Papers by Walter Vandereycken
Japanese Journal of Psychosomatic Medicine, 1995
As late as 1873, morbid self-starvation was identified as a distinct clinical entity and recogniz... more As late as 1873, morbid self-starvation was identified as a distinct clinical entity and recognized as such by the medical establishment. First termed hysterical anorexia, it soon became known as anorexia nervosa. The British physician W.W. Gull and the French neuropsychiatrist E.C. Lasegue must be awarded “joint parenthood” for the first description that opened the eyes of their colleagues to this peculiar disorder (Vandereycken and Van Deth 1989). This is far from saying that self-starvation was unknown in former days. Our ancestors surely were familiar with self-starvation, but they did not consider it primarily a pathological phenomenon.
International Journal of Eating Disorders, 1990
The conceptualization of fairly new disorders such as bulimia (nervosa) is usually based on an an... more The conceptualization of fairly new disorders such as bulimia (nervosa) is usually based on an analogy model. In that sense, bulimia has been interpreted on phenomenological grounds as being a form of addictive behavior. We discuss this assumption as well as its therapeutic implications. We have always been struck by the fact that in many books on behavior therapy or behavior medicine obesity is grouped, with drinking and smoking, under the heading of addictive behaviors. This attitude implies that obesity is essentially a disorder of overconsumption of food in the same way as other addictions result from excessive or chronic substance abuse. Focusing on bulimia (nervosa), such comparison seems even more plausible. Quite similarly as in the well-known although still controversial issue of the possible association between bulimia and affective disorder, a linkage between eating disorders and addiction is suggested on the basis of various arguments, arisen from the following areas: 1. Phenomenology (and course of illness): bulimic patients show an addictionlike behavior (craving, preoccupation with obtaining the substance, loss of control, adverse social and medical consequences, ambivalence towards treatment, risk of relapse) and they also tend to abuse alcohol or drugs at some point of their history. 2. Family studies: a higher-than-expected prevalence of substance abuse is reported among the relatives of bulimic patients. 3. Biological level: animal studies and therapeutic trials with opiate antagonists (naloxone) suggest the involvement of endogenous opioid systems in the pathogenesis of bulimia.
International Journal of Eating Disorders, 1987
The conceptualization of an eating disorder as a symptom of family dysfunctioning has become quit... more The conceptualization of an eating disorder as a symptom of family dysfunctioning has become quite popular. Following the example of Minuchin and Selvini Palazzoli, many clinicians seem to prefer family therapy as the treatment of choice in anorectic patients. This movement, however, is based upon personal beliefs rather than on solid research. Family therapy should be viewed as a component to be integrated within a multidimensional approach that is guided by a constructive and positive attitude towards the family and is based upon a pragmatic but flexible “scientist-practitioner” spirit.
Psychopraxis, 2008
... Inés Hulpiau studeerde recent af als klinisch psycholoog aan de KU Leuven met een eindscripti... more ... Inés Hulpiau studeerde recent af als klinisch psycholoog aan de KU Leuven met een eindscriptie over het thema van dit artikel. ... Daarnaast bena-deren onderzoekers het vraagstuk vaak vanuit hun eigen theoretische achtergrond. ...
Psychopraktijk, 2012
Geïnspireerd door de uitgebreide literatuur over zelfverandering bij verslavingen bespreken we he... more Geïnspireerd door de uitgebreide literatuur over zelfverandering bij verslavingen bespreken we het te boven komen van een psychische stoornis zonder professionele behandeling of formele hulp. We gaan in op enkele veel geopperde bezwaren tegen het idee van ‘spontaan herstel’. Actieve coping en het benutten van ‘herstelkapitaal’ zijn sleutelkenmerken van zelfverandering. De conclusie is dat dit proces een onderschatte weg is naar herstel van psychische stoornissen.
