Paul E. Garfinkel

Paul E. Garfinkel
University of Toronto | U of T · Department of Psychiatry

OC, MD FRCP

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243
Publications
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Publications

Publications (243)
Article
Full-text available
This study examined the effectiveness of a journal club for teaching critical appraisal skills to residents in psychiatry and their transfer of those skills to clinical scenarios. Twelve residents participated in a 12-week journal club, and 12 residents were matched control subjects. Following the journal club, there remained no difference in perfo...
Article
Full-text available
To investigate the psychometric properties of the Body Uneasiness Test (BUT) in a large sample of subjects with obesity seeking treatment. BUT is a 71-item self-report questionnaire in two parts: BUT-A which measures weight phobia, body image concerns, avoidance, compulsive self-monitoring, detachment and estrangement feelings towards one's own bod...
Article
Evidence is reviewed to support the idea that effects of starvation cause the syndrome of anorexia nervosa to be self-perpetuating. This article emphasizes physiological abnormalities of sympathetic activity, norepinephrine and serotonin metabolism, arginine vasopressin, gut hormones and endorphinergic activity, and how they may be implicated in th...
Article
Full-text available
To investigate the psychometric properties of the Body Uneasiness Test (BUT), a 71-item self-report questionnaire that consists of two parts: BUT*A which measures weight phobia, body image concerns, avoidance, compulsive self-monitoring, detachment and estrangement feelings towards one's own body (depersonalization); and BUT*B which looks at specif...
Article
Full-text available
Objective: To study the problem of false negatives in the screening for eating disorders. Subjects and Methods: We administered the Eating Attitudes Test (EAT40) and the Eating Disorder Inventory (EDI) to 186 Italian female students (age 17.68 ± 0.9; BMI 20.84 ± 2.69). Then we submitted not only high-scorers but also all the subjects to a semi-stru...
Article
In this study we describe the frequency of eating disorders (EDs) in a group of bipolar (BP) patients. We evaluated a sample of 51 outpatients, diagnosed as having BP I disorder on the basis of the Structured Clinical Interview for DSM-IV (SCID). Each of these subjects was administered the Binge Eating Disorder Clinical Interview (BEDCI) to determi...
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Many factors, including personal experience and personality traits, contribute to the emotional difficulties that psychiatrists experience in their professional work. The nature of the work itself also plays a significant role. To determine those personal and professional characteristics that predict satisfaction with the practice of psychiatry. We...
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To further investigate the differentiation between non-purging bulimia nervosa (BN-NP) and binge eating disorder (BED), particularly as concerns weight-shape overconcern affecting self-esteem, a core belief to both anorexia and bulimia nervosa. Twenty-five female subjects with BN-NP and 25 female subjects with BED, consecutively referred to the Eat...
Article
In this study, we investigate the affective temperamental characteristics in a sample of ED (eating disorder) patients. 49 ED patients diagnosed by the SCID (Structured Clinical Interview for DSM-IV), were divided into two groups on the basis of the presence or absence of Binge Eating (restricting-anorexia nervosa [R-AN]= 16; Binge Eaters= 33). All...
Article
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The authors explored practice characteristics, activities, and career satisfaction of male and female psychiatrists. A questionnaire was mailed to all practicing psychiatrists in Ontario, Canada, to which 52% responded. More women specialized in child, women's mental health and geriatrics than did men, while men specialized more in forensics and ps...
Article
The aim of this study was to investigate two samples of patients affected by anorexia nervosa (AN) or bulimia nervosa (BN), respectively, with and without the diagnostic feature of drive for thinness (DT). The samples comprised 70 consecutive eating disorder (ED) outpatients at the Department of Psychiatry (University of Pisa) and 106 AN patients a...
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Article
Relationship between nurses’ pain knowledge and pain management outcomes for their postoperative cardiac patients Nurses’ knowledge and perceived barriers related to pain management have been examined extensively. Nurses have evaluated their pain knowledge and management practices positively despite continuing evidence of inadequate pain management...
