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Eating Disorders (Advances in Psychotherapy
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Table of Contents

Preface; Acknowledgment; Dedication; 1 Description; 1.1 Terminology; 1.2 Definitions; 1.2.1 Anorexia Nervosa (AN); 1.2.2 Bulimia Nervosa (BN); 1.2.3 Eating Disorder Not Otherwise Specified (EDNOS) or Atypical Eating Disorder; 1.3 Epidemiology; 1.4 Course and Prognosis; 1.5 Differential Diagnosis; 1.6 Comorbidities; 1.7 Diagnostic Procedures and Documentation; 1.7.1 Structured Diagnostic Interviews; 1.7.2 Semistructured Diagnostic Interviews; 1.7.3 Self-Report Measures; 1.7.4 Medical Assessments; 2 Theories and Models of Eating Disorders; 2.1 Psychological Models; 2.1.1 Bruch's Psychological Model; 2.1.2 Fairburn's Risk Factor Model; 2.1.3 The Addiction Model; 2.1.4 Cognitive Models; 2.2 Predisposing Personality Theories; 2.3 Biological/Physiological Models; 2.3.1 Genetic Theories; 2.3.2 Hormonal Theories; 2.4 Sociocultural Models; 2.5 Integrative/Biopsychosocial Model; 3 Diagnosis and Treatment Indications; 3.1 Diagnosing Eating Disorders; 3.2 Undertaking the Initial Interviews; 3.3 Identifying the Appropriate Treatment; 3.3.1 Inpatient Hospitalization; 3.3.2 Day Hospital Treatment; 3.3.3 Outpatient Treatments; 3.4 Factors that Influence Treatment Decisions; 3.4.1 Age; 3.4.2 Gender; 3.4.3 Race/Ethnicity; 3.4.4 Patient Preference for a Particular Type of Therapy; 3.4.5 Clinical Presentation; 3.4.6 Comorbidity; 3.4.7 Treatment History; 4 Treatment; 4.1 Methods of Treatment; 4.1.1 Psychoeducation; 4.1.2 Cognitive Behavior Therapy (CBT) for BN; 4.1.3 Cognitive Behavior Therapy for AN; 4.1.4 A Recipe for Treatment; 4.1.5 Family Therapy in Adolescents and Children with Anorexia Nervosa; 4.2 Mechanism of Action; 4.2.1 Psychodynamic and Related Therapies; 4.2.2 Cognitive Behavior, Cognitive, and Behavior Therapies; 4.2.3 Other "Behavioral"Therapies; 4.2.4 Interpersonal Psychotherapy; 4.2.5 Feminist Therapy; 4.2.6 Motivational Enhancement Therapy; 4.2.7 Conclusion; 4.3 Efficacy and Prognosis; 4.3.1 Methods of Systematic Review; 4.3.2 Predictors of Outcome; 4.4 Combinations with Medication; 4.5 Problems in Carrying out Treatment; 4.6 Compulsory Treatment; 4.7 Multicultural Issues; 5 Case Vignettes; Case Vignette 1: Tracey (Anorexia Nervosa); Case Vignette 2: Belinda (Bulimia Nervosa); Case Vignette 3: Mark (Binge Eating Disorder); 6 Further Reading; 7. References; 8. Appendices: Tools and Resources.

