Recovered eating disorder therapists using their experiential knowledge in therapy: A qualitative examination of the therapists' and the patients' view.

In the eating disorder (ED) field there is a lack of guidelines regarding the utilization of recovered therapists and the experiential knowledge they can bring to therapy. In this study, a qualitative design was used to examine recovered eating disorder therapists using their experiential knowledge and how this influences therapy and the patients they treat. Respectively, 205 patients (response rate 57%), and 26 recovered therapists (response rate 75%) completed a questionnaire about advantages and disadvantages of the utilization of experiential knowledge in therapy. Results showed that using experiential knowledge can have several advantages and disadvantages in therapy. Therapists can use this knowledge as a therapeutic intervention with specific goals, such as providing the patient with insight into the recovery process, establishing a working relationship, and enhancing hope for recovery. To be effective, self-disclosure and experiential knowledge need to be shared thoughtfully, and should not include specific details about ED symptoms. Other factors noted that enhanced the benefits of experiential knowledge included therapist self-insight and self-care, adequate training and guidance, and a safe work environment. Patients stated that being treated by a recovered therapist had a positive effect on their recovery process. It is advised to establish guidelines in the ED field about working with recovered therapists and the experiential knowledge they might use in therapy. Further research is needed on the process of when, how, and which experiential knowledge is shared by recovered therapists in therapy, and the effects of these interventions on patients and their treatment outcomes.

The relationship among critical inner voices, low self-esteem, and self-criticism in eating disorders.

Hilde Bruch (1978) was one of the first to describe the phenomenon of anorectic patients experiencing a critical inner voice. Although several qualitative studies regarding eating disorder patients report this experience, few quantitative studies have been conducted in which hearing voices was examined in eating disorder patients. This motivated us to investigate whether eating disorder patients (N = 74) experience critical inner voices significantly more often than a healthy control group (N = 58). Is voice hearing related to the severity of the eating disorder and to low self-esteem and high self-criticism? These questions will be addressed in this article.

Which criteria for recovery are relevant according to eating disorder patients and therapists?

In the treatment of eating disorders (ED), no consensus exists on relevant criteria for recovery and goals for treatment. Which criteria do ED patients and therapists evaluate as most relevant for recovery? And do patients and therapists differ in their evaluations? This article presents a review of research on the opinions about recovery criteria of former patients and therapists. Criteria most often mentioned by the patients could be divided into the following themes: eating and drinking; physical activity and exercising; attitude towards food and weight; body evaluation; relaxation; physical recovery; psychological recovery; emotion regulation; social relations; sexual attitude; and comorbidity. Only slight differences were found between the opinions of former patients and therapists.

When have eating disordered patients recovered and what do the DSM-IV criteria tell about recovery?

Lack of consensus about criteria for recovery from eating disorders results in greatly varying percentages of recovered patients. Outcome studies not only use different criteria for recovery, but also quite different instruments, rendering their results incomparable. The same problem occurs among studies of predictors for recovery from eating disorders. Without consensus on criteria for recovery, it is not clear which goals of treatment are important to realize full recovery. In order to develop larger consensus on criteria for recovery, this study critically analyzes the most important outcome scores and the criteria for recovery deduced from the DSM-IV.

The quality of treatment of eating disorders: a comparison of the therapists' and the patients' perspective.

OBJECTIVE: The aims of this study were to investigate the quality of treatment of eating disorders (EDs) from the therapists' and patients' perspective and to compare their views. METHOD: The Questionnaire for Eating Problems and Treatment (QEPT) was administered to 73 therapists working with patients with ED, to 156 current ED and 148 former ED patients. The QEPT addresses the quality of treatment of EDs. ED diagnosis was assessed by the Eating Disorder Examination Questionnaire. Answers were analyzed quantitatively and qualitatively. RESULTS: Both therapists and patients most often mentioned focus of treatment, therapeutic alliance, and communicational skills as important aspects of the quality of treatment. However, they valued similar topics differently. Therapists valued the focus on ED symptoms and behavioral change more highly, whereas patients underscored the importance of the therapeutic relationship and addressing underlying problems. Most therapists work from a cognitive behavioral orientation, but protocol-based treatment was not found important. CONCLUSION: There is an avid need for dissemination of evidence-based treatment. Therapists' and patients' views supplement current evidence-based knowledge on treatment quality of EDs. Optimal treatment of EDs will be facilitated when these three bodies of knowledge-the available evidence and the therapists' and patients' views-are integrated.

The patient's view on quality of life and eating disorders.

