Anorexia Nervosa,Buliminarexia, and Bulimia

No abstract available for this article.     

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.     

Dialectical Behavior Therapy of Anorexia and Bulimia Nervosa Among Adolescents: A Case Series

The aim of this study was to describe a case series of adolescents (mean age = 16.5 years, SD = 1.0) with anorexia nervosa (AN) and bulimia nervosa (BN) who received dialectical behavior therapy (DBT). Twelve outpatients with AN and BN took part in 25 weeks of twice weekly therapy consisting of individual therapy and a skills training group. Family members were involved in the treatment. The patients were compared pre- and posttreatment on behavioral symptoms of AN and BN and symptoms of general psychopathology using standardized instruments (Structured Inventory for Anorectic and Bulimic Syndromes, Eating Disorder Inventory-2, The Symptom Checklist-90-Revised). Posttreatment, significant improvements in behavioral symptoms of eating disorder and symptoms of psychopathology were identified. The application of DBT adapted for the treatment of AN and BN among adolescents was associated with a decrease in behavioral symptoms of eating disorders and symptoms of general psychopathology. However, randomized controlled studies are required to prove the efficacy of this approach.     

Eating Behaviors Which May Lead to and Perpetuate Anorexia Nervosa,Bulimarexia, and Bulimia

No abstract available for this article.     

Morita-Based Therapy and Its Use Across Cultures in the Treatment of Bulimia Nervosa

In this article the author presents an overview of classical inpatient Morita therapy, contrasts it with features of rational emotive therapy (RET), and illustrates an intervention program (based on Shoma Morita's theory and practice) for women suffering from bulimia nervosa. Given that Morita therapy is scantly documented in the literature as an outpatient treatment outside Japan, a session-to-session short-term treatment methodology that was used for a pilot study in Australia is provided. A case example is presented with direct dialogue from treatment sessions.     

Treatment of Body Image Dissatisfaction Among Women With Bulimia Nervosa

Body image dissatisfaction contributes to the development and maintenance of bulimia nervosa. Many women with bulimia are unhappy with their body's appearance and yearn to attain the thin shape glamorized by our culture. This obsession breeds low self-esteem, feelings of inadequacy, and resistance to recovery from bulimia. This article offers treatment suggestions for body image dissatisfaction as it relates to bulimia. Counselors must be comfortable with their own bodies and must be cognizant of sociocultural dictates demanding a thin body for women.     

Addressing Weight Suppression to Improve Treatment Outcome for Bulimia Nervosa

Cognitive behavioral therapy (CBT) is regarded as the gold-standard treatment for bulimia nervosa (BN), yet despite impressive empirical support for its effectiveness, over 50% of patients fail to achieve abstinence from binge eating and purging by the end of treatment. One factor that may contribute to reduced efficacy rates in CBT is weight suppression (WS; the difference between a person's highest weight ever at their adult height and current weight). A growing body of research indicates that WS in patients with BN may have a clinically significant effect on symptomatology and prognosis. However, the current cognitive behavioral framework for BN does not explicitly acknowledge the role of WS in the onset or maintenance of BN symptoms and does not provide guidance for clinicians on how to address WS during treatment. The relationship between WS, biological pressure to regain lost weight, and the maintenance of BN symptoms suggest that current cognitive behavioral models of BN may be improved by considering the role of WS and exploring needed treatment modifications. Indeed, a reconceptualization of existing models may offer insight into potential strategies that can be used to reduce the susceptibility to treatment dropout, nonresponse, and relapse. It is therefore necessary to consider whether, and how, clinicians' consideration of WS during case conceptualization and treatment planning could serve to improve CBT outcomes. The current review explores ways in which high WS could contribute to poor CBT outcomes, provides preliminary clinical recommendations for incorporating WS into existing cognitive behavioral treatments based on extant data and clinical wisdom, and proposes suggestions for future research needed in this domain.     

Case Conceptualization and Treatment of Comorbid Body Dysmorphic Disorder and Bulimia Nervosa

Body dysmorphic disorder (BDD) and eating disorders often co-occur and share some clinical features. In addition, the co-occurrence of BDD and an eating disorder may be associated with greater impairment in functioning. Furthermore, clinical impressions suggest that this comorbidity may be more treatment resistant than either disorder alone. The current article discusses the treatment of a 48-year-old female diagnosed with BDD and comorbid bulimia. We attempted to address these co-occurring disorders in a strategic, formulation-based manner using a variety of cognitive-behavioral strategies such as cognitive restructuring, rational disputation, exposure with response prevention, and mirror retraining. Despite the complexity of this case, results suggest that comorbid BDD and bulimia nervosa can be effectively managed with cognitive behavioral therapy.     

