Perception of changes in eating disorder patients during group treatment

Childhood body-focused behaviors and social behaviors as risk factors of eating disorders

BACKGROUND

The risk factors for adolescent eating disorders are poorly understood. It is generally agreed, however, that interactions with one's body and interactions with others are two important features in the development of anorexia and bulimia nervosa. Therefore, we assessed a variety of childhood body-focused behaviors and childhood social behaviors in eating-disordered patients as compared to non-eating-disordered subjects.

METHOD

We compared 50 female inpatients with eating disorders (anorexia or bulimia nervosa), 50 female inpatients with polysubstance dependence, and 50 nonpatient female control subjects with no history of eating or substance abuse disorders (all defined by DSM-IV criteria), using a semi-structured interview of our own design. We asked questions about (1) childhood body-focused behaviors (e.g. thumb-sucking) and body-focused family experiences (e.g. bodily caresses), and (2) childhood social behaviors (e.g. numbers of close friends) and family social styles (e.g. authoritarian upbringing).

RESULTS

Many body-focused measures, such as feeding problems, auto-aggressive behavior, lack of maternal caresses, and family taboos regarding nudity and sexuality, characterized eating-disordered patients as opposed to both comparison groups, as did several social behaviors, such as adjustment problems at school and lack of close friends. However, nail-biting, insecure parental bonding, and childhood physical and sexual abuse were equally elevated in both psychiatric groups.

CONCLUSION

It appears that eating-disordered patients, as compared to substance-dependent patients and healthy controls, show a distinct pattern of body-focused and social behaviors during childhood, characterized by self-harm, a rigid and 'body-denying' family climate, and lack of intimacy.

The place of inpatient care in the treatment of anorexia nervosa: questions to be answered

BACKGROUND

The chance that an anorexia nervosa patient will be hospitalized depends more on circumstantial rather than on scientifically based factors. Although there is a lot of information on the treatment of anorexia nervosa patients in a residential setting, answers to questions relating to the "when," "where," and "how" of treatment are subjective. There is no clinical consensus and the paucity of controlled research is hampering the development of an evidence-based practice.

RESULTS

Increasing economic restraints through managed care policies limit the length of inpatient treatment, which leads to early discharge at a lower body weight, which leads to a higher likelihood of readmissions, which leads to increasing costs.

DISCUSSION

We will highlight important issues in the ongoing debate between economic demands and clinical challenges. Our goal is to stimulate critical reflections and systematic research.

Outpatient group therapy for anorexia nervosa: a preliminary study

Group therapy is generally recognized as an important form of psychotherapy for anorexia nervosa patients, but there are few controlled studies of its effectiveness. The aim of the current study was to determine the effectiveness of cognitive-behavioural therapy (CBT) for the treatment of anorexia nervosa in outpatients. Twenty-six outpatients with anorexia nervosa, were assessed for depression (BDI, Beck Depression Inventory), eating psychopathology (EDI, Eating Disorders Inventory), eating attitudes (EAT, Eating Attitudes Test) and weight at the beginning and at the end of the treatment and at one year follow-up. Our results substantiate the effectiveness of the CBT approach as a treatment and also at one year follow-up. Good EAT scores were observed in 70% of our cases after the treatment and in 60% at follow-up. Further research should assess the effectiveness of therapeutic groups more intensively because of their economic advantages.

Depression and psychosocial adjustment in adolescent anorexia nervosa. A controlled 3-year follow-up study

This study investigated depressive psychopathology and psychosocial functioning in adolescent anorexia nervosa patients at a three year follow-up in comparison to healthy age-matched controls. Three standardized rating instruments (HRSD, SDS, BDI) were used for assessing depression and the Morgan-Russell scales for defining the outcome of the eating disorder. Our findings suggest 1) a highly positive correlation between eating disorder and depressive psychopathology; 2) recovered anorectics score higher on depression scales than healthy controls; 3) recovered and unrecovered anorectics are similar to age-matched controls in terms of occupational adjustment, social contacts and dependency on family, but differ significantly in psychosexual functioning.

Group therapy for anorexic and bulimic patients. Some aspects on the conduction of group therapy and a critical review of some recent studies

Group psychotherapy for Anorexia Nervosa (AN) and Bulimia Nervosa (BN) patients may be a major therapeutic challenge. The cognitive-behavioural approach may seem promising and some important stages in the conduction of cognitive-behavioural group therapy in particular are discussed. Furthermore, some problems concerning inpatient versus outpatient groups are mentioned. Studies on group therapy that have appeared between 1984 and 1989 are briefly reviewed and some recommendations concerning the improvement of methodology for future studies are put forward.