Eating disorder and EDNOS
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Transcript of Eating disorder and EDNOS
“ACT on LIFE, NOT on Weight”Diététique & philosophie
Nicolas Sahuc Nîmes/Montpellier [email protected]
www.nicolassahuc.fr
Fondateur et vice-Président de l’association “L’ACT, redonnons du sens au comportement alimentaire”www.sudtca.fr
PlanA. Food identity
B. Primun non nocere
C. Foodchoice and confusion: Hungry / Emotions
D. In practice
E. Conclusion: “the wind and the sun”
A“ACT on LIFE, NOT on Weight”
Food identity
Food identity 1/2
Food identity 2/2
B Primun non nocere
“ACT on LIFE, NOT on Weight”
“First do no harm”
Connect the 9 points with only 4 straight line. You could not up the stylo of the paper.
Game
TRY
TRY
Need to take care with people who wants to loose weight
Elis
a C
osso
nnet
They try to control hungry but every time they loose and sometimes binge eating.
“Find the answer into the plate to losse weight: dieting, calories count...People focus on their body and weight scale”. (N. Sahuc)
Elisa Cossonnet www.elisacossonnet.com
“Plate focusing”BMI Vs body perception
Over-evaluation of shape and weight and their control
Strict dieting;non-compensatory
weight-control behavior
Binge eating Significantly low weight
Compensatory vomiting/laxative
misuse
Events and associated
mood change
The “transdiagnostic” cognitive behavioral theory EDNOS
Christopher G. FairburnProfessor of psychiatry at the university of Oxford
Impact sur les choix alimentaires
Over-evaluation of shape and weight and their control
Strict dieting;non-compensatory
weight-control behavior
Binge eating Significantly low weight
Compensatory vomiting/laxative
misuse
Events and associated
mood change
The “transdiagnostic” cognitive behavioral theory EDNOS
Christopher G. FairburnProfessor of psychiatry at the university of Oxford
Impact sur les choix alimentaires
Lunch
10h
17h
breakfast
After
Dinner
End of the day ?
Lunch
10h
17h
breakfast
After
Dinner I crack and give in to my cravings
Guiilty
Binge eating
End of the day ?
Lunch
10h
17h
breakfast
After
Dinner I crack and give in to my cravings
Guiilty
Binge eating
“Tomorrow I restrictive day”
End of the day ?
Lunch
10h
17h
breakfast Breakfast control
After
Dinner I crack and give in to my cravings
Guiilty
Binge eating
“Tomorrow I restrictive day”
End of the day
“Are you hungry in the morning?” “No”
?
Lunch
10h
17h
breakfast Breakfast control
I eat a low-calorie meal
After
“I want to eat but eat=gaining weight”
I crack and give in to my craving
Dinner I crack and give in to my cravings
Hungry
Guiilty
or
Binge eating
Strategies to fight hunger and thoughts about food
“Tomorrow I restrictive day”
End of the day
“Are you hungry in the morning?” “No”
?
Lunch
10h
17h
breakfast Breakfast control
I eat a low-calorie meal
After
“I want to eat but eat=gaining weight”
Frustrated
I crack and give in to my craving
Dinner I crack and give in to my cravings
Hungry
Guiilty
or
GuiltyHungry
Eaten too much
Binge eating
Strategies to fight hunger and thoughts about food
“Tomorrow I restrictive day”
I must not crack
ECHECE.S.➘
End of the day
“Are you hungry in the morning?” “No”
?
Lunch
10h
17h
breakfast Breakfast control
I eat a low-calorie meal
After
“I want to eat but eat=gaining weight”
I need suggarFrustrated
I crack and give in to my craving
Dinner I crack and give in to my cravings
Hungry
Guiilty
or
GuiltyHungry
Eaten too much
Binge eating
Strategies to fight hunger and thoughts about food
“Tomorrow I restrictive day”
I must not crack
I fight to not eat
ECHECE.S.➘
ECHECE.S.➘
End of the day
“Are you hungry in the morning?” “No”
?
Lunch
10h
17h
breakfast Breakfast control
I eat a low-calorie meal
Control my hungry
After
“I want to eat but eat=gaining weight”
I need suggarFrustrated
Frustrated
Hungry
I crack and give in to my craving
Dinner I crack and give in to my cravings
Hungry
Guiilty
or
GuiltyHungry
Eaten too much
Hungry I want to eatBinge eating
Strategies to fight hunger and thoughts about food
“Tomorrow I restrictive day”
I must not crack
I fight to not eat
ECHECE.S.➘
ECHECE.S.➘
I fight to not eatECHEC
E.S.➘
End of the day
“Are you hungry in the morning?” “No”
?
Lunch
10h
17h
breakfast Breakfast control
I eat a low-calorie meal
Control my hungry
After
“I want to eat but eat=gaining weight”
I need suggarFrustrated
Frustrated
Hungry
I crack and give in to my craving
Dinner I crack and give in to my cravings
Hungry
Guiilty
or
GuiltyHungry
Eaten too much
Hungry I want to eatBinge eating
Strategies to fight hunger and thoughts about food
“Tomorrow I restrictive day”
I must not crack
I fight to not eat
ECHECE.S.➘
ECHECE.S.➘
I fight to not eatECHEC
E.S.➘
End of the day
“Are you hungry in the morning?” “No”
?
