An Integrative Group Treatment Model for Women with Binge Eating Disorder: Mind,Body and Self in Connection

Binge eating disorder (BED) is the most prevalent eating disorder reported among women, and its recent diagnostic recognition in the DSM-5 (APA 2013) calls for further discussion on effective treatment. Women with BED commonly report a diet/binge cycle that can exacerbate a disconnection between mind and body and reinforce feelings of shame and isolation. This article presents an integrative group treatment model for women with BED that has shown positive outcomes in clinical practice. The group model addresses key biopsychosocial factors associated with BED and incorporates mindfulness principles tailored to problems of the disorder. A core foundation of the group model is the relational context that fosters connections between women members and promotes self-efficacy. The discussion includes etiology of BED and current empirical support for integrating mindfulness skills in treatment for binge eating problems, as well as the author’s clinical experience in formulating a short-term group model. The eight-session semi-structured group format integrates evidence-based treatments in resonance with treatment-based evidence that reflects the distinct clinical needs of women with BED. Clinical vignettes illustrate how the group model can provide an anchoring therapeutic support to women with BED for linking experiences of mind, body, and self.     

Women and agricultural productivity: Reframing the Issues

Should agricultural development programmes target women in order to increase productivity? This article analyzes the challenges in distinguishing women's agricultural productivity from that of men. Most of the literature compares productivity on plots managed by women with those managed by men, ignoring the majority of agricultural households in which men and women are both involved in management and production. The empirical studies which have been carried out provide scant evidence for where the returns to projects may be highest, in terms of who to target. Yet, programmes that do not consider gendered responsibilities, resources and constraints, are unlikely to succeed, either in terms of increasing productivity or benefitting men and women smallholder farmers.     

Older Adults: Work‐Related Issues and Implications for Counseling

In a period of business downsizing, older workers are at risk for unemployment. They often have difficulty finding suitable replacement jobs and frequently face emotional and financial distress. Employers, as well as older workers, may have perceptions and concerns that can create barriers to reemployment. Older workers are a valuable asset in the labor market. Their plight affects society as a whole. Counselors should be aware of work related issues of older workers, career theories and supporting research pertaining to this unique population, and suitable interventions with which to help older adults make smooth career and life transitions.     

A Perspective on Problem Gambling Treatment: Issues and Challenges

Researchers face several challenges in conducting gambling treatment research. These include the impact of monetary incentives to participate, difficulty in subject recruitment, treatment ambivalence, heterogeneity of gambling behaviors among treatment samples, the role of natural recovery, the impact of intractable financial pressures, and the specification of adequate process and outcome measures. Each challenge is defined and potential resolutions suggested.     

Social Support: A Mixed Blessing for Women in Substance Abuse Treatment

Using a personal social network framework, this qualitative study sought to understand how women in substance abuse treatment describe their network members' supportive and unsupportive behaviors related to recovery. Eighty-six women were interviewed from residential and outpatient substance abuse treatment programs. Positive and negative aspects of women's social networks were assessed via open-ended questions. Analysis was guided by grounded theory techniques using three coders. The findings extend classic social support concepts such as emotional, tangible, and informational support. Practice implications are presented in light of the potential roles network members may play in substance use and recovery.     

Paving the Way for A Normal Life: A Qualitative Study of Coping Strategies Among Iranian Divorced Women

Regarding the devastating aftermath of divorce among Iranian divorced women, which is mainly affected by sociocultural factors, this qualitative study was conducted to explore their applied strategies in reorganizing their lives. Data collection started through deep unstructured interviews followed by semistructured interviews with 18 divorced women who were chosen by purposive sampling from mental health clinics, social work centers, or available cases. Gathered data were analyzed using the qualitative content analysis method. Two main themes—behaviors of self-preservation and abstinence and struggling for balance—emerged. Subcategories were concealing the divorce, feminine self-restriction, avoidance behaviors, replacement of losses, seeking support, role development, handling the tensions, and defending oneself against the divorce failure. This study provides comprehensive knowledge of how Iranian divorced women reregulate their lives and also highlights their unique and culture-based coping strategies. Therefore, it provides specialists with a context-specific foundation for mental health care and enables them to intervene more effectively.     

