Treatment of Eating Disorders (eBook)

Front Cover 
1 
Treatment of Eating Disorders 4
Copyright 5
Contents 6
Biographies 10
Abbreviations 20
Introduction 22
PART I - 
28 
Chapter 1 A Perfect Biopsychosocial Storm: Gender, Culture, and Eating Disorders 30
NATURE VERSUS NURTURE: A FALSE DICHOTOMY 31
GENDER: DIFFERENCE OR SIMILARITY? 31
NATURE, NURTURE, AND THE BRAIN 32
GENDERING: A BIOPSYCHOSOCIAL PROCESS 33
PSYCHOLOGICAL DEVELOPMENT IN A GENDERED ENVIRONMENT 34
MEDIA IMAGES, GENDER, AND OBJECTIFICATION THEORY 35
GENDER DISTINCTIONS AND THE OUTCOME OF OBJECTIFICATION 36
FEMINIST PERSPECTIVES: PROTECTION IN THE FACE OF OBJECTIFICATION? 37
GENDER-INFORMED TREATMENT 38
ENHANCING GENDER COMPETENCE 39
Conclusion 41
References 41
Chapter 2 What’s Weight Got to Do with It? Weight Neutrality in the Health at Every Size Paradigm and Its Implications for Clinical Practice 44
THE PANIC ABOUT FAT 45
ABOUT THE DATA 47
THE VALUE OF A WEIGHT NEUTRAL STANCE: PART 1 48
THE VALUE OF A WEIGHT NEUTRAL STANCE: PART 2 50
THE VALUE OF A WEIGHT NEUTRAL STANCE: PART 3 53
THE VALUE OF A WEIGHT NEUTRAL STANCE: PART 4 57
STEREOTYPE MANAGEMENT SKILLS 58
INTERNALIZED OPPRESSION, EATING DISORDERS, AND HEALTH 58
AFTER 60
References 60
Chapter 3 Neuroscience: Contributions to the Understanding and Treatment of Eating Disorders 64
UNCOVERING THE NEUROLOGICAL AND PSYCHOBIOLOGICAL CORRELATES OF EATING DISORDERS 65
A UNIFYING THEORY: EATING DISORDERS AND THE NEUROLOGICAL DEVELOPMENT OF AFFECT-REGULATION CAPACITIES 65
THE BODY AND A BIPHASIC SYSTEM OF AFFECT-REGULATION 67
DISSOCIATION AND POST TRAUMATIC STRESS DISORDER IN THE DEVELOPMENT OF EATING DISORDERS 68
ATTACHMENT THEORY, AFFECT-REGULATION THEORY, AND EATING DISORDERS 69
THERAPEUTIC IMPLICATIONS 71
CONCLUDING THOUGHTS 74
References 75
Chapter 4 Are Media an Important Medium for Clinicians? Mass Media, Eating Disorders, and the Bolder Model of Treatment, Prevention, and Advocacy 80
SOCIOCULTURAL MODELS OF RISK 81
THE PERSONAL: EATING DISORDER PROFESSIONAL AS ROLE MODEL 86
THE PROFESSIONAL: BEING A BOLDER CLINICIAN 88
THE POLITICAL: THERAPY, THERAPISTS, POWER, AND EMPOWERMENT 90
A FINAL REFLECTION AS AN EXAMPLE OF ADVOCACY 90
References 91
PART II - 
96 
Chapter 5 The Assessment Process: Refining the Clinical Evaluation of Patients with Eating Disorders 98
WEIGHT, MENSTRUATION, AND PHYSICAL CONDITIONS 98
WEIGHT-RELATED PHYSIOLOGICAL MARKERS 100
DIETARY RESTRICTION AND DIETARY RESTRAINT 101
BINGE EATING 102
INAPPROPRIATE COMPENSATORY BEHAVIORS 103
BODY IMAGE AND SELF-EVALUATION 106
DENIAL AND MINIMIZATION 108
ADDITIONAL AREAS TO ASSESS 109
BRINGING IT ALL TOGETHER 109
References 110
Chapter 6 Medical Assessment of Eating Disorders 116
WOLVES IN SHEEP's CLOTHING 116
MENTAL ILLNESSES OR MEDICAL ILLNESSES? 117
WHAT PATIENTS DO IS MORE IMPORTANT THAN THEIR DIAGNOSTIC CATEGORY 118
GENERAL RECOMMENDATIONS ON EATING DISORDER ASSESSMENT 119
GATHERING THE HISTORY 120
THE EXAMINATION: CORRELATE WITH THE HISTORY 121
CARDIAC ASSESSMENT 126
NEUROPSYCHIATRIC ASSESSMENT: IMPAIRED BRAIN MEANS IMPAIRED MIND 128
