Develop a taxonomy” of DSIA document. A taxonomy is a way of org.docx

Develop a “taxonomy” of DS/IA document. A taxonomy is a
way of organizing something on a “group within group” basis.
(Remember how the biological taxonomy is structured.)
Initially, define data security and information assurance.
Secondly, develop an outline of the major “elements” within the
discipline of DS/IA.
The paper should be of “significant depth,” suitable for a
graduate program; that is, the paper should be approximately 5
pages in length. The paper should be free from spelling and
grammatical errors.
Additional background: In this taxonomy document you will be
outlining and giving an “abstract” of DS/IA. Imagine you need
to give a meaningful overview of DS/IA to someone unfamiliar
with the field. The taxonomy allows you to “group” major
aspects of DS/IA and present it in a meaningful way. Remember
the grand idea of abstraction. In this document you will simplify
the complex field of DS/IA into a few pages of information.
For family therapy:
After reviewing the assigned material for eating disorders,
choose one specific diagnosis from the presented descriptions
and conduct additional research pertaining to this diagnosis.
Please note that a specific diagnosis, such as eating disorders,
should be focused on. You will have to locate at least five
additional peer-reviewed articles pertaining to the chosen
diagnosis, including existing conceptualization and treatment
options for this mental health condition. Within these five
articles, issues of diversity must be considered. For example,
you may include research articles that are diverse according to
the sample used (age, race, etc.), or you may find theoretical
pieces that discuss diverse viewpoints related to your chosen

diagnosis. After reading the articles, create an annotated
bibliography of these five articles.
Start the annotation by giving the full reference for the article
using APA formatting. Then write a brief synopsis of the
literature in your own words that highlights the most relevant
“take home” points. Essentially, each annotation should address
the following: 1) a brief synopsis of the content of the given
resource and 2) a statement of the relevance of the given
resource within your topic of study.
In other words, your annotations should state, for each resource,
what it says and why it is relevant to your intended
topic/research. The finished annotation should serve as a
detailed overview of the literature that reduces your need to go
back and re-read the entire article or chapter later.
Summarize the article in a paragraph by including the
following:
If the article is a research study it should include the purpose of
the study, sample and method of the study, and key results of
the study.
If the article is a literature review or theoretical piece, aim to
highlight three to four of the most significant “take home”
points.
Do not use direct quotes—the annotation should be written in
your own words. You do not need to use in-text (parenthetical)
citations in your paragraph because it is assumed that
everything is from the named reference. Your annotated
bibliography does not need to be lengthy, but it does need to be
informative and useful.
Length: 2-3 pages

Guest Authored by Margo Maine, Ph.D.
Volume 1 Issue 6 November 1999
A supplement to the Family Therapy News
The American Association for Marriage and Family Therapy
Eating Disorders
CLINICAL UPDATE
Contents:
2...Diagnosis & Assessment
3...Terminology
4...Treatment Options
5...BioMedical Issues
6...Professional Resources
7...Sample Consumer Update
8...Collaborating With Other
Professionals
In the past quarter century, eating disorders
have become a major public health problem in

the United States, Canada, and other
Western nations. According to conserva-
tive estimates, .5 percent of adolescent
and young adult women meet the criteria
for anorexia nervosa, and 5 percent for
bulimia. Incidence rates are considerably
higher in subgroups of the performing arts
and athletics, where weight and body
shape are overemphasized. In the past
decade, subclinical or partial-syndrome
eating disorders have increased dramati-
cally and incidence patterns have
changed. Earlier, Caucasian females from high-
er socioeconomic levels were most at risk.
Today, eating disorders are homogenized
throughout classes, races, ethnicities, and
subcultures. Prepubescent children, adults,
women, and men living in non-Western coun-

tries such as the Far East, South America, and
Eastern Europe are developing these problems.
Unfortunately, eating disorders have rapidly
become a global concern.
The treatment of eating disorders is a serious
undertaking. Eating disorders have the highest
morbidity and mortality rates of all psychiatric
disorders. The mortality rate ranges from 5 to
10 percent, including both physical causes and
suicide. Estimates are that approximately one
third of clients with eating disorders will fully
recover. Another third will recover with some
residuals, such as an overemphasis on weight,
exercise, and eating, or periods of relapse.
Finally, one third will remain chronically ill.
The importance of families in the etiology and
treatment of eating disorders has been recog-
nized since their earliest clinical descriptions in

