Any treatment modality stands to be tested based on the outcome, and outcome of treatment must be compared to the natural history of the illness. There are insufficient data regarding the natural history of eating disorders. This refers to patients with any one of the three eating disorders mentioned at the beginning of this chapter in terms of what takes place regarding the outcome of their illness when no treatment is used. This needs to be compared to a variety of treatment modalities, and when treatment interventions produce better outcome compared to the natural history of the eating disorder, such a treatment modality may be considered as effective. The following are criteria which I use to measure the effectiveness of a specific treatment intervention:
1. Symptom relief: Patients who come for treatment suffer from a variety of symptoms that can be measured and recorded with the psychiatric interview, the Mental Status Examination, and a variety of scales such as the Eating Disorders Inventory (EDI) (Garner, Olmsted & Polivy, 1983), the Zung Scale for rating Anxiety (Zung, 1971), and the Zung Scale for rating Depression (Zung, 1965). There should be an easing of these symptoms in terms of intensity, frequency, and effect on the patient's ability to function adaptively with the activities of daily living.
2. Behavioral change: I expect to see improvement in the patient's ability to form healthy, interpersonal relationships, their social skills, their ability to hold a job, to be gainfully employed (for adults), and perform academically (for adolescents).
3. Improvement in self-esteem: I expect to see a change in the patient's sense and stability of a positive self-image which can be reflected in the sentence completion test, the psychiatric interview and specific projective testing such as the Thematic Apperception Test (TAT).
4. Body image: The patient's body image should move from a distortion to a realistic assessment and perception of the patient's body image. This can be evaluated by the use of the Mental Status Examination (MSE), as well as the Eating Disorders Inventory (EDI), and the Draw a Person Test (DAP).
Some of these assessments may also be done with the aid of hypnoanalytic exploratory techniques such as ideomotor signalling. All of the assessments can be supplemented by data collected from close family members who know the patient prior to the treatment, during the treatment, and after the treatment intervention has been completed; this will help assess how the patient has changed.
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