Dth, 1992
SamenvattingIk heb de lezer van dit tijdschrift al eerder pogen te verleiden tot nieuwsgierig kui... more SamenvattingIk heb de lezer van dit tijdschrift al eerder pogen te verleiden tot nieuwsgierig kuieren in antiquariaten of stoffige archieven. Deze keer lijkt het resultaat van mijn speurtocht op een eerdere bijdrage over Alexander Herzberg, een inventief clinicus die nog dacht in de psychoanalytische sfeer maar zich in zijn werk ontpopte als voorloper van de gedragstherapie. Een tijdgenoot van Herzberg was de overigens totaal onbekende Brusselse zenuwarts Th. Hénusse. In het door de Duitsers bezette Brussel hield deze op de bijeenkomst van de Societé Belge de Médicine Mentale van 22 februari en 29 maart 1941 een tweedelige lezing over agorafobie. Of de tekst nog hetzelfde jaar werd gepubliceerd is onduidelijk want de oorlogsomstandigheden dwongen het tijdschrift Journal Belge de Neurologie et de Psychiatrie twee jaargangen in één uitgave te bundelen: het vrij lange artikel van Hénusse zet de jaargang 1941–1942 in.
The International journal of eating disorders, 2003
The chance that an anorexia nervosa patient will be hospitalized depends more on circumstantial r... more The chance that an anorexia nervosa patient will be hospitalized depends more on circumstantial rather than on scientifically based factors. Although there is a lot of information on the treatment of anorexia nervosa patients in a residential setting, answers to questions relating to the "when," "where," and "how" of treatment are subjective. There is no clinical consensus and the paucity of controlled research is hampering the development of an evidence-based practice. Increasing economic restraints through managed care policies limit the length of inpatient treatment, which leads to early discharge at a lower body weight, which leads to a higher likelihood of readmissions, which leads to increasing costs. We will highlight important issues in the ongoing debate between economic demands and clinical challenges. Our goal is to stimulate critical reflections and systematic research.
International Journal of Eating Disorders, 2008
The weight percentage of body fat in anorexic adolescents on the basis of four distinct formulas ... more The weight percentage of body fat in anorexic adolescents on the basis of four distinct formulas (Siri; Lohman; Westrate and Deurenberg; Heyward and Stolarczyk) is compared. The body composition of 238 anorexia nervosa (AN) patients, divided into four age categories (13-15, 15-17, 17-19, and 19-22 years), was measured by means of densitometry (underwater weighing). Depending on the formula, the results calculated by the formulas differ significantly in each age category. The Siri formula generally results in the highest mean fat percentage (12.76%-13.39%) whereas the Heyward and Stolarczyck formula shows the lowest figures (8.77%-9.31%). Applying the Lohman and the Heyward and Stolarczyck formulas to the 19-22 years category, results in negative fat percentages. A clinically useful formula is important for the estimation of body composition in specific age categories. We recommend with some restrictions, to apply the Siri formula in AN patients.
International Journal of Eating Disorders, 2004
Objective: Studies on sleep patterns in anorexia nervosa (AN) have yielded inconsistent results. ... more Objective: Studies on sleep patterns in anorexia nervosa (AN) have yielded inconsistent results. Therefore, we have studied the evolution of subjective and objective sleep characteristics in AN patients before and after weight restoration. Method: Thirty-four severely underweight AN inpatients of the restrictive subtype had a polysomnographic sleep registration at the time of admission and after weight restoration. Subjective sleep quality was also measured with self-report instruments. Results: Objective sleep variables did not change with weight restoration, whereas subjective quality of sleep did improve. Percentage of underweight at admission and amount of slow wave sleep were predictors of the length of time required for weight restoration. Discussion: The finding that weight restoration does not affect polysomnographic sleep variables in AN patients seems to contradict previous studies.
