Psychotherapy in Eating Disorders

1977 ◽  
Vol 22 (3) ◽  
pp. 102-108 ◽  
Author(s):  
H. Bruch
Keyword(s):  
Eating Disorders ◽  
Anorexia Nervosa ◽  
Severe Malnutrition ◽  
Developmental Factors ◽  
Early Experiences ◽  
Number Of Patients ◽  
The Family ◽  
Similarities And Differences ◽  
Early Developmental

This paper emphasizes that neither obesity nor severe malnutrition represents a uniform clinical psychiatric picture. The therapist must always pay attention to and integrate the various factors involved in eating disorders such as the underlying personality problems, resolution of the interactional conflicts within the family and correction of the abnormal nutritional states. The similarities and differences of both obesity and anorexic states are described. Primary or typical anorexia nervosa is differentiated from the atypical kinds. The importance of early developmental factors of how the child differentiates inner and outer stimuli, the appropriate or inappropriate responses to these and the manner in which these early experiences later affect somatic, social and psychological self concepts are discussed. Various parameters and modalities of treatment are described based on the author's long-term experiences with a large number of patients.

Anorexia Nervosa, Parental ‘Expressed Emotion’ and Dropping Out of Treatment

1985 ◽  
Vol 147 (3) ◽  
pp. 265-271 ◽  
Author(s):  
G. I. Szmukler ◽  
I. Eisler ◽  
G. F. M. Russell ◽  
C. Dare
Keyword(s):  
Anorexia Nervosa ◽  
Social Adjustment ◽  
Expressed Emotion ◽  
Strong Relationship ◽  
Term Treatment ◽  
Dropping Out ◽  
Mothers And Fathers ◽  
Long Term Treatment ◽  
The Family

The number of dropouts from a long-term treatment study of patients with anorexia nervosa (AN) and bulimia nervosa (BN) was substantial. A variety of social, clinical, parental, and treatment factors were examined for their association with early termination of treatment by the patient or the family. Parents ‘expressed emotion’ (EE) (particularly critical comments), BN, and the type of therapy offered (family or individual) were found to interact in some manner to result in dropping out. Some other aspects of parents' EE were also examined, including a comparison of scores in parental pairs; EE was found to be influenced by social class, and there were significant associations with the patient's symptomatology and social adjustment. There was a strong relationship between mothers' and fathers' scores in parental pairs.

scholarly journals Avoiding deaths in hospital from anorexia nervosa: the MARSIPAN project

2012 ◽  
Vol 36 (3) ◽  
pp. 109-113 ◽  
Author(s):  
Paul Robinson
Keyword(s):  
Eating Disorders ◽  
Anorexia Nervosa ◽  
Eating Disorder ◽  
Adult Patients ◽  
Refeeding Syndrome ◽  
The Family ◽  
Key Issues ◽  
Medical Teams ◽  
Medical Wards

SummaryThe MARSIPAN (MAnagement of Really SIck Patients with Anorexia Nervosa) project was established in response to reports of patients admitted to medical wards and proving refractory to treatment, sometimes dying on the ward. Psychiatrists, physicians and other clinicians in nutrition and eating disorders were brought together to discuss key issues in the assessment and management of such patients. The resulting guidance report, which applies to adult patients over 18, addresses: assessment of risk, where to treat the patient, specialist support for medical teams, key elements of treatment, namely (a) safe refeeding to avoid refeeding syndrome and underfeeding syndrome, (b) management of problematic behaviours, (c) support for the family, and (d) transfer to a specialist eating disorder unit when appropriate and possible.

scholarly journals Eighteen-year trajectories of depressive symptoms in mothers with a lifetime eating disorder: findings from the ALSPAC cohort

2019 ◽  
Vol 216 (2) ◽  
pp. 90-96 ◽  
Author(s):  
Yu Wei Chua ◽  
Gemma Lewis ◽  
Abigail Easter ◽  
Glyn Lewis ◽  
Francesca Solmi
Keyword(s):  
Eating Disorders ◽  
Body Image ◽  
Anorexia Nervosa ◽  
Depressive Symptoms ◽  
Bulimia Nervosa ◽  
Growth Curves ◽  
Sensitivity Analyses ◽  
Continuous Measure ◽  
In Pregnancy

