A Description of the Continuum of Eating Disorders: Implications for Intervention and Research

Many authors have proposed the notion of an eating disorder continuum to aid in the understanding of similarities and differences among various types of eating disturbances and disorders. The purpose of this article is to present an eating disorders continuum and to describe groups on the continuum by highlighting differences among the groups on behavioral, cognitive-attitudinal, and self-esteem issues. The relationship of the continuum to the developmental course of eating disorders is discussed. Prevention, early intervention, and treatment programs for various groups on the continuum are presented. Recommendations for future research on the continuum of eating disorders are provided.     

Psychological and Physychological Changes with the Menstrual Cycle: Implications for Counselling

Throughout the reproductive years, from around age 13 to about 5o, the menstrual cycle provides continual, mainly positive, changes in the internal environment of women. This cycle of change is an integral and influential part of normal existence. Knowledge of the reproductive cycle and of its effects is essential to a full understanding of women. This paper describes each phase of the cycle in terms of broad psychological and physiological changes. Although personal and social events will clearly affect each woman's experience, it is clear that a background climate is set by the cycle which predisposes towards certain feelings and behaviour.With information and advice, not only can there be great benefit from the whole menstrual cycle, but any distress in the premenstrual days can be alleviated. More serious menstrual disorder should be appropriately investigated, preferably with continued counselling support.The counsellor must first discover whether any menstrual disorder is a central problem, or possibly an exacerbating factor. Occasionally the cycle is made a focus for problems which have a quite different basis. In all cases the counsellor can help women to turn to good account a biological cycle which is predominantly favourable.     

The Children of Mothers with Eating Disorders

There is good evidence that children of parents with psychological disorders are themselves at increased risk of disturbances in their development. Although there has been considerable research on a variety of disorders such as depression and alcohol, research on the children of parents with eating disorders has been relatively recent. This paper aims to review the evidence and covers a number of areas, including genetic factors, pregnancy, the perinatal and postpartum period, infancy, and the early years of life, focusing on feeding and mealtimes, general parenting functions, and growth. This is followed by a consideration of psychopathology in the children, parental attitudes to children's weight and shape, and adolescence. What is clear is that although there are numerous case reports and case series, the number of systematic controlled studies is relatively small, and almost nothing has been written about the children of fathers with eating disorders. What is evident from the available evidence is that children of mothers with eating disorders are at increased risk of disturbance, but that the risk depends on a variety of factors, and that difficulties in the children are far from invariable. The paper concludes by summarizing five broad categories of putative mechanisms, based on the evidence to date, by which eating disturbance in parents can influence child development.     

Social Change and Marital Problems: Implications for Marriage Counselling

There are many reasons why people experience marital dissatisfaction. This paper is concerned with those who experience dissatisfaction not as a result of individual personality problems but as a result of the impact of social change on contemporary marriage. On the whole, these people are emotionally mature even if they present, initially, with 'clinical' symptoms. The paper identifies the effect of social change on such couples and suggests an approach to marriage counselling designed specifically to meet their needs. Background material is provided by a study of 40 couples seen for marriage counselling in a psychiatric clinic.     

Health-Related Quality of Life in Women with Eating Disorders: Association with Subjective and Objective Binge Eating

This study examined health-related quality of life (QOL) and its association with different forms of binge eating in 53 women with eating disorders. Participants had enrolled in treatment for anorexia nervosa, bulimia nervosa, binge eating disorder, or other eating disorders not otherwise specified and completed measures of QOL, eating-related psychopathology, and mood disturbance. Eating- and mood-related psychopathology, and to a lesser extent, mental-component QOL scores, were severely impaired in this sample relative to population norms. QOL was significantly and independently predicted by subjective bulimic episodes and compensatory behaviors, including food avoidance, laxative abuse, and self-induced vomiting, accounting for 32% of the variance. Subjective bulimic episodes and food avoidance also independently predicted the physical-component QOL, accounting for 27% of the variance. These findings suggest that subjective bulimic episodes may be independently associated with impairment in QOL and may require specific attention as targets of treatment.     

