A Relational Cultural Approach to Working With Clients With Eating Disorders

The authors examine eating disorders through the conceptual framework of relational cultural theory (RCT). Taking into account the importance of relationships and connection, it is suggested that RCT may be a useful lens for conceptualizing and working with people who are experiencing eating disorders. Ways that RCT can be applied to enhance prevention efforts and recommendations for combining relationally focused counseling with evidence‐based individual eating disorder treatment are presented.     

Spirituality and Ten False Beliefs and Pursuits of Women With Eating Disorders: Implications for Counselors

Women with eating disorders often struggle with deep spiritual conflicts that can be a major impediment to their recovery. On the basis of clinical experience with more than 350 women in an inpatient eating disorder treatment facility, the authors describe 10 false beliefs that women with eating disorders may hold; the authors explain how the pursuit of these beliefs can prevent the women from connecting with God and with others in genuine ways. The authors also suggest some therapeutic strategies that may help women with eating disorders find a healing and helpful spiritual perspective.     

Eating Disorders in African American Girls: Implications for Counselors

Given the recent focus on eating disorders in children, it is imperative that counselors consider eating concerns that affect children of all racial and ethnic groups and hence are effective in working with this population. The author discusses risk factors that potentially contribute to eating disorders in African American girls given their unique socialization experiences as racial and ethnic minorities. Also, the author provides strategies for developing effective and culturally responsive counseling interventions to work with this population.     

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.     

Moving From Efficacy to Effectiveness in Eating Disorders Prevention: The Sorority Body Image Program

Although eating disorders prevention research has begun to produce programs with demonstrated efficacy, many such programs simply target individuals as opposed to engaging broader social systems (e.g., schools, sororities, athletic teams) as participant collaborators in eating disorders prevention. Yet, social systems ultimately will be responsible for the real-world delivery of eating disorder prevention programs, suggesting that an important issue has yet to be addressed. Namely, it is unclear to what degree efficacious individual-focused eating disorder prevention programs remain effective when incorporated into critical social systems under real-world conditions. Over the past 5 years, we have collaborated with the campus sororities in the development of a sustainable eating disorders prevention program that is based on the prevention efficacy literature. This paper describes both challenges and helpful strategies that we encountered in tailoring an evidence-based eating disorders prevention program to the needs of a relevant social system.     

The Continuum Versus Categorical Debate on Eating Disorders: Implications for Counselors

The authors summarize a study by D. A. Williamson et al. (2002) in which clinical groups with anorexia nervosa, bulimia nervosa, eating disorder not otherwise specified, and binge eating disorder were contrasted with nonclinical groups of participants (i.e., obese and normal weight). The eating disorder groups were qualitatively different. Also, bulimia nervosa, purging and nonpurging types, may fall on a continuum of pathology with the binge‐eating, purging type of anorexia. Anorexia nervosa, restricting type, may be distinct from bulimia nervosa, purging and nonpurging types, and the binge‐eating, purging type of anorexia.     

Individuals With Visual Disabilities and Substance Use Disorders: Recommendations for Counselors

Given the prevalence of substance use disorders in individuals with visual disabilities, counselors must be prepared to address the distinctive needs of this population. The authors summarize evidence‐based interventions, offer contextual considerations, and provide recommendations for counselors.     

Body Weight and Body Image Among College Women: Perception,Cognition, and Affect

This study examined the relations between body weight and multiple parameters of body image in a nonclinical sample. Thirty-six female undergraduate students with stable body weights served as subjects; 12 were underweight, 12 were normal weight, and 12 were overweight, as determined using recent normative tables. Each subject responded to a general weight information questionnaire and to the BodySelf Relations Questionnaire, a standardized instrument assessing affective, cognitive, and behavioral components of appearance-related body image. A newly developed apparatus and procedure for estimating body size, the Body Image Detection Device, was utilized for perceptual and cognitive measures of body image. Each subject estimated and also subjectively appraised the width of her own body at five points and that of a realistic female mannequin. A caliper was used to record actual widths, and a standard laboratory scale and rule measured weight and height. The general finding of the study was that the perceptual, affective, and cognitive components of body image differed as a function of body weight, but the nature of the differences varied with the measure employed. The pattern of results for the perceptual measure suggest a cautious view of its reliability and validity. The multidimensional approach of our study, in marked contrast to earlier fractionated studies, offers a more integrated perspective on body image and provides new directions for future research.     

The Influence of Television and Film Viewing on Midlife Women's Body Image,Disordered Eating,and Food Choice

A recent trend in screen media is the casting of older women who have bodies that are the shapes and sizes of younger women. These aging beauties can be found in shows such as Cougar Town and Desperate Housewives. It was predicted that heavy viewers of these media would report stronger eating disorder symptomatology, greater body ideal discrepancies, and stricter food choices than light viewers. Participants were 166 midlife women (M: 44.57 years) who completed an online questionnaire that asked about body ideals, disordered eating, food choices, and exposure to aging beauty programming. Results demonstrate that media exposure was associated with stronger reports of disordered eating, greater discrepancies between actual body size and both women's ideal body size as well as perceptions of how others wanted them to look, and stricter food choices when around other people. Ideal self-discrepancies mediate the association between aging beauty media and disordered eating symptomatology. Our study builds on extant work related to media consumption, body concerns, and eating behaviors among a non–college-aged sample.     

