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Stephen Wonderlich,
James E Mitchell,
Ross D Crosby, Tricia Cook Myers,
Kelly Kadlec,
Kim Lahaise,
Lorraine Swan-Kremeier,
Julie Dokken,
Marnie Lange,
Janna Dinkel,
Michelle Jorgensen,
Linda Schander
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ABSTRACT: The purpose of this article is to review the available literature regarding treatment and management of eating disorder patients who fail to change over protracted periods of time.
Literature was reviewed pertaining to approaches to promoting change in treatment-resistant cases and the treatment of chronic eating disordered individuals.
Although there are a number of clinical perspectives on the treatment of chronic eating disorder patients, fundamental studies defining the concept of "chronicity" and standardized treatment approaches do not exist. Empirical studies of chronic cases are needed, given the absence of investigation of maintenance factors in chronic eating disorders and evidence-based approaches for treatment. An integrative and practical clinical protocol is provided.
The results of this review suggest that a significant number of eating disorder patients display a chronic course, which is poorly understood. Treatments for these individuals are not based on evidence-based findings.
International Journal of Eating Disorders 01/2012; 45(4):467-75. · 2.95 Impact Factor
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ABSTRACT: Psychological trauma in childhood has been shown to increase a variety of psychological disturbances and psychiatric disorders. Although evidence-based treatments for children who have been traumatized exist, they are infrequently used by clinicians treating children. The present paper describes the creation of the Treatment Collaborative for Traumatized Youth (TCTY) which is a statewide partnership in North Dakota designed to disseminate efficacious treatments for traumatized children and monitor outcomes across a broad, rural, geographic expanse. The paper reviews the dissemination strategy developed by the TCTY, reports outcomes regarding both clinicians and child participants, and highlights problems identified in the project and solutions that were generated.
Behaviour research and therapy 07/2011; 49(10):579-87. · 3.00 Impact Factor
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ABSTRACT: In order to replicate findings from previous community-based research, conducted in Australia, in a different sample, we examined relationships between exercise behaviour, eating-disordered behaviour and quality of life among young adult women attending one of two primary care facilities in the upper Midwest region of the United States.
A high level of guilt when exercise is missed was associated with markedly elevated levels of eating disorder psychopathology and significantly reduced quality of life. The combination of exercising solely for weight and shape and intense guilt after missing exercise was associated with very high levels of eating disorder psychopathology, comparable to those of individuals seeking specialist treatment.
The findings provide further evidence that where young adult women experience intense guilt when exercise is missed, high levels of eating disorder psychopathology and poor quality of life can be expected, particularly when exercising solely for weight or shape reasons is also reported. Information to this effect should be included in both eating disorder and obesity prevention programmes.
European Eating Disorders Review 06/2008; 16(3):215-21. · 1.38 Impact Factor
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ABSTRACT: A major problem in the delivery of mental health services is the lack of availability of empirically supported treatment, particularly in rural areas. To date no studies have evaluated the administration of an empirically supported manual-based psychotherapy for a psychiatric condition via telemedicine. The aim of this study was to compare the relative efficacy and acceptability of a manual-based cognitive-behavioral therapy (CBT) for bulimia nervosa (BN) delivered in person to a comparable therapy delivered via telemedicine.
One hundred twenty-eight adults meeting DSM-IV criteria for BN or eating disorder-not otherwise specified with binge eating or purging at least once per week were recruited through referrals from clinicians and media advertisements in the targeted geographical areas. Participants were randomly assigned to receive 20 sessions of manual-based, CBT for BN over 16 weeks delivered either face-to-face (FTF-CBT) or via telemedicine (TV-CBT) by trained therapists. The primary outcome measures were binge eating and purging frequency as assessed by interview at the end of treatment, and again at 3- and 12-month follow-ups. Secondary outcome measures included other bulimic symptoms and changes in mood.
Retention in treatment was comparable for TV-CBT and FTF-CBT. Abstinence rates at end-of-treatment were generally slightly higher for FTF-CBT compared with TV-CBT, but differences were not statistically significant. FTF-CBT patients also experienced significantly greater reductions in eating disordered cognitions and interview-assessed depression. However, the differences overall were few in number and of marginal clinical significance.
CBT for BN delivered via telemedicine was both acceptable to participants and roughly equivalent in outcome to therapy delivered in person.
Behaviour Research and Therapy 06/2008; 46(5):581-92. · 3.30 Impact Factor
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ABSTRACT: To determine if clinically defined multi-impulsive bulimia (MIB) can be validated using an empirical classification approach.
