Rachel Lawson

Compulsive features in the eating disorders: a role for trauma?

There is considerable evidence of a link between reported childhood trauma and the current presence of impulsive behaviors in eating-disordered populations. However, there is no research testing the possibility of links with compulsive behaviors in this group, despite evidence that both impulsive and compulsive behaviors can serve to affect regulation functions. This study of 62 eating-disordered women examined potential links between different forms of reported childhood trauma (emotional, physical, sexual) and current compulsive behaviors (cleaning, checking). Each woman was interviewed to establish diagnosis, reported trauma history, and the presence of compulsive checking and cleaning behaviors. Chi-squared analyses demonstrated that there were no associations of either emotional or physical abuse with checking or cleaning behaviors. However, there was a significant association of reported childhood sexual abuse with the presence of cleaning behaviors. Although further research is needed to establish the generalizability of this conclusion across diagnostic group and measures, it implies that treatment of eating-disordered patients with comorbid compulsive cleaning behaviors might need to include a focus on the cognitive and affective consequences of childhood sexual abuse.

Attributional style in the eating disorders.

Previous research has shown that patients with eating disorders have a characteristic cognitive bias, making internal attributions when evaluating negative events. However, there is less clarity about their attributions for positive events. There are suggestions that this cognitive style might be influenced by depressed mood. This study examines attributional style in the eating disorders for positive and negative events, independent of covariant effects of depression. Twenty-five eating-disordered women and 26 nonclinical women each completed measures of attributional style, depressed mood, and eating pathology. They also completed a measure of verbal intelligence (to ensure comparability of groups). Women with an eating disorder had a greater tendency to attribute negative situations to the self when compared with nonclinical women, even when differences in depressed mood were controlled for. There were no comparable differences in positive attributional biases. Women with an eating disorder adopt a self-blaming style when evaluating negative events, and such self-blame is likely to contribute to the maintenance of an eating disorder. This suggests that therapy for the eating disorders should include an element that focuses on highlighting and re-evaluating such interpretations.

Persistence, perseveration and perfectionism in the eating disorders.

BACKGROUND Perseveration, persistence and perfectionism are traits that have been suggested to be relevant to the eating disorders. This study explored the levels and correlates of these three traits in the eating disorders and control groups. METHOD A measure of these three elements (the Persistence, Perseveration and Perfectionism Questionnaire - PPPQ-22) was administered to 99 women with eating disorders, 25 women with other psychiatric disorders, and 91 non-clinical women. Differences in PPPQ-22 scores across groups were measured, as were the associations between PPPQ-22 scores and eating attitudes. RESULTS The eating disordered groups showed lower levels of persistence (the drive towards goal achievement) than the non-clinical group, but did not show higher levels of perseveration (the following of rules, without considering whether goals are achieved). Both women with eating disorders and non-clinical controls showed correlations between eating disorder symptoms and perseveration. CONCLUSIONS The current study, using a relatively new measure, suggests that low levels of persistence, rather than high levels of perseveration, may be implicated in the eating disorders. It was less clear that perfectionism per se was a useful construct in understanding eating pathology. If confirmed by future research, persistence should be considered in treatment of these complex and challenging conditions.

Beating Your Eating Disorder: a Cognitive-Behavioral Self-Help Guide for Adult Sufferers and their Carers: General points to help normalize your food intake

academic work 175; see also cognitive changes acceptance, of body image 84, 87, 91 accreditation of clinicians 121 achievement, sense of 26 action (starting to change) 25; see also time for action active listening 104–5 advantages of eating disorders see pros and cons Aesop’s fable 104 alcohol 2, 60, 69 alertness 151; see also cognitive changes anorexia; see also eating disorders complications 156–8 physiology (biology) 54 Anorexics and Bulimics Anonymous 149 anticipating obstacles 35–6 anti-contemplation 24, 104 anxiety 34, 48, 141 carers 102 CBT self-help program 49–50 challenging 71 exposure 78–9 apathy 151; see also cognitive changes application to self-help program xii–xiii, 13, 48, 59, 106; see also making time for therapy approaching the sufferer 100 assertiveness 38 assessment, preparation for forma 115–16 assumptions, dysfunctional see beliefs atypical cases 6, 12, 19 Australian organizations, eating disorder support 149 automatic thoughts/behavior 60, 71, 72, 75 avoidance 49, 88, 99; see also safety behaviors

Beating Your Eating Disorder: a Cognitive-Behavioral Self-Help Guide for Adult Sufferers and their Carers: Have I done myself permanent damage?

