Eating disorder treatment

Words can be tricky things

Words can be tricky things and need to be used carefully. A brief article by former editors of the International Journal of Eating Disorders (Weissman et al., 2016) look at words we should avoid or reconsider in the field of eating disorders. The article seems largely written for researchers submitting articles to the journal, but has application to clinicians as well. Terms that we should no longer use include “anorexic” “bulimic” and “binge eater”. These terms confuse the person with the disorder and refer to them as one and the same thing. We don’t refer to someone with a diagnosis of cancer as “canceric”. There is a [...]

How long should eating disorder treatment take?

We are often asked how long should treatment take. At the recent ICED in New York there was a plenary on shorter treatments where the panel seemed to feel that short treatments were equivalent to longer treatments. Put another way, most change in eating disorder symptoms occurs early in treatment. This of course is true in some cases and predicts a better outcome. If all patients could turn up highly motivated to change and successfully manage the difficulty of change (and preferably be normal weight with mild symptoms) this would be great. There is a risk of the idea that all change occurs in the first 4-8 sessions leading [...]

A helpful stance and information for carers

Treatment manuals tell clinicians what to do in therapy. They outline the things that we think to be useful in helping someone suffering from an eating disorder. What is underemphasised in those manuals is the stance of the therapist that may be most helpful in making the most of the treatment manual. Collaboration or Direction? A ‘collaborative stance’ is central to most therapies. Josie Geller from Canada is one of the worlds leading investigators of stance in eating disorder treatment.  Geller defines a collaborative stance as one that is supporting or encouraging change, whilst also supporting the individuals and showing concern and caring that is not contingent [...]

Did they just take the F out of FBT

A recent, and important article has just been published in the Journal of the American Academy of Child and Adolescent Psychiatry by Le Grange et al. The paper is the results of a Randomised Controlled Trial of Family Based Treatment (FBT) and Parent Focused Treatment (PFT) done at Royal Childrens’ Hospital in Melbourne. FBT is probably well known to most in the field. PFT is a variant of FBT which is very interesting. There is a manual available and an outline in the book Family Therapy for Adolescent Eating and Weight Disorders edited by Loeb, le Grange & Lock.  In PFT the adolescent only has a brief session with [...]

Self Compassion in Eating Disorders: Science or Fluffy Bunnies?

Self compassion is one of the pretty trendy topics in eating disorders.  It is becoming part of many therapist treatment packages despite it not being in any of the evidenced based treatment programs.  In fact,  strident evidence based practitioners, such as Glenn Waller warn against the incorporation of self compassion as an indication of therapist drift.  It is seen as somewhat the realm of fluffy bunnies rather than having a scientific base. I wonder if that is fair. Self-compassion is a multi-dimensional construct based on the recognition that suffering, failure, and inadequacy are part of the human condition, and that all people—oneself included—are worthy of compassion. It [...]

The Eating Disorder Voice

Almost all my patients talk to me of the “voice” that they hear. The (usually) harsh and critical voice that talk, shouts and cajoles all the time.  Sometimes it is reported as a friend, sometimes more like a dictator. Patients often feel scared and trapped by this voice, compelled to do what it says in an effort to silence it.  Often the voice feels more powerful than the person. What is the relationship between the anorexic voice and anorexic symptoms. In a paper that I was involved with we (Scott, Haystack & Thornton, 2014) found that the voice played a role as an “abuser” and also an “ascetic voice” [...]

What to do when the ‘evidence based treatments’ are not successful?

What to do when the ‘evidence based treatments’ are not successful? One of the big questions in the field is what should you do if an evidence based treatment is not successful. If we look at binge eating as a behaviour, and thus covering the diagnosis of bulimia nervosa (BN) and binge eating disorder (BED), then the “treatment of choice” would be Cognitive Behavioural Therapy (CBT). Yet we know that not all people recover using CBT and some relapse after treatment ends. It has been suggested that an ‘additive’ design, where other therapy protocols are added onto the treatment of choice, may be useful to examine. McIntosh [...]

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