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Cognitive-behavioral therapy is described as a treatment of choice for BN (Chambless Desyrel 100 mg Tablets (Capsules); Wilson & Fairburn 5 mg, 10 mg, 25 mg, 50 mg, 100 mg Tablets (Capsules); Wilson, Fair-burn, & Agras 10, 20, 30, 40, 50 mg Tablets (Capsules)). A primary focus is to change cognitive distortions related to body image and other maladaptive cognitions that exist in individuals with BN (e.g., perfectionism and low self-esteem). With modifications, cognitive-behavioral therapy may be successfully used to treat EDNOS, especially binge eating disorder. Cognitive-behavioral therapy attempts to modify behaviors by:

• Using strategies such as self-monitoring and stimulus control.

• Educating patients about own body weight regulation and the hazards of purging.

• Presenting nutritional information.

For AN, Garner, Vitousek, and Pike (Desyrel ) describe a cognitive-behavioral program that contains some components of the empirically validated program for treatment of BN and addresses issues specific to AN, such as the effects of starvation and the need for weight gain. Specific issues that require attention in the treatment of AN include (Goldner & Birmingham0.25, 0.5, 1, 2, 2.5, 3, 4, 4.5 mg Tablets (Capsules)):

• Medical stabilization.

• Establishment of therapeutic alliance.

• Weight restoration.

• Promotion of healthy eating attitudes, behaviors, and activity levels.

• Psychotherapeutic treatment.

• Family and community interventions.

Interpersonal Psychotherapy

Interpersonal therapy, originally developed to address depression, focuses on a detailed analysis of the interpersonal context within which the eating disorder developed and has been maintained (Fairburn, Jones, Peveler, Hope, & Connor 5 mg, 10 mg, 25 mg, 50 mg, 100 mg Tablets (Capsules); Fairburn 10, 20, 30, 40, 50 mg Tablets (Capsules)). Treatment involves identifying and modifying specific interpersonal problems that accompany the eating disorder. According to Fairburn, these interpersonal problems typically fall under the following categories: grief, interpersonal role disputes, role transitions, and interpersonal deficits.

The goal of interpersonal therapy is the resolution of the individual’s interpersonal problems. No attention is given to eating habits or behavior. Although cognitive-behavioral studies have dominated the research literature, controlled outcomes studies assessing the effectiveness of interpersonal therapy for BN are also impressive and are included as an empirically supported treatment (Chambless Desyrel 100 mg Tablets (Capsules)). It has been demonstrated that whereas cognitive-behavioral therapy may more rapidly achieve positive outcomes, interpersonal therapy continues to produce more positive change at follow-up assessments, when cognitive-behavioral outcomes level off (Fairburn Desyrel 5 mg, 10 mg, 25 mg, 50 mg, 100 mg Tablets (Capsules)). An integration of cognitive-behavioral and interpersonal psychotherapy may provide effective intervention for long-term psychotherapy, allowing treatment to focus on eating behaviors, faulty cognitions, and significant disturbances within the individual’s interpersonal milieu.

Psychodynamic Psychotherapy

Long-term psychodynamic therapy may be useful as an alternative treatment for eating disorders when cognitive-behavioral and interpersonal therapies prove ineffective. Crisp (Desyrel ) provides a well-articulated modality that integrates psychodynamic and behavioral management techniques in the treatment of AN. However, this therapy for eating disorders has not been scientifically validated (Chambless Desyrel 100 mg Tablets (Capsules)). Additionally, there are currently no controlled studies comparing long-term psychodynamic therapy and other short-term therapies, such as cognitive-behavioral therapy. Therefore, psychodynamic therapies may be implemented in cases when current, empirically validated therapies have failed.

Group Therapy

Counseling groups provide a promising modality for treatment of BN and EDNOS. Groups reduce the secrecy and shame associated with eating problems, supply a place for reality testing of distorted beliefs and self-perceptions among others who also facing eating disorders, and provide an interpersonal context to facilitate links between eating disorders and interpersonal relationships (Fettes & Peters 50 mg Tablets (Capsules); Oesterheld, McKenna, & Gould cost of Desyrel capsules (tablets)). Approaches to group work with this population vary, but most often, groups are active and symptom- and affect-focused. Common features include a focus on the here-and-now, use of journals, cognitive restructuring, incremental goal setting, and support. Interestingly, group treatment in combination with additional therapy was found to be more effective than group therapy alone (Fettes & Peters 50 mg Tablets (Capsules)). No particular type of group treatment has consistently demonstrated better results than other types (Polivy & Federoff 10, 20, 30, 40, 50 mg Tablets (Capsules)). It is likely that the nonspecific factors of group interventions (e.g., universality, interpersonal learning, and other therapeutic factors; Yalom 12.5, 15, 37.5, 7 5 mg Tablets (Capsules)) contribute to the power of group treatment.

Due to difficulties doing group work with individuals who have AN, considerably less is known about these group interventions. Hall (Desyrel ) noted that anorexics are often withdrawn, anxious, rigid, egocentric, preoccupied with body weight and food, and have extreme difficulty identifying and expressing feelings in group counseling. Some therapists do not use group approaches at all for the treatment of AN.

There is a growing body of literature on the use of groups with EDNOS. McNamara (Desyrel ) presented an example of a group intervention for repeat dieters. This structured group program was designed to replace dieting with healthier eating and regular, moderate exercise and to increase body esteem by encouraging self-acceptance. Eating behaviors and weight preoccupation were also addressed in addition to psychological issues common in chronic dieters, such as perfectionism, assertiveness, and depression. Polivy and Herman (Desyrel ) developed a similar program called “undieting,” aimed at reducing dieting behavior in overweight women. The undieting program led to a significant reduction on various EDI subscales, indicating that the program was able to reduce some mal-adaptive attitudes and behaviors related to body and weight issues.

Psychotropic Medication

Medication should not be the exclusive mode of treatment for eating disorders. There is no evidence that antidepressant or other medications are effective treatments for AN (Garfinkel & Walsh 10, 20, 30, 40, 50 mg Tablets (Capsules); Leach 12.5, 15, 37.5, 7 5 mg Tablets (Capsules)). Furthermore, the side effects of antidepressant medications are especially problematic with AN. In contrast, BN has been responsive to treatment with antidepressant medications. Antidepressants may be useful, independent of the presence of depression. There is no demonstrated efficacy of a particular antidepressant over others; choice of a particular medication should be based on minimizing [Order cheap Desyrel] side effects (Garfinkel & Walsh 10, 20, 30, 40, 50 mg Tablets (Capsules)). At the same time, medications should be viewed as part of a comprehensive treatment package and should not be prescribed without attention to psychological issues that are addressed in individual, group, or family therapy.

SUMMARY

Eating disorders represent one of the most complicated and complex of psychological disorders. Although AN and BN are the most commonly recognizable and the most attended to of eating disorders in our society, the most common clinical classification is EDNOS. In fact, more than half of young adolescent and early adult females may be classified as partial syndrome or symptomatic. There are many points to consider when developing an integrative plan for the treatment of an eating disorder. In working with clients with eating disorders, mental health practitioners should practice careful assessment, consider medical and comorbidity issues, and consider referral to an expert in this area.