©2011 National Association of Social Workers. All Rights Reserved. 1

Skinny Revisited: Rethinking Anorexia Nervosa and Its Treatment

Maria Baratta, PhD, LCSW

• Introduction• Overview of Anorexia• Multidimensional Model for the treatment of

Anorexia• Introduction to the “Language of the Anorexic” • Case studies

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Photograph: Lucas Dolega/EPA

W Magazine,Photographs by Alexis Dahan

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TWIGGY

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A Multidimensional Model for the Treatment of Anorexia Nervosa• Engagement• Diagnosis, Evaluation, Assessment• The “language of the anorexic”• Integration of comorbid disorders• Address of familial issues• Address of “skinny” from a cultural/feminist

perspective ©2011 National Association of Social Workers. All Rights Reserved. 6

DSM-IV Diagnostic Criteria for Anorexia Nervosa 307.1A. Refusal to maintain body weight at or above a minimally normal

weight for age and height

B. Intense fear of gaining weight or becoming fat, even though underweight.

C. Disturbance in the way in which one’s body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or denial of the seriousness of the current low body weight.

D. In postmenarcheal females, amenorrhea ,the absence of at least three consecutive menstrual cycles.

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“The language of the anorexic”

• “The language of the anorexic,” simply stated, is a way obsessing with the patient--allowing them to obsess about every particle of food, and thus, on their own, begin to make better food choices.

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Comorbidity

Anorexia Nervosa is comorbid with the following:• Obsessive–Compulsive Disorder• Obsessive–Compulsive Personality Disorder• Body Dysmorphic Disorder

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Feminist literature

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Review of Multidimensional Treatment Model

• Engagement – “unconditional positive regard” (Carl Rogers) Therapist is accepting and welcoming without judgment.

• Axis I Diagnosis of Anorexia Nervosa 307.1 (DSM-IV)

• Evaluate for suicidal risk

• Assess whether patient is treatment compliant

• Be sure patient is under the care of a physician

• Integrate comorbid disorders

• Address familial issues

• Address “skinny” from a cultural/feminist perspective – challenge patients’/cultural belief that thinness is a prerequisite to attractiveness and esteem

©2011 National Association of Social Workers. All Rights Reserved. 11

Questions & Answers

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SKINNY REVISITED: RETHINKING ANOREXIA NERVOSA AND ITS TREATMENT

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