GASTROINTESTINAL (GI) ASSESSMENT 130
SKIN ASSESSMENT 131
ENDOCRINE ASSESSMENT 132
BONE ASSESSMENT 132
RENAL ASSESSMENT 133
MEDICAL AND LABORATORY TESTS 134
REFEEDING SYNDROME 134
RISK OF LIFE-THREATENING INFECTION 135
BRIDGING THE GAP FOR MEDICAL ASSESSMENT 135
References 136
Chapter 7 Psychiatric Medication: Management, Myths, and Mistakes 138
ANOREXIA NERVOSA: OVERVIEW OF PSYCHIATRIC MEDICATION MANAGEMENT 138
BULIMIA NERVOSA: OVERVIEW OF PSYCHIATRIC MEDICATION MANAGEMENT 142
EATING DISORDERS NOT OTHERWISE SPECIFIED: OVERVIEW OF PSYCHIATRIC MEDICATION MANAGEMENT 146
MEDICATION MANAGEMENT: BRIDGING THE PUZZLING GAPS 149
References 149
Chapter 8 Nutritional Impact on the Recovery Process 154
PHYSICAL AND PSYCHOLOGICAL IMPACTS OF NUTRITIONAL INTAKE 154
FINDING NUTRITIONAL BALANCE: NUTRITIONAL REHABILITATION 157
CLOSING THE RESEARCH/PRACTICE GAP IN THE NUTRITIONAL TREATMENT OF EATING DISORDERS 167
References 168
Chapter 9 Science or Art? Integrating Symptom Management into Psychodynamic Treatment of Eating Disorders 170
INTRODUCTION 170
INTEGRATING SYMPTOM-FOCUSED INTERVENTIONS WITHIN PSYCHODYNAMIC THERAPY: THEORY 172
INTEGRATING SYMPTOM-FOCUSED INTERVENTIONS WITHIN PSYCHODYNAMIC THERAPY: PRACTICE 173
CONCLUSION 186
References 186
Chapter 10 New Pathways: Applying Acceptance and Commitment Therapy to the Treatment of Eating Disorders 190
ACCEPTANCE AND COMMITMENT THERAPY IN A NUTSHELL 192
THE ACT PROCESSES 195
COGNITIVE DEFUSION VERSUS FUSION 198
MINDFULNESS AS AN INTERVENING ACTION VERSUS BEING LOST IN THE FUTURE OR PAST 
200 
SELF AS CONTEXT VERSUS ATTACHMENT TO THE CONCEPTUALIZED SELF 202
CONNECTING TO AND COMMITTING TO ACTION ALIGNED WITH CORE VALUES 
203 
CLOSING NOTE 206
References 206
Chapter 11 Outpatient Treatment of Anorexia Nervosa following Weight Restoration: Practical and Conceptual Issues 208
TRANSITIONING FROM INPATIENT TREATMENT 209
BUILDING A TREATMENT TEAM 210
BACK TO REALITY: FAMILY AND FRIENDS 213
BODY IMAGE, WEIGHT CONCERNS, AND EXERCISE 215
INTERPERSONAL AND DYNAMIC ISSUES 217
INTEGRATED APPROACHES 218
ASSESSING AND ADDRESSING COMORBIDITIES 220
SUMMARY 221
References 222
Chapter 12 Recipe for Recovery: Necessary Ingredients for the Client’s and Clinician’s Success 224
THE EFFECTIVE CLINICIAN’S CUPBOARD 224
THE SUCCESSFUL CLIENT’S RECIPE 229
CONCLUSIONS: BRIDGING EXPERIENCE AND EMPIRICISM 237
References 238
PART III - 
242 
Chapter 13 Borderline Personality and Eating Disorders: A Chaotic Crossroads 244
OVERVIEW OF BPD 244
BPD: A MULTI-DETERMINED DISORDER 246
THE DIAGNOSIS OF BPD 248
IMPLICATIONS OF THE BPD DIAGNOSIS IN PATIENTS WITH EATING DISORDERS 
249 
TREATMENT APPROACHES TO BPD 250
ECLECTIC TREATMENT APPROACHES: A BRIEF EXAMPLE 252
OUTCOME 254
CONCLUSIONS 254
References 255
Appendix A 
257 
Appendix B 
258 
Chapter 14 Managing the Eating Disorder Patient with a Comorbid Substance Use Disorder 260
PREVALENCE DATA 261
THE COMPLEX RELATIONSHIP BETWEEN EATING DISORDERS AND SUBSTANCE ABUSE 262
SIMILARITIES AND DIFFERENCES BETWEEN EATING DISORDERS AND SUBSTANCE USE DISORDERS 263
