Warning message

This content is filtered. APPPAH membership is required for full access to journal articles.
-A +A
Issue: 
Publication Date: 
September, 2020
Page Count: 
25
Starting Page: 
369
Brief Summary: 

In this article, the authors assert a need for a new perspective on treatment for adolescents and adults with extreme recurring anorexia, underlying prenatal and perinatal trauma, early childhood trauma (or Adverse Childhood Experiences), and complex multi-problems. Current evidence-based therapies are successful with 66% of patients suffering from anorexia with a BMI higher than 17.5. An approach is suggested that regards the eating disorder as a coping strategy for underlying emotional pain.

Abstract: 

There is a need for a new perspective on treatment for adolescents and adults with extreme recurring anorexia, underlying prenatal and perinatal trauma, early childhood trauma (or Adverse Childhood Experiences), and complex multi-problems. Current evidence-based therapies are successful with 66% of patients suffering from anorexia with a BMI higher than 17.5. An approach is suggested that regards the eating disorder as a coping strategy for underlying emotional pain. We advocate this approach, which is based on principles like those from CBT, the Self-Determination Theory, and trauma therapy: Past Reality Integration (PRI). The following initial results of a PRI pilot study with 13 clients appear promising.

References: 

Abbass, A.A., Kisely, S.R., Town, J.M., Leichsenring, F., Driessen, E., De Maat, S., Gerber, A., Dekker, J., Rabung, S., Rusalovska, S. & Crowe, E. (July 1, 2014). Short‐term psychodynamic psychotherapies for common mental disorders. Cochrane Database of Systematic Reviews, 7. https://doi.org/10.1002/14651858.CD004687

American Psychiatric Association (2014). Handboek voor de classificatie van psychische stoornissen. [Dutch translation of the Diagnostic and statistical manual of mental disorders, fifth edition, DSM-5]. Uitgeverij Boom.

Anglin, J.P. (2002). Pain, normality, and the struggle for congruence: Reinterpreting residential care for children and youth. The Haworth Press.

Arcelus, J., Mitchell, A.J., Wales, J., & Nielsen, S. (2011). Mortality rates in patients with anorexia nervosa and other eating disorders: A meta-analysis of 36 studies. Archives of General Psychiatry68(7), 724-731.

Attia, E. (2010). Anorexia nervosa: Current status and future directions. Annual Reviews of Medicine, 62, 425 – 435.

Berends, T., van Elburg, A., van Meijel, B. (2010). Richtlijn terugvalpreventie anorexia nervosa: Werken met een signaleringsplan ter preventie van terugval bij patiënten met anorexia nervosa. [Relapse prevention anorexia nervosa guideline: Working with an identification plan to prevent relapse in patients with anorexia nervosa.] Koninklijke Van Gorcum BV.

Bornstein, R.F. (2001). A meta-analysis of the dependency-eating-disorders relationship: Strength, specificity, and temporal stability. Journal of Psychopathology and Behavioral Assessment23(3), 151-162.

Bremner, J.D. (2006). Traumatic stress: Effects on the brain. Dialogues in Clinical Neuroscience8(4), 445.

Bosch, I. (2003). Ilusies. Over de bevrijding uit destructieve emoties. [Illusions. About the liberation from destructive emotions.] Uitgeverij Atlas Contact.

Brennan, L. (2020). Eating disorders: The latest evidence. InPsych42(1), 1–5. https://www.psychology.org.au/formembers/publications/inpsych/2020/February-March-Issue-1/Eating-disorders

Bulik, C.M., Kleiman, S.C., & Yilmaz, Z. (2016). Genetic epidemiology of eating disorders. Current Opinion in Psychiatry, 29(6), 383-388.

Caglar-Nazali, H.P., Corfield, F., Cardi, V., Ambwani, S., Leppanen, J., Olabintan, O., Deriziotis, S., Hadjimichalis, A., Scognamiglio, P., Eshkevari, E., Micali, N., & Treasure, J. (2014). A systematic review and meta-analysis of ‘Systems for Social Processes’ in eating disorders. Neuroscience & Biobehavioral Reviews42, 55-92. https://doi.org/10.1016/j.neubiorev.2013.12.002

Clausen, L., & Jones, A. (2014). A systematic review of the frequency, duration, type, and effect of involuntary treatment for people with anorexia nervosa, and an analysis of patient characteristics. Journal of Eating Disorders2(1), 29.