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.     

A Pilot Study of a Functional Contextual Treatment for Bulimia Nervosa

This paper describes the initial development of a treatment for bulimia nervosa using a functional contextual treatment approach. Seven women (6 with a diagnosis of bulimia nervosa and 1 with a diagnosis of eating disorder not otherwise specified) completed 12 sessions of functional contextual treatment. Participants were assessed with the Eating Disorders Examination at baseline and following treatment. The intervention produced significant reductions in binge eating, purgative behavior, dietary restraint, and eating concerns. A functional contextual treatment holds promise for the treatment of bulimia nervosa. However, the treatment needs to be refined further and will need to be tested in controlled clinical trials with long-term follow-up.     

The Role of Maternal Illness Perceptions in Family Functioning in Adolescent Girls with Anorexia Nervosa

Family based treatment of anorexia nervosa (AN) requires heavy parental involvement. To be effective, parents must possess a coherent understanding of the illness and believe that it is treatable. Yet we know little of how parents view the illness, nor whether these views are unique to AN. We examined illness perceptions in AN, how they compare to those of individuals with a serious medical illness, and how they relate to adjustment and coping. Twenty-five girls with AN, 24 girls with Type I diabetes, and their mothers completed measures of family functioning and psychological symptoms. Mothers also completed a measure of illness perceptions. Mothers viewed AN as less chronic, understandable, and controllable than mothers of girls with diabetes viewed their daughter’s respective illness. Such negative cognitions were associated with poor family functioning and maternal and adolescent adjustment. These findings have implications for enhancing family based treatments, as well as for modifying public health messages to reduce the pervasive stigma that influences such unhelpful perceptions about the illness.     

Adaptability of Family Therapy Modalities in the Treatment of Lesbian and Gay Clients with Bulimia Nervosa

Bulimia nervosa (BN) has becoming an increasingly common form of eating disorder, particularly with gay and lesbian populations. The lack of current literature on this particular topic, as well as the limited resources for recommendations of treatment adaptations for this population is evident by the disproportionate number of sexual minorities that present for treatment. This paper discusses the possible reasons for the lack of literature and resources, and provides clinicians with the adaptations of Emotion Focused Therapy, Cognitive Behavioral Therapy, Structural Family Therapy, and Internal Family Systems when working with lesbian and gay populations who are suffering from BN. This paper aims to contribute more to the limited research in the area of sexual minorities in hopes to broaden the understanding of the treatment of individuals, as well as family functioning. We attempt to adapt these therapy modalities to be more inclusive of these nuanced presenting concerns, and to provide clinicians from all scopes of practice a thorough look into the treatment of a sexual minority population.     

The Cognitive‐Behavioural Theory and Treatment of Bulimia Nervosa: An Examination of Treatment Mechanisms and Future Directions

Enhanced cognitive‐behavioural therapy (CBT‐E) is the current treatment of choice for bulimia nervosa. While the cognitive‐behavioural theory and treatment of bulimia nervosa have made a substantial contribution to our understanding of the disorder, approximately half of patients treated with CBT‐E fail to achieve remission of binge eating and purging. There is evidence showing that mechanisms proposed by the CBT‐E model are associated with binge eating and purging symptoms, and therefore likely important targets for treatment. To identify future directions in improving the efficacy of this treatment, and informed by a model of the client change process, we review the evidence for the hypothesised treatment mechanisms of CBT‐E. We conclude that while the proposed treatment mechanisms of CBT‐E largely change over the course of treatment, there is limited evidence that the treatment manipulations of CBT‐E are responsible for the specific changes in the proposed treatment mechanisms. In addition, given a lack of research in this area, we could find no evidence that changes in the additional treatment mechanisms outlined in CBT‐E are associated with changes in the core symptomatology of binge eating and purging. Based on these findings, we recommend that future efforts are directed towards understanding the client change process in CBT‐E and outline three clear directions for research.     

The Counselor's Role in the Development of Staff Competence

This article describes competence assessment as a method by which counselors can relate staff development directly to success on the job.