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Introduction and Background

The speaker introduces herself as Evgeniya Dashkova, a psychologist with qualifications in counseling for eating disorders. She discusses her experience working with eating disorders and the focus of today's seminar.

Qualifications and Experience

  • Evgeniya Dashkova is a psychologist specializing in eating disorders.
  • She has two qualifications: one as a psychologist and another as a consultant for eating disorders.
  • She completed extensive training at the Higher School of Economics.
  • Her main area of expertise is working with people with eating disorders, particularly in an outpatient setting.

Seminar Focus

  • The seminar will primarily focus on the specifics of working with people with eating disorders in an outpatient setting.
  • The speaker will also touch upon criteria for hospitalization when necessary.
  • She aims to share her experience and evidence-based psychotherapy approaches for treating eating disorders.

Audience Interaction

The speaker engages with the audience, asking them to share their cities and if they have encountered cases of eating disorders in their practice.

Audience Interaction

  • Participants are asked to write their city names in the chat to get acquainted.
  • They are also encouraged to share any clinical cases or issues related to eating disorders that they have encountered in their practice.

Types of Eating Disorders

The speaker discusses different types of eating disorders she encounters in her practice, focusing on bulimia and overeating.

Types of Eating Disorders

  • Bulimia is a common disorder that clients seek help for.
  • Overeating is another issue that many individuals struggle with.
  • Anorexia is less frequently seen by the speaker, as most individuals seeking help are already at an advanced stage.

Seminar Plan

The speaker outlines the plan for

Understanding the Importance of Cognitive-Behavioral Therapy (CBT)

In this section, the speaker discusses the significance of cognitive-behavioral therapy (CBT) in the treatment of eating disorders. They highlight the lack of resources and textbooks specifically focused on therapy for eating disorders in Russian, making CBT a valuable approach.

The Role of CBT in Eating Disorder Treatment

  • CBT is considered the first-line therapy for adults with eating disorders who do not have anorexia.
  • Other recommended models for adults with weight deficit include Maudsley Model and Clinical Management.
  • CBT is also considered as an alternative to family therapy for adolescents with anorexia.
  • CBT has been found effective in clinical trials and real-life practice.

Challenges and Benefits of Using CBT

  • CBT can be effective even with complex cases or chronic conditions, although it may be more challenging.
  • CBT incorporates knowledge about nutrition, allowing psychologists to work without dietitians in many cases.
  • Finding dietitians who understand and support eating disorder treatment can be difficult in Russia.
  • Explaining therapeutic processes and conceptualization helps clients understand their condition better.

The Need for Practical Knowledge in Eating Disorder Treatment

This section emphasizes the importance of practical knowledge when working with individuals with eating disorders. It highlights the need to assess risks, differentiate between different types of disorders, and evaluate whether intervention is appropriate.

Practical Knowledge for Therapists

  • Practical knowledge enables therapists to recognize and differentiate eating disorders from other conditions.
  • It helps assess risks, determine if intervention is necessary, and avoid harming the client.

DSM-5 and ICD-10 Classification of Eating Disorders

This section discusses the classification of eating disorders in the DSM-5 and ICD-10 diagnostic manuals.

DSM-5 vs. ICD-10 Classification

  • In the American Diagnostic and Statistical Manual of Mental Disorders (DSM-5), only one category can be assigned to an individual, such as anorexia or bulimia.
  • It is unclear how this classification works in the International Classification of Diseases (ICD-10) used in Russia.

Categories in ICD-10

  • The current ICD-10 classification includes five main categories related to eating disorders:
  • Anorexia nervosa
  • Bulimia nervosa
  • Atypical anorexia nervosa
  • Atypical bulimia nervosa
  • Other specified feeding or eating disorders

New Eating Disorder Classifications

  • Starting from 2022, new eating disorder classifications will be introduced that align with the DSM-5 criteria.
  • For detailed information on eating disorders, it is recommended to refer to the DSM-5 manual.

