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Rothschild, L. Stein, D. (2009). Treatment Monitoring: Changes in Affective Distress and Dependency Following Symptom Alleviation of Eating Disorders. J. Amer. Psychoanal. Assn., 57(2):451-456.

(2009). Journal of the American Psychoanalytic Association, 57(2):451-456

Treatment Monitoring: Changes in Affective Distress and Dependency Following Symptom Alleviation of Eating Disorders

Lily Rothschild and Daniel Stein

Most outcome researchers today rely on self-report measures that for the most part assess behavioral and symptomatic changes. Few studies use tools and measures (e.g., the Rorschach) that allow the assessment of implicit experiences and changes in intrapsychic process. A notable exception is an extensive study reported by Blatt and Ford (1994) that detected different configurations of change among different personality styles.

Eating Disorders

Eating Disorders (EDs) are classified by DSM-IV into four types: (1) anorexia, restricting, hereafter AN-R; (2) anorexia, binge-eating/purging, or AN-BP; (3) bulimia, purging, BN-P; and (4) bulimia, nonpurging. Blatt and colleagues (Blatt and Schichman 1983; Blatt and Zuroff 1992) referred to all types of ED as presenting an anaclitic configuration and proposed that preoccupation with food serves as a defense against anaclitic depression. Joyce McDougall's theory of the body-mind matrix and the psychic economy of affect (1989) also conceptualized all the ED subtypes as forming a single dynamic configuration, and traced ED sufferers to a familial upbringing that avoided emotions. For those unable to recognize and conceptualize psychic pain at the level of verbal thought, EDs can serve as a coping strategy by which to escape awareness of unbearable experiences.

Several studies have proposed that binging/purging behavior is a more discriminative criterion of ED type than is body weight, and present data indicating that two distinct groups (restricting and binging/purging) differ in personality attributes and mental functioning (Vitousek and Manke 1994).

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