the 1800s. Since then, a considerable body of
knowledge has developed, stimulated by Mara
Selvini Palazzoli, Salvador Minuchin, and many
others. The American Psychiatric Association
(1993) practice guidelines for eating disorders
suggest that family therapy be mandatory for
younger patients and urges marital therapy for
adults. Thus, MFTs have an important role in
the treatment of eating disorders.
The current clinical climate driven by
cost containment, however, is focused on
brief, individual, and fragmented treatment.
Similarly, the majority of clinical research
emphasizes individual prescriptive treatment
like cognitive-behavioral therapy, and psy-
chotropic medication. Research on family
therapy or on multimodal therapy, including
various approaches in a comprehensive

package, is rare today because of the
inherent complications and costs. Although
more clinical and research emphasis is
placed on individual techniques and models,
in the trenches of specialized treatment
programs, family therapy abounds.ν
Review of the Prevalence of Eating Disorders in
Adolescent and Adult Women in the United States1
1Adapted from Shisslak, C. M., Crago, M., & Estes, L. M.
(1995). The spectrum
of eating disorders. International Journal of Eating Disorders,
18(3), 209-19.
The Gap In Treatment
Page 1 of 7CLUP11999_6_11
10/6/2010mhtml:http://admin.ncu.edu/syllabus/download_file.as
p?syllabus_rr_id=121761
2
bulimic symptoms during the course of the
illness. Trying to control bulimia, for exam-

ple, an individual may severely restrict her
or his eating. Or an anorexic may purge to
deal with distress about eating.
Before the MFT diagnoses an eating
disorder, medical causes for the behaviors
should be ruled out. Many illnesses can
cause some of the symptoms of anorexia,
including brain tumors, hyperthyroidism,
diabetes mellitus, Crohn's disease, celiac
disease, malabsorption disorders, ulcerative
colitis, tuberculosis, AIDS, cancer, medica-
tion-related side effects, or amphetamine
abuse. The differential diagnoses related
to bulimia include tumors, hepatitis, pancre-
atitis, pregnancy, peptic ulcer, viral
About the Author
Eating disorders are determined by multiple
factors. These include individual personality

traits, physiological predispositions, family
patterns, critical experiences such as loss
or abuse, the sociocultural influences of
gender roles, and the meanings ascribed
to food, weight, and appearance. The family
is a factor that mediates all others. Eating
disorders also reflect and coincide with
developmental stressors. Anorexia is most
likely to emerge in adolescence, with an
average age of onset at 17 and bimodal
peaks at 14 and 18. At 14, adolescents are
beginning to deal with a changing sexual
body while meeting increased social, acad-
emic, and interpersonal demands. They are
pressured to separate more from the family
and define themselves individually. Many
adopt the prevailing cultural attitudes that
emphasize the value of lean, fit bodies,

dieting, and appearance, leading teens to
agonize more and like their bodies less. At
18, stress can intensify with the need to
make decisions about the future and leave
the family home. Bulimia, usually emerging
between adolescence and age 25, is also
linked to these developmental passages.
Although still disproportionately a female
condition, the incidence of eating disorders
in men has risen from one out of twenty
cases to one out of twelve. The factors
contributing to eating disorders are similar
in men and women, though most cases in
men begin as exercise abuse. The increase
in men is due to many factors, in addition to
greater awareness of the disorder. Based
on messages from cultural images and the
media, and the pressures of a demanding

job market, men may try to achieve the cul-
tural ideal of physical attractiveness as a
sign of competence and success. With the
transformation of gender roles and the
progress of feminism, old definitions of mas-
culinity no longer fit. The pursuit of the ideal
body type answers the confusing questions
about what it means to be a man or a
woman today.
The DSM-IV (1994) identifies three types
of eating disorders. In anorexia nervosa
(DSM-IV 307.1), characterized by a refusal
to maintain a normal weight, individuals
either fail to gain weight during puberty or
lose weight, weighing 15 percent less than
expected for height and age. Some weigh
even less. Despite this, they are terrified of
gaining weight, feel fat, and deny any relat-

