Eating Disorders - fieldi

Afterword 181
With eating disorders escalating around the globe, patients, as
stated earlier, have come from Europe, Asia, and Latin America for
treatment at the Wilkins Center. As with our American patients,
treatment is most effective when tailored to these patients’ particular
family and cultural background. Emerging data support the benefits
of adapting treatments to particular subsets of patients.
Younger teens, for example, may benefit more from family therapy
and a focus on maturity fears, whereas older patients may derive
greater benefit from individual therapy and medication for depression
and anxiety (Heebink, Sunday, and Halmi 1995; Eisler et al.
1997). Studies continue to demonstrate the high prevalence of borderline
personality disorder among eating disordered patients
(Wonderlich, Peterson, and Mitchell 1997). These individuals tend
to have greater psychiatric difficulties and often require more extensive
and enduring treatment.
The past twenty years have seen a burgeoning of new information
in the field of eating disorders. Current studies are delineating the
neurobiology of these illnesses and the genetic vulnerabilities to
their development. Pharmacological and psychological treatments
continue to expand and improve. Meanwhile, the advocacy movement
continues to work for legislation and insurance coverage for
patients who need intensive or long-term treatment. Finally, prevention
efforts continue to address the cultural milieu that fosters
eating disorders and the identification of young women with high
risk of illness and those not receiving adequate treatment.
Strides in related fields also benefit patients with eating disorders.
The expanding array of safer and more effective psychiatric medication
has been helpful to many patients with eating disorders. New
treatments for obesity have benefited some overweight patients with
binge eating disorder. The most recent groups added at the Wilkins
Center provide dialectical behavioral therapy (DBT) for a subset of
suitable patients. DBT, developed by Marsha Linehan, Ph.D., professor
of psychology at the University of Washington in Seattle, is a
treatment for patients with borderline personality disorder and has
been adapted to other settings. It helps patients develop techniques
to regulate moods, reduce self-harming behaviors, and increase
interpersonal effectiveness, skills very useful for a subgroup of
patients with eating disorders.