Eating Disorders E-Book

Stephen Touyz

• Herausgeber: Hogrefe Publishing
• Kategorie: Fachliteratur
• Serie: Advances in Psychotherapy - Evidence-Based Practice
• Sprache: Englisch

Seitenzahl: 253

Veröffentlichungsjahr: 2008

Beschreibung

Even those clinicians who have a special expertise in the treatment of eating disorders frequently find themselves in despair after trying unsuccessfully to persuade a seriously ill patient to accept treatment. This book can help. Eating disorders are causing increasing problems in our society, and many approaches to treatment are used, some more successful than others. This book provides therapists and students with practical and evidence-based guidance on diagnosis and treatment of anorexia nervosa (AN), bulimia nervosa (BN), eating disorders not otherwise specified (EDNOS), and binge eating disorder (BED). Building on existing knowledge as well as the enormous wealth of clinical experience that the authors have developed over the past three decades, it describes a successful, evidence-based approach. It will thus be of interest not only to those clinicians who have developed a special expertise in eating disorders, but to psychologists, psychiatrists, general practitioners, dieticians, social workers, nurses, and other allied mental health practitioners as well.

Leseprobe

Eating Disorders

About the Authors

Stephen W. Touyz, PhD, is Professor of Psychology and Honorary Professor of Psychological Medicine at the University of Sydney and Co-Director of the Peter Beumont Centre for Eating Disorders at Wesley Private Hospital. He has written or edited five books and over 180 research articles and book chapters on eating disorders and related topics. He is a Fellow of the Academy of Eating Disorders and the Australian Psychological Society and is Past President of the Eating Disorders Research Society. He was the inaugural treasurer of the Australian and New Zealand Academy of Eating Disorders and is an executive member of the Eating Disorder Foundation. He is a member of the Editorial Board of the European Eating Disorders Review.

Janet Polivy, PhD, is Professor of Psychology and Psychiatry at the University of Toronto at Mississauga. She has written or edited 4 books and over 150 research articles and book chapters on dieting, eating, and eating disorders. She is a Fellow of the Royal Society of Canada, the Association for Psychological Science, the Canadian Psychological Association, and the Society for Personality and Social Psychology, and is Treasurer of the Academy for Psychological Clinical Science.

Phillipa Hay, MD, is former Professor of Psychiatry and Head of Discipline of the School of Medicine, James Cook University, and Senior Consultant Psychiatrist at the Townsville Hospital. In August 2007 she took up the Foundation Chair in Mental Health at the University of Western Sydney School of Medicine. She has written over 80 research articles and book chapters on eating disorders and related topics. She is a Fellow of the Royal Australian and New Zealand College of Psychiatrists (RANZCP), Chair of the RANZCP Board of Research, Vice-President of the Australian and New Zealand Academy of Eating Disorders, and member of the Editorial Board of the International Journal of Eating Disorders, the Academy of Eating Disorders, and the Board of Examiners of the Australian Medical Council.

Advances in Psychotherapy – Evidence-Based Practice

Danny Wedding; PhD, MPH, Prof., St. Louis, MO

(Series Editor)

Larry Beutler; PhD, Prof., Palo Alto, CA

Kenneth E. Freedland; PhD, Prof., St. Louis, MO

Linda C. Sobell; PhD, ABPP, Prof., Ft. Lauderdale, FL

David A. Wolfe; PhD, Prof., Toronto

(Associate Editors)

The basic objective of this series is to provide therapists with practical, evidence-based treatment guidance for the most common disorders seen in clinical practice – and to do so in a “reader-friendly” manner. Each book in the series is both a compact “how-to-do” reference on a particular disorder for use by professional clinicians in their daily work, as well as an ideal educational resource for students and for practice-oriented continuing education.

The most important feature of the books is that they are practical and “reader-friendly:” All are structured similarly and all provide a compact and easy-to-follow guide to all aspects that are relevant in real-life practice. Tables, boxed clinical “pearls”, marginal notes, and summary boxes assist orientation, while checklists provide tools for use in daily practice.

Eating Disorders

Stephen W. Touyz

School of Psychology, University of Sydney, Australia

Janet Polivy

Department of Psychology, University of Toronto, Canada

Phillipa Hay

School of Medicine, University of Western Sydney, Australia

Library of Congress Cataloging in Publication

is available via the Library of Congress Marc Database under the LC Control Number 2008921333

Library and Archives Canada Cataloguing in Publication

Touyz, S. W. (Stephen W.)

Eating disorders / Stephen W. Touyz, Janet Polivy, Phillipa Hay.

(Advances in psychotherapy--evidence-based practice)

Includes bibliographical references.

ISBN 978-0-88937-318-1

1. Eating disorders. 2. Eating disorders--Treatment.

I. Polivy, Janet II. Hay, Phillipa III. Title. IV. Series.

RC552.E18T69 2008       616.85’26       C2008-900543-0

© 2008 by Hogrefe & Huber Publishers

PUBLISHING OFFICES

USA:

Hogrefe & Huber Publishers, 875 Massachusetts Avenue, 7th Floor, Cambridge, MA 02139

Phone [phone], Fax [phone]; E-mail [email protected]

EUROPE:

Hogrefe & Huber Publishers, Rohnsweg 25, 37085 Göttingen, Germany

Phone [phone], Fax [phone], E-mail [email protected]

SALES & DISTRIBUTION

USA:

Hogrefe & Huber Publishers, Customer Services Department, 30 Amberwood Parkway, Ashland, OH 44805

Phone [phone], Fax [phone], E-mail [email protected]

EUROPE:

Hogrefe & Huber Publishers, Rohnsweg 25, 37085 Göttingen, Germany

Phone [phone], Fax [phone], E-mail [email protected]

OTHER OFFICES

CANADA:

Hogrefe & Huber Publishers, 1543 Bayview Avenue, Toronto, Ontario M4G 3B5

SWITZERLAND:

Hogrefe & Huber Publishers, Länggass-Strasse 76, CH-3000 Bern 9

Hogrefe & Huber Publishers

Incorporated and registered in the State of Washington, USA, and in Göttingen, Lower Saxony, Germany

No part of this book may be reproduced, stored in a retrieval system or transmitted, in any form or by any means, electronic, mechanical, photocopying, microfilming, recording or otherwise, without written permission from the publisher.

