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Eating Disorders

Eating Disorders: New Directions in Treatment and Recovery

Copyright Date: 2001
Edition: 2
Pages: 160
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  • Book Info
    Eating Disorders
    Book Description:

    Fully revised to reflect changes in the field, this collection of essays by psychotherapists who specialize in the treatment of anorexia nervosa and bulimia explains in accessible and humane terms how the treatment process works and demonstrates strategies that lead to recovery. The book details the interaction between practitioner and patient, practitioner and practitioner, and family members. The collection, which draws upon the knowledge and experience of clinicians who have practiced at the Wilkins Center for Eating Disorders, also points up the advantages of a collaborative team, for both the patient and professionals.

    eISBN: 978-0-231-50259-7
    Subjects: Psychology, Sociology

Table of Contents

  1. Front Matter
    (pp. i-vi)
  2. Table of Contents
    (pp. vii-viii)
    (pp. ix-xii)
    B. Timothy Walsh

    Disturbances in human eating behavior are hardly new phenomena. Uncontrollable hunger and binge eating were described by ancient Greek and Roman physicians long before the birth of Christ, and the syndrome of anorexia nervosa was clearly recognized and named more than a century ago. Literally for hundreds of years, clinicians have been struggling to assist individuals unable to control their food intake.

    Unfortunately, there is much we do not understand. We do not know, in any meaningful sense, the fundamental causes of eating disorders. Our best understanding is that these disorders are multifactorial in origin—that individuals are at risk...

    (pp. xiii-xviii)
    Barbara P. Kinoy
    (pp. xix-xx)
  6. List of Contributors
    (pp. xxi-xxiv)
  7. Introduction
    (pp. 1-6)

    I am often asked why the Wilkins Center was established. In 1981 I had a general medical practice in Greenwich, Connecticut. As one of the few female physicians in town, I saw many women, especially young women. Several appeared with anorexia nervosa.

    The approach to eating disorders in those days was simple. Because anorexia was a psychiatric problem, the patient was referred to a psychotherapist. I found, however, that many therapists were reluctant to treat anorexics. A psychiatrist whose work I respected told me candidly that he did not find he could help such women. Others accepted patients for years...

  8. 1 Medical Aspects of Anorexia and Bulimia
    (pp. 7-16)

    Eating disorders involve a complex interplay of physical and emotional factors. The medical complications of anorexia and bulimia can be life-threatening but may give no outward warning symptoms. Attention to health realities must accompany (or even precede) therapy to provide the time and safety for recovery.

    Most patients with anorexia do not see themselves as starved, since they do eat and often very healthy foods such as salads. But just as a car with the best tires and oil cannot run without gas, no amount of “healthy” foods can make up for inadequate calories. Without sufficient calories, the body slows...

  9. 2 Recovery Through Nutritional Counseling
    (pp. 17-48)

    Is there really a need to educate eating disordered patients about nutritional balance and healthy eating habits? Don’t they know this already? Haven’t they read books about dieting, and haven’t they been counseled about the importance of good eating habits by physicians and therapists? Frequently, they do know. However, in my experience their nutritional knowledge is mostly related to how they can diet to lose weight in order to feel better about themselves and to give them a sense of control. An educational approach emphasizing the value of nutritional counseling may therefore be helpful to resistant patients when their denial...

  10. 3 Psychiatric Consultation with Eating Disordered Patients
    (pp. 49-56)

    Psychiatric consultation may play an important role in the evaluation and treatment of many patients with eating disorders. Any clinician working with eating disordered patients quickly becomes aware that the range and intensity of their symptoms and eating behaviors vary widely. A psychiatric consultation may be indicated for those patients whose symptoms are persistent or severe, whose clinical presentations are complicated or atypical, who present with symptoms of other disorders along with their eating symptoms, or who fail to respond to conservative management. The consultation can help to clarify diagnostic questions and may help to guide the treatment more effectively....

  11. 4 A Family Systems Perspective on Recovery from an Eating Disorder
    (pp. 57-76)

    Mary Brown, fourteen years old, 5 feet, 6 inches tall, and weighing 95 pounds, was brought to the Wilkins Center by her mother, Jean. Jean could not understand what had caused Mary’s recent refusal to eat and her irritable behavior. According to Jean, Mary had always been an “easy” child, had excelled at school, and had been cooperative at home. Now she was not eating and was having mood swings that upset everyone in the family.

    Family therapists think about the development of an eating disorder as a signal that the family is under stress. By stress we mean the...

  12. 5 Relationship to Food as to the World
    (pp. 77-88)

    Food—consuming it, restricting it, hating it, loving it—what does it mean? What is the “food obsession” about for people who suffer from an eating disorder? Their relationship to food can be viewed as a metaphor for how they connect to the world. Linguists have long maintained that one constructs one’s world through organizing thought in language. Thus the language in which one frames one’s therapeutic interpretations has tremendous importance. The metaphor chosen to connect experiences that the patient knows with experiences that are effectively cut off, unknown to the patient, must be meaningful.

    As a therapist, in order...

