Self-Harm Behavior and Eating Disorders: Dynamics, Assessment and Treatment
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Self-Harm Behavior and Eating Disorders: Dynamics, Assessment, and Treatment
See all 2 pre-owned listings. Buy It Now. Add to cart. Be the first to write a review About this product. About this product Product Information This book is designed to provide professionals with the information and tools they need to treat patients who have eating disorders and engage in self-harm beahviours.
Grouped into four major sections these chapters examine the co-occurance of self harm behaviour from a variety of perspectives. Additional Product Features Dewey Edition. Levitt, Sansone, Cohn, Epidemiology.
Nasser, Cross-cultural Issues and Self-harm Behavior. Clients: A Case Illustration. Like many psychiatric disorders, anorexia nervosa AN is a multidetermined disorder with diffuse symptomatology.
Because of this, successful treatment requires an individualized yet integrated psychotherapy approach. In this article, we outline a fundamental psychotherapy strategy and illustrate how this might interface with other aspects of treatment. In presenting this approach, we emphasize that there are many variations of AN and that no single approach or intervention is consistently effective in all patients.
Individualizing the treatment approach to each specific patient is of key importance for effective outcomes. Psychiatric evaluation. For psychiatric assessment, the diagnosis of AN is based upon the criteria identified in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition DSM-IV 1 and includes 1 the patient's refusal to maintain a weight at or above a minimally normal weight for age and height i.
Additional diagnostic supports include 1 a history of dieting behavior e. Height and weight assessment are essential as a number of individuals do not meet the explicit DSM-IV diagnostic criterion of 15 percent loss of initial body weight, yet suffer from subthreshold or subclinical cases of the disorder. Following the confirmation of an eating disorder diagnosis, the assessment of other Axis I disorders, such as mood and anxiety disorders, would seem to be in order.
However, the effects of weight loss and starvation make the assessment of some symptoms, such as anxiety and depression, which are inherently present in starvation states, extremely difficult to evaluate. As in all psychiatric assessments, Axis II evaluation should be considered. However, the young age of these patients as well as starvation and its related symptomatology often compromise effective evaluation.
According to empirical studies, the diagnostic subtype of AN appears to have some predictive value with regard to Axis II features. Physical evaluation.
All patients with AN should undergo a physical examination with a determination of height and weight, cardiac examination, and laboratory studies. Further cardiac evaluation i. According to the Practice Guideline for the Treatment of Eating Disorders Revision , 4 recommended routine laboratory studies include a blood urea nitrogen, creatinine, complete blood count with differential, thyroid assessment, and electrolytes. Treatment entry. In our experience, adolescent patients with recent-onset AN are highly resistant to entering into a treatment.
While the disorder is multidetermined, the resulting symptomatology functions similarly in nearly all cases to develop and maintain an isolated inner world that perpetuates the illusion of personal control while being devoid of meaningful relationships with others. So while there are many adaptive functions associated with AN e. The function of AN is to develop and maintain an isolated inner world that perpetuates the illusion of personal control while being devoid of meaningful relationships with others and, therefore, disconnected from the pain and disappointments encountered in the real world.
Treatment threatens the illusive safety of this complexly constructed inner world, exposing the patient to the very realities that he or she attempted to escape from in the first place through the development of symptoms.
Self-Harm Behavior and Eating Disorders: Dynamics, Assessment, and Treatment – Bóksalan
In conjunction with body-image distortion i. As a result, psychological insight is very low or non-existent in AN, and adolescent patients are typically forced into treatment by parents. Understandably, the patient perceives the treatment providers as external threats—as adversaries who will force the patient to gain weight.
To the patient, this is unacceptable. Low weight is the cornerstone of his or her illusionary world. All thoughts and behaviors align with the pursuit of low weight, and these time-consuming symptoms create the daily world of the sufferer. Given these negative attitudes towards treatment, developing a therapeutic alliance with the patient is a genuine challenge. In our experience, a therapeutic interface can be facilitated by being absolutely honest with the patient about the treatment, validating the problematic symptoms related to the disorder e.
It's hard for me to be in a role where my help is not understood. As various therapeutic relationships are initially being established with the patient e. When possible, treatment team participants should consider group supervision sessions or, at the very least, team meetings to coordinate and consolidate a unanimous management philosophy for each patient.
During the initial phase of psychotherapy treatment, patients with AN tend to be detached, defensive, exhausted, and intellectualizing. The psychopathology and accompanying starvation process seem to remove any semblance of emotions and feelings from these young patients. Their inner world seemingly functions according to complex and unemotional rules and guidelines. Given this clinical scenario, it is impractical to begin psychotherapy treatment with an emotion-based intervention e. The initial recommended psychotherapy intervention is cognitive-behavioral, and the emphasis in this approach is cognitive restructuring.
In addition, ongoing supportive psychotherapy is essential in developing and maintaining a therapeutic relationship. Cognitive restructuring is based upon eliciting faulty thought patterns from the patient and using logic to correct them. Within the framework of anorexic thinking, there are unending distortions around food, body, and weight issues.
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Examples include the beliefs that losing weight is good and gaining weight is bad; there are good foods and bad foods; losing weight will make one more popular; and being thin is being successful and in control. Using cognitive restructuring, the therapist attempts to elicit the preceding cognitions and then systematically challenges them in a logical and intellectual manner.
I understand that you periodically slip into arrhythmias. How can that be good? Over the past few months, how have your friends related to you? Do you feel closer to them? With cognitive restructuring, the therapist takes a non-forceful position, so as not to threaten the patient's sense of control. The therapist simply and unobtrusively questions the genuine reality basis for the patient's belief system, step by step.
In our experience, the process of cognitive restructuring continues throughout the entire treatment, but is most present at the outset and during the initial period of weight restoration. At some point in the weight restoration process, biological stress recedes and the patient begins to experience a return to premorbid personality functioning.