ICED 2017 Plenaries

Plenary I (Treatment)
Thursday, June 8, 9:00AM - 10:45AM

Setting the Stage: Clinical Staging and Personalized Approaches to Treating Eating Disorders
Chairs: Kelsie Forbush, PhD and Kelly Bhatnagar PhD

Clinical Staging across the Illness Spectrum: From Emerging Psychopathology to Chronic and Enduring Psychopathology
Professor Patrick McGorry, MD, PhD, FRCP, FRANZCP, Orygen, The National Centre of Excellence in Youth Mental Health, Victoria, Australia

This Time it’s “Personal”: Adapting Empirically Based Therapies in the Era of Personalized Medicine
Daniel Le Grange, PhD, FAED, University of California, San Francisco, San Francisco, CA, USA

Get “SMART”: Using Innovative Methods to Test Sequential (Stepped) versus Simultaneous Clinical Change in Eating Disorders
Carlos Grilo, PhD, Yale University School of Medicine, New Haven, CT, USA

Discussant: Embarking on new adventures – Are we ready to use a staging model to map the course of eating disorders? 
Heather Thompson-Brenner, PhD, FAED, Boston University, Somerville, MA, USA

In recent years, there has been growing concern over the utility of existing diagnostic procedures in psychiatry. Namely, the procedures categorize symptoms appearing only in the later stages of illness when it has already been consolidated. Some believe this method hampers the development of treatments geared towards earlier forms of the illness and thus, increases the risk of illness progression (Treasure et al., 2015). Clinical staging offers an alternative to conventional diagnostic practice in that it a) defines the extent of a progression of a disorder at a particular point in time and b) identifies where a person lies at any given time along the continuum of the course of an illness (McGorry et al., 2007). Clinical staging has the potential to allow clinicians to select treatments relevant to earlier stages of an illness and assumes that such interventions will be more effective than treatments delivered later in the course of illness (McGorry et al., 2007). The clinical staging framework has been used with some success in other psychiatric disorders (Cosci et al., 2013; Hickie et al., 2013; Scott et al., 2013), which begs the question – Is it time for a staging model to map the course of eating disorders? This plenary strives to examine the evidence surrounding this question and explore treatment implications that may come about as a result.

Learning Objectives
The goals of this plenary are to:

1. Explore the utility of using a staging approach to map the course of illness in eating disorders. 
2. Examine how a staging or adaptive (personalized) model may influence treatment recommendations and approaches during different phases of illness. 
3. Describe new methods for testing personalized approaches and propose ways in which these methods could be applied to eating disorders.

Plenary II (Wildcard)
Thursday, June 8, 11:15AM - 1:00PM

Atypical Eating Disorders: Addressing the Overlooked and Misunderstood
Chairs: Angela Celio Doyle PhD and Leah Dean

Looking for Signs and not Symptoms: Improving Precision in the Measurement of Eating Disorders
Kamryn T. Eddy, PhD, FAED, Massachusetts General Hospital, Boston, MA, USA

Never Too Old for Eating Disorders: Eating Disorder Onset and Symptoms in Middle Aged Men and Women
Hans Wijbrand Hoek, MD, PhD, FAED, Parnassia Psychiatric Institute, The Hague, The Netherlands

Seeing Atypical Eating Disorders in Young Children: Identification and Treatment of Atypical Eating Disorders in the Clinic
Richard E. Kreipe, MD, FAED, University of Rochester Medical Center, Rochester, NY, USA

Discussant: Can atypical presentations of eating disorders be better understood and treated?
Pamela K. Keel, PhD, FAED, Florida State University, Tallahassee, FL, USA

Atypical eating disorders comprise a large proportion of eating disorder syndromes. DSM 5 changes have more effectively captured varied presentations of disordered eating with the inclusion of Avoidant/Restrictive Food Intake Disorder (ARFID) and named examples of Other Specified Feeding or Eating Disorder (OSFED); however, there remains great heterogeneity within these groups and in the category of Unspecified Feeding and Eating Disorders. Dedicated research on these more unusual patterns of disordered eating and related experiences is essential for addressing suffering within individuals with atypical presentations and may help to create more valid and reliable phenotypes as more research integrates genetics, neuroscience and behavioral components. In this plenary, speakers will present on our growing understanding of eating disorder phenotypes and chart a course for how the field will forge ahead in the assessment, treatment, and further study of atypical eating disorders.

Learning Objectives
Participants will be able to: 

1. Describe efforts being made to increase precision in the measurement of eating disorders using Research Domain Criteria (RDoC) and what impact this might have on treatment. 
2. Summarize the research on older men and women with later-onset eating disorders as well as young children for more optimal assessment and treatment. 
3. Synthesize key topics in the understanding of atypical eating disorder phenotypes, taking into consideration the contributions of genetics, neuropsychiatry, and behavioral methods.