  13. 6 The Therapeutic Use of Humor in the Treatment of Eating Disorders; or, There Is Life Even with Fat Thighs
    (pp. 89-97)

    “What is real?” asked the Rabbit one day, when they were lying side by side near the nursery fender, before Nana came to tidy the room. “Does it mean having things that buzz inside you and a stick-out handle?”

    “Real isn’t how you are made,” said the Skin Horse. “It’s a thing that happens to you. When a child loves you for a long, long time, not just to play with, but really loves you, then you become Real.”

    “Does it hurt?” asked the Rabbit.

    “Sometimes,” said the Skin Horse, for he was always truthful. “When you are Real you...

  14. 7 Jodie’s Story
    (pp. 98-106)

    In his essay, “Grimm’s Greatest Tale,” Stephen Jay Gould (1991) said, “We must never doubt the power of names as Rumpelstiltskin learned to his sorrow.” So it is with anorexia nervosa and bulimia. In the past brief time span leading up to this paper, I have had occasion to address audiences of schoolteachers, schoolchildren, parents, alcoholism counselors, and therapists who all seem inclined to define these symptoms as a disease entity and to launch a battle against it. I fear becoming a spinner of the tale by citing data that are true and factual without looking at how an individual...

  15. 8 Eating Disorders and Managed Care
    (pp. 107-111)

    The nineties have witnessed a dramatic and revolutionary transformation of health care in the United States. In the wake of the public’s rejection of President Clinton’s proposals for universal health care and the single-payer model in the early nineties, there has been a radical takeover of health care by large corporate interests who consider health care a product and are driven by the demand for profits.

    Managed behavioral health care is marketed as offering early detection of mental health problems, offering a broad range of services with continuity of care, reducing the cost borne by the patient, and improving the...

  16. 9 Cognitive-Behavioral Therapy and Other Short-Term Approaches in the Treatment of Eating Disorders
    (pp. 112-126)

    Over the past fifteen years significant strides have been made in identifying, developing, and implementing therapeutic strategies used in the treatment of eating disorders. At the same time, the exigencies of providing psychiatric treatment in this era of managed heath care have necessitated finding clinically effective, yet cost-effective, short-term approaches. One treatment that has emerged is cognitive-behavioral therapy (CBT), and a growing body of empirical evidence has clearly demonstrated its effectiveness in the treatment of bulimia nervosa (Agras et al. 1992; Fairburn, Agras, and Wilson 1992; Garner et al. 1993) and binge eating disorder (Agras et al. 1997). Moreover, although...

  17. 10 The Nurse’s Role in a Pilot Program Using a Modified Cognitive-Behavioral Approach
    (pp. 127-132)

    As I approached the room to meet my first CBT patient I was both excited about this new responsibility and apprehensive about how we would work together and whether I was equipped to do this. As it turned out, she was experiencing the same feelings. And thus we began.

    I explained that this was a self-help program, and I was there to guide and encourage her and to answer any questions she might have.

    The following is a summary of my role, as a nurse, in a modified cognitive-behavioral therapy program. This treatment approach is based on a book by...

  18. 11 Individual Psychotherapy: A Long Journey of Growth and Change
    (pp. 133-147)

    How does psychotherapy heal psychic pain and overcome disordered eating?

    Some individuals, particularly late-adolescent and young-adult women whose eating disorders are transitory and maturational, often respond to short-term individual and group therapy. Others who have experienced difficulties in many areas of life for many years require more intensive lengthy psychotherapy. This involves duration of treatment from at least one to several years with a frequency of one or more sessions weekly. The continuity and intensity experienced by the person under such conditions facilitates recovery, change, and growth in a way that is less likely in the short-term treatment programs that...

  19. 12 Young Adult Women: Reflections on Recurring Themes and a Discussion of the Treatment Process and Setting
    (pp. 148-158)

    As a psychotherapist who specializes in the treatment of eating disorders, I see many women of college age, as well as recent college graduates. Certain themes recur in varying degrees and disguises. They appear in my weekly groups as well as in my individual sessions with these young women. Though the causation of eating disorders is considered to be multifaceted, including genetic predispositions and physiological components, the therapist, in session, addresses the content that emerges both verbally and interactively.

    A devastating and confusing mix of societal messages continues to surface and present in treatment as young women battle the demands...

  20. 13 Recovery
    (pp. 159-177)

    I was asked to write this paper from the position of both a professional and a recovered anorexic. I am frequently asked about recovery, both by my patients and those close to me, those who witnessed the transformation that took place in my own life as a result of the recovery process.

    I had promised myself that were I truly to recover from anorexia nervosa, I would someday communicate to others who also suffer from eating disorders the “how” of recovery. I had imagined a step-by-step approach that would somehow end the terrible obsession. My goal in writing this paper...

  21. Afterword
    (pp. 178-184)

    In the previous papers, clinicians have shared glimpses of their experiences treating eating disordered patients and their families. Ideally we could draw from the practice and literature of the last decade and conclude with clear guidelines for treatment. In 1993 the American Psychiatric Association published a set of official recommendations for the treatment of eating disorders; recently an updated revision has been issued (Work Group on Eating Disorders 2000). Yet crucial questions remain unresolved. Who can expect a favorable outcome? Which treatment approach is suitable for each patient? How intensive should treatment be, and how long should it last? How...

  22. INDEX
    (pp. 185-200)