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Early treatment for eating disorders
... This theoretical paper responds to the ongoing challenges in understanding and treating eating disorders, herein limited to anorexia and bulimia as diagnosed among Western girls and women. Taking into account the growing use of art therapy in the disorders' multi-disciplinary treatment settings (e.g., Fleming, 1989;Frisch, Franko, & Herzog, 2006;Levens, 1987Levens, , 1994aLevens, , 1994cLubbers, 1991;Matto, 1997;Wolf, Willmuth, Gazda, & Watkins, 1985;Wolf, Willmuth, & Watkins, 1986;Wood, 2000), the aim is to encourage the integration of feminist poststructuralist elucidation of eating disorders into art therapy, toward enhanced treatment. The paper begins with a brief overview of psychosexual theories of gender, body, and identity while focusing on ideas that have been appropriated into feminist poststructuralist theory, which elucidates the discursive construction of gendered embodied subjectivity. ...
... According to this theory, eating disorders are rooted in a disturbed separation-individuation stage of development owing in large part to the negative influence of the family, especially of the mother. Based on this understanding, art therapists identify the main goal for their clients as achieving a psychologically mature and healthy self -a self that is separate and individuated (e.g., Acharya, Wood, & Robertson, 1995;Crowl, 1980;Fleming, 1989;Gillespie, 1996;Levens, 1987Levens, , 1994aLevens, , 1994bLevens, , 1994cLubbers, 1991;Luzzatto, 1994aLuzzatto, , 1994bMacks, 1990;Mitchell, 1980;Morenoff & Sobol, 1989;Rehavia-Hanauer, 2003;Rust, 1992Rust, , 1994Schaverien, 1994;Wolf et al., 1985Wolf et al., , 1986Wood, 2000). In turn, the function of art is explained in terms of helping to repair psychological deficits associated with incomplete separation-individuation (e.g., Acharya et al., 1995;Fleming, 1989;Levens, 1987;Lubbers, 1991;Macks, 1990;Wood, 2000). ...
... Based on this understanding, art therapists identify the main goal for their clients as achieving a psychologically mature and healthy self -a self that is separate and individuated (e.g., Acharya, Wood, & Robertson, 1995;Crowl, 1980;Fleming, 1989;Gillespie, 1996;Levens, 1987Levens, , 1994aLevens, , 1994bLevens, , 1994cLubbers, 1991;Luzzatto, 1994aLuzzatto, , 1994bMacks, 1990;Mitchell, 1980;Morenoff & Sobol, 1989;Rehavia-Hanauer, 2003;Rust, 1992Rust, , 1994Schaverien, 1994;Wolf et al., 1985Wolf et al., , 1986Wood, 2000). In turn, the function of art is explained in terms of helping to repair psychological deficits associated with incomplete separation-individuation (e.g., Acharya et al., 1995;Fleming, 1989;Levens, 1987;Lubbers, 1991;Macks, 1990;Wood, 2000). Underlying object-relation's theorization of eating disorders and of art therapy's helping role is the assumption that a healthy self is complete and separate. ...
The objective in this theoretical paper is to encourage the integration of feminist poststructuralist perspectives into art therapy, toward enhanced understanding and treatment of Western girls and women diagnosed with anorexia and bulimia. Feminist poststructuralists share the view that eating disorders represent an attempt to reconcile a double bind of femininity that is embedded in the Western gendered mind-body discourse within which the body is associated with femininity and construed negatively as the other of idealized mind-as-self associated with masculinity. The double bind pervades popular culture and psycho-medical treatment, contributing to the development and maintenance of eating disorders. Sensitized to feminist poststructuralist elucidation of eating disorders, art therapists can become aware of patriarchal assumptions within adopted theories, enhance responsiveness to clients’ visual and verbal references to the double bind, and realize art therapy's potential pertaining to engagement with clients’ metaphors and their bodies’ active and creative role during art-making and interacting with physical materials. Consequently, clients’ incorporated gendered mind-body hierarchy can be destabilized and their feminine embodied subjectivity reconstructed to include: a more positive and strengthened relationship with their body, awareness of eating disorders’ socio-cultural context, reduced self-blame, and new skills to cope with life challenges.