International Journal of Eating Disorders, 1994
In this study comparing 41 eating disorder patients and 34 female controls, the video distortion ... more In this study comparing 41 eating disorder patients and 34 female controls, the video distortion technique was used to test the accuracy of body size estimation and to assess the ideal body image. No difference was found in the estimation of actual body sizes, although the accuracy of estimation was quite variable in both bulimics and anorexics. With regard to the ideal body image, significant differences were found: All bulimics and 92.6% of the controls wished to be thinner versus 42.9% of the anorexics (23.8% wished to be larger). Looking at subjective body experience, as measured with a self-report questionnaire (Body Attitudes Test), body dissatisfaction appeared to be negatively correlated with the ideal body image but not with the estimation of actual body sizes.
International Journal of Eating Disorders, 1998
To assess the relationship between body size estimation on the one hand and clinical and psycholo... more To assess the relationship between body size estimation on the one hand and clinical and psychological variables on the other. Body size estimation was tested with the video distortion method on a life-size screen in normal women (n = 45) and compared to a total of 189 female eating disorder patients (100 with restricting anorexia nervosa, 41 with binging/purging anorexia nervosa, 48 with bulimia nervosa). The subjects' cognitive responses (what they think they really look like), affective responses (what they feel they look like), and optative responses (what they want to look like) were correlated with clinical parameters (including body composition) and with the scores on a series of self-report questionnaires assessing general psychological well-being and body experience. No significant relationship was found between the body size estimations and the clinical variables. The cognitive and affective responses showed a moderate relationship with self-reported body attitude. Body dissatisfaction was negatively correlated with the optative response (desired body size). This study contributes to the construct validity of the video distortion method. Body size estimation includes more than just a perceptual task. Hence, the narrow notion of body image should be replaced by the more complex construct of "body experience," the multidimensionality of which should be addressed in both research and treatment of eating-disordered patients.
Psychopraxis, 2003
Problemen waardoor een psychotherapeut dreigt vast te lopen in zijn werk hebben veelal te maken m... more Problemen waardoor een psychotherapeut dreigt vast te lopen in zijn werk hebben veelal te maken met persoonlijke emotionele betrokkenheid in een intensieve werkrelatie met de client. Een belangrijke valkuil is de idealisering van een ‘therapeutische vriendschap’ als prototype van ‘intiem’ contact. Deze kan door beide partijen worden gebruikt om aan de frustrerende realiteit te ontsnappen. Niet alleen therapeuten kunnen hun vak of hun clienten misbruiken, de omgekeerde situatie komt ook in allerlei vormen voor. Wanneer de therapeut dergelijke misbruiken negeert, kan zijn directe omgeving (partner, gezin) hiervan indirect het slachtoffer zijn. In deze bijdrage gaan we hier nader op in.
The International journal of eating disorders, 2012
The present study examined the role of "a breakdown in inhibition" as a mechanism to ex... more The present study examined the role of "a breakdown in inhibition" as a mechanism to explain differences in impulsivity between restrictive and bingeing/purging eating disorders (ED). Two types of inhibition (i.e., executive and reactive inhibition) were assessed by means of personality and neuropsychological tests. Forty-eight female in patients with ED completed the Effortful Control Scale, the BISBAS scales, and a set of neuropsychological tests. The results showed that executive inhibition measures were able to differentiate restrictive from bingeing/purging ED subtypes. Patients with ED and bingeing/purging behavior scored significantly lower on the Effortful Control Scale, needed more time to finish the Trail Making Test/STROOP, and showed more reaction time variability on the Go No-Go task. We did not find significant associations between personality and neuropsychological measures of executive/reactive inhibition. Insight in the breakdown of inhibition in bingeing/...
Psychotherapy and Psychosomatics, 1991
After a brief historical overview of the literature on family therapy in eating disorders, the au... more After a brief historical overview of the literature on family therapy in eating disorders, the authors' own clinical experience is summarized in some practical guidelines: give the family therapist a central position within the team, engage the family and/or spouse as co-therapist, explore the message of the eating disorder on different levels, neutralize the symptoms outside of the family interaction, promote direct communication, facilitate the separation-individuation process, and be available for a long time. Finally some special issues are discussed: sexual and/or physical abuse in the family, broken-home situations and single-parent families, married and chronic patients.