ed problems. Females stop menstruating. In
the restricting type, people rigorously limit
their food intake. In the purging type, they
may also binge and purge by vomiting and
exercising, or by using laxatives, diuretics,
enemas, or other pathogenic weight control
techniques.
In bulimia nervosa (DSM-IV 307.51), people
experience a lack of control over their eating
and consume excessive food. Purging fol-
lows. Like anorexia, bulimia is characterized
by preoccupation with weight and shape,
and having a negative self-image. Most
often a secret, it causes great guilt, shame,
and self-loathing. In the purging type, peo-
ple regularly use vomiting or medications
to get rid of what they ingested. In the non-
purging type, they use fasting or exercise.

The term eating disorders not otherwise
specified or “EDNOS” (DSM-IV 307.50)
applies when individuals meet some but
not all of the criteria for anorexia or bulimia.
For example, women may be anorexic but
still have periods, may have lost a significant
amount of weight but are still in the normal
range, or may purge without bingeing or
binge without purging. The common ground
between these disorders is a fragile identity
and excessive self-doubt that are focused
on the body. Many, about 40 percent, will
move back and forth between anorexic and
Margo Maine, Ph.D., is a clinical psy-
chologist and family therapist who
has specialized in the treatment of
eating disorders for 20 years. She
serves as the director of eating dis-

orders at the Institute of Living in
Hartford, Connecticut. Author of
Father Hunger: Fathers, Daughters,
and Food and recently Body Wars:
Making Peace With Women's Bodies,
she is a senior editor of Eating
Disorders: The Journal of Treatment
and Prevention. Maine is an Affiliate
Member of AAMFT, and a board
member and past president of the
organization Eating Disorders
Awareness and Prevention, Inc.
The Clinical Update is published bi-monthly by
the American Association for Marriage and Family
Therapy Research and Education Foundation
(1133 Fifteenth St., NW, Suite 300, Washington,
DC 20005-2710).
To order issues, contact: AAMFT (202) 452-0109

For reprinting and duplication information, con-
tact: Professional Development Administrator
(202) 452-0109.
© Copyright 1999 by the AAMFT. All rights
reserved. Printed in the USA. No part of this
publication may be reproduced, stored in a
retrieval system, or transmitted, in any form
or by any means, electronic, mechanical,
photocopying, recording, or otherwise, with-
out the prior written permission of the publisher.
Diagnosis & Assessment
or bacterial infections, certain cancers, and body dissatisfaction.
These tools should
3
Below are definitions of words that are not defined elsewhere in

this issue.
Lanugo: A layer of fine downy hair that covers the body in an
attempt to keep the
body warm.
Hypometabolic: A state that occurs when the body slows down
or stops processes
that are not essential to human life so the body can preserve
energy.
Bradycardia: A slow heart rate.
tuberculosis, toxic medications, and dia-
betes. Several medical illnesses frequently
coexist with eating disorders, including dia-
betes, cystic fibrosis, tuberculosis, inflam-
matory bowel disease, and thyroid disor-
ders. By manipulating their medications,
eating disordered individuals with these
conditions can easily lose weight. Mental
health clinicians should understand the
medical ramifications of these problems
and work closely with medical providers.

Eating disorders also frequently co-occur
with depressive disorders, anxiety, obses-
sive-compulsive disorder, posttraumatic
stress disorder, personality disorders,
and less frequently, psychotic disorders.
As many as 50 percent of bulimics suffer
chemical dependence, and 40 to 50 per-
cent of women with eating disorders have a
history of sexual trauma. Eating disordered
behaviors help the person set boundaries,
develop a false sense of control, express
complicated emotions, and cope with a
desire to punish themselves or fade away.
With less research available for men, the
incidence of sexual abuse is unclear but
quite likely.
Because of the profound impact of starva-
tion on mood, ability to regulate affect,

