THE ASSESSMENT & TREATMENT OF EATING DISORDERS IN AN - PowerPoint PPT Presentation

THE ASSESSMENT & TREATMENT OF EATING DISORDERS IN AN OUTPATIENT SETTING PRESENTED BY: BRANDI STALZER, LIMHP , LPC

CONTENTS • JUSTIFICATION FOR OP EATING DISORDER TREATMENT • EATING DISORDER BEHAVIORS & THEIR FUNCTION • INFORMATION TO OBTAIN IN ASSESSMENT • LEVELS OF CARE & WHEN TO REFER • ROLES ON THE TREATMENT TEAM • EMPIRICALLY SUPPORTED TREATMENTS • EVIDENCED BASED TREATMENTS FOR CO-OCCURING DISORDERS • REFERENCES

JUSTIFICATION FOR OP EATING DISORDER TREATMENT

JUSTIFICATION FOR OP EATING DISORDER TREATMENT Striegel-Moore, R. H., Leslie, D., Petrill, S. A., Garvin, V., & Rosenheck, R. A. (2000). One-year use and cost of inpatient and outpatient services among female and male patients with an eating disorder: evidence from a national database of health insurance claims. International Journal of Eating Disorders, 27(4), 381-389.

JUSTIFICATION FOR OP EATING DISORDER TREATMENT Toulany, A., Wong, M., Katzman, D. K., Akseer, N., Steinegger, C., Hancock-Howard, R. L., & Coyte, P. C. (2015). Cost analysis of inpatient treatment of anorexia nervosa in adolescents: hospital and caregiver perspectives. CMAJ open, 3(2), E192.

JUSTIFICATION FOR OP