Academy for Eating Disorders

SIG Panels

Thursday, April 23, 2015 from 4:30 – 6:00 p.m.

Assessment and Diagnosis of Men with Eating Disorders (presented by the Assessment & Diagnosis and Males & Eating Disorders SIGs)
Kelly Berg, PhD, University of Minnesota, United States; Alison Darcy, PhD, Stanford University, United States; Kelsie Forbush, PhD, University of Kansas, United States; Jerel Calzo, PhD, Harvard Medical School, United States; Lazaro Zayas, MD, Harvard Massachusetts General Hospital, United States

Previous studies indicate that full-threshold eating disorders are approximately three times more likely to occur in women than men.  However, recent epidemiological data demonstrate a much lower gender disparity, with certain sub-threshold forms marked by binge eating exhibiting significantly higher lifetime prevalence rates in men compared to women. Despite these data, men are often excluded from studies of eating pathology, leaving clinicians “in-the-dark” regarding best practices for this specific sub-population. The proposed SIG panel will provide discussion and overview of assessment needs and important diagnostic considerations for men with eating disorders from recognized experts in eating disorders treatment and research.

Learning Objectives:

  • Identify and describe specific diagnostic presentations of eating pathology in men that may warrant clinical attention, such as orthorexia, muscle dysmorphia, and avoidant and restrictive food intake disorder.
  • Name and describe common assessment tools that are appropriate for use in men with eating disorders, including assessments of general eating disorder behaviors, body dissatisfaction, and muscle dysmorphia.
  • Describe the barriers to effective assessment and diagnosis of men with eating pathology, and ways to mitigate these issues during the course of clinical care.

Body Shaming: Stigma Can Come in Many Different Forms
(presented by the Body Image and LGBT SIGs)
Martha Peaslee Levine, MD, Penn State College of Medicine, United States; Margo Maine, PhD, FAED, CEDS,  Institute of Living, United States; Kaley Maureen Roosen, MA, PhD(pending), York University, Canada; Debbie Ann Carlsen, BA, Western Washington University, United States

Stigma can come in many different forms, whether it is weight-stigma or shame related to one’s sexual or gender orientation. The psychological effects of stigma and shame can have long-standing reverberations. This includes the development of eating disorders, impacted body image and an overall struggle for self-acceptance. What does research tell us about the impact of stigma? What are ways that we can influence these phenomena? It is important to consider how to help individuals identify shaming behaviors—if you don’t know what it looks like, how can you stop it? What are ways to help individuals recover from stigma and shaming episodes and become empowered within their lives? How can we as a clinical and scholarly community raise awareness about the damaging effects of stigma and work to create a healthier and accepting environment? The panel will guide the discussion of these and other important questions. Through the discussion, attendees will be able to understand the various forms that body shaming can take and ways that we can help make a positive impact at the individual and global levels.

Learning Objectives:

  • Recognize and describe body shaming and its effects, as well as contexts in which it is likely to occur.
  • Understand how body shaming links into the greater culture or disordered eating, over-emphasis on physical appearance, and appearance-based stigma.
  • Understand and implement strategies for decreasing body shaming in various settings.

Combining FBT and DBT for Adolescents with Eating Disorders (presented by the DBT, FBT and Child & Adolescent SIGs)
Lucene Wisniewski, PhD, FAED, The Emily Program & Case Western Reserve University, United States; Peter Doyle, PhD, Evidence Based Treatment Centers of Seattle, United States; Leslie K. Anderson, PhD, UCSD Eating Disorders Center, United States; Allison K. Chase, PhD, CEDS, AK Chase & Associates, United States; Therese S. Waterhaus, PhD, RD, Willamette Nutrition Source, LLC, United States; Loren E. Prado, MS, LMHC, LPC,  EDCASA, United States

Family Based Treatment (FBT) has accumulated an impressive body of literature showing its effectiveness for adolescent eating disorders. However, the fact remains that it does not work well for a sizable minority of patients. In particular, patients with comorbid Axis I disorders, greater emotional dysregulation, traits of personality disorders and more binge-purging episodes tend to be less likely to remit in FBT. In order to augment standard FBT, some practitioners and clinics have begun to combine FBT with dialectical behavior therapy (DBT) in order to meet the needs of these difficult to treat adolescents. This panel will present the rationale for combining FBT and DBT, the patients for whom this approach should be considered, practical considerations and challenges in implementing the treatment, and two examples of how existing clinics have structured their FBT-DBT programs. The discussants will facilitate a dialogue about contributing developmental issues, role of the dietician, confidentiality, how this approach might provide more support to emotionally dysregulated parents, and other relevant topics.