Psychodynamic Issues in the Treatment of Binge Eating: Working with Shame,Secrets, No-Entry,and False Body Defenses

Two clinical moments from patients in treatment for Binge Eating Disorder (DSM 5) are described where a manifest problem with body image difficulty was initially denied. Each patient entered treatment with the desire to lose weight as well as gain a fuller understanding of self and mastery over addictive eating patterns that caused considerable psychological anguish. An integrated treatment matrix of practical, contemporary psychodynamic interventions and more behavioral, experiential and supportive tools allowed each patient to uncover and work through heretofore split off aspects of their bodily selves. Defense mechanisms such as ‘no entry’ fantasies and ‘the false body’ that have recently been described in the analytic literature are applied in formulating each case example. The author underscores how therapists must probe for secrets in the personal and family history that are ‘hidden, but in plain view’ and pursue them in order for the patient to embrace a more coherent, true sense of her/his bodily self. These secrets often contain a less conscious rationale for treating the body poorly and perpetuating hated, shameful and derogatory aspects of body image that may become externalized onto the therapist. These externalizations can further complicate countertransference reactions that must be acknowledged and worked through by the therapist in personal or self-analysis.     

Drunkorexia: Understanding the Co-occurrence of Alcohol Consumption and Eating/Exercise Weight Management Behaviors

Abstract

Objective: Examine the co-occurrence of alcohol consumption, physical activity, and disordered eating behaviors via a drunkorexia perspective. Participants: Nationally representative sample (n = 22,488) of college students completing the Fall 2008 National College Health Assessment. Methods: Hierarchical logistic regression was employed to determine if physical activity and disordered eating behaviors uniquely predicted binge drinking, while controlling for age, race, gender, year in college, Greek membership, and place of residence. Results: Physical activity and disordered eating made unique, statistically significant contributions. Moreover, including physical activity and disordered eating behaviors allowed for the correct classification of an additional 431 cases (ie, binge drinkers) over and above the predictive ability of the covariate-only model. Conclusions: Findings corroborate prior research indicating highly active college students are more likely to binge drink than their nonactive peers, and highlight the potential of a drunkorexia perspective in explaining the counterintuitive alcohol–activity association among college students.     

Children Exposed to Community Violence: Issues for Assessment and Treatment

Community violence is increasingly recognized as a risk factor for serious psychological problems with children particularly vulnerable to its effects. This article summarizes the existing knowledge on the effects of chronic exposure to community violence, highlights essential issues in assessing children for both exposure and resulting trauma from community violence, and provides treatment guidelines for those affected children.     

Psychosocial and Environmental Determinants of Eating Behaviors,Physical Activity,and Weight Change Among College Students: A Qualitative Analysis

Abstract

Objective: The goal of this study was to identify factors that college students perceived as contributing to healthy and unhealthy eating patterns, physical activity (PA) levels, and weight change. Participants: Forty-nine 18- to 22-year-old students at a midwestern university participated. Methods: Six focus groups (3 with each gender) were conducted, and data were analyzed using qualitative software to code and categorize themes and then reduce these to clusters according to commonly practiced methods of qualitative analysis. Results: Eating and PA behaviors appear to be determined by a complex interplay between motivations and self-regulatory skills as well as the unique social and physical environment comprising college life. Moreover, there appear to be gender differences in how these determinants impact behavior. Conclusions: Future research should examine these interactions in the college context in order to further our understanding of potential interventions or environmental modifications that support healthy eating and PA.     

Service Provision for Men with Eating Issues in Australia: An Analysis of Organisations', Practitioners', and Men's Experiences

Abstract

Research was undertaken to explore issues surrounding service provision for men with eating issues in Australia. Qualitative and quantitative data were gathered from key stakeholders—organisations that provide treatment (n=15), practitioners that have worked with men with eating issues (n=10), and individual men with eating issues (n=5). Four key areas were explored: rates of access to services, the expression and development of eating issues in men, factors inhibiting or facilitating the recovery process, and recommendations to improve service provision. Results highlighted the need for increased awareness about men's eating issues within society generally, but for health professionals specifically, the need for better recognition of the expression of eating issues in men, and the expansion of existing services to be more “male friendly”. It is anticipated that service providers will benefit from these findings by identifying ways to reduce barriers and encourage help-seeking behaviour in men. Future research should seek to replicate and expand these findings using a larger sample size.     