... Anorexia nervosa (AN) significantly affects adolescents' social, emotional, cognitive, and physiological developmental processes in a detrimental manner (Loeb et al., 2011;Quine, 2012). Although various medical complications associated with AN may improve with recovery, potentially irreversible sequelae pose a serious threat to adolescents' current and future health status (Loeb et al., 2011). ...
... Anorexia nervosa (AN) significantly affects adolescents' social, emotional, cognitive, and physiological developmental processes in a detrimental manner (Loeb et al., 2011;Quine, 2012). Although various medical complications associated with AN may improve with recovery, potentially irreversible sequelae pose a serious threat to adolescents' current and future health status (Loeb et al., 2011). Given that the onset of AN typically occurs in adolescence, early intervention is crucial. ...
... These findings align with previous related work, demonstrating that machine learning is a powerful tool for categorizing the content of posts on social media (Chancellor et al., 2016). Leveraging social media for early intervention may be especially important for individuals with an eating disorder because untreated symptoms tend to become more frequent, severe, and persistent over time, and shorter latency between eating disorder onset and start of treatment is associated with better out comes (Lewinsohn, Striegel-Moore, & Seeley, 2000;Loeb, Craigen, & Goldstein, 2011). Making use of these algorithms would require part-nerships with social media platforms. ...
Objective:
Online forums allow people to semi-anonymously discuss their struggles, often leading to greater honesty. This characteristic makes forums valuable for identifying users in need of immediate help from mental health professionals. Because it would be impractical to manually review every post on a forum to identify users in need of urgent help, there may be value to developing algorithms for automatically detecting posts reflecting a heightened risk of imminent plans to engage in disordered behaviors.
Method:
Five natural language processing techniques (tools to perform computational text analysis) were used on a data set of 4,812 posts obtained from six eating disorder-related subreddits. Two licensed clinical psychologists labeled 53 of these posts, deciding whether or not the content of the post indicated that its author needed immediate professional help. The remaining 4,759 posts were unlabeled.
Results:
Each of the five techniques ranked the 50 posts most likely to be intervention-worthy (the "top-50"). The two most accurate detection techniques had an error rate of 4% for their respective top-50.
Discussion:
This article demonstrates the feasibility of automatically detecting-with only a few dozen labeled examples-the posts of individuals in need of immediate mental health support for an eating disorder.
... Halmi et al. (2005) described AN in adulthood as one of the most difficult psychiatric disorders to treat. Treatment outcomes in adults are generally poorer than in adolescence (Fairburn 2005;le Grange and Lock 2005;Loeb et al. 2011;Treasure and Russell 2011). ...
Treatments for anorexia nervosa provided early in the onset of the illness lead to better outcomes. Despite the treatment approach used, the therapeutic alliance may be instrumental in successful outcomes. The aim of this study was to explore the young people and their families’ experiences of the illness, and their access to and satisfaction with the services received. Of particular interest was their view of the working alliance with their therapist/s. Participants were interviewed by telephone using a semi-structured questionnaire. Family based treatment or the Maudsley was found superior to other treatments with regard to physical markers of recovery, satisfaction with the services and therapy received, as well as the strength of the therapeutic alliance. All the interviewees stressed the need for more research, education, accessibility and flexibility of services and increased support for both the young people and their families.
... The strong outcomes of evidence-based therapies in research settings can also be reached in clinical settings if clinicians adhere to manuals and protocols (Pederson Mussell et al., 2000;Wilson, 2005). Unfortunately, there is clear evidence that protocols and manualized approaches are underused by clinicians across a number of therapies for eating disorders (Tobin, Banker, Weisberg, & Bowers, 2007;Wallace & von Ranson, 2011;Waller, Stringer, & Meyer, 2012). ...