Reviews

"The book is a remarkable achievement and will be of great value to those wanting an up-to-date overview of a complex and multifaceted field." Christopher G. Fairburn, FMedSci, FRCPsych, Professor of Psychiatry, University of Oxford, UK "... a brilliant handbook for all professionals in the field. With wisdom and compassion, they have masterfully brought together decades of empirical investigation on eating disorders." Kathleen M. Pike, PhD, Department of Psychiatry, Columbia University, New York and Temple University, Tokyo, Japan "In keeping with the aim of this series, this book is a great clinical guide, combining biological, psychological and social perspectives into concrete and excellent treatment recommendations." Glenn Waller, DPhil, Vincent Square Clinic Eating Disorders Program, CNWL NHS Foundation Trust and King's College London, UK "This book will be an outstanding educational resource for educators and trainees, as well as a terrific reference or guide to clinicians in this field." Daniel le Grange, PhD, Director, Eating Disorders Program, Associate Professor of Psychiatry, The University of Chicago, IL "Highly readable, brief yet comprehensive, this book is recommended reading for anyone who needs a crash course on the state of the art of treatment for eating disorders." Marion Olmsted, PhD, CPsych, Director of Ambulatory Care for Eating Disorders, Toronto General Hospital and Associate Professor in Psychiatry, University of Toronto"PsycCRITIQUES,Vol. 53, Issue 46, November 2008, reviewed by James M. HepburnEating Disorders is a book written for clinicians looking for a guide to the often complex and confounding dynamics inherent in eating disorders. As part of the series Advances in Psychotherapy-Evidence-Based Practice, the information in this volume is both clear and easily accessible. The format, structure, and content of this brief text make it a valuable resource for clinicians who areinterested in providing quality care informed by current advances in research and treatment methodologies. The authors and editors of this book have worked hard to provide substantive, state-of-the-art information that is accessible both clinically and conceptually.The book presents five chapters that cover the following topics: relevant descriptions and definitions of eating disorders, theories and conceptual models, diagnoses and treatment indications, and summaries of treatment methodologies. Also included in this volume are clinical vignettes, resources for advanced research on eating disorders, and-perhaps most valuable to practicing clinicians-an appendix with checklists and handouts to be used in therapy.Even though this book is introductory in scope, it is intended for the practicing clinician who has a basic understanding of psychological processes and therapeutic dynamics. The format of the text and the layout of the book are such that the reader can gain quick and easy access to needed information. There are brief phrases summarizing the main points of the text printed in the margins ofevery page, as well as highlighted boxes titled Clinical Vignettes and Clinical Pearls that serve to illustrate the concepts presented in the chapters. The short chapters in this book (only one chapter exceeds 10 pages) provide a summary of relevant research that many clinicians are likely to find familiar in broad terms but informative in its presentation of new data and acknowledgment of unresolved theories relevant to eating disorders. For example, disputed definitions and diagnostic criteria for certain eating disorders are mentioned, such as the current requirement that amenorrhea must be present for a diagnosis of anorexia nervosa or the appropriateness of the cutoff for bulimia set at a minimum of two binges per week.Despite its brevity, Eating Disorders strives to be comprehensive in presenting (sometimes merely in passing) a variety of perspectives related to eating disorders. This could be seen as a weakness in that it seems to sacrifice depth of coverage for a more pluralistic view of these disorders, but this approach is in keeping with the aims and purposes of this text. Furthermore, it is clear that thepurpose of this series is to emphasize evidence-based practices, which this volume does well. Clinicians needing to know more can follow the literature review and references cited to obtain further information. Many clinicians, however, will find that the theories, strategies, and resources provided in this text may be enough to help them face the challenges of working with individuals who have eating disorders. In fact, it is most likely that the clinician reading thisbook will be inspired to learn more, to obtain one of the manualized treatments recommended, or to seek out additional training in eating disorders treatment. There is much to be learned in this text about effective approaches to diagnosis and treatment of eating disorders. For example, in addition to reviewing the diagnostic criteria, the authors present a summary description and review of the individual merits of structured diagnostic interviews, semistructured interviews,and self-report measures. These clinical scales are likely to be unfamiliar to most clinicians, who may be inclined to base their diagnosis on observation, unstructured interviews, and clinical judgment. The value in using structured interviews or self-report measures becomes evident when you realize that 30 to 60 percent of patients are diagnosed as having an eating disorder not otherwisespecified because of the ambiguity in the criteria for specific disorders. The critical issue here is that different eating disorders often require their own treatment regimens (for example, the treatment for an emaciated individual suffering from anorexia nervosa would not be the same as that for a normalweight person with bulimia). Comorbidity also muddies the clinical waters, and itis therefore advisable for one to have as much data and specificity as possible when developing a diagnosis and treatment plan. This book provides both a framework and a list of the most used and valid assessment tools for this purpose. The heart of this book is its review of treatment approaches and strategies. Cognitive behavioral therapies (CBT) predominate the evidenced-based approaches and get the lion's share of the coverage. Specific treatments coveredinclude a model of CBT for bulimia developed by Fairburn, Marcus, and Wilson (1993) that incorporates a three-phase model involving psychoeducation, dietary restraint, and maintenance. Cognitive treatments for anorexia are based on the work of Aaron Beck and hisassociates (Beck, 1976; Beck, Rush, Shaw, & Emery, 1979). In this approach, efforts are made to engage the person who has anorexia in a collaborative relationship in which a healthy eating regimen can be introduced without coercion by focusing on cognitions and feelings that support the anorexic behaviors. The essential goals of Beck's CBT approach to anorexia nervosa are working collaboratively toward an acceptable and reasonable weight range (rather than a specific target weight) and helping the individual with anorexia gain sufficient self-monitoring skills to maintain healthy eating practices. Perhaps the most significant challenge for clinicians working with individuals who have anorexia nervosa is the ego-systonic nature of the disorder. Motivation for change is usually negligible because these people often have very distorted views of their weight and size, as well as of their perceived virtue in not giving in to their hunger pangs. Motivational enhancement therapies such as motivational interviewing (Miller & Rollnick, 2002) have been adapted for use with individuals with eating disorders (Vitousek, Watson, & Wilson, 1998; Ward, Troop, Todd, & Treasure, 1996) and can be of obvious benefit in working with people who have eating disorders. The role of the family and social influence in the etiology and maintenance of eating disorders has long been an integral part of understanding and treating eating disorders. The text points out the importance of involving family members to help them become facilitators in the treatment. Assessing the overallstrengths and weaknesses within the family as well as addressing emotional conflicts within the family system that generate guilt or anger among its members are essential tasks that must be addressed if therapy is going to be successful. The need for medical and dietary consultation and evaluation for any patient with an eating disorder is discussed, as well as appropriate cautions about medical complications that can arise when refeeding the anorexic patient.The fact is that the treatment of eating disorders is a complicated endeavor in which the therapist must address biological, intrapsychic, interpersonal, familial, and sociocultural dynamics. As this book illustrates in a section titled A Recipe for Treatment (pp. 51-65), the actual techniques and approaches used in therapy borrow from a variety of sources and schools of thought. At times, onemust acknowledge and address psychodynamic issues; CBT and motivational interviewing also have their role, as do systems work and cultural awareness. I would argue that the greatest strength of the book Eating Disorders is that it provides a clear and concise review of the best treatment practices in use today while acknowledging the complexities and the confusions that are inherent in the treatment of eating disorders. This text is not intended to be comprehensive in its coverage of any single approach or in its coverage of eating disorders treatments. Rather, it is a primer and a quick reference guide for clinicians who are seeking help in knowing what to expect or how to proceed in treatment. It would also be of great value to those studying eating disorders to learn aboutthe state of the art in treatment and research. Eating Disorders is a highly pragmatic guide that should offer hope to the clinician, provide basic clinical suggestions and tools, and serve as an inspiration for further investigation and training.

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