Chapter 8
Education and Intervention
Programs for Disordered Eating in
the Active Female
Jacalyn J. Robert-McComb, PhD,
FACSM
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
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 selfperception.
Definition of Self-esteem


Self-esteem – extent to which a person feels positive
about himself or herself
Self-esteem has 3 major components:
1)
2)
3)
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.
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.)
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:
1)
2)
3)
4)
Stage of change
Self-efficacy
Decisional balance
Processes of change
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

Self-efficacy

Refers to an individual’s confidence in his/her
ability to perform specific behavior, which can
increase as individual moves through stages
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.
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.
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
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)
General Treatment Principles Cont’


Therapists and their personality are major
therapeutic parts of treatment of patients with
AN
Family therapy effective in younger patients
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
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

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

Web Resources for Treatment of Eating
Disorders Targeted for Physicians

The Academy for Eating Disorders (AED)


American Psychiatric Association (APA)


Web site: http://www.psych.org
Internet Mental Health (IMH)


Web Site: http://www.aedweb.org
Web site: http://www.mentalhealth.com
National Association of Anorexia and
Associated Disorders (ANAD)

Website: http://www.anad.org
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
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_revisebook
index.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.