[Internet-based approaches in the therapy of eating disorders]. / Internetbasierte Ansätze in der Therapie von Essstörungen.

Recent technological developments of communication media offer new approaches to diagnostic and therapeutic interactions with patients. One major development is Internet-based primary prevention in vulnerable individuals not yet suffering as well as the development of new therapeutic approaches for affected individuals based on the experiences of guided self-help through CD, DVD or bibliotherapy. The eating disorder literature shows several interesting, partly controlled and randomized, studies on bulimia nervosa, a few studies on binge eating disorder and no studies on anorexia nervosa. As part of the German Eating Disorder Network on Psychotherapy (EDNET) a 9-month Internet-based relapse prevention program for patients with anorexia nervosa after inpatient treatment was evaluated. Conception, first experiences and first results of the Internet-based relapse prevention program for anorexia nervosa are reported.

Body image in eating disorders and analysis of its relevance: a preliminary study.

The purpose of the present study was to assess body perception in eating disorders and its meaning in therapy. A total of 44 patients, 25 bulimia nervosa and 19 anorexia nervosa, admitted at a specialized in-patient treatment center participated in the present study. Body size estimation procedures (video-distortion and image-marking techniques) and self-report questionnaires were used for the assessment. No significant differences were found in actual body size estimation between the two eating disorder groups, either before or after therapy. It emerged after therapy that the outcome was not related to body size estimation. These findings suggest that there is no evidence for a serious impairment of body perception (size estimation) in eating-disordered patients, but rather for a disturbance in the emotional aspect of body image, as expressed in negative body attitudes. Body size perception does not appear to be a predictor of treatment outcome in eating disorders.

[Therapy of anxiety disorders from the behavior therapy viewpoint]. / Therapie von Angsterkrankungen aus verhaltenstherapeutischer Sicht.

Every patient with severe anxiety symptoms needs a physical examination in a medical practice first. Secondly, the indication for a specific psychiatric treatment is the decision of a physician with the proper qualifications. Due to practical views, the psychiatric diagnostic is described with following classical forms: agoraphobia, anxiety neurosis, and cardioneurosis. The beginning of the treatment consists of the behaviour analysis. This is followed by the decision for an outpatient or hospitalized treatment as well as the general treatment plan. Systematic desensitization and exposure are introduced as specific behavior treatment techniques as well as the availability of behaviour treatment in Germany.

Chronic illness behavior and noncompliance with treatment: pathways to an interactional approach.

The increasing cost of medical overconsumption is partially due to the physicians' neglect in everyday clinical practice of the intrinsic gratification of the sick role in our society. Many health care providers do not seem to realize that their intervention as experts in the patient's personal life inevitably implies they are becoming part of the ongoing learning history of that individual. Chronic somatic complaining and partial or complete refusal to follow therapeutic advice have to be viewed, first and foremost, as a symptom of a dysfunctional interaction between the patient and his/her immediate environment of which the clinician became a significant member. Management of chronic illness behavior and non-compliance with treatment requires both a functional analysis and a strategy inspired by an interactional perspective on the attitudes and behaviors of at least three parties involved in health care: doctor, patient, and family.

Methodological problems of body image research in anorexia nervosa patients.

The significance of the disturbed body image as a psychopathological phenomenon in anorexia nervosa patients is quite evident to clinicians. It appears to be difficult, however, to assess this disturbance in a more objective way. The studies on body image perception discussed here make use of objective psychometric methods of measurement: image marking procedure, visual size estimation apparatus, distorting photograph technique, and video distortion. The following methodological problems are discussed: reliability, validity, experimental situation, and selection of subjects. Experimental data are presented on 52 anorectic patients as well as 210 control subjects, studied with three different perceptual tasks.

[Influencing factors of different durations of behavioral therapy in in-patients with anxiety disorders]. / Bedingungsfaktoren unterschiedlicher Behandlungsdauer bei Angststörungen im Rahmen stationärer Verhaltenstherapie.

In this study, the influencing factors of different durations of in-patient therapy were examined. We investigated 1173 patients with anxiety disorders who were treated in the psychosomatic clinic of Bad Pyrmont with behavioural therapy. Patients with anxiety disorders have an average treatment duration of 52.4 days with a minimum of less than one week and a maximum of more than five months. The duration of treatment depends on the one hand on sociodemographic variables such as age, marital status, partnership, residential status, and professional activity, but not on gender or education. The duration of treatment also depends on factors of severity of the disorder, such as the number of in-patient or psychotherapeutic treatments, duration of disorder and disability, and the number of psychiatric diagnoses, but not on the number of somatic diagnoses. There is a positive correlation between duration of treatment and effect of therapy as well as recovery of fitness for work.

[Evaluation of body image perception in patients with anorexia nervosa]. / Zur Evaluation der Körperbild-Wahrnehmung bei Patienten mit Anorexia nervosa.

In the patient unit of the University Clinic for Psychiatry at Kortenberg (K.U. Leuven) Belgium and in the Psychosomatic Hospital Bad Pyrmont, which specialises in the treatment of anorexia nervosa, a great deal of attention is given to the evaluation of body image via the video-distortion technique, the video-confrontation technique and the body attitude test (a questionnaire). These different methods as well as the first findings and experiences are described.

Body size estimation and body dissatisfaction in eating disorder patients and normal controls.

In this study comparing 41 eating disorder patients and 34 female controls, the video distortion technique was used to test the accuracy of body size estimation and to assess the ideal body image. No difference was found in the estimation of actual body sizes, although the accuracy of estimation was quite variable in both bulimics and anorexics. With regard to the ideal body image, significant differences were found: All bulimics and 92.6% of the controls wished to be thinner versus 42.9% of the anorexics (23.8% wished to be larger). Looking at subjective body experience, as measured with a self-report questionnaire (Body Attitudes Test), body dissatisfaction appeared to be negatively correlated with the ideal body image but not with the estimation of actual body sizes.

[Anorexia nervosa in German medical literature of the 19th century]. / Die Anorexia nervosa in der deutschsprachigen medizinischen Literatur des 19. Jahrhunderts.

After its first description in 1873, anorexia nervosa seems not to have attracted much attention in countries of German language. Compared to French and English literature, German publications on the subject were rather scarce in the 19th century. This article gives an overview of those writings and an explanation of the lack of interest on the part of the German-speaking physicians. Apparently, to them anorexia nervosa did not appeal as a nosological entity distinct from the popular diagnosis of "nervous dyspepsia".

[Study of the practicability of qualitative and quantitative documentation of outcome in inpatient psychotherapy]. / Praktikabilitätsstudie zur qualitativen und quantitativen Ergebnisdokumentation stationärer Psychotherapie.

The results of a study evaluating the practicability of two newly-developed documentation forms are presented (n = 336 inpatient psychosomatic-psychotherapeutic treatment episodes in 8 clinics). Parallel versions of the forms were completed by patients and therapists. The "ErgeDoku-A-Form" allows for the naming of up to five therapy goals determined at the beginning of therapy and evaluated in relation to their achieved quality at the end of therapy. The "ErgeDoku-B-Form" describes a variety of problem areas as well as questions related to medication and changes in data structure are presented. Results reveal high levels of acceptance in daily clinical practice (indicating clear and appropriate semantics) as well as highly significant relationships between patient and therapist evaluations.