Eating Disorders in Men: Current Considerations

Over the past two decades, there has been a change in the way men think about their bodies. The media portrays images of men with muscular bodies and a six pack abdomen. These images can create body dissatisfaction in males. With the change in the way that the media and society in the United States look at men, so has the drive for men to achieve this ideal body image. Eating disorders, body dysmorphia, and strict exercise and diet regimens seem to plague young men as do the images in advertisements. Although eating disorders in men are similar to what women experience, men seem to strive for more body mass whereas women try to obtain thinness. Gay men and heterosexual men seem to experience eating disorders in the same way although there are differences between how they perceive their bodies. This paper outlines how the media contributes to body dissatisfaction in men. In addition to understanding how the media affects men, it is important to review and possibly revise out understanding of eating disorders and body dysmorphia symptoms to gain a solid understanding of how these symptoms appear in men today.     

Eating Disorders on Campus: A Procedure for Community Intervention

Concern for students with eating disorders and concern for the environment served as the catalyst for the development of a procedure for responding to eating disorders. The procedure, which relies heavily on residence hall staff, is presented here, with emphasis on training, prevention, and issues in implementation.     

Fairy Tales: Visions for Problem Resolution in Eating Disorders

This article introduces a framework that uses fairy tales, such as Cinderella, as a vision-to-action treatment alternative for psychological dysfunctions focusing on eating disorders. Clinical examples are provided that integrate guided imagery, cognitive reframing, and behavioral assignments.     

The Effectiveness of Encounter Groups: Implications of Research for Counselling Practice

In the past decade, encounter groups have become a widely recognised technique of intervention for counsellors. Empirical research on encounter groups is confusing. Trends in research are obscured by a diversity of definitions, methodologies and subjects. This review considers the most significant research on the effectiveness of encounter groups, focusing on positive and negative effects, leader behaviour, group characteristics, participant characteristics, and the maintenance of change. Conclusions are drawn relating the research to practice, with some suggested guidelines for use of encounter groups in counselling interventions.     

Career Indecision: A Summary of the Research and Implications for Counselling

The vocationally-indecisive individual presents a major counselling problem. The theory and research behind career indecision is discussed and a counselling approach based on identity formation is outlined. Four identity statuses — Identity Achievements, Foreclosures, Identity Diffusions, and Moratoriums — are described and counselling approaches for each are explored.     

Transdiagnostic Theory and Application of Family-Based Treatment for Youth with Eating Disorders

This paper describes the transdiagnostic theory and application of family-based treatment (FBT) for children and adolescents with eating disorders. We review the fundamentals of FBT, a transdiagnostic theoretical model of FBT and the literature supporting its clinical application, adaptations across developmental stages and the diagnostic spectrum of eating disorders, and the strengths and challenges of this approach, including its suitability for youth. Finally, we report a case study of an adolescent female with eating disorder not otherwise specified (EDNOS) for whom FBT was effective. We conclude that FBT is a promising outpatient treatment for anorexia nervosa, bulimia nervosa, and their EDNOS variants. The transdiagnostic model of FBT posits that while the etiology of an eating disorder is unknown, the pathology affects the family and home environment in ways that inadvertently allow for symptom maintenance and progression. FBT directly targets and resolves family level variables, including secrecy, blame, internalization of illness, and extreme active or passive parental responses to the eating disorder. Future research will test these mechanisms, which are currently theoretical.     

