1. What’s Up With “ED?” Eating Disorders Q&A CLICK ON THIS SLIDE TO BEGIN This is the interactive game that is a part of the Family Eating Disorder Manual FED Manual © 2012 The Center for Balanced Living, All rights reserved

2. Eating Disorders Questions and Answer Interactive Game Directions and Rules This eating disorder interactive game is one of the activities addressed in the Family Eating Disorders Manual developed by The Center for Balanced Living. It is to help give you a context of some overall eating disorder facts with research. There are four categories. 1. Click on any question within each category. The question is listed. 2. Click on the slide and you will see the answer. 3. Click on “Category” and it will take you back to the main screen to choose another question. 4. Once you have asked a question, the square is highlighted to show you have already answered that question. 5. There are “Bonus Questions” in some of the answered squares. All bonus questions have “ED” in the answer. 6. You can choose any question and have fun playing this informational game. This game was developed by David Dagg, PCC, LICDC and Laura Hill, Ph.D. This game is not to be altered in any way. © The Center for Balanced Living

3. Categories Eating Disorder ID ED Facts ED Biology/Genetics Family Support & Recovery 100 200 300 400 FED Manual © 2012 The Center for Balanced Living, All rights reserved

4. Eating Disorder ID 100 I am a severely underweight person who: Restricts food, leading to significant weight loss in the context of age and sex Restricts food, leading to significant weight loss in the context of age and sex Delays eating, or eats very little Delays eating, or eats very little Binges or purges at times Binges or purges at times May exercise many hours a day May exercise many hours a day Sees myself as fat while others see me as thin Sees myself as fat while others see me as thin Thinks of my body shape continuously and is intensely afraid to gain weight Thinks of my body shape continuously and is intensely afraid to gain weight What type of eating disorder do I have ? FED Manual © 2012 The Center for Balanced Living, All rights reserved

5. Eating Disorder ID 100 Answer Anorexia Nervosa Restrictor subtype if no binge or purge Binge and purge subtype Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5). Categories FED Manual © 2012 The Center for Balanced Living, All rights reserved

6. Eating Disorder ID 200 I am a person who is normal or overweight who: Eats uncontrollably large amounts of food: more than others eat in a discrete amount of time Eats uncontrollably large amounts of food: more than others eat in a discrete amount of time Purges at least weekly to prevent weight gain in ways such as self-induced vomiting, laxative or diuretic abuse, excessive exercise, or other compensatory behaviors such as medication abuse Purges at least weekly to prevent weight gain in ways such as self-induced vomiting, laxative or diuretic abuse, excessive exercise, or other compensatory behaviors such as medication abuse Fasts or severely restricts food intake at times Fasts or severely restricts food intake at times Loathes my body and weight and feels fat Loathes my body and weight and feels fat Is afraid of gaining weight Is afraid of gaining weight What type of eating disorder do I have? FED Manual © 2012 The Center for Balanced Living, All rights reserved

7. Eating Disorder ID 200 Answer Bulimia Nervosa Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5). BONUS QUESTION Categories FED Manual © 2012 The Center for Balanced Living, All rights reserved

8. ED ID 200 BONUS QUESTION The Von Trapp family sang about this flower. FED Manual © 2012 The Center for Balanced Living, All rights reserved

9. ED ID 200 Bonus Answer What is EDelweiss? Categories FED Manual © 2012 The Center for Balanced Living, All rights reserved

10. Eating Disorder ID 300 I am usually an overweight person who: Eats uncontrollably larger amounts of food than others would eat in a discrete period of time Eats uncontrollably larger amounts of food than others would eat in a discrete period of time Binges at least one or more times a week Binges at least one or more times a week Often binges alone and may be angry and upset with myself afterwards Often binges alone and may be angry and upset with myself afterwards Often eats alone and/or eats faster than others Often eats alone and/or eats faster than others What type of disorder do I have? FED Manual © 2012 The Center for Balanced Living, All rights reserved

11. Eating Disorder ID 300 Answer Binge Eating Disorder Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5). Categories FED Manual © 2012 The Center for Balanced Living, All rights reserved

12. Eating Disorder ID 400 I am a person who: Is normal weight but experiences all other symptoms of anorexia nervosa Is normal weight but experiences all other symptoms of anorexia nervosa Has many symptoms of bulimia or binge eating disorder, but binges and purges less than 1 X week Has many symptoms of bulimia or binge eating disorder, but binges and purges less than 1 X week Does not binge, but makes myself purge Does not binge, but makes myself purge Eats a large amount of my food during the night after awaking from sleep Eats a large amount of my food during the night after awaking from sleep What disorder do I have? FED Manual © 2012 The Center for Balanced Living, All rights reserved