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Few studies have examined the predictors of psychiatrists' perceived success and personal satisfaction with their careers. The present study examines self-reported success and personal satisfaction with their careers in a cohort of psychiatrists followed for more than 20 years. A total of 29 psychiatrists, all of whom had participated in a study du...
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Nurses' knowledge and perceived barriers related to pain management have been examined extensively. Nurses have evaluated their pain knowledge and management practices positively despite continuing evidence of inadequate pain management for patients. However, the relationship between nurses' stated knowledge and their pain management practices with...
Article
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Article
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The authors compared 62 men who met all or most of the DSM-III-R criteria for eating disorders with 212 women who had similar eating disorders and 3,769 men who had no eating disorders on a wide variety of clinical and historical variables. The groups of subjects were derived from a community epidemiologic survey performed in the province of Ontari...
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This manuscript reviews the literature involved with the Eating Attitudes Test (EAT), first developed in the late 1970s as a self-report, indicative of the symptoms of eating disorders. The EAT has good psychometric properties of reliability and validity, and reasonable sensitivity and specificity for the eating disorders, but very low positive pre...
Article
Although nurses have the major responsibility for pain management, little is known about nurses' responses to patients in the process of managing acute pain. To examine the relationship between nurses' empathic responses and their patients' pain intensity and analgesic administration after surgery. Two hundred twenty-five patients from four cardiov...
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The field of psychiatry is experiencing great excitement at this time, much as it was 100 years ago. Current excitement is rooted in the greatly strengthened therapeutics, new models for understanding, and an exponential increase in knowledge of brain function as well as in the opportunity to revise health care delivery. While public expectations o...
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The authors suggest that a charismatic leadership style has an impact on the maintenance of boundaries and standards of practice within a department of psychiatry. They also underline the need for all members of a self-regulated professional group to assume responsibility for the maintenance of standards within the group. An overview of leadership...
Article
The field of psychiatry is experiencing great excitement at this time, much as it was 100 years ago. Current excitement is rooted in the greatly strengthened therapeutics, new models for understanding, and an exponential increase in knowledge of brain function as well as in the opportunity to revise health care delivery. While public expectations o...
Article
The relationship between characteristics of self-soothing ability, the capacity for evocative memory, and aloneness was investigated in a clinical sample of 50 bulimia nervosa (BN) patients. Individuals meeting DSM-III-R criteria for BN who participated in a randomized trial of guided imagery completed measures of Soothing Receptivity and a modifie...
Article
This study examined the effectiveness of a journal club for teaching critical appraisal skills to residents in psychiatry and their transfer of those skills to clinical scenarios. Twelve residents participated in a 12- week journal club, and 12 residents were matched control subjects. Following the journal club, there remained no difference in perf...
Article
Full-text available
Patients with eating disorders (EDs) are often difficult to treat. Despite recent advances in treatment, a significant percentage of patients remain treatment refractory. This paper reviews variables that contribute to these difficulties and recent strategies that focus on increasing patient motivation for treatment. The authors relate their clinic...
Article
Evidence suggests that assessment of global type A behaviour as a coronary risk factor may not be the most fruitful strategy because some components, particularly hostility, may be more harmful than others. Measurement of hostility has been primarily through two types of instrumentation: the Type A Structured Interview (SI) and the Cook-Medley (Ho)...
Article
Reviews epidemiologic research on eating disorders in relation to its role in understanding trends in etiology and treatment. Since anorexia nervosa and bulimia are considered to be influenced by cultural forces; as these forces change, the disorders themselves may be altered. Such changes could affect the rates of the disorders, the ages of onset,...
Article
Objective The present study examined changes in women's mood states resulting from their viewing pictures in fashion magazines of models who represent a thin ideal.Method Female university students completed the Profile of Mood States (POMS), the Body Parts Satisfaction Scale (BPSS), and the Eating Disorder Inventory (EDI). They were then exposed t...
