Transdiagnostic Cognitive-Behavioral Therapy for Patients With Eating Disorders: A Two-Site Trial With 60-Week Follow-Up (original) (raw)
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Initial evaluation, diagnosis, and treatment of anorexia nervosa and bulimia nervosa
2015
Eating disorders are life-threatening conditions that are challenging to address; however, the primary care setting provides an important opportunity for critical medical and psychosocial intervention. The recently published Diagnostic and Statistical Manual of Mental Disorders, 5th ed., includes updated diagnostic criteria for anorexia nervosa (e.g., elimination of amenorrhea as a diagnostic criterion) and for bulimia nervosa (e.g., criterion for frequency of binge episodes decreased to an average of once per week). In addition to the role of environmental triggers and societal expectations of body size and shape, research has suggested that genes and discrete biochemical signals contribute to the development of eating disorders. Anorexia nervosa and bulimia nervosa occur most often in adolescent females and are often accompanied by depression and other comorbid psychiatric disorders. For low-weight patients with anorexia nervosa, virtually all physiologic systems are affected, ran...
AgiAl Publishing House (http://www.agialpress.com), 2013
The diagnostic consideration of the eating disorders anorexia nervosa and bulimia nervosa has been given much focus over the last two decades than previously, as clinicians have become more aware of the frequency of these disorders and the difficulties associated with their treatment (Brownell andFairburn 1995). Anorexia nervosa and bulimia nervosa as known in the DSM-IV as eating disorders which are characterized by physically and/or psychologically harmful eating patterns. Although the psychological explanation of what we now call anorexia nervosa have been known about for centuries, it has only recently attracted much interest, due to greater public knowledge and increased incidence (although the latter claim has been disputed) (Gross and MclLveen 2006;Fombonne 1995). Most people suffering from anorexia nervosa and bulimia nervosa start by fasting. Anorexia nervosa is a deliberate self-starvation. A person whose body weight is less than expected for his or her body height and weight is considered to be anorexic. In contract, bulimia involves binge eating a large quantity of food followed by purging by self induced vomiting,enemas, laxatives, or diuretics (Goodenough et al. 2005).
The current status of treatment for anorexia nervosa and bulimia nervosa
A survey investigating the current status of treatment for anorexia nervosa and bulimia nervosa was distributed at the International Conference on Eating Disorders in 7988 and again in 1990. Respondents answered questions regarding treatments they had endorsed for their last patient with anorexia nervosa and for bulimia nervosa. One hundred and seven medical doctors and psychologists completed the survey in 1988 and 115 in 1990. The results indicate that: (1) less than 50% of the respondents believe there is a consensus regarding the treatment of eating disorders; (2) talking therapy is overwhelmingly endorsed for the treatment of both anorexia and bulimia nervosa; (3) there is a trend in clinical practice towards using drug therapy more frequently in treating patients with bulimia nervosa than in treating patients with anorexia nervosa; (4) physicians are more likely than psychologists to endorse drug therapy when treating patients with anorexia and for bulimia nervosa; and (5) about one third of the respondents endorse drug therapy for treating anorexia nervosa.
Advances in diagnosis and treatment of anorexia nervosa and bulimia nervosa
This paper reviews four areas of research into anorexia nervosa (AN) and bulimia nervosa (BN). First, in terms of diagnosis, the psychological concerns about weight and shape are now addressed in BN, bringing it more in line with the related disorder, anorexia nervosa. Second, studies of psychiatric comorbidity confirm the overlap between eating disorders and depression, obsessive compulsive disorder, substance abuse, and personality disorder. Nevertheless, there are reasons to accept the distinct qualities of each syndrome, and eating disorders are not merely a variant of these other conditions. Third, treatment advances in BN involve mainly cognitive-behavioural or interpersonal psychotherapies and pharmacotherapies primarily with antidepressants. The effect of combining more than one approach is beginning to be addressed. Finally, outcome studies involving people with both AN and BN have shown that the disorders "cross over" and that both conditions have a high rate of relapse. A renewed interest in the treatment of AN is needed. R esearch into anorexia nervosa (AN) and bulimia nervosa (B.N) is progressing at a rapid rate. Meanwhile, patients with eating disorders continue to present major therapeutic challenges to clinicians. In a review of the progress made in clinical research on AN and BN, Garfinkel and colleagues (I) described a series of risk factors which may both initiate and perpetuate these chronic disorders and highlighted several serious complications. This paper will provide an update on the issues of diagnosis, comorbidity, treatment and outcome in this rapidly changing field. Diagnostic Criteria Minor changes to the diagnostic criteria in the DSM-III for AN were made for the DSM-III-R. The revised criteria re
Eating disorders: Efficacy of pharmacological and psychological interventions
Clinical Psychology Review, 1996
Estimates of the prevalence of eating disorders are less than 1% for anorexia nexvosa (AN), l-3% for bulimia nervosa (BN), and between 2 and 5% for binge eating disorder (BED). While these estimates reflect the proportion of community populations satisfying formal diagnostic criteria, the prevalence of caloric restriction, binge eating, purging, and other pathogenic weight control behaviors (PWCBs) is much higher, ranging from 15 to 40% (Schlundt &Johnson, 1990, Spitzer et al., 1992). Eating disorders have profound health, economic, and personalsocial consequences. AN is associated with a significant mortality (5-15%), and BN is closely related to depression and various Correspondence should be addressed to 457 458 W G. Johnson, J. I! Tsoh, and II J. Varnado
Management of anorexia and bulimia nervosa: An evidence-based review
Indian Journal of Psychiatry, 2010
hospitalized or who received tertiary-level care and were followed up at least four years after the onset of illness indicates that "good" outcomes occurred in 44% of the patients and approximately 5% of the patients died. [3] In case of BN, the overall short term success rate for patients receiving psychosocial treatment or medication has been reported to be 50-70%. [4] Relapse rates of 30-85% have been reported for successfully treated patients at six months to six years of follow-up. [6,7] Although widely described in Western literature, anorexia nervosa and related eating disorders are rare in nonwestern cultures. In India, the information regarding these disorders is very limited. [8] Indian patients chiefly present with refusal to eat, persistent vomiting, marked weight loss, amenorrhea and other somatic symptoms, but do not show over activity or disturbances in body image seen characteristically in anorexia nervosa. [9] Mortality rates in eating disorders, specifically anorexia nervosa, are among the highest in the mental disorders. [3,7,10] The scenario does not appear to have improved during the 20th century despite the plethora of options available to the psychiatrists as very few patients utilize the healthcare facilities. [11] Thus it becomes prudent to review the management of eating disorder to have a better understanding of this puzzling topic. For this purpose the wealth of evidence has been subdivided under two broad categories namelyanorexia nervosa and bulimia nervosa.
2014
In the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the diagnostic threshold for binging and compensation in bulimia nervosa (BN) decreased from twice to once weekly for 3 months. This study investigates the validity of this change by examining whether BN patients and those whose diagnoses "shift" to BN with DSM-5 are similar in their psychological functioning. EDNOS patients whose symptoms met DSM-5 BN criteria (n = 25) were compared to DSM-IV BN patients (n = 146) on clinically relevant variables. No differences were found on: BMI; weight-based self-evaluation; perfectionism; depression and anxiety symptoms; or readiness for change. Differences were found on one Eating Disorder Inventory subscale (i.e., bulimia), with the BN group reporting higher scores, consistent with group definitions. These findings support the modified criteria, suggesting that psychopathology both directly and indirectly related to eating disorders is comparable between those with once weekly versus more frequent bulimic episodes.