thought patterns, problem solving, con-
centration, and attention, the clinician
needs to determine if such problems are
separate diagnostic issues or are due to
the eating disorder.
Due to limited professional knowledge
and a culturally shared preoccupation with
appearance and weight control, anorexia is
often not diagnosed until two to three years
after symptoms have appeared. Likewise,
bulimia often goes unnoticed for as long
as five years. By the time many people are
diagnosed, the disorder has taken hold and
become both a way of life and an identity.
Generally, it is easier to diagnose anorexia
due to the obvious weight loss. Although
bulimics are literally starving and nutritional-
ly depleted, they may maintain a weight

at or above normal due to hypometabolism
secondary to starvation, and are not
determined to be at risk physically. In
anorexia, the body adjusts slowly to the
depletion of fat, muscle, and eventually
organs, so it continuously readjusts and can
withstand years of starvation. In contrast,
bulimics' dramatic fluctuations of input and
output place their bodies in chemical chaos.
Unfortunately, less is known about the long-
term outcome of bulimia. Even estimates of
the mortality rate associated with eating dis-
orders are limited because the cause of
death is listed as the physical symptom,
such as cardiac arrest, kidney failure, or
esophageal bleed, rather than the eating
disorder itself.
Assessment. A number of self-report ques-

tionnaires are available for the assessment
of eating disorders. Most used are the
Eating Attitudes Test (EAT) (Garner,
Garfinkel, Olmstead, & Bohr, 1982), the
abbreviated version EAT-26, the Eating
Disorder Inventory (EDI), and the EDI-2
(Garner, 1991), which measure a variety of
attitudes and behaviors contributing to eat-
ing disorders. These instruments assess
the severity of the illness and can reflect
improvement during treatment. They may
provide helpful prognostic information by
assessing variables like drive for thinness
not be used alone because they do not
address underlying issues, contributing
dynamics, or interpersonal and family rela-
tionships. They are limited by self-report,
and cannot necessarily provide the history,

impact, and severity of the symptoms.
The Eating Disorders Examination (EDE)
(Fairburn & Cooper, 1993) is a well-
researched structured interview, but also
limits its scope to dimensions related to
eating and weight rather than to systemic
or family issues.
A comprehensive assessment to evaluate
the acuity and type of care required should
include an exploration of the following
areas: contact with the primary care
physician to rule out a medical cause and
to assess the physiological impact of the
eating disorders; history, duration, and fre-
quency of symptoms; physical complaints;
co-existing medical problems; mental
status; occupational, vocational, and educa-
tional status; suicidal ideation or other risk to

self or others; stresses contributing to the
illness; history of abuse or neglect; family
history of chemical dependence and
psychiatric illness; availability of a support
system or other resources; current relation-
ship to family; family's attitudes toward food,
weight, and appearance; previous treatment
and response; motivation; family willingness
to participate or support treatment; and
strengths and goals for treatment. The MFT
should also assess the role of food, appear-
ance, weight, dieting, and exercise in this
family. What are the customs, rituals, duties,
and meanings of mealtime? What are meals
like? How has the eating disorder affected
their meals? What are the health and exer-
cise habits of others family members? Have
people dieted frequently? ν

Terminology
Treatment Options characterized by anorexia is a perfect
metaphor. In contrast, the bulimic family
is apt to be more open to admitting prob-
4
Family Patterns. A family member's eat-
ing disorder can be particularly terrifying
to other family members because it often
seems to be a willful or intentional behav-
ior. Common family patterns seem to
reappear for both men and women with
eating disorders. In adult clients, unre-
solved family dynamics will play out with
significant others and, untreated, will
serve to maintain the symptoms. Eating

disordered individuals have usually
played a very central role in the family,
often as the caretaker of others. In this
adultified, parentified, other-directed
script, they are unable to focus on their
own feelings and needs, even for food.
The families of those with eating disor-
ders often have similarities. Fathers tend
to be disengaged and emotionally
unavailable. Mothers tend to be either
over- or underinvolved, and the sibling
subsystem is often underdeveloped.
These families have difficulty communi-
cating and managing conflict directly,
so food and weight become the lan-
guage. Marital conflicts often exist or, in
separated or divorced families, persist
but are not addressed. The identified

