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 pre-

teen 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 middle-

class 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 follow-up.

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 5-

hour 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, Pinto-

Gouveia, & 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

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