Toward a More Optimal Selfobject Milieu: Family Psychotherapy from the Perspective of Self Psychology

This paper applies the theory of self psychology to the understanding and treatment of families. The healthy family is viewed as a reliable source of selfobject experience for its members, while problems in or between family members are seen as due to a lack of adequate selfobject experience for one or more members. Causes of selfobject failures or misattunements in the family are examined, with an emphasis on the influence of previous relational experiences on current needs, capacities, and experiences of others. Curative factors in this form of family therapy are then outlined, and a treatment approach designed to help family members become better able to provide empathically attuned responses to each other is described, with a case example used to illustrate key points.     

Cultural Factors in Collegiate Eating Disorder Pathology: When Family Culture Clashes With Individual Culture

Objective: The authors evaluated the validity of familial enmeshment (extreme proximity in family relationships) as a risk factor for eating disorders across cultural value orientations. They tested the hypothesis that although familial enmeshment may be a risk factor for eating disorder pathology for (1) participants of non-Asian descent or (2) culturally independent participants, enmeshment will not be a risk factor for (1) participants of Asian descent or (2) culturally interdependent participants. Participants: 255 undergraduate women participated. Methods: Participants completed questionnaires on cultural value orientations, enmeshment, and eating disorder pathology. Results: As hypothesized, enmeshment was related to eating disorder pathology in non-Asian American and culturally independent participants, but not in Asian American and culturally interdependent participants. Conclusions: Depending on cultural values, enmeshment may or may not be a risk factor for eating disorders. This study highlights the importance of examining risk factors in the appropriate cultural framework when considering college student mental health.     

College Women Eating Disorder Diagnostic Profile and DSM-5

Abstract

A consistent diagnostic profile describing college women with eating disorders has been well established in the college health and mental health literature. This diagnostic framework traditionally has been associated with the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision¹ Eating Disorders Not Otherwise Specified category. In this article, the authors discuss implications of the recently revised Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition² eating disorder diagnostic categories for the existing college women eating disorder profile.     

The Relationship Between Family Mealtime Interactions and Eating Disorder in Childhood and Adolescence: A Systematic Review

During childhood and adolescence, family meal frequency has been found to have an inverse relationship with disordered eating behaviour. Also, family interactional patterns differ in families where there is a child with and without an eating disorder. This paper examines the relationship between family mealtime interactions during childhood and adolescence and eating disorder behaviour through a systematic review of the literature. The method was an asystematic electronic search of PsycInfo, Medline and Web of Knowledge undertaken in April 2012. Ten studies demonstrated a significant relationship between family mealtime interactions and disordered eating behaviour. Families where there is a child with an eating disorder display less positive interactions during mealtimes. While the findings can be linked to family based treatment for anorexia nervosa there is a need for prospective research in this area.     

Eating Disorder Symptoms Among College Students: Prevalence,Persistence, Correlates,and Treatment-Seeking

Abstract

Objective: To examine the prevalence, correlates, persistence, and treatment-seeking related to symptoms of eating disorders (EDs) in a random sample of college students. Participants: A random sample of students at a large university were recruited for an Internet survey in Fall 2005 and a follow-up survey in Fall 2007. Methods: ED symptoms were measured using the SCOFF screen and adjusted for nonresponse using administrative data and a nonresponse survey. Results: 2,822 (56%) students completed the baseline survey. Among undergraduates the prevalence of positive screens was 13.5% for women and 3.6% for men. Among students with positive screens, 20% had received past-year mental health treatment. In the follow-up sample (N = 753), ED symptoms at baseline significantly predicted symptoms 2 years later. Conclusions: Symptoms of EDs were prevalent and persistent among college students in this study. These findings suggest that brief screens can identify a large number of students with untreated EDs.     

Eating Disorders and Body Image of Undergraduate Men

Eating disorders and body dissatisfaction among undergraduate men are less documented and researched than are eating disorders and body dissatisfaction among undergraduate women. Objective and Participants: In this study, the authors examined these issues in undergraduate men to identify similarities and differences between this population and undergraduate women. Methods: In a random sample of undergraduates, the authors categorized respondents by gender and by presence or absence of an eating disorder. The authors compared undergraduate men with an eating disorder with (1) undergraduate women with an eating disorder and (2) undergraduate men without an eating disorder. Results: The patterns of responses suggest that undergraduate men with an eating disorder are preoccupied with body shape and tone but not necessarily with losing weight. Conclusions: The authors discuss implications for future prevention as well as clinical and research efforts based on male symptoms within the diagnostic category of bulimia nervosa and eating disorder, not otherwise specified.     

