Quantum Units Education®

What Every Therapist Needs To Know About Treating Eating and Weight IssuesMultiple Choice

1. Introduction While it was initially thought that the causes of anorexia and bulimia nervosa were solely psychological and intrapsychic, in time psychology began to view them as being caused, or at least exacerbated, by family dynamics, traumatic events, and societal pressures to be thin.

2.   A significant portion of the population in the United States is concerned about losing weight, and they consider dieting the way to do it. According to Multi-Service Eating Disorder Association (MEDA), at any given time in this country, ____ of women and ____ of men are on a diet, but only ____ keep weight off more than five years.

3. The author, Karen R. Koenig, believes that referring clients to diet plans and programs as a solution to dealing with weight and eating issues does not support what clinicians know and try to teach clients. In dealing with weight and food issues, as with any problems, clients must realize that:

Chapter One: A Comprehensive Approach to Treating Eating, Weight, and Body Image Issues

4. Many clients may not share their concerns about their weight or food difficulties because they feel that these problems are trivial and superficial. Instead, clients believe that therapy should concentrate on important issues such as building interpersonal skills and relationships, dealing with a life-changing decision, or managing a crisis, or they may not actually realize how much stress they are feeling about their size or their eating.

5. Professionals describe a new way of thinking and behaving around food that may not reach a level of clinical disorder but, nevertheless, is unhealthy and benefits from treatment. This occurs on a continuum from chronic dieting and fear of food and weight gain, to the most severe, life-threatening cases of anorexia, and from compulsive and emotional food consumption that causes gradual weight gain to binge eating. This is referred to as:

6. Binge eating occurs when a person eats well beyond the point of feeling full at least two times a week, and it may be accompanied by bulimia, but more often is not.

7. Sleep eating disorder is an unusual disorder that is characterized by abnormal eating patterns during the night, including uncontrolled eating urges and splurges. Which of the following accurately describes this condition?

8. The author reports that the quest for thinness and abhorrence of fat has filtered down to young children, and predominantly young girls. The National Eating Disorders Association reports that 68% of 10-year-old girls are afraid of being fat, and that the biggest concern of 10 to 15-year-old girls is their weight.

9. Body Dysmorphic Disorder (BDD) is an extreme distortion of body image which often occurs with men and women of normal weight who think they are fat, or with those who are ultrathin but still see themselves as chubby. Each of the following is a correct statement about this disorder EXCEPT:

10. Although becoming overweight and obese may appear to be the result of overeating, and dieting may seem to be the solution, the author believes that dieting is actually the most common behavior that leads to an eating disorder.

11. While diets do not generally work in the long term, they may be useful and successful occasionally. For example, if a client traditionally has had a positive relationship with food, has maintained a stable weight for a long period, and wants to lose a small amount of weight, say 5 to 10 pounds, for the right reasons, a diet may be appropriate.

12. Three therapeutic elements are needed to help clients resolve their problems with food for life. These include shifting attitudes, teaching skills to “eat normally”, and:

Chapter Two: How Clients Express Themselves Through Food

13. Due to institutional cultural bias, many Americans suffer from prejudice against fat people, although these prejudices don’t tend to be anywhere near our natural biases against color and racism.

14. In our society, it is important for clinicians to realize that those who grow up and live in our culture may have various biases and judgments about their bodies and food, while those from other cultures may have very different views about food, fatness, and thinness.

15. A common conflict that drives disordered eating has to do with underlying anger, and much of this anger comes from beliefs about ____________.

16. Children who were forced to eat or finish all their food while growing up often become overeaters in their adult life, as if the parent were still standing over them.

17. It may be very helpful for a professional working with a client experiencing eating and weight issues to ask this question, “Is how you look any kind of rebellion against your parents or society?” This may help the clinician assess:

18. Mixed messages about sexuality, intimacy, body image, and weight are very common in our culture. Which of the following is a true statement about these issues?

19. When a client experiences distorted thinking or difficulty regulating emotions in regard to food and weight issues, an important goal is to help the client connect his or her actions with what is going on emotionally.

20. Unconscious, underlying conflicts that get played out in the eating or weight arena generally add to what we already understand about a client. Many of these conflicts are connected to rebellion, autonomy, and:

Chapter Three: The Biology of Eating and Weight

21. Although parental attitudes toward food and weight are a large contributor to a client’s ability to eat “normally” and maintain a comfortable weight, genetic makeup is also a critical factor. A recent controversial theory maintains that __________ of our weight may be genetically determined.

22. Some research points to a popular explanation which holds that our bodies are preprogrammed genetically to maintain a certain weight and that we cannot remain for long either above or below this limit. This is known as:

23. Since an individuals’ genetically preprogrammed weight is thought to be influenced by many factors, it is important for therapists to remind overweight clients that willpower cannot override biology.

