By: Maria Nemec, LCSW, CEDS, Pathways to Peace, Inc.
Anorexia Nervosa is a severe mental illness with a high rate of mortality. Ten years post hospitalization, the mortality rate is 10 times greater than that of an age and gender matched population. Half of all deaths occur within the first 3 years after discharge. Medical complications and suicide are the most common causes of death and the average age at death is 34.
Predictors of mortality include chronicity of illness, critically low body weight, and binging and purging behavior. Impaired judgment and delusional beliefs caused by starvation often result in these patients adamantly resisting treatment efforts.
Despite the severity and risk of the illness, providers are often reluctant to initiate involuntary treatment for patients with anorexia. However, this respect for a patient’s autonomy may lead to a fatal outcome in patients with eating disorders.
Recent legal cases are cited in this article suggesting that the court’s role generally is to decide if the patient meets criteria for commitment including having a serious mental illness, being perceived as gravely disabled, and the potential to bring harm to oneself by not taking in the nutrients necessary to sustain life.  In one case, the court went so far as to order involuntary medications and tube feedings.  However, in most cases, the courts refrained from rulings involving the treatment of anorexia as long as the treatments were believed to be the standard of care.  It is important to note that patients who may resist treatment initially, may later realize they needed treatment all along.
 
Read full article here: http://jaapl.org/content/jaapl/45/4/419.full.pdf
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In a study published in the Journal of Behavior Therapy and Experimental Psychiatry researchers found that controlled exposure to an individual’s own body in a mirror was effective in reducing body dissatisfaction and symptoms in women with bulimia nervosa.
Researchers compared two different controlled exposure techniques to reduce negative thoughts and feelings related to body image. Guided exposure asks participants to observe their bodies in the mirror while describing what they see in an objective manner.  The second method, pure exposure, has participants observe their bodies in the mirror while expressing the thoughts and feelings that come up. All participants received 6 exposure sessions.
The results of this study showed that both techniques were shown to reduce negative thoughts in bulimic women AND increase positive thoughts and cortisol levels over the course of the 6 sessions. However, pure exposure was found to be significantly more effective in improving body satisfaction and reducing overall subjective discomfort with one’s own body.
Sandra Diaz Ferrer, lead author of the paper and University of Granada researcher says the findings suggest that pure exposure “could be an effective therapeutic strategy for reducing body dissatisfaction in people with eating disorders.”
The most surprising finding in this study is that techniques which allow for negative expression of one’s body were more effective than those which guide patients through more neutral descriptions.
To read the full article:
https://brookhavenhospital.com/mirror-exposure-therapy-reduces-body-dissatisfaction-in-women-with-bulimia/  

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