Criteria for Anorexia Nervosa

This section explains the criteria for diagnosing anorexia nervosa according to the ICD-10.

Intentional Weight Loss

  • Anorexia nervosa is characterized by intentional and sustained low body weight maintained by individuals themselves.

Body Mass

Understanding Body Mass Index (BMI) and Anorexia

In this section, the speaker discusses the concept of body mass index (BMI) and how it relates to anorexia. They also mention the criteria for diagnosing anorexia according to the International Classification of Diseases (ICD-10).

Body Mass Index (BMI) Criteria for Anorexia

  • The BMI criteria for diagnosing anorexia is set at 18 or lower, according to the ICD-11.
  • Different sources provide varying information on the classification of anorexia based on BMI:
  • Mild anorexia: BMI less than 17.5
  • Moderate anorexia: BMI between 16 and 17.5
  • Severe anorexia: BMI between 15 and 16
  • An extremely low BMI below 15 indicates a critical stage of anorexia that requires hospitalization.

Specific Fear of Weight Gain

  • Individuals with anorexia often have a specific fear of weight gain or body fat.
  • This fear becomes more important to them than other aspects of life, such as relationships or work.
  • The fear of weight gain has been removed from the ICD-11 criteria for anorexia in order to include broader motivations for weight loss.

Secondary Endocrine and Metabolic Disorders

  • Amenorrhea, the absence of menstruation, is commonly observed in individuals with anorexia.
  • Other symptoms associated with anorexia may include restrictive diets

Understanding the Symptoms and Impact of Eating Disorders

In this section, the speaker discusses the symptoms and impact of eating disorders, specifically focusing on anorexia nervosa.

Anorexia Nervosa Symptoms and Body Mass Index (BMI)

  • The speaker mentions that when assessing a person with an eating disorder, it is important to inquire about their height, weight, and episodes of purging.
  • Additional symptoms associated with anorexia nervosa include social isolation, insomnia, decreased libido, obsessive thoughts about food and body image.
  • An example is given where a person restricts their food intake until noon but then overeats on salad. This behavior leads to emotional distress later on.
  • The severity of the disorder often correlates with increased social isolation, insomnia, decreased libido, obsessive thoughts about food and body image.

Diagnosis Challenges

  • Many individuals seeking help for eating disorders may not receive a proper diagnosis. Instead, they may be diagnosed with anxiety or depressive disorders due to limited knowledge among healthcare professionals.
  • Treatment should focus on addressing the underlying causes rather than solely targeting weight regulation.

Prevalence and Gender Differences

  • Anorexia nervosa affects approximately 2% of women during their lifetime. However, accurate statistics are challenging to obtain due to limited data in Russia.
  • Research suggests that individuals with anorexia nervosa have a genetic predis

Genetic Factors and Inheritance of Anorexia

This section discusses the genetic factors and inheritance patterns associated with anorexia. The speaker mentions that anorexia has a high heritability rate, ranging from 58% to 88%. They also observe that in their practice, mothers often bring their daughters with anorexia, suggesting a familial link.

  • Anorexia has a high heritability rate of 58% to 88%.
  • Mothers often bring their daughters with anorexia to the clinic.
  • These girls are usually thin.
  • Many of these girls were raised by someone other than their mother, such as grandparents or nannies.
  • The genetic predisposition for weak impulse control can manifest in various ways, including substance abuse and risky behaviors.
  • Girls with anorexia tend to have a strong need for control and perfectionism.

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Main Causes of Death

The main causes of death are often the risk of death from heart failure and a high risk of suicide.

Major Causes of Death

  • The main causes of death include a high risk of death from heart failure and a significant risk of suicide.

Dutch Questionnaires as Diagnostic Tools

The speaker discusses the use of Dutch questionnaires as diagnostic tools and their effectiveness in simplifying the diagnostic process.