Counselling women with post natal depression: Implications from recent qualitative research

This paper explores the role of the counselling psychologist with women who experience post natal depression. Traditionally post natal depression has been identified as a clinical condition, and the woman referred for psychiatric assessment; or it is seen as the result of stressful childbirth and associated events, and the woman is offered treatment by her GP or referred to a post natal support group. A recent study suggests that some degree of depression following childbirth is ‘normal’, and that far from being a clinical condition, its origins appear to be located in the context of problematic relationships (in both domestic and obstetric settings) as well as in women's expectations and inadequate preparation for childbirth and early motherhood. These expectations seem to be embedded in female psychology and wider cultural values. Women appear to be prepared for the fact that they will bear and mother children, but not the experience of motherhood itself, and consequent changes in identity and relationships are rarely made explicit. This study suggests that childbirth and the early months of motherhood (even for second and third children) are likely to precipitate some degree of depression in most women, and that this depression appears to be reactive rather than determined by individual pathology. Further, the experience of becoming a mother (each time) equates with a model of loss and bereavement, suggesting a very specific role for the counselling psychologist.     

Disorders of Eating in the Elderly

The most common eating disorder in the elderly in both community and hospital settings is food refusal. This may lead to weight loss and malnutrition with all the adverse consequences on independence and function. The management of disorders of eating in the elderly is a diagnostic and therapeutic challenge, requiring the combined skills of the medical and nursing staff. The causes are often multifactorial and require careful and repeated assessment of the patient's social, psychological, and medical history. Approach to treatment involves these factors, as well as ethical and cultural considerations. Eating is the most basic biological drive for survival in nature. In human societies there are additional cultural and social aspects that may override this instinct, as in the case of hunger strikes for political motives. In the elderly, food is one of the major sources of possible pleasure and it is the challenge for health providers to try and give this enjoyment to their patients for as long as possible.     

Assessment and Diagnosis of Eating Disorders: A Guide for Professional Counselors

Despite the prevalence of and risk associated with disordered eating, there are few guidelines for counselors on how to conduct an eating disorder assessment. Given the importance of the clinical interview, the purpose of this article is to provide recommendations for the assessment and diagnosis of eating disorders that (a) specifically focus on assessment in the context of a clinical interview and (b) can be used by counselors whether or not they specialize in eating disorder treatment.     

Nutritional Intervention in Young Women with Eating Disorders: A Brief Report

Eating disorders in young women are often associated with a number of comorbid conditions, including mood disorders and cognitive problems. Although group therapy is often used as part of overall treatment for eating disorders in many types of settings, specific nutritional interventions used in such settings have rarely been evaluated. In this study, I evaluated the effects of a nutritional intervention used by 78 girls, aged 12–18 years, at a private school. My results showed that nutritional knowledge increased following intervention, but attitudes toward eating healthy did not change.     

Enhanced Cognitive Behavior Therapy: A Single Treatment for All Eating Disorders

Eating disorders are serious mental illnesses affecting a significant proportion of women and a smaller number of men. Approximately half of those with an eating disorder (ED) will not meet the criteria for anorexia or bulimia nervosa, and will be diagnosed with an eating disorder not otherwise specified (EDNOS). Until recently, there were no recommended treatments for EDNOS. This article provides an overview of enhanced cognitive behavior therapy, a validated treatment for all forms of EDs.     

Acceptance and Commitment Therapy for Eating Disorders: Rationale and Literature Review

Empirical studies using Acceptance and commitment therapy (ACT) and its components to treat eating disorders (EDs) were reviewed. Evidence suggests that emotional avoidance is a major component in the onset and maintenance of EDs. Acceptance and commitment therapy targets emotional avoidance and control strategies with six core processes. These core processes have been applied to EDs and demonstrated improvement in subjects’ functioning and reduction in disordered eating. There are several advantages of using ACT for treating EDs: ACT fundamentally equalizes the therapeutic relationship; experiential techniques in ACT may facilitate lasting treatment gains; ACT navigates the ego-syntonic nature of EDs; the ACT conceptualization based on experiential avoidance and cognitive rigidity in EDs is consistent with current literature. The six core processes of ACT can be further modified to fit the challenges of treating EDs. Specifically, concerns about client motivation for treatment can be addressed by emphasizing creative hopelessness and a values construction process earlier in treatment.