Michelle A. Steen
University of North Carolina at Pembroke
This paper explores the proposed use of Dialectic Therapy (DBT) on adolescents between the ages of twelve and eighteen who are diagnosed with Anorexia Nervosa (AN). It will address the nature and extent of the issue of AN in the target population, weigh the positive and negative aspects of different types of therapies on the target population and show the potential limitations of the use of DBT versus other forms of therapies.
Proposal for Evidence Based Practice Paper
This paper will discuss Anorexia Nervosa as an eating disorder that predominantly affects girls and young women. In industrial countries, such as the United States the disorder’s prevalence can be as high as 370 per 100,000 (Hoek & van Hoeken, 2003). Anorexia nervosa may affect a patient’s mental and physical condition to such an extent that involuntary hospital admission is inevitable. PROBLEM TO BE ADDRESSED
According to The National Association of Anorexia Nervosa and Associated Disorders (ANAD), Anorexia Nervosa (AN) occurs when an adolescent refuses to maintain body weight at or above a minimal normal weight for age and height. The weight loss is usually self-imposed and the adolescent usually weighs less than 85% of their expected weight. The condition occurs most frequently in females; however, it can occur in males. (2010) Generally, the teenager has an intense fear of gaining weight or becoming fat even though underweight. Self evaluation of body weight and shape may be distorted and there may be denial of the potential health hazards caused by the low body weight. (Guest, 2000) Physical symptoms can include the absence of regular menstrual cycles, dry skin, low pulse rate, and low blood pressure. Behavioral changes commonly occur such as social withdrawal, irritability, moodiness and depression. Without treatment, this disorder can become chronic and with severe starvation, some teenagers may die. (Buchanan, 2006) CHOSEN POPULATION
For this intervention I have chosen to attempt to work with adolescent females between the ages of twelve to eighteen who have a clinical diagnosis of AN who reside in the inner piedmont region of North Carolina. NATURE AND EXTENT OF PROBLEM
According to the National Institute of Mental Health, approximately three percent of children between the ages of thirteen and seventeen suffer from some type of eating disorder. Within that percentage girls are more than two and a half times as likely as boys to have an eating disorder. Of the documented mental disorders, AN has the highest mortality rate. According to ANAD, with more research attention clinicians will be better able to treat, understand and hopefully prevent eating disorders earlier if not prevent them from happening in the first place.
For this literature review I will be covering several articles regarding different evidence based practice interventions that have been evaluated to address AN in adolescent girls. There are four interventions that will be discussed Cognitive Behavioral Therapy (CBT), Dialectic Therapy (DBT), Family/Marital Therapy using the Maudsley approach Cognitive Behavior Therapy (CBT): CBT has been used more frequently n recent history. In the case of AN it would be a time-limited directed therapy where the professional and client would work as a team to find irrational thinking patterns and illogical beliefs associated with body image, perfectionism and other issues. For AN there would be a focus on changing the behaviors of the illness such as ritualistic exercise, purging, and extreme dieting. CBT with its short-term structure and availability of manuals has become a useful resource. (Santucci, 2010) This form of talk therapy could be appropriate but is not as focused on AN as Dialetic Therapy. Dialectic Therapy (DBT): Although...