Eating Disorders - fieldi

More documents

Recommendations

Info

Introduction 5 therapy or on medication but continues to struggle, would a change jeopardize progress or speed recovery? Over the past two decades we have been confronted by these issues every day. We have the luxury of comprehensive services: medical, nutritional, psychiatric, psychological, individual therapists of many styles, family and marital therapists, and a wide array of groups. All the professionals on the staff have extensive clinical experience and many years of specialization in eating disorders. Many have particular strengths: working with adolescents, with parents, with alcoholics, with victims of abuse, and so on. Having worked together on hundreds of patients, we are used to collaborating. We can trust the physician to monitor medical problems. We expect the dietitians to be doing cognitive and behavioral work on the reality of eating. Therapists will be working to help patients understand what needs their symptoms are serving. Groups can lessen isolation. Staff professionals work in conjunction with one another, sharing observations, problems, and goals. Our answering machines fill with long messages as we share significant developments from a patient’s session. Though we work exclusively on an outpatient basis, we are able to provide the intensity of treatment, as well as the sense of being in a therapeutic community, that facilitates progress in hospital settings. Each patient needs a treatment plan suitable to her needs. Would outpatient or hospital care be preferable? Should patients work individually or in family therapy? Will nutritional counseling be useful? Should medication be avoided or encouraged? When might group therapy be helpful? Not only must we decide what to recommend but we must enlist and maintain the patient’s involvement and the parents’ trust (if the patient is a child or adolescent) if treatment is to proceed and succeed. Sound recommendations require a thorough evaluation. This includes a careful history, psychological assessment, review of physical findings, and laboratory tests. A plan is developed in conjunction with the patient and, if appropriate, with the patient’s family. Four to six weeks may be required for patient, therapist, and nutritionist to begin to work together enough to assess potential success. Throughout treatment, however, periodic review is necessary to adjust care, as needed, to a person’s current situation.
6 Introduction Eating disorders impact health and emotional well-being. They also complicate major and minor life decisions. Should she go to camp? Should she go to (or back to) boarding school or college? Is it wise to travel or study abroad? To ski, run, or play varsity sports? How should families handle food shopping and mealtimes? How do they respond to “I feel so fat”? Members of the treatment team collaborate with patients and families in working out the many immediate issues that continue throughout the extended time it may take to resolve eating disorder symptoms and then to ferret out their psychological underpinnings. The following papers describe the approach of some of the Wilkins Center staff. They offer a variety of perspectives. But which is best suited to each patient and at what point in treatment? There is no cookbook recipe for treating eating disorders. The success of treatment hinges on its suitability for the person involved and its adaptation to her evolving needs over time. This requires the skills of experienced specialists in a good working alliance with the patient and the patient’s family. References McCann, U. D., and W. S. Agras. 1990. “Successful Treatment of Nonpurging Bulimia Nervosa with Desipramine.” American Journal of Psychiatry 147:1509–13. Spitzer, R. L., S. Yanovski, T. Wadden, R. Wing, M. D. Marcus, A. Stunkard, M. Devlin, J. Mitchell, D. Hasin, and R. L. Horn. 1993. “Binge Eating Disorder: Its Further Validation in a Multisite Study.” International Journal of Eating Disorders 13, no. 2: 137–53.
Page 1 and 2: editor BARBARA P. KINOY EATING DISO
Page 4 and 5: Eating Disorders New Directions in
Page 6: To our patients’ children and gra
Page 9 and 10: viii Contents 3. Psychiatric Consul
Page 11 and 12: x Foreword Although serious deficie
Page 14 and 15: preface In 1994, in the first editi