Cumella, E.J., & Simpson, S. (April 1, 2007). Efficacy of equine therapy: Mounting evidence. Wickenburg, AZ: Remuda Ranch Center for Anorexia and Bulimia. http://www.remudaranch.com

Deci, E.L., & Ryan, R.M. (2008). Self-determination theory: A macrotheory of human motivation, development, and health. Canadian Psychology/ Psychologie Canadienne, 49(3), 182-185.

Delfos, M. (2011). De lijn kwijt [Lost the line]. Pearson Benelux.

De Keijser, J., Boelen, P.A., & Smid, G. (2018). Handboek traumatische rouw [Handbook traumatic grief]. Boom.

De Valk, S. (2019). Under pressure–Repression in Residential Youth Care. Dissertatie                 forensische orthopedagogiek. [Forensic remedial education dissertation]. Amsterdam.

De Vos, J.A., LaMarre, A., Radstaak, M., Bijkerk, C.A., Bohlmeijer, E.T., & Westerhof, G.J. (2017). Identifying fundamental criteria for eating disorder recovery: A systematic review and qualitative meta-analysis. Journal of Eating Disorders5(1), 34.

Dings, R.P.J.M. (2020). Not being oneself? Self-ambiguity in the context of mental disorder. Dissertation. Radboud Universiteit.

Draijer, N., & Langeland, W. (2017). Psychoanalyse, psychoanalytische psychotherapie en wetenschappelijke evidentie [Psychoanalysis, psychoanalytic psychotherapy and scientific evidence]. Tijdschrift voor Psychotherapie [Magazine for Psychotherapy], 43(1), 33-59.

Driessen, E., Hegelmaier, L.M., Abbass, A.A., Barber, J.P., Dekker, J.J., van Henricus, L., Jansma, E.P. & Cuijpers, P. (2015). The efficacy of short-term psychodynamic psychotherapy for depression: A meta-analysis update. Clinical Psychology Review42, 1-15.

Earles, J.L., Vernon, L.L., & Yetz, J.P. (2015). Equine‐assisted therapy for anxiety and posttraumatic stress symptoms. Journal of Traumatic Stress28(2), 149-152.

Elchardus, M. (2012). De crisis van de sociaaldemocratie [The crisis of social democracy]. Samenleving en Politiek [Society and Politics], 19(6), 59-67.

Engel, G. (1977). The need for a new medical model: A challenge for biomedicine. Science, 196(4286), 129–136.

Fairburn, C.G., & Cooper, Z. (1993). The Eating Disorder Examination in binge eating: Nature, assessment and treatment. In Fairburn C.G. (Ed) Cognitive Behavior Therapy and Eating Disorders, pp. 317-360. Guildford Press.

Favaro, A., Tenconi, E., & Santonastaso, P. (2006). Perinatal factors and the risk of developing anorexia nervosa and bulimia nervosa. Archives of General Psychiatry63(1), 82-88.

Godart, N.T., Flament, M.F., Lecrubier, Y., & Jeammet, P. (2000). Anxiety disorders in               anorexia nervosa and bulimia nervosa: Co-morbidity and chronology of appearance. European Psychiatry15(1), 38-45.

Graham, A.M., Rasmussen, J.M., Entringer, S., Ward, E.B., Rudolph, M.D., Gilmore, J.H., Styner, M., Wadhwa, P.D., Fair, D.A. & Buss, C. (2018). Maternal cortisol concentrations during pregnancy and sex-specific associations with neonatal amygdala connectivity and emerging internalizing behaviors. Biological Psychiatry, 85(2). http://doi.org/10.1016 /j.biopsych.2018.06.023

Guerry, J.D., & Prinstein, M.J. (2010). Longitudinal prediction of adolescent nonsuicidal self-injury: Examination of a cognitive vulnerability-stress model. Journal of Clinical Child and Adolescent Psychology, 39(1), 77–89. https://doi.org/10.1080/15374410903401195

Hachtel, H., Vogel, T., & Huber, C. (2019). Mandated treatment and its impact on therapeutic   process and outcome factors. Frontiers in Psychiatry10, 219.