One hundred and twenty-five women who met DSM-IV criteria for bulimia nervosa were interviewed and completed a two-week EMA protocol. Participants who reported at least three highly impulsive behaviors were compared to participants who did not report such impulsive behavior. Also, Latent Class Analysis (LCA) was conducted to determine if the MIB classification could be replicated empirically.
LCA produced a two-class solution consistent with the traditional clinical approach to MIB classification. In both approaches, MIB was associated with higher levels of anxiety disorders, child abuse, and daily self-damaging behaviors than the non-MIB class.
Clinical classification of MIB was empirically supported through LCA. Although the classes failed to differ in bulimic behavior, MIB appears to represent a group of bulimic individuals with significant trauma histories and associated psychopathology.
International Journal of Eating Disorders 01/2007; 39(8):655-61. · 2.95 Impact Factor
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ABSTRACT: This article will review the treatment research literature on patients with anorexia nervosa. Perhaps somewhat surprisingly, the controlled treatment literature on this disorder is fairly limited. This is attributable to several factors, including the fact that many patients with anorexia nervosa are difficult to engage in treatment and unwilling to participate in randomized trials, and that many of these patients are so critically ill that they require a multiplicity of interventions and long-term therapy, creating design problems for randomized trials. Nonetheless, the extant literature will be reviewed, including pharmacologic and psychotherapeutic interventions in adolescents and adults. One point that needs to be addressed at the outset is the proper venue for the treatment of anorexia nervosa. Many patients, particularly those very low in weight, require in-patient and/or partial hospital treatment as the initial intervention. Although third-party payers are increasingly reluctant to pay for such interventions, they remain the treatments of choice for many anorectic patients. Another issue concerns acute treatment, focusing on weight gain, versus relapse prevention, focusing on weight maintenance and further work on anorectic psychopathology. Different studies have focused on different areas.
Women s Health 07/2005; 1(1):115-23.
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Psychiatric Clinics of North America 04/2005; 28(1):105-16, viii. · 2.13 Impact Factor
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ABSTRACT: In considering possible revisions to the diagnostic criteria for anorexia nervosa (AN), questions can be raised regarding the 85% cutoff and consideration could be given to using a body mass index (BMI) score instead. The criterion most likely to change in the 4th ed. of the Diagnostic and Statistical Manual of Mental Disorders (Washington, DC: American Psychiatric Association) is the amenorrhea criterion because this does not appear to add to the diagnostic specificity.
International Journal of Eating Disorders 02/2005; 37 Suppl:S95-7. · 2.95 Impact Factor
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ABSTRACT: This chapter is designed to provide an introduction to the basic principles of counseling outpatients with bulimia nervosa
who are being seen in a general medical setting. A summary of these principles and chapter outline is presented in Table 1.
The purpose is not to make psychiatrists or counselors out of family physicians or other generalists, but rather to improve
patient care and to briefly review some basic principles that can be useful in an office setting when working with these patients.
Emphasis is placed on a few issues that may significantly increase the likelihood that cases of bulimia nervosa will be detected
and that individuals with bulimia nervosa will become engaged in treatment and will take the first steps in the process of
recovering from this disorder.
12/2004: pages 13-21;
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ABSTRACT: The purpose of the current article is to review the literature regarding the use of alternative delivery systems, such as telemedicine, and new technologies, such as the use of hand-held computers, in the treatment of patients with eating disorders.
The literature is reviewed in the following areas: self-help (supervised and unsupervised), telemedicine, telephone therapy, e-mail, internet, computer software, CD-ROMs, portable computers, and virtual reality techniques.
A growing literature suggests a number of alternative delivery systems hold promise, in particular permitting patients to access services who otherwise would not be able to receive treatment. Although most of these areas are early in their development, a growing literature supports the utility of several of these approaches.
Although the literature in this area is limited, and the research base is small, a number of these technologies appear to hold substantial promise for the treatment of patients with eating disorders.
International Journal of Eating Disorders 10/2004; 36(2):123-43. · 2.95 Impact Factor
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09/2003: pages 1195 - 1202; , ISBN: 9780470854877
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ABSTRACT: In this article, the authors cover two areas of interest regarding eating disorders in childhood and adolescence: (1) the detection of eating disorders in medical practice and their medical complications and (2) the psychopharmacologic treatment of patients with eating disorders.
Child and Adolescent Psychiatric Clinics of North America 05/2002; 11(2):365-85, xi. · 2.60 Impact Factor