13. Eating Disorder ID 400 Answer Eating Disorder: not otherwise specified (ED: NOS) Includes sub-threshold AN, BN, BED and Night Eating Syndrome Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5). Categories FED Manual © 2012 The Center for Balanced Living, All rights reserved

14. ED Facts 100 Eating Disorders are ___________ ___________ ____________ mental illnesses. A.Mortal, ignorant, co-morbid B.Serious, intense, thought-based C.Serious, biologically based D.Family and socially caused FED Manual © 2012 The Center for Balanced Living, All rights reserved

15. ED Facts 100 Answer C: Serious, biologically based mental illnesses Determined from studies on Heritability Neurobiological abnormalities Cognitive and emotional deficits Social and medical disabilities Kaye, W.H, Frank, G.K, Bailer, U.F., & Henry, S.E. (2005). Neurobiology of anorexia nervosa: Clinical implications of alterations of the function of serotonin and other neuronal systems. International Journal of Eating Disorders, 37, S15–S19. doi: 10.1002/eat.20109 Klump, K.L., Bulik, C.M., Kaye, W.H., Treasure, J., & Tyson, E. (2009). Academy for Eating Disorders position paper: Eating disorders are serious mental illnesses. International Journal of Eating Disorders, 42, 97–103. Thomas Insel, MD, Director of National Institute of Mental Health (NIMH) statement in letter to National Eating Disorder Asosication. (2006). Retrieved July 2012 http://www.nationaleatingdisorders.org/nedaDir/files/documents/NIMHLetter.pdf BONUS QUESTION Categories FED Manual © 2012 The Center for Balanced Living, All rights reserved

16. ED Facts 100 BONUS QUESTION Adam and Eve’s favorite hangout. FED Manual © 2012 The Center for Balanced Living, All rights reserved

17. ED Facts 100 Bonus Answer What is EDen. Categories FED Manual © 2012 The Center for Balanced Living, All rights reserved

18. ED Facts 200 This mental illness has the highest mortality or death rate of all mental illnesses: A. Obsessive Compulsive Disorder B.Major Depressive Disorder C.Eating Disorders D.Schizophrenia FED Manual © 2012 The Center for Balanced Living, All rights reserved

19. ED Facts 200 Answer C: Eating disorders Eating Disorders have the highest death rate of all psychiatric illnesses. Mortality rates from a longitudinal assessment in 2009 of 1,885 persons: 4.0% for anorexia nervosa, 3.9% for bulimia nervosa, 5.2% for eating disorder not otherwise specified. Weighted mortality rates in 2011 study were 5.1 for AN, The standardized mortality ratios were 5.86 for AN, 1.7 for BN, The standardized mortality ratio was 1.93 for BN 3.3 for EDNOS., and standardized was1.92 for EDNOS. One in 5 individuals with AN who died had committed suicide. The mortality rate of anorexia nervosa is about 12 times higher than the annual death rate from all causes of death among females ages 15-24 in the general population. Sullivan P.F. (1995). Mortality in anorexia nervosa. American Journal of Psychiatry, 152(7), 1073-4. Crow, S.J., Peterson, C.B., Swanson, S.A., Raymond, N.C., Specker, S., Eckert, E.D., & Mitchell, J.E. (2009). Increased mortality in bulimia nervosa and other eating disorders. The American Journal of Psychiatry, 166(12), 1342-6. Arcelus, J., Mitchell, A.J., Wales, J., Nielsen, S. (2011). Mortality rates in patients with anorexia nervosa and other eating disorders: A meta-analysis of 36 studies. Arch Gen Psychiatry, 68(7), 724-31. doi:10.1001/archgenpsychiatry.2011.74 Categories FED Manual © 2012 The Center for Balanced Living, All rights reserved

20. ED Facts 300 After doing this action, vasopressin (a brain chemical and anti-diuretic) surges and makes the person feel like she/he is on a morphine-like high. FED Manual © 2012 The Center for Balanced Living, All rights reserved

21. ED Facts 300 Answer Self-induced vomiting BONUS QUESTION Categories FED Manual © 2012 The Center for Balanced Living, All rights reserved

22. ED Facts 300 BONUS QUESTION Her novel Age of Innocence won the 1921 Pulitzer Prize for literature, making her the first woman to win it. FED Manual © 2012 The Center for Balanced Living, All rights reserved

23. ED Facts 300 Bonus Answer Who is EDith Wharton? Categories FED Manual © 2012 The Center for Balanced Living, All rights reserved

24. ED Facts 400 Name three mental illnesses that commonly co-occur or co-exist with eating disorders. FED Manual © 2012 The Center for Balanced Living, All rights reserved

25. ED Facts 400 Anxiety disorder Major depression Panic disorder Post-traumatic stress disorder Obsessive compulsive disorder Attention deficit-hyperactivity disorder Categories FED Manual © 2012 The Center for Balanced Living, All rights reserved