BackgroundTwo longitudinal studies have shown that depressive symptoms in women with eating disorders might improve in the antenatal and early postnatal periods. No study has followed up women beyond 8 months postnatal.AimsTo investigate long-term trajectories of depressive symptoms in mothers with lifetime self-reported eating disorders.MethodUsing data from the Avon Longitudinal Study of Parents and Children and multilevel growth curves we modelled trajectories of depressive symptoms from the 18th week of pregnancy to 18 years postnatal in women with lifetime self-reported anorexia nervosa, bulimia nervosa or both anorexia and bulimia nervosa. As sensitivity analyses we also investigated these trajectories using quintiles of a continuous measure of body image in pregnancy.ResultsOf the 9276 women in our main sample, 126 (1.4%) reported a lifetime diagnosis of anorexia nervosa, 153 (1.6%) of bulimia nervosa and 60 (0.6%) of both anorexia and bulimia nervosa. Women with lifetime eating disorders had greater depressive symptoms scores than women with no eating disorders, before and after adjustment for confounders (anorexia nervosa: 2.10, 95% CI 1.36–2.83; bulimia nervosa: 2.28, 95% CI: 1.61–2.94, both anorexia and bulimia nervosa: 2.86, 95% CI 1.81–3.90). We also observed a dose–response association between greater body image and eating concerns in pregnancy and more severe trajectories of depressive symptoms, even after adjusting for lifetime eating disorders which also remained independently associated with greater depressive symptoms.ConclusionsWomen with eating disorders experience persistently greater depressive symptoms across the life-course. More training for practitioners and midwives on how to recognise eating disorders in pregnancy could help to identify depressive symptoms and reduce the long-term burden of disease resulting from this comorbidity.

scholarly journals Functional Hypothalamic Amenorrhoea in Adolescent girls as a Result of Stress-Related Conditions in Covid-19 Pandemic Situation

2021 ◽  
Keyword(s):  
Mental Health ◽  
Social Media ◽  
Eating Disorders ◽  
Anorexia Nervosa ◽  
Adolescent Girls ◽  
Physical And Mental Health ◽  
Short Term ◽  
Restricted Movement ◽  
Hormonal Imbalance

Functional hypothalamic amenorrhoea (FHA) is a form of anovulation due to the suppression of HypothalamicPituitary-Ovarian (HPO) axis, not related to identifiable organic cause. FHA is a state of hormonal imbalance related to stress, exercising too much or consuming too few calories. In the unprecedented Covid-I9 Pandemic, there is an upsurge of FHA in adolescent girls. Being confined to ‘stay at home’, the phobia of gaining weight due to restricted movement is often triggering eating disorders like Anorexia Nervosa(AN);indulging in indoor overexercise, stress associated with routine change, exposure and preoccupations with social media in the changed scenario are causing a disruption of HPO axis manifesting as FHA. But FHA has serious short-term and longterm effects on the physical and mental health of the adolescent individuals. The present article aims at reviewing the causes, effects, evaluation and management of FHA in the present scenario. Adolescent girls with FHA should be carefully diagnosed and properly managed to prevent both short-term and long-term deleterious effects with appropriate and timely intervention.

scholarly journals Experiencing Eight Psychotherapy Approaches Devoted to Eating Disorders in a Single Day Workshop Increases Insight and Motivation to Engage in Care

2021 ◽  
Author(s):  
Elisabetta Scanferla ◽  
Bernard Pachoud ◽  
Philip Gorwood
Keyword(s):  
Eating Disorders ◽  
Newly Diagnosed ◽  
Motivation To Change ◽  
Long Term Outcomes ◽  
Commitment To Change ◽  
Outcomes Evaluation ◽  
Number Of Patients ◽  
Almost All ◽  
Action Stage