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.     

Family Experience of Borderline Personality Disorder

Individuals with borderline personality disorder (BPD) struggle with unbearable emotions that arise out of interpersonal difficulties. Self‐harm and suicidal behaviours serve to regulate these emotions and to gain a sense of well‐being and control in a treatment context where hospital admissions are avoided by mental health services. Clinician engagement with families may be constrained by their knowing the accepted etiology of the disorder, which includes a causal link with the family environment. Other constraining factors include the negativity of those with BPD toward their family, and their clinicians' diagnostic uncertainty or confusion. This qualitative study explored the experience of families whose close relative with BPD has a long history of self‐harm and/or suicide attempts. Family members were found to have chronic and traumatic stress. Family roles and relationships were strained, as were relationships between the family and the mental health system. The findings of this study indicate that treatment for BPD needs to adopt a systemic approach that considers individuals and their significant family relationships, as well as relationships between the family and treatment providers.     

Kernberg Versus Kohut: A (Case) Study in Contrasts

In this paper, the main concepts of Otto Kernberg and Heinz Kohut—two theorists who have greatly influenced clinical social work practice with severely disturbed patients—are presented, and then compared by using a case from the practice of the author. The case illustrates the value of utilizing some of the treatment principles put forward by Kernberg and Kohut without becoming too wedded to either of the overall treatment approaches they have formulated. Some aspects of the manner in which the practitioner determines when the treatment approach needs to be modified—to avoid the pitfalls of either being too wedded to an approach or too eclectic—are discussed as well.     

Female Collegiate Athletes: Prevalence of Eating Disorders and Disordered Eating Behaviors

Objective: The authors assessed the prevalence of pathogenic eating and weight-control behaviors among female college athletes, using a psychometrically valid measure. Participants: Participants were 204 college athletes (M age = 20.16 years, SD = 1.31 years) from 17 sports at 3 universities. On average, they participated in their sport for 10.88 years (SD = 16.68 years) and on their college team for 2.10 years (SD = 1.03 years). Methods: Participants completed a demographic and weight background questionnaire, Questionnaire for Eating Disorder Diagnoses, and the Bulimia Test-Revised. Results: The authors classified participants as eating disordered (n = 4, 2.0%), symptomatic (n = 52, 25.5%), and asymptomatic (n = 148, 72.5%). Few participants engaged in binge eating; most used exercise, as opposed to vomiting, dieting, laxatives, or diuretics, to control their weight. Conclusions: Female athletes suffer from eating disorders, and most experience symptom levels that are subclinical but problematic.     

The Making of Multiple Personality Disorder: A Social Constructionist View

This article explores the social construction of multiple personality disorder by analyzing professional agreements about the nature of the diagnosis, while locating these within their historical and cultural context. First, a historical review of the disorder traces various overlapping streams of discourse that have shaped the construction of the diagnosis. This is followed by a cross-cultural comparison of MPD and dissociative phenomena in several non-Western societies. The article concludes with some reflections on the cultural meanings of MPD in contemporary America.     

Symptoms of Eating Disorders Among Females in Drug Addiction Treatment

The aim of this study is to measure and describe symptoms of eating disorders among females in treatment for drug addiction in Norway. Previous clinical and epidemiological studies have revealed coprevalence between eating disorders and substance use or abuse. However, few studies have measured eating disorders in drug-using samples and even fewer within the context of drug treatment. In this study, 29 females with drug use disorder in residential treatment were tested with the Eating Disorder Inventory–2. A subgroup of 9 females (31%) with significant symptoms of eating disorders was identified. The characteristics of this group and possible clinical consequences are discussed.     