client becomes the peacemaker, pal,
or confidant to one or both parents.
Typically, the anorexic family is constrict-
ed emotionally and there are unspoken
rules that family members are not to
identify conflicts or flaws. The denial
lems but never resolves them. The eating
disorder instills order amidst this chaos.
The task of treatment is to deal with con-
flicts directly so that no one has to be ill.
The parenting style of eating disordered
families tends to extremes: either
enmeshed and overprotective, or chaotic
and underinvolved. The eating disordered
individual responds by either feeling guilty
and frightened of separating and individu-
ating, or by feeling overwhelmed by dis-
connection and loneliness. The symptoms

allow some separation while simultane-
ously asking for closeness, comfort,
and care. The MFT's task is to help
clients see how the eating disorder
functions to solve these problems, and
to reorganize relationships to end such
desperate measures.
When families are either unavailable
or resistant to family therapy, individual
therapy with a systemically informed
therapist can help the client understand
the family context of the eating disorder.
This will help the client overcome the
shame, isolation, and feelings of inade-
quacy that accompany the symptoms.
A client can understand how the eating
disorder makes sense as a response to
other family issues.

Phases In Treatment. After meeting and
evaluating the client and family, it is useful
to develop a contract with them that out-
lines an explicit treatment plan. Include
the family's input to set shared goals and
define expectations. At the outset, the
client's physical and psychological safety
must be assured. Contact with the other
professionals involved is time consuming
but essential. The MFT must know the
issues, experiences, and needs being
discussed in individual therapy to guide
the pace and tone of family sessions.
The MFT must also be certain that med-
ical providers and dietitians are oversee-
ing the physical status and health restora-
tion. By communicating well with other
professionals, the MFT models important

behaviors: the value and necessity of
relationships, listening to others, and
jointly solving problems.
Initially, family or marital therapy must
be problem-focused. The symptoms and
potential long-term side effects of eating
disorders are frightening and, without
proper guidance, family members may
be overcontrolling, underreactive, or
rejecting. At this point, psychoeducation
is critical. Reading materials, a session
devoted to a discussion of the illness
process, a meeting with the dietitian,
or referrals to a family support group
can help (see the Consumer Update for
suggested resources). The next step is
to define who is responsible for what.
By clarifying what medical and nutritional

monitoring and interventions are in
place, the MFT assures safety so the
family can stop intruding. Clarify what
help the client needs from the family.
Discuss who grocery shops, what foods
must be available, who prepares food,
whether the client should eat alone or
with others, and how to talk about these
issues outside of sessions. Another fac-
tor to discuss is the kind of support the
eating disordered person needs after
eating, since anxiety and desires to
purge usually increase at that time.
Be sure that both parents have a role
in these tasks. Too often, fathers are
excused and mothers feel overly
burdened and alone.
This attention begins to reorganize

the roles and relationships. The eating
disordered individual needs to be
responsible for her or his eating, but at
The parenting style of
eating disordered families
tends to extremes.
Serious but often misunderstood,
anorexia and bulimia are health-impair-
to the lack of protein and fat;
decreased core body temperature;
sensitivity to cold; appearance of
lanugo; fatigue and weakness; sleep-
ing problems; poor concentration and
BioMedical Issuesthe same time, feel like she or he is not
completely alone. Tailor these recom-
mendations to developmental needs: a
12-year-old needs more structure than
someone who is 18 or 25. Help

of 7CLUP11999_6_11
anorexia and bulimia are health-impair-
ing and potentially life-threatening. In
both disorders, the individual enters a
starvation state because adequate nutri-
ents are either not consumed or not
completely digested. The body defends
against starvation by becoming
hypometabolic. These changes happen
gradually and organ damage occurs
very late in the process. Medical assess-
ment, monitoring, and intervention are
critical components to effective treat-
ment due to these consequences,
although alone they are insufficient. In
acute situations, intravenous rehydration