Head, B.W., & Alford, J. (2015). Wicked problems: Implications for public policy and management. Administration & Society47(6), 711-739.

Hearing, S.D. (2004). Refeeding syndrome. BMJ, 328, 908-909.

Hoek, H.W. (2006). Incidence, prevalence and mortality of anorexia nervosa and other eating disorders. Current Opinion in Psychiatry, 19(3), 89–94.

Hunot, V., Moore, T.H., Caldwell, D.M., Furukawa, T.A., Davies, P., Jones, H., Honyashiki, M., Chen, P., Lewis, G. & Churchill, R. (2013). ‘Third wave’ cognitive and behavioural therapies versus other psychological therapies for depression. Cochrane Database of Systematic Reviews, 10. https://doi.org/10.1002/14651858.CD008704

Judd, N., Sauce, B., Wiedenhoeft, J., Tromp, J., Chaarani, B., Schliep, A., van Noort, B., Penttilä, J., Grimmer, Y., Insensee, C., Becker, A., Banaschewski, T., Bokde, A.L.W., Burke Quinlan, E., Desrivières, S., Flor, H., Grigis, A., Gowland, P., Heinz, A., Ittermann, B., ... & Becker, A. (2020). Cognitive and brain development is independently influenced by socioeconomic status and polygenic scores for educational attainment. PNAS117(22), 12411–12418.

Juvonen, J., Nishina, A., & Graham, S. (2000). Peer harassment, psychological adjustment, and school functioning in early adolescence. Journal of Educational Psychology92(2), 349.

Kaufman, E.A., & Crowell, S.E. (2018). Biological and behavioral mechanisms of identity pathology development: An integrative review. Review of General Psychology22(3), 245–263.

Kaye, W. (2008). The neurobiology of anorexia and bulimia nervosa. Physiology and Behavior, 94, 121–135.

Kaye, W., Bulik, C.M., Thornton, L., Barbarich, N., Masters, K. (2004). Comorbidity of anxiety disorders with anorexia and bulimia nervosa. The American Journal of Psychiatry, 161(12), 2215–2221.

Keel, P.K., & Klump, K.L. (2003). Are eating disorders culture-bound syndromes? Implications for conceptualizing their ethiology. Psychological Bulletin, 129(5), 747 – 769.

Keel, P.K., Dorer, D.J., Eddy, K. T., Franko, D., Charatan, D.L., & Herzog, D.B. (2003). Predictors of mortality in eating disorders. Archives of General Psychiatry, 60, 179-183.

Kivlighan III, D.M., Goldberg, S.B., Abbas, M., Pace, B.T., Yulish, N.E., Thomas, J.G., Cullen, M.M., Flückiger, C., & Wampold, B.E. (2015). The enduring effects of psychodynamic treatments vis-à-vis alternative treatments: A multilevel longitudinal meta-analysis. Clinical Psychology Review40, 1-14. https://doi.org/10.1016/j.cpr.2015.05.003

Larsen, J., Bulik, C., Thornton, L., Koch, S., & Petersen, L. (2020). Prenatal and perinatal factors and risk of eating disorders. Psychological Medicine, 1-11. https://doi.org/10.1017/S0033291719003945

Lay, B., Jennen‐Steinmetz, C., Reinhard, I., & Schmidt, M.H. (2002). Characteristics of inpatient weight gain in adolescent anorexia nervosa: Relation to speed of relapse and re‐admission. European Eating Disorders Review: The Professional Journal of the Eating Disorders Association10(1), 22-40.

Le Grange, D., Accurso, E.C., Lock, J., Agras, S., & Bryson, S.W. (2014). Early weight gain predicts outcome in two treatments for adolescent anorexia nervosa. International Journal of Eating Disorders47(2), 124-129. 

Leichsenring, F., & Rabung, S. (2011). Long-term psychodynamic psychotherapy in complex mental disorders: Update of a meta-analysis. The British Journal of Psychiatry199(1), 15-22.