Objective:
Research has shown that clinicians underuse or omit techniques that constitute an essential part of evidence-based therapies. However, it is not known whether this is the case in DBT for eating disorders. The aims of this study were; 1) exploring the extent to which DBT techniques were used by self-identified DBT clinicians treating eating disorders; 2) determining whether therapists fell into distinct groups, based on their usage of DBT techniques; and 3) examining whether clinician characteristics were related to the use of such techniques.
Method:
Seventy-three clinicians offering DBT for eating disorders completed an online survey about their use of specific DBT techniques. They also completed measures of personality and intolerance of uncertainty.
Results:
In relation to the first aim, the pattern of use of DBT techniques showed a bimodal distribution - most were used either a lot or a little. Considering the second aim, clinicians fell into two groups according to the techniques that they delivered - one characterized by a higher use of DBT techniques and the other by a higher use of techniques that were specific to the treatment of eating disorders, rather than DBT methods. Finally, more experienced clinicians were more likely to be in the 'DBT technique-focused' group.
Discussion:
DBT clinicians are encouraged to implement both sets of techniques (DBT techniques and standard techniques for the treatment of eating disorders) in an integrated way. Training, supervision and the use of manuals are recommended to decrease therapist drift in DBT.
... Finally, the client's approach to starting and stopping the creative process also elucidates their responses to boundaries in life. A client might spend so much time in preparatory talk prior to the art that there is very little time for creation; this can be seen as a tactic for avoiding the unknown or delaying what is perceived as potentially frightening or painful (Jacobse, 1995). Alternatively, the client might not know when to stop the creative process, persist too long in adding color or details, and become dissatisfied with the finished product (Hinz, 2009b). ...
The Expressive Therapies Continuum (ETC) is a model that helps explain how people interact with art media to process information and form images. The ETC provides a framework for understanding the use of materials and processes in art assessment and art therapy. The model is a developmental hierarchy that is hypothesized to reflect brain and body functions because the ways in which people process information in art therapy is believed to mirror the ways that they think, feel and act in their lives. Therefore, the ETC can be used in a practical way to explain to clients the uses of art in therapy and to help clients and therapists communicate about needs, interventions, and treatment goals. This chapter reviews the model of the ETC, and illustrates its use in assessment and treatment planning with case examples.
... Ebenso bedeutsam ist die oft beschriebene Situation, dass PatientInnen mit einer Essstörung, vor allem mit einer Anorexia nervosa, oft deutliche Schwierigkeiten im Umgang mit anderen haben (Zeeck, 2012). Auch auf Grund des ausgeprägten Untergewichts können psychodynamische Gruppen eine Überforderung für sie darstellen und sie können sich emotionalem Erleben nicht öffnen (Zeeck, 2012 (Lubbers, 1991;Yalom, 2007und Zeeck, 2012, Mander, 2015 überein und kann somit auch als Außenvalidierung der Skalen angesehen werden. ...
