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1. 00:02 When you are having a long-term complicated relationship with food, you may be suffering from an eating disorder. Well, eating disorders are behavioral patterns. And yet, the diagnostic and statistical manual warns against pathizing certain types of compensatory behaviors.
2. 00:30 Is this a right approach or does it mean that we are misdiagnosing or missing many people with actual eating disorders? If we tend to ignore or we instructed to ignore certain types of compensatory behaviors, are we actually looking the other way when patients are
3. 00:51 presenting with what should have been diagnosed as an eating disorder? Now today I'm going to review a new study in the field that says that yes we are misdiagnosing people and many many people with eating disorders are not diagnosed and are not getting help. My
4. 01:14 name is Samatn. I'm the author of malignant self- loveve narcissism revisited a professor of psychology and someone who has had a very complicated relationship with food throughout my life as you see in my videos I fluctuate in weight plus minus 10 to 15% of body mass
5. 01:35 uh within months every year year in and year out. Now before we proceed in the description you will find a link to a conference presentation I've made on eating disorders and personality. Uh in that presentation I deal with the ethiology the psychonamic and
6. 02:01 psychological causation of personality disorders. Today I'm going to focus on the new study and the behaviors that go hand inhand with eating disorders. Before we start, just to remind you, I'm available to give free, totally free seminars and lectures in your city. Go
7. 02:24 to the description, click on the link, follow the instructions to book me. Okay, Shushani. Now, the new study is titled Beyond the Checklist, a large-scale analysis of underrecognized weight loss behaviors in individuals with eating disorders.
8. 02:46 It was authored by KAR K A K A R Unafoy
9. 02:53 Helena Davis and others. The study it was published in in Med Archive. So the study identifies several
10. 03:05 behavioral themes and one good thing about this study is that um all types of personality disorders were amply represented. 27% of the participants had a binge eating purging subtype of anorexia nervosa. 13 about 14% had the restricting subtype of anorexia nervosa
11. 03:30 and about 54% had bulimia nervosa and 5% had a binge eating disorder. So all eating disorders were represented and then what the study aimed to do is to identify certain types of behaviors which go hand in hand and are often associated with eating disorders.
12. 03:52 behaviors which are not mentioned in the DSM or even where the DSM warns against pathizing these behaviors. And so what the study found is that number one there is a group of behaviors that keeps recurring. These behaviors keep appearing time and again in all
13. 04:15 types of eating disorders and most frequently cited behaviors included structured weight loss diets, calorie counting, restrictive eating. But there were others there were others behavior other behaviors which were less common. For example, compression garments and
14. 04:36 beriatric surgery. So the researchers, the authors of the study grouped all these behaviors into four subtypes, four types. Number one, restrictionbased approaches, including weight loss diets, calorie counting, restrictive eating patterns, participation in weight loss
15. 04:58 groups such as Weight Watchers, and limiting fluid intake. Group number two, medical interventions that include these encompass buriatric surgery, off label prescription medications, for example, metformin. Um other medications used to treat
16. 05:19 attention deficit hyperactivity disorder and taken in order to reduce weight and levy used to treat hypothyroidism. other weight loss injections such as ozumpic and appetite suppressants such as caff caffeine and smoking. The next group has to do with body manipulation tactics.
17. 05:44 That for example, wearing compression garments that restrict the stomach, using stimulants or other illicit drugs, lowering body temperature, including sweating, intentionally consuming foods incompatible with known intolerances, for example, with gluten, in order to
18. 06:03 throw up, in order to cause discomfort and suppress appetite. engaging in micro exercise such as constant fidgeting or leg shaking, chewing gum, depriving oneself of sleep or overeating in order to trigger vomiting. And the final group is food avoidance
19. 06:23 behaviors which may involve chewing and spitting out food without swallowing it. Hiding food, consuming non-food items such as cotton balls or tissue to stimulate chewing without ingesting calories or using sleep or smoking as strategies to suppress appetite and avoid eating.
20. 06:44 Now these four categories, behavioral categories, captured the vast majority of behaviors associated intimately, recurrently with eating disorders. Certain certain behaviors could and were categorized under multiple themes. Smoking, for example, may be considered both a
21. 07:05 restriction-based approach and a medical intervention depending on the individual's intent and context. Karp K A KR the lead author noted that to her knowledge no previous studies have as she says systematically categorized weight loss behaviors in
22. 07:26 this way making it a novel contribution to the literature. Kker added that most of the behaviors her team identify are not explicitly included in the current diagnostic criteria. She said, "While some of these behaviors may be familiar to experienced
23. 07:44 clinicians, they are not formally recognized in diagnostic manuals, suggesting a significant gap between clinical practice and diagnostic guidance. Nothing new. So, she thinks it's time to update the Diagnostic and Statistical Manual of Mental Disorders. She thinks it's time
24. 08:06 to rewrite the criteria." What they found is that people with binge eating disorders engaged in weight loss and compensatory behaviors typically linked to bulimia nervosa. Kher noted that the DSM5 criteria for binge eating disorder stipulate that
25. 08:25 binge eating should not be accompanied by recurrent inappropriate compensatory behaviors. And she is dead set against it. She thinks it's a mistake. She says this exemplifies the fact that people are possibly missed or misdiagnosed, which means adequate treatment may not
26. 08:43 be offered. She suggests uh to use the study's findings as a basis and to leverage it in order to update eating disorder criteria in the next edition of the DSM. She recognizes that additional research is needed, but she thinks it's a good start and I fully agree to ignore these
27. 09:11 typical behaviors, behaviors which are which are characteristic of all eating disorders. To ignore them is a curious way of diagnosing eating disorders. How does one diagnose eating disorders safely without resort to these observations and these
28. 09:35 behavioral patterns in the patients is not clear to me to this very day. Whereas in personality disorders especially cluster B personality disorders the emphasis is completely relational interpersonal relationships with other people and behavioral. In
29. 09:55 eating disorders, the emphasis is more on internal dynamics and the expression of these internal alleged internal dynamics rather than on simple simple easily identifiable and observable behaviors which could serve as red flags and warning signs that something is
30. 10:16 seriously all right. Something is seriously wrong in that person's relationship with food intake and body image.