Overcoming destructive societal values in the treatment of anorexia nervosa: An intensive day treatment model

Sociocultural contributions to the development of anorexia nervosa are examined, and a treatment approach for counteracting these factors are presented. An intensive day treatment program serves as a prototype of such an approach, designed to help overcome the destructive effects of certain values prevalent in North America. This treatment program is outlined and evaluated. The program includes expressive therapies (art, dance, music, and drama), skill-focused activities (stress management, assertiveness training and nutrition programs) and a fitness/recreation program. Significant psychological changes in the participants were found on 10 of the 11 measures employed for evaluatio—the eight scales of the Eating Disorder Inventory, the two clinical scales of the Eysenck Personality Inventory, and the Self-Control Scale of the Reid-Ware Multidimensional Internal-External Scale. The value of such a program as one component of an overall treatment strategy is discussed.     

Medical practitioners' competence and confidentiality decisions with a minor: An anorexia nervosa case study

Minors (i.e., those under 18 years of age) hold a tenuous legal position in medical settings. While recent legal authority in numerous jurisdictions affords competent minors the right to consent to medical treatment, the guidelines for assessing competence are often vague or non-existent. In addition, these changes have not adequately addressed the issue of confidentiality, and it is unclear whether general practitioners (GPs) owe a duty of confidentiality to competent minors. As medical practitioners are the first point of contact in medical settings, the present study explored GPs' competence and confidentiality determinations regarding a 16-year-old female patient who presented with symptoms of an eating disorder. Questionnaires and hypothetical scenarios were sent to a sample of 1000 GPs, of which 305 responded. Results indicated that 62% of respondents would have found the patient competent, while 82% would have maintained her confidentiality. However, analysis of the rationales provided for these decisions revealed a wide discrepancy in GPs' understanding and implementation of current legal principles. This research highlights the necessity of providing GPs with clear guidelines regarding competence and confidentiality determinations when dealing with minors.     

Cross-cultural issues in the treatment of intractable anorexia nervosa

This paper presents a case of intractable anorexia nervosa in a child burdened beyond her capabilities by unresolved conflicts in a parent. The dynamics will be assessed in the context of open systems theory of family function to suggest that the mother's conflicts, fixated at the time she left her native country, and her attempts to adapt to a new one, combined with other family members' failure to understand or appreciate the mother's cultural roots, interrupted the patient's normal maturation/development. The paper also presents a successful course of treatment of the binational anorexic girl, using a comprehensive inpatient program, emphasizing intensive family therapy with an open systems theory framework.The earlier version of this paper was presented at the Sixth World Congress of the International College of Psychosomatic Medicine, Montreal, Canada, September, 1981. Helpful comments by Regina Casper, M.D., helpful discussion by Kenneth Calestro, M.A., and support and encouragement by Katharine N. Dixon, M.D. are greatly appreciated.     

Adolescent eating disorder: anorexia nervosa

Anorexia nervosa is an eating disorder observed with increasing frequency, especially among adolescent females. No consensus exists concerning the causes of the disorder. Social, psychosexual, family system, biological theories, and the regression hypothesis have been advanced to explain the phenomenon. The major characteristics are 25% loss of body weight, use of various means to lose weight, weight phobia, preoccupation with food, body image disturbances, as well as numerous associated medical conditions: bradycardia, hypotension, dehydration, hypothermia, electrolyte abnormalities, amenorrhea, metabolic changes, and abdominal distress. Anorexic adolescents resist treatment and may die if not cured. The following therapeutic modalities have been effective: hospitalization, and cognitive, behavioral, and family therapy. Some of the typical family patterns, early characteristics, social adjustment problems, and society's contribution to the disorder are presented.     

The Peter Pan Syndrome: Inpatient treatment of adolescent anorexia nervosa

Specific strategies designed for intervening in family, hospital, community, and school systems are discussed as crucial components in the treatment of adolescent anorexia nervosa. It is suggested that all these systems inadvertently collude in the “Peter Pan Syndrome”: maintaining the adolescent-identified patient in a latency age role in order to protect mother from depression and the family in its entirety from an “empty nest” developmental crisis. When strategic and structural alterations occurred within the above mentioned systems while the child was hospitalized and after discharge, the anorectic symptom was alleviated.     

The Peter Pan Syndrome: Inpatient treatment of adolescent anorexia nervosa

Specific strategies designed for intervening in family, hospital, community, and school systems are discussed as crucial components in the treatment of adolescent anorexia nervosa. It is suggested that all these systems inadvertently collude in the “Peter Pan Syndrome”: maintaining the adolescent-identified patient in a latency age role in order to protect mother from depression and the family in its entirety from an “empty nest” developmental crisis. When strategic and structural alterations occurred within the above mentioned systems while the child was hospitalized and after discharge, the anorectic symptom was alleviated.     

Assessment of self and others during treatment for anorexia nervosa

Abstract

Repertory grids were used to compare a group of anorexic women (n = 12) with normal-weight (n = 12) and dieting (n = 10) control groups. Anorexics differed from both control groups in their perceptions of themselves and others. The constructs used were more meaningful to anorexics than to either control group. The way in which anorexics saw themselves differed from the way in which clinicians have indicated in the literature that they see their anorexic patients. Some constructs adopted a differential meaning and relevance for observer and observed when applied to the anorexic condition. The discrepancies between internally defined and externally imposed interpretations of construct meaning may help to explain why resistance to treatment and high relapse rates are encountered in anorexic women.     

