Pathological Conflict Avoidance in Anorexia Nervosa: Family Perspectives

Conflict avoidance is a common pattern in families of patients with anorexia nervosa (AN), but little systematic controlled research has been conducted to elucidate the formal mechanics of such interaction. Forty family triads with daughters suffering from AN were compared to 40 matched control (CON) triads, on five measures of conflictual family situations. Results revealed that the AN group had significantly more difficulty in choosing the topic of discussion, adhering to the topic, developing and exploring the chosen topic, and reaching a solution—all within a family setting. Findings empirically support previous clinical and research evidence on the pathological avoidance of conflict in families with a member who has AN. Therapeutic implications are discussed.     

Recovering Identity from Anorexia Nervosa: Women's Constructions of Their Experiences of Recovery from Anorexia Nervosa Over 10 Years

There is little consensus about the meaning of recovery in anorexia nervosa with most studies focusing on researcher selected variables of weight gain and improvement in eating disorder symptomatology. There is also a paucity of research that focuses on how the experiencing person themselves define recovery and whether this term is useful to them to depict their journey of reclaiming their life and identity from anorexia nervosa. This article explores 21 Australian women's experiences of anorexia nervosa (AN) over 10 years and the ways they negotiated their identities in relation to the question of recovery. The research interviews sought to provide a context for these women to speak on their own terms, terms not confined to the medical discourse. The discursively constructed category of recovery was troublesome for the majority of these women, despite the researcher inadvertently taking up this category in lines of questioning, particularly in the earlier interviews. Most troubling for the women was the assumption that recovery erased their experiences with the expectation that they should return to a pre-illness state. On the other hand, speaking on their own terms—including the use of metaphor and (re)authoring their experiences as an identity journey—was significant in scaffolding the women toward narratives of reclaiming their lives and identities from AN and its effects. The women in this study refused to confine the terms of their speaking to a recovery discourse; instead, they honored the narratives of their experiences and histories as profound in their identity formation. The implications of this research are significant given that the majority of research and many treatments to date confine the terms of speaking to the “anorexia” discourse.     

Anorexia Nervosa: The Hospital's Role in Family Treatment

When an anorexia nervosa patient requires hospitalization for her ¹ 1 We will use the pronoun “her” to refer to anorexic patients since the overwhelming majority are female. Our discussion will focus mainly on younger adolescent girls who are still living with their families.
medical condition, the treatment team faces the problem of integrating the individual focus of inpatient care with the systems focus of family therapy. In this paper we propose a family-systems model of hospitalization, the aim of which is to facilitate such integration. The model draws on current theories of anorexia nervosa, as well as general concepts from psychodynamic, developmental, and family systems theories. The major hypothesis of the model is that all members of the anorexic family are developmentally arrested in the area of separation-individuation. On this assumption, we propose that the entire treatment team (including medical professionals and therapists) needs to function as “parents” to the anorexic family in much the same way that two cotherapists become parental figures in family therapy. Specifically, the team needs to provide those parenting responses that facilitate the family's individuation process.     

An Island Entire of Itself: Narcissism in Anorexia Nervosa

ABSTRACT

This article explores the idea of anorexia nervosa as a narcissistic disorder, in which the denial of the need for food symbolically represents a denial of the need for relatedness and dependence. Narcissism is a state in which self and object are undifferentiated and all objects are felt to be within the individual’s omnipotent control. Primary narcissism occurs when the capacity for object relations has never developed and secondary narcissism develops as a defense against dependence which is associated with overwhelming anxiety, envy, or fear of disappointment. Both processes can occur in anorexia nervosa, which provides a cognitive and behavioral framework for the expression and maintenance of the narcissistic position. Narcissistic anorexia is a state of omnipotent isolation in which the patient denies one of her most basic needs and rejects a powerful source of connection with the outside world. An important aim of therapy is to help the patient to develop a capacity for object relations and to be able to acknowledge dependence. This is achieved through coming to experience the therapist as separate and real and requires the therapist to resist being taken over by the patient’s projections.     

Anorexia Nervosa,Buliminarexia, and Bulimia

No abstract available for this article.     

Inpatient Brief Group Therapy for Anorexia Nervosa: Patient Experience

There is increasing interest in group therapy for the treatment of eating disorders. However, there is a lack of research evaluating group therapy that reflects on patient feedback in order to inform practice and improve treatment. This exploratory qualitative study attempted to evaluate patient feedback about the group therapy offered on a specialist inpatient eating disorders program. This qualitative analysis of patients’ feedback highlights areas for improvement that can be targeted to increase the effectiveness of the psychotherapy groups in the future. The research has implications for making inpatient hospitalization more effectively tailored to patients’ needs. This study also helps to improve qualitative research protocols.     