24. Appetite and weight are regulated by the brain through chemicals that bring it information about the body’s energy and fuel needs. Which of the following is an accurate statement about these processes?

25. Neurotransmitters such as serotonin, dopamine, norepinephrine, and gamma-aminobutyric acid (GABA) transmit information from one cell or another to regulate mood and affect. One way that pleasure registers in the brain is through the release of norepinephrine when a carbohydrate rich food is consumed.

26. Evidence has shown that eating certain foods can increase neurotransmitter levels in the brain. This elevation suggests that specific foods register in the reward circuitry of the brain in much the same way as alcohol and some drugs, which indicates that food is also addictive.

27. Clients may insist they have a food allergy because they “cannot” stop eating certain foods, particularly carbohydrate-rich foods that are high in sugar and/or fat. However, current research indicates that people who eat sugar and crave more of it do not have an allergy to sugar, in spite of the fact that eating it may trigger a craving for more.

28. Professionals working with eating and/or weight issues should have an understanding of what clients go through in order to avoid getting fat, to lose weight, or to keep it off. Which of the following is an accurate statement about diet approaches that have been used over the last decade?

29. Hypothyroidism, a condition in which the thyroid gland produces too little hormone, slows down metabolism and may cause weight gain. Which of the following are not included in the symptoms of hypothyroidism?

30. While it is important that clients understand that they may have underlying illnesses and conditions that contribute to eating and weight problems, it is also critical that they begin to hold themselves 100% accountable for their weight struggles, as this is the first step toward becoming healthy and fit.

Chapter Four: Health and Medical Problems

31. Although mental health professionals may not be experts in nutrition, biochemistry, and fitness, it is important that they recognize in broad terms what promotes good health, what harms it, and what clients can do to develop a healthier lifestyle. Educating clients about the risks of being over- and underweight and malnourished helps them:

32. A BMI of 18.5 or lower is considered underweight and may endanger health. However, it is not a guarantee that the client is unhealthy any more than it is a guarantee that a slender client who fails to exercise is healthier than an overweight one who exercises regularly.

33. Which of the following is an accurate statement about the dangers of being overweight or obese according to the U.S. Department of Health and Human Services?

34. Current National Institutes of Health guidelines state that weight-loss surgery is appropriate for people whose BMI is greater that 35. In addition, those with a BMI of 30 with three or more significant obesity-related problems may be good candidates for surgery.

35. Clients who are above or below average weight often complain of being lectured, talked down to, humiliated, and blamed for their medical problems by health practitioners. Although some clients may be sensitive and overreact to even the slightest criticism, there is good reason to believe that they are treated differently by health professionals.

Chapter Five: Personality Traits and Family Dynamics

36. The author suggests that in order to understand how being overweight or underweight affects the client, the clinician should ask each of the following questions EXCEPT:

37. Sometimes a client may do everything to succeed at work or help others but does little to take care of herself. Or, a client cannot refrain from shopping because buying new things gives him a high and saying no makes him feel deprived or depressed, which Koenig refers to as:

38. Character traits that accompany eating problems are likely precursors to eating disorders, rather than existing concurrently with them.

39. Many clients with eating problems suffer from a victim mentality. They often focus on the unfairness and anger associated with food and weight struggles.

40. Clients who have eating or weight problems may believe that change will happen without effort, no harm will come from self-destructive habits, and that one can avoid having bad things happen if one refuses to think about them. This is known as adaptive thinking.

41. Which of the following is a correct statement about counter dependency and eating or weight issues?

42. Chronic under-eaters and those are who underweight often have a harsh super ego and a tendency toward perfectionism. However, these characteristics are rarely seen in over-eaters.

43. A sister characteristic of perfectionism is when clients are exceedingly hard on themselves and possess only a minimum of _______________ .

44. Questions such as, “Is it easier to depend on food for comfort than people?” and “Do you often feel shame about your thoughts or actions?” can be used to help the client understand:

45. Because three of the key criteria for borderline personality disorder (BPD) are affective instability, impulsivity, and chronic feelings of emptiness, it is often linked to eating problems.

46. Clients’ views about their bodies and food may still be impacted by family dynamics when they reach adulthood. This is especially true when clients have not adequately separated emotionally from parents and are unable to think for themselves about (and stand up for) their size and how they wish to eat. and when:

Chapter Six: Assessment

47. Clinicians may assume that an underweight client is happy with his or her size and an overweight client is unhappy, which may or may not be true. The meaning that weight has to a client cannot really be determined until some direct or indirect communication about it has occurred.

48. Experts believe that it is inappropriate to assess a clients feelings in the food and body arena during an initial interview since a wide spectrum of underlying issues need to be covered before discussing weight and food concerns.

49. In general, it is more likely that an overweight client will acknowledge eating and weight problems in order to get help that an underweight client.