Learning Objectives:

  • List and describe the characteristics of difficult to treat patients that might benefit from a combination of FBT and DBT.
  • Describe the different strategies of FBT and DBT that might be useful across the continuum of care, including skills groups, phone coaching, motivation building, behavioral parent training and empowering the parents.
  • Name and discuss three practical considerations in designing an FBT/DBT program.

Bringing Technology into Your Practice: using IT tools in Research on and Treatment for Eating Disorders (presented by the Information Technology and Eating Disorders SIG)
Jenna Tregarthen, PGdip, Stanford University/Recovery Record, United States; Marta Ferrer-Garcia, PhD, University of Barcelona, Spain; Perpiñá Conxa, PhD, University of Valencia, Spain; Martha Ireland, PhD, RN, CS, CEDS, DCC, Altering Disordered Eating, Inc. Virtual Therapy Connect, United States; Stephanie Bauer, PhD, University Hospital Heidelberg, Germany; Tara Deliberto, PhD, Weill Cornell Medical College, United States

Growing research demonstrates that internet websites, telephone applications and other technological programs are promising tools to be used in the treatment of eating disorders. Studies show that these IT applications can be beneficial in the prevention of eating disorders, help increase treatment success and provide support in for maintaining therapeutic gains. These IT tools allow for individuals to receive support instead of or in addition to their typical appointments with providers, outside of health care facilities such as over the Internet or via mobile phones and text-messaging.

The use of novel technology also offers flexible treatment and support in order to reach large samples at relatively low cost (e.g. in the fields of health promotion and prevention), to facilitate access to care (e.g., by reducing barriers to help seeking) and to match treatment to the individual needs of patients (e.g., offering or suggesting more support/treatment when needed). This provides alternative ways of treatment delivery for individuals who would not typically seek treatment for different reasons, e.g. due to time, geographic distance, finances, embarrassment, etc.

Although plenty of research is being conducted on these different types of applications, and promising results are published, their dissemination and implementation within the clinical practice remains minimal. In this workshop we want to provide some examples of technological tools that can directly be used by clinicians. Moreover, we will describe how technology can be used to run large-scale research.

Learning Objectives:

  • List a number of different technological tools that may support clinicians or patients in the prevention of, treatment or after-care for eating disorders.
  • Name potential benefits for using virtual reality in the treatment for binge eating, and describe existing virtual reality programs and their specific aims and strategies.
  • Understand the benefits and down-falls of using online tools for data collection for clinical or research purposes.

Weathering The Perfect Storm: Malnutrition, Medical Instability and Pressure to Perform in the  College Athlete (presented by the Medical Care, Sports & Exercise, Universities and Nutrition SIGs)
Jennifer Carlson, MD, Stanford University School of Medicine, United States; Ron Thompson, PhD, FAED, CEDS, The Victory Program, United States; Micaela Hayes, MD, Penn State University, United States

Identifying and caring for the college athlete with disordered eating can be a challenging proposition. Symptoms of disordered eating are often similar to the characteristics of a “good athlete.” Competitive pressures can create conflicts of interest in the care provided to the athletes. Decisions about exercise during eating disorder recovery can be particularly fraught. Nutritional needs of athletes in training differ from those of the average college student. This panel will focus on how to detect and manage disordered eating in the college athletic environment. The goal of this discussion will be to (i) identify stakeholders in the college athletic environment and discuss strategies for mitigating conflicts of interest in the care of student-athletes; (ii) familiarize attendees with current consensus and best-practice guidelines for identifying and managing eating disorders of student-athletes; (iii) clarify the medical risks of the athlete with disordered eating, with particular focus on bradycardia and osteopenia; (iv) and speak to adequate fueling for competition, as well as incorporating athletic activity during recovery.

Learning Objectives:

  • Identify stakeholders in the college athletic environment within whom to collaborate for prevention, early detection and management of disordered eating.
  • Name the current consensus guidelines for identifying and managing eating disorders in athletes
  • Evaluate and counsel the athlete with disordered eating about the risks of bradycardia and issues of hypothalamic suppression and bone health.
  • Advise the athlete on how to achieve adequate fueling for competition and how to best incorporate athletic activity during recovery.

