Academic journal article Journal of Cognitive Psychotherapy

Treating Anorexia Nervosa in the Couple Context

Academic journal article Journal of Cognitive Psychotherapy

Treating Anorexia Nervosa in the Couple Context

Article excerpt

Anorexia nervosa is a serious mental illness that affects women and men of all ages. Despite the gravity of its chronic morbidity, risk of premature death, and societal burden, the evidence base for its treatment-especially in adults-is weak. Guided by the finding that family-based interventions confer benefit in the treatment of anorexia nervosa in adolescents, we developed a cognitive-behavioral couple-based intervention for adults with anorexia nervosa who are in committed relationships that engages both the patient and her or his partner in the treatment process. This article describes the theoretical rationale behind the development of Uniting Couples (in the treatment of) Anorexia nervosa (UCAN), practical considerations in delivering the intervention, and includes reflections from the developers on the challenges of working with couples in which one member suffers from anorexia nervosa. Finally, we discuss future applications of a couple-based approach to the treatment of adults with eating disorders.

Keywords: eating disorders; anorexia nervosa; couple therapy; psychotherapy; cognitive-behavioral

Anorexia nervosa (AN) is a serious and perplexing psychiatric disorder that strikes females and males of all ages. Briefly, AN is marked by low body weight, fear of weight gain, and disturbance in the way in which one's body size is perceived, denial of illness, or undue influence of weight on self-evaluation. Demographic trends in AN are changing. No longer just the province of young females, women and men of all ages are presenting with the disorder and posing new treatment challenges as the impact of AN on families and partners varies depending on the age and interpersonal situation of the patient.

Family members and partners are deeply challenged to understand how their loved one can starve before their eyes. Complicated by high comorbidity (Fernandez-Aranda et al., 2007; Godart, Flament, Perdereau, & Jeammet, 2002; Halmi et al., 1991; Kaplan, 1993; Katzman, 2005; Kaye, Bulik, Thornton, Barbarich, & Masters, 2004; Sharp & Freeman, 1993), around 25% of individuals with AN develop a chronic, relapsing course (Berkman, Lohr, & Bulik, 2007). It is rarely appreciated that AN ranks among the 10 leading causes of disability in young women (Mathers, Vos, Stevenson, & Begg, 2000), and has the highest mortality rate of any psychiatric disorder (Birmingham, Su, Hlynsky, Goldner, & Gao, 2005; Millar et al., 2005; Papadopoulos, Ekbom, Brandt, & Ekselius, 2009; Sullivan, 1995; Zipfel, Löwe, Reas, Deter, & Herzog, 2000). Individuals with AN are 57 times more likely to commit suicide than individuals in the general population (Keel et al., 2003).

These statistics allow one to envision the devastating and often long-term effect that AN can have on families and partners. AN is associated with considerable and prolonged caregiver stress. People with AN become more dependent on their families and partners, both financially and emotionally, as AN is associated with loss of employment or underemployment and social isolation because of weight loss, malnourishment, and high treatment utilization (Treasure et al., 2001). Caregiving for AN is reported to be more stressful than for bulimia nervosa (Santonastaso, Saccon, & Favaro, 1997) and schizophrenia (Treasure et al.). Disorder specific factors, including managing difficult eating behaviors such as refusal to eat and purging, dependency of the patient on the caregiver, relapse, chronicity, secrecy, stigma, and cost of treatment, are particularly challenging for families and partners (Santonastaso et al., 1997; Treasure et al., 2001; Treasure, Whitaker, Todd, & Whitney, 2011; Whitney et al., 2005). Partners report an array of emotional responses to dealing with a loved one with AN including anger, grief, shame, anxiety, depression, and guilt.

Again defying stereotypes, individuals with AN enter into committed relationships at rates comparable to healthy peers (Maxwell et al. …

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