Friederich / Wild / Zipfel Anorexia Nervosa

Focal Psychodynamic Psychotherapy
2019
ISBN: 978-1-61334-554-2
Verlag: Hogrefe Publishing
Format: EPUB
Kopierschutz: 6 - ePub Watermark

E-Book, Englisch, 124 Seiten

This manual presents an evidence-based focal psychodynamic approach for the outpatient treatment of adults with anorexia nervosa, which has been shown to produce lasting changes for patients. The reader first gains a thorough understanding of the general models and theories of anorexia nervosa. The book then describes in detail a three-phase treatment using focal psychodynamic psychotherapy. It provides extensive hands-on tips, including precise assessment of psychodynamic themes and structures using the Operationalized Psychodynamic Diagnosis (OPD) system, real-life case studies, and clinical pearls. Clinicians also learn how to identify and treat typical ego structural deficits in the areas of affect experience and differentiation, impulse control, self-worth regulation, and body perception. Detailed case vignettes provide deepened insight into the therapeutic process. A final chapter explores the extensive empirical studies on which this manual is based, in particular the renowned multicenter ANTOP study. Printable tools in the appendices can be used in daily practice. This book is of interest to clinical psychologists, psychotherapists, psychiatrists, counselors, and students.

Zielgruppe

Clinical psychologists, psychiatrists, psychotherapists, and
counselors, as well as students.

Autoren/Hrsg.

Friederich, Hans-Christoph

Wild, Beate

Zipfel, Stephan

Schauenburg, Henning

Herzog, Wolfgang

Fachgebiete

• Sozialwissenschaften Psychologie Psychotherapie / Klinische Psychologie Psychopathologie
• Medizin | Veterinärmedizin Medizin | Public Health | Pharmazie | Zahnmedizin Medizinische Fachgebiete Essstörungen & Therapie
• Medizin | Veterinärmedizin Medizin | Public Health | Pharmazie | Zahnmedizin Medizinische Fachgebiete Psychiatrie, Sozialpsychiatrie, Suchttherapie
• Medizin | Veterinärmedizin Medizin | Public Health | Pharmazie | Zahnmedizin Medizinische Fachgebiete Psychosomatische Medizin

Leseproben

|1|1 Description of the Disorder

1.1 Description

The case studies of the French physician Ernest-Charles Lasègue (using the term anorexia hysterica) and of the British physician Sir William Gull (anorexia nervosa), both published in 1873, constituted the first detailed descriptions of anorexia nervosa (Gull, 1873; Lasègue, 1873/1997). Both authors emphasized the psychological causes of anorexia nervosa and the missing disease insight and compliance of the affected individuals. Anorexia nervosa was thus the first autonomously defined eating disorder entity. Exaggerated fasting for religious motives had been documented even earlier, with case descriptions of ascetic, fasting saints going back to the 12th century.

The current use of the term anorexia nervosa (translating as “loss of appetite due to a nervous state”) is misleading, since affected persons by no means lack appetite. On the contrary, patients suffering from anorexia nervosa of the binge-eating/purging type show fits of repeated overeating, similar to those of bulimic patients. Instead, it is the preemptive intense fear of gaining weight and the associated bodily changes that are the distinguishing symptoms. The phobia of gaining weight as the central motive for prolonged fasting was delineated as the core differential diagnostic criterion by the German-American psychoanalytic therapist Hilde Bruch. In her popular book The Golden Cage: The Enigma of Anorexia Nervosa (Bruch, 1978), Bruch helped form an awareness and understanding of the disease, not only for doctors and therapists, but also for the general public.

1.2 Definition

The diagnostic criteria of the International Classification of Mental and Behavioral Disorders (ICD-10; Chapter VF) of the World |2|Health Association (WHO, 1992) and of the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5) of the American Psychiatric Association (APA, 2013), with a few exceptions, show agreement regarding the disorder of the disease anorexia nervosa (see Table 1). A stable version of the 11th revision of the ICD was released on June 18, 2018 for the implementation phase (WHO, 2018). The final version is due to be released in 2022.

Table 1 Diagnostic criteria for anorexia nervosa according to the ICD-10 and DSM-5

DSM-5	ICD-10 (F50.0)

A. Restriction of energy intake relative to requirements, leading to a significantly low body weight in the context of age, sex, developmental trajectory, and physical health. Significantly low weight is defined as a weight that is less than minimally normal or, for children and adolescents, less than that minimally expected.

A. Body weight is maintained at least 15% below that expected (either lost or never achieved), or Quetelet’s body-mass index ( = weight (kg) to be used for age 16 or more) is 17.5 or less. Prepubertal patients may show failure to make the expected weight gain during the period of growth.

B. Intense fear of gaining weight or of becoming fat, or persistent behavior that interferes with weight gain, even though at a significantly low weight.

B. The weight loss is self-induced by avoidance of “fattening foods”. One or more of the following may also be present: • self-induced vomiting; • self-induced purging; • excessive exercise; • use of appetite suppressants and/or diuretics.

C. Disturbance in the way in which one’s body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or persistent lack of recognition of the seriousness of the current low body weight.

C. There is body-image distortion in the form of a specific psychopathology whereby a dread of fatness persists as an intrusive, overvalued idea and the patient imposes a low weight threshold on himself or herself.

D. |3|A widespread endocrine disorder involving the hypothalamic – pituitary – gonadal axis is manifest in women as amenorrhoea and in men as a loss of sexual interest and potency. (An apparent exception is the persistence of vaginal bleeds in anorexic women who are receiving replacement hormonal therapy, most commonly taken as a contraceptive pill.) There may also be elevated levels of growth hormone, raised levels of cortisol, changes in the peripheral metabolism of the thyroid hormone, and abnormalities of insulin secretion.

Coding note: The ICD-9-CM code for anorexia nervosa is 307.1, which is assigned regardless of the subtype. The ICD-10-CM code depends on the subtype (see below).

E. If onset is prepubertal, the sequence of pubertal events is delayed or even arrested (growth ceases; in girls the breasts do not develop and there is a primary amenorrhoea; in boys the genitals remain juvenile). With recovery, puberty is often completed normally, but the menarche is late.

Specify whether: (F50.01) Restricting type: During the last 3 months, the individual has not engaged in recurrent episodes of binge eating or purging behavior (i.e., self-induced vomiting or the misuse of laxatives, diuretics, or enemas). This subtype describes presentations in which weight loss is ...