Usefulness of Dutch Questionnaires

  • Dutch questionnaires can be helpful in providing initial insights to individuals before their first appointment, allowing them to focus on specific areas during consultations. Extensive research has been conducted on these questionnaires, adapting them to Russian norms.
  • Publishing these questionnaires online could be an option worth exploring.

Benefits of Using Dutch Questionnaires

The speaker explains the benefits of using Dutch questionnaires for individuals seeking help and professionals conducting assessments.

Advantages for Individuals and Professionals

  • Using Dutch questionnaires allows individuals to have some understanding before their first appointment, helping them identify areas they need to pay attention to. Extensive research has been conducted with students, resulting in adaptations that align with Russian norms.

Importance of Meeting Needs in Early Life

Meeting needs plays a crucial role in the development of nervous anorexia, particularly during the first year of life.

Significance for Psychological Health

  • Satisfaction of needs and attachment to the mother during the first year have significant importance for overall psychological health. Neglecting these needs may lead to increased risks such as depression and anxiety disorders later in life

Understanding Bulimia

In this section, the speaker discusses the characteristics and criteria of bulimia, as well as how it differs from other eating disorders.

Characteristics of Bulimia

  • Bulimic episodes are subjective and can occur multiple times a day.
  • The criteria for a bulimic episode include distress caused by overeating and loss of control.
  • Bulimic individuals may engage in purging behaviors such as vomiting or excessive exercise.

Distinguishing Bulimia from Anorexia

  • Unlike anorexia, bulimia is not solely characterized by low body weight or significant weight loss.
  • If there is overeating and purging with a normal weight, it is likely to be bulimia.

Prevalence and Onset

  • Bulimia is more common than anorexia among young women, with prevalence ranging from 1% to 2%.
  • Bulimia often

Understanding Bulimia

This section discusses the characteristics of individuals with bulimia and their eating behaviors.

Characteristics of Individuals with Bulimia

  • People with bulimia are not necessarily extremely thin or underweight.
  • They do not reach a dangerously low weight, as they consume significantly more food than healthy individuals in experiments.
  • Bulimic individuals tend to eat two and a half times more food than healthy people when given the opportunity.
  • There is a strong correlation between hunger and the amount of food consumed by individuals with bulimia.
  • Compensatory behaviors such as vomiting, excessive exercise, laxative use, or diuretic use may be present in some cases but not all.

Therapeutic Interventions for Bulimia

This section focuses on therapeutic interventions aimed at reducing hunger and promoting healthier eating habits in individuals

Understanding Overeating in Women with Excess Weight

This section discusses the relationship between overeating and excess weight in women, particularly during pregnancy and postpartum period. It also highlights the potential risks and comorbidities associated with overeating and obesity.

Overeating and Excess Weight in Women

  • Among women with excess weight, only 20-40% engage in overeating as a psychological disorder.
  • Pregnancy and postpartum period are considered high-risk periods for developing overeating behaviors.
  • Factors such as dieting, stress from childbirth, lack of sleep, relationship difficulties, and social deprivation can contribute to the development of overeating behaviors.
  • Overeating is associated with comorbidities such as anxiety disorders, depressive disorders, and chronic somatic diseases like type 2 diabetes and hypertension.

Impact on Quality of Life

  • Individuals with high body mass index (BMI) experience a significant decline in their quality of life due to increased stress levels.
  • Addressing overeating can help prevent further weight gain but may not necessarily lead to significant weight loss.
  • Realistic goals for individuals with obesity include long-term maintenance of a 5% reduction in body weight.

Challenges in Addressing Overeating

Understanding Eating Disorders

In this section, the speaker discusses the prevalence of eating disorders among women in Russia and introduces the concept of binge eating disorder as a clinical disorder.

Prevalence of Eating Disorders

  • Approximately 1.6 million women in Russia suffer from binge eating disorder.
  • The number of men affected by eating disorders is also significant.