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A recent study demonstrated guided imagery therapy to be an effective treatment to promote self-comforting in women with bulimia nervosa (BN) (Esplen et al., 1998). This article reviews the literature on self-soothing and briefly reports the results from the randomized trial. Clinical vignettes from the study are utilized to further describe the im...
Article
The objective of this study was to test a guided imagery therapy designed to enhance self-comforting in bulimia nervosa. A randomized controlled trial compared 6 weeks of individual guided imagery therapy with a control group. Fifty participants who met DSM-III-R criteria for bulimia nervosa completed the study. Measures of eating disorder symptoms...
Article
This study examines the prevalence of anorexia nervosa and bulimia nervosa in relatives of probands, and examines the probandwise specificity of any familial clustering. Data were collected from probands using the family history method. Probands were recruited in a sequential cohort fashion. Information collected from probands was rated semiblindly...
Article
Full-text available
Bulimia nervosa (BN) has been described as involving impairment in affect regulation and in self-soothing. Such a conceptualization suggests the need to design treatments that specifically target these problems in order to assist individuals with BN in comforting themselves. A model of guided imagery therapy suggests that imagery therapy has multip...
Article
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To demonstrate that sexual abuse of patients by psychiatrists can be due to a variety of contributors, which may include therapists' psychopathic and narcissistic personality styles. Data from a prospective cohort of residents training in psychiatry were examined to evaluate the personality traits of 2 psychiatrists subsequently convicted of bounda...
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To explore a number of issues related to boundary violations in psychiatry, including the relationship between the individual physician and his or her patient and broader issues related to various dilemmas arising in academic departments of psychiatry. Several potentially troublesome scenarios are presented and discussed in the contexts of 1) the d...
Article
The past thirty years have seen dramatic changes in our approach to the eating disorders. These include marked improvements in the recognition and understanding of the disorders, and the reduction of the morbidity and mortality of anorexia and bulimia nervosa. Bulimia nervosa itself, now the focus of so much attention, was described less than twent...
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Objective Recent consensus on the subclassification of the eating disorder bulimia nervosa into purging and nonpurging forms is examined in the context of a large psychiatric epidemiological survey in Ontario, Canada. Method: Among a sample of 8,116 individuals, 62 met criteria for bulimia nervosa. Of these, the 17 who were of the purging subtype c...
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This study compares the characteristics of women with anorexia nervosa with those of women who have all the diagnostic features of that disorder except amenorrhoea. The study uses data from a large community epidemiological survey of the mental health status of household residents in Ontario, Canada. A multi-stage stratified sampling design generat...
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To identify important trends and themes that will affect psychiatric training and practice. Selective literature review and reflections by the authors. Three principal themes are elucidated relating to empiricism and integration, accountability and collaboration, and training and the public trust. There must be debate and action on these and other...
Article
In recent years evidence has accumulated to implicate a disturbance in serotonin function in the eating disorder bulimia nervosa. This study employs a neuroendocrine technique to assess the effect of intravenous 5-hydroxytryptophan, the immediate precursor to serotonin, on peripheral hormones in bulimia nervosa subjects and controls. Blunted prolac...
Article
Objective: To identify important trends and themes that will affect psychiatric training and practice. Method: Selective literature review and reflections by the authors. Results: Three principal themes are elucidated relating to empiricism and integration, accountability and collaboration, and training and the public trust. Conclusions: There must...
Article
To highlight developments in the taxonomy of eating disorders since Russell's original description of bulimia nervosa (BN) in 1979 and through 3 versions of the Diagnostic and Statistical Manual. Criteria for anorexia nervosa (AN), BN and binge eating disorder (BED) are systematically described. While criteria for AN remain largely unchanged betwee...
