1. Biological Stress vulnerability A model of eating disorders Restriction of eating Social Cultural & family pressures Psychological Anxiety about appearance Anorexia Continued restriction Reduced anxiety Excessive weight loss Bulimia Bingeing Purging Maintain weight Based on Barlow & Durand (1995) psychlotron.org.uk

2. Treatments for EDs Behaviour therapy Cognitive behaviour therapy Weight restoration (anorexia only) psychlotron.org.uk

3. BT with bulimia Attempts to directly manipulate behaviour e.g.: Allowing bingeing & preventing purging (Exposure with Response Prevention) Reinforcement of appropriate eating; punishment of inappropriate etc. Prescribed alterations in eating patterns psychlotron.org.uk

4. BT with bulimia “Waist cord therapy” – patients given cord to tie around waist Assumed it might provide stimulus to stop bingeing. Made bingeing more likely (Boggs et al, 2006) ERT better than no treatment No advantage over other therapies (Carter et al, 2002; Leitenberg et al, 1988) psychlotron.org.uk

5. BT with bulimia Patients given eating programme to follow (Fairburn et al, 1985): Small, manageable meals 5-6 times a day No more than 3 hours between meals Improvement in about 40% of patients; half these had relapsed after 4 months psychlotron.org.uk

6. BT with anorexia Use of reinforcement/punishment to encourage appropriate eating Useful for facilitating weight gain (reinforcer=access to physical activity; Blinder et al, 1970) Generally helpful in weight restoration (Bemis, 1987) Target weight for release from hospital facilitates weight restoration (Barlow & Durand, 1995) psychlotron.org.uk

7. BT with anorexia nervosa Can play a part in initial treatment of anorexia Not a cure and not sufficient to bring about long term change May raise ethical questions (patients’ rights; consent to treatment; see token economy) psychlotron.org.uk