Lilliengren, P., Johansson, R., Lindqvist, K., Mechler, J., & Andersson, G. (2016). Efficacy of experiential dynamic therapy for psychiatric conditions: A meta-analysis of randomized controlled trials. Psychotherapy53(1), 90.

Neuvel, K. (2019). Nora & Co, zeven meisjes in een eetstoornistragedie. [Nora & Co, seven girls in an eating disorder tragedy]. Uitgeverij Podium.

Noordenbos, G., & Ten Napel, M. (2017). Innerlijke kritiek bij eetproblemen [Inner criticism for eating problems]. Boom Uitgevers.

Papadopoulos, F.C., Ekbom, A., Brandt, L., & Ekselius, L. (2009). Excess mortality, causes of death and prognostic factors in anorexia nervosa. British Journal of Psychiatry, 194(1), 10-17. https://doi.org/10.1192 /bjp.bp.108.054742

Peterson, C.B., Crosby, R.D., Wonderlich, S.A., Joiner, T., Crow, S.J., Mitchell, J.E., Bardone-Cone, A.M., Klein, M., & le Grange, D. (2007). Psychometric properties of the Eating Disorder Examination‐Questionnaire: Factor structure and internal consistency. International Journal of Eating Disorders40(4), 386-389.

Preti, A., Rocchi, M.B.L., Sisti, D., Camboni, M.V., & Miotto, P. (2011). A comprehensive meta‐analysis of the risk of suicide in eating disorders. Acta Psychiatrica Scandinavica124(1), 6-17.

Quality Standard Eating Disorders (January 8, 2018), NICE. https://www.nice.org.uk/guidance/qs175

Raevuori, A., Linna, M.S., & Keski‐Rahkonen, A. (2014), Prenatal and perinatal factors in eating disorders: A descriptive review. International Journal of Eating Disorders, 47, 676-685. https://doi.org/10.1002/eat.22323

Ryan, R.M., & Deci, E.L. (2000). Self-determination theory and the facilitation of intrinsic motivation, social development, and well-being. American Psychologist, 55(1), 68-78.

Ryan, R.M., & Deci, E.L. (2017). Self-determination theory: Basic psychological needs in motivation, development, and wellness. Guilford Publications.

Scherag, S. (1968). The psychology of affiliation: Experimental studies of the sources of gregariousness. Stanford.

Schoemaker, C., Kleinjan, M., Van der Borg, W., Busch, M., Muntinga, M., Nuijen, J., & Dedding, C. (2019). Mentale gezondheid van jongeren: enkele cijfers en ervaringen [Mental health of young people: Some figures and experiences]. Amsterdam UMC.

Sliedregt, T. (January 8, 2019). Onderbouwing van PRI-therapie: evidence based bouwstenen, ervaring klinische praktijk en eerste onderzoeksresultaten. [Substantiation of PRI therapy: Evidence-based building blocks, experience of clinical practice and initial research results.] https://www.pastrealityintegration.com/images/pdfforms/Sliedregt_2019_On...

Smolak, L., & Murnen, S.K. (2002). A meta‐analytic examination of the relationship between child sexual abuse and eating disorders. International Journal of Eating Disorders31(2), 136-150.

Stanga, Z., Brunner, A., Leuenberger, M., Grimble, R.F., Shenkin, A., Allison, S.P., & Lobo, D.N. (2008). Nutrition in clinical practice–the refeeding syndrome: Illustrative cases and guidelines for prevention and treatment. European Journal of Clinical Nutrition, 62, 687–694.

Steinhausen, H.C. (2009). Outcome of eating disorders. Child and Adolescent Psychiatric Clinics of North America18(1), 225-242.

Steinhausen, H., Grigoroju-Serbanescu, M., Bovadijeva, S., Neumarker, K., & Metzke, C.W. (2008). Course and predictors of rehospitalization in adolescent anorexia nervosa in a multisite study. International Journal of Eating Disorders, 41(1), 29 – 36.

Swaab, D.F. (2004). The human hypothalamus: Basic and clinical aspects. Part I: Nuclei of the human hypothalamus and adjacent brain structures. Elsevier Utrecht: Movisie.

