[Type text] [Type text] Liu 1
Shuang Liu
Dr. Hammer
English 105
2/26/15
Leading clinicians and researchers have called for work aimed at the development of eating disorder prevention interventions (killen 936).
1
Beyond Killen, Herzog & Copeland (1985) have also demonstrated the importance of
“[i]ntervention” with eating disorders. Simply, the medical profession is now seeking to identify
“effective preventions” (page 936) for ED; a “significant public concern” (page 936).
Consequently, when seeking to identify pre-curser symptoms, researchers examine both physical and psychological determiners. Specifically, whether from physical or psychological characteristics, “self-criticism” 2 serves as a catalyst to the “over-evaluation of shape and weight”
3
in eating disorder patients. As such, scientists examine how both “confirmatory factor
1 Killen, Joel D., et al. "Weight concerns influence the development of eating disorders: a 4-year prospective study."
Journal of consulting and clinical psychology 64.5 (1996): 936.
2 Dunkley, David M., and Carlos M. Grilo. "Self-criticism, low self-esteem, depressive symptoms, and overevaluation of shape and weight in binge eating disorder patients." Behaviour Research and Therapy 45.1 (2007):
139-149.
3
Dunkley, David M., and Carlos M. Grilo. "Self-criticism, low self-esteem, depressive symptoms, and overevaluation of shape and weight in binge eating disorder patients." Behaviour Research and Therapy 45.1 (2007):
139-149.

[Type text] [Type text] Liu 2 analysis”
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and “structural equation modeling”
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can be used to identify symptoms of ED. Yet, scholars have gained evidence in support of both biological (genetic and early developmental trauma) and cultural (social identification) factors that contribute to the increased risk for the development of eating disorders.
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As such, understanding which risk factors contribute more to the development of ED remains unsettled. Concomitantly, the cultural contexts for what Dr.
Bulik terms, “thin idealization”, provide an all- too-easy explanation of how ED demarcates the
“pursuit of beauty” 7 . With this understanding as my foundation, my essay will analyze the classification and treatments of eating disorder to demonstrate a causal link between each type of
ED and its most efficacious therapy.
Classification and Symptoms
So as to the precise treatments were to be established, the question of how to classify eating disorder becomes significant, in order to provide clinical work with “guidance for different treatment response and prognosis”
8
. Accordingly, the existence of three general classes is supported: “anorexia nervosa”, “ bulimia nervosa”, and “binge eating disorder” (BED).
Further, the symptom of each type is learned experimentally as the diagnosis method advanced
4 Dunkley, David M., and Carlos M. Grilo. "Self-criticism, low self-esteem, depressive symptoms, and overevaluation of shape and weight in binge eating disorder patients." Behaviour Research and Therapy 45.1 (2007):
139-149.
5 Dragan, Alina, and Noori Akhtar-Danesh. "Relation between body mass index and depression: a structural equation modeling approach." BMC medical research methodology 7.1 (2007): 17.
6 Striegel-Moore, Ruth H., and Cynthia M. Bulik. "Risk factors for eating disorders." American Psychologist 62.3
(2007): 181. Striegel-Moore, Ruth H., and Cynthia M. Bulik. "Risk factors for eating disorders." American
Psychologist 62.3 (2007): 181.
7 Striegel-Moore, Ruth H., and Cynthia M. Bulik. "Risk factors for eating disorders." American Psychologist 62.3
(2007): 181.
8 Dilling H. Classification. In: Gelder MG, Lopez-Ibor JJ, Andreasen N, editors. New Oxford Textbook of
Psychiatry. Oxford: Oxford University Press, 2000, pp. 109–133.