Problematic Eating and Food-related Behaviours and Excessive Weight Gain: Why Children in Out-of-home Care Are at Risk

Emerging evidence suggests that abuse and neglect in childhood may play a role in subsequent development of obesity. One population group particularly at risk is children and young people living in out-of-home care (OOHC). Given this population is already a vulnerable group, identifying potential mechanisms by which childhood abuse and neglect increases risk for obesity is essential. A possible explanation is that problematic eating and food-related behaviours (i.e., emotional eating, compulsive eating, overeating, binge eating, stealing or hoarding food) might mediate the association between adverse childhood experiences and obesity. Hence, the overall goal of this paper was to provide a narrative review of eating and food-related difficulties for children in care and their possible association with unhealthy and excessive weight gain. This review revealed a shortage of existing empirical papers and signalled particular need for further examination of the mediating effects of problematic eating.     

Becoming Overweight without Gaining a Pound: Weight Evaluations and the Social Integration of Mexicans in the United States

Mexican women gain weight with increasing duration in the United States. In the United States, body dissatisfaction tends to be associated with depression, disordered eating, and incongruent weight evaluations, particularly among white women and women of higher socioeconomic status. However, it remains unclear how being overweight and obesity are interpreted by Mexican women. Using comparable data of women aged 20–64 from both Mexico (the 2006 Encuesta Nacional de Salud y Nutricion; N = 17,012) and the United States (the 1999–2009 National Health and Nutrition Examination Surveys; N = 8,487), we compare weight status evaluations among Mexican nationals, Mexican immigrants, US‐born Mexicans, US‐born non‐Hispanic whites, and US‐born non‐Hispanic blacks. Logistic regression analyses, which control for demographic and socioeconomic variables and measured body mass index and adjust for the likelihood of migration for Mexican nationals, indicate that the tendency to self‐evaluate as overweight among Mexicans converges with levels among non‐Hispanic whites and diverges from blacks over time in the United States. Overall, the results suggest a US integration process in which Mexican‐American women's less critical self‐evaluations originate in Mexico but fade with time in the United States as they gradually adopt US white norms for thinner body sizes. These results are discussed in light of prior research about social comparison and negative health assimilation.     

Cocaine Abusing Women Who Report Sexual Abuse: Implications for Treatment

ABSTRACT

Four hundred seventy-three substance-abusing women were assessed for histories of sexual abuse. The results of bivariate analysis indicated that Sexual Abuse Survivors (SAS) had higher levels of depression, anxiety, and psychological distress. A greater number of SAS reported histories of emotional and physical abuse. They also had greater severity on ASI scales of alcohol, drug, medical, and family/social difficulty. Logistic regression analysis indicated that women who were survivors of sexual abuse were more likely to have histories of emotional and physical abuse, higher levels of addiction severity, and more family members who used drugs. Implications for research and treatment are discussed.     

Methadone and Menopause: Midlife Women in Drug Treatment

ABSTRACT

As a rising number of midlife women receive methadone treatment, issues related to the menopausal transition take on increased importance. The similarity between many of the symptoms associated with opiate withdrawal, methadone and menopause (hot and cold flashes, sweats, fatigue, decreased libido, menstrual irregularity and insomnia), make it plausible these women and clinical staff attribute menopausal symptoms to other conditions of greater familiarity. The paucity of research, multiplicity of health problems and typically poor access to health care, further complicate the picture and underscore the importance of better integration of health care and social work intervention.     

Electoral Context,Issues, and Voting for Women in the 1990s

Abstract

This research hypothesizes that, because of the particular stimulation provided by the focus on candidate sex and gender-related issues in the electoral environment, there was a unique set of demographic and attitudinal variables related to voting for a woman candidate for the House of Representatives in 1992. Because the environments of the elections of 1994 and 1996 were relatively “gender-free,” these variables were not related to voting behavior in these years. The analysis supports the hypothesis that the determinants of support for women congressional candidates are different in 1992 than in subsequent elections. It also suggests that the differing environments of the three elections may be a contributing factor to these differences.     

Housing Costs in an Oil and Gas Boom Town: Issues for Low-Income Senior Women Living Alone

In resource-based towns that have historically been dominated by young workers and their families, seniors’ housing issues have received little attention by community leaders and senior policymakers. However, since the 1980s there has been a growing trend of older women living alone in Canadian rural and small town places. Although research on rural poverty focuses on small towns in decline, booming resource economies can also produce challenges for low-income senior women living alone due to higher housing costs and the retrenchment of health care and service supports. Because housing costs can consume a significant proportion of household income, low-income senior women living alone may not have the financial resources to cover expenses in a competitive housing market. Using a household survey, we explored this different dimension of the Canadian rural landscape by looking at housing costs for low-income senior women living alone in the booming oil and gas town of Fort St. John, British Columbia, Canada. The authors findings indicate that low-income senior women living alone are incurring higher housing costs compared with other senior groups.