Swierstra, T., & Tonkens, E. (Eds.). (2008). De beste de baas?: Verdienste, respect en solidariteit in een meritocratie [The best in charge?: Merit, respect and solidarity in a meritocracy]. Amsterdam University Press.

Ten Brummelaar, M., Harder, A., Knorth, E.J., Post, W., Kalverboer, M., & van der Ploeg, J. (2017). Balanceren tussen grenzen en mogelijkheden: De participatie van jeugdigen in           gesloten residentiële zorg. [Balance between limits and possibilities: The participation of young people in residential care.] SWP Uitgeverij.

Treasure, J., Crane, A., McKnight, R., Buchanan, E., & Wolfe, M. (2011). First do no harm: Iatrogenic maintaining factors in anorexia nervosa. European Eating Disorders Review19(4), 296-302.

Van der Helm, P. (2020). Leefklimaat! Voor jeugd en volwassenen. [Living environment! For youth and adults.] Uitgeverij SWP Amsterdam.

Van der Kolk, B. (2014). The body keeps the score: Mind, brain and body in the transformation of trauma. Penguin UK.

Van der Kolk, B.A. (2017). Developmental trauma disorder: Toward a rational diagnosis for children with complex trauma histories. Psychiatric Annals35(5), 401-408.

van Os, J. (2014). De DSM-5 voorbij! Persoonlijke diagnostiek in een nieuwe GGZ. [The DSM-5 for example! Personal diagnostics in a new GGZ.] Springer media B.V.

van Os, J., Delespaul, P., Barge, D., & Bakker, R.P. (2014). Testing an mHealth momentary assessment Routine Outcome Monitoring application: A focus on restoration of daily life positive mood states. PLoS One9(12).

Vansteenkiste, M., Simons, J., Lens, W., Soenens, B., & Matos, L. (2005). Examining the motivational impact of intrinsic versus extrinsic goal framing and autonomy‐supportive versus internally controlling communication style on early adolescents’ academic achievement. Child Development76(2), 483-501.

Vansteenkiste, M. & Soenens, B. (2015). Vitamines voor Groei. [Vitamins for Growth]. Den Haag: Acco.

VSNU Universities. (January 8, 2014). De Nederlandse Gedragscode Wetenschapsbeoefening. [The Dutch Code of Conduct for Scientific Practice]. https://vsnu.nl/files/documenten/Domeinen/Onderzoek/Code_wetenschapsbeoe...

Ward, A., Ramsay, R., Russell, G., & Treasure, J. (2015). Follow‐up mortality study of compulsorily treated patients with anorexia nervosa. International Journal of Eating Disorders48(7), 860-865.

Wesselius, H. (2018). De ervaring van anorectische adolescenten met hun klinische behandelingen. Een kwalitatief onderzoek met een focus op autonomie, zelfacceptatie en persoonlijke groei. [The experience of anorectic adolescents with their clinical treatments. A qualitative study with a focus on autonomy, self-acceptance, and personal growth.] Bachelor scriptie. [Bachelor thesis].

Winkler, L.A.D., Christiansen, E., Lichtenstein, M.B., Hansen, N.B., Bilenberg, N., & Støving, R.K. (2014). Quality of life in eating disorders: A meta-analysis. Psychiatry    Research219(1), 1-9.

Wolf, K.T. & Baglivio, M.T. (2017). Adverse childhood experiences, negative emotionality and pathways to juvenile recidivism. Crime and Delinquency, 1495-1521.

Woods-Jaeger, B.A., Sexton, C.C., Gardner, B., & O’Malley, D. (2018). Development, feasibility, and refinement of a toxic stress prevention research program. Journal of Child and Family Studies, 27, 3531–3543. https://doi.org/10.1007/s10826-018-1178-1

Young, M.D. (1994/1958). The rise of the meritocracy. Transaction Publishers.

Zipfel, S., Sammet, I., Rapps, N., Herzog, W., Herpertz, S. & Martens, U. (2006). Gastrointestinal disturbances in eating disorders: Clinical and neurobiological aspects. Autonomic Neuroscience, 30, 99-106. https://doi.org/10.1016/j.autneu.2006.07.023