Touyz / Polivy / Hay Eating Disorders

1. Auflage 2008
ISBN: 978-1-61334-318-0
Verlag: Hogrefe Publishing
Format: EPUB
Kopierschutz: 6 - ePub Watermark

E-Book, Englisch, 118 Seiten

Reihe: Advances in Psychotherapy - Evidence-Based Practice

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.

Autoren/Hrsg.

Touyz, Stephen W.

Touyz, Stephen

Polivy, Janet

Hay, Phillippa

Hay, Phillipa

Fachgebiete

• Medizin | Veterinärmedizin Medizin | Public Health | Pharmazie | Zahnmedizin Medizinische Fachgebiete Essstörungen & Therapie
• Sozialwissenschaften Psychologie Psychotherapie / Klinische Psychologie Essstörungen & Therapie
• Medizin | Veterinärmedizin Medizin | Public Health | Pharmazie | Zahnmedizin Medizinische Fachgebiete Psychiatrie, Sozialpsychiatrie, Suchttherapie

Leseproben

1 Description 1.1   Terminology The first documented eating disorder (ED) was anorexia nervosa (AN), which was described in the medical literature in 1874. In the 1970s AN was subtyped into those who simply restricted and exercised (anorexia nervosa – restricting type) and those who purged, some of whom also binge ate (anorexia nervosa – purging type). This latter type of AN was identified as a separate disorder in normal weight women in 1979 and named bulimia nervosa (BN). It later became apparent that not all patients met the full criteria for either AN or BN, but seemed nonetheless to have more than simply a subthreshold version of the disorder. These patients were grouped together into the category of eating disorder not otherwise specified (EDNOS) in DSM-III-R in 1987 (American Psychiatric Association, 1987). A subtype of EDNOS that has received a lot of attention because it is more common, especially among obese individuals, is binge eating disorder (BED) wherein individuals binge eat but do not purge the excess food. 1.2   Definitions Fairburn and Walsh (2002) defined an eating disorder as “a persistent disturbance of eating behavior or behavior intended to control weight, which significantly impairs physical health or psychosocial functioning. This disturbance should not be secondary to any recognized general medical disorder…or any other psychiatric disorder” (page 171). In this book, we will discuss the major recognized eating disorders, using the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision (DSM-IV-TR; American Psychiatric Association, 2000a) and the International Statistical Classification of Diseases and Related Health Problems, 10th Edition (ICD-10; World Health Organization, 1992) to describe the primary features of anorexia nervosa (AN), bulimia nervosa (BN), and atypical eating disorders, or eating disorder not otherwise specified (EDNOS), a somewhat controversial category described by some as a catchall or residual group of subthreshold disorders, whose sufferers do not quite meet the criteria for AN or BN (Williamson et al., 2002), or by others as a set of distinct, long-lasting, and debilitating disorders rather than as simply subthreshold versions of AN or BN (Fairburn & Bohn 2005, Fairburn & Harrison, 2003). The DSM-IV-TR reflects the North American standard criteria for defining eating disorders, and in Europe the criteria detailed in the ICD-10 predominate. It should be noted, that the questions of whether to divide the eating disorders into separate diagnoses and exactly how to separate them are both still controversial (Fairburn, Cooper, & Shafran, 2003; Polivy & Herman, 2002), but we will maintain the usual diagnostic conventions for the purposes of this book. Clinical Vignette Different Eating Disorders What do a 12-year-old girl who refuses to eat more than a minute amount of vegetables each day, and who weighs less than 85% of what her peers weigh, and a 21-year-old woman who gorges herself with cake, cookies, and junk food three nights a week and then forces herself to vomit have in common? Both would be diagnosed as having an eating disorder. Eating disorders have become increasingly prevalent recently in Westernized societies, possibly due, at least in part, to periods of relative affluence and enhanced social opportunities for women (Bemporad, 1997). In fact, however, the sorts of voluntary self-starvation and episodes of binge eating and purging that characterize eating disorders have been reported throughout history. Diagnostic criteria for eating disorders To establish the DSM-IV-TR criteria for eating disorders, empirically validated symptoms were compiled by a panel of experts, and refined further by others in the field. The ICD-10 operationalizes the eating disorders in a similar manner to the DSM-IV-TR. Not all criteria for the disorders are easy to define (e.g., exactly what behaviors constitute binge eating? How much food comprises a binge?), and there is a lack of consensus on some symptoms (such as the requirement of amenorrhea for AN); the criteria as listed