Psychology of Eating Disorders

Semester & Location:	Spring 2023 - DIS Copenhagen
Type & Credits:	Elective Course - 3 credits
Major Disciplines:	Psychology, Pre-Medicine/Health Science, Neuroscience
Prerequisite(s):	One psychology course at university level.
Faculty Members:	Suman Ambwani, PhD Current Students: please contact your faculty using the canvas inbox function
Time Place	Fridays, 1:15pm – 4:10pm Classroom: V10-D11

 

Description of Course

Disordered eating behavior is influenced by a multitude of neurobiological, sociocultural, and psychological factors. We will draw upon scientific research to explore this complex, multifaceted etiology: for instance, how do body dissatisfaction, psychiatric genetics, and a pro-diet/anti-fat culture contribute to disordered eating, and what can families, schools, and communities do to mitigate harm? We will also discuss ethical and pragmatic considerations for prevention strategies and psychological interventions, including special considerations for the use of emerging technologies in eating disorder treatment.

 

Learning Objectives

By the end of this course, you should be able to demonstrate the following:

1. Understanding of the biopsychosocial model of disordered eating (i.e., the complex interplay of multiple etiological and maintenance factors).
2. Knowledge about various options for prevention and treatment of disordered eating.
3. An in-depth understanding about one particular area of research within the eating disorder literature.
4. The ability to summarize, integrate, critically evaluate, and communicate about research relevant to disordered eating.

 

Faculty

Suman Ambwani. PhD (Psychology, Texas A&M University, 2008, Clinical Psychology Internship, Medical University of South Carolina, 2007-2008). MS (Psychology, Texas A&M University, 2005). BA (Psychology, Sociology, Macalester College, 2003). Previously an associate professor of psychology at Dickinson College, visiting researcher at King’s College London, and visiting scientist at Boston Children’s Hospital/Harvard T.H. Chan School of Public Health. My research broadly examines factors associated with the development and maintenance of eating disorders, particularly cultural features (such as fat-shaming environments and pseudoscientific diet fads) and difficulties with interpersonal relationships. I am also a co-investigator on two UK multisite randomized clinical trials investigating guided self-help for anorexia nervosa. I grew up in Mumbai, India, and Jakarta, Indonesia, and have spent most of my adult years in the United States (Minnesota, Texas, South Carolina, Pennsylvania, Massachusetts) and UK (London). With DIS since 2022.

 

Field Studies

1. Psykiatrisk Center Ballerup. In this field study, we will visit a treatment center for eating disorders and learn from providers about their approach to supporting people with EDs. We will also learn about research currently underway which focuses on understanding biomarkers and clinical aspects of EDs.
2. Mindful Eating. In this field study, we will have the opportunity learn more about an intervention for disordered eating behaviors: mindful eating.

 

Guest Lecturer

1. Adrienne Shannon. Adrienne received her Master’s in Cognition and Communication from the University of Copenhagen, and has worked in public policy and advocacy for the National Eating Disorders Association (NEDA). Adrienne has both personal and professional experience with eating disorders, placing her in a unique position to share her story, dismantle common myths, and advocate for greater awareness and support for people with eating disorders.

 

Approach to Teaching 

The purpose of this seminar-based course is to facilitate dialogue, debate, and critical thinking about eating disorders from various theoretical and empirical perspectives. This format may be somewhat unfamiliar to students, who are often better acquainted with lecture-style courses. In this course, it is expected that learning will occur primarily through reading, discussion, and the exchange of ideas – consequently, the outcome of the seminar depends largely on your active participation. If you are concerned about your ability to speak up in class (or worry that you may speak too much) please see me so I can help you work on this – I expect that everyone in the seminar will offer insightful questions and answers during every class meeting.

We will typically begin class with 1-2 research presentations to enhance our understanding of a particular area of sub-specialization within the research literature. I will then provide a mini-lecture, which will be followed by class discussion (facilitated by discussion leaders). Please note that our class meetings will typically not involve repetition of the assigned readings. Thus, you must do the readings in advance to prepare for our class activities and discussions. 

