Stephen W. Touyz

Relevance of a standard measurement of undernutrition to the diagnosis of anorexia nervosa: Use of Quetelet's Body Mass Index (BMI)

Quetelets Index provides a measure of nutritional status which is both objective and easy to calculate. A review of the normative data published in the literature indicates that a BMI value of 16 provides a convenient criterion for the recognition of significant undernutrition. This value was applied successfully to a group of 150 anorexia nervosa patients. On the other hand, a BMI of over 18 appeared appropriate in the case of a small group of 22 bulimia nervosa subjects.

Body shape perception in bulimia and anorexia nervosa

Nineteen female patients with bulimia and thirty-one with anorexia nervosa were studied using a distorting lens technique. Both groups overestimated their actual body shapes and the bulimia patients desired to be much thinner than they were. These findings are discussed in relation to the literature on the treatment of these disorders.

Nutritional management and dietary counseling in bulimia nervosa: Some preliminary observations

A retrospective study evaluating the effectiveness of nutritional counseling in the management of patients with bulimia was carried out on 28 consecutive outpatients. They were referred to a clinical nutritionist experienced in the treatment of eating-disordered patients, whose approach included nutritional and cognitive strategies. The effectiveness was assessed in terms of the reduction in the occurrence of binge eating, self-induced vomiting, and laxative abuse. Of the 28 patients initially referred, 18 continued in treatment for an average of 9.5 sessions. All patients ceased laxative abuse, and there was a significant reduction in the frequency of binge eating and self-induced vomiting. The role of the clinical nutritionist in the management of patients with bulimia is discussed.

Accuracy of body image with varying degrees of information about the face and body contours

Two studies concerned with the method involved in video distortion of body image are reported. In the first, 40 students were asked to estimate their body contours on a TV monitor with and without the benefit of facial cues. In the second, 15 anorectic patients and 15 matched controls were studied under two conditions of dress: with figure-hugging leotards or with loose clothing. The findings suggest that to reduce variability in studies of body image, information about the face and body contours should be available.

Forensic neuropsychology: a selective introduction.

During the last decade, neuropsychology has emerged as one of the fastest growing disciplines within clinical psychology. One of the most important roles for neuropsychologists is their contribution to the forensic sciences. The present paper reviews how lawyers may best utilize the services of clinical neuropsychologists. Suggestions are also offered to neuropsychologists on how better to meet the needs of lawyers. The following forensic science issues are discussed: the legal framework in which neuropsychologists function; contributions psychologists may make towards answering basic medicolegal questions such as the elucidation of the nature, extent, and duration of head injury sequelae; criteria for acceptable neuropsychological reports; medicolegal aspects of severe head injury, minor head injury (posttraumatic syndrome), and pseudo-head injury (malingering). There are many causes of damage to the nervous system (for example, industrial toxins and medical malpractice) that are eligible for compensation. Examples will be confined to head injury since the basic forensic science principles remain the same, whatever the etiology of such brain damage.

Behaviour Therapy in the Management of Patients with Anorexia nervosa

Many different treatment approaches have been advocated for anorexia nervosa, and most clinicians now incorporate some aspects of behaviour modification in refeeding an emaciated patient. Traditional operant programmes have required the patient to spend prolonged periods of time confined to a solitary existence in a bedroom devoid of her normal possessions. The present paper evaluated the rate of weight gain in 68 patients with anorexia nervosa (100 consecutive admissions to a specialised eating disorders unit) using a lenient, flexible approach to refeeding. Despite this more humane approach, similar results were achieved when compared to other more rigid behavioural programmes in that they gained 0.16 kg/day. This finding is discussed in the context of the rigid application of behavioural programmes which can be seen as punitive, undermine the patients co-operation and destroy any therapeutic relationship which may develop.

Anorexia nervosa in a patient with multiple sclerosis: A case report

A case is presented in which a 29-year-old married woman developed anorexia nervosa following an 8-year history of multiple sclerosis. She was admitted to a specialized eating disorders unit for refeeding following a dramatic reduction in her body weight.

CORRECTING THE EATING DISORDER IN ANOREXIA NERVOSA

The aim of the present study was to assess whether direct informational feedback using videotape recordings would improve abnormal eating behaviour in patients with anorexia nervosa. Eight inpatients participated in the study. A statistically significant improvement was noted in the occurrence of obsessional eating behaviour and in table manners. However, there was no change in the speed of eating, disposal of food or behaviours which reduce caloric intake. The implications of these findings for the treatment and prognosis of anorexia nervosa are discussed.