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Psychological Treatment for Eating Disorders
In seeking treatment for eating disorders, it is extremely important to know how various evidence-based psychological treatments for eating disorders have been evaluated. This article addresses all of these issues in determining psychological treatment for eating disorders.
Although the name eating disorders lends a cohesiveness to the various disorders in the group - which include anorexia nervosa, bulimia nervosa, binge eating, pica, and rumination disorder - they not only respond to different treatments, but people may respond differentially to treatment depending on their age and the duration of the disorder. Also important to consider are co-existing issues and the results of the disorder, which may also require treatment.
Anorexia nervosa is an eating disorder in which a person restricts their diet and uses other measures in order to be thin, with a resulting body weight that is characterized as less than 85 percent of the expected weight for someone their size. Patients may fear becoming fat and losing control and feel proud of achieving control, but eventually nearly 50 percent binge. Long-term lack of nutrition affects physiology, behavior, and mood and often results in the need for inpatient treatment and an extended period of treatment, which is able to secure a full recovery in about 50 percent of cases overall.
A much higher percentage of recovery is achieved for young patients with a recent onset of the disorder and treated with the Maudsley model of family therapy. In this model, which takes places over 6 - 12 months with 10 - 20 therapy sessions, parents take control of the anorexic child’s eating and weight until compliance is achieved, and then control is returned to the child. When all these criteria are met, 90 percent of patients treated are free of symptoms five years out from treatment. Ego-oriented psychotherapy and cognitive behavioral-therapy were also found to be effective in this patient population. For patients who are older or have been anorexic longer, neither family therapy nor a dynamically oriented individual therapy approach, nor any other studied therapy was anywhere near as effective as prompt treatment of young adolescents.
Cognitive-behavioral therapy is a therapy that has often been tested with anorexia nervosa, but because truncated courses of therapy were offered and therapy differed from what is recommended by experts, and in each case CBT was compared to an ineffective therapy, leading to the conclusion that neither nutritional counseling nor medication without psychotherapy should be used in treating anorexia.
Bulimia nervosa is an eating disorder in which binge eating - not just over-eating, but uncontrolled eating of enormous amounts of food - is followed by a purging method to compensate for the calorie intake. That compensation may be through excessive exercise, self-induced vomiting, or laxative abuse. It is accompanied by a negative self-image, but a person with bulimia may have a normal body weight, as well as be slightly underweight or be overweight. The disorder is commonly associated with depression and personality disorders. Remission is, unfortunately, often short-lived, with relapse being common. Recovery rate estimates range from 31 percent to 74 percent. Bulimia nervosa often becomes an eating disorder not otherwise specified.
Cognitive-behavioral therapy is the most successful treatment, whether administered to an individual or in a group. Usually 16 - 20 sessions over 4 - 5 months is the treatment course. The treatment is effect in up to 50 percent of patients. Interpersonal psychotherapy has been found less effective than CBT immediately following treatment, but the results even out by a year following treatment. It is suspected that impulsivity, a history of obesity, coexisting substance abuse, and borderline personality disorder may be indicators for predicting that treatment will not be successful.
Eating Disorders Not Otherwise Specified
Although this is the most common eating disorder, it is not well specified diagnostically - with the exception of binge-eating disorder, and a frequent diagnosis of adolescents. Binge eating disorder features repeated and persistent episodes of binging when emotionally distressed, but without any compensatory weight-control measures being attempted. Binge eating is spread across a wider demographic, including more people, more adults, more men, and more people of color than anorexia nervosa, for example. It is typically associated with depression and psychosocial issues. Cognitive-behavioral therapy achieves remission in over 50 percent of patients - but not necessarily weight loss - and helps with the psychological issues as well. Interpersonal psychotherapy and dialectical behavior therapy have also shown efficacy. Researchers are looking into therapy that combines self-help with cognitive-behavioral therapy.
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