1. Eating Disorders
Preventive Intervention

2. Eating Disorders
Anorexic Nervosa
Bulimia Nervosa
Binge Eating Disorder

3. DSM-IV-TR
Anorexic Nervosa Bulimia Nervosa Binge Eating Disorder
Refusal to maintain Recurrent episodes
Eating
normal body weight of binge eating
misappropriate
Recurrent and amount of food
Intense fear of
gaining weight (even inappropriate
Lack of control over
though under weight) compensatory
eating
behaviors
Distorted perception
Marked distress
of body shape & size Self evaluation is
dependent on weight
Amenorrhea and body shape

4. DSM-IV-TR
Categoriza*on
Emphasis on outwardly
observable facets
Ea*ng disorder =
obsession with body
image and control?

5. Intervention
Onset of Illness
Prevention Treatment
*note: the rationale behind these t wo types of
inter vention should not be much different

6. Prevention
Onset of ED typically during adolescence
or early adult life
Easier to treat ED early before it
becomes chronic
Preventing it before it starts will even
be better

7. Prevention Objectives
Increase knowledge
Discourage calorie-restrictive dieting
and promote healthy eating and exercise
Develop skills to resist social pressure to
eat
Promote self-acceptance and development
of positive image
Smolak, 1999

8. Middle School Primary
Prevention Program for
Eating Disorders
A controlled study with a Twelve-Month Follow-up
Grave et al., 2001

9. Prevention Program
Grave et al., 2001
Evaluate efficacy of a new school-based
eating disorder prevention program
designed to reduce
dietary restraint, and
the level of preoccupation with regard to
shape and weight

10. Prevention Program
Grave et al., 2001
N= 106 (M age: 11 - 12 years old)
61 girls, 45 boys (Universal-selective program*)
(McVey et al., 2007)
Experimental group = 55
Control group = 51
These groups were formed by randomly selecting
classes
The experimental group went through the program devised by the authors;
nothing was administered to the control group (it was just for comparison).

11. Methods
Grave et al., 2001
Program
(6 weeks)
1 week 1 week 6-month 2 booster 12-month
before after follow-up sessions follow-up
program program

12. Methods
Program Grave et al., 2001
(6 weeks)
1 week 1 week 6-month 2 booster 12-month
before after follow-up sessions follow-up
program program
Questionnaires
- Eating disorder Examination (EDE-Q)
- Eating Attitude Test (EAT)
- Rosenberg Self-Esteem Scale (RSES)
- 35-item knowledge questionnaire (KQ) by the authors
- demographic and background info*

13. Methods
Program Grave et al., 2001
(6 weeks)
2 hour-long sessions
30 mins: educational materials
Remaining: practical activities, group
discussions, revision of homework

14. Methods
Program Grave et al., 2001
(6 weeks)
increase knowledge
interactive rather than didactic
friendly approach to cognitive restructuring
HW: to encourage students to apply the prevention
program in their lives
Role playing: teach how to deal with adverse
comments about shape and weight

15. Methods
Program Grave et al., 2001
(6 weeks)
2 booster
sessions
2-hour long
similar to program

16. Results & Conclusion
Grave et al., 2001
led to increase in knowledge and
decrease in some attitudes
these effects were maintained at 12-
month follow-up
significant reduction obser ved on EAT
and global EDE-Q scores in both
experimental and control group

17. Results & Conclusion
Grave et al., 2001
increase in knowledge did not trigger
immediate effect on attitudes, but
delayed positive effect

18. Results & Conclusion
Grave et al., 2001
no significant changes on the
levels of restraint, shape and weight concern
self-esteem
Authors conclude:
difficult to statistically achieve significant
decrease in the behavior and attitudes
more intensive inter vention is necessary to
modify these attitudes

19. Finally, a Question!
What do you think of this pilot study?
Also, what is the assumption behind
such inter vention method?
changing attitude towards body shape and
weight
maintain habits of healthy living style
increase knowledge of aversive impact of
weight management

20. Discussion
Grave et al., 2001
general aim of the program
to create a counter-culture in which
the pupils helped each other to
discourage dieting and to challenge
media messages about thinness and
beauty

21. Approaches to
Preventive Intervention
Disease-specific (DS) pathways approach
Non-Specific Vulnerability-Stressors
(NSVS) approach
Feminist Empowerment Relational (FER)
model

22. Disease-Specific
Pathways approach
Social Cognitive Theory (SCT)
sociocultural factors that create/maintain
disordered eating
Decrease risk factors associated with
disordered eating (e.g. idealization of
slenderness, drive for thinness, or fear of
fatness)
Foster protective factors (e.g. healthy eating)

