Schwere Anorexia nervosa

Background

Psychosomatic support during acute medical treatment of patients with anorexia nervosa is a special need but up to now a rare constellation. These patients can barely accept necessary somatic procedures even if they suffer from severe consequences of the eating disorder. The ambivalence of patients towards treatment is explained by the loss of the right perception of their bodies and the strong obsession with further weight loss.

Methods

This article reports on eight consecutively treated patients on a medical ward who received a liaison psychosomatic, psychotherapeutic visit twice a week. The aim was to maintain better therapy adherence, to support oral food intake and understanding of the disorder as well as to motivate patients for further psychosomatic treatment.

Results

By means of a respectful cooperation between the departments of internal medicine and psychosomatics it was possible to gain psychotherapeutic access to the patients in this highly complicated situation.

Consequence

The psychodynamic aspects of this collaboration are discussed with a focus on the triangulation of the therapeutic process.     

Anorexia nervosa och beteendeterapi

Efter en kort beskrivning av den historiska utvecklingen av beteendeterapeutisk behandling av anorexia nervosa följer en redogörelse för en kontrollerad studie av verksamma komponenter i en operant behandlingsmetod. Avslutningsvis beskrivs den praktiska tillampningen av en klinisk metod, samt påpekas vikten av att in—kludera patienteris naturliga miljö i behandlingen     

Anorexia nervosa and oversized experiences

In this paper, I discuss what I call the oversized experiences that anorexic patients suffer from. It has been known for some time that anorexic patients mentally picture their bodies as larger than reality. While this constitutes one kind of oversized experience, I claim there is another, less explored kind. This is an experience of the body as oversized in relation to the affordances of its environment. I discuss recent evidence suggesting anorexic patients exhibit distorted affordance perception. I then discuss how this distorted affordance perception also constitutes an oversized experience of the body. Along with sociocultural influences, I claim oversized experiences ground negative propositional attitudes regarding body size.     

Anorexia nervosa: treatment satisfaction

Patient satisfaction plays a central role in treatment alliance and outcome. Investigating patient expectations and experiences of treatment sheds light on its importance. This study examines adolescent anorexia nervosa patients and their parents' satisfaction with family‐based treatment. Patients and parents answered a questionnaire at the eighteen‐month follow‐up focusing on expectations and experiences of treatment, therapists, aims of treatment and accomplishment. The results show that 73 per cent of the patients and 83 per cent of the parents felt that their pre‐treatment expectations had been fulfilled. The majority agreed that individual patient sessions and parental sessions were of great help, while the patients valued family therapy sessions as being less helpful than did parents. In overall terms, parents were more pleased with the therapists than were the patients. These data suggest that family‐based treatment with individual sessions for patients, in parallel with parental sessions combined with family sessions, corresponds well to patients' and parents' treatment expectations.     

Fokale psychodynamische Psychotherapie der Anorexia nervosa

The paper presents a manual for the focal psychodynamic psychotherapy of anorexia nervosa (AN). The manual was developed in the context of the largest randomized controlled trial of outpatient psychotherapy for AN so far [Anorexia Nervosa Treatment of OutPatients (ANTOP), n=234]. The study compares focal psychodynamic psychotherapy with cognitive-behavioral therapy and with a control group with free choice of therapy outside the study. The manual comprises instructions for the working through of typical focal emotional and interpersonal issues of AN. Also recommendations for anorexia-specific therapeutic difficulties in the course of treatment are given. First results concerning the efficacy of the therapies carried out based on the manual are expected after completion of the ANTOP study in the middle of the year 2010.     

Anorexia nervosa: The counsellor's role

Thispaper is an attempt to describe and examine the role of the counsellor in relation to anorexia nervosa. The condition is analysed in terms of its social and psychological factors. The need for control and self-mastery is put forward as a dominating characteristic. The role of refeeding in anorexia is discussed, with the suggestion that the attitudes of anorexies and their doctors need to be understood as a whole. Finally, the counselling possibilities are suggested, and the position of the counsellor vis-à-vis the refeeders is discussed.     

The Gnostic Syndrome: Anorexia nervosa

‘The Gnostic Syndrome’ discusses anorexia nervosa in terms of its poetics and in the context of a developmental object-relations theory. One case is used to illustrate the problems of therapy and the antecedents of the anorexia in childhood and adolescence. The paper forms an investigation into pre-moral states and the interaction of anorexia with character structure.     

Anorexia nervosa: A pastoral update

Anorexia nervosa is a disorder of unknown etiology that is a complex of physical, emotional, and behavioral changes occurring in individuals who starve themselves. The incidence of this disease has increased dramatically in the last twenty years. Most patients seem to be unaware of or unconcerned about their emaciation. After presenting a case, this study reviews the most recent findings about this disease, including the symptoms, social characteristics of its victims, increaed incidence, history, and prognosis. Suggestions are offered for pastoral care and counseling.     