Possible differences in family patterns in anorexia nervosa and bulimia nervosa

This paper examines the interactions in three families, one where the daughter had anorexia nervosa and two where the daughters had bulimia nervosa, and proposes some differences in the families’ patterns of enmeshment. It is hypothesized that these may be linked to differences in the development of the mother—child relationship. Implications for the choice of therapeutic strategies are discussed.     

Action monitoring and perfectionism in anorexia nervosa

To study action monitoring in anorexia nervosa, behavioral and EEG measures were obtained in underweight anorexia nervosa patients (n=17) and matched healthy controls (n=19) while performing a speeded choice-reaction task. Our main measures of interest were questionnaire outcomes, reaction times, error rates, and the error-related negativity ERP component. Questionnaire and behavioral results indicated increased perfectionism in patients with anorexia nervosa. In line with their perfectionism and controlled response style patients made significantly less errors than controls. However, when controlling for this difference in error rates, the EEG results demonstrated a reduced error-related negativity in the patient group. These seemingly contradictory outcomes of improved performance and reduced error monitoring are discussed in relation with indications of anterior cingulate cortex hypoactivity in anorexia nervosa patients.     

A controlled trial of cognitive-behavioural and behavioural treatment of anorexia nervosa

This study was undertaken to investigate whether a cognitive-behavioural treatment procedure was superior to a standard behavioural treatment, in the outpatient therapy of patients with anorexia nervosa. The two treatments were also compared with a control treatment procedure consisting of routine outpatient management. Each group consisted of eight subjects. All the groups showed some improvement, but the findings did not provide support for the prediction that cognitive-behavioural treatment, designed specifically to manipulate both attitudes and behaviour, was superior to the other types of treatment. The implications of the findings are considered.     

Other than obedient: Girls' constructions of doctors and treatment regimes for anorexia nervosa

This paper examines how teenage girls diagnosed with and being treated for anorexia nervosa in hospital construct their anorexia, their identity as patients, medical authority and their doctors. In‐depth interviews were conducted with 25 adolescent girls in two large, metropolitan hospitals in Australia. Using a discourse analytic approach informed by poststructural theory, we elucidate how girls perform as patients, contest the authoritative position of doctors and deploy popular, taken‐for‐granted discourses of femininity to resist treatment regimes and the construction of themselves by others as ‘anorexic’ and ‘sick’. Our analysis indicates that medical discourses in the hospital do not necessarily define or delimit girls' constructions of themselves, of anorexia, treatment or their relationships with doctors. The paper argues that understanding and validating girls' perspectives is essential in building and maintaining a therapeutic alliance in hospitals. We conclude by discussing how insights from poststructural analysis can assist in improving hospital practice. Copyright © 2009 John Wiley & Sons, Ltd.     

Emotion regulation difficulties in anorexia nervosa: Relationship to self-perceived sensory sensitivity

Changes in sensation (e.g., prickly skin) are crucial constituents of emotional experience, and the intensity of perceived changes has been linked to emotional intensity and dysregulation. The current study examined the relationship between sensory sensitivity and emotion regulation among adults with anorexia nervosa (AN), a disorder characterised by disturbance in the experience of the body. Twenty-one individuals with AN, 20 individuals with AN who were weight–restored, and 23 typical controls completed self-report measures of sensory sensitivity and emotion regulation. AN participants reported heightened sensory sensitivity and greater difficulty regulating emotions relative to controls. Self-perceived sensory sensitivity was associated with greater emotion dysregulation. Weight-restored AN participants reported greater ability to regulate emotions than their currently underweight counterparts, despite heightened sensitivity. Findings suggest that hypersensitivity may be a persisting feature in AN, and that weight restoration may involve improved ability to cope with sensation.     

Predisposition factors in anorexia nervosa.

Since its first recognition, a number of researchers have endeavored to link anorexia nervosa to underlying pathology. For example, in the past, attempts were made to associate anorexia with such psychiatric disturbances as schizophrenia, anxiety disorders, and obsessive-compulsive and antisocial personality disorders. Most recent efforts have focused on the possible link between anorexia nervosa and affective disorders. This article reviews the literature concerned with investigating psychiatric disturbances and genetic variables hypothesized as predisposing factors in the etiology of anorexia nervosa. Particular emphasis is given to research which discusses the association between anorexia nervosa and depression. Psychopharmacological evidence and family genetics studies are reviewed. Suggestions for future research are also made.     

Perceived-competence deficit in anorexia nervosa.

Anorexia nervosa patients are portrayed as competent and accomplished and yet they feel ineffective and diffident. The assessment of this aspect of their self-esteem presents methodological problems. The Interests and Abilities Questionnaire was designed to measure interests and perceived abilities in typical adolescent activities. The disparity between interests and perceived abilities--perceived-competence deficit (PCD)--was hypothesized to be characteristic of anorexics. Three groups of females, aged 14 to 24, were studied: 13 anorexic inpatients, 13 psychiatric inpatients without an eating disorder but of similar severity of illness, and 48 nonclinical subjects. Similar to the nonclinical controls, anorexics were interested in a variety of activities; similar to control patients, anorexics rated their abilities lower than nonclinical subjects. In PCD, anorexics scored significantly higher than both control groups; this difference was not related to level of depression.