Eating Disorders are not easy to treat. The traditional medical-psychological literature is surprisingly meagre in mentioning hypnosis as an effective intervention in the treatment of eating disorders and most eating disorders programs hardly utilize it. However, the use of hypnosis can be very helpful in the treatment of eating disorders. This chapter provides professionals and the general public valuable information on the use of hypnosis in the treatment of eating disorders. Specific methods and techniques are described in great detail including their rationale, the expected outcome, and the exact words to say to a patient who was guided into a hypnotic state. The reader will find in this chapter material on such interventions as: therapeutic imagery, healing suggestions, symbolic guided imagery, ego-strengthening, relaxation techniques, therapeutic age-progression and “back from the future” technique.
A theoretical model is proposed to help the clinician organize the multiple interrelationships between factors that may influence a female adolescent's compliance with her birth control method. 1 variable that has been found to be predictive for compliance in adults that was not included in the model is the quality of the patient-physician relationship. This variable was excluded because the model is a social psychological model that focuses on the attitudes and behavior of the female adolescent. The female adolescent's perception of the quality of her relationship with her health care provider can be accounted for under the component of the model discussing costs of acquiring birth control. A table contains a checklist of information the clinician may want to obtain from a patient to help determine if she may be at risk for noncompliance. Factors that influence contraceptive compliance are reviewed: frequency of sexual intercourse, perceived probability of pregnancy, premarital sexual standards and experiences, intimacy of sexual relationship, physical and emotional development, cognitive assessment of pregnancy, parental and peer support, and personality development. Lindemann and DeLamater argue that frequency of intercourse is the "prime mover" in the process of acquiring and using birth control. As the frequency of coitus increases or decreases, awareness of the possibility will increase or decrease. DeLamater hypothesizes that before assessing that pregnancy may be undesirable and thus initiating contraceptive use to prevent pregnancy, a woman 1st must perceive that she is at significant risk for becoming pregnant. Russ proposes that a major reason that sexually active female adolescents fail to use effective birth control is that they do not fully accept sexual intercourse as morally acceptable for themselves and thus are unable to rationally prepare for it. Rains argues that when a female adolescent initiates sexual activity, she is in a state of moral ambivalence, which is defined as being unable to accept her own sexual activity. Based on available data, it is proposed that female adolescent physical development, postmenarcheal age, and length of time since 1st intercourse will be positively associated with both coital frequency and contraceptive compliance. The model also specifies that several factors will have a direct effect on contraceptive compliance, independent of the influence of frequency of sexual intercourse. These include the female adolescent's cognitive assessment of pregnancy, parental and peer support, and their personality development.
It is clear that a number of factors are emerging as necessary criteria for helping physically abused adolescents: The need to establish specific residential treatment units for treating physically abused adolescents. The importance of educational programming to develop community awareness of the seriousness of this issue. The growing need for an awareness is conventional treatment environments to recognize the physically abused adolescent. The need to develop a sensitive and therapeutic approach for such children.
Adolescent sexual abuse is an overwhelming issue for society and the medical community. Adolescent medicine has only begun to emerge in the mainstream of medical practice. Sexual medicine, adolescent chemical dependency, and abusive medicine are emerging subspecialties of mainstream medicine, with victimization syndromes just beginning to be explored. Adolescent sexual abuse, sexual addiction disorders, family incest, eating disorders, depression, and suicide in adolescents all need to be viewed from epidemiologically regarding family and community orientation. I refer to physician and troubled adolescent relations as the quadruple passivity syndrome. The ego-centered, troubled adolescent denies he or she has problems but no desire for treatment; the physician denies that the adolescent has health problems and has no desire to evaluate them. Physicians need to take an aggressive role in identifying, treating, and preventing the victimization process in children, adolescents, adults, spouses, families, and geriatric patients. Physicians need to be trained to identify these patients and to develop treatment protocols. The victimization syndrome needs more research, publication, and surveillance by all medical associations, but primarily by family physicians and pediatricians. In conclusion this clinical discussion describes four main points: Sexually abused adolescents can be successfully treated by a multidisciplinary advocacy team. A community multidisciplinary team can work in a unified approach for the good of the community by putting an end to future generations of victimized adolescents and families. The medical community has the greatest challenge in training, educating, and becoming more aware about adolescent sexual abuse. The community must provide support for victims of sexual abuse.
There are legal issues involved in child sexual abuse matters that are complex. They are exacerbated by economics and traditions and by the rising impact of social work theory. The courts are seeking ways to improve methods of resolving these issues, but the other professions involved in the abuse system must help.
