NEDA TOOLKIT for Parents
For some outpatients, a short-term course of family
therapy using these methods may be as effective as a
long-term course; however, a shorter course of
therapy may not be adequate for patients with severe
obsessive-compulsive features or non-intact families
[II]. For adolescents who have been ill <3 years, after
weight has been restored, family therapy is a
necessary component of treatment [I]. Although
studies of different psychotherapies focus on these
interventions as distinctly separate treatments, in
practice there is frequent overlap of interventions [II].
Most inpatient-based nutritional rehabilitation
programs create a milieu that incorporates emotional
nurturance and a combination of reinforcers that link
exercise, bed rest, and privileges to target weights,
desired behaviors, feedback concerning changes in
weight, and other observable parameters [II]. For
adolescents treated in inpatient settings, participation
in family group psychoeducation may be helpful to
their efforts to regain weight and may be equally as
effective as more intensive forms of family therapy
[III]. It is important for clinicians to pay attention to
cultural attitudes, patient issues involving the gender
of the therapist, and specific concerns about possible
abuse, neglect, or other developmental traumas [II].
Clinicians need to attend to their countertransference
reactions to patients with a chronic eating disorder,
which often include beleaguerment, demoralization,
and excessive need to change the patient [I].
ii. Anorexia Nervosa after Weight Restoration
Once malnutrition has been corrected and weight gain
has begun, psychotherapy can help patients with
anorexia nervosa understand 1) their experience of
their illness; 2) cognitive distortions and how these
have led to their symptomatic behavior; 3)
developmental, familial, and cultural antecedents of
their illness; 4) how their illness may have been a
maladaptive attempt to regulate their emotions and
cope; 5) how to avoid or minimize the risk of relapse;
and 6) how to better cope with salient developmental
and other important life issues in the future. Clinical
experience shows that patients may often display
improved mood, enhanced cognitive functioning, and
clearer thought processes after there is significant
improvement in nutritional intake, even before there is
substantial weight gain [II].
To help prevent patients from relapsing, emerging
data support the use of cognitive-behavioral
psychotherapy for adults [II]. Many clinicians also use
interpersonal and/or psychodynamically oriented
individual or group psychotherapy for adults after
their weight has been restored [II].
At the same time, when treating patients with chronic
illnesses, clinicians need to understand the
longitudinal course of the disorder and that patients
can recover even after many years of illness [I].
Because of anorexia nervosa’s enduring nature,
psychotherapeutic treatment is frequently required for
at least 1 year and may take many years [I].
Anorexics and Bulimics Anonymous and Overeaters
Anonymous are not substitutes for professional
treatment [I]. Programs that focus exclusively on
abstaining from binge eating, purging, restrictive
eating, or excessive exercising (e.g., 12-step programs)
without attending to nutritional considerations or
cognitive and behavioral deficits have not been
studied and therefore cannot be recommended as the
sole treatment for anorexia nervosa [I].
It is important for programs using 12-step models to
be equipped to care for patients with the substantial
psychiatric and general medical problems often
associated with eating disorders [I]. Although families
and patients are increasingly accessing worthwhile,
helpful information through online web sites,
newsgroups, and chat rooms, the lack of professional
supervision within these resources may sometimes
lead to users’ receiving misinformation or create
unhealthy dynamics among users.
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