This is an archived article. Although much of the information contained within this article will likely still be relevant and helpful, there may be some content that is outdated or written by a former employee of Center for Change.
By: Randy K. Hardman, Vice-President, Center for Change, P. Scott Richards, Vice-President and Director of Research, Foundation for Change
Jan was a nineteen-year-old, caucasian female from the Western United States. Jan had suffered with anorexia since the eighth grade and it had become extremely severe in the year prior to her admission. She had also had a longstanding depressive disorder, with a general state of guilt and unhappiness. She had tried some outpatient therapy, but had not persisted with it. She came to Center for Change following an assessment and referral by an outpatient therapist in her community.
Jan’s physical exam at admission revealed that she was 5′ 6″ tall and weighed 94.5 lbs. Jan’s physical exam revealed that her heart rate was only 55. The physician also noted that Jan was “thin and somewhat cachectic appearing”, and “occasionally gets some sharp chest pains and constipation.” Her last menstrual period was 6 months earlier.
>The nutritionist estimated Jan’s Body Mass Index at 15.5. She also concluded that Jan’s body weight and somatic protein stores were below normal limits. She noted that Jan had “poor hair growth and falling out”, “skin bruises easily”, “increased sensitivity in teeth and gums bleeding”, “stomach pain, bloating, and gas”, and “cold body temperature”. She concluded that Jan is “at risk for malnutrition”.
During her psychiatric interview, Jan described eating disorder symptoms, as well as symptoms of major depression that had been present for several years. Her DSM-IV Axis I diagnosis was Anorexia Nervosa (Purging Type, Severe) and Major Depression (Single Episode, Moderate). Jan’s scores on the Eating Attitudes Test and Body Shape Questionnaire confirmed that she was suffering from clinically disordered levels of eating disorder symptoms and body image disturbances.
Jan’s elevated MMPI-2 profile confirmed that she was suffering from clinically significant levels of a variety of psychiatric symptoms such as depression, anxiety, fearfulness, obsessive thoughts, guilt, low self-esteem, self-blame, and feelings of worthlessness. Jan also suffered from multiple somatic symptoms, including poor appetite, fatigue, insomnia, and cardiac pain.
In her first individual therapy session, Jan said: “I’m at a stand still. I have no social life. I don’t see any way for a future family or career because of my eating disorder. My eating disorder controls everything. Health is a big concern. I’m very worried about it. I’m scared of a heart attack. I feel sick inside, tired. I’m aged. I’ve aged myself fifty years. I’m not okay.”
Does Jan sound familiar? If you are a practitioner who works with women who suffer from eating disorders, we suspect you would respond with a resounding, “Yes!”
As you read about “Jan”, did you find yourself beginning to think about how you would go about trying to help her? For just a moment, we invite you to assume that you were the clinician who had been assigned to work with Jan. What would be your response to the following questions:
- To what extent would your treatment approach with Jan be guided by your clinical experience?
- To what extent would your treatment approach with Jan be guided by research findings?
- Can you think of any empirical studies you have read recently about eating disorders and their treatment that would inform your work with Jan?
- Have you conducted any of your own studies recently that might inform your work with Jan?
If you are like us at Center for Change, your treatment decisions are guided in part by your clinical experience, and in part by research findings. But what is the relative balance between the two for you?
Many practitioners question the relevance and value of research for clinical practice. As practitioners ourselves, we have often found that many research studies provide little or no insight into how we can more effectively assist our clients. Nevertheless, perhaps because we had been trained in the scientistpractitioner model as we went through our doctoral training programs in psychology, we remained committed in theory, at least, to the idea that good research could help inform effective psychological practice. As a result, several years ago, when we decided to open an inpatient treatment program for women with eating disorders, we made a philosophical, time, and financial commitment to using research to help inform our clinical practice.
Although at times we have wondered if the effort and cost were worth it, we are now seeing some major benefits of our decision. First, we have been able to document empirically that our treatment program is effective, and that the vast majority of women that we treat benefit substantially from our program on an immediate and long-term basis. Second, our research program has helped us provide to accrediting agencies and insurance companies needed documentation about our treatment outcomes. We assume the need for such accountability will only continue to grow in the managed care environment of contemporary health care. Third, we have used the information garnered from empirical data to make specific positive changes and improvements in various components of our treatment program. Last, and certainly not the least, we have gained valuable insight into women with eating disorders and how we can more effectively treat them. We feel that we are better practitioners today because of the research we have done.
In this month’s newsletter, we would like to share more about our research program with you, including a brief summary of the studies we have done and research findings that we think may be of interest to you as a practitioner. We would also like to invite you to get involved in research about eating disorders and their treatment, if you are not already so involved. To encourage and help you in this, one section of this newsletter contains an article called “A Research Primer for Practitioners”. We also provide some information about Foundation for Change’s research and outcome assessment services that will become available to interested practitioners and clinical treatment sites in the future.