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Treatment of early trauma and dissociation in eating disorders of late onset
Author(s) -
Tobin David
Publication year - 1995
Publication title -
european eating disorders review
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.511
H-Index - 67
eISSN - 1099-0968
pISSN - 1072-4133
DOI - 10.1002/erv.2400030305
Subject(s) - eating disorders , psychodynamics , dissociative , dissociative disorders , psychology , dissociation (chemistry) , personality disorders , cognition , personality , psychiatry , clinical psychology , psychotherapist , psychoanalysis , chemistry
A subgroup of older patients with a strikingly consistent pattern of symptoms and historical detail is presented with an outline for treatment. Deviation from standard approaches to treatment for eating disorders is discussed as a consequence of managing not only severe eating disorder symptoms, but also severe dissociative and personality disorders. Based on the work of Putnam (1989) and case material, an outline of treatment is presented that includes: (1) diagnosis, (2) history and alter identification, (3) initial stabilization, (4) acceptance of diagnosis, (5) communication between alters, (6) metabolism of trauma, and (7) integration. The integration of cognitive‐behavioural, psychodynamic, and feminist‐relational techniques is discussed as a way to help these patients overcome both eating and dissociative disorder symptoms. Though treatment of this subgroup is considerably longer and more intensive than standard approaches (e.g. twice weekly for several years), case studies reveal that prognosis is generally good if patients remain in treatment. Other indicators of good prognosis include the patient's ability to remain or return to premorbid levels of employment.