Introduction to Binge Eating Disorder

  • Binge eating disorder is characterized by recurrent episodes of overeating and loss of control.
  • The speaker humorously refers to herself as the "timing queen" for finishing her talk on time.

Q&A Break

  • A 10-minute break is announced for participants to ask questions.
  • Participants are encouraged to take this time to reflect and come up with any questions they may have.

Questions and Answers

During this Q&A session, participants ask various questions related to the topic discussed so far.

Participant Questions

  • Participants express gratitude for the presentation and share their personal experiences.
  • One participant mentions being renamed without knowing who changed their name.
  • Another participant asks about warning clients about potential weight loss during therapy sessions.
  • The importance of managing expectations in therapy is highlighted.

Technical Difficulties

The speaker addresses technical difficulties with audio and requests participants to mute themselves.

Audio Issues

  • The speaker notices that some participants' audio is not working properly.
  • Participants are requested to check their audio settings and adjust accordingly.

Transdiagnostic Approach in Therapy

The

The Pathology of Eating Disorders

This section discusses the pathology and development of eating disorders, specifically focusing on the obsession with body image, food control, and self-esteem.

Importance of Body Image and Food Control

  • The obsession with body image and food control becomes more important than anything else in life.
  • This pathology contributes significantly to the development and maintenance of eating disorders.
  • It leads to a chain reaction of symptoms and affects various aspects of an individual's life.

Self-Esteem Issues

  • Individuals with eating disorders often have conditional self-esteem that is based on very little.
  • Even successful individuals can struggle with their self-worth due to this pathology.
  • External achievements such as having a great spouse, children, or career become insignificant compared to the importance placed on body image.

High Level of Self-Criticism

  • People with eating disorders often engage in negative self-talk, using derogatory terms related to weight or appearance.
  • This high level of self-criticism stems from not meeting societal standards regarding body weight and shape.

Criteria for Eating Disorders

  • Christopher Fairburn's two pillars for diagnosing eating disorders are excessive concern about weight, body shape, and food control.
  • Constant disruptions in eating habits and behaviors related to weight regulation are also key criteria.

Impact on Health and Social Functioning

  • The constant disruptions in eating habits lead to health impairments or difficulties in social functioning.
  • These disturbances are not caused by any other somatic or mental illness but are directly linked to the obsession with weight and body shape.

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The Significance of Being Thin

In this section, the speaker discusses the importance of being thin and how it is associated with health and diet restrictions.

The Importance of Being Thin

  • Being thin is considered cool and great for one's health.
  • Losing weight is seen as a significant achievement and leads to further dietary restrictions.
  • Social reinforcement plays a role in feeling superior due to being able to restrict oneself while others cannot.

Anorexia and its Complexity

  • Anorexia involves a sense of pride in one's disorder.
  • Social reinforcement directly impacts dietary restrictions.
  • The hunger syndrome affects mental health, physical well-being, and emphasizes the importance of nutrition.

Starvation Experiment by Ancel Keys

  • In 1945, during World War II, millions of people were starving worldwide.
  • The experiment aimed to understand the consequences of starvation on the human body and rehabilitation methods.
  • Thirty-six physically fit men were selected from over 400 volunteers who refused military service for various reasons.
  • The experiment lasted for a year, with three months of observation followed by six months of semi-starvation.

Daily Caloric Intake during Semi-Starvation

  • Participants consumed a standardized healthy diet consisting of 3,200 calories per day.
  • Detailed medical examinations were conducted throughout the experiment to assess various aspects such as blood pressure and lung capacity.

Dramatic Reduction in Caloric Int

Effects of Restricted Diet

This section discusses the effects observed in individuals after their diet was restricted. It covers changes in behavior, interests, and physical health.

Changes in Behavior and Interests

  • After the diet was restricted, participants experienced fatigue, loss of interest in life, and a general sense of apathy.
  • Participants found it difficult to perform tasks and became more focused on food and culinary activities.
  • Conversations shifted towards food-related topics, with participants discussing recipes and meal plans.
  • One participant even published a cookbook during the experiment.