 

Expectations of the Students

As this is a predominantly discussion-based seminar, the success of the course depends on your serious commitment to truly engage with the material. To that end, I expect you to spend at least 6 hours every week outside of class preparing for this seminar. You must come to class prepared, having closely read and evaluated the reading assignments, and your class discussions should reflect this careful reading. While taking notes on the reading assignments, try to identify which portions of the assignments were particularly notable/important and why they caught your attention. Include summaries in your own words, write questions to yourself, agree/disagree with the content, and generally try to delve yourself deeply into a thoughtful evaluation of the reading assignments.

You are expected to behave professionally and participate actively during class and field studies. This includes all of the following:

• Attend all class meetings, field studies, and related activities.
• Be punctual and stay for the entire experience.
• Contribute to shared learning: ask relevant questions, offer critical reflections, and respond respectfully to others’ comments.
• Put your phone away and turn off notifications on any other electronic devices.

 

Evaluation

To be eligible for a passing grade in this class you must complete all of the assigned work.

You will be evaluated based on your performance on the course assignments as outlined below. Additional details will be provided in class.

 

1. Class participation and engagement.

Preparation, attendance, and engagement in classes, field studies, and guest lectures is essential in this discussion-based course because it shows that you are taking responsibility for your own learning. It also demonstrates that you are keeping up with the readings and understanding the theoretical perspectives and research evidence discussed in class. Your participation and engagement grade will be calculated based on your ability to meet the following criteria:

• You are engaged throughout our class meeting/field study/guest lecture and demonstrate this by prompting discussion and/or responding to your peers by linking comments and asking relevant questions.
• Your contributions reflect a thoughtful (rather than superficial) understanding of the reading assignments and demonstrate an ability to integrate knowledge across reading assignments.
• You offer more than just personal opinion or anecdote – that is, you root your comments in the text we are discussing (e.g., “this reminds me of p. 76 where the authors indicate X”) and link ideas and comments with content from past reading assignments.
• You listen attentively and respectfully to others (and you avoid dominating or silencing others).
• You work collaboratively with people to achieve learning goals when you are placed in a small group.

 

2. Critical questions and observations.

The purpose of this assignment is to encourage you to think critically about the reading assignments before class and allow me to plan the content of the class based on your interests and questions. By noon on the Thursday before class, you should post on Canvas at least one thoughtful question or observation regarding the reading material for the following class period. Each question/observation should be ~1 paragraph long and should reflect your own thinking about a particular issue. Avoid sharing whether you liked the reading or found it to be interesting. Instead, through your comments, you must communicate that you have done each of the following: 

• Read the assignment closely,
• Challenged yourself to think critically about the theory/research findings, and,
• Attempted to integrate the information with other class materials (e.g., other readings from the same class period or earlier class periods).

For instance, you may discuss how two seemingly consistent arguments are in fact contradictory, or, how one particular concept suggests X, but you disagree because… etc.

Please end your post with one discussion question that you would like to pose to the class after completing the reading. A good question is one that might produce a difference of opinion or has no clear-cut easy answer.  It might require an understanding of an issue or research finding, or an understanding of another area of psychology.  Simple factual questions should be avoided because they tend not to elicit much discussion.

Please proof-read carefully, use standard punctuation, appropriate language, and make sure you provide sufficient context so that your comments/questions make sense. You should be prepared to discuss your discussion post during our class session so please review it before class. You are permitted to “skip” one discussion post (but please still do the readings to prepare for class). 

 

3. Co-facilitation of class discussion.

You will be responsible for co-facilitating class discussion on one of the assigned topics. You will have the opportunity to select your topic during the first class. During your assigned session, you should come prepared with several (at least 4-6) discussion questions. Please note that good discussion questions are those that go beyond mere factual inquiry to integration and critical evaluation of the reading assignments; the best questions are those that engender lively, thoughtful, academic discussions. You are strongly encouraged to use media and activities/demonstrations that bring the readings and their implications to life.

Please note that you must submit a co-facilitation outline by noon on the Tuesday preceding your scheduled session so that I can review your plan and provide suggestions/feedback. This outline should include your questions as well as your ideas for any video clips/activities/demonstrations.

You will be graded on: 1) your timely submission of a complete co-facilitation outline, 2) the thoughtfulness of your discussion questions, 3) your level of comprehension of the readings, and 4) the degree to which you facilitate in-depth discussion.

