![[ Visit Client Website ]](images/banner.gif)
II. Models of maintenance of eating disorders
A. Cognitive behavioral
B. Sociocultural
C. Functional contextualist
D. Psychobiological
III. The eating disorder maintenance cycle
A. Elevated emotional drives
B. Unreliable discrimination of safety and danger
C. Chronic anxiety
D. Decreased mentalization and awareness of intrinsic values
E. Increased negative emotions and decreased positive emotions
F. Low self-directedness and emotion-dependent behavior
G. Habitual modulation of emotions with eating disorder
H. Reinforcement of chronic anxiety
IV. The need to elevate character
A. Regulation of emotional drives is a function of character
B. Elevation of character correlates with self-awareness
C. Emotional intelligence correlates with elevation of character
D. Eating disorders impede character growth
V. Values awareness
A. Values provide life direction
B. Values provide a context for actions
C. Values provide a context for emotions
D. Values help determine the utility of emotions and thoughts
E. Self-directedness is difficult, if not impossible, without awareness of values
F. Negative experiences are not tolerated well without a values context
VI. Intrinsic versus instrumental values
A. Intrinsic values are core values emanating from our human nature
B. Instrumental values are a means to getting something else
C. Instrumental values do not pass the “isolation test”
D. Most eating disorder values are instrumental relating to management of negative emotions
VII. Values assessment
A. Intrinsic values are the source of positive emotions
B. Intrinsic values reflect the information already within us (our own nature)
C. Intrinsic values relate to our intuitive senses
D. Values are hierarchical
VIII. Mentalizing—having mindsight
IX. What does non-mentalizing look like?
A. Excessive detail to the exclusion of motivations, feelings, or thoughts
B. Focus on external social factors, such as the school, the government, the neighbors
C. Focus on physical or structural labels
D. Preoccupation with rules, responsibilities, “should” or “should nots”
E. Denial of involvement in problems
F. Blaming or fault finding
G. Expressions of certainty about the thoughts or feelings of others
X. Mentalizing stance of therapy
XI. Summing up Breaking the Maintenance Cycle of Eating Disorders +
Eating disorders have proven to be highly refractory to treatment in as many as a third of the patients seen in therapy. Temperamental biases such as high harm avoidance and high novelty seeking can elevate emotional drives and make recovery from eating disorders quite difficult. Studies of active cases and recovered eating disordered persons show that they have longstanding persistent anxiety dating from childhood. A recent study indicates two clusters of anxious predisposition. It is thought that patients with eating disorders unreliably discriminate safety and danger. One cluster of patients with cognitive anxiety is hypervigilant while the other with somatic anxiety is hypovigilant. The long term common result is chronic anxiety which drives emotion-focused coping behavior.
The effect of chronic anxiety is profound in eating disordered patients. Anxiety is known to suppress the capacity to self-observe or mentalize. To mentalize is to be able to see one’s own mind and that of others. It is “the mental process by which an individual implicitly and explicitly interprets the actions of himself and others as meaningful on the basis of intentional mental states such as personal desires, needs, beliefs, and reasons.” The average state of self-awareness in many eating disordered patients is such that they are unable to mentalize their own intrinsic values which would underly self-directed behavior. The result is that they are dominated by emotion-dependent behavior that they do not want to have. They attempt to escape this state by means of their eating disorder. Because escape behavior only reinforces the underlying anxiety, they are stuck in a vicious cycle. Recognizing and breaking this vicious cycle by developing values awareness and enhancing mentalizing capacity is the focus of treatment.
Dr. Bishop has over 25 years experience in the treatment of eating disorders and is with Eating Recovery Center, Denver, Colorado where he is the Director of Research and Outpatient Services. He was the Medical Director of the Clark Center Eating Disorders program in Savannah, Georgia from 1986 to 1996. Serving on the board of directors of the International Association of Eating Disorders Professionals since 1993, he is currently the immediate Past President. He is a Fellow of the Academy for Eating Disorders and is also on the editorial board of Eating Disorders: Journal of Treatment and Prevention.
Dr. Weiner has been treating eating disorders for over 25 years and is currently Medical Director of the Eating Recovery Center, Denver, Colorado. He created and directed the Eating Disorder Center of Denver from 2001-2007. Dr. Weiner is Assistant Clinical Professor of Psychiatry at the University of Colorado Health Sciences Center and received the prestigious Gold Apple Teaching Award, as well as being named a Fellow of the Academy of Eating Disorders and a Distinguished Fellow of the American Psychiatric Association. A dedicated clinician and teacher Dr. Weiner has co-authored numerous articles on eating disorders.