Article
SYNOPSIS A variety of sociocultural, familial and individual features associated with the eating disorders were examined in subjects with full syndrome (FS) and partial syndrome (PS) eating disorders and in normal high school students. The EAT-26 was administered to 995 high school students. This was followed by individual interviews with those who...
Article
Objective: To highlight developments in the taxonomy of eating disorders since Russell's original description of bulimia nervosa (BN) in 1979 and through 3 versions of the Diagnostic and Statistical Manual. Method: Criteria for anorexia nervosa (AN), BN and binge eating disorder (BED) are systematically described. Results: While criteria for A...
Article
Full-text available
Previous epidemiological studies of bulimia nervosa have generated differing estimates of the incidence and prevalence of the disorder. These differences are attributable, in part, to varying definitions of the illness and a range of methodologies. The authors sought to define the prevalence of bulimia nervosa in a nonclinical community sample, exa...
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This paper presents the results of a study examining self-reported family functioning by patients with bulimia nervosa (BN) and their parents before and after treatment for the eating symptoms of BN. Ratings of family functioning improved significantly over the course of treatment. There was no evidence of excessive denial or social desirability in...
Article
This paper extends the analyses performed in part one to the area of complex intrafamily comparisons. Ratings by patients are consistently elevated compared to ratings by parents on all scales of the Family Assessment Measure (FAM), and there are significant interaction effects, which, when examined, suggest that patient scores improve while parent...
Article
This paper presents the results of a study examining self‐reported family functioning by patients with bulimia nervosa (BN) and their parents before and after treatment for the eating symptoms of BN. Ratings of family functioning improved significantly over the course of treatment. There was no evidence of excessive denial or social desirability in...
Article
In a clinical sample of 198 female patients with anorexia nervosa (N=83) and bulimia nervosa (N=115), 43% met criteria for major depression using the Structured Clinical Interview for DSMIII-R. This group had a mean score of 30.9±8.7 on the Beck Depression Inventory (BDI) which was significantly higher than the BDI mean score of 20.5±8.9 among the...
Article
Since the delineation of bulimia nervosa as a distinct syndrome in 1979, a variety of etiological models and related treatments have evolved. Methodological advances in evaluation have been reflected in recent outcome studies. There is now extensive evidence for the effectiveness of various short-term psychotherapies for bulimia nervosa. However, t...
Article
Bulimia nervosa is an eating disorder characterized by episodes of binge eating and various attempts to counteract the effect of the ingested calories. Relatively little is known about the metabolic adaptation to this nutritional chaos. The baseline metabolic state of 12 bulimic women was compared with 9 healthy matched controls; evidence of decrea...
Article
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 di...
Article
This paper presents age of onset data for anorexia nervosa and bulimia nervosa, derived from a sample of 323 patients referred to a tertiary referral center. Patients had anorexia nervosa (n = 39), bulimia nervosa (n = 173), or bulimia nervosa with a history of anorexia nervosa (n = 173). While the pattern of onset of anorexia nervosa and bulimia n...
Article
Full-text available
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 di...
Article
Presents a theoretical argument in support of retaining the Diagnostic and Statistical Manual of Mental Disorders-III—Revised (DSM-III—R) criterion of a persistent overconcern with body shape and weight for the diagnosis of bulimia nervosa. Empirical studies are reviewed that (1) use a structured interview to assess weight and shape concerns and (2...
Article
The evolution of diagnostic criteria from DSM-III to DSM-Ill-R for bulimia nervosa included the addition of overconcern with body shape and weight as a psychological dimension. This survey of 524 bulimic females in Toronto and New York documents the prevalence of the more specific dimension of body dissatisfaction in this population and highlights...
Article
The Marlowe-Crowne Social Desirability Scale, a 33-item self-report questionnaire, was administered to an age-matched sample of twenty-five irritable bowel syndrome (IBS) patients, twenty-four psychiatric patients meeting a diagnosis of major depression, and nineteen controls. As predicted, planned comparisons analysis showed a significant group ef...
