World Digestive Health Day WDHD – May 29, 2016 EATING DISORDERS AND THE GI TRACT: DEFINITION, RECOGNITION, THE ROLE OF THE PSYCHOLOGIST IN CARE, continued Table 1: Definition and summary of the primary forms of ED-focused psychological therapies Psychological treatment form and definition: Cognitive-Behavior Therapy (CBT): Symptoms targeted directly to re-evaluate thinking (i.e., identifying and correcting negative core beliefs/unhelpful thoughts), promote helpful behavioral responses, and reduce individual distress. Focus on unhelpful behaviors and dysfunctional attitudes relating to eating, weight, body shape, exercise, and other psychosocial issues (e.g., bullying, and family discordance). Psychodynamic Interpersonal Therapy (IPT): Interventions that have a primary focus on understanding and working with transference (the unconscious transferring of feelings from one person to another). Focus is to foster psychological insight and address underlying personality disorders. Dialectical Behavioral Therapy (DBT): Disordered eating is viewed as an attempt to regulate uncomfortable emotions, and are treated with mindfulness, tolerance of distress, regulation of emotion, and interpersonal skills. Regulating emotions can address the sense of losing control and binge-eating, reducing its frequency. Family Therapy (FT; e.g., The Maudsley Approach): Interventions that incorporate the whole family system and focus on fostering new skills in relationships, communication, and problem-solving. When individuals are younger and of shorter illness duration, parental support of re-nutrition is effective. from psychotropic medications such as selective serotonin reuptake inhibitors (SSRIs).7 Cognitive-Behavior Therapy (CBT; including self-help oriented CBT) and Psychodynamic Interpersonal Therapy (IPT) have been identified as an effective treatment for AN, BN, and BED.7,8 For BN, both CBT and IPT, but not Dialectical Behavioral Therapy (DBT), are effective in reducing binge-eating and compensatory methods, and also decreased body dissatisfaction. 9 CBT has also been demonstrated to reduce the frequency of binge-eating episodes in adults diagnosed with BED.10 Specifically regarding AN, Family Therapy (FT) shows the most potential when patients are younger and in the earlier stages of their ED.11 The research is less advanced in the treatment of ARFID. No treatments have been recommended for ARFID, due to a lack of research trials.12 Although it has been found hospitalization tends to be longer than in AN.13 It should be noted that psychological therapies for EDs range in terms of their format (individual, group, or combined), frequency, and duration, for a detailed summary and recommendations for the treatment of EDs.6,7 See Table 1 for definition and summary of several common forms of ED-focused psychological therapies. ROLE OF THE PSYCHOLOGIST FOR PATIENTS WITH EDS • Provide psychological assessment and associated ED-specific psychological interventions • Develop treatment formulations that identify and take into account patient predisposing factors (e.g., developmental traumas, attachment style, and cognitive development), precipitating factors (e.g., stressors), perpetuating factors (e.g., defense styles, level of insight, and ED maintaining cognitions/behaviors), protective factors (e.g., personal strengths), and ED severity • Provide psychological interventions associated with, but not directly related to, the eating disorder, such as school/ socialization problems, and family difficulties • Provide input to team treatment plan for patient with an ED • Providing psychoeducation to both patients and families affected by an ED • Providing ongoing advice and support to medical and allied health team • Facilitate insight, self-esteem, and psychological and physical recovery • Facilitate positive coping strategies and resilience to manage future stress and challenges • Work with medical and allied health professionals to monitor and reduce patient self-harm • As relapse is extremely common for AN, BN, and BED, long term monitoring and relapse prevention work is often needed ORTHOREXIA NERVOSA Orthorexia Nervosa (ON) is a dysfunctional eating condition not yet recognized by the Diagnostic and Statistical Manual (DSM-5),1 but may be observed in GI cohorts. ON involves an obsession with an increasingly limited diet focused upon consuming the most healthy or ‘pure’ foods and World Digestive Health Day WDHD May 29, 2016 WGO Handbook on DIET AND THE GUT 43
WGO Handbook on Diet and the Gut_2016_Final
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