COMMON SUBSTANCES OF ABUSE 265
TREATMENT 267
CONCLUSIONS AND FUTURE DIRECTIONS 272
References 272
Chapter 15 Comorbid Trauma and Eating Disorders: Treatment Considerations and Recommendations for a Vulnerable Population 278
INTRODUCTION 278
A WORKING CONCEPTUALIZATION OF "TRAUMA'' 
279 
RESEARCH ON TRAUMA AND EATING DISORDERS 280
ASSESSMENT OF TRAUMA 280
TREATING THE INDIVIDUAL WITH COMORBID TRAUMA AND EATING DISORDER 281
CLINICAL VIGNETTES 286
CONCLUSION 293
References 293
Chapter 16 Healing Self-Inflicted Violence in Adolescents with Eating Disorders: A Unified Treatment Approach 296
DEFINITION AND SCOPE OF THE PROBLEM 296
UNDERPINNING: TRAUMA 298
IMPACT: PATIENT AND ECOLOGICAL SYSTEM 300
RECOVERY DEFINED 301
A UNIFIED TREATMENT APPROACH FOR PATIENTS WITH ED AND SIV 302
IMPACT OF SIV ON TREATMENT PROVIDERS 306
CONCLUSIONS 307
References 307
Appendix A: Twelve Steps of Self-Mutilators Anonymous 
309 
Appendix B: Representative Art from a Teenage DBT 
 
310 
Chapter 17 The Weight-Bearing Years: Eating Disorders and Body Image Despair in Adult Women 312
THE SHAPE OF ADULT EATING DISORDERS 313
THE TROUBLE WITH TRANSITIONS 315
A PERFECT STORM: MIDLIFE TRANSITIONS IN AN ERA OF GLOBAL TRANSFORMATION 316
PREGNANCY AND PARENTING: RISK OR OPPORTUNITY? 317
THE CHALLENGE OF CHILDREN 318
CLINICAL ISSUES 320
MEDICAL ISSUES 322
OBSTACLES TO GETTING HELP 323
FINAL THOUGHTS: NOTES TO, AND ABOUT, THE SELF 323
BRIDGING THE RESEARCH-PRACTICE GAP 324
References 325
Chapter 18 Men with Eating Disorders: The Art and Science of Treatment Engagement 328
AN OVERVIEW OF MALE EATING DISORDERS 329
CLINICAL FEATURES AND DIAGNOSIS 329
GROWING UP MALE 332
PSYCHOTHERAPY WITH MEN 335
CONCLUSIONS 340
References 341
PART IV - 
344 
Chapter 19 Mutuality and Motivation in the Treatment of Eating Disorders: Connecting with Patients and Families for Change 346
AN INTEGRATED RELATIONAL/MOTIVATIONAL APPROACH 346
THE NEED FOR AN INTEGRATED RELATIONAL/MOTIVATIONAL 351
AN INTEGRATED RELATIONAL/MOTIVATIONAL APPROACH FOR EATING DISORDERS 351
CONCLUSION: IT TAKES AT LEAST TWO 358
References 359
Chapter 20 When Helping Hurts: The Role of the Family and Significant Others in the Treatment of Eating Disorders 362
DAWN: WHERE WE BEGAN 362
WHAT WE THOUGHT WE KNEW: SYSTEMS THEORY AND DISENGAGEMENT FROM THE BATTLES WITH FOOD 364
WHAT WE HAD TO LEARN: PARENTAL NEGLECT 364
NEW DIRECTIONS: FAMILY-BASED TREATMENT AND PARENTAL INTERVENTION WITH FOOD 365
EMPIRICAL SUPPORT FOR FAMILY-BASED TREATMENT 366
LIMITATIONS OF EMPIRICAL RESEARCH 367
WHAT DO WE DO NOW? ASSESSING TREATMENT DIRECTIONS 369
FACTORS INFORMING TREATMENT RECOMMENDATIONS 369
WHEN THE PATIENT IS NOT A CHILD: SPOUSES, PARENTS, SIBLINGS, AND OTHERS AS THE EATING-DISORDERED PATIENT 371
WHAT WE KNOW, WHAT WE DO NOT KNOW...AND MAYBE WHAT WE SHOULD NOT KNOW 
372 
References 373
Chapter 21 The Most Painful Gaps: Family Perspectives on the Treatment of Eating Disorders 376
INTRODUCTION 376
IN MEMORY OF ANNA SELINA WESTIN: NOVEMBER 27, 
376 
THROUGH THE LOOKING GLASS 382
OUR "IN A PERFECT WORLD'' DESIRES 