or tube feeding may be necessary.
The newer antidepressants, selective
serotonin reuptake inhibitors (SSRIs), are
frequently used with both anorexia and
bulimia. They can lift mood and some-
times help to control the obsessive think-
ing associated with eating disorders.
While this group of drugs has fewer side
effects than previous antidepressants,
low-weight anorexics may have a harder
time gaining weight due to a potential
increased metabolic rate. Medication
can certainly enhance treatment. Used
alone, it will have a limited impact.
Occasionally, short-acting antianxiety
agents are used to manage intense anxi-
ety around mealtime, and low doses of
antipsychotics may be used to address

severely distorted thought patterns.
Health consequences of anorexia ner-
vosa include: bradycardia; thinning of
the heart wall; decreased blood pres-
sure; increasing risk for cardiac arrhyth-
mia or heart failure as heart rate and
blood pressure decrease; dehydration
due to limited fluids; gradual changes in
kidney function possibly resulting in kid-
ney failure or need for dialysis; hormonal
changes; loss of menstrual cycle; poten-
tial fertility problems even after weight
restoration; decreased bone density; risk
for early osteoporosis and stress frac-
tures; fainting, dizziness, and blackouts;
dry skin and cuticles, and hair loss, due
5
problem-solving; constipation and

other gastrointestinal distress; multiple
abnormalities in blood work secondary
to starvation; and stunted growth in
younger patients.
Health consequences of bulimia
nervosa include: electrolyte imbal-
ances leading to irregular heart beats,
arrhythmia, and potential cardiac
arrest; dehydration contributing
both to cardiac and kidney problems;
inflammation, tears causing bleeding,
and potential rupture of esophagus
from vomiting; potential gastric
rupture due to bingeing; constipation,
diarrhea, and other gastrointestinal
problems, especially in laxative
abusers; heartburn, reflux, and
ulcers; loss of dental enamel and

increased decay due to vomiting;
decreased heart rate, blood pressure,
and body temperature; muscle cramp-
ing and weakness; fatigue; fainting,
dizziness, blackouts; menstrual irregu-
larities, increasing risk for fertility
problems and osteoporosis; and prob-
lems sleeping, concentrating, and
problem-solving.ν
Serious but often
misunderstood, anorexia
and bulimia are health-
impairing and potentially
life-threatening.
family members to see how they can
be useful aside from symptom man-
agement, by talking about other issues
and feelings. Family therapy aims at

extracting the eating disorder from the
center of relationships so true intimacy
can develop.
As symptoms subside, families often
choose to leave treatment. Discuss
what else family therapy could achieve,
but if they choose to terminate, provide
relapse prevention information,
acknowledge their progress and
strengths, and help them to define
what signs should prompt a return to
treatment. For those who remain
involved, the real work of role revision
and insight can take place. Then the
prospects of full recovery are much
higher. Minuchin's model, applying
the principles of treatment for psycho-
somatic families, resulted in a positive

outcome for 80 percent of cases (Dare
& Eisler, 1997). Other family research
reports similar success.
Family therapy puts the eating
disorder in the context of a family
system, relieving the blame, self-
degradation, and confusion for the
individual and giving loved ones clear
guidelines of how to help. It can accel-
erate the self-acceptance, feelings of
self-worth, ability to express feelings
directly, and development of satisfying
connections with others, all essential
to the recovery process.ν
As symptoms subside,
families often choose to
leave treatment.
The sources cited throughout the text, and

the references listed below, include clinical
books and research which should be help-
ful when undertaking family treatment for
References and Bibliography:
American Psychiatric Association (1993).
Practice guidelines for eating disorders.
American Journal of Psychiatry, 150 (2),
212-228.
American Psychiatric Association
(1994). Diagnostic and statistical manual
treatment of anorexia nervosa. New Jersey:
Jason Aronson.
Root, M., Fallon, P., & Friedrich, W. (1986).
Bulimia: A systems approach. NY: W. W.
Norton.
Van Den Broucke, S., Vandereycken, W., &
Professional Resources