thus have some ambiguities. The categorical nature of these classificatory systems has been questioned (e.g., Williamson, Gleaves, & Stewart 2005), given the shifts in both criteria and the categories themselves over time. Moreover, the two sets of criteria are only moderately concordant in some areas because of different symptom criteria and thresholds for diagnoses (Ottosson, Ekselius, Grann, & Kullgren, 2002). Despite these ambiguities in the criteria, the two diagnostic systems help to point to symptoms that need to be treated, methods of treating them, and also allow for assessment of successful change, and thus they remain the standard for diagnosing the disorders. Finally, the use of these diagnostic criteria is not encouraged for children younger than age 10 (who do not usually present with traditional eating disorders), as they have not been found to be reliable for diagnosing the eating problems of younger children (Nichols, Chater, & Lask, 2000), despite the fact that children as young as 8 are now presenting with eating disorders (Watkins & Lask, 2002). 1.2.1  Anorexia Nervosa (AN) The key criteria for the diagnosis of AN are: (a) Weight loss and/or maintenance of a weight at least 15% below what is normal for height (and age); (b) Intense fear of becoming fat (DSM-IV-TR) or self-infliction of reduced weight by avoidance of “fattening foods” (ICD-10); (c) Disturbed or distorted perception of one’s body, which is seen as too fat despite the emaciation; (d) Amenorrhea in postmenarcheal females (DSM-IV-TR) or hypothalamic-pituitary-gonadal endocrine disorder leading to amenorrhea in females and loss of sexual interest or potency in males (ICD-10). In addition, the DSM-IV-TR specifies either restricting type (no regular incidents of binge eating or purging) or binge-eating/purging type (regular episodes of binge eating and/or purging behavior occur during the current anorexic episode), while ICD-10 requires that the disorder not meet the first two criteria for BN. Table 1
DSM IV-TR Diagnostic Criteria for 307.1 Anorexia Nervosa A.   Refusal to maintain body weight at or above a minimally normal weight for age and height (e.g., weight loss leading to maintenance of body weight less than 85% of that expected; or failure to make expected weight gain during period of growth, leading to body weight less than 85% of that expected). B.   Intense fear of gaining weight or becoming fat, even though underweight. C.   Disturbance in the way in which one’s body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or denial of the seriousness of the current low body weight. D.   In postmenarcheal females, amenorrhea, the absence of at least three consecutive menstrual cycles. (A woman is considered to have amenorrhea if her periods occur only following hormone, e.g., estrogen, administration.) Specify type: Restricting Type: During the current episode of anorexia nervosa, the person has not regularly engaged in binge-eating or purging behavior (i.e., self-induced vomiting or the misuse of laxatives, diuretics, or enemas). Binge-Eating/Purging Type: During the current episode of anorexia nervosa, the person has regularly engaged in binge-eating or purging behavior (i.e., self-induced vomiting or the misuse of laxatives, diuretics, or enemas). Reprinted with permission from the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (© 2000), American Psychiatric Association.   Table 2
ICD-10 Diagnostic Criteria for Anorexia Nervosa A.   There is weight loss or, in children, a lack of weight gain, leading to a body weight at least 15% below the normal or expected weight for age and height. B.   The weight loss is self-induced by avoidance of “fattening foods.” C.   There is self-perception of being too fat, with an intrusive dread of fatness, which leads to a self-imposed low weight threshold. D.   A widespread endocrine disorder involving the hypothalamic-pituitary-gonadal axis is manifested in women as amenorrhea and in men as a loss of sexual interest and potency. (An apparent exception is the persistence of vaginal bleeds in anorexic women who are on replacement hormonal therapy, most commonly taken as a contraceptive pill). E.   The disorder does not meet the criteria A and B for bulimia nervosa (F50.2) World Health Organization (1992). International statistical classification of diseases and related problems (10th rev.). Geneva: Author. Two types of AN: those who do and those who do not binge/purge Two subtypes are generally distinguished in AN (as in the DSM-IV-TR diagnostic criteria): those who do and those who do not engage in binge eating and/or purging behaviors. Those who binge and purge seem to differ on a variety of dimensions from those who merely restrict, ranging from premorbid differences, such as higher childhood weight and more familial obesity, to personality differences such as borderline,...