387 
CONCLUSION 391
References 391
PART V - 
392 
Chapter 22 The Role of Spirituality in Eating Disorder Treatment and Recovery 394
FAITH AND SPIRITUALITY AS RESOURCES IN TREATMENT AND RECOVERY 396
COMMON SPIRITUAL ISSUES OF EATING DISORDER PATIENTS 397
PROCESS GUIDELINES FOR A MULTIDIMENSIONAL SPIRITUAL FRAMEWORK 398
SIX SPIRITUAL PATHWAYS TO RECOVERY FROM AN EATING DISORDER 400
RECOMMENDATIONS FOR RESEARCH 409
RECOMMENDATIONS FOR TRAINING 409
CONCLUSION 410
References 410
Chapter 23 The Case for Integrating Mindfulness in the Treatment of Eating Disorders 414
WHAT IS MINDFULNESS? 415
MINDFULNESS AND THE BRAIN 417
MINDFULNESS-BASED THERAPIES 417
BRINGING THE BRAIN INTO TREATMENT 418
BEGINNING THERAPY WITH AN EMPHASIS ON MINDFULNESS 419
SKILLS FOR WELLBEING 421
MINDFUL EATING 423
IDENTITY, PERFECTIONISM, AND MINDFULNESS 424
RADICAL ACCEPTANCE 425
THE ROLE OF THE MINDFULNESS PRACTICE OF THE THERAPIST 426
SUMMARY AND FUTURE PATHS 429
References 429
Chapter 24 
432 
EATING DISORDERS AND THE SHATTERED SELF 433
EXPANDING CLINICIAN RESOURCES 434
UNDERSTANDING THE GESTALT PERSPECTIVE 434
YOGA AS A PATHWAY TO WHOLENESS 437
DANCE/MOVEMENT THERAPY: EXPLORING THE DANCE OF CONNECTION 440
LANGUAGE AS A GATEWAY TO THE BODY 444
CONCLUSION 448
References 449
Chapter 25 Incorporating Exercise into Eating Disorder Treatment and Recovery: Cultivating a Mindful Approach 452
THE HARMFUL ROLE OF EXERCISE IN THE CONTEXT OF EATING DISORDERS 453
EXERCISE: A NEGLECTED COMPONENT OF EATING DISORDERS TREATMENT 453
IT’S NOT THE EXERCISE: QUALITY TRUMPS QUANTITY 454
EVIDENCE FOR EXERCISE PROTOCOLS IN EATING DISORDERS TREATMENT 456
CRITICAL THEMES OF EXERCISE PROTOCOLS IN EATING DISORDERS TREATMENT 460
TAKING A MINDFUL APPROACH TO EXERCISE 461
FUTURE DIRECTIONS AND PERSPECTIVES 464
References 465
Chapter 26 Body Talk: The Use of Metaphor and Storytelling in Body Image Treatment 470
ABOUT BODY IMAGE AND EATING DISORDERS 471
METAPHOR AND HEALING 472
LEARNING THE LANGUAGE OF SYMBOLISM AND METAPHOR 474
TRANSLATING A "FAT ATTACK'' INTO METAPHORICAL LANGUAGE 
477 
BREAKING WITH TRADITION 478
A NEW LENS FOR FOOD AND FAT 480
FINAL THOUGHTS ON THE TRANSFORMATIVE POWER OF METAPHOR 482
References 483
PART VI - 
484 
Chapter 27 The Research-Practice Gap: Challenges and Opportunities for the Eating Disorder Treatment Professional 486
EVIDENCE FOR A RESEARCH-PRACTICE DIVIDE IN THE EATING DISORDERS FIELD 487
CAUSES OF THE GAP 488
STRATEGIES FOR BRIDGING THE GAP 491
INTEGRATING RESEARCH AND PRACTICE-OPPORTUNITIES AND CHALLENGES 498
CONCLUSIONS 499
References 500
APPENDIX A 502
GUIDING PRINCIPLES FOR RESEARCH – PRACTICE INTEGRATIONIN THE FIELD OF EATING DISORDERS 
502 
GUIDING PRINCIPLES FOR RESEARCH – PRACTICE INTEGRATION 
502 
References 504
Chapter 28 Call to Action 506
BRIDGING THE GAP: THE OVERVIEW 506
BRIDGING THE GAP: DIAGNOSIS AND TREATMENT 508
BRIDGING THE GAP: SPECIAL POPULATIONS 511
BRIDGING THE GAP: FAMILY ISSUES 513
BRIDGING THE GAP: MIND, BODY, AND SPIRIT 515
BRIDGING THE GAP: FUTURE DIRECTIONS 515
References 517
Index 518
Color Plates 528