DClinPsy Portfolio Volume 1 of 3 - University of Hertfordshire ...

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Introduction Disordered eating in adolescence Eating Disorders can be viewed on a continuum, with disordered eating not reaching diagnostic criteria but potentially leading to either an eating disorder or obesity. Disordered eating refers to unhealthy eating behaviours such as severe caloric restriction followed by bingeing and the consumption of large quantities of high fat foods, which increase the risk of obesity (Stice, Presnell, Shaw and Rohde, 2005). Disordered eating also includes the use of meal supplements for weight loss, skipping meals or laxative, diuretic and diet pill use, binge eating, exercising obsessively and self-induced vomiting, (Neumark-Sztainer, 2005). It has been found that those with disordered eating or subclinical levels of eating disorders in adolescence have an increased risk for developing Bulimia Nervosa (BN), (i.e. up to a nine-fold increase in risk in late adolescence and a 20-fold increase in adulthood, Kotler, Cohen, Davies, Pine and Walsh, 2001). Transdiagnostic approach in understanding eating disorders and obesity Obesity and the different eating disorders can be considered together as overweight adolescents are at a high risk of using unhealthy weight control behaviours (i.e. disordered eating, Neumark-Sztainer 2005). Secondly, the commonalities between the eating disorders are apparent when they are viewed longitudinally as individuals can cross over from one diagnostic condition to another over time (i.e. about a quarter of patients with BN have had AN in the past, Agras, Walsh, Fairburn, Wilson and Kraemer, 2000). Thirdly, there is much co-morbidity in relation to mood disturbance across the eating disorders and obesity (Pryor and Wiederman, 1998). Studying disordered eating instead of looking at the diagnostic categories of eating disorders separately, may enable findings to be generalised to the understanding, prevention and treatment of all forms of eating disorders and obesity. 264
Taking such a perspective may also provide an explanation for the co-morbidity in clinical practice as ‘pure’ cases of a disorder are thought to be relatively rare with many individuals diagnosed with ED also having depression/anxiety (Kessler, McGonagle, Zhao, Nelson, Hughes, Eshleman, Wittchen and Kendler, 1994). Thus a treatment that reverses the maintaining processes in one disorder could improve all the disorders present. Gowers and Bryant-Waugh (2004) point out that although eating disorders in children and adolescents remain a serious cause of morbidity and mortality, the evidence base for effective interventions is surprisingly weak. Fairburn, Shafran and Cooper (2003), have concluded that available therapies that have undergone evaluation are not effective enough, as at best, only half the patients make a full and lasting response which raises the question “Why aren’t more people getting better?” There is research currently being conducted into a transdiagnostic perspective on the maintenance of eating disorders, with Fairburn (2008) pioneering an enhanced approach. However, Fairburn’s approach does not consider ‘inflexibility’ as investigated in this study. A further indicator of a transdiagnostic model of understanding eating pathology is the shared risk factors identified of which body image dissatisfaction has been put forward as the single strongest predictor of eating disorder symptomatology among women (Polivy and Herman, 2002). Body image dissatisfaction and mood regulation Body image dissatisfaction defined as ‘subjective dissatisfaction (negative thoughts and feelings) with ones physical appearance’ (Littleton and Ollendick, 2003) is higher in adolescent females reporting disordered eating, (Croll, Neumark-Stainer, Story & Ireland, 2002). Individuals with body image dissatisfaction have also been found to present with negative cognitive distortions, (Williamson, 1996), thus helping to explain the link between body image dissatisfaction and depression. 265
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DClinPsy Portfolio Volume 1 of 3 A
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Discuss the importance of the thera
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Psychoanalytically, the focus has b
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Type 2 refers to joint working and
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It appears that what links the conc
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It was concluded that the direct as
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Importance of Therapeutic Relations
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The therapist must also be aware of
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Understanding what constitutes a po
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References Alexander, L. B. & Lubor
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Gutfreund, M. J. (1992). A close-up
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Lambert, M. J. & Bergin, A. E. (199
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Shin, Sung-Man; Chow, Clifton; Cama
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Introduction Historically there has
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Furthermore connections’ in relat
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A triangular pattern of protection
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Another issue related to empowering
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There are many issues that the psyc
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Furthermore a common tendency in pe
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Conclusion Although systemic and ps
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References Banks, R. (2003). Psycho
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Linington, M. (2002). ‘Whose hand
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Small Scale Service Related Project
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• 36% stated that voluntary atten
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CONTENTS Pages Introduction 50-58 M
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Individual authors from different p
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Aim of current project This study w
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- appointment times given to all at
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RESULTS Forty professionals took pa
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The highest rated factor is about t
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Figure 2 Ratings of importance of e
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Figure 4 Ratings of importance of e
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Nursing rated the following five po
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Question Graph showing views of pro
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Other comments from Nursing stated
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However, the comments section invol
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e audited. Furthermore, it may be u
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Hodgson, R., Jamal, A., Gayathri, B
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APPENDICES 77
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How Multi-disciplinary Staff View W
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28 Are the patients attending given