Clinical Picture of Eating Disorders

  • The clinical picture of eating disorders can be identified through online profiles filled with numerous recipes.
  • Such profiles may indicate

The Effects of Balanced Nutrition on Recovery

This section discusses the impact of balanced nutrition on recovery and rehabilitation for individuals with anorexia. Providing a high-calorie, balanced diet resulted in faster recovery and minimized losses.

Effects of Starvation and Rehabilitation

  • During starvation, body weight decreased by an average of 25%, with a significant reduction in fat mass (70%) and muscle mass (40%).
  • After stabilization of nutrition, all participants regained their initial weight. However, those who received higher calorie intake recovered faster.
  • Muscle mass was difficult to regain due to the body's resistance to rebuilding muscles during starvation.
  • Psychological consequences included anxiety about weight and body shape, leading to a desire to maintain thinness even after recovery.

Metabolism and Body Composition Changes

This section explores the impact of starvation on metabolism and changes in body composition. Starvation leads to a decrease in metabolic rate and alters the ratio of muscle mass to fat mass.

Metabolic Changes

  • Starvation causes a decrease in basal metabolic rate due to reduced muscle mass.
  • Individuals on diets often develop a specific body structure characterized by low muscle mass and high fat content, which further slows down metabolism.

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[t=2:09:46s] Stomach Pain and Bloating After Eating

The speaker discusses the issue of stomach pain and bloating after eating, particularly in relation to dieting and food intolerance.

Understanding Digestive Issues

  • Stomach pain and bloating can be caused by digestive disorders or sensitivities to certain types of food.
  • It is important to understand the underlying causes of these symptoms rather than simply focusing on weight loss goals.
  • Symptoms such as irregular menstrual cycles, skin problems, frequent colds, and water retention may also be related to digestive issues.

Exploring Dietary Experiences

  • The speaker encourages participants to share their dietary experiences, including intentional or unintentional restrictions in food intake.
  • Cognitive symptoms such as changes in attention and mood, as well as changes in energy levels and relationships with others, may be associated with restricted eating.

Case Study: Anorexia Nervosa

  • An example case study is presented involving a 16-year-old girl who developed anorexia nervosa after starting a restrictive diet with a friend.
  • The girl experienced weight loss and reduced anxiety initially but later faced cognitive decline, increased anxiety, depression, and decreased motivation for studying.

Importance of Addressing Underlying Issues

  • It is crucial to address the underlying issues related to restricted eating patterns rather than solely focusing on weight loss

Impact of Dieting on Mental Health

This section discusses the negative effects of dieting on mental health, including worsening of overall well-being, communication difficulties, increased social anxiety, and heightened perfectionism. Dieting can also lead to dietary restrictions as a means to control anxiety and perfectionism.

The Influence of Body Mass Index (BMI) and Genetic Disposition

  • The speaker's mother had a low BMI and did not have any specific dietary restrictions.
  • The speaker's mother had a genetic disposition towards low body weight but never intentionally tried to lose weight.

Understanding the Spiral of Dieting and Mental Health

  • There is no understanding or awareness among individuals about why the spiral of dieting and worsening mental health occurs.
  • People often fail to connect their deteriorating mental state with their diet because diets are initially perceived as positive and healthy.
  • The therapy aims to conceptualize the connection between dieting and mental health by highlighting how diets trigger changes in the body that reinforce existing disorders.

Realizations during Therapy

  • During therapy sessions, clients begin to understand that their emotional distress was caused by not eating rather than personal shortcomings.
  • Clients realize that they experienced intense emotions such as sleepiness or crying spells due to lack of food intake.
  • One powerful realization is when clients recognize that their academic performance declined not because they were lazy or unintelligent but because they were malnourished.

These notes provide an overview of the discussed topics related to the impact of dieting on mental health. For more detailed information, please refer to the corresponding timestamps in the transcript.