SIG Panel Discussions

ICED 2017 Special Interest Group (SIG)
Discussion Panels
Thursday, June 8 from 4:15 PM - 5:45PM

SP 1.1  Prioritizing Suicidal Behaviors in the Treatment of Eating Disorders: Evidence-based Approaches for Assessing, Targeting and Consulting. 
Club A, First Floor

Anne Cusack, BA, MA, PsyD1, Lucene Wisniewski, BA, MS, PhD, FAED2, April Smith, BA, MS, PhD3, Leslie Anderson, BA, MA, PhD1, Lori Prado, LPC
1University of California San Diego, San Diego, California, USA; 2The Emily Program, Cleveland, Ohio, USA; 3Miami University, Oxford, Ohio, USA; 4Center for Dialectical and Cognitive Behavioral Therapies, San Antonio, Texas, USA

Regardless of specific diagnosis, individuals with eating disorders have strikingly high rates of self-injurious behavior and suicidal ideation (SI). It is essential that clinicians working with eating disorders conduct regular and thorough assessments of suicidality and self-harm in their patients, and understand a variety of strategies for intervention with these problems. Dialectical Behavior Therapy (DBT) is a well-validated treatment that was developed specifically for patients with suicidality and self-harm, and it has also been adapted for use with eating disorder patients. Perhaps more than any other treatment for suicidality, DBT has thoroughly articulated a series of treatment strategies for interacting with suicidal patients in a way to minimize risk of immediate suicide, as well as risk of recurrence of suicidality in the future. Additionally, DBT describes how to prioritize the targeting of suicidal behaviors in a context of multiple, comorbid high-risk behaviors. This panel will outline evidence-based approaches to assessment and intervention with suicidality and self-harm, and discuss how to adapt and utilize these strategies with both acutely and chronically suicidal eating disorder patients. We will talk about how to prioritize targeting suicidality, self-harm, and high-risk eating disorder behaviors from a DBT approach. We will outline strategies from DBT for managing both self-harm and suicide risk, such as contingency management, diary card self-monitoring, telephone coaching, and behavioral chain analysis. The panel will also discuss the fears that providers feel when working with these high-risk patients, and self-care strategies for coping and avoiding burnout.

Learning Objectives:

  • Outline evidence-based approaches to assessment and intervention with eating disorder patients experiencing suicidal ideation and self-harm. Highlight DBT strategies to help shape and manage these behaviors.
  • Identify similarities and differences between acutely and chronically suicidal eating disorder patients, while explaining treatment adaptations to fit patient need.
  • Discuss fears that clinicians and mental health providers feel when working with high-risk patients and examine research related to those fears. DBT skills based self-care strategies for treatment providers to cope with and avoid burnout will also be considered. 

SP 1.2  International Forum on Integrated Treatment for Traumatized Eating Disorder Patients with Substance Use Disorders: What We Know and What We Still Need to Figure Out. 
Club C, First Floor

Amy Baker Dennis, PhD, FAED1, Tamara Pryor, PhD, FAED2, Timothy Brewerton, MD, FAED3, Umberto Nizzoli, MPH, PhD4, Christina Tortolani, PhD5
1Dennis & Moye & Associates, Bloomfield Hills, Michigan, USA; 2Eating Disorder Center of Denver, Denver, Colorado, USA; 3Medical University of South Carolina, Charleston, South Carolina, USA; 4University of Bologna and Modena IPU., Bologna, Italy; 5Rhode Island College, Providence, Rhode Island, USA

For the past decade, the mental health field has been moving toward integrated treatment for patients with comorbid and complex disorders. Research funding priorities, in the United States, have changed and are now primarily focused on defining mechanisms of complex behaviors, e.g., endophenotypes, and attempting to discover when, where and how to intervene. In 2010, the eating disorder/substance abuse special interest group was established at AED with the primary mission of exploring how the eating disorder community might better serve this comorbid population. In the past 15 years we have discovered a great deal about the lack of services available in either Substance Abuse or Eating Disorder facilities. And, to date, there are very few centers even attempting to develop fully integrated treatments in either field. This forum is designed to discuss what we have discovered about treating this complex subgroup of eating disorders, and exposing some of the significant barriers treatment providers and programs have encountered when attempting to provide integrated treatment. The remainder of the forum will be a round table discussion (think tank). The forum organizers will pose numerous questions to the audience and encourage discussion and debate about how to treat these patients. The long-range goal is to develop an international research consortium that will collaborate on finding evidence-based protocols for this comorbid population. We encourage treatment providers from around the world to help us move this project forward.