50. Two major reasons that clients fail to raise concerns about food and the scale are shame and:

51. Clients who fuss too much over appearance, including obsessing about their weight, may be responding to neglect or abuse from childhood and may be spending their adulthood trying to make up for it. Additionally, needing to look perfect at all times may hint at body image problems and could lead to underlying eating or weight issues.

52. Some illnesses and diseases may lead to changes in eating and/or weight. Which of the following conditions is likely to lead to weight loss?

53. Clients who have recently given up an addiction may be vulnerable to switching vices and turn to food for comfort. This may be a good thing for a client who is in recovery from drug addiction or alcoholism, as weight gain may be positive in that it may mean the addict is taking better care of his or her nutritional needs.

Chapter Seven: Clinical Disorders

54. Sometimes eating and weight problems coexist with other disorders such as depression, anxiety, dissociative disorders and personality disorders. Which of the following is a true statement about potential links between mood disorders and food problems?

55. One of the most obvious signs of depression is loss of appetite , and this usually signals the beginning of a serious eating problem.

56. Repetitive behaviors or mental acts that a client feels driven to perform according to rigidly applied rules are known as:

57. More and more studies are being conducted on the correlation between sexual trauma and eating disorders. The author reports that clients who have been sexually violated may have body and food regulation issues due to feelings of powerlessness, breaking of trust, fear of intimacy, and:

58. Clients who have been sexually traumatized may have problems staying connected to reality and to their bodies. Eating disordered clients may experience “a disruption in the usually integrated functions of consciousness, memory, identity, or perception of the environment”, which is called going unconscious.

Chapter Eight: Life-Cycle Issues

59. Therapists are treating more and more overweight youth, and are seeing escalating numbers of children of normal weight who are preoccupied with thinness. Studies indicate that children as young as six are expressing body dissatisfaction, that ____ percent of girls in the first through third grades want to be thinner, and ____ percent of 9-and 10-year old girls feel better about themselves when they are on a diet.

60. The focus of childhood eating problems falls into two categories. The first is when children are overweight or obese and have low self-esteem, and the second category is those who enter treatment because they are dieting or starving themselves.

61. Adolescence has always been a time of turbulence and turmoil, and it is understandable that adolescents may want to experiment with eating more or less as they observe what friends do and see the examples set by celebrities and other adults. Which of the following accurately describes eating and weight issues with adolescents?

62. Tip-offs that adolescents might be overly concerned with weight include intense desire to fit in with a particular peer group, yearning for popularity, insisting on getting to or maintaining an ultra-low weight for sports competition, and a preoccupation with appearance.

63. Statistics about eating disorders, especially females during late adolescence, are scary and disheartening. More than 84% of those with eating disorders are adolescent and adult young women, 92% of female college students surveyed had attempted to control their weight through dieting, and 32% said they dieted “often” or “always”.

64. Sometimes clients who have been minimizing overeating or weight problems finally decide to face them squarely when they become interested in dating or deepening a relationship with one person in particular. Which of the following is NOT one of the suggested questions to ask when assessing eating and weight concerns in regards to dating and mating?

65. For women who have had long-standing weight and eating problems, pregnancy may exacerbate or alleviate concerns. Additionally, many women who have never had food or weight problems first encounter them during pregnancy, when their bodies begin to enlarge, and they worry that they won't be able to take off the weight once the baby is born

66. Female clients often complain about putting on weight due to menopause and shifting hormones. Approximately ________ percentage of menopausal women gain weight between the ages of 35 and 55, mostly between 10 to 15 pounds.

67. Since menopausal weight gain is inevitable, clinicians should help these clients accept their fate and think more positively about appetite and body changes.

68. Clients who have not adjusted well to aging and retirement are at risk for centering their life around food and gaining weight. In contrast, some elderly clients may experience a diminished appetite and weight loss because of pain, worsening heart failure, depression, dementia, or pneumonia.

69. Weight may become a strong focus when individuals become heavily involved in competitive athletics, and high school and college athletes are especially vulnerable to developing eating disorders. In a study done by Cornell University, 30% of male football players were found to engage in some form of disordered eating, and a study of 425 female college athletes showed that 53% of them were terrified of being too heavy, and 45% reported experiencing pressure to achieve or maintain a certain weight.

70. Eating and weight concerns may surface when clients choose to quit smoking. Each of the following is a true statement about smoking cessation and weight issues EXCEPT:

71. It is important for clients to realize that if they have had eating problems in the past, there is a good chance that stressful situations will trigger food issues again. As clinicians get to know their clients, they should encourage them to think ahead when major change is about to happen in order to anticipate if food and weight concerns will reoccur and how they will be dealt with.

72. Therapists working with clients with food and weight issues should address nutritional concerns immediately while helping them to become “normal eaters”.