Ambulante manualisierte Verhaltenstherapie bei Anorexia nervosa

Anorexia nervosa is a serious illness leading to high morbidity and mortality. Its treatment poses a particular challenge to psychotherapists offering outpatient treatment. Often therapists follow or work according to a treatment manual. Supervision in the treatment of anorexia nervosa patients intends to promote quality assurance as well as to foster therapists’ mental hygiene. It offers the opportunity to collect plenty of practical experiences. Some of these will be presented here to provide suggestions and support to therapists working with anorexia nervosa patients. Certain treatment modules of cognitive-behavioral therapy (CBT) such as motivation, eating behavior, case formulation and relapse prevention will be considered. Regarding the therapist-patient relationship ambivalent relation shaping and motivational interviewing will be targeted.     

Anorexia nervosa masculina--concordance in monozygotic twins

The case report presents the courses of the disease of an infantile-juvenile masculine monozygotic pair of twins suffering from anorexia nervosa. Beginning, therapy and result turned out differently in spite of a commonly suffered disease. Already the importance of smaller differences in their personality development as well as the merit of the intrageminate dynamic of parts are worked out.     

Anorexia nervosa: the tyranny of appearances

This paper explores the possibility that many families of anorexics are overly preoccupied with appearances, valuing what other people think of them more than healthier families do, and that this influences the origin and maintenance of anorexia. This‘rule’is simple and should be open to testing more widely through research.     

Anorexia nervosa treated with response prevention and prolonged exposure

This paper presents two cases of anorexia nervosa who became overweight following an operant behavioral inpatient treatment program which, in addition, included prolonged exposure to phobic stimuli and response prevention of compulsive exercising.     

Anorexia nervosa: a misdiagnosis of the adolescent male

The rarity of anorexia nervosa among the male population is discussed with primary reference to differences from female symptomology. A case is presented which implies that anorexia nervosa in the male may be a marker for other more severe pathology. These findings suggest a diagnostic strategy based on familial, behavioral, environmental, educational, and psychological factors.     

Anorexia nervosa and brain tumor in a 14-year-old girl

A 14-year-old girl with anorexia nervosa (AN) was found to have an intracranial neoplasm. Atypical psychological symptoms prompted further evaluation, including electroencephalogram and neuroimaging, which revealed a sellar and suprasellar mass. This patient had an eating disorder and a brain tumor, which appear to be two unrelated conditions. However, it remains unclear how each affected the other. The diagnosis of AN, like all other psychiatric disorders, requires that possible medical etiologies and coexisting medical problems be excluded. AN and other eating disorders are particularly difficult to diagnose in children and adolescents because they often do not present in the manner typical of adults. Perceptual and cognitive disturbances associated with AN are difficult to evaluate because children and adolescents normally change over time as they progress through different stages of development. Therefore, it is particularly important to evaluate for the presence of medical conditions when a diagnosis of an eating disorder is made in a child or adolescent.     

Anorexia nervosa in association with diabetes mellitus--a cognitive-behavioural approach to treatment

A case of anorexia nervosa occurring in a patient with diabetes mellitus is reported. The patient was successfully managed using a cognitive-behavioural treatment approach. The presence of diabetes necessitated certain modifications to the standard cognitive-behavioural treatment for anorexia nervosa, including self-monitoring of diabetic regimen behaviours, attention to the adequacy of glycaemic control, and advice about changes in insulin dosage. Cognitive restructuring techniques also had to address diabetes-related thoughts. The general applicability and cost-effectiveness of this type of approach for the treatment of patients with co-existing eating disorders and diabetes is discussed.     

Anorexia nervosa and autism spectrum disorders: guided investigation of social cognitive endophenotypes

Death by suicide occurs in a disproportionate percentage of individuals with anorexia nervosa (AN), with a standardized mortality ratio indicating a 57-fold greater risk of death from suicide relative to an age-matched cohort. Longitudinal studies indicate impaired social functioning increases risk for fatal outcomes, while social impairment persists following recovery. Study of social cognition in AN may elucidate impaired processes that may influence therapeutic efficacy. Symptoms of autism spectrum disorders (ASD) are overrepresented in those who evidence a chronic course. Relative to that in AN, social information processing in ASD is well characterized and may inform systematic study in AN. This article (a) reviews impaired interpersonal processes in AN, (b) compares the phenotype of AN with that of ASD, (c) highlights deficits of social cognitive disturbance in ASD relative to AN, and (d) proposes a new framework to understand the interaction of individuals with AN with their social context.