Following are some suggestions for co-facilitators…

1. Make extensive preparations – it always takes more effort than you might anticipate to lead a discussion. This means that you should have closely read (and re-read) all of the assigned reading materials, made note of particularly salient theories and empirical findings, and integrated the material with prior course material. Consider how the articles relate to each other – for instance, do they suggest disagreement in the field, or do the researchers generally agree? Similarly, do the empirical findings in one support the theory in another? What are the implications of key findings?
2. Bring a strong set of discussion questions – if unsure, practice these questions with peers – do they lead to interesting, thought-provoking discussions? You should bring two copies (one that will be submitted to me at the beginning of class and one to help you with the discussion facilitation).
3. Be able to answer all of your own questions. But do not share your answers (i.e., the goal is have your classmates arrive at those answers on their own).
4. Preparing activities, such as small group discussions/debates/role plays, and showing short video clips, may enhance class involvement and understanding of the material. I would strongly recommend that you plan some form of activity for your class period.
5. Be ok with silence. One of the most difficult aspects about being a discussion leader is the pause that follows the question. It can take up to 10 seconds between when you ask a question and receive a response. People must digest what you said, think about it, formulate a response, and then speak. Typically, however, the 10 seconds seems more like 2 hours. Be patient. If there is a problem with the question, people will ask you to repeat it or I will ask you to reword what the question.
6. There is a tendency for discussion leaders to dominate the discussion. This is not surprising. As a discussion leader, you probably know the topic better than any other student in the class. You have thought about it more and probably have the answer written down in front of you. Avoid the temptation to dominate discussion. The best discussion leaders elicit the answers from others in the class. It is a discussion not a lecture.
7. Avoid the laundry-list method of asking questions where you pose one question, someone answers, then you pose the next question, and so forth. Instead, try to connect your classmates’ comments to each other and to earlier readings (e.g., “your comment reminds me of the article we read last week on X…”). Also try to interject summary comments periodically (e.g., “so it sounds like we agree that X impacts Y”) and feel free to go “off-script” to ask follow-up questions to maintain good conversation flow.
8. Keep everyone in your line of sight and call on your classmates who look like they are trying to say something but haven’t had the opportunity to do so.

 

4. Research presentation.

Given the short duration of the semester and the incredible breadth of research on eating disorders, we are necessarily limited in our ability to review all the areas of sub-specialization within the research literature. Thus, you will have the opportunity to conduct an in-depth exploration of a topic within the eating disorder scientific literature that is of particular interest to you and share this information with your classmates.

The purpose of this activity is not only to allow you to gain in-depth knowledge, but also to educate and stimulate your classmates by presenting new research and insights into a particular area of scholarship. During the first class, you will identify your topics of interest and I will assign the dates of the presentations to fit with the course schedule and assigned readings. You may select topics from the list below or propose your own topics – however, I would suggest that you identify topics that are reasonably focused/finite, non-overlapping with class content/readings, and are either controversial, difficult to understand, or perhaps “hot topics” in the current literature.

To prepare, you are expected to synthesize at least 6 recent peer-reviewed journal articles on your topic; these should form a coherent group, and at least one should be a systematic review or a meta-analysis paper (the rest may be empirical articles). You may also consult other scholarly sources (e.g., reputable news media, books) in addition to the 6 journal articles (note that you will need to skim more than 6 papers to find the ones that you wish to synthesize for your presentation). You are strongly encouraged to incorporate Scandinavian research and/or perspectives into your presentation. You are also encouraged to share your presentation plan with me in advance (ideally at least 3 days before your presentation so that you have time to receive feedback and make adjustments as needed).

In terms of presentation format, try to draw inspiration from TED-talks and share the overall "story" (themes, take-aways, limitations, pending questions...) about the research rather than just presenting a summary of each individual article. You should also include interactive bits to stimulate discussion and reflection on your research topic - for example, these could include group activities, videos, discussion questions, or other strategies to engage the class. You must submit your full list of references in APA format along with your presentation slides in advance of your presentation. Finally, you should be prepared to answer questions from the class on your research topic (note that this may require you to read more than 6 articles to prepare for the presentation). Additional details on how to present your research findings will be presented in class.

