Chapter 8 Education and Intervention Programs for Disordered Eating in the Active Female

1. Chapter 8Education and Intervention Programs for Disordered Eating in the Active Female Jacalyn J. Robert-McComb, PhD, FACSM

2. Learning Objectives After viewing this presentation, you should have an understanding of: • The importance of self-esteem in the prevention and treatment of disordered eating • The transtheoretical model used to explain the process of health behavior change • Athletes@Risk Prevention program • General treatment principles • Medical criteria for hospitalization • Eating disorder organizations and resources

3. Introduction • Low self-esteem, accompanied with perfectionism, is a well-recognized trait of those with disordered eating and could be a precipitating factor in the development of eating disorders. The terms self-concept, self-worth, and self-image are often used interchangeably with self-esteem and are all based on self-perception.

4. Definition of Self-esteem • Self-esteem – extent to which a person feels positive about himself or herself • Self-esteem has 3 major components: • Social identities - how individual defines him/herself in society • Personal dispositions – perceptions of traits, preferences, response tendencies • Physical characteristics – height, weight, body fat distribution, attractiveness, etc.

5. Introduction Cont’ • Education to prevent disordered eating is only effective if the individual understands and accepts herself, even her limitations • Physically active women are more aware of their body and its limitations, which can lead to low self-esteem (losing a race, finishing last, etc.)

6. The Transtheoretical Model used to Explain the Process of Health Behavior Change • Transtheoretical Model (TTM) – model of intentional behavior change • Four concepts considered central to health behavior change: • Stage of change • Self-efficacy • Decisional balance • Processes of change

7. Stages of Change • Five stages of change: • Precontemplation – no intention to change health behaviors within next 6 months • Contemplation – seriously considering behavioral change within next 6 months • Preparation – still lack commitment to change, but investigating the possibility of change within next 30 days • Action - actively modifying problematic behavior within last 6 months • Maintenance – self-control of behavior established more than 6 months ago

8. Self-efficacy • Refers to an individual’s confidence in his/her ability to perform specific behavior, which can increase as individual moves through stages

9. Decisional Balance • Relates to the benefits and costs of behavior • Example: Eating gives me more energy, yet it might make me fat (individual might change behavior because benefit outweighs cost) • Individuals who change their behaviors have positive decisional balance because the positive beliefs about the behavior outweigh the negative ones. • The benefits increase while the cons decrease as one moves through the stages of change.

10. Process of Change • Defined as a “type of activity that is initiated or experienced by an individual in modifying affect, behavior, cognition or relationships” • Health professionals can help with process of change and the maintenance of the new behavior with follow-up support.

11. Athletes at Risk Program • Preventative educational program for female athletes in recreational and competitive sport who are at risk for developing disordered eating, amenorrhea, and osteoporosis

12. General Treatment Principles • Recovery unlikely without fundamental change in attitudes such as: • Perfectionist attitudes • Low self-esteem • Unrelenting pursuit of thinness • Intolerance of mood fluctuations • Poor coping skills • All lead toward anorexia nervosa (AN) and bulimia nervosa (BN)

13. General Treatment Principles Cont’ • Therapists and their personality are major therapeutic parts of treatment of patients with AN • Family therapy effective in younger patients

14. General Treatment Principles Cont’ • Most BN patients are treated in outpatient setting • Inpatient treatment recommended for patients: • Less than 75% of average weight, severe metabolic disturbances, suicidal feelings, or no improvement after outpatient or partial program treatment • Inpatient treatment continued until patient reaches healthy body weight

15. General Treatment Principles Cont’ • Outpatient treatment: • Cognitive behavioral therapy (CBT) choice treatment • Fairburn developed most used CBT over 18 weeks: • First Stage: behavioral techniques replace binge eating with regular eating • Second Stage: eliminate dieting, focus on thoughts, beliefs, and values that reinforce dieting • Third Stage: maintenance of new healthy behaviors and thought patterns

16. General Treatment Principles Cont’ • Self-help (SH) • Written based manual based on principles of CBT • More accessible than CBT (use without therapist) • 7 sessions over 12 weeks

17. Web Resources for Treatment of Eating Disorders Targeted for Physicians • The Academy for Eating Disorders (AED) • Web Site: http://www.aedweb.org • American Psychiatric Association (APA) • Web site: http://www.psych.org • Internet Mental Health (IMH) • Web site: http://www.mentalhealth.com • National Association of Anorexia and Associated Disorders (ANAD) • Website: http://www.anad.org

18. For additional Eating Disorder Organizations and Resources • National Mental Health Association or additional resources: 1-800-969-NMHA (6642) or http://www.nmha.org/infoctr/index.cfm

19. Summary • Practice guidelines for the treatment of patients with eating disorders have been developed by psychiatrists who are in active clinical practice and are available on the web at http://www.psych.org/psych_pract/treatg/pg/eating_revisebookindex.cfm?pf=y . • These guidelines were approved by the American Psychiatric Association in 1999 and published in 2000. • These guidelines are not intended to serve as a standard of medical care but rather provide recommendations for treating patients with eating disorders.