How Plastic Is Your Brain? Ways the Brain May Change With Recovery (presented by the Neuroimaging SIG)
Stefan Ehrlich, MD, Technische Universität Dresden, Germany; Guido Frank, MD, University of Colorado School of Medicine, United States; Jamie Feusner, MD, UCLA, United States; Cara Bohon, PhD, Stanford University School of Medicine, United States
SIG Panel Session Description (for Conference Program, Website and Marketing): One goal of neuroimaging research has been the identification of brain-based targets for treatment. Despite this goal, our ability to change the brain through psychotherapy and/or refeeding is still uncertain. This panel will highlight research findings from neuroimaging before and after therapy or refeeding protocols in eating disorders, as well as in a related and often comorbid disorder, obsessive-compulsive disorder. Three presentations will review new research in this area, while a fourth presentation will provide a discussion of the work and apply it to clinical practice and future directions. These presentations will cover change in brain connectivity and functional processing of reward with weight restoration in anorexia nervosa, as well as change in connectivity and neurometabolite concentration after intensive CBT for OCD.

Learning Objectives:

  • Describe the ways therapy may impact brain function in patients with eating disorders, as well as a related/comorbid disorder: OCD.
  • Explain the potential benefits of these brain changes to patients.
  • Identify gaps in our knowledge and what future research is needed to better understand how the brain may change during recovery from an eating disorder.

Beyond Weight and Vital Signs: An Examination of Clinician, Researcher and Patient Perspectives on What Constitutes Success in Eating Disorder Treatment (presented by the Professionals & Recovery SIG)
Wayne Bowers, PhD, ABPP, FAED, University of Iowa, United States; Carolyn Costin, MA, MEd, MFT, FAED, CEDS, Monte Nido Treatment Centers, United States; Suzanne Dooley-Hash, MD, The Center for Eating Disorders and The University of Michigan, United States; Debra Gill, PhD, Licensed Psychologist, Private Practice, United States; Beth Hartman McGilley, PhD, FAED, CEDS, University of Kansas School of Medicine, United States

Research on the effectiveness of eating disorders (EDs) treatments, and their impact on the recovery process frequently emphasize quantitative, observable outcomes. The vast majority of ED outcome research has focused on easily measured variables such as weight and other physical parameters, ED behaviors, and scores on diagnostic assessment tools, while overlooking the rich and relevant phenomenological experience of the recovering patient. While objective measures necessarily inform the development of evidence-based treatments, they are not sufficient in assessing the experiences of ED recovery which are equally impacted by and vital to successful therapeutic interventions. Clinical experience and qualitative research on ED recovery consistently reveal that patients emphasize the intangible aspects of recovery, such as regaining a sense of identity or self apart from their ED, freedom from ED thoughts, or renewed self-efficacy. The lack of integration between quantitative and qualitative assessments of ED treatment and recovery is a serious gap in ED research and literature and can compromise the development of trust between patients and providers critical to effective practice. This workshop is an effort to bridge this research/practice gap, with the goal of integrating current understandings of ED recovery from differing perspectives. Panelists will discuss ways to assimilate data from both the quantitative and qualitative literature in an effort to move towards a more inclusive understanding and description of successful treatment of an ED.  Panelists will include researchers and clinicians, some with a prior history of an ED. Audience participation will be encouraged with a lively discussion/debate anticipated.

Learning Objectives:

  • Describe successful eating disorder treatment and recovery in terms of objective, measurable outcomes often used in research.
  • Describe successful eating disorder treatment and recovery using more subjective patient-centered terms.
  • Recognize the significant differences between the various perspectives on treatment and recovery and describe at least two methods of reconciling these.

The Role of the Therapeutic Relationship in the Treatment of Eating Disorders (presented by the Psychodynamic & Integrated Psychotherapies SIG)
Judith Banker, MA, LLP, FAED, Center for Eating Disorders, United States; Wayne Bowers, PhD, ABPP, FAED, University of Iowa, United States; Laura Weisberg, PhD, Duke University Medical Center, Duke Center for Eating Disorders, United States; Renee Hoste, PhD, University of Michigan Comprehensive Eating Disorders Program, United States; Mary Tantillo, PhD, RN, PMHCNS-BC, FAED, University of Rochester School of Nursing, United States

Interpersonal issues (e.g. social anxiety, rejection sensitivity, attachment and other relational trauma) are often associated with the development and maintenance of eating disorders. Dropout rates from treatment also tend to be unacceptably high. The quality of the therapeutic relationship stands out in psychotherapy research as one of the most robust variables in predicting treatment outcome. While the majority of therapy models tip their hats at the importance of the therapeutic alliance, how the therapy relationship is viewed and used within the treatment varies in conceptualization and emphasis between different therapeutic approaches. This panel will provide an opportunity to hear from representatives of cognitive-behavioral, experiential-psychodynamic, family based, and relational-cultural schools regarding the role of the therapy relationship within their approaches. Presentations will be followed by a discussion among the panelists and then with the larger audience regarding similarities and differences as well as potential ways of integrating understandings and strategies from different therapy approaches.