[Type text] [Type text] Liu 3 over time. And the most possible targeting people in each group are clarified to improve clinical prevention. Yet, the boundaries among each type are still vague: binge eating disorder is a
“newly conceptualized eating disorder” 9
that developed out of the bulimia nervosa; the diagnostic crossover rates between diagnostic crossover are approximately 50%
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high. Further,
BED is not otherwise specified in the DSM-IV, diagnosis and statistical manual of mental disorders
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. Thereby, more experiments and data are needed to separate and distinguish these three classes. Consistent with the statement above, three paragraphs are established to demonstrate each class.
One of the most obvious sign in anorexia nervosa is weight loss
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, as its essence is a relentless pursuit of thinness and a phobia of the consequences of eating 13 . Simply, individuals tend to have a restrict food intake physically, whether they eat a controlled range of food, avoid eating regularly, or eat in a prescribed order. In some cases, the individual’s intense anxiety over eating causes them to vomit or misuse laxatives
14
. Nevertheless, because appetite is so strictly measured and controlled, many individuals end up with reoccurring binge eating, an inability to satiate. This inconsistent eating behavior differentiates two type of anorexia nervosa: one with occasional binge eating and one without, through the definition of DSM-IV-TR (text revision).
9 Spitzer, Robert L., et al. "Binge eating disorder: a multisite field trial of the diagnostic criteria." International
Journal of Eating Disorders 11.3 (1992): 191-203.
10 Eddy, Kamryn T., et al. "Diagnostic crossover in anorexia nervosa and bulimia nervosa: implications for DSM-
V." (2008): 245-250.
11 Grilo, Carlos M. "Binge eating disorder." Eating disorders and obesity: A comprehensive handbook 2 (2002):
178-182.
12 Halmi, Katherine A. "Classification of eating disorders." International Journal of Eating Disorders 2.4 (1983):
21-26.
13 STEIGER, HOWARD, and KENNETH R. BRUCE. "Defining Features Anorexia Nervosa." Oxford Textbook of
Psychopathology (2008): 431.
14 STEIGER, HOWARD, and KENNETH R. BRUCE. "Defining Features Anorexia Nervosa." Oxford Textbook of
Psychopathology (2008): 431.

[Type text] [Type text] Liu 4
Recurrent episodes of binge eating and inappropriate compensatory behaviors
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are signals for bulimia nervosa. Individuals incline to overeating, a consequence of profound lack of control and intractable urge to eat. However, they also have a morbid fear of becoming fat
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, causing the “inappropriate compensatory behaviors” such as vomiting and misuse of medications, which overlapped with the definition of anorexia nervosa. Astonishingly, BN appears to be a more common disorder, indicating by 1-2% relevance in young adult women
(Cooper & Fairburn, 1983). Evidence has also supported the argument that BN is closely related to major affective disorder
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. For example, depressive symptoms are common amongst patients with bulimia, and patients with bulimia respond to treatment with antidepressant drugs
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. The prominent depressive symptom causes a high degree of psychiatric morbidity
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, according to a clinical analysis of BN.
Binge eating disorders are associated at least with three typical features like eating much more rapidly than normal, eating feeling uncomfortably full, and eating large amounts of food when not feeling physically hungry
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. Basically, its symptoms are much similar with those of bulimia nervosa. Thus historically, BED was reserved for possible new diagnostic categories that
15 Thelen, Mark H., Laurie B. Mintz, and Jillon S. Vander Wal. "The Bulimia Test—Revised: Validation with DSM-
IV criteria for bulimia nervosa." Psychological Assessment 8.2 (1996): 219.
16 Fairburn, Christopher G., and Peter J. Cooper. "The clinical features of bulimia nervosa." The British Journal of
Psychiatry 144.3 (1984): 238-246.
17 Cooper, Peter J., and Christopher G. Fairburn. "The depressive symptoms of bulimia nervosa." The British
Journal of Psychiatry 148.3 (1986): 268-274.
18 Cooper, Peter J., and Christopher G. Fairburn. "The depressive symptoms of bulimia nervosa." The British
Journal of Psychiatry 148.3 (1986): 268-274.
19 Fairburn, Christopher G., and Peter J. Cooper. "The clinical features of bulimia nervosa." The British Journal of
Psychiatry 144.3 (1984): 238-246.
20 Manzato, Emilia. "Classification of Eating Disorders." Eating Disorders and the Skin . Springer Berlin Heidelberg,
2013. 3-7.

[Type text] [Type text] Liu 5 were not included in DSM-IV since there were insufficient data to warrant their inclusion
21
.
Hitherto, as more researches are conducted, some distinctive features, such as night eating syndrome, are known and confirmed. And now BED is considered as a distinct diagnostic category of eating disorder. Social studies show that The prevalence of binge eating disorder in the general population is about 1-3%, and in patients with obesity, and in patients seeking help for weight loss, a much higher prevalence has been reported (25% or more)
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.
Treatment
Based on classification and symptoms of eating disorder, specialized therapies have been developed over years on both pharmacological and psychological approaches. In general, four major psychological treatments are created, Cognitive behavioral therapy (CBT), Interpersonal psychotherapy (IPT), psychodynamic therapy (PT), and behavior therapy (BT). And each therapy has its own effective target and efficiency. But one common problem of studies related to the treatment is that most researches address only the immediate effect of a treatment.
Therefor, the further influence over patient is needed in clinical field. Based on these understandings, paragraphs below will compare and contrast these four methods and demonstrate some pharmacological treatments in details.
As a psychological treatment, cognitive behavior therapy is particularly used for bulimia nervosa to enhance motivation for change, replace dysfunctional dieting with a regular and flexible pattern of eating, decrease undue concern with body shape and weight, and prevent relapse
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. Experiment suggests that complete version of CRT is superior to the simplified and
21 Grilo, Carlos M. "Binge eating disorder." Eating disorders and obesity: A comprehensive handbook 2 (2002):
178-182.
22 Pull, Charles B. "Binge eating disorder." Current Opinion in Psychiatry 17.1 (2004): 43-48.
23 Wilson, G. Terence, Carlos M. Grilo, and Kelly M. Vitousek. "Psychological treatment of eating disorders."
American Psychologist 62.3 (2007): 199.

