Moderation of bulimia

This paper examines those factors which appear to influence the response of bulimia to treatment. Poorer prognosis is associated with a previous history of weight disorder (in either direction); also, with a personality disorder, particularly one marked by alcohol abuse. The paper indicates the aetiological and clinical structure of what is a heterogeneous disorder and describes the mechanisms of a successful treatment programme.

Advances in behavioral approaches to adolescent health care

Behavior change professionals have developed treatment programs for a wide variety of health care problems affecting adolescents. Although a substantial data base of experimentally tested techniques exists for obesity, smoking prevention, and dysmenorrhea, much work remains in other areas. For example, the case studies reported on neurodermatitis and the survey work in teenage alcohol abuse must give way to systematic interventions employing group experimental designs. In addition, behavioral procedures should be compared to other treatments. Also, component analysis should be performed when multiple treatment strategies are used. Finally, strategies aimed at increasing the generalization of treatment, such as from classrooms to different community settings in substance abuse prevention programs and maintenance of treatment effects over long follow-up periods, are necessary. Only in this way will the efficacy of behavioral interventions for specific health problems be established. The leading causes of mortality among adolescents are due to accidents. Of the total number of deaths due to accidents, approximately 50% are attributed to motor vehicle accidents (National Safety Council, 1977). Many of these accidents are due to negligence, substance abuse, and, in general, immature behavior (Bakwin & Bakwin, 1972). In spite of a slow but consistent trend toward lower accidental deaths over time (National Safety Council, 1977), there still is a need for interventions designed to decrease risk-taking behavior, substance abuse, and carelessness in adolescents. Again, behavior change professionals might follow the example set by researchers who have begun to develop successful strategies for decreasing onset of cigarette smoking. These interventions and research methods, designed for use in schools, may provide a promising approach for addressing other kinds of prevention problems. It also seems appropriate to categorize cigarette smoking not only as a risk factor in the development of cardiovascular disease (Kuller, 1976), but also as a member of the risk-taking behaviors. Thus, procedures used to prevent cigarette smoking might also be adapted to prevent other kinds of risk-taking behaviors among adolescents. The work of McAlister et al. (1980), in preventing alcohol abuse as well as cigarette smoking by use of the same or similar procedures, is a case in point. Use of a procedure designed to train competency in refusing peer pressure has clear implications for reducing other risk-taking behaviors, such as reckless driving, drug abuse, and swimming and boating accidents.(ABSTRACT TRUNCATED AT 400 WORDS)

The end phase of analysis: indicators, functions, and tasks of termination

This paper considers the end phase of analysis. Beginning with a brief review of the literature on termination, specifically the indicators for initiating the termination process, we identify the structural attainments necessary for the patient to successfully complete the analysis and to maintain smooth post-analytic functioning. We stress in this regard the significance of self-analytic functions and the relative immutability of the transference neurosis. These points are illustrated with clinical examples. Our paper concludes with a discussion of the tasks and contributions of the analyst during the termination process. We make special reference to countertransference vulnerability resulting from the analyst's own termination experiences.

Anorexia nervosa and bulimia in dancers. Accurate diagnosis and treatment planning

Ballet dancers have an increased risk of developing anorexia nervosa, perhaps because of their preoccupation with appearance and body shape related to their career. The author lists the early warning signs of anorexia nervosa and bulimia in dancers. Techniques are described to assist the practitioner in differentiating the normal dieting dancer from the anorectic dancer. The author emphasizes strategic treatment planning with anorectic dancers who initially deny the severity of their illness.

Treatment of bulimia

Bulimia (bulimia nervosa; binge eating) is characterized by episodic eating of large amounts of food, followed by self-induced vomiting or laxative abuse. Psychotherapy has been the mainstay of treatment and often has been unsuccessful. The similarity of bulimia to major depression has led to evaluation of antidepressant drugs for treatment of the disease. Imipramine has proven effective in reducing binging episodes, and further evaluation of antidepressants seems warranted. Phenytoin also has been effective in some cases, suggesting that bulimia may be a neurologic disorder analogous to epilepsy. Optimal treatment may be antidepressants combined with a nutrition/psychotherapy program.