OBJECTIVE: This study investigated the personal views of eating disorder (ED) patients on their quality of life (QOL). METHOD: The views of 146 current ED patients and 146 former ED patients on their QOL were studied using a self-report questionnaire. Patients were requested to name the most important aspects of their life and they subsequently rated themselves on these aspects. Qualitative analysis clustered items into meaningful categories. RESULTS: A sense of belonging was mentioned most often (93.0%) by the participants. Work or education, health and well-being were also mentioned frequently. Furthermore, participants stated a sense of self, disease-specific psychopathology, life skills, leisure activities, a sense of purpose, financial situation, living condition, and pets. Current ED patients more frequently mentioned disease-specific psychopathology than former ED patients. Current ED patients reported poor QOL on most domains, particularly on self-image and well-being. Former ED patients reported better QOL than current ED patients, but ratings were just above average. CONCLUSION: The views on QOL of ED patients broadens the scope of relevant domains of QOL. The assessment of these views may be a useful adjunct to the use of standardized QOL measures.

Evaluating the treatment of eating disorders from the patient's perspective.

OBJECTIVE: This study investigated the evaluation of treatment of eating disorders (EDs) from the patient's perspective in a large community based sample in the Netherlands. It investigated perceived helpfulness of different types of treatment. Furthermore it investigated which patient and treatment characteristics contribute to the evaluation of treatment. METHOD: The Eating Disorder Examination questionnaire was administered to 44 anorexia nervosa (AN), 43 bulimia nervosa (BN), 69 EDNOS (ED not otherwise specified), and 148 former ED patients. A questionnaire specifically designed for the purpose of this study addressing treatment history and patient's evaluation of their treatment was administered. RESULTS: There is a substantial patient and doctor delay in seeking and finding treatment. Treatment in specialized ED centers, self-help groups, and treatment with a partner were reported to be most helpful. Beneficial components of treatment reported in specialized ED centers refer to the communication skills of professionals, the therapist-patient working alliance, the contact with peers, and the focus of treatment on both ED symptoms as well as underlying issues. CONCLUSION: The patient's perspective on treatment of EDs does provide recommendations for the improvement of treatment of EDs that will facilitate clinical decision making and treatment planning.

Criteria for recovery from eating disorders according to patients and therapists.

No consensus exists on criteria for recovery from eating disorders. Different criteria are used in effect and outcome studies, suggesting different rates of recovery. The questions for research were: Which criteria for recovery are important to ex-patients and therapists, and which criteria for recovery are actually realized by ex-patients? A list of 52 possible criteria for recovery was compiled from the literature on eating disorders, representing the domains of eating behavior, body experience, physical and psychological well-being, and emotional and social functioning. Ex-patients (n = 41) and therapists (n = 57) were asked to select criteria from this list, that they viewed as important for recovery from eating disorders. Ex-patients were asked which criteria they had realized by the end of their most recent therapy or treatment and in the period thereafter. Ex-patients and therapists agreed on most of the criteria for recovery. At the end of their therapy, more than 50% of the ex-patients had realized 44 of the criteria for recovery but thereafter they improved on 38 criteria. To realize full recovery and to prevent relapse, it is important to consider not only eating behavior and weight, but also psychological, emotional, and social criteria.

The quality of life of family caregivers of eating disorder patients.

Having a relative with an eating disorder (ED) affects the life of family caregivers and may thus affect their quality of life. To study this aspect, 40 caregivers of ED patients filled out a health-related quality of life questionnaire (Short Form-36) and a questionnaire on the impact of the ED on various areas of life domains, and on the relationship with the ED patient and the need for professional support. Quality of life of caregivers was worse than in a normal reference group. Specifically, mental health, vitality and emotional role functioning were reported to be most impaired. ED appeared to affect families' lives substantially. In response to the ED, caregivers felt anxious, powerless, sad, or desperate. The relationship of the caregiver with the ED patient had also changed. Caregivers were more worried, lost their trust, and reported more conflicts. Seventy five percent welcomed professional support. Caregivers need practical advice, information on ED, and emotional support. Quality of life of caregivers should be addressed in the treatment of ED.

Characteristics and treatment of patients with chronic eating disorders.

This article presents the results of a study of 41 patients with an eating disorder (ED) for ten years or longer. Their mean age was 34 years, the mean duration of their ED was 15.2 years, and their mean lowest BMI was 14.8. We describe the characteristics of their ED, weight history and BMI, the reasons for the onset of their ED, the physical and psychological complaints and social problems, the process of diagnosing their ED, the treatment history, and the patients' evaluation of their treatments. Finally, we will describe whether the patient recovered. The article ends with a discussion about possibly improving their treatment and quality of life.