The Eating Disorders NOS Diagnostic Profile Among College Women

Abstract

The authors examined a proposed profile of eating-related behaviors, associated features, developmental issues, and help-seeking behavior among college women, using an eating disorder response program. The most common symptom scenario was a pattern of regular binge eating, together with daily exercise and occasional purging. The most common associated features were distressing or dysfunctional overconcern about body image and self-esteem, usually with day-to-day stress and intermittent depression. The women who fit this pattern also presented developmental issues of perfectionism, conflictual relationships with parents, and struggles for independence; and they tended to be ambivalent about seeking services. Implications for practice, including the need to develop a framework for eating disorder responses on campus that includes preventive programs and developmental interventions to target emerging and moderate concerns are discussed; limitations and the preliminary nature of the findings are explicated.     

The Critical Shapes of Body Image: The Role of Culture and Family in the Production of Eating Disorders

Although research has pointed to the influence of culture and family in the etiology of eating disorders, few studies have examined how these influences conjoin in this process. This research explores how the family mediates cultural ideas about thinness and how the family conveys these messages to family members. Using a grounded theory approach, open‐ended interviews were conducted with 32 White, middle‐class women (with and without eating disorders) on the topic of body image and eating problems. In conjunction with this method, qualitative comparative analysis (QCA) was also performed to identify family characteristics, and their specific combinations, that were associated with eating disorders. The findings indicate that a critical family environment, coercive parental control, and a dominating discourse on weight in the household are salient conditions, and their specific configurations are discussed in relationship to current theoretical conceptualizations regarding the influences of culture and family in the production of eating disorders.     

A Brief Treatment with a Posttraumatic Stress Disordered Patient—A Self Psychological Perspective

Treatment of posttraumatic stress disordered patients has focused predominantly on symptom removal. The assumption is that once the symptoms of stress are alleviated, the individual can return to a previous level of functioning. This focus overlooks the psychological importance of the unique and permanent effects that traumatic stress can have on the way individuals experience themselves and the world. This brief paper contributes to an understanding of the importance of psychoanalytic treatment in helping a patient understand her longstanding need for preoccupation with thoughts of destruction and how this need prolonged her thinking about the 9/11 tragedy. As her understanding proceeded, the patient’s preoccupation with the suicide attacks diminished as did her negative preoccupations in general.     

The Extramarital Affair: A Language of Yearning and Loss

This paper presents an extramarital relationship as an experience of self-enhancement, not of pathological conflict. It will suggest that the simultaneous relationship with the lover AND an empathically attuned therapist can be healing for the patient. It is seen as often an opportunity for essential developmental needs to be fulfilled when damaging failures in the bond between child and caretaker have restricted the vitalizing atmosphere of mutual influence that results in unrecognized subjectivity. Rather than viewed as a reality-escaping midlife enactment, these relationships can be better thought of as efforts to revisit the traumatic experiences that have created the organizing patterns that have limited a patient's self-development. An extramarital affair is often about yearning and loss and the freedom to enact one's own desire.     

The Selfobject in the Age of Technology

The author considers self-psychology concepts including the selfobject and influences on self-esteem in the observation and exploration of the significance patients assigned to their cellular telephones, computers, and other electronic communication devices. The intrusion of these devices in sessions and their presence in the patients lives is explored.     

Attention-Deficit/Hyperactivity Disorder in Community College Students

Abstract

Attention-Deficit/Hyperactivity Disorder (ADHD) is often unrecognized and infrequently treated in community college students. Since students with disabilities including ADHD are more likely to attend a 2-year rather than a 4-year college and to drop out before graduating, this article describes current conceptualizations of adult ADHD for community college social workers, psychologists, faculty, counselors, and staff. It presents counseling and educational interventions, which can result in greater academic success and an increase in self-esteem for individual students, as well as an increase in retention rates for the college.     

Patterns of Compensatory Behaviors and Disordered Eating in College Students

Abstract. Objective: The current study investigated rates of endorsement of eating-related compensatory behaviors within a college sample. Participants: This sample included male and female students (N = 1,158). Methods: Participants completed the Eating Disorder Examination Questionnaire (EDE-Q). The study defined 3 groups of students: those who did not endorse purging behaviors, those who endorsed only exercise, and those who endorsed laxative use or vomiting. Rates of related eating disorder risk variables were compared across the 3 groups. Results: Almost half of college students reported utilizing exercise as a compensatory strategy over the past 28 days. Those reporting compensatory exercise did not differ from other community and college samples on EDE-Q subscales. Conclusions: Findings suggest that college students report significant rates of compensatory exercise, and those who report exercise as their only compensatory behavior also report relatively low levels of eating disorder risk.