Psychology of Eating Disorders

Semester & Location:	Spring 2024 - 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 Theresa Dahm, PhD, ClinPsyD Current Students: please contact your faculty using the canvas inbox function
Program Contact:	Department email address psy.cns@dis.dk
Time Place	Thursdays, 1:15pm – 4:10pm Classroom: F24-302

 

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.

Theresa Dahm. ClinPsyD (Clinical Psychology, University of East Anglia, 2015). PhD (Biological Sciences/Cognitive Psychology, University of Cambridge, 2012). MSc (Rehabilitation Psychology, University of Nottingham, 2007). BSc Hons (Psychology and Cognitive Neuroscience, University of Nottingham, 2006). Currently working as a psychologist in private practice in Copenhagen. Previously worked as a Clinical Psychologist in the National Health Service in the UK (2015-2022) across numerous Trusts, with specialist experience in Eating Disorders and Clinical Health Psychology. In my clinical practice, I predominantly use Compassion Focused Therapy (CFT), an integrative, biopsychosocial model of therapy which draws on the evidence base in neuroscience, cognitive-, developmental- and evolutionary psychology, as well as attachment theory, and I completed a Postgraduate Diploma in CFT from the University of Birmingham, UK, in 2021. I have previously been involved in clinical trials on childhood PTSD and treatment of depression at the University of Cambridge. 

Field Studies

1. Yoga, mediation, and sound healing workshop:  Contemporary treatments for eating disorders often draw upon yoga and meditation to help people reconnect and form new relationships with their bodies. In this workshop, you will have the opportunity to gain hands-on experience with the healing power of movement and mediation. Further details will be provided in class.
2. TBD 

 

Guest Lecturer

1. Dr Rasmus Køster-Rasmussen: Dr. Køster-Rasmussen is an Associate Professor in Body Weight and Health at the University of Copenhagen. 

 

Approach to Teaching 

The purpose of this course is to facilitate dialogue, debate, and critical thinking about eating disorders from various theoretical and empirical perspectives. It is expected that learning will occur primarily through reading, discussion, and the exchange of ideas – consequently, the outcome of the course 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 us so we can help you work on this – we expect that everyone in the course will offer insightful questions and answers during every class meeting.

Our classes will involve mini-lectures, class discussions and activities, opportunities to explore and practice various clinical tools, and brief excursions into the city to understand how social context shapes disordered eating attitudes and behaviors. Please note that our class meetings will typically not involve extensive 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

In this highly interactive course, the success of the course depends on your serious commitment to truly engage with the material. To that end, we expect you to spend at least 6 hours every week outside of class preparing for this course. You must come to class prepared, having closely read and evaluated the reading assignments, and your contributions 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 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 (10%).

Preparation, attendance, and engagement in classes, field studies, and guest lectures is essential in this 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 class participation and engagement grade will be calculated based on 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 specifically 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). Please note that active participation and engagement also refers to active listening, so there is no need to speak solely to fill the silence.
• You work collaboratively with people to achieve learning goals when you are placed in a small group.

 

2. Canvas discussion forum (20%).

The purpose of the Canvas discussion forum is to give you an opportunity to think critically and ask questions about the readings before we meet for class. Discussion posts are due by noon on each Wednesday before class. Each discussion post 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 conclude 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 and questions make sense. You should be prepared to discuss your discussion post during our class session so please review it before class. You are expected to write a discussion post for each class except for the class that you are responsible for co-facilitating with another student.

 

3. Co-facilitation of class (20%).

The purpose of the co-facilitation assignment is twofold: first, to help you hone your knowledge of the readings, and second, to help you refine your skills in critical analysis, reflection, and communication of scientific research. You will be responsible for co-facilitating one class period, which will involve completing all of the following:

• Before class:
  • Prepare to lead your classmates through activities, demonstration, excursions, and discussion on the assigned topics. This means that you should closely read (and re-read) all of the assigned reading materials, make note of particularly salient theories and empirical findings, and reflect on how the material does or does not connect 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?
  • Read and respond to at least 5 comments and questions from your classmates on the Canvas discussion forum (ideally you and your co-facilitator(s) should respond to different comments).
  • Collaborate with your co-facilitator(s) to prepare one set of 5-6 discussion questions based on the assigned readings. 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 welcome to draw inspiration from your classmates' Canvas discussion posts (please give them credit), but you should not rely solely on their questions and should bring your own ideas forth.
  • Collaborate with your co-facilitator(s) to formulate a plan to lead a thoughtful and lively discussion about the readings in class. Part of this plan will include the discussion questions (you will need to think about how to split the class into smaller groups as needed), but should also include mini-excursions (e.g., 10-minute field observations/document sociocultural phenomena), activities (e.g., design a tool for X; review online children's programming for Y; role play a particular technique; debate different positions on a topic), demonstrations (e.g., test out a particular psychological assessment), or other forms of interaction to bring the readings and their implications to life. If you would like feedback on a draft of your plan, please submit it to us by noon on the Monday before your scheduled class session.

• During class:
  • 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).
  • Be ok with silence. One of the most difficult aspects about co-facilitating class 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. 
  • There is a tendency for co-facilitators to dominate the discussion. This is not surprising as you have prepared well and probably know the topic better than any other student in the class. Avoid the temptation to dominate discussion - remember, we are aiming for discussions, not lectures.
  • 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.
  • 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 lightning talk (20%).

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 via a 10-minute research lightning talk. You are welcome to present this "live" during class, or, if you prefer to record the talk in advance, you may do so and we will watch the talk together in class (we will still have a brief Q/A session at the end in case there are questions).

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. We 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 7-8 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 required 7-8 journal articles (note that you will likely need to skim more 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. 

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. Think about what we know and what we don't know - what are the strengths and limitations of the current state of evidence on the topic?

Please submit your presentation slides, video (if pre-recorded), and full list of references in APA format in advance of your presentation. Please be prepared to answer questions from the class on your research topic. If you would like feedback on a draft of your plan, please submit it to us by noon on the Monday before your scheduled class session.

 

5. Eating disorder prevention project (20%).

The purpose of the eating disorder prevention project is to help you 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.

 

6. Brief final reflection (10%).

The purpose of this brief (1-2 page) final reflection is to give you an opportunity to consider your learning journey in this course and from your time in Denmark. What are some key take-away messages about eating disorders and what have you observed in terms of cross-cultural similarities or differences? Has the course changed any of your perceptions about eating disorder development, maintenance, prevention, or intervention? Is there anything you might do differently in the future as a result of taking this course? How can you carry your new learning forward? Please note that this final reflection will be graded as complete-incomplete so you should feel free to write authentically.

Grading

Assignment	Percent
Class participation and engagement	10%
Canvas discussion forum	20%
Co-facilitation of class	20%
Research lightning talk	20%
Eating disorder prevention project	20%
Brief final reflection	10%

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. 

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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