that it assumes that disturbed eating behavior is a consequence of difficulties in emotion regulation. It focuses on imparting skills that improve self-management, foster mindful and healthy eating behavior, emotion regulation, social skills and distress tolerance."Treatment of Eating Disorders by Emotion Regulation" has a modular structure and is designed for use as the basis for inpatient and outpatient treatment and besides that has a self-help manual. It contains a plenty of psychoeducational materials, work sheets, case vignettes and background information for therapists.

Part 1

1 Symptoms of the eating disorder module

1.1 Who is this manual for?

The treatment of eating disorders through emotion regulation is aimed at patients who suffer from an eating disorder and other related problems. This module is intended to assist the patient in becoming an expert with his or her own problem. There are many individual variations of eating disorders. In order to plan your treatment accurately, it is important that you know what symptoms are present and what symptoms are not present. If you are unsure whether an eating disorder is a major problem for you, just work through the module and discuss any outstanding issues with your therapist.

For an eating disorder to be present, two criteria must be fulfilled:

1. The eating behaviour must be altered (e.g., intense fasting, vomiting of food) and

2. The altered eating behaviour leads to physical endangerment (e.g. underweight, disruptions of mineral metabolism) or psychological impairment (e.g. your whole attention is directed towards thinking about food, depression).

Eating disorders are often associated with problems of emotion regulation. This manual deals with this relationship between emotions and eating behaviour.

1.2 Symptoms of an eating disorder

If you’re wondering whether you are suffering from an eating disorder or not, or if you suffer from an eating disorder and you want to characterise this disease more precisely, then go through the list and consider which symptoms apply to you (worksheet 1).

Are you underweight or overweight?

To determine this, you need to know your body weight and body size. For measuring purposes use a calibrated scale and a calibrated height measurement device (e.g. at your GP). Weigh yourself before breakfast in the morning in light clothing. Your body height must be measured without wearing any shoes. The formula BMI = weight (kg) / height² (m²) can be used to calculate the body mass index. You can find BMI calculators on the internet, e,g, at http://www.bmi-calculator.net/.

The BMI in young women is too low if it less than 18 kg / m², whereas over 26 kg / m² it is too high. Health endangering obesity starts at a BMI of 30 kg / m².

For men, the same relationship exists between BMI and health as it does in women, even if higher limits are given in some tables.

For women and men who engage in power sports, higher BMI limits apply. During the course of a healthy aging process the BMI increases slightly, i.e. a slightly higher BMI is associated with a maximum life expectancy.

For children there is no simple “rule of thumb” for the normal range of weight. It is therefore necessary to use either special tables derived from the internet or paediatric textbooks to determine whether the BMI of a child or adolescent lies within the reference range. These tables use percentiles. Underweight or overweight is considered as the weight below the 3rd or 5^th, or above the 95th or 97th percentile.

Waist girth: Waist girth measurements are designed to assess body fat distribution. If a woman’s waist girth exceeds 88 cm and a man’s exceeds 102 cm it is assumed that the volume of abdominal fat (visceral or intra-abdominal fat) is too high. It is important to measure horizontally with a tape measure while standing upright, half-way between the lower ribs and upper edge of the pelvis, and while exhaled and with a relaxed abdominal wall. If you are unsure about this you can let your doctor do the measurement.

Do you think a lot about food and food related matters?

An important indicator of an eating disorder can be if you constantly think about food or think about your eating behaviour so that it affects your ability to concentrate.

Do you restrict your calorie intake?

Check which of the following behaviours are typical for you:

Multiple daily weighings for closely monitoring changes in body weight

Avoidance of high-calorie, fatty or carbohydrate-containing foods

Skipping meal components such as desserts or even whole meals

Chewing and spitting out food

Precise determination of the calorific content of meals, e.g. by weighing and use of calorie tables

Avoidance of foods whose calorific content is not clearly identifiable, e.g. where someone else has prepared some soup

Use of sweeteners, fat substitutes and light products

Use of appetite suppressants or nicotine for appetite control

(Self) limitation to one or two meals per day

Limitation to a certain number of very small meals

Consumption of large quantities of fluid before meals in order to restrict intake of nutrients

Restriction of fluid intake in order to make it more difficult to eat (e.g. thirst or dry mucous membranes)

Shopping for food which you know you do not like to eat in order to control your own eating habits

Hoarding of food that is looked at but not eaten

Use of salt, pepper and other spices to make food difficult to eat

Use of specific thoughts to make the consumption of food that you would otherwise like to eat unappealing. For example, the notion that chocolate is contaminated with mouse droppings or the notion that the chef spat in the soup

Avoidance of eating publicly in order to avoid distraction while eating

Avoidance of eating publicly due to shame about one’s eating habits or to prevent others commenting on your eating behaviour

Use of constricting abdominal belts, confining clothing or muscular tensing in order to create an early feeling of satiation when eating

Use of tongue piercings or self-injury in the oral cavity to make it more difficult to eat

Do you try to undertake something once you have eaten?

This refers to all behaviours intended to remove liquids or other energy sources rapidly from the body once they have been consumed.

Vomiting, either automatically, after stimulation of the throat, or assisted by chemical substances that promote vomiting, such as cough syrup or salt solutions, or vomiting promoted by revolting thoughts

Consumption of herbal or chemical laxatives

Consumption of herbal or chemical diuretic agents

Use of thyroid hormones (to increase the basal metabolic rate)

Excessive exercise, i.e. exercise that no longer serves an individual’s health or well-being, but which merely burns calories

Intentional tightening of the muscles (isometric exercises)

Intentional shivering (by wearing thin clothing) to consume calories

Intentional sweating to lose fluid (e.g. longer visits to the sauna without adequate fluid replacement)

Omission of insulin (if you have type 1 diabetes) to excrete sugar in the urine

Do you eat at unusual times or without a fixed st...

Table of contents

• Deckblatt
• Titelseite
• Impressum
• Inhalt
• Acknowledgements
• Foreword
• Handling of the manual
• Part 1
• Part 2 Characteristics of severely ill patients with eating disorders
• References
• Index