[Winter 1998; Vol.25 No. 3]
"In the past fifteen years there have been far-reaching dramatic changes in the treatment of eating disorders." reported Harry Brandt, M.D., director of the Medical Center for Eating Disorders at the St. Joseph Hospital. Under the leadership of Dr. Brandt and the Center's associate director, Steven Crawford, M.D., a conference on eating disorders was held on September 19, 1998 at the St. Joseph Hospital. The conference brings together experts on various aspects of eating disorders from across the country.
Dr. Brandt began the conference with a panoramic discussion of the specific syndromes, associated psychopathology, models for their pathogenesis, and specific methods of treatment. Dr. Brandt's presentation paid special attention to advances that have been made in the understanding and treatment of these syndromes in recent years. For example he documented how the evolution of an integrated "treatment team" approach to the acute care of anorexia nervosa has decreased the mortality from 9.1% to 5% since 1975.
There was a discussion of the psychological purpose of eating disorders, particularly anorexia nervosa and bulimia, by Craig Johnson, Ph.D., of the University of Tulsa. He focussed on temperamental traits and internal conflicts that typify anorectic and bulimic women. For instance he characterized food-restricting anorectic patients as risk-avoiding, compulsive and compliant, while bulimic patients are described as risk-taking, impulsive and angry.
"There are significant disturbances in body image in eating disorders." According to Ann Kearney-Cooke, Ph.D. of the University of Cincinnati. She expanded on the cultural, familial and psychological factors that affect body image, and specific methods of exploring and treating these disturbances. For example she described helping patients to identify and to rethink a tendency to dichotomize themselves (fat/thin; good/bad) and to react to minor problems as if they were catastrophic. She works most commonly through group and individual psychotherapy.
An update on the psychopharmacology of eating disorders was presented by James Mitchell, M.D. He noted the lack of robust pharmacological treatments for anorexia nervosa. However there might be a modest role for SSRI's as an adjunct to non-pharmacological treatments to prevent relapse in anorectic girls. Patients with bulimia nervosa often respond to antidepressants, especially serotonin re-uptake inhibitors, but doses toward the upper range used in treating depression are needed. Obesity continues to be very common and psychopharmacology of limited use, since weight is usually regained once the medications are stopped.
The thesis of "father hunger" as an underlying cause of eating disorders in women was presented by Margo Maine, Ph.D. of The Institute Of. She defines "father hunger" as the deep and persistent desire for emotional contact with the father. She presented a number of ideas about how pressures within the family arising from its members and from society may result in a girl's experience of a lack of needed emotional connection with her father.
Glenn Brynes, PhD, MD is co-chair of the MPS Computer Committee and is in private practice in Baltimore County