Learning Objectives:

  • Identify the barriers to providing fully integrated treatment for ED/SUD patients in both ED and SUD treatment programs
  • Outline what we have discovered about the ED/SUD patient that impedes successful recovery from both disorders
  • Create an international consortium to promote research on evidence-based interventions for this comorbid population 

SP 1.3  Show Me the (Grant) Money! Identifying and Applying for Funding as a Student and Early Career Researcher* 
Club E, First Floor

Helen Murray, BA1, Lisa Hail, MA2, Adrienne Juarascio, PhD1, Siân McLean, PhD3, Jennifer Thomas, PhD4, Linsey Utzinger, PsyD5, Andrea Goldschmidt, PhD
1Drexel University, Philadelphia, Pennsylvania, USA; 2University of California, San Francisco, San Francisco, California, USA; 3La Trobe University, Melbourne, Australia; 4Massachusetts General Hospital;Harvard Medical School, Boston, Massachusetts, USA; 5Stanford University School of Medicine, Stanford, California, USA; 6Alpert Medical School of Brown University, Providence, Rhode Island, USA

Early career researchers are increasingly reliant on grant funding to develop and sustain their research careers. Grant funding is necessary to promote new knowledge on eating disorders, and importantly, provides integral training opportunities for new investigators. As the funding climate progressively becomes more competitive, mentorship in crafting and obtaining grants is valuable to young professionals. This workshop will create an interactive forum for discussing the process of applying for research grants as a new investigator (i.e., trainee or professional for whom research is a career objective). International panelists representing multiple early career stages—from graduate students to faculty—will discuss challenges and successes in applying for research grants from private foundations, professional organizations, and federal institutions in multiple countries. Panelists will share their successful experiences with several prestigious grant awards (e.g., U.S. National Institutes of Health R01 and K23, and NEDA Feeding Hope for Clinical Research Grant; Australian Rotary Health PhD funding) and discuss important lessons learned from proposals that were not ultimately funded. Panelists will offer unique perspectives on identifying appropriate funding sources; brainstorming research ideas and selecting a project; navigating the application process; tailoring an application to fit the funding opportunity; assembling a mentorship and/or research team; and processing and responding to reviewer feedback. Experiential exercises will mirror critical decision points during the application process, such as constructing effective project aims and significance statements (e.g., audience discussion of mock proposal), and responding to reviews (e.g., breakout group activity to generate responses to difficult grant reviews). By the end of the workshop, attendees will have enhanced skills and competencies necessary for navigating the grant application process.

Learning Objectives:

  • Become familiar with the variety of funding opportunities that are available to student and early career researchers across the globe.
  • Learn how to identify fundable research topics and develop testable hypotheses that will effectively build a programmatic line of research.
  • Understand how to craft components for a successful grant proposal, including resubmissions, that align with the funding source. 

*Please note that this session is NOT NBCC approved for CE and CME credits.

SP 1.4  Optimizing the Dietitian’s Role in Multidisciplinary Treatment
Club H, First Floor

Julia Cassidy, BS, MS, RD1, Douglas Bunnell, PhD, FAED2, Shane Jeffrey, RD3, Leah Graves, RD, FAED4, Marcia Herrin, EdD, MPH, RD, FAED
1Center for Discovery, Los Alamitos, California, USA; 2Chief Clinical Development Officer, Monte Nido & Affiliates, Westport, Connecticut, USA; 3Eating Disorder Outreach Service, Queensland, Australia; 4Veritas Collaborative, Tulsa, Oklahoma, USA; 5Geisel School of Medicine and Children's Hospital at Dartmouth, Lebanon, New Hampshire, USA

Four dietitians from diverse backgrounds and three continents will describe their roles and the challenges of serving on a multidisciplinary team in diverse settings: outpatient solo practice, outpatient center, residential, partial hospitalization, and acute inpatient. The panel will be moderated by a psychotherapist who will review the state of the evidence around the efficacy of multidisciplinary teams in the treatment of eating disorders. The moderator will also interact with the panel and the audience to clarify the often overlapping roles and responsibilities of dietitians and therapists on a treatment team and highlight shared goals.