Adolescent Focused Psychotherapy for Adolescents with Anorexia Nervosa

The paper describes a manualized specific form on individually based developmentally oriented therapy for Anorexia Nervosa (AN) in adolescents. Adolescent focused psychotherapy for AN is derived from a self-psychology model and is designed to address key deficits in development associated with AN. Adolescents with AN are viewed as using food and weight to avoid negative affective states associated with adolescent developmental issues that they perceive as intolerable. To develop a more constructive coping style and improve self-efficacy, adolescent patients need to first learn to identify and define their emotions, and later, to tolerate emotions, particularly negative ones. In withdrawing from the environment and situations which provoke distress through self-starvation and preoccupations with food and weight, emotional and psychological development is arrested. Learning to identify and cope adaptively with emotions and developmental challenges presented by the environment form the key therapeutic targets of treatment. Specific therapeutic procedures, a case illustration and discussion of therapeutic rationale are also provided.     

The Entropic Body: Primitive Anxieties and Secondary Skin Formation in Anorexia Nervosa

This paper develops a metapsychological view of anorexia nervosa, including not only its symptomatic presentation but also its etiology and characteristic psychic and relational styles. Because patients with anorexia are understood as not having internalized maternal comforting functions in the period of separation-individuation, they are unable to digest trauma experiences of infancy. I argue that the anorexic patient’s disturbed relationship with food reflects distortions in transitional object usage. Lacking the ability to contain intense anxieties about disintegration and falling apart, patients with anorexia must find other ways to hold themselves together. The fear of getting fat expressed by these patients is one way that this fear of disintegration is expressed. Furthermore, the almost addictive experience of emaciation holds the personality together. Elaborating this idea, I develop the notion of the entropic body, a particular version of the false body (Goldberg, 2004) employed by patients with anorexia nervosa in an attempt to compensate for absent maternal comforting functions. This body-state (Petrucelli, 2014), which develops against a background of profound early trauma, eschews hunger and dependence in favor of omnipotently controlled protection.     

Occupational Therapy in the Rehabilitation of the Patient with Anorexia Nervosa

The first part of this paper develops an ecological and rehabilitative stance for the occupational therapist in relation to the anorexic patient. Maximizing the individual's level of psychosocial functioning is regarded as the primary aim of treatment. A model for approaching the anorexic patient is described which examines environmental factors, and the importance of assessment and follow up. The cognitive behavioral approach is discussed and suggestions are made for adapting it to the occupational therapist's orientation towards practical activity. In the second part of the paper concrete suggestions for therapy are made.     

Anorexia Nervosa in Adolescence and Maudsley Family‐Based Treatment

Anorexia nervosa is a serious psychiatric disorder that usually occurs in adolescence. The course of the illness can be protracted. Current empirical evidence suggests that the Maudsley Family‐Based Treatment (MFBT) is efficacious for adolescents. MFBT empowers parents as a crucial treatment resource to assist in their child's recovery. The authors review the diagnostic criteria and course of anorexia in adolescence, present empirical evidence and key theoretical concepts of MFBT, and provide a case study.     

Futility in Chronic Anorexia Nervosa: A Concept Whose Time Has Not Yet Come

Comparatively little scholarly attention has been given to the question of futility in chronic psychiatric disorders, with the exception of a small body of work on so-called end-stage anorexia nervosa (AN). A review of this literature provides the background for a critical examination of whether the concept of futility has any clinically meaningful, ethically justifiable, and legally defensible application to AN. In this article, the arguments for and against futility judgments in AN are analyzed with special emphasis on determinations of capacity in this serious mental illness. Parallels between the futility disputes in medical and psychiatric disorders, where applicable, will be drawn to further illuminate whether or not the concept that continued psychiatric treatment for AN is ever truly futile.     

Childhood anxiety associated with low BMI in women with Anorexia Nervosa

Objective

Extremely low body mass index (BMI) values are associated with increased risk for death and poor long-term prognosis in individuals with anorexia nervosa (AN). The present study explores childhood personality characteristics that could be associated with the ability to attain an extremely low BMI.

Methods

Participants were 326 women from the Genetics of Anorexia Nervosa (GAN) Study who completed the Structured Interview for Anorexia Nervosa and Bulimic Syndromes and whose mother completed the Child Behavioral Checklist and/or Revised Dimensions of Temperament Survey.

Results

Children who were described as having greater fear or anxiety by their mothers attained lower BMIs during AN (p < 0.02). Path analysis in the GAN and a validation sample, Price Foundation Anorexia Nervosa Trios Study, confirmed the relation between early childhood anxiety, caloric restriction, qualitative food item restriction, excessive exercise, and low BMI. Path analysis also confirmed a relation between childhood anxiety and caloric restriction, which mediated the relation between childhood anxiety and low BMI in the GAN sample only.

Conclusion

Fearful or anxious behavior as a child was associated with the attainment of low BMI in AN and childhood anxiety was associated with caloric restriction. Measures of anxiety and factors associated with anxiety-proneness in childhood may index children at risk for restrictive behaviors and extremely low BMIs in AN.