Anorexia nervosa and bulimia: diagnosis and comprehensive treatment

The following principles are associated with successful treatment of anorexia nervosa and bulimia: (1) correct identification of these syndromes by history and mental examination, rather than by the elimination of all possible medical explanations; (2) a balanced approach between changing the abnormal weight or eating pattern and understanding and correcting the predisposing and underlying psychodynamics; (3) an empirical practical approach to treatment that avoids speculative concepts of origin; (4) an understanding of the natural history and underlying psychopathology of these disorders; (5) a non-blaming supportive approach, with variation in the specific kind of psychotherapy chosen according to the needs and abilities of the patient; (6) global treatment goals including psychologic, biologic, and social improvement; (7) avoidance of procedures with high morbidity such as tube feeding, hyperalimentation, and high-dose medication; and (8) an attitude of realistic optimism. Virtually all aspects of these disorders have the potential for complete improvement.

Reduction of food theft and long-term maintenance of weight loss in a Prader-Willi adult

Behavioral interventions have had limited success in managing the chronic hyperphagia and obesity that are of presumed organic etiology in Prader-Willi syndrome. Thus, frequent foraging for food and covert consumption continue to be health-threatening problems for many Prader-Willi individuals. This case study was designed to replicate methods for assessment and treatment of food theft. A token program based on differential-reinforcement-of-other-behavior and response-cost eliminated theft in three hospital settings. Prior to discharge, the program was expanded to include contingencies on exercise behavior and weight loss, and staff from the subject's group home residence were trained to implement a modified program in the natural environment. Reduced food theft and continued weight loss were maintained in the group home and an apartment-living arrangement. A total of 81 lb (37 kg) was lost during a 2-yr period.

The significance of subclassification in anorexia nervosa: a comparative study of clinical features in 141 patients

Within a sample of 141 female anorexia nervosa patients comparative investigations were carried out between three subgroups: dieters, binge-eaters, and vomiters/purgers. A number of significant differences were found, especially with respect to age and duration of illness, previous treatment failures, and long-term outcome. The results appear to support the authors' view that the static idea of anorexia nervosa as a unitary illness should be abandoned and replaced by a dynamic dimensional model according to which, in the course of time, changes may occur in the clinical picture of dysorectic patients.

Bulimia nervosa, binge eating, and psychogenic vomiting: a controlled treatment study and long term outcome

An "epidemic" prevalence of binge eating and vomiting (bulimia nervosa) has been reported, and treatment has been claimed to be difficult. This paper describes a short term outpatient treatment programme of eclectic orientation capable of being conducted by non-specialist staff, under medical supervision, in local centres. The treatment programme was evaluated in a controlled trial and in long term follow up. In 30 women with severe bulimia the treatment programme significantly reduced their incidence of dietary manipulation without producing weight gain, weight disorder, or neurotic illness. After treatment all the women had fewer symptoms; 24 stopped binge eating and vomiting at the end of treatment, and a further four stopped shortly afterwards. During formal follow up 20 showed no dietary abuse and a further eight reduced their attacks to an average of three episodes a year: all judged treatment to be a success. Pretreatment indicators of poorer prognosis include alcohol abuse and a history of anorexia nervosa. Married patients experienced marital difficulties or illness in the spouse.

Personal writings in psychotherapy

The author suggests that written materials can be used within a psychoanalytic psychotherapy. They are particularly valuable as a tool for sustaining communication when a spoken dialogue falters, as, for example, in the treatment of patients with marked schizoid tendencies. In the past, written materials have often been regarded as a resistance to a verbal therapy. The article begins with a letter Freud wrote to the American poet H. D. Freud tells H.D. that he has read her poems in order to "get a glimpse of her personality" before starting her analysis. Five clinical examples are presented demonstrating the usefulness of writings in psychotherapy. The patients are all young women with borderline and schizoid features. The article concludes with a discussion describing a variety of uses for writings in psychotherapy. Since therapist reading time is usually given without a fee, the occasional gift of time may be particularly valuable.