Hintergrund: Die Kunsttherapie ist in der klinischen Behandlung von PatientInnen mit Essstörungen (Anorexia nervosa, Bulimia nervosa und Binge-Eating Störung) eine Therapiemethode und gehört im Rahmen der stationären und teilstationären psychosomatisch-psychotherapeutischen Behandlung zum Standard in der Bundesrepublik Deutschland (Jantschek 2004). Es gibt jedoch nur wenige wissenschaftliche Arbeiten und kaum empirische Daten zum Thema Kunsttherapiegruppe und Essstörungen (vgl. Ganter, 2009 und Lauschke, 2014). Ebenso fehlt bisher ein psychometrisch überprüftes Messinstrument, welches das Erleben der Kunstthera-piegruppe aus PatientInnen- und TherapeutInnensicht erheben kann. Methode: Es wurde ein Fragebogen konstruiert, welcher das Erleben der Kunsttherapiegruppe aus PatientInnensicht (FEKTP) und TherapeutInnensicht (FEKTTH) erhebt. In diesem Fragebogen wurden 16 Wirkfaktoren von Grawe (2005) und Yalom (1985) für die Kunsttherapiegruppe umformuliert. Es fand mit n= 133 PatientInnen aus der Abteilung für Psychosomatische Medizin und Psychotherapie des Universitätsklinikums Tübingen und Heidelberg eine einmalige Befragung nach der 6. Kunsttherapiesitzung statt. Die Kunsttherapeutinnen (n=4) schätzten das Erleben der PatientInnen ebenfalls ein. Der FEKTP wurde mit einer Itemanalyse und einer Explorativen Faktorenanalyse untersucht. Der FEKTTH wurde anhand der Konfirmatorischen Faktorenanalyse überprüft. Um etwas über das Erleben der Kunsttherapiegruppe bei PatientInnen mit einer Essstörung aussagen zu können, wurden n=22 PatientInnen einmalig nach der 6. Kunsttherapiesitzung mit dem FEKTP befragt. Mit Hilfe des U-Test nach Mann & Whitney wurde die Nullhypothese: Es gibt keinen Unterschied des Erlebens in der Kunsttherapiegruppe zwischen den beiden Grundgesamtheiten (Essstörungen/ andere psychosomatische Erkrankungen), überprüft. Um die subjektiven Relevanzstrukturen der PatientInnen besser erheben zu können, wurden zusätzlich zwei qualitative, leitfadengestützte Interviews mit zwei an Anorexia nervosa erkrankten Patientinnen am Therapieende durchgeführt. Diese wurden mit der Qualitativen Inhaltsanalyse (Mayring, 2012) ausgewertet. Hauptfragestellung der Untersuchung war: Wie erleben PatientInnen mit einer Essstörung die Kunsttherapiegruppe? Ergebnisse: Die Explorative Faktorenanalyse ergab für den FEKTP eine sechs-faktorielle Lösung, die 64,98% der Gesamtvarianz aufklärt. Die interne Konsistenz der sechs Faktoren lag mit Cronbach´s α zwischen 0,448 und 0,807. Die quantitativen Gütekriterien wurden erfüllt. Die Konfirmatorische Faktorenanalyse für den FEKTTH ergab eine geringe Modellpassung. Der U-Test ergab, dass die Skalen 2 (Klärende Erfahrungen des Sozialverhaltens) und 6 (Erfahrene Anteilnahme) von PatientInnen mit einer Essstörung im Vergleich zu den anderen psychosomatischen Krankheitsbildern, signifikant weniger positiv erlebt worden sind. Somit muss die Nullhypothese abgelehnt werden. Die Qualitative Inhaltsanalyse der Interviews ergab drei Hauptkategorien: Kunsttherapeutische Erlebensdimensionen aus Patientinnensicht, Kunsttherapeutische Erlebensdimensionen in Bezug auf die Kunsttherapeutin und in Bezug zur Kunst-therapiegruppe und Veränderte Selbstwahrnehmung der Patientin. Die Interviews zeigen vor allem den Wert der künstlerisch-ästhetischen Erfahrungen auf und veranschaulichen Bewältigungs- und Handlungsmöglichkeiten. Die Interviews unterstützten zudem die Ergebnisse der Fragebogenerhebung. Die Fragebögen FEKTP und FEKTTH sowie die Interviews stellen erstmalig verschiedene empirisch erhobene Erlebensdimensionen der Kunsttherapiegruppe dar. Diskussion: Die Skala 6 (Erfahrene Anteilnahme) des FEKTP sollte auf Grund des Cronbach´s α= 0,448 Wert eventuell neu formuliert und erneut überprüft werden. Der FEKTTH muss mit einer größeren Anzahl an KunsttherapeutInnen erneut überprüft werden. Ebenso wäre eine Überprüfung des Fragebogens mit einem Außenkriterium wünschenswert. Eine größere Anzahl an Interviews zum Erleben der Kunsttherapiegruppe auch mit PatientInnen mit einer Bulimia nervosa oder Binge-Eating Störung wären erstrebenswert.