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There should be a named person resp
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Literature Review Body Image, Disor
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Prevalence studies across Europe, t
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For example, the use of appetite su
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The next part of this review will e
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Similarly, negative characteristics
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When body image distress is very lo
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The role of emotion regulation in t
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Experiential avoidance is the unwil
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Ineffective avoidance coping strate
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References Alexander, L. C., Gratz,
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Croll, J. Neumark-Stainer, D., stor
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Hayes, S. C., Masuda, A., Bissett,
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Keel, P. K., Fulkerson, J. A., and
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McVey, G.L., Pepler, D., Davis, R.,
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Piran, N and Cormier, H.C. (2005) t
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Stice, E., Presnell, K., Shaw, H. a
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APPENDIX I: Search strategy Consult
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Body Image, Disordered Eating and E
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ACT and weight control 139 ACT and
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Demographics of sample and epidemio
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Acknowledgements I would like to th
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Introduction This study reports on
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Consequences of disordered eating P
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Transdiagnostic approach in underst
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Factors implicated in the developme
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Feelings of depression/ high levels
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ACT and processing unpleasant emoti
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Applying ACT theory to weight contr
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Heffner et al, (2002) assert that t
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This phenomenon has encouraged furt
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This project will therefore seek to
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Method Design: A non experimental,
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The researcher remained in the room
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The psychological scales will be de
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The comparison group (n = 770) cons
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4) Hospital Anxiety and Depression
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The BMI-for-age weight status categ
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Results Section I will provide desc
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The majority were in the middle set
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Table 5: Frequency counts and perce
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As regards experience of an illness
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Min-Max Skewness (Std error) 1-23 0
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The lower boundary of the box repre
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3. Moderate EDR compared to High ED
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Comparison of Body Image Acceptance
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Table 12 - Descriptive statistics f
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The boxplot above shows that there
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Hospital Anxiety & Deperssion Scale
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3. Anxiety-Underweight compared to
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As can be seen from the above scatt
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Hospital Anxiety & Deperssion Scale
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Comparison Mean difference (SE) Z p
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Section III - Further contributing
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Due to the small sample size in the
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Eating Disorder risk categories Tot
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25 (28%) out of the 88 participants
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% within Body mass index USA 35.7%
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Table 33: Results of the logistic r
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Moreover, 13% of those aged 12-14 y
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The clinical variables of anxiety a
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Summary of additional findings The
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Low self esteem involves an uncondi
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This study has supported the relati
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Co-morbidity with other psychopatho
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Page 215 and 216: This is consistent with the asserti
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Page 219 and 220: Conclusion This study found that in
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Page 223 and 224: Greco, L. A., Blomquist, K. K., Acr
Page 225 and 226: HADS, and the influence of age, gen
Page 227 and 228: Mykletun, A., Stordal, E. & Dahl, A
Page 229 and 230: Smolak, L., Levine, M. P., & Strieg
Page 231: Willcox, M. & Sattler, D. N. (1996)
Page 237 and 238: Appendix 3 Body Image Acceptance an
Page 239 and 240: Appendix 4 Hospital Anxiety and Dep
Page 241 and 242: Appendix 5 Background information D
Page 243 and 244: Appendix 6 Information sheet for pa
Page 245 and 246: If after reading this information s
Page 247 and 248: Dear Sir/Madam, U H Doctor of Clini
Page 249 and 250: U H CONSENT FORM Title of Project:
Page 251 and 252: CERTIFICATE OF ACHEIVEMENT This is
Page 253 and 254: Debriefing sheet Title of project:
Page 255 and 256: Appendix 10 Ethics approval Form SC
Page 257 and 258: Appendix 12 Boxplots and Descriptiv
Page 259 and 260: Appendix 13 Box plot and Descriptiv
Page 261 and 262: Journal-Ready Copy Helen Eracleous
Page 263: Abstract Objective: The study inves
Page 267 and 268: ACT suggests that inflexibility (i.
Page 269 and 270: The EDI has been the measure of cho
Page 271 and 272: Additional research questions were
Page 273 and 274: Hypotheses III Inflexibility was po
Page 275 and 276: A potential explanation may be that
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Page 279 and 280: Clinical implications Due to the cr
Page 281 and 282: Conclusion The hypotheses investiga
Page 283 and 284: Greco, L. A., Lambert, W., & Baer,
Page 285: Smolak, L., Levine, M. P., and Stri
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