23. Non-Specific Vulnerability
Stressor (NSVS) Approach
Foster generic life-skills e.g. stress
management, assertion, decision-
making, social competency & resiliency

24. Feminist Empowerment
Relational (FER) model
Emphasizes developing critical thinking
towards the gendered issues
contributing to negative body image
promote new norms of relating,
acceptance, support and power
participatory approach

25. She felt that she had not been “successful”
as an anorexic because she did not reach an
extremely low weight.
She believed that truly successful anorexics
die of star vation and that somehow
they should be revered for their
accomplishments.
Ms A,
Bulik & Kendler,,2000

26. Every time I felt guilty, painful, angry, hate,
fearful, embarrassed, I would start to eat
because every time I ate, I would feel so
happy and “high”.
All the stress and worries just disappeared
and I would feel like I have escaped into
another world.
Jenn,
(Not just surface damage)

27. "I had a very complicated
childhood, very difficult, very
painful. My mother's big
phobia was that I would grow.
She spent her time measuring
my height. She wouldn't let me
go outside because she'd heard
that fresh air makes children
grow, and that's why I was
kept at home. It was
completely traumatic." Isabelle Caro, model
Died 17 Nov 2010 (aged 28)

28. Mere Obsession of Body Image?
Long-standing patterns of interpersonal
discomfort (Kaye et al., 2004)
Sustained pattern of interpersonal deficit

29. Mere Obsession of Body Image?
Disruption of attachment process during
adolescence (O’Kearney, 1996)
Ambivalent attachment scores were positively
correlated with Drive for Thinness and Bulimia
subscale scores of EDI-2
Consistent with empirical studies linking anxious-
ambivalent attachment with ED
Suldo & Sandberg, 2000

30. Mere Obsession of Body Image?
Poor interoceptive awareness (Fassino et al., 2004)
an anorexic is disconnected from her internal
experiences and thus does not use internal signals
of hunger, fatigue or affective state to guide
behavior effectively
Zucker and colleagues (2007) instead suggest that
we study social cognition in anorexia

31. Social Cognition in ED
Zucker and colleagues (2007) propose following reasons
to study interpersonal interaction in an AN:
Improvements in social acceptance and interpersonal
proficiency are the areas which individuals with AN are
motivated to improve
Only effective treatment for youths to date rely on the
involvement of the family (Lock & le Grange, 2005)
Social cognition indices such as social perception have
been reported to be crucial mediators bet ween
neurocognitive impairment and functional status

32. Final Thoughts
Is there more to mere body image
perception?
How should we then devise the efficient
preventive inter vention method?
Is EVERYONE with the ED having such a
complicated causes for ED?
Strengths?

33. Although core behavioral features are often
constant across patients, the underlying
complexity of biological and environmental
factors that converge to create an eating
disorder are unique to each individual.

34. Bulik, C. M., & Kendler, K. S. (2000). “I Am What I (Don’t) Eat”: Establishing an Identity Independent of an
Eating Disorder. American Journal of Psychiatry. 157(11). 1755-1760.
Grave, R. D., De Luca, L., Campello, G. (2001) Middle School Primary Prevention Program for Eating
Disorders: A Controlled Study with a Twelve-Month Follow-Up. Eating Disorders, 9: 4, 327-337 .
McVey, G., Tweed, S., & Blackmore, E. (2007). Healthy Schools-Healthy Kids: A controlled evaluation of a
comprehensive universal eating disorder prevention program. Body Image. 4, 115-136.
Stice, E., Rohde, P., Gau, J., & Shaw, H. (2009). An Effectiveness Trial of a Dissonance-Based Eating
Disorder Prevention Program for High-Risk Adolescents Girls. Journal of Consulting and Clinical
Psychology. 77(5), 825-834.
Suldo, S. M., Sandberg, D. A. (2000). Relationship Bet ween Attachment Styles and Eating Disorder
Symptomatology Among College Women. Journal of College Student Psychotherapy. 15(1), 59-73.
Yager, Z., O'Dea, J. (2010). A controlled intervention to promote a healthy body image, reduce eating
disorder risk and prevent excessive exercise among trainee health education and physical education
teachers. 25(5), 841-852.
Zucker, N. L., Losh, M., Bulik, C. M., Labar, K. S., Piven, J., Pelphrey, K. A. (2007). Anorexia Nervosa and
Autism Spectrum Disorders: Guided Investigation of Social Cognitive Endophenotypes. Psychological
Bulletin. 133(6), 976-1006.
Compilation of testimonials from eating disorder survivors in Singapore (http://issuu.com/finte/docs/
notjustsurfacedamage)