Article
Full-text available
Chronic fatigue syndrome is an increasingly popular diagnosis consisting of multiple psychiatric and somatic symptoms. It bears a striking resemblance to the nineteenth-century diagnosis of neurasthenia. Both disorders arose during periods characterized by a preoccupation with commerce and material success and major changes in the role of women. Th...
Article
Nine female subjects with anorexia nervosa (AN) were studied when emaciated (mean 72% of average body weight), and after refeeding (mean 85% of average body weight). They were compared to 9 individually age-matched female control subjects. On each occasion blood was sampled for serum melatonin and plasma cortisol through the night, and urine was co...
Article
A survey among psychiatric residents about their satisfaction with and concerns about their training in psychopharmacology was conducted. One hundred and seventy responders (61%) from ten post-graduate psychiatric programs in Canada completed the questionnaire. The questionnaire assessed the residents' satisfaction with the training they had receiv...
Article
Bulimia nervosa is an eating disorder with multiple causes that has been the object of extensive research since it was first described in 1979. This review evaluates both the theoretical rationale and empirical evidence for a model which suggests that disturbed serotonin activity is involved in the development of this disorder. Limitations of the h...
Article
Depressed mood and the psychiatric diagnosis of major depressive episode (MDE) are common findings in patients with chronic fatigue syndrome (CFS). The relationship between depression and CFS is unclear and may be explained by one of four models: (1) CFS is an atypical manifestation of MDE; (2) depression is the result of CFS as either an organic m...
Article
The number of patients who are identified as having chronic fatigue syndrome (CFS) has increased, and as a result, chronic fatigue syndrome has received widespread attention. Research has demonstrated that cognitive, affective and behavioural symptoms are prominent in CFS. Psychiatrists are therefore being asked to participate in the assessment and...
Article
Clinical empathy research has been plagued with conceptual and methodological difficulties. This paper describes a model of the empathic process that enables clinicians, teachers, and researchers to examine specific components of the model and to determine the influence of particular mediators on the empathic process. Empathy is conceptualized as a...
Article
Clinical research on the eating disorders has continued to expand and develop. Several significant conceptual and methodological problems are identified in the extant literature. The problem areas include the definition of cases, the control of relevant variables, and methods of assessment and strategies for treatment outcome trials. Suggestions ar...
Article
Urinary excretion of the principal melatonin metabolite, sulphatoxy melatonin (aMT6s), was assessed both during the day and during the night in 38 female eating disorder patients (anorexia nervosa, n = 17; bulimia nervosa, n = 12; anorexia nervosa + bulimia nervosa, n = 9) and 14 female control subjects. Correlations between nocturnal serum melaton...
Article
Three categories of treatments for premenstrual syndrome (PMS) have been proposed: those designed to correct the cause of the disorder; those designed for symptom relief; and those aimed at eliminating the menstrual cycle. Many of these recommendations are based on poor research with loose definitions of the disorder and uncontrolled open trials. T...
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This paper describes the prevalence and incidence of psychiatric disorders in IBS patients using a standardized psychiatric interview, and proposes a psychological model for investigating one aspect of IBS. Forty-four IBS patients and 28 nonclinical participants received a psychiatric interview (Diagnostic Interview Schedule) and completed the Lie...
Article
Some investigators have suggested that irritable bowel syndrome (IBS) represents a physiologic expression of an affective disorder. This study investigated whether IBS patients differed in their self-schema from depressed patients. Self-schema refers to a cognitive framework of the individual's beliefs, attitudes, and self-perceptions which is stor...
Article
Postinfectious neuromyasthenia (PIN) is a clinical syndrome of protracted and incomplete recovery after an apparent viral-like illness. Medical investigation yields few abnormalities which might account for the symptomatology. A substantial number of PIN patients complain of cognitive changes. Specific complaints include impaired attention, concent...