Sample topics for expert presentations:

• What is the impact (if any) of pro-anorexia and pro-bulimia websites?
• Is “orthorexia,” an excessive preoccupation with healthy eating, really an eating disorder?
• How do EDs differ across one’s lifespan (i.e., onset at adolescence vs. older adulthood)?
• Do feminist beliefs/ideologies “protect” against the development of disordered eating?
• Do nutrition labels (on food packaging) play a role in disordered eating?
• What is “night eating syndrome” and how is it different from other eating disorders?
• Among those who have recovered from eating disorders, what do they describe as being pivotal experiences in their journeys toward recovery?
• How are eating disorders linked with other clinical syndromes (e.g., obsessive compulsive disorder, substance use disorders, anxiety disorders, autism, etc.)?
• What is fat activism and how might it be useful for eating disorder prevention?
• What is “diet culture” and “clean eating” and how can we resist diet fads?
• What are some public health policies that might help to reduce ED risk on a population level?
• Is there such a thing as “exercise addiction” (or "food addiction") and how is it related to disordered eating?
• Is inpatient hospitalization effective for the treatment of EDs?
• What does the latest research on genetics suggest about the heritability of EDs?

 

5. Final project.

You will be asked to complete a final project in which you will have the opportunity to synthesize your knowledge and demonstrate your learning over the course of the semester. This project may take the form of a traditional paper, or, you may use alternative strategies to communicate your learning (e.g., podcast, board game, brochure for family members, policy brief for lawmakers, resource for teens, and so forth). Additional details about this assignment will be provided in class.

 

Grading

Assignment	Percent
Class participation and engagement	20%
Critical questions and observations (discussion forum)	20%
Co-facilitation of class discussion	20%
Research presentation	20%
Final project	20%

Readings

Required readings will be listed for each individual class, so please check the calendar to identify what you should read before class. 

Book(s):

• Burton, S. (2021). Empty: A memoir. Random House.

Articles and Other Media on Canvas:

