Inpatient Cognitive- Behavioral Treatment of Eating Disorder Patients with Dissociative Disorders

Although several investigations have noted an association between eating disorders and dissociative disorders, little work has addressed the treatment of patients with both conditions. As an inpatient service focused on severely-ill eating disorder patients, it became necessary to diagnose and treat concomitant dissociative disorders. We describe a cognitive-behavioral inpatient program developed and specifically adapted to treat eating disorder patients with dissociative disorders. Patients were identified by self-report measures (the Eating Disorder Inventory and the Dissociative Experiences Scale) and clinical interviews. Specificeatingsymptoms linked to post-traumatic stress or conversion disorders were approached with stimulus control and hierarchical desensitization. Individual and group cognitive therapy as well as diary techniques addressed irrational beliefs common to both disorders. Skill enhancement through relaxation training, anxiety management, and anger management, initially tailored for the eating disorder patient, required adaptation for dissociativepathology. Addressing both disorders reduced eating pathol ogy whereas inattention to dissociative symptoms led to continued disturbed eating and purging. Identification and treatment of dissociative pathology may improve treatment outcome in the treatmentresistant eating disorder patient.