C Foodchoice confusion: Hungry / emotions
“ACT on LIFE, NOT on Weight”
Dichotomia behavior
Craving Craving
Hungry/mood
Food Restrictive behavior
Tmie
Frustrated
GuiltyCraving
Food Restrictive behaviorFood Restrictive behavior
The Minnesota semi-starvation experiment (Keys et al., 1950)
significant increases in mood (depression) and important personality changes
most of the subjects experienced perdiodsof severe emotional distress and depression
extreme reactions: self mutilation and binge eating during the rahbilitation phase
Participants exhibited a dramatic increase in food preoccupation while the both phase
sexual interest was drastically reduced
The volunteers showed signs of social withdrawal and isolation
the participants reported a decline in concentration, comprehension and jugement capabilities
Severe and prolonged dieatry restriction can lead t o serious physical and pshycological complications. Many of the symptoms once thought to ne primary features of
anorexia are actually symptoms of starvation
Strict dietingBreakfast
25% of Energy
1 32 4 5 6
Lunch 40% of energy
7 8 9 10 11 12
Snack 10% of energy
Dîner 35% de l’AET
Food crisis zone1 ounce bread
fat-free yagourth tea
without sugar
Omelette with a green salad and one fruit
150kcal 300kcal ? ?
600kcal 960kcal 240kcal 840kcal
I’m not hungry /
hungry / or strategy
I’m not hungry /
hungry / or strategy
Fight against hungry
8h 12h30 17h 20h
Strict dietingBreakfast
25% of Energy
1 32 4 5 6
Lunch 40% of energy
7 8 9 10 11 12
Snack 10% of energy
Dîner 35% de l’AET
Food crisis zone1 ounce bread
fat-free yagourth tea
without sugar
Omelette with a green salad and one fruit
150kcal 300kcal ? ?
600kcal 960kcal 240kcal 840kcal
I’m not hungry /
hungry / or strategy
I’m not hungry /
hungry / or strategy
Fight against hungry
8h 12h30 17h 20hI can hold
Vs well being
DietingSensory
Specific Satiety
Sensory Specific Satiety
too much pleasure
Frustrated Guilty
Food quantity
-1-2-3-4 +1 +2 +3 +4
Feeling well in my body➚ self-esteem
Real Sensory Specific
Satiety
Feelingmyself
The triggers(“Vaincre l’anorexie” Ed. Dr. Vanderliden)
4 cases:
Emotions: qualify as negative (ex: feeling alone)
Not eating
Negative thinking
Seeing food
A are nutrition-related
Seeing food
Not eating
Barlow et Allen (2007)
Unacceptable mood
Strategy to erase the mood
Aboard strategy
Acceptanceno strategy
to erase
well being
feeling bad mood
D In practice
“ACT on LIFE, NOT on Weight”
Focus on emotions = loose psuchological flexibility“the more I try to control my weight, more I loose energy, more I cannot
use it for the essential of my life”
Work on body perception
Dietetic:
Focus on when I hungry
Feel sensory specific satiety
correction du flux alimentaire
Mindfulness
Wok on dieting behavior and cognitions
CBT-E
Prevent Eating Disorder (?)
“Plates focusing” vs Dietetic
Psychoeducation on HungryNot the same
Always different as an other day
Not weird to feel hungry
Depend from the last meal
Could appear many times per day
“I prefer people craving when they are hungry more than people dieting when they are hungry”
Could be different if:
I’m tired
Feeling bad...
Professionnal strategyEmpathie
Expert
Links between client and professional
Motivational approaches
Reflective listening
Philosophia
Hypnotic communication
DO
Collaborate with patient
Ask “open” question
Be patient
Explore the views of the patient
Ask for what the patient is worried
Show interest and understanding
Use Socratic style of interviewing
If the patient shows ambivalence, show understanding
DO NOT
Argument too much
Put patient on the weight scale
Criticize the patient
Judge morally
Start a debate
Threat or warn the patient
Make the patient ridiculous
Order the patient
Ignore the patient point of view
Propose solution
E Conclusion:“the wind and the sun”
“ACT on LIFE, NOT on Weight”
The North Wind and the Sun were disputing which was the stronger, when a traveler came along wrapped in a warm cloak.They agreed that the one who first succeeded in making the traveler take his cloak off should be considered stronger than the other.Then the North Wind blew as hard as he could, but the more he blew the more closely did the traveler fold his cloak around him;and at last the North Wind gave up the attempt. Then the Sun shined out warmly, and immediately the traveler took off his cloak.And so the North Wind was obliged to confess that the Sun was the stronger of the two.
The North Wind and the Sun were disputing which was the stronger, when a traveler came along wrapped in a warm cloak.They agreed that the one who first succeeded in making the traveler take his cloak off should be considered stronger than the other.Then the North Wind blew as hard as he could, but the more he blew the more closely did the traveler fold his cloak around him;and at last the North Wind gave up the attempt. Then the Sun shined out warmly, and immediately the traveler took off his cloak.And so the North Wind was obliged to confess that the Sun was the stronger of the two.
“KINDNESS EFFECTS MORE THAN SEVERITY.”
Questions time ! “Let us think of interesting
questions, rather than criticise”
Next Eating Disorder ConventionNîmes 1 et 2 avril 2011 www.sudtca.fr
Thanks for your reading
Questions time ! “Let us think of interesting
questions, rather than criticise”
Next Eating Disorder ConventionNîmes 1 et 2 avril 2011 www.sudtca.fr