Hidden Eating Disorders: Attachment and Affect Regulation in the Therapeutic Relationship

From the time I began working at a clinic that specialized in therapy with individuals with eating disorders, I have repeatedly encountered cases of clients hiding these symptoms from their therapists. When they finally do reveal the disorder, their therapists often worry that their clients are more disturbed than they thought and that, they, the therapists, did something wrong in the therapy. Although some therapeutic rupture can be part of the picture, I have found that these disclosures often reflect a client’s growing trust in the therapist’s presence and ability to help with feelings that have been, until now, dealt with through the eating behaviors themselves. In my attempts to understand what happens before and after an individual shares a hidden eating disorder with a therapist, I have found ideas from attachment theory, in particular those that explore links between attachment, affect regulation, and self-reflection, to be very helpful. Many authors have noted that eating disorders are related to problems with attachment, loss and separation, and affect regulation. Difficulties in these areas make it hard for clients to be self-reflective or use insight productively. In this article, I discuss my experience with the integration of these dynamics, which I have found to be key to successful psychotherapy with clients who hide their eating disorders.

Revisiting a theory of negotiation: the utility of Markiewicz (2005) proposed six principles

People invited to participate in an evaluation process will inevitably come from a variety of personal backgrounds and hold different views based on their own lived experience. However, evaluators are in a privileged position because they have access to information from a wide range of sources and can play an important role in helping stakeholders to hear and appreciate one another's opinions and ideas. Indeed, in some cases a difference in perspective can be utilised by an evaluator to engage key stakeholders in fruitful discussion that can add value to the evaluation outcome. In other instances the evaluator finds that the task of facilitating positive interaction between multiple stakeholders is just ‘an uphill battle’ and so conflict, rather than consensus, occurs as the evaluation findings emerge and are debated.As noted by Owen [(2006) Program evaluation: Forms and approaches (3rd ed.). St. Leonards, NSW: Allen & Unwin] and other eminent evaluators before him [Fetterman, D. M. (1996). Empowerment evaluation: An introduction to theory and practice. In D. M. Fetterman, S. J. Kaftarian, & A. Wandersman (Eds.), Empowerment evaluation: Knowledge and tools for self-assessment and accountability (pp. 3–46). Thousand Oaks, CA: Sage Publications; Patton, M. Q. (1997). Utilization-focused evaluation (3rd ed.). Thousand Oaks, CA: Sage Publications; Stake, R. A. (1983). Stakeholder influence in the evaluation of cities-in-schools. New Directions for Program Evaluation, 17, 15–30], conflict in an evaluation process is not unexpected. The challenge is for evaluators to facilitate dialogue between people who hold strongly opposing views, with the aim of helping them to achieve a common understanding of the best way forward. However, this does not imply that consensus will be reached [Guba, E. G., & Lincoln, Y. S. (1989). Fourth generation evaluation. Newbury Park, CA: Sage]. What is essential is that the evaluator assists the various stakeholders to recognise and accept their differences and be willing to move on.But the problem is that evaluators are not necessarily equipped with the technical or personal skills required for effective negotiation. In addition, the time and effort that are required to undertake this mediating role are often not sufficiently understood by those who commission a review. With such issues in mind Markiewicz, A. [(2005). A balancing act: Resolving multiple stakeholder interests in program evaluation. Evaluation Journal of Australasia, 4(1–2), 13–21] has proposed six principles upon which to build a case for negotiation to be integrated into the evaluation process. This paper critiques each of these principles in the context of an evaluation undertaken of a youth program. In doing so it challenges the view that stakeholder consensus is always possible if program improvement is to be achieved. This has led to some refinement and further extension of the proposed theory of negotiation that is seen to be instrumental to the role of an evaluator.     