Eating Issues in Schools: Detection,Management, and Consultation With Allied Professionals

School counselors play a crucial role in the prevention, assessment, treatment, and overall management of eating‐related problems among children and adolescents. This article provides a framework for conceptualizing these difficulties on a continuum of severity and includes recommendations at each level for intervention and consultation. Collaboration with other professionals is encouraged when confronted with these multifaceted issues. Efforts by school counselors are vital to prevention and recovery from eating disorders.     

Intuitive Heuristics Linking Perfectionism, Control, and Beliefs Regarding Body Shape in Eating Disorders

A number of correlational studies have established a clear association between perfectionism, control and beliefs regarding body shape in eating disorders (EDs). The aim of this study is to test the effectiveness of the above- mentioned associations in exploring the presence of intuitive heuristics. Intuitive heuristics can be conceived as as mental shortcuts, cognitive processes that are highly susceptible to irrational biases. Forty one non clinical female controls and 27 in-patient females with an ED diagnosis participated in an experimental task that tested whether participants would show an intuitive rather than a logically based link between perfectionism in different domains (study, work, hygiene) and a thin body shape. In the healthy female participants the occurrence of proposed link was noted in the hygiene domain only, while ED participants showed this intuitive association in all the domains explored: study, work, and hygiene. The study confirms in clinical ED sample a wider employment of heuristics associating perfectionism and thinness that is based on purely intuitive irrational reasoning.     

Associations Between Impulsivity and Body Dissatisfaction in Females at Risk for Developing Eating Disorders

Sixty-one women (40 at-risk for an eating disorder based on the Screening Instrument for Identifying Individuals at Risk for Developing Anorexia and Bulimia Nervosa, SCANS) completed a self-report packet of questionnaires concerning executive function, impulsive behavior, mood, anxiety, delayed discounting and measures of body image dissatisfaction. Results revealed that the at-risk group were more depressed, had lower motivation, displayed more empathy, were more anxious (state and trait) and had a greater impulse behavior of urgency.     

Perfectionism and Eating Attitudes In Competitive Rowers: Moderating Effects of Body Mass,Weight Classification and Gender

Abstract

One purpose of the present research was to determine the relationship between perfectionism and eating attitudes among national level rowers. A second purpose was to determine if body mass, weight classification and gender moderate perfectionism-eating attitude relations. Rowers from New Zealand and Australia (W=449) completed the Positive and Negative Perfectionism Scale (PANPS; Terry-Short, Owens, Slade and Dewey, 1995), the Eating Attitude Test-40 (EAT-40; Garner and Garfinkel, 1979), and the Short Form of the Marlowe-Crowne Social Desirability Scale (MC-SDS; Reynolds, 1982). In addition, a Body Mass Index (BMI) was calculated from the height and weight measurements of each participant. Hierarchical multiple regression analyses showed that, after accounting for social desirability effects. Negative (unhealthy) Perfectionism scores were positively related to disturbed eating attitude scores, whereas Positive (healthy) Perfectionism scores were unrelated to disturbed eating attitude scores. In addition, body mass, weight classification and gender operated in a conjunctive fashion to produce a maximum moderator effect. That is, relations between Negative Perfectionism and disturbed eating attitudes were strongest for female lightweight rowers with higher BMI scores. Recommendations for future research are discussed.     

Assessment Methods for Eating Behavior,Food Intake and Food Preferences

Abstract

A survey is provided of methods for the assessment of food intake and eating behavior in clinical and research contexts. Five methods of dietary assessment in the epidemiological tradition are presented: dietary history, 24-hour recall, 7-day recall, 7-day record and food-frequency. Behavioral measures of eating behavior, food choice, food preference and hunger are presented and studies of their reliability and validity and other methodological properties are reviewed. Methodological recommendations and suggestions for future research are provided.     

Working Through Countertransference: Navigating Between Safety and Paranoia for a Client With Complex Trauma History and Borderline Personality Organization

The aftermath of complex trauma deeply impacts one's self-organization and interpersonal relationships, often resulting in clients who present to therapy with borderline characteristics and are typically labeled as difficult to treat. Further clinical complications with paranoid features may quickly place the therapist at a loss with respect to managing perceived and/or actual threats to client safety. Using psychodynamic theories, especially Kleinian understandings of psychosis and Winnicottian approaches to early disturbance and its impact on the emergence of self, this article provides a detailed case illustration that explores how a critical reflection of countertransference as “enactment,” “communication,” and “imagination” can help the therapist to understand the client's unconscious symbolic psychic struggles and to guide treatment selections in the therapy process.