the study by Carter and associates (1998) found an increase in eating disordered behaviors following the conclusion of the psycho-educational program. Predictors of outcome. The literature records significant controversy as to which predictors indicate a favorable outcome, a negative outcome, or whether any significant pretreatment predictors are present at all (American Psychiatric Association,2000b; Button et al., 1997; Fairburn et al., 1987). Although some research suggests that poorer prognosis is associated with older age at illness onset (American Psychiatric Association, 2000b; Eckert, Halmi, Marchi, Grove, & Crosby, 1995), high frequency of bulimic behaviors (American Psychiatric Association, 2000b; Ben-Tovim, 2003; Eckert et al., 1995; Richards et al., 2000; Stein et al., 2001;Steinhausen, 2002), chronicity of disorder (Eckert et al., 1995; Richards et al., 2000; Steinhausen, 2002), and comorbid depression (Eckert et al., 1995; Keel & Mitchell, 1997; Stein et al., 2001), other research contradicts or negates these findings (Fairburn, Agras, Walsh, Wilson, & Stice, in press; Fichter et al., 2003; Hsu, 1995; Keel et al., 1999; Shoemaker, 1997; Sunday, Reeman, Eckert, &Halmi, 1996). However, a high level of self-esteem at admission appears consistently as a predictor of therapeutic treatment outcome (Fairburn et al., 1987; Ghaderi, 2001; Stein et al., 2001). While unclear indicators and poor methodology have been cited as contributing to the cause of this controversy (Fairburn, Agras, Walsh, Wilson, & Stice, in press; Hsu, 1995; Striegel-Moore & Cachelin, 2001),it has also been posited that some researchers advanced predictor conclusions while conceding weak evidence (Richards et al., 2000). Eating disorder treatment. Given the chronicity and the variability of presenting symptomology, there is much debate about the most effective treatment for this disorder.
Psychotherapists frequently use group and personal cognitive behavioral therapy (CBT)and interpersonal psychotherapy (IPX) (Mussell, Crosby et al., 2000; Wilson, 2003). Family therapy and a variety of pharmacological therapies have also been shown to be effective, to some degree, in treating patients with eating disorders (de Zwaan & Roerig, 2003; Kennedy & Garfinkel, 1992). Although religious issues may intensify eating disorder symptomology, spiritual and religious interventionshave been found to be influential on eating disorder recovery (Richards et al., 1997). Whatever treatment is chosen, however, it has been suggested by Treasure and Schmidt (2003) in the Handbook of Eating Disorders, that a stepped care approach, starting with the least costly, least intensive, and least invasive interventions, may be the best method to match treatment to patient. The AmericanPsychiatric Association's (2000) Practice Guideline for the Treatment of Patients With Eating Disorders recommends three steps in treating patients with Anorexia Nervosa: (1) Nutritional rehabilitation, (2) Psychosocial interventions, and (3) Medications. Unfortunately, there is relatively limited evidence to recommend one therapy over another when treating restricting patients (Treasure & Schmidt,2003; Wilson, 2003). Wilson (203), in his recent review of the research, suggests that adolescents with anorexia nervosa demonstrate the most promising results with family therapy while Stein and his associates (2001) advocate individual therapy as more beneficial for patients with late onset AN. Wilson and other researchers propose that individual CBT is moderately effective when treating patientswith anorexia nervosa (Waller & Kennerley, 2003; Wilson, 2003). In addition, researchers suggest that the medication, Fluoxetine, has some support for its use with patients experiencing AN,
although overall there is little current empirical evidence demonstrating any specific medication is helpful in treating underweight patients (Klein & Walsh, 2003; Stein et al., 2001). In contrast...
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