Format: EPUB

ISBN 978-1-61334-318-0

Preface

This book describes the well-known eating disorders comprising anorexia nervosa (AN), bulimia nervosa (BN), eating disorders not otherwise specified (EDNOS), and binge eating disorder (BED). Despite the serious nature of eating disorders, and AN in particular (which has the highest mortality rate of all psychiatric disorders), the development of clinically effective treatments that would prove to be successful in the majority of our patients remains elusive. Yet each day, in consulting rooms in hospitals, clinics, and private practice, patients afflicted with an eating disorder turn to therapists to provide them with treatment to alleviate their suffering. And despite the ego-syntonic nature of AN, patients suffer an ever decreasing quality of life. Even those clinicians who have a special expertise in the treatment of eating disorders find themselves in despair trying to persuade a seriously ill patient to accept treatment with absolutely no success.

This is where this book can help. It builds on existing knowledge as well as the enormous wealth of clinical experience that the authors have developed over the past three decades. It assumes a basic understanding of therapeutic intervention and some clinical training. This book will be of interest, not only to those clinicians who have developed a special expertise in eating disorders, but to psychologists, psychiatrists, general practitioners, dietitians, social workers, nurses, and other allied mental health practitioners as well.

The book is divided into five chapters. The first chapter describes the different eating disorders (AN, BN, EDNOS, and BED) and then sets out to show how they are defined and diagnosed. Empirically supported diagnostic and assessment techniques are then reviewed. Chapter 2 explores the theoretical models which underpinning the development and maintenance of eating disorders and their implications for treatment. In Chapter 3, practical strategies are provided to facilitate undertaking the initial interviews and to ensure that the appropriate medical assessment and laboratory investigations have been done. Chapter 4 provides a detailed practical account using in-session dialogs and didactic pearls to illustrate as clearly as possible the psychological techniques and interventions available to the clinician. Potential obstacles to treatment, especially with the poorly motivated and uncooperative patients are given special attention. Finally, Chapter 5 includes a series of case examples which illustrate the complexities of these disorders and the obstacles to successful treatment. The appendices provide handouts and additional information to use in treatment sessions.

Eating disorders remain an interesting challenge for clinicians. Because these disorders are heterogeneous in nature, one treatment does not fit all. As a result, this book has not been written as a “cookbook” or manual but rather as a practical guide so that the clinician can better tailor the treatment to the needs of each particular patient. It also provides helpful strategies and clinical pearls to assist the clinician especially at those difficult moments when confronted by a recalcitrant patient. There is much didactic material that can be shared with patients and when all else seems lost, some humor to keep the ship afloat.

Acknowledgments

We are indebted to a large number of people who have contributed in their own special way to the success of this book. These include editors Danny Wedding and Linda Carter Sobell, and Robert Dimbleby of Hogrefe and Huber Publishers, whose guidance and support was invaluable and very much appreciated. We are also indebted to the late Peter Beumont, not only for his innovation in clinical practice, but for his determination to leave no stone unturned in the quest to alleviate the suffering for those with an eating disorder.

This book is dedicated to all our patients, both past and present from whom we have learnt so much. They have challenged us and, unfortunately, at times found us wanting, but this has inspired us to continue our search to better understand and to find new ways to treat these debilitating disorders.

We are very grateful to our wonderful colleague and friend, Peter Herman, for his invaluable encouragement and support throughout this endeavor and for his special brand of humor which got us through the difficult times.

The objective of this new series is to provide clinicians with practical evidence-based treatments for the most common disorders in clinical practice but written in a reader friendly and practical manner. To this end, we would like to thank Jonathan S. Abramowitz for setting the benchmark in this series and for future books such as ours. We would also like to thank Christopher Fairburn for the up to date information regarding the publication of his EDE-Q6. To Cindy Li, who despite her onerous workload, found the time to type drafts and format figures, our much appreciated gratitude. A special word of thanks to Ethel Harris, Eva Naumann, and Alex Blaszczynski for their contribution to formatting the diagrams and to Belinda Ingram for her assistance with the final draft.

Finally to our families, for their enduring love, patience, encouragement, and affection.

Dedication

To Wren and our children, Justin and Lauren, for their enduring love and affection and to my mentor, colleague, and friend, the late Peter Beumont for his inspiration and wisdom.

SWT

To Peter, Lisa/Leah, Eric, and Saretta for all they are to me and to Dick Bootzin and Ken Howard for all they did to help me to become a psychologist and therapist.

JP

To Anne Hall who provided inspiration and superb mentoring in my “salad days,” and to Kevin and Beatrix for their enduring love and patience.

PH

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 (Bulima Nervosa)

           Case Vignette 3: Mark (Binge Eating Disorder)

6         Further Reading

7         References

8         Appendices: Tools and Resources

Because the greater majority of patients who have eating disorders are female, we have used feminine nouns and pronouns throughout this book.

1

Description

1.1   Terminology