Preface: read this bit first Part I. Getting Started: 1. Who is this book for? 2. The key elements of cognitive-behavioural therapy and the self-help approach 3. How to use this book Part II. For the Sufferer: 4. Am I making a fuss about nothing? 5. Motivating yourself to treat your eating disorder 6. Is now the time to act? 7. Getting started with CBT Part III. The CBT Self-Help Programme: 8. Start here: how to use this programme 9. The practical steps of CBT for your eating disorder Part IV. For Carers: 10. Am I to blame for the eating problem? 11. What can I do to support the sufferer? Part V. Transitions into More Formal Help: 12. Thinking about getting more formal therapeutic help 13. Starting the process of getting formal therapeutic help 14. What to look for in a good CBT practitioner 15. The role of carers in the transition to more formal help Part VI. Letting Go of the Eating Disorder: 16. The journey of recovery 17. Relapse prevention 18. Have I done myself permanent damage? 19. Carers need to move on too Conclusion: eating normally again References and further reading Appendices Index.

Cognitive Behavioral Therapy for Eating Disorders: Acknowledgments

This book describes the application of cognitive behavioral principles to patients with a wide range of eating disorders: it covers those with straightforward problems and those with more complex conditions or comorbid states. The book takes a highly pragmatic view. It is based on evidence published, but stresses the importance of individualized, principle-based clinical work. It describes the techniques within the widest clinical context, for use across the age range and from referral to discharge. Throughout the text, the links between theory and practice are highlighted in order to stress the importance of the flexible application of skills to each new situation. Case studies and sample dialogues are employed to demonstrate the principles in action and the book concludes with a set of useful handouts for patients and other tools. This book will be essential reading for all those working with eating-disordered patients including psychologists, psychiatrists, nurses, occupational therapists, counsellors and dietitians.

Cognitive Behavioral Therapy for Eating Disorders: Frontmatter

This book describes the application of cognitive behavioral principles to patients with a wide range of eating disorders: it covers those with straightforward problems and those with more complex conditions or comorbid states. The book takes a highly pragmatic view. It is based on evidence published, but stresses the importance of individualized, principle-based clinical work. It describes the techniques within the widest clinical context, for use across the age range and from referral to discharge. Throughout the text, the links between theory and practice are highlighted in order to stress the importance of the flexible application of skills to each new situation. Case studies and sample dialogues are employed to demonstrate the principles in action and the book concludes with a set of useful handouts for patients and other tools. This book will be essential reading for all those working with eating-disordered patients including psychologists, psychiatrists, nurses, occupational therapists, counsellors and dietitians.

Cognitive Behavioral Therapy for Eating Disorders by Glenn Waller

This book describes the application of cognitive behavioral principles to patients with a wide range of eating disorders: it covers those with straightforward problems and those with more complex conditions or comorbid states. The book takes a highly pragmatic view. It is based on evidence published, but stresses the importance of individualized, principle-based clinical work. It describes the techniques within the widest clinical context, for use across the age range and from referral to discharge. Throughout the text, the links between theory and practice are highlighted in order to stress the importance of the flexible application of skills to each new situation. Case studies and sample dialogues are employed to demonstrate the principles in action and the book concludes with a set of useful handouts for patients and other tools. This book will be essential reading for all those working with eating-disordered patients including psychologists, psychiatrists, nurses, occupational therapists, counsellors and dietitians.