Abstract PurposeFor patients with eating disorders (EDs), early engagement in care is usually considered as a positive prognostic factor. The aim of the present study is to investigate how a single-day intervention devoted to an early experiential exposure to a variety of psychotherapy approaches, supports transition to specialised care and commitment to change in patients with EDs.MethodsOne hundred and sixty-nine outpatients newly diagnosed with an ED took part in a single-day workshop for groups of up to 10 patients, where they discovered and experienced eight psychotherapeutic approaches. Motivation to change care, and level of insight were assessed at baseline and 10 days after the intervention.ResultsMotivation and commitment to take active steps toward change (expressed by the “Committed Action” composite score) significantly improved after intervention (p<0.001), and a significant number of patients specifically moved from “contemplation” to “action” stage (p<0.001). The improvement of motivation to change is significantly associated to an increase of insight capacity (p<0.001), and this for almost all dimensions.ConclusionA single-day session devoted to experiencing a range of group psychotherapies increased patients’ insight and motivation to actively engage in care. Further studies including different factors and long-term outcomes evaluation may be necessary to better establish which aspects are specifically involved in patients' increased motivation for care and confirm potential longer-term benefits of this intervention.Level of evidenceLevel V: Opinions of respected authorities, based on descriptive studies, narrative reviews, clinical experience, or reports of expert committees.

scholarly journals Experience of management of anorexia nervosa patients with extremely severe malnutrition in a transdisciplinary eating disorders inpatient unit

2020 ◽  
Author(s):  
Marie Guinhut ◽  
Jean-Claude Melchior ◽  
Nathalie Godart ◽  
Mouna Hanachi
Keyword(s):  
Eating Disorders ◽  
Anorexia Nervosa ◽  
Medical Care ◽  
Care Pathway ◽  
Adult Patients ◽  
Severe Malnutrition ◽  
Psychiatric Ward ◽  
Supportive Psychotherapy ◽  
Average Patient ◽  
First Time

Abstract Background: The question of where to hospitalize extremely malnourished patients with anorexia nervosa (AN) is a real dilemma. On one hand, psychiatrists have to deal with severe medical complications that are not within their competences and that justify hospitalization in an internal medicine ward. On the other hand, medical doctors have to face psychic decompensations that would justify admission to a psychiatric ward. In this context, we share our experience of management of severely malnourished AN adult patients in a transdisciplinary specialized eating disorders (ED) unit, referral center for AN associated with somatic severity.Method: First, we described the modalities of care proposed to patients with AN hospitalized in the medical unit. Intensive medical care, both somatic and psychiatric, are provided thanks to a transdisciplinary therapeutic program, where objectives are to: medically stabilize the patient, initiate progressive refeeding and start supportive psychotherapy before being transferred to a psychiatric ED unit. Secondly, we conducted a retrospective descriptive study that included all adult patients with AN admitted for the first time to the unit, between November 1997 and January 2014, for severe malnutrition and/or complications of the ED. Objective was to specify patients characteristics: demographic, nutritional status, history of ED, care pathway. Finally we discussed the value of such a unit.Results: Among a cohort of 386 adult patients with AN (21 males and 365 females) admitted for the first time in the unit, mean age was 29.4 (± 11.5) years, mean BMI was 12.7 (± 2.2) kg/m². Before being supported in the unit, 78.2% of patients had already been hospitalized in other hospitals. Mean length of stay was 35.2 days. Patients were clinically serious and unstable because of life-threatening somatic complications due to a low BMI. During hospital stay, a temporary transfer to medical intensive care unit was necessary for 25.6% of patients. Average patient weight gain was 0.777 kg per week and 81.9% of patients benefited from enteral nutrition.Conclusion: This specialized transdisciplinary unit where physician nutritionists and psychiatrists coordinate medical care together, allow a better understanding and management of extreme malnutrition associated with AN. Thanks to their expertise, care teams are less critical and less rejecting towards patients. Thus, therapeutic alliance could be optimized.

scholarly journals A SYSTEMATIC REVIEW OF SCIENTIFIC STUDIES ON THE EFFECTS OF MUSIC IN PEOPLE WITH OR AT RISK FOR EATING DISORDERS

2020 ◽  
Author(s):  
Francesca Testa ◽  
Sarah Arunachalam ◽  
Annie Heiderscheit ◽  
Hubertus Himmerich
Keyword(s):  
At Risk ◽  
Eating Disorders ◽  
Anorexia Nervosa ◽  
Eating Disorder ◽  
Bulimia Nervosa ◽  
Binge Eating ◽  
Music Therapy ◽  
Binge Eating Disorder ◽  
Therapeutic Application ◽  
Number Of Patients