Psychotherapy and Psychosomatics, 1997
The video-distortion method on a life-size screen is one of the new methods to systematically stu... more The video-distortion method on a life-size screen is one of the new methods to systematically study the body experience of eating-disordered patients. Using this method, we have studied body-size estimation in female patients suffering from eating disorders: anorexia nervosa restricting type (n = 87) and mixed type (n = 34); bulimia nervosa (n = 44), and a normal control group (n = 45). Subjects had to estimate a neutral object (neutral response) and their own body size: what they think they really look like (cognitive response); what they feel they look like (affective response), and what they want to look like (optative response). No significant differences were found for the neutral and the cognitive response. Eating-disordered patients clearly did not overestimate their body size. The different subgroups showed interesting differences in the degree of discrepancy between cognitive and affective responses, and in the thinness of their body ideal. Researchers should focus on these elements of body experience, because they are clinically far more relevant than the simple question of over/underestimation.
Journal of Psychiatric Research, 1985
Over a period of more than 15 years, our approach to the inpatient treatment of anorexia nervosa ... more Over a period of more than 15 years, our approach to the inpatient treatment of anorexia nervosa has changed considerably. Three major steps may be distinguished in this evolution. Until 1974, weight restoration was induced by a medical regime, and most patients had to stay in a psychotherapeutic community for several months. Between 1974 and 1980, different types of behavior therapy have been tried and compared ending up in a standardized behavioral contract system that is still used now. However, a large follow-up study forced us to question the second psychotherapeutic phase of the program and the long stay in the hospital. Moreover, the increasing number of patients made it practically impossible to treat them all individually. For these reasons, from 1982, an intensive multifaceted group approach was developed, the major components of which are described. It is concluded that continuing research from a scientistpractitioner's viewpoint is the best guide for a fruitful trial-and-error process in the therapeutic approach to patients with eating disorders. CHANGES IN THE TREATMENT PROGRAM AT the University Psychiatric Center (U.P.C.) Kortenberg, inpatient treatment of anorexia nervosa patients has received specific and systematic attention for more than 15 yr. The approach has been changed several times and these alterations were based on clinical experiences or research findings. Figure 1 summarizes the major steps in this evolution. Until 1980, in accordance with the ideas of other clinicians (e.g. BRUCH, 1973), our treatment approach was divided into two phases. A certain degree of weight restoration and normalization of eating behavior (aim of the first, symptom oriented phase) was considered as an essential prerequisite for further psychotherapy in the second, problem oriented phase.
Journal of Clinical and Experimental Neuropsychology, 2005
In a previous study young seriously underweight anorexia nervosa (AN) patients in the early phase... more In a previous study young seriously underweight anorexia nervosa (AN) patients in the early phase of treatment were found to react faster in psychomotor tasks. To further understand this finding we studied the impact of weight restoration on the performance of AN patients in drawing and copying tasks. A group of 17 female AN patients, aged 14 to 25, was compared with 17 healthy controls, matched for sex, age and educational level. Patients were tested when severely underweight and after weight restoration. Control subjects were also tested twice. Using computerized recording and analysis of writing and drawing behavior, reaction times and drawing times were derived, while cognitive and motor demands were manipulated. Overall, AN patients showed shorter reaction times in copying tasks and shorter drawing time in the drawing task than normal controls, and this pattern persisted after weight restoration. No significant group (AN vs. controls) by session (test vs. retest) effect emerged. The finding of a consistent pattern of shorter reaction and drawing times in AN patients before and after weight restoration is compatible with a personality characteristic of perfectionism and overachievement in AN patients.
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Papers by Walter Vandereycken