Objective: To explore young adults' views regarding: the inpatient treatment they received for anorexia nervosa during their adolescences; their experiences of discharge; and the impact their admission had on issues of control and low self-esteem. Method: Semi-structured interviews were conducted with seven young adults treated in general adolescent psychiatric units. Data were analysed using Interpretative Phenomenological Analysis. Results: Four super-ordinate themes emerged from participants' accounts: (1) Removal from normality versus connecting with the outside world; (2) Treated as another anorexic versus a unique individual in distress; (3) Control and collaboration; (4) The importance of peer relationships. Discussion: Findings unique to this study concerned a sense of feeling removed and disconnected from 'normality'; a feeling that one's developmental needs were not always addressed; and the importance placed on supportive relationships with fellow patients. It was also found that authoritarian approaches may compound patients' feelings of ineffectiveness, worthlessness and isolation.

OBJECTIVE -To describe the clinical outcomes of adolescent and young adult female subjects with type 1 diabetes in relation to the disturbance of eating habits and attitudes over 8 -12 years.RESEARCH DESIGN AND METHODS -Patients were recruited from the registers of pediatric and young adult diabetes clinics (including nonattenders) and interviewed in the community. A total of 87 patients were assessed at baseline (aged 11-25 years), and 63 (72%) were reinterviewed after 8 -12 years (aged 20 -38 years). Eating habits and attitudes were assessed by a semistructured research diagnostic interview (Eating Disorder Examination).RESULTS -Clinical eating disorders ascertained from the interview and/or case note review at baseline or follow-up were found in 13 subjects (14.9% [95% CI 8.2-24.2]), and an additional 7 subjects had evidence of bingeing or purging, bringing the total affected to 26%. Insulin misuse for weight control was reported by 31 (35.6% [25.7-46.6]) subjects. Overall outcome was poor; serious microvascular complications were common and mortality was high. There were significant relationships between disordered eating habits, insulin misuse, and microvascular complications.CONCLUSIONS -Although the cross-sectional prevalence of clinical eating disorders in young women with diabetes is modest, the cumulative incidence of eating problems continues to increase after young adulthood, and this is strongly associated with poor physical health outcomes. The combination of an eating disorder and diabetes puts patients at high risk of mortality and morbidity. Better methods of detection and management are needed. Diabetes Care 28:84 -88, 2005

Article available under the terms of the CC-BY-NC-ND licence (https://creativecommons.org/licenses/by-nc-nd/4.0/) eprints@whiterose.ac.uk https://eprints.whiterose.ac.uk/ Reuse Unless indicated otherwise, fulltext items are protected by copyright with all rights reserved. The copyright exception in section 29 of the Copyright, Designs and Patents Act 1988 allows the making of a single copy solely for the purpose of non-commercial research or private study within the limits of fair dealing. The publisher or other rights-holder may allow further reproduction and re-use of this version -refer to the White Rose Research Online record for this item. Where records identify the publisher as the copyright holder, users can verify any specific terms of use on the publisher's website. TakedownIf you consider content in White Rose Research Online to be in breach of UK law, please notify us by emailing eprints@whiterose.ac.uk including the URL of the record and the reason for the withdrawal request. AbstractTherapist drift occurs when clinicians fail to deliver the optimum evidence-based treatment despite having the necessary tools, and is an important factor in why those therapies are commonly less effective than they should be in routine clinical practice. The research into this phenomenon has increased substantially over the past five years. This review considers the growing evidence of therapist drift. The reasons that we fail to implement evidence-based psychotherapies are considered, including our personalities, knowledge, emotions, beliefs, behaviors and social milieus. Finally, ideas are offered regarding how therapist drift might be halted, including a cognitive-behavioral approach for therapists that addresses the cognitions, emotions and behaviors that drive and maintain our avoidance of evidence-based treatments.Keywords: therapist drift; psychotherapies; evidence-based practice; training; cognitivebehavioral therapy Therapist drift redux 3 Therapist drift redux: Why well-meaning clinicians fail to deliver evidence-based therapy, and how to get back on track There are different reasons why evidence-based therapies might be delivered poorly, such as clinicians being inadequately trained in the therapy in question (e.g., Royal College of Psychiatrists, 2013) or working in a setting that does not permit the implementation of the necessary methods (e.g., not being permitted to provide the necessary number of sessions).Among those reasons is one that is centred in our own practice -therapist drift (Waller, 2009). Therapist drift can be conceptualised as our failure to deliver treatments that we have been trained to deliver, or failure to deliver them adequately, even where resources exist to allow us to do so. Such failure can be a consciously or an unconsciously-driven course of action. Regardless, it has the same consequence -the patient receives treatment that deviates significantly from the evidence-base, reducing their chances of improvement or recovery. This paper will review the substantial recent evidence fo...