Issues of compliance specific to sexually transmitted diseases (STDs) are reviewed along with general issues of compliance as they pertain to STDs and adolescents. Treatment of STDs is unlike that of other common illnesses for which compliance poses a problem: they are some of the most common treatable diseases and are socially stigmatizing; their treatment often is at public expense or in public facilities; physicians are undereducated about them in proportion to their ubiquity and complexity; laboratory confirmation of eradication of infection usually is desirable; persons other than the primary patients need examination and treatment; and these infections often are detected in asymptomatic persons. Each of these problem areas testifies to the need for strategies to increase compliance with diagnosis and treatment. Practitioners need to make the effort to find these infections in asymptomatic persons who are likely to be infected. Screening for STDs often is a wise course of action with sexually experienced adolescents. Less invasive methods of testing often are appropriate. 2 strategies have been shown to enhance the return of patients for tests of cure. Kroger found that the presence of college undergraduates who were studying health education by observing and critiquing nurses in a venereology clinic approximately doubled the rate of return of male patients and tripled the rate of female patients returning for tests of cure of gonorrhea. Ogunbanjo et al. found that additional counseling of Nigerian patients resulted in more return visits for patients but not for their partners. Certain strategies that generally are applicable to enhancing compliance have special implications for the treatment of STDs. Simplification of treatment is one of these strategies. Diseases treatable with a single dose of medicine include gonorrhea, trichomoniasis, and bacterial vaginosis. An obviously preferable course is the prevention of STDs. The enhancement of adolescent compliance with treatment involves considerations unique to this age group. The provision of treatment without parental knowledge or consent may improve compliance. Adolescents have a mentality different from that of adults, and their concrete style of thinking, which may not be apparent to the practitioner, warrants consideration when explaining sequelae of STDs to the adolescent patient.
Any clinician providing health care to adolescents needs to be able to communicate with them about behavior problems. For reasons relating both to adolescents and to health care providers, such communication is often challenging and sometimes frustrating. Nevertheless, one can develop a method of communicating with adolescents about their problems that will provide information that can be used therapeutically and will make the practice of adolescent medicine more rewarding for the professional. Numerous skills and techniques have been presented that enable the practitioner to initiate, facilitate, and encourage effective communication. These include both verbal and nonverbal methods. Methods for maintaining communication also have been discussed, since there are numerous ways in which communication with adolescents can go awry once it is established. Many health care providers already have developed other individualized skills and techniques; they are encouraged to consider adding those presented in this article. However, communication skills and techniques are useless unless they are based on an interest in the patient. As Peabody wrote almost 6 decades ago: "The secret of the care of the patient is in caring for the patient."
Many adolescent athletes take nutritional supplements in the hope that such supplements will make them better athletes. Protein supplements will not build muscles unless the athlete is not ingesting adequate amounts of protein in food. Vitamins and mineral supplements will not improve performance unless the athlete suffers from a deficiency. No nutritional supplement contains any ingredient that cannot be obtained from food. However, following the scientific principles outlined in this article, on what and when to eat foods and drink fluids, can improve athletic performance.
Health care delivery to Mexican-American adolescents requires knowledge of the general health needs of adolescents, as well as culturally determined beliefs about health and illness. Specific concepts about the cause and treatment of a variety of symptoms may cause some Mexican-American families to seek help from parallel systems of health care (i.e., the curandera and the physician). By understanding the family's beliefs about the problem, the physician can incorporate both systems to enhance a positive outcome. The physician needs to be aware of the extent to which the family both suffers with the ill adolescent patient and contributes to the acquisition of the patient's health. Differences in the extent of acculturation between adolescents and their parents may intensify the common parent-adolescent conflicts seen as a developmental phenomenon. As with any adolescent patient, a thorough history will help to assess the problem and will provide clues as to the best methods for intervention.
In this article, we have tried to point out ways in which the initial interview can be facilitated, and in which it can be made to be both a pleasant and informative experience for the adolescent patients, and a productive and enjoyable encounter for the practitioner. The major areas include appropriate attitudes of personnel and the physical environment in which the patient is seen; the way in which a physician can introduce him- or herself to the family; methods of obtaining information from adolescent patients; differences of which one should be aware when interviewing adolescent patients at different developmental levels; and ways in which to establish rapport and to approach especially sensitive issues. Techniques to reduce anxiety in the physical examination and how to conclude the encounter are also reviewed. By using some of the techniques discussed for the initial encounter, and by incorporating those into his or her own style, the ability to care for adolescent patients can be enhance so that the physician can enjoy and, therefore, be willing to address effectively the health needs of adolescent patients.
Many adolescents have needs that are not always met in traditional medical settings. A number of sociomedical problems known as the new morbidities have presently emerged as national health-related problems among adolescents. However, in a recent national review, the 15 most frequent reasons for adolescent visits to a hospital or practitioner's office did not include these problems. We know that the major causes of death among adolescents are accidents, homicide, and suicide, and they experience untold mortalities related to teenage pregnancy, alcohol abuse, and drug abuse. Special programs are needed to address these problems. Our traditional health care facilities fail to reach the majority of high-risk adolescents. Through innovative programs such as Teen-Link, The Door, The Bridge over Troubled Waters, School Based Health Clinics, and other alternative health care facilities, many of these problems are being identified; and the at-risk population is targeted and served. Health care promotion and education have become major components of these programs. The key to attracting adolescent patients to these facilities has been the ability to reach out and serve them on their ground, and to effectively communicate with them despite their different socioeconomic and cultural backgrounds. No ideal approach to delivering health care exists for adolescent patients; however, a program that addresses their medical, social, educational, vocational, and psychologic needs may be utilized more frequently than programs that do not address the adolescent in a holistic manner. Further evaluation of these existing programs is necessary to assess which components are cost-effective, and which ones significantly affect the life-styles of adolescents as they progress toward adulthood.(ABSTRACT TRUNCATED AT 250 WORDS)