6
ful when undertaking family treatment for
eating disorders.
Suggested Reading:
Anderson, A. (1990). Males with eating dis-
orders. NY: Brunner/Mazel. One of the only
examination of men and eating disorders
looks at physiology, psychology, and the
cultural context of male eating disorders.
Includes useful information on treatment
approaches.
Fallon, P., Katzman, M. A., & Wooley, S. C.
(Eds.). (1994). Feminist perspectives on eat-
ing disorders. NY: Guilford. A rich collection
by experts examining the role of gender,

the current context of women's bodies,
treatment issues, and prevention, from a
feminist perspective.
Lask, B., & Bryant-Waugh, R. (1993).
Childhood onset anorexia nervosa and relat-
ed disorders. East Sussex, UK: Lawrence
Erlbaum Associates. Explores the special
problems inherent to childhood eating dis-
orders including the medical and psycho-
logical factor assessment, and treatment
for individuals and families.
Nasser, M. (1997). Culture and weight con-
sciousness. NY: Routledge. A sociohistori-
cal and sociocultural examination of the
impact of the global village and information
systems such as the Internet on body dis-
satisfaction and eating problems. Reviews
the research documenting the cross-cultur-

al increase of eating disorders.
Schwartz, M., & Cohn, L. (1996). Sexual
abuse and eating disorders: A clinical
overview. NY: Brunner/Mazel. Addresses
the complex relationship between sexual
trauma and eating disorders. It discusses
prevalence, treatment, and prevention.
Includes a first-person description of
the transition from sexual abuse to an
eating disorder and areas such as false
memory syndrome, revictimization, and
medical issues.
(1994). Diagnostic and statistical manual
of mental disorders (4th ed.). Washington,
DC: Author.
Crowther, J. H., & Sherwood, N. E. (1997).
Assessment. In D. M. Garner, & P. E.
Garfinkel (Eds.), Handbook of treatment for

eating disorders (pp. 34-49). NY: Guilford.
Dare, C., & Eisler, E. (1997). Family therapy
for anorexia nervosa. In D. M. Garner, & P.
E. Garfinkel (Eds.), Handbook of treatment
for eating disorders (pp. 307-326). NY:
Guilford.
Fairburn, C. G., & Cooper, Z. (1993). The
Eating Disorder Examination (12th ed.). In
C. G. Fairburn, & G. T. Wilson (Eds.),
Binge-eating: Nature, assessment, and treat-
ment (pp. 317-360). NY: Guilford Press.
Garner, D. M., Garfinkel, P. E., Olmsted,
M. P., & Bohr, Y. (1982). The Eating
Attitudes Test: Psychometric features and
clinical correlates. Psychological Medicine,
12, 871-878.
Garner, D. M. (1991). Eating Disorders
Inventory -2. Odessa, FL: Psychological

Assessment Resources.
Garner, D., & Garfinkel, P. (Eds.). (1997).
Handbook of treatment for eating disorders.
NY: Guilford.
Kaplan, A., & Garfinkel, P. (Eds.). (1993).
Medical issues and eating disorders. NY:
Brunner/Mazel.
Keys, A., et al. (1950). The biology of human
starvation. Minneapolis, MN: University of
Minnesota Press.
Mickley, D. W. (1999). Medical dangers
of anorexia nervosa and bulimia nervosa.
In R. Lemberg (Ed.), Eating disorders:
A reference sourcebook (pp. 46-51).
Phoenix, AZ: Oryx.
Minuchin, S., Rosman, B., & Baker, L.
(1978). Psychosomatic families: Anorexia in
context. Cambridge, MA: Harvard

University Press.
Palazolli, M. S. (1985). Self-starvation:
From individual to family therapy in the
*These and other AAMFT audio and video
tapes can be ordered from Convention
Cassettes Unlimited at (800) 776-5454.
Or visit the AAMFT web site at
www.aamft.org. To request a catalogue
of other AAMFT products, please call
AAMFT at (202) 452-0109.
To order additional copies of the
Clinical Update, please use the order
form on the back page. AAMFT Members:
$7.95/copy, Non-Members: $9.95/copy.
Available topics:
Eating Disorders by Margo Maine,
Item I050
Female Sexual Dysfunction by Dixie A.