• Acle, A., Cook, B. J., Siegfried, N., & Beasley, T. (2021). Cultural considerations in the treatment of eating disorders among racial/ethnic minorities: A systematic review. Journal of Cross-Cultural Psychology, 52(5), 468-488.
• Ambwani, S., Berenson, K. R., Simms, L., Li, A., Corfield, F., & Treasure, J. (2016). Seeing things differently: An experimental investigation of social cognition and interpersonal behavior in anorexia nervosa. International Journal of Eating Disorders, 49(5), 499-506.
• Ambwani, S., Baumgardner, M., Guo, C., Simms, L., & Abromowitz, E. (2017). Challenging fat talk: An experimental investigation of reactions to body disparaging conversations. Body image, 23, 85-92.
• Ambwani, S., Cardi, V., Albano, G., Cao, L., Crosby, R. D., Macdonald, P., ... & Treasure, J. (2020). A multicenter audit of outpatient care for adult anorexia nervosa: Symptom trajectory, service use, and evidence in support of “early stage” versus “severe and enduring” classification. International Journal of Eating Disorders, 53(8), 1337-1348.
• Anderson-Fye, E. R. (2018). Cultural influences on body image and eating disorders. In W. S. Agras & A. Robinson (Eds.), The Oxford Handbook of Eating Disorders (pp. 187–208). Oxford University Press.
• Andersen, S.T., Linkhorst, T., Gildberg, F.A., Sjögren, M. (2021). Why do women with eating disorders decline treatment? A qualitative study of barriers to specialized eating disorder treatment. Nutrients, 13(11), 4033. https://doi.org/10.3390/nu13114033
• Bentz, M., Pedersen, S. H., & Moslet, U. (2021). An evaluation of family-based treatment for restrictive-type eating disorders, delivered as standard care in a public mental health service. Journal of Eating Disorders, 9(1), 1-12.
• Bulik, C. M., Coleman, J. R., Hardaway, J. A., Breithaupt, L., Watson, H. J., Bryant, C. D., & Breen, G. (2022). Genetics and neurobiology of eating disorders. Nature Neuroscience, 25(5), 543-554.
• Chami, R., Cardi, V., Lawrence, N., MacDonald, P., Rowlands, K., Hodsoll, J., & Treasure, J. (2022). Targeting binge eating in bulimia nervosa and binge eating disorder using inhibitory control training and implementation intentions: A feasibility trial. Psychological Medicine, 52(5), 874-883.
• Deloitte Access Economics (2020, June). The social and economic cost of eating disorders in the United States of America: A report for the Strategic Training Initiative for the Prevention of Eating Disorders and the Academy for Eating Disorders. https://www.hsph.harvard.edu/striped/report-economic-costs-of-eating-disorders/.
• Duffy, M. E., Calzo, J. P., Lopez, E., Silverstein, S., Joiner, T. E., & Gordon, A. R. (2021). Measurement and construct validity of the Eating Disorder Examination Questionnaire Short Form in a transgender and gender diverse community sample. Psychological Assessment, 33(5), 459.
• Karlstad, J., Moe, C. F., Wattum, M., & Brinchmann, B. S. (2021). The experiences and strategies of parents of adults with anorexia nervosa or bulimia nervosa: a qualitative study. BMC Psychiatry, 21(1), 1-11.
• LaMarre, A., & Rice, C. (2021). Recovering Uncertainty: Exploring Eating Disorder Recovery in Context. Culture, Medicine, and Psychiatry, 45(4), 706-726.
• Mikhail, M. E., Fowler, N., Burt, S. A., Neale, M. C., Keel, P. K., Katzman, D. K., & Klump, K. L. (2022). A daily diary study of emotion regulation as a moderator of negative affect‐binge eating associations. International Journal of Eating Disorders.
• Nagata, J. M., Ganson, K. T., & Murray, S. B. (2020). Eating disorders in adolescent boys and young men: an update. Current Opinion in Pediatrics, 32(4), 476.
• Nielsen, S., & Vilmar, J. W. (2021). What can we learn about eating disorder mortality from eating disorder diagnoses at initial assessment? A Danish nationwide register follow-up study using record linkage, encompassing 45 years (1970–2014). Psychiatry Research, 303, 114091.
• Sala, M., Shankar Ram, S., Vanzhula, I. A., & Levinson, C. A. (2020). Mindfulness and eating disorder psychopathology: A meta‐analysis. International Journal of Eating Disorders, 53(6), 834-851.
• Treasure, J., & Ambwani, S. (2021). Addressing weight stigma and anti-obesity rhetoric in policy changes to prevent eating disorders. The Lancet, 398(10294), 7-8.
• Treasure, J., Parker, S., Oyeleye, O., & Harrison, A. (2021). The value of including families in the treatment of anorexia nervosa. European Eating Disorders Review, 29(3), 393-401.
• Vervaet, M., Puttevils, L., Hoekstra, R. H., Fried, E., & Vanderhasselt, M. A. (2021). Transdiagnostic vulnerability factors in eating disorders: A network analysis. European Eating Disorders Review, 29(1), 86-100.
• Wang, S. B. (2021). Machine learning to advance the prediction, prevention and treatment of eating disorders. European Eating Disorders Review, 29(5), 683-691.

 

Other recommended resources:

Podcasts:

Full of Beans: a podcast that focuses on increasing ED awareness via interviews with those with personal and professional experience with EDs.

Full Bloom Podcast: a podcast involving interviews with experts on a wide range of ED-related topics such as body positive spaces, nutrition in schools, weight-based bullying, and de-medicalizing fatness.

 

Class Policy

Late papers/assignments:

• Late papers/assignments will be accepted for up to 3 days after the deadline, but the grade for the paper will be reduced by 10% for each day that it is late. Please note that some assignments cannot be submitted late because they require presentation during class time (i.e., co-facilitation and expert presentation).

Late to class:

• Students who are repeatedly late for class will receive a lower participation grade.

Laptops/tablets and phones:

• Laptop/tablet use during class time is by permission only. Please see the instructor if you would like to use your laptop/tablet during class. Students who use their laptop/tablet for reasons not related to class will have their class participation grade reduced significantly.
• Use of cell phones is not allowed during class (including field trips).
• NB: If your use of technology is due to a learning accommodation required for you to succeed in class, please discuss it with Academic Support or the instructor directly.

 

Disability and Resource Statement

Any student who has a need for accommodation based on the impact of a disability should contact the Office of Academic Support (email) to coordinate this.  In order to receive accommodations, students should inform the instructor of approved DIS accommodations within the first two weeks of classes.

 

Academic Regulations 

Please make sure to read the Academic Regulations on the DIS website. There you will find regulations on:

• Course Enrollment and Grading
• Academic Expectations and Honor Code

 

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