Learning Objectives:

  • Following the training, participants will be able to identify four ways to improve their role on a multidisciplinary team.
  • Following the training, participants will be able to differentiate the effects and challenges of diverse treatment settings on the role of a dietitian.
  • Following the training, participants will be able to describe the evidence for efficacy of multidisciplinary team treatment. 

SP 1.5  Neural Circuits and the Motivation to Eat 
Meeting Hall 1A, First Floor

Carrie McAdams, MD, PhD1, Christina Wierenga, PhD2, Cara Bohon, PhD3, Stefan Ehrlich, MD4, Amy Harrison, DClinPsy5  
1UT Southwestern Medical School, Dallas, Texas, USA; 2University of California San Diego, San Diego, California, USA; 3Stanford University, Stanford, California, USA; 4TU Dresden, Dresden, Germany; 5Regent's University London, London, United Kingdom

Common to all eating disorders are alterations in the motivation to eat. Here, we review evidence for distortions of the neural circuitry that underlies feeding behaviors. In eating disorders there are both bottom-up differences, related to the sensory experiences associated with consuming food, as well as top-down differences, related to the emotional and cognitive experiences of thinking about, selecting, and deciding on food. Further, the physiological consequence of starvation may impact this circuit. The relative role of bottom-up and top-down disruptions in perpetuating eating disorder behaviors may vary by diagnosis and individual patient. The efficacy of treatments to alter these processes may also vary. Here, we review these circuits and their disruptions in AN, BN, and BED, and provide evidence for neuroplasticity related to both bottom-up and top-down processes. Dr. Ehrlich will provide an overview of the neural circuits involved in feeding behaviors, and how these circuits may be altered by the effects of starvation and re-alimentation. Dr. Wierenga will review evidence for sensory disturbances related to taste and texture in eating disorders. Dr. Bohon will discuss how emotional processing impacts this circuit. Dr. Harrison will review social biases and the evidence for top-down controls during feeding behaviors. Dr. McAdams will moderate the discussion, and provide clinical cases reflective of differences in how this circuit may be disrupted.

Learning Objectives:

  • Recognize the neurocircuits that underlie eating behaviors.
  • Identify differences in these circuits related to different eating disorder diagnoses including anorexia nervosa, bulimia nervosa, and binge-eating disorder.
  • Develop an awareness of how physiology, sensation, emotion, and cognition can change brain function.

SP 1.6  Therapeutic Alliance Across Child/Adolescent Eating Disorder Treatments 
Meeting Hall 1B, First Floor

Mindy Solomon, PhD1, Jocelyn Lebow, PhD2, Kelly Bhatnagar, PhD3, Renee Rienecke, PhD, FAED4, Leslie Sims, PhD, Other2, Roxanne Rockwell, PhD5, Peter Doyle, PhD6  
1University of Colorado School of Medicine, Denver, Colorado, USA; 2Mayo Clinic, Rochester, Minnesota, USA; 3The Emily Program, Cleveland, Ohio, USA; 4Medical University of South Carolina Friedman Center for Eating Disorders, Charleston, South Carolina, USA; 5UC San Diego Eating Disorders Center for Treatment and Research, La Jolla, California, USA; 6Evidence Based Treatment Centers of Seattle, Seattle, Washington, USA

Eating disorder treatment poses a challenge for therapeutic alliance. The symptoms are often ego-syntonic, and consequently, patients tend to present with some degree of ambivalence towards recovery. Alliance is further complicated in working with adolescents. Young patients are often brought to treatment against their preference, and, depending on the provider’s orientation, adolescents may not agree with the goals or methods of therapy. The current evidence-base is fairly conclusive that working within the family system is an essential aspect of providing effective treatment for adolescent eating disorders. Therapeutic alliance, then, involves more than just the patient, which can lead to complicated balancing acts, in which the provider is charged with establishing alliance with both patient and parent without inadvertently colluding with the eating disorder. Evidence-based treatments such as Family Based Treatment (FBT), Dialectical Behavioral Therapy (DBT), or behavior therapy approach this balance differently, though all treatments recognize and attempt to leverage therapeutic alliance in order to affect change. The proposed panel will address the following questions: 1.What are the specific stances of leading evidence-based treatments (FBT, DBT and behavior therapy) on alliance with patients and parents? 2. Is therapeutic alliance with a young eating disorder patient possible? 3.Is alliance with the patient necessary in a family treatment? 4.How should a provider balance establishing alliance without inadvertently colluding with the eating disorder? The proposed panel will be comprised of 3 clinicians specializing in adolescent eating disorders. Dr. Renee Rienecke will speak about alliance in FBT approaches. Dr. Kelly Bhatnagar will speak about alliance in DBT and DBT/FBT combination treatments. Finally, Dr. Leslie Sim will discuss alliance in behavioral family-based approaches.