... spouse/ cohabiting partner, aunts/uncles, grandparents, etc.) CBT-E, cognitive-behavioral therapy -enhanced ; SSCM, specialist supportive clinical management ; MANTRA, cognitive-interpersonal treatment (Maudsley model of anorexia nervosa treatment for adults) ; CRT, cognitive remediation therapy ; TAU, treatment as usual ; LEAP, Loughborough Eating disorders Activity therapy ; BMI, body mass index ; rhIGF-1, recombinant human insulin-like growth factor-1 ; AN-EX/RP, exposure and response prevention for anorexia nervosa ; ECHO, Experienced Carers Helping Others self-help intervention ; ECHOc, Experienced Carers Helping Others guided self-help intervention ; CAT, cognitive analytic therapy ; FPT, focal psychodynamic therapy. and FBT for children and adolescents with prodromal presentations (PI : Loeb) (Loeb et al. 2011). ...
Background:
Anorexia nervosa is a potentially deadly psychiatric illness that develops predominantly in females around puberty but is increasingly being recognized as also affecting boys and men and women across the lifespan. The aim of this environmental scan is to provide an overview of best practices in anorexia nervosa treatment across the age spectrum.
Method:
A triangulation approach was used. First, a detailed review of randomized controlled trials (RCTs) for anorexia nervosa published between 1980 and 2011 was conducted; second, clinical practice guidelines were consulted and reviewed; third, information about RCTs currently underway was sourced. This approach facilitated a comprehensive overview, which addressed the extant evidence base, recent advances in evidence and improvements in treatment, and future directions.
Results:
The evidence base for the treatment of anorexia nervosa is advancing, albeit unevenly. Evidence points to the benefit of family-based treatment for youth. For adults no specific approach has shown superiority and, presently, a combination of renourishment and psychotherapy such as specialist supportive clinical management, cognitive behavioral therapy, or interpersonal psychotherapy is recommended. RCTs have neither sufficiently addressed the more complex treatment approaches seen in routine practice settings, such as multidisciplinary treatment or level of care, nor specifically investigated treatment in ethnically diverse populations. Methodological challenges that hinder progress in controlled research for anorexia nervosa are explained.
Conclusions:
The review highlights evidence-based and promising treatment modalities for anorexia nervosa and presents a triangulated analysis including controlled research, practice guidelines, and emerging treatments to inform and support clinical decision making.
... The CD-ROM contains nine interactive modules teaching carers disease-and self-management skills, including how to communicate with the young person about his/ her AN, how to support them at meal times, how to manage crises and conflict, how to assess and manage risk, information on the use of the mental health act, how to address the carers' own needs, how to work with NHS and voluntary services, and the role of different practitioners in the EDs team. 93 Participants are randomized to receive 14 family therapy sessions or 14 individual therapy sessions, in which parents are offered an opportunity to discuss progress and any concerns with the therapist prior to each session, but are not involved in the treatment. The explicit aim is to prevent participants from developing AN; those who already meet diagnostic criteria are therefore excluded. ...
Aim:
Early intervention in eating disorders (EDs) has been a neglected area. Peak onset is in adolescence, suggesting that early intervention should include parents. We synthesize findings from five key theoretical domains, and present pilot data from a phase-specific early intervention for new onset EDs in young people.
Methods:
From literature searches, we reviewed current knowledge on risk factors for EDs; ED prevention in young people; the evidence base for treatment for young people with EDs; early intervention in other mental health fields; and parenting interventions. Based on these findings, we devised and piloted a parent group intervention.
Results:
Presenting features are typically parental concern about changes in eating behaviour and/or weight loss. There is a delay between symptom onset and help seeking, by which time the illness is well established. Early intervention should therefore target parents and be delivered at secondary rather than primary care. Effective treatments favour family-focused interventions with parental responsibility for symptom management. We hypothesized that a parents' group might be effective for addressing the specific emotional experience of parents in the early stages and their relative lack of knowledge and understanding. Pilot data show significant improvements in knowledge, skills, confidence, understanding and their child's adherence to meal plans as a result of a 6-week parent group intervention.
Conclusion:
A parent group intervention addressing themes identified from risk factor, prevention and treatment research is a potentially promising approach to early intervention for EDs. The impact of the intervention on patient outcome needs evaluation.