26. ED Biology/Genetics 100 Eating disorders are influenced in their development and maintained by which of the following: A.Genetics B.Neurobiological abnormalities C.Biological influences D.Social/environmental pressures to be thin E.Psychological traits F.Severe life stressors G.Family dynamics H.All the above FED Manual © 2012 The Center for Balanced Living, All rights reserved

27. ED Biology/Genetics 100 Answer H: All the above All are potential inter-related causes of eating disorders A. Genetics B. Neurobiological abnormalities C. Biological influences D. Social/environmental pressures to be thin E. Psychological traits F. Severe Life Stressors G. Family dynamics Categories FED Manual © 2012 The Center for Balanced Living, All rights reserved

28. ED Biology/Genetic 200 Both environment and genetics influence the development of weight, shape and eating disorders, but environment has a stronger influence over genes during ______ stage of development, while genes have a higher influence during ______ stage of development. a) Childhood b) Adolescence c) Older adulthood FED Manual © 2012 The Center for Balanced Living, All rights reserved

29. ED Biology/Genetic 200 Answer a) Childhood (environment has stronger influence) b) Adolescence and early adulthood (genes stronger influence) Work by Kelly Klump et.al: Michigan State University found that influence of one's genes on eating disorder symptoms was much greater in pubertal girls with higher levels of estradiol than pubertal girls with lower levels of estradiol. "The reason we see an increase in genetic influences during puberty is that the genes for disordered eating are essentially getting switched on during that time," said Klump. “What's turning on the genes during puberty? And what we found is that increases in estradiol apparently are activating genetic risk for eating disorders.“ Estradiol is the most potent estrogen of a group of endogenous estrogen steroids which includes estrone and estriol. Estrogen is a steroid hormone. It codes proteins in the brain. It increases at puberty and then progesterone increases as puberty progresses. Klump, K.L., Keel, P.K., Sisk, C.,& Burt, S.A. (2010). Preliminary evidence that estradiol moderates genetic influences on disordered eating attitudes and behaviors during puberty. Psychological Medicine, 40(10), 1745-53. Klump, K.L., McGue, M., & Iacono, W.G. (2000. Age differences in genetic and environmental influences on eating attitudes and behaviors in preadolescent and adolescent female twins. Journal of Abnormal Psychology, 109(2), 239-251. doi: 10.1037/0021-843X.109.2.239 Klump, K. L., Burt, S. A., Spanos, A., McGue, M., Iacono, W.G., & Wade, T. D. (2010). Age differences in genetic and environmental influences on weight and shape concerns. International Journal of Eating Disorders, 43, 679–688. doi: 10.1002/eat.20772 Categories FED Manual © 2012 The Center for Balanced Living, All rights reserved

30. ED Biology/Genetics 300 This action allows a person with anorexia nervosa to: Think more calmly Think more calmly Experience less mental “noise” Experience less mental “noise” Feel a reduction in anxiety Feel a reduction in anxiety Feel better and think better Feel better and think better FED Manual © 2012 The Center for Balanced Living, All rights reserved

31. ED Biology/Genetics 300 Answer NOT eating Increases in 5 HT and dopamine along a brain pathway result in increased anxiety, agitation, and psychological delusions. When eating, thoughts in AN are more disturbed than in schizophrenia, anxiety increases in AN, BN and BED, and delusions increase. Kaye, W.H., Barbarich, N.C., Putnam, K., Gendall, K.A., Fernstrom, J., Fernstrom, M., …Kishore, A. (2003). Anxiolytic effects of acute tryptophan depletion in anorexia nervosa. International Journal of Eating Disorders, 33, 257–267. doi: 10.1002/eat.10135 Kaye, W.H, Frank, G.K, Bailer, U.F, & Henry, S.E. (2005). Neurobiology of anorexia nervosa: Clinical implications of alterations of the function of serotonin and other neuronal systems. International Journal of Eating Disorders, 37, S15–S19. doi: 10.1002/eat.20109 Kaye, W.H. (2008). Neurobiology of anorexia and bulimia nervosa. Physiology and Behavior, 94, 121-135. doi:10.1016/j.physbeh.2007.11.037 Kaye, W.H. (2008). Neurobiology of anorexia and bulimia nervosa. Physiology and Behavior, 94, 121-135. doi:10.1016/j.physbeh.2007.11.037 Eddy, K.T, Crosby, R.D., Keel, P.K, Wonderlich, S.A, le Grange, D., Hill, L., Powers, P., & Mitchell, J.E, (2009). Empirical identification and validations of eating disorder phenotypes in a multi-site clinical sample. Journal of Nervous and Mental Disease, 197, 41-49. doi: 10.1097/NMD.0b013e3181927389 Categories FED Manual © 2012 The Center for Balanced Living, All rights reserved