Learning Objectives:

  • Describe different strategies for establishing provider/patient alliance across child and adolescent treatment modalities.
  • Apply methods of establishing provider/parent alliance across child and adolescent treatment modalities.
  • Recognize the impact of both parent and patient alliance on treatment outcomes. 

SP 1.7  Using & Developing Technology to Improve the Treatment of Eating Disorders Worldwide*
Meeting Hall IV, Second Floor

Sean Kerrigan, MD1, Jennifer Henretty, PhD2, Tara Deliberto, PhD1, Anna-Charlotte Wiberg, BA3, Kristofer Ekstrom, BA3, William Hamilton, BA
1Weill Cornell Medicine & New York-Presbyterian Hospital, Westchester Division, White Plains, New York, USA; 2Center for Discovery, Los Alamitos, California, USA; 3Karolinska Institutet, Stockholm, Sweden

Recent advances in technology present us with the opportunity to improve treatment for people with eating disorders worldwide with the use of telemedicine and novel electronic-based treatments. Presenters on the Technology & Innovations SIG panel will discuss the ways in which they have developed or used technology to improve eating disorder treatment. Kerrigan & Deliberto will review influential research projects on telemedicine in the treatment of eating disorders and discuss its application through a new technological platform, NYP On Demand, currently in use at New York-Presbyterian Hospital. Henretty will then present on a technological tool, The Recovery Report Card, created by a residential treatment center to aid clinicians in the treatment of eating disorders. The Recovery Report Card is a convenient visual tool that can help clinicians with case conceptualization, targeting interventions, tracking progress in treatment, communicating with utilization reviewers, and involving family members. Henretty will guide audience members through using the The Recovery Report Card with clinical vignettes. Similarly, Wiberg & Ekstrom will discuss a smartphone application developed at the Stockholm Center for Eating Disorders that functions as a digital meal diary and behavior tracker. Wiberg & Ekstrom will also discuss the barriers encountered in the development of this application and how they were each overcome. Taken together, the panel presenters for the Technology & Innovations SIG will each discuss ways in which they have used technology to improve the treatment of eating disorders and encourage as well as advise others on how to do the same.

Learning Objectives:

  • Foster an understanding of how to integrate eating disorder technologies and innovations into one’s practice in an effort to improve the standard of eating disorder treatment
  • Reflect on ways to enhance current eating disorder treatments with the use of ancillary emerging technology (e.g. apps)
  • Consider potential barriers to the development and use of technology in the treatment of eating disorders 

*Please note that this session is NOT NBCC approved for CE and CME credits.

SP 1.8  Transdisciplinary Research on Eating Disorder Etiology* 
Meeting Hall V, Second Floor

Karen Mitchell, PhD1, Zeynep Yilmaz, PhD2, Alexis Duncan, PhD3, Tracey Wade, PhD4, Linda Mustelin, PhD5, Cynthia Bulik, PhD6
1VA Boston Healthcare System/Boston University School of Medicine, Boston, Massachusetts, USA; 2University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, USA; 3Washington University, St. Louis, Missouri, USA; 4Flinders University, Adelaide, Australia; 5University of Helsinki, Helsinki, Finland; 6University of North Carolina-Chapel Hill / Karolinska Institutet, Stockholm, Sweden

Objective: Eating disorders (EDs) are multifactorial disorders, with biological, psychological, and social factors contributing to their onset and maintenance. The complexity of EDs underscores the need for transdisciplinary research in order to integrate and move beyond discipline-specific theoretical and methodological approaches to study their etiology. This panel discussion reviews empirical findings from genetic and epidemiologic studies of EDs as well as methodological considerations in conducting transdisciplinary research. Method: Four panelists will discuss research relevant to this topic area. (1) Within the unifying theme of understanding etiology in order to develop better interventions for EDs, Dr. Wade will present on diverse aspects of her research, from etiological models, including gene x environment interactions, interventions, and predicting outcomes of these interventions that can inform model development. (2) Dr. Mustelin will present on methods to combine twin data and epidemiologic data to investigate the etiology of eating disorders. (3) Dr. Yilmaz will discuss how epidemiological data could aid in following up on significant genomic findings in eating disorders and present examples from the Avon Longitudinal Study of Parents and Children. (4) Dr. Bulik’s presentation will focus on methodological considerations and how to assemble a transdisciplinary team in genetic epidemiology research. Discussion: The etiological and translational implications of this research will be discussed.