Learning Objectives:

  • Identify similarities and differences between the ways in which the therapeutic relationship influences the design and implementation of four types of psychotherapies used in the treatment of adolescents and adults with eating disorders.
  • Describe and utilize specific techniques for enhancing therapeutic alliance, addressing therapeutic ambivalence, and reducing premature dropouts in the psychotherapeutic treatment of adolescents and adults with eating disorders.
  • Recognize and integrate common approaches for managing temperamental and attachment factors that influence therapeutic engagement and outcome.

Intervention and Postvention for Suicide in Residential and Inpatient ED Treatment Settings (presented by the Residential & Inpatient and Suicide SIGs)
Nicole Siegfried, PhD, Castlewood at The Highlands Treatment Center for Eating Disorders, United States, Mary Bartlett, PhD, University of Alabama at Birmingham, United States; Timothy Brewerton, MD, FAED, The Hearth Program for Eating Disorders; Medical University of South Carolina, United States; Keesha Broome, MFT, Monte Nido Treatment Center, United States; Felicia Kolodner, LPC, CEDS, Reflections at Dominion Hospital, United States; Gary Litovitz, Reflections at Dominion Hospital, United States

Suicidality is prevalent among individuals with eating disorders. Patients with eating disorders at inpatient and residential levels of care may be at particular risk for suicide. Clinicians in residential and inpatient centers may require additional training specific to suicide prevention and assessment to adequately address suicidality in this population. Additionally, based on the possibility of a serious suicide attempt or completion occurring at residential and inpatient levels of care, staff also requires training in postvention to facilitate healing for staff and to prevent future attempts by clients. Panelists will provide participants with an overview of the challenges of addressing suicidality in residential and inpatient populations, a review of psychobiological and psychopharmacological factors that may impact suicidality in eating disorder clients, strategic evidence-based tools for assessing suicidality, and postvention techniques for suicide attempts and completions. Finally, the moderator will facilitate discussion among panel members with regard to the road ahead in evaluating and treating suicidality in clients with eating disorders.

Learning Objectives:

  • Identify challenges of addressing suicidality in residential and inpatient populations
  • Describe psychobiological and psychopharmacological factors that may impact suicidality in eating disorder clients
  • Implement strategic evidence-based tools for assessing suicidality and addressing suicide attempts and completions.

Commonalities and Differences in the Treatment of Eating Disorders across Diverse
Populations: Considering Transcultural Issues (presented by the Transcultural SIG)
Marisol Perez, PhD, Arizona State University, United States; Debra Franko, PhD, Northeastern University, United States; Mae Lynn Reyes-Rodriguez, PhD, University of North Carolina at Chapel Hill, United States; Tiffany Rush-Wilson, PhD, LP, PCC-S, CCC, Walden University, United States and Canada

Globalization and immigration is a reality in our contemporary world and the impact of transcultural issues in mental health services is unprecedented. The prevalence and incidence of eating disorders are becoming more widely recognized across diverse populations. As such, topics in the academic and scientific literature have become increasingly more focused on transcultural and diversity issues. While there has been an increase in the published literature, there continues to be some confusion about how theoretical concepts and principles can be applied to transcultural and diversity issues in the eating disorder field. The purpose of this workshop is to identify and operationalize how theoretical constructs can guide clinical interventions in eating disorders work involving transcultural dynamics. To illustrate the salience and benefits of using a transcultural approach, practical applications to relevant case studies will be presented.

Learning Objectives:

  • Define and describe critical terms essential to the intersection between eating disorder and transcultural research.
  • Differentiate between traditional eating disorder treatment methods and culturally sensitive modalities as they relate to the treatment of clinical eating disorder cases potentially categorized as “transcultural”.
  • Formulate treatment goals that would be appropriate for use with eating disorder presentations for clients who have specific cultural and diversity characteristics.