73. When eating is instinctive, it is based primarily on innate body signals about hunger, cravings, and satiation. When a person is able to eat when hungry, eat with awareness and enjoyment, and stop when full or satisfied, this is known as normal or ___________ eating.

74. Overloading a client with nutritional information such as calorie counts and how to weigh their food may actually promote or reinforce disordered eating because it may encourage them to obsess about food and deny themselves pleasure.

75. Vitamins and minerals are substances the body needs in small but steady amounts for normal growth, function, and health, and they are also known as bionutrients.

Chapter Nine: Nutrition and Fitness

76. Fitness is generally defined as the attributes that people have or achieve relating to their ability to perform physical activity. Clients with food and weight issues may view exercise negatively, as yet another self-care chore that is considered work rather than pleasure.

77. According to most experts, there are five basic components of physical fitness that are equally important to physical health. These include cardio-respiratory endurance, muscular strength, muscular endurance, flexibility, and:

78. The current rule of thumb is to exercise for 30 minutes a day in order to stay fit. Experts believe it is much more beneficial to complete the 30 minutes at one time rather than break it up into shorter spurts.

79. For some clients, starting and stopping exercise over and over means that they probably have conflicting feelings about getting or staying in shape. Most clients are in touch with ____________ beliefs and feelings that they should exercise, but are out of touch with ____________ ones about why they don’t want to exercise.

Chapter Ten: Transference and Countertransference

80. As clinicians help clients identify their issues and reactions toward the therapist, therapists must also deal with their own issues about the clients’ size and shape.

81. When a therapist is overweight, a number of client reactions are possible. Which of the following is NOT one of the possible reactions that the author describes?

82. Thin therapists may be an asset to underweight clients. They may use their own experiences of eating nutritiously and living a healthy lifestyle to show their clients that they can keep their weight down in a reasonable, healthful way and not have to resort to starvation, purging, or over exercising.

83. It is generally accepted that an average-weight therapist would have the easiest time with overweight or underweight clients, because clients tend to have more confidence in the average-weight therapist’s abilities.

84. Each of the following is an appropriate guideline for dealing with problematic reactions to eating and weight issues EXCEPT:

Chapter Eleven: Treatment Options

85. The most obvious approach to addressing eating and weight issues with a client is to raise concerns about self-care and self-esteem issues.

86. It is important to ask clients what they know about the health risks of being obese or severely underweight. However, most clients with weight issues tend to be offended with therapists who distribute handouts, articles, or other information about these issues.

87. Many clients will say openly that they have “low self-esteem” and connect it to having weight problems. In the Six Pillars of Self-Esteem, Nathan Brandon states that self-esteem has two interrelated concepts including self-efficacy and:

88. Therapists may ask clients to rate their self-care abilities on a scale of 1 to 10, from poor care to excellent care. Self-care should include physical, emotional, spiritual, and ________________ aspects of care.

89. Although some people completely lose their appetite when they come down with the blahs or the blues, most are likely to at least occasionally incline toward food for comfort.

90. To help clients assess if food problems are related to an inability to comfort and soothe themselves without abusing food, Koenig recommends asking each of the following EXCEPT:

91. When therapists address food or weight issues that are related to stress, they must engage clients on two levels. Clinicians should help clients identify and diffuse emotions that are related to stress eating and:

92. Often times food, weight, and body problems indicate that something has gone wrong in an interpersonal or intimate relationship. Generally, females act out in the food and weight arena more often than males, but the dynamics are the same for either gender.

93. Which of the following is an accurate description of how people use eating and weight problems as symbols of other issues?

94. A client who comes to therapy with an eating problem may be disappointed, shocked, or angry that his difficulties are about more than food. Although he or she may be resistant to talking about anything else, it is quite natural for dialogue to shift to other important topics.

95. Many clients with eating problems report an increased ability to curb disordered eating when taking medications for anxiety and depression. Experts believe that this is due to drugs remedying underlying chemical balances rather than acting directly.

96. Appetite suppressants decrease appetite and increase the sensation of fullness. The most commonly prescribed appetite suppressants in the United States are:

97. The psychological treatment technique that uses a combination of behaviorism, cognitive therapy, and mindfulness to decrease self-harming behaviors and expand life skills is called:

98. Group therapy is especially helpful for disordered eaters who have serious relational problems and sufficient ego strength to help them overcome shame. Clients with major trust issues are encouraged to participate in group therapy in order to help them learn to accept feedback and rely on others.

99. Body work such as massage, meditation, yoga, tai chi, and dance, among others, can help clients with food problems connect to their physical selves. However, while massage helps most clients relax and feel connected to their body, it can also bring up painful feelings about past trauma, especially of a sexual nature.

100. Clinicians working with weight and food issues should be willing to consult an eating disorder specialist to provide new insights and approaches, and should be willing to refer clients to eating disorders experts.