32. ED Biology/Genetics 400 People with eating disorders have impaired neurocircuits, with the result that they: Can’t see the global picture Can’t see the global picture Can’t discern positives and negatives when there are too many choices Can’t discern positives and negatives when there are too many choices Can’t shift well from one set to another Can’t shift well from one set to another This is why they have severe difficulty in making and trusting their own __________. FED Manual © 2012 The Center for Balanced Living, All rights reserved

33. ED Biology/Genetics 400 Answer Decisions Frank, G.K., Kaye, W.H., Meltzer, C.C., Price, J.C., Greer, P., McConaha, C., & Skovira, K. (2002). Reduced 5-HT2A receptor binding after recovery from anorexia nervosa. Biol Psychiatry, 52, 896–906. Oberndorfer, T.A., Kaye, W.H., Simmons, A.N., Strigo, I.A., & Matthews, S.C. (2011). Demand-specific alteration of medial prefrontal cortex response during an inhibition task in recovered anorexic women. International Journal of Eating Disorders, 44, 1–8. doi: 10.1002/eat.20750 Kaye, W.H., Fudge, J., & Paulus, M. (2009, August). New insights into symptoms and neurocircuit function of AN. Nature Reviews Neuroscience, 10, 573-584. doi:10.1038/nrn2682 Wagner, A., Aizenstein, H., Venkatraman, V.K., Bischoff-Grethe, A., Fudge, J., May, J.C., …Kaye, W.H. (2010). Altered striatal response to reward in bulimia nervosa after recovery. International Journal of Eating Disorders, 43, 289–294. doi: 10.1002/eat.20699 Lopez, C., Tchanturia, K., Stahl, D., & Treasure, J. (2008), Central coherence in eating disorders: a systematic review. Psychological Medicine, 38(10), 1393-1404. doi:10.1017/S0033291708003486 Phillips, M.L, Drevets, W.C., Rauch S.L., & Lane, R. (2003) Neurobiology of emotion perception I: The neural basis of normal emotion perception. Biol. Psych., 54, 504–514. doi:10.1016/S0006-3223(03)00171-9 Categories FED Manual © 2012 The Center for Balanced Living, All rights reserved

34. ED Support/Recovery 100 ED Support/Recovery 100 My loved one will be in recovery when s/he: A.Stops purging B.Stops binge eating C.Establishes a healthy weight & follows the meal plan D.Works to reduce his/her ED behaviors and thoughts one day at a time E.All of the above FED Manual © 2012 The Center for Balanced Living, All rights reserved

35. ED Support/Recovery 100 Answer E- all of the above BONUS QUESTION Categories FED Manual © 2012 The Center for Balanced Living, All rights reserved

36. ED Support/Recovery 100 BONUS QUESTION Quothe the raven, never more, never more. (Author) FED Manual © 2012 The Center for Balanced Living, All rights reserved

37. ED Support/Recovery 100 Bonus Answer Who is EDgar Alan Poe? Categories FED Manual © 2012 The Center for Balanced Living, All rights reserved

38. ED Support/Recovery 200 ED Support/Recovery 200 I can support my loved one when s/he constantly talks about calories and weight by doing this: A.Distract B.Interrupt C.Stop, Reboot, reroute D.All the above FED Manual © 2012 The Center for Balanced Living, All rights reserved

39. ED Support/Recovery 200 Answer D: All the above Categories FED Manual © 2012 The Center for Balanced Living, All rights reserved

40. ED Support/Recovery 300 ED Support/Recovery 300 When my loved one is binge eating and is alone these are things I can do (include all that apply): A.Leave him/her alone B.Interrupt and be near C.Call to interrupt D.Not argue with him/her E.Stop, Reboot, Reroute FED Manual © 2012 The Center for Balanced Living, All rights reserved

41. ED Support/Recovery 300 Answer B – E B. Interrupt and be near C. Call to interrupt D. Not argue with him/her E. Stop, Reboot, Reroute Categories FED Manual © 2012 The Center for Balanced Living, All rights reserved

42. ED Support/Recovery 400 ED Support/Recovery 400 What tools can you offer that could help your loved one with his/her eating disorder: (include all that apply) A)Increase structure and repetition B)Limit options for decisions, using multiple choice C)Use open ended questions D)Follow meal plan, e.g. same daily plan for AN FED Manual © 2012 The Center for Balanced Living, All rights reserved

43. ED Support/Recovery 400 Answer A, B and D A)Increase structure and repetition B)Limit options for decisions, using multiple choice (three options maximum) C)NO: Use open ended questions D)Follow meal plan, e.g. same daily plan for AN Categories FED Manual © 2012 The Center for Balanced Living, All rights reserved