Page 16 and 17: Preface xv psychological hazards to
Page 18 and 19: Preface xvii partial, complete, or
Page 20 and 21: acknowledgments We wish to acknowle
Page 22 and 23: contributors Debra Bader, CSW, BCD:
Page 24 and 25: Eating Disorders
Page 26 and 27: Introduction diane w. mickley I am
Page 28 and 29: Introduction 3 needs of patients wh
Page 32 and 33: 1 Medical Aspects of Anorexia and B
Page 34 and 35: Medical Aspects of Anorexia and Bul
Page 42 and 43: 2 Recovery Through Nutritional Coun
Page 44 and 45: Recovery Through Nutritional Counse
Page 46 and 47: Lesson 1: Daily Caloric Need and Me
Page 54 and 55: ical activity to a normal level. If
Page 56 and 57: patient who binges, it may be helpf
Page 58 and 59: and allowing herself to consume a l
Page 60 and 61: Figure 2.3 Typical Hunger and Food
Page 62 and 63: herself. She frequently feels hopel
Page 74 and 75: 3 Psychiatric Consultation with Eat
Page 76 and 77: Psychiatric Consultation 51 standab
Page 78 and 79: Psychiatric Consultation 53 difficu
Page 80 and 81:
Psychiatric Consultation 55 Obsessi
Page 82 and 83:
4 A Family Systems Perspective on R
Page 84 and 85:
A Family Systems Perspective on Rec
Page 86 and 87:
Page 88 and 89:
Page 90 and 91:
she calls her mother and tells her
Page 92 and 93:
Page 94 and 95:
Page 96 and 97:
Page 98 and 99:
Page 100 and 101:
Page 102 and 103:
5 Relationship to Food as to the Wo
Page 104 and 105:
iors—somehow to integrate the fra
Page 106 and 107:
treatment, Theresa wanted to see an
Page 108 and 109:
Relationship to Food as to the Worl
Page 110 and 111:
Page 112 and 113:
Page 114 and 115:
6 The Therapeutic Use of Humor in t
Page 116 and 117:
The Therapeutic Use of Humor 91 Amy
Page 118 and 119:
The Therapeutic Use of Humor 93 was
Page 120 and 121:
The Therapeutic Use of Humor 95 ass
Page 122 and 123:
The Therapeutic Use of Humor 97 Ron
Page 124 and 125:
Jodie’s Story 99 capacity to make
Page 126 and 127:
Jodie’s Story 101 house and a ter
Page 128 and 129:
Jodie’s Story 103 She did not do
Page 130 and 131:
adness. The dream also revealed tha
Page 132 and 133:
8 Eating Disorders and Managed Care
Page 134 and 135:
Eating Disorders and Managed Care 1
Page 136 and 137:
Eating Disorders and Managed Care 1
Page 138 and 139:
Cognitive-Behavioral Therapy and Ot
Page 140 and 141:
Page 142 and 143:
Page 144 and 145:
Page 146 and 147:
Page 148 and 149:
Page 150 and 151:
Page 152 and 153:
10 The Nurse’s Role in a Pilot Pr
Page 154 and 155:
The Nurse’s Role in a Pilot Progr
Page 156 and 157:
The Nurse’s Role in a Pilot Progr
Page 158 and 159:
11 Individual Psychotherapy: A Long
Page 160 and 161:
Individual Psychotherapy 135 Such p
Page 162 and 163:
Individual Psychotherapy 137 empath
Page 164 and 165:
weight and shape, as well as change
Page 166 and 167:
Individual Psychotherapy 141 vomiti
Page 168 and 169:
Individual Psychotherapy 143 During
Page 170 and 171:
Individual Psychotherapy 145 and re
Page 172 and 173:
Individual Psychotherapy 147 Mitche
Page 174 and 175:
Young Adult Women 149 to surface an
Page 176 and 177:
Young Adult Women 151 with their at
Page 178 and 179:
Young Adult Women 153 ing; in fact,
Page 180 and 181:
Young Adult Women 155 doomed, and a
Page 182 and 183:
part of a treatment team where the
Page 184 and 185:
13 Recovery margaret goldkopf-woodt
Page 186 and 187:
Recovery 161 I can appreciate both
Page 188 and 189:
Recovery 163 meant. I certainly cou
Page 190 and 191:
Recovery 165 ate other uncomfortabl
Page 192 and 193:
Recovery 167 connection between my
Page 194 and 195:
Recovery 169 safe place, and our ow
Page 196 and 197:
Recovery 171 My pregnancies and mot
Page 198 and 199:
Recovery 173 They seem to be living
Page 200 and 201:
Recovery 175 Self-disclosure remain
Page 202 and 203:
nel. All that I feared, the hurts I
Page 204 and 205:
Afterword 179 surprisingly rapidly
Page 206 and 207:
Afterword 181 With eating disorders
Page 208 and 209:
Treatment helped me to face life, i
Page 210 and 211:
AA/BA. See American Anorexia/Bulimi
Page 212 and 213:
37; prevention of, 29-31; rigid die
Page 214 and 215:
problems and, 19; events triggering
Page 216 and 217:
Keel, P. K., 180 Keller, H., 133 Ke
Page 218 and 219:
Psychoeducational group therapy, 12
Page 220:
112-20; IPT, 121-22; psychoeducatio
show all

Eating Disorders - fieldi

Create successful ePaper yourself

Delete template?

Save as template?