Minimizing and treating chronicity in the eating disorders: a clinical overview.

Objective: The purpose of this article is to review the available literature regarding treatment and management of eating disorder patients who fail to change over protracted periods of time.

Method: Literature was reviewed pertaining to approaches to promoting change in treatment-resistant cases and the treatment of chronic eating disordered individuals.

Results: Although there are a number of clinical perspectives on the treatment of chronic eating disorder patients, fundamental studies defining the concept of "chronicity" and standardized treatment approaches do not exist.

Evidence-based mental health interventions for traumatized youth: a statewide dissemination project.

Psychological trauma in childhood has been shown to increase a variety of psychological disturbances and psychiatric disorders. Although evidence-based treatments for children who have been traumatized exist, they are infrequently used by clinicians treating children. The present paper describes the creation of the Treatment Collaborative for Traumatized Youth (TCTY) which is a statewide partnership in North Dakota designed to disseminate efficacious treatments for traumatized children and monitor outcomes across a broad, rural, geographic expanse.

Bulimic eating disorders in primary care: hidden morbidity still?

The current study examined the features of women with bulimic-type eating disorders (n = 24) attending primary care in two smaller urban regions of the USA. The assessment included measures of eating disorder psychopathology, medical comorbidity, impairment in role functioning, potential barriers to treatment and actual use of health services. Eating disorders, primarily variants of bulimia nervosa and binge eating disorder not meeting formal diagnostic criteria, were associated with marked impairment in psychosocial functioning.

A randomized trial comparing the efficacy of cognitive-behavioral therapy for bulimia nervosa delivered via telemedicine versus face-to-face.

Objective: A major problem in the delivery of mental health services is the lack of availability of empirically supported treatment, particularly in rural areas. To date no studies have evaluated the administration of an empirically supported manual-based psychotherapy for a psychiatric condition via telemedicine. The aim of this study was to compare the relative efficacy and acceptability of a manual-based cognitive-behavioral therapy (CBT) for bulimia nervosa (BN) delivered in person to a comparable therapy delivered via telemedicine.

Screening for eating disorders in primary care: EDE-Q versus SCOFF.

Objective And Methods: The comparative validity of the Eating Disorder Examination Questionnaire (EDE-Q) (22 items) and SCOFF (five items) in screening for cases of the more commonly occurring eating disorders was examined in a primary care sample of young adult women (n=257). Diagnoses were confirmed in a sub-group of interviewed participants (n=147).

Results: Twenty-five cases, primarily variants of bulimia nervosa (BN) not meeting formal diagnostic criteria, were identified in the interviewed sample.

'Excessive exercise' and eating-disordered behaviour in young adult women: further evidence from a primary care sample.

Objective And Methods: In order to replicate findings from previous community-based research, conducted in Australia, in a different sample, we examined relationships between exercise behaviour, eating-disordered behaviour and quality of life among young adult women attending one of two primary care facilities in the upper Midwest region of the United States.

Results: A high level of guilt when exercise is missed was associated with markedly elevated levels of eating disorder psychopathology and significantly reduced quality of life. The combination of exercising solely for weight and shape and intense guilt after missing exercise was associated with very high levels of eating disorder psychopathology, comparable to those of individuals seeking specialist treatment.

Is multi-impulsive bulimia a distinct type of bulimia nervosa: Psychopathology and EMA findings.

Objective: To determine if clinically defined multi-impulsive bulimia (MIB) can be validated using an empirical classification approach.

Method: One hundred and twenty-five women who met DSM-IV criteria for bulimia nervosa were interviewed and completed a two-week EMA protocol. Participants who reported at least three highly impulsive behaviors were compared to participants who did not report such impulsive behavior.

Pharmacologic and Psychotherapeutic Treatment of Anorexia Nervosa.

This article will review the treatment research literature on patients with anorexia nervosa. Perhaps somewhat surprisingly, the controlled treatment literature on this disorder is fairly limited. This is attributable to several factors, including the fact that many patients with anorexia nervosa are difficult to engage in treatment and unwilling to participate in randomized trials, and that many of these patients are so critically ill that they require a multiplicity of interventions and long-term therapy, creating design problems for randomized trials.

The use of alternative delivery systems and new technologies in the treatment of patients with eating disorders.

Objective: The purpose of the current article is to review the literature regarding the use of alternative delivery systems, such as telemedicine, and new technologies, such as the use of hand-held computers, in the treatment of patients with eating disorders.

Method: The literature is reviewed in the following areas: self-help (supervised and unsupervised), telemedicine, telephone therapy, e-mail, internet, computer software, CD-ROMs, portable computers, and virtual reality techniques.

Results: A growing literature suggests a number of alternative delivery systems hold promise, in particular permitting patients to access services who otherwise would not be able to receive treatment.

Pharmacotherapy and medical complications of eating disorders in children and adolescents.

In this article, the authors cover two areas of interest regarding eating disorders in childhood and adolescence: (1) the detection of eating disorders in medical practice and their medical complications and (2) the psychopharmacologic treatment of patients with eating disorders.