Learning Objectives:

  • Participants will identify methodological considerations in transdisciplinary research on eating disorders.
  • Participants will interpret genetic and environmental findings regarding the etiology of eating disorders.
  • Participants will demonstrate understanding of the advantages of conducting transdisciplinary research on eating disorders. 

*Please not that this session is NOT NBCC approved for CE and CME credits.

SP 1.9  Athletes with Disordered Eating and Exercise: Key Issues, Opportunities, and Challenges
Terrace 2, Second Floor

Carolyn Becker, PhD, FAED1, Karin de Bruin, PhD2, Marianne Martinsen, PhD3, Tiffany Stewart, PhD4, Jorunn Sundgot-Borgen, PhD5, Lisa Smith Kilpela, PhD6
1Trinity University, San Antonio, Texas, USA; 2University of Amsterdam, Amsterdam, Netherlands; 3Hedmark University, Lillestrøm, Norway; 4Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA; 5Norwegian School of Sport Sciences, Olso, Norway; 6University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA

The overarching aim of this SIG panel is to provide participants with the chance to interact with experts in the areas of eating disorders, body image, and sport and to address aspects of diagnosis, treatment, and prevention of eating disorders and associated risk factors and syndromes (e.g., contextual body image, Relative Energy Deficiency in Sport (REDS), and risk assessment in the return to play decision) in athletes. This session will include a moderated panel designed facilitate dialogue on the challenges and opportunities in working with athletic populations, to provide lessons learned from those who have successfully partnered with athlete organizations, and to elucidate future directions needed in this field. To maximize the interactive nature of this panel, initial “jumping off” questions will be generated by the Sport and Exercise SIG co-chairs with input from SIG members via the AED online community; feedback will be gathered in the spring to maximize the up-to-date nature of the panel. In addition, ample time will be allocated during the panel for participants to ask questions and guide discussion. In summary, this panel will not include a series of talks followed by questions but will be an interactive discussion between the panelists, the online SIG community (via the initial questions) and audience participants. Format: Specific presentations will not be made. Rather, speakers will speak briefly about their area of expertise. This will be followed by discussion points facilitated by moderator and fielding of audience questions, group and audience discussion.

Learning Objectives:

  • Identify and define key issues in the diagnosis, treatment, and prevention of eating disorders and associated risk factors in athletes.
  • Facilitate discussion to address important aspects included in treatment, education, and research with athletic populations.
  • Evaluate challenges and opportunities in working with athlete populations and organizations, including strategies for maximizing opportunities and overcoming barriers in working with this population. 

SP 1.10 Anorexia Nervosa Narratives: Patients Perspective and Primary Caregivers
Forum Hall, Second Floor
Simultaneously translated from Spanish to English

Special Invited Speaker: Laura Gonzalez Macias, PhD
Hospital Medica Sur, Ciudad de Mexico, Mexico

Considering that Anorexia Nervosa (AN) is the only mental suffering that leads to death by compromising the body`s integral functioning due to the nutritional status, and considering that arises during adolescence, family plays a major role in the suffering maintenance, the investigation objective is to get to know the narratives about Binge-Purge subtype of Anorexia Nervosa, from the sufferer`s point of view (patient) and from the people that coexist with it (parents), the purpose is to obtain information of four different moments of the disorder; the symptom appearance, the treatment itself, symptomatology remission and the relapse significance. A structural analysis was developed based on qualitative investigation as exploration method and the narrative analysis for data interpretation. It was observed that family relations condition the way the ANBP symptom appears, through overprotection mechanisms and negligent care, driven by a mother with a great need of taking control and an absent father, this family dynamic results on symbiotic relations with emotional emptiness that do not allow child’s individuation, this dynamic is not the cause of ANBP, but it is a maintenance factor. According to every family member's life situation, the ANBP has a different meaning but they all conclude that it is a difficulty on emotions management and relapse is a part of the treatment that leads to observing the needed changes for recovery.

Learning Objectives:

  • Learn the importance of support nets on Patients with ANPB
  • Identify different moments on patients evolution
  • Acknowledge the importance of relapse