Primary Care Treatment of Eating Disorders: From Diagnosis to Referral

Primary care treatment of eating disorders: from diagnosis to referral

Currin, L. G. London, King’s College Ph.D. 2006 G6s 56-9781

General practitioners (GPs) have a key role in the early management of eating disorders but also act as gate-keepers for access to specialist care. Despite this key role, research on eating disorders in primary care is limited.

METHOD: A variety of designs and methods were employed to address: the epidemiology of eating disorders in primary care; current treatment practices in relation to published guidelines; predictors of variability in treatment behaviour; and different perspectives of primary care treatment.

RESULTS: A national database was used to study recorded cases of anorexia and bulimia nervosa. Annual incidence rates were calculated for the years between 1994 and 2000 and compared with previously published figures. While the incidence of anorexia nervosa was stable over the period studied, there were significant fluctuations in the incidence of bulimia nervosa.

A cohort of primary care clinicians in a defined region (population of 6.4 million) participated in a survey of treatment behaviour for patients with eating disorders. There was considerable variability in practice, and little concordance with the recommendations in published guidance.

To determine the influence of patient and clinical variables on treatment behaviour, vignettes were presented to 150 GPs from diverse regions. The gender of the case vignettes influenced treatment decision, as did professional knowledge and attitude towards eating disorders.

Read this story: The Wellbeing of Carers of People With Severe & Enduring Eating Disorders

The Wellbeing of Carers of People With Severe & Enduring Eating Disorders

The Wellbeing of Carers of People With Severe & Enduring Eating Disorders

Linacre, Stephen James Leeds D.Clin.Psych. 2011 B2c

Introduction

Research on carers of people with eating disorders (ED) is limited and on carers of people with severe and enduring eating disorders (SEED) almost nonexistent. Nearly 40% of carers of people with ED experience clinical level mental health difficulties. The current aims investigated wellbeing in carers of people with ED and specifically, carers of people with SEED; investigated gender differences; and compared data with wellbeing studies investigating carers of people with other long-term conditions. The Stress Process Model (SPM) (Pearlin, Mullan, Semple, & Skaff, 1990) was used to better understand predictors of wellbeing. Method: Carers (28 male, 76 female) were recruited from ED carer support groups. Carers were stratified using duration (since diagnosis) of their recipient’s ED (0-2 years, 2-6 years, over 6 years). The “over 6 years” category was classified as SEED. Comparison data were drawn from carers of people with dementia, brain injury, ED and psychosis. Standardised questionnaires measured wellbeing (SF-36), experiences of caregiving (ECI), perceived caregiver competence (MoCC), sense of personal mastery (MoPM) and expressive support (MoES).

Results

Carers of people with SEED were not significantly different on reported wellbeing to the whole sample of carers of people with ED. However, carers of people with ED reported significantly less wellbeing than community norms, carers of people with brain injury and dementia. Perceived dependency, carer gender and sense of personal mastery accounted for 29% of the variance in mental wellbeing scores. Differences in reported positive experiences of caregiving were identified.

Discussion

The mental wellbeing of carers of people with SEED and ED appears poorer than carers of other conditions. Further research on carers of people with SEED is needed. The SPM is a helpful framework to use. Clinical implications include ensuring that perception of dependency and the positive experiences of caregiving are addressed in workshops and support groups.

Read this story: Exploring Support & Therapist Perspectives

Eating Disorders : Exploring Support & Therapist Perspectives

Eating Disorders : Exploring Support & Therapist Perspectives

Lever, Emma Warwick D.Clin.Psych. 2013 G6s 62-19549

The National Institute for Clinical Excellence (NICE) recommends that the treatment of eating disorders should generally be managed on an outpatient basis using psychologically informed approaches (Clinical Guideline 9, NICE, 2004).

As such, carers and psychological therapists are crucial in providing support to individuals with eating disorders. Although there is a wealth of research literature focusing on the understanding and treatment of eating disorders, further consideration of carers and therapists in this area is warranted.

This thesis therefore gives prominence to these two groups.

Chapter 1 reviews the literature on education and support interventions for carers of those with eating disorders. Findings suggest that face-to-face and self-help interventions show effectiveness in reducing negative carer symptoms and meeting carers’ needs. Methodological limitations, research recommendations and clinical implications are outlined.

Chapter 2 presents an empirical study which explores the impact of eating disorders work on eight psychological therapists, including the effects on their eating and body image. A grounded theory approach is adopted. Findings illustrate that therapists are affected by the complexity of their day-to-day work in many ways and that they have a number of means of coping. Recommendations are made for clinical practice and future research.

Chapter 3 provides a reflective account of the research journey. It gives an overview of the research process and provides an opportunity for the researcher to be considered in this.

Read this story: Retrospective Accounts of Cognitive Behaviour Therapy For Eating Disorders

Accounts Of Cognitive Behaviour Therapy

Retrospective Accounts of Cognitive Behaviour Therapy For Eating Disorders: Which Aspects Were Most Useful?

Research Abstract

Brown, N. Lancaster D.Clin.Psych. 2008 B2c 59-13297

The trans-diagnostic model of eating disorders (Fairburn, Cooper & Shafran, 2003) proposes that differential eating disorder diagnosis is irrelevant, as eating disorders are similar disorders sharing common processes. This model suggests that in addition to extreme concerns about shape, weight and controlling food intake, four additional mechanisms may create barriers to successful change in individuals with eating disorders. These mechanisms are core low self-esteem, mood intolerance, clinical perfectionism and interpersonal difficulties.

The literature review focuses specifically on the mechanism of ‘mood intolerance’. Studies investigating relationships between negative affect, coping, emotional regulation and disordered eating are reviewed. Evidence suggests that difficulties with affect regulation are associated with the use of disordered eating. Individuals with higher levels of disordered eating engage in more avoidant and emotional coping than individuals with less disordered eating. Additionally, negative affect is associated with avoidant coping and disordered eating.

Therefore, affect regulation is a key area to consider in eating disorder treatment.

The research paper is a qualitative study investigating people’s experiences of cognitive behaviour therapy (CBT) for an eating disorder, in order to find out more about how change occurs during therapy, specifically in relation to the mechanisms outlined by the trans-diagnostic model of eating disorders.

Ten women were interviewed and data were analysed using Framework Analysis. Responses covered four main themes: support for the trans-diagnostic model; CBT related change; the therapeutic alliance; and personal factors. The trans-diagnostic model for eating disorders provides a useful framework for understanding experiences of change during CBT for an eating disorder.

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