Early detection of emerging eating disorder symptoms is critical to rapid intervention, which can reduce the negative impact of illness on individuals, families, and society. However, the evidence base to guide these efforts is quite limited. This chapter reviews existing research related to early detection (noticing the earliest symptoms) and early intervention (targeting symptoms at the earliest point possible) for child and adolescent eating disorders, emphasizing the role of parents and other primary caregivers. Early intervention can be redefined to encompass distinct phases of an emerging eating disorder including risk factors, prodromal symptoms, and initial disorder onset. Extant research suggests that specific behaviors like extreme diet changes are the most easily detected by others, although a variety of other behavioral and cognitive symptoms are present prior to eating disorder onset. Improving eating disorder education and support will be critical for parents and others in the early detection network (e.g., schools, healthcare providers). Once concerns are identified, parents have a role in carrying out early interventions to reverse the risk factors, early symptoms, or early disorder phase of illness. Interventions targeted to each phase will likely draw from eating disorders prevention science (particularly selective and indicated prevention approaches), treatment research, or both. Overall, research on early interventions is lacking, with most falling within child and adolescent anorexia nervosa. In general, research highlights the experiences of girls and young women from white Western European and North American backgrounds, leaving room for scientific advancement within early detection and early intervention for diverse individuals.
This pilot study adapted family-based treatment (FBT) for youth with potentially prodromal anorexia nervosa (AN). Fifty-nine youth with clinically significant AN symptom constellations, but who never met full Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.) (DSM-IV) criteria for AN, were enrolled in a partially randomized preference design study. Participants were offered randomization to FBT or supportive psychotherapy (SPT); those who declined to be randomized because of a strong treatment preference were entered into a parallel, non-randomized self-selected intervention study. Without accessing outcome data, an observational analysis with three diagnostic subclasses was designed based on AN symptom severity profiles, combining randomized and non-randomized participants, such that participants receiving FBT and SPT within each subclass were similar on key baseline characteristics. Outcomes of this pilot study were explored by calculating effect sizes for end-of-treatment values within each subclass, and also with a longitudinal mixed effect model that accounted for subclass. Weight trajectory was measured by percent expected body weight. Psychological outcomes were fear of weight gain, feeling fat, importance of weight, and importance of shape. Results show that the pattern of symptom observations over time was dependent on subclass of SAN (least symptomatic, moderately symptomatic, or most symptomatic) and on the target outcome variable category (weight or psychological). Results from this study, which should be considered in the context of the small sample sizes overall and within groups, can generate hypotheses for future, larger research trials on early treatment strategies. Feasibility findings illustrate how the innovative partially randomized preference design has potential broader application for AN intervention research.
Clinical Trial Registration
ClinicalTrials.gov, identifier NCT00418977.
Objective
To evaluate the feasibility, acceptability, and preliminary efficacy of a couple‐based intervention for binge‐eating disorder (BED), called UNiting couples In the Treatment of Eating disorders‐BED edition (UNITE‐BED).
Method
In an open pilot trial, 11 couples in which one or both adult partners had a diagnosis of DSM‐5 threshold or sub‐threshold BED participated in 22 weekly sessions of UNITE‐BED. Patients also received individual treatment, outside of the context of the trial. Couples completed measures on treatment satisfaction, eating disorder symptom severity, depression, anxiety, emotion regulation, and relational functioning at post‐treatment and 3‐month follow‐up. Statistical analyses were conducted to identify change over the course of treatment.
Results
UNITE was feasible and acceptable to the majority of couples (9% dropout; high satisfaction ratings). Objective binge abstinence was 81.8% and subjective binge abstinence was 45.5% by post‐treatment. Patient binge‐eating symptomatology reduced over the course of treatment with results maintained at follow up. Patients' depression symptoms decreased and patients' emotion regulation improved at both time points.
Discussion
Including partners in treatment for BED may be beneficial. Results support further evaluation of the efficacy of couple‐based interventions for BED in larger randomized‐controlled trials.
Describes an evidence-supported model of family therapy for children and adolescents with eating disorders.