Guldner, Item I046
Alcohol Use Disorders by M. Duncan
Stanton, Item I044
Depression by Michael Yapko, Item I039
Male Sexual Dysfunction by David
Schnarch, Item I036
To order additional copies of the
Consumer Update brochures, please use
the order form on the back page. AAMFT
Members: $.39/copy, Non-Members:
$.49/copy.
Available topics:
Eating Disorders, Item I051
Female Sexual Problems, Item I047
Alcohol Problems, Item I045
Depression, Item I040
Male Sexual Problems, Item I037
Ordering Information

Norre, J. (1997). Eating disorders and marital
relations. London: Routledge.
Vandereycken, W., Kog, E., & Vanderlinden,
J. (Eds.). (1989). The family approach to eating
disorders. Dana Point, CA: PMA Publishing.
Collaborating With Other
Professionals
Based on the assessment, the therapist and family need
to make preliminary decisions regarding the level of care:
inpatient for immediate medical or psychiatric stability,
normal limits. Frequently they play into family pathology,
including resistance to treatment. Periodic phone consultation
and clear communication about the goals of treatment and the
responsibilities of each provider is time well invested and will
avoid splitting and inconsistency.
With severe eating disorders, outpatient treatment alone
will rarely result in sufficient symptom relief. Inpatient
hospital-
ization is warranted if the client is at risk medically, is actively

suicidal, or if symptoms are rapidly intensifying or are severe
A A M F T O R D E R F O R M
AAMFT
1133 15th Street, NW, STE. 300
Washington, D.C. 20005-2710
Call 202-452-0109 to order
or fax form to 202-223-2329
Item # Quantity Description Unit Price Total Price
Shipping & Handling (See Charge List) +
TOTAL (U.S. $) =
UPS Ground (3-7 days)
Canadian orders shipped via Airborne
Express; please add $10 to prices below
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checks)
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(If Credit Card - Circle One) MasterCard Visa AMEX
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Contact person’s name: Company/Institution:
Address:
Telephone: Fax:
$10 and under $2.50
$11 - $20 $3.50
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PRODUCT ORDER INFORMATION (See page 6 for more

information)
PAYMENT
DELIVER TO:
MAIL, CALL, OR FAX TO:
TO RECEIVE MEMBERSHIP DISCOUNTS, PLEASE
PROVIDE THE FOLLOWING INFORMATION:
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inpatient for immediate medical or psychiatric stability,
residential, partial hospital, intensive outpatient, or outpatient.
Forms of treatment can be addressed: individual, family,
group, nutritional counseling medication, expressive arts,
and medical monitoring.
Particularly with eating disorders, the MFT needs to collabo-
rate closely with others involved in the treatment. Physicians,
psychiatrists, dietitians, and individual therapists will make
more informed decisions with knowledge of family issues.
Medical providers especially have a limited understanding of
the complex relationships among emotions, food intake, and

body image. They often oversimplify by conveying the mes-
sage, “Just eat,” or overmedicalize, such as sending clients
for extensive gastrointestinal tests or threatening tube feeding
when it is not necessary. They may also underreact, by
endorsing low body weights that will only maintain the illness
or by failing to discuss the potential damage incurred by an
eating disorder because current laboratory findings are within
suicidal, or if symptoms are rapidly intensifying or are severe
and have not responded to outpatient treatment. Partial hospi-
tal programs specifically designed for eating disorders can be
used as an alternative to inpatient treatment, with psychiatric
and medical monitoring to assure safety, or as a step down
from inpatient programs. Intensive outpatient programs, with
interdisciplinary services including individual, group, and
family therapy, dietary counseling, and psychiatric consulta-
tion can provide intense treatment to those whose symptoms
are less severe but need more than psychotherapy alone.
Often, clients want to avoid these more intense treatments.

The family therapist, in consultation with other providers
involved, should design a contract with gradual goals
regarding symptom management and improvement, family
involvement, and compliance with outpatient treatment. If
the client is unable to meet the contract goals, referral to
higher level of treatment, such as intensive outpatient or
partial hospital, is necessary.ν

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