Echoes of the baby boom and bust: Recent and prospective changes in living alone among elderly widows in the united states

Today the great majority of noninstitutionalized elderly widows live alone, a striking increase from a quarter-century ago. A noticeable difference has occurred, however, in trends by age; the proportion of the young-old widows living alone is starting to decline. while that of the old-old continues to increase. We use a model suggested by earlier studies to explain the emergence of this difference, and assess the prospects of its continuing over the next three decades. We find that the recent differential change in the proportions of younger and older widows living alone is due primarily to a differential change in kin availability that has emerged as the baby boomers’ parents have begun to reach retirement age. Over the next decade, the same type of differential change by age in kin availability will continue; living alone is likely to become less common among young-old than among old-old widows, in a reversal of the pattern of the last quarter-century. In the first two decades of the next century, as the baby boom affects kin availability among the old-old, and as the subsequent baby bust affects that among the young-old, the age pattern of living arrangements among elderly widows will reverse once again.     

Environmental Refugees? Classifying Human Migrations Caused by Environmental Change

What distinguishes environmental refugees from other refugees—or other migrants? Are all environmental refugees alike? This essay develops a classification to begin to answer these questions and facilitate future policies and research on environmental refugees. Environmental refugees may have considerable control over the decision to migrate, but this varies by the type of environmental disruption. The origin, intention, and duration of environmental disruptions shape the type of refugee. Refugees from disasters and expropriations have limited control over whether environmental changes will produce migration. Gradual degradation allows “environmental emigrants” to determine how they will respond to environmental change.     

Managing the critical transition from volume to value

Experts say value-based health care delivery truly is the wave of the future. Learn what you need to do to get ready to embrace the change.     

eDiary and Female Sexual Distress Scale(©) in evaluating distress in hypoactive sexual desire disorder (HSDD)

Sex-related distress is integral to the diagnosis of hypoactive sexual desire disorder (HSDD). This article describes the results of three prospective, non-treatment validation studies (two North American and one European), each testing over 200 participants with HSDD, other types of female sexual dysfunction (FSD), or no FSD in which the 12-item Female Sexual Distress Scale(?) (FSDS(?)), the 13-item FSDS-Revised(?)(FSDS-R(?)), and a single question asked using a daily electronic diary (the eDiary For HSDD Trials(?); eDiary) were used to measure sex-related distress. FSDS results with 30- and seven-day recall were equivalent. The results observed with FSDS-R Item 13 (a single question assessing concern due to low sexual desire) were comparable to the FSDS. Mean eDiary monthly distress scores were closer to the minimum possible score (equivalent to "a little bit" of distress) and were about twice as variable as FSDS or FSDS-R Item 13 scores in participants with HSDD. All three measures confirmed that there is more distress in women with HSDD compared to women with no sexual dysfunction at all time points, demonstrating discriminant validity.     

Specifying links between infants' theory of mind,associative learning,and selective trust

The psychological mechanisms underlying infants' selective social learning are currently a subject of controversy. The main goal of the present study was to contribute data to this debate by investigating whether domain-specific or domain-general abilities guide infants' selectivity. Eighteen-month-olds observed a reliable and an unreliable speaker, and then completed a forced-choice word learning paradigm, two theory of mind tasks, and an associative learning task. Results revealed that infants showed sensitivity to the verbal competence of the speaker. Additionally, infants with superior knowledge inference abilities were less likely to learn from the unreliable speaker. No link was observed between selective social learning and associative learning skills. These results replicate and extend previous findings demonstrating that socio-cognitive abilities are linked to infants' selective social learning.     

Changing Signs: The Political Pragmatism of Poststructuralism

In a recent issue of The New Republic, Martha Nussbaum singled out Judith Butler for a particularly venomous attack. Nussbaum's criticism was very simple: good theory leads to practical political action, and Butler's theories do not. Nussbaum's criticism of Butler echoes a general criticism leveled against the emerging field of queer theory. Many advocates of sexual rights have suggested that poststructuralist approaches do not have practical political application. In this essay, the authors argue that Butler's work points to a new political pragmatism. In the past, many advocates of sexual rights have focused on essentialized notions of sexual identity. A politically pragmatic approach, informed by Butler's theories, can shift the debate so that the issue of homophobic discrimination, rather than sexual identity, becomes a primary focus of the sexual rights movement.