[Type text] [Type text] Liu 6 exclusively BT version. And it was more effective at modifying psychopathology facets
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that are not viewed by patients as problematic compared to IPT. It is also the most well-established psychotherapeutic treatment for BED
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. Yet, one problem with CBT studies is that, in spite of the impressive overall reductions in the frequencies of binge eating and purging, a large percentage of individuals remains symptomatic at the end of treatment
.
Interpersonal psychotherapy (IPT) has been examined as an alternative treatment to target
BED by directly addressing the social and interpersonal deficits observed among individuals
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. It does not focus on eating behavior, but rather on relational factors associated with the onset and maintenance of binge eating
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. As for bulimia nervosa, IPT is the leading empirically supported alternative to CBT for those patients who don’t react to CBT, because it is effective in ameliorating the patients' depressive symptoms, and psychiatric symptoms in general, as well as in improving social functioning. However it “takes longer to achieve its effects”
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according to the experiment. Therefor, in clinical terms, IPT is regarded inferior to CBT in the treatment.
Psychodynamic therapy (PT) is mainly useful in long-term treatment for patients with self-destructive symptom, because it “emphasizes personal narrative and subjective
24 Fairburn, Christopher G., et al. "Three psychological treatments for bulimia nervosa: A comparative trial."
Archives of General Psychiatry 48.5 (1991): 463-469.
25 Wilfley, Denise E., et al. "A randomized comparison of group cognitive-behavioral therapy and group interpersonal psychotherapy for the treatment of overweight individuals with binge-eating disorder."
26 Wilfley, Denise E., et al. "A randomized comparison of group cognitive-behavioral therapy and group interpersonal psychotherapy for the treatment of overweight individuals with binge-eating disorder." Archives of general psychiatry 59.8 (2002): 713-721.
27 Vaidya, Varsha. "Cognitive behavior therapy of binge eating disorder." Advances in psychosomatic medicine 27.R
(2006): 86.
28 Murphy, Rebecca, et al. "Interpersonal psychotherapy for eating disorders." Clinical psychology & psychotherapy
19.2 (2012): 150-158.

[Type text] [Type text] Liu 7 experience” 29
. Basically, PT helps patients to develop self-knowledge and to reconstruct personal characteristics. Besides, PT is beneficial for “ Patients with a relatively intractable anorexia nervosa” 30
, since it targets personal life history and family.
Pharmacological interventions have always been seen as an adjunct to “multi-disciplinary treatment”
31
of anorexia nervosa, because patients with AN demonstrate “a variety of psychological disturbances” 32
. Accordingly, with the aim of improving appetite or weight and
AN’s associated psychopathology suck as depressed mood, several classes of drugs have been utilized. Nevertheless, no specific pharmacological agent has proved to have significant utility due to few controlled medication trials. Thus evidence for the efficacy of medications is lack for regulatory agencies in “the United Kingdom (Medicine and Health Care Regulatory Agency
[MHRA])” and “the United States (Food and Drug Administration [FDA])”. As a result, pharmacological approaches to AN recommended in recognized treatment guidelines, such as those published by the “American Psychiatric Association (APA)” and “National Institute for
Health and Clinical Excellence (NICE)”
33
.
29 Zerbe, Kathryn J. "Psychodynamic therapy for eating disorders." The treatment of eating disorders: A clinical handbook (2010): 339-358.
30 DARE, CHRIS, et al. "Psychological therapies for adults with anorexia nervosa Randomised controlled trial of out-patient treatments." The British Journal of Psychiatry 178.3 (2001): 216-221.
31 Zerbe, Kathryn J. "Psychodynamic therapy for eating disorders." The treatment of eating disorders: A clinical handbook (2010): 175-176.
32 Fairburn, CHRISTOPHER G. "Interpersonal psychotherapy for eating disorders." Eating disorders and obesity:
A comprehensive handbook (2002): 325-327.
33 Kaplan, Allan S., and Andrew Howlett. "Pharmacotherapy for anorexia nervosa." The treatment of eating disorders: A clinical handbook (2010): 175-186.