Reviews essential principles, objectives and techniques (along with clinical illustrations) of this therapeutic model. This chapter focuses on the first level of family intervention, involving all families of ED children and adolescents
Abstract A 22-year-old female diagnosed with anorexia nervosa received brief psychotherapy within a span of 1.5 months. Detailed cognitive-behavioral assessment was done and eating attitude was rated. Intervention of eating behavior and cognitive restructuring were initiated along with regular practice of self-hypnosis with ego-strengthening suggestions. Age regression was done to identify conflicts. Significant improvement in eating attitude was noted after 8 sessions without relapse at 3 months. Details of the psychotherapy are discussed.
The Health-Related Quality of Life for Eating Disorder-Short questionnaire is one of the most suitable existing instruments for measuring quality of life in patients with eating disorders. The objective of the study was to evaluate its reliability, validity, and responsiveness in a cohort of 377 patients. A comprehensive validation process was performed, including confirmatory factor analysis and a graded response model, and assessments of reliability and responsiveness at 1 year of follow-up. The confirmatory factor analysis confirmed the two second-order latent traits, social maladjustment, and mental health and functionality. The graded response model results showed that all items were good for discriminating their respective latent traits. Cronbach's alpha coefficients were high, and responsiveness parameters showed moderate changes. In conclusion, this short questionnaire has good psychometric properties. Its simplicity and ease of application further enhance its acceptability and usefulness in clinical research and trials, as well as in routine practice.
There is growing evidence of a correlation between bulimia nervosa and hypnotic susceptibility. The present study supports the existence of a similar relationship in non-clinical populations between restrained eating and increased hypnotizability. In the second part of the study, a modified version of the Creative Imagination Scale was used to investigate the responsiveness of restrained and non-restrained eaters in a non-clinical group to suggestions of body image change. Non-restrained eaters resisted suggestions both of increased and decreased body size. The restrained eaters also resisted suggestions of decreased body size but were more responsive to suggestions of increased body size. Implications for the aetiology and treatment of eating disorders are considered. Copyright © 1996 British Society of Experimental and Clinical Hypnosis
Anorexia nervosa (AN) patients exhibit a disparity in their actual physical identity and their cognitive understanding of
their physical identity. Functional magnetic resonance imaging (fMRI) tasks have contributed to understanding the neural circuitry
involved in processing identity in healthy individuals. We hypothesized that women recovering from AN would show altered neural
responses while thinking about their identity compared with healthy control women. We compared brain activation using fMRI
in 18 women recovering from anorexia (RAN) and 18 healthy control women (CON) using two identity-appraisal tasks. These neuroimaging
tasks were focused on separable components of identity: one consisted of adjectives related to social activities and the other
consisted of physical descriptive phrases about one’s appearance. Both tasks consisted of reading and responding to statements
with three different perspectives: Self, Friend and Reflected. In the comparisons of the RAN and CON subjects, we observed differences in fMRI activation relating to self-knowledge (‘I am’, ‘I look’) and perspective-taking (‘I believe’, ‘Friend believes’) in the precuneus, two areas of the dorsal anterior cingulate, and the left middle frontal gyrus. These data suggest that
further exploration of neural components related to identity may improve our understanding of the pathology of AN.
Initial research suggested that only European American women developed eating disorders (Garner, 1993), yet recent studies have shown that African American women do experience them (e.g., Lester & Petrie, 1998b; Mulholland & Mintz, 2001) and also may be negatively affected by similar sociocultural variables. In this study, we examined a sociocultural model of eating disorders for African American women but included the influences of ethnic identity (e.g., Hall, 1995; Helms, 1990). Participants (N = 322) were drawn from 5 different universities. They completed measures representing ethnic identity, societal pressures regarding thinness, internalization of societal beauty ideals, body image concerns, and disordered eating. Structural equation modeling revealed that ethnic identity was inversely, and societal pressures regarding thinness directly, related to internalization of societal beauty ideals. Societal pressures regarding thinness was also related to greater body image concerns. Both internalization of societal beauty ideals and body image concerns were positively associated with disordered eating (R² = .79). Overall, the final model fit the data well, supporting its generalizability and the importance of ethnic identity in determining risk.