Plenary III (Sociocultural)
Friday, June 9, 4:00PM - 5:30PM

Reframing Conflict as Collaboration: Bringing Together Food, Weight, and Eating Science
Chairs: Kendrin Sonneville ScD RD LDN and Rachel Rodgers PhD

The Intersection between Weight-Related Disorders
Caroline Braet, PhD, University of Gent, Gent, Belgium

Eating Disorders, Obesity, and Addiction: A Critical Analysis
G. Terence Wilson, PhD, Rutgers University, Piscataway, NJ, USA

Can Addiction and Eating Disorder Perspectives Coexist?
Ashley N. Gearhardt, PhD, University of Michigan, Ann Arbor, MI, USA

Discussant: Collaborative Conversations Towards Successful Solutions
Kelly D. Brownell, PhD, Duke University, Durham, NC, USA

Eating disorders and obesity share both clinical and conceptual overlap, and frequently are linked to the broader sociocultural discourse around weight and eating. Are our goals contradictory or are we really all trying to achieve the same outcomes, but just saying the same thing in different ways? What can we learn from other fields, and how can we best integrate our efforts? How does the “noise” around food, nutrition, appearance, fitness, and health created by for-profit industry create a confusing and harmful sociocultural context? This session aims to start a conversation that will contribute to reframing issues around risk factors, prevention, and treatment of eating and weight-related disorders. Specifically, this plenary will aim to discuss the overlap between obesity and eating disorders and how this comorbidity may be produced by the sociocultural context, and how this can inform our understanding and efforts to address weight-related disorders. In addition, the usefulness of food addiction models in conceptualizing the role of the food industry in the emergence of weight-related disorders will be considered and argued. Finally, these issues will be brought together in a discussion of how different aspects of the environment contribute to eating and weight-related concerns, and the role of the eating disorder field in helping to advance the conversation and develop successful collaborative solutions.

Learning Objectives
Participants will be able to:

1. Understand the role of the sociocultural context, including appearance stereotypes, in the comorbidity of eating disorders and obesity. 
2. Understand the food addition model and its potential implications for eating disorders.
3. Critically analyze the empirical evidence in support of, or not, the food addition model. 
4. Understand the need for collaborative conversations with the aim of decreasing sociocultural pressures contributing to eating disorders and other comorbid disorders.

Plenary IV (Biology)
Saturday, 9:00AM - 10:45AM

Neuroimaging and Beyond: The Clinical Value of Eating Disorders Brain Research
Chairs: Anja Hilbert PhD, Annemarie van Elburg MD PhD FAED, and Hana Papezova MD PhD

Background of Neuroimaging and Clinical Applications: Evidence of These Approaches in Psychiatric Disorders and Their Application to Eating Disorders
Damiaan Denys, MD PhD, Amsterdam Medical Center, University of Amsterdam, Amsterdam, The Netherlands

Empirical Evidence from Brain-Directed Interventions and/or Treatments for Eating Disorders
Hans-Christoph Friederich, MD, Medical University Hospital Dusseldorf, Dusseldorf, Germany

An Overview of New Research into Food Choice and Habit Formation and the Effect Seen in the Brain
Joanna Steinglass, MD, Columbia University, New York, NY, USA

Discussant: Neuroimaging in Eating Disorders – Has the Money Been Worth it for Our Patients?
Ursula Bailer, MD, FAED, Medical University of Vienna, Vienna, Austria

Over the past decade, research on neuroimaging of eating disorder-related brain circuitry has been accruing. Volumetric evidence suggests increased volumes of the left medial orbitofrontal gyrus rectus and of the right insula in anorexia nervosa and bulimia nervosa, deemed important in the regulation of food intake and interoception. The white matter integrity of the fornix, a limbic pathway involved in the regulation of food intake and emotions was decreased. Functional brain imaging studies found reward pathways to be involved in the processing of food stimuli, including insula and striatum, which could contribute to over- and undereating in eating disorders. The main aim of this plenary will be to provide an overview of the clinical value of neuroimaging research on eating disorders. The contributions and limitations of neuroimaging techniques, such as functional magnetic resonance imaging (fMRI), positron emission tomography, and single photon emission computed tomography will be discussed. Non-invasive intervention strategies, including realtime fMRI or EEG neurofeedback, repetitive transcranial magnetic stimulation, and transcranial direct-current stimulation will be presented. Brain-directed psychological treatments such as cognitive remediation therapy will be highlighted. These approaches will be discussed against the background of recent evidence, while addressing practical questions. Their potential as therapeutic tools in brain-directed treatment of eating disorders will be discussed, focusing on applicability and ethics. These approaches will be discussed against the background of their meaning for clinical use.

Learning Objectives
Participants will be able to:

1. Understand the scope and clinical implications of neuroimaging research in the eating disorders. 
2. Understand food choice and habit formation in relation to brain research. 
3. Understand the scope, content, and effects of non-invasive brain-directed interventions and brain-oriented psychological treatments as well as their ethical implications. 
4. Understand necessary adaptations for translation of brain research into practice.