Background: The prevalence of the three main eating disorders (EDs) anorexia nervosa (AN), bulimia nervosa (BN) and binge eating disorder (BED) is increasing, and a growing number of patients with EDs is seeking professional help. Thus, there is a need for additional treatment strategies in EDs. The aim of this review was to summarize the literature on the benefits and risks of music as well as the evidence for its therapeutic application in people with EDs.Methods: Following the PRISMA guidelines, we performed a systematic literature review on scientific studies on the effect of music in people with or at risk for EDs using PubMed and the Web of Science database. The search terms used were: “music”, “music therapy”, “eating disorders”, “anorexia nervosa”, “bulimia nervosa” and “binge eating disorder”. Results: 16 out of 119 identified and screened articles qualified as scientific studies involving a total of 3,792 participants. They reported on the use of music or music therapy in individuals with or at risk of AN and BN, but not BED. In inpatients with AN, listening to classical music was beneficial to food consumption. Singing in a group reduced post-prandial anxiety in AN inpatients and outpatients. Vodcasts which also included positive visual or autobiographical stimuli helped BN patients with anxiety and body image perception. Songwriting and sessions with a Body Monochord helped with the processing of therapeutically relevant topics in AN. Watching music videos, however, reinforced body dissatisfaction, drive for thinness, bodyweight concerns, preoccupation with physical appearance in pre-teenage and teenage girls, and drive for muscularity in adolescent boys. Conclusions: These findings suggest that the therapeutic application of music may be beneficial in patients with AN and BN. However, the availability of studies with a rigorous randomized controlled trial (RCT) design is scarce.

Cognitive Behavioral Therapy for the Eating Disorders

2021 ◽  
Vol 17 (1) ◽  
pp. 417-438
Author(s):  
W. Stewart Agras ◽  
Cara Bohon
Keyword(s):  
Eating Disorders ◽  
Anorexia Nervosa ◽  
Eating Disorder ◽  
Clinical Practice ◽  
Cognitive Behavioral Therapy ◽  
Behavioral Therapy ◽  
Cognitive Behavioral ◽  
Research Findings ◽  
Short And Long Term

Research findings strongly suggest that cognitive behavioral therapy for the eating disorders (CBT-ED) is more effective than other treatments for bulimia nervosa (BN) and for binge eating disorder (BED), although interpersonal psychotherapy appears to be equally effective for BED. Evidence for the effectiveness of CBT-ED for the persistent (adult) form of anorexia nervosa (AN) is insufficient at present and is essentially absent for AN in adolescents except for some evidence from uncontrolled trials. This article begins with an overview of the early studies in the development of CBT-ED that showed a similar effectiveness of other symptom-focused psychotherapies—a finding that was neglected at the time. Later developments are then considered, including comparisons of CBT-ED with other psychotherapies, efforts to develop Internet-based training and treatment, and electronic applications for treatment. Finally, implications of the findings for future short- and long-term research and for clinical practice are considered.

A comparison of intra- and inter-organizational global careers

2014 ◽  
Vol 2 (2) ◽  
pp. 183-202 ◽  
Author(s):  
Malin H. Näsholm
Keyword(s):  
Career Paths ◽  
Design Methodology ◽  
Narrative Approach ◽  
Subjective Experiences ◽  
Content Type ◽  
Talent Pool ◽  
The Family ◽  
Similarities And Differences ◽  
Practical Implications

Purpose – Although research has shown differences between self-initiated experiences and expatriation, this differentiation has rarely been made when it comes to more long-term global careers. The purpose of this paper is to identify similarities and differences between repeat expatriates and international itinerants in their career paths, subjective experiences, and narratives of how they relate to their context. Design/methodology/approach – A narrative approach was used and interviews were conducted with ten repeat expatriates and ten international itinerants. The career paths of the 20 Swedish global careerists and how they narrate their careers are analyzed, and the two types of global careerists are compared. Findings – Results show that the repeat expatriates and international itinerants differ in their subjective experiences of global careers, and how they narrate them. Three broad domains are identified that integrate a range of issues that are important for global careerists. These domains are the organization and career domain, the country and culture domain, and the family, communities, and networks domain. The repeat expatriates and international itinerants differ in how they relate to these and what is important to them. Practical implications – The differences found have implications for organizations in terms of recruitment, management, and retention of a global talent pool. Originality/value – This research contributes to the understanding of subjective experiences of global careers and integrates a range of aspects in the context of global careerists that are important to them. Moreover, it contributes to the understanding of global careers by differentiating between those with intra- and inter-organizational global careers.

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