Objective: The coronavirus pandemic has led to a dramatically different way of working for many therapists working with eating disorders, where telehealth has suddenly become the norm. However, many clinicians feel ill equipped to deliver therapy via telehealth, while adhering to evidence-based interventions. This article draws together clinician experiences of the issues that should be attended to, and how to address them within a telehealth framework.Method: Seventy clinical colleagues of the authors were emailed and invited to share their concerns online about how to deliver cognitive-behavioral therapy for eating disorders (CBT-ED) via telehealth, and how to adapt clinical practice to deal with the problems that they and others had encountered. After 96 hr, all the suggestions that had been shared by 22 clinicians were collated to provide timely advice for other clinicians.Results: A range of themes emerged from the online discussion. A large proportion were general clinical and practical domains (patient and therapist concerns about telehealth; technical issues in implementing telehealth; changes in the environment), but there were also specific considerations and clinical recommendations about the delivery of CBT-ED methods.Discussion: Through interaction and sharing of ideas, clinicians across the world produced a substantial number of recommendations about how to use telehealth to work with people with eating disorders while remaining on track with evidencebased practice. These are shared to assist clinicians over the period of changed practice.

Objective: A substantial proportion of eating disorder presentations receive a DSM-IV diagnosis of eating disorder not otherwise specified (EDNOS), yet research comparing EDNOS with anorexia nervosa (AN) and bulimia nervosa (BN) is limited. The aim of this study was to further investigate EDNOS in clients at a UK Community Eating Disorder Service. Method: The Eating Disorder Examination (EDE) was used to generate DSM-IV diagnoses. Clinical profiles of EDNOS clients are compared with those of patients with AN and BN and cluster analysis used to identify subgroups based on presenting features rather than diagnosis. Results: 190 of 200 participants had a clinical eating disorder: 11 had AN, 45 had BN, 134 had EDNOS. Cluster analysis suggested four subgroups within the clinical sample: three with similar cognitive psychopathology but varied behavioural presentation, and one with less severe cognitive and behavioural features, but low mean BMI. Discussion: These results highlight the need for further investigation into EDNOS and its usefulness as a diagnosis.

therapy for outpatients with eating disorders: Effectiveness for a transdiagnostic group in a routine clinical setting. Behaviour Research and Therapy,[68][69][70][71][72][73][74][75] https://doi.org/10.1016/j.brat.2015.03.001 eprints@whiterose.ac.uk https://eprints.whiterose.ac.uk/ Reuse Unless indicated otherwise, fulltext items are protected by copyright with all rights reserved. The copyright exception in section 29 of the Copyright, Designs and Patents Act 1988 allows the making of a single copy solely for the purpose of non-commercial research or private study within the limits of fair dealing. The publisher or other rights-holder may allow further reproduction and re-use of this version -refer to the White Rose Research Online record for this item. Where records identify the publisher as the copyright holder, users can verify any specific terms of use on the publisher's website. TakedownIf you consider content in White Rose Research Online to be in breach of UK law, please notify us by emailing eprints@whiterose.ac.uk including the URL of the record and the reason for the withdrawal request. These preliminary studies of effectiveness indicate that CBT can be delivered with strong outcomes in routine clinical settings. However, it is well-established that clinicians routinely fail to use CBT when working with the eating disorders (e.g., Tobin, Banker, Weisberg, & Bowers, 2007) or that they deliver it in sub-optimal ways (Waller, Stringer, & Meyer, 2012), expressing concerns about the use of those core CBT techniques (e.g., Turner, Tatham, Lant, Mountford, Waller, 2014) and discounting the use of evidence-based manuals to support their work (e.g., Waller et al., 2013). Therefore, there is a need for further evidence from other routine clinical settings to demonstrate that CBT for the eating disorders is an effective treatment, which others can use in their own clinics. This study aims to build on previous work by testing the effectiveness of CBT in a further routine clinical setting. It reports clinical outcomes for a large group of transdiagnostic patients who were offered CBT in a community eating disorders service in the UK. Unlike previous studies, there were very few exclusion criteria and no BMI cut-off. In this case, the variant of CBT used was based on a combination of elements from the relatively similar approaches of Fairburn (2008) and Waller et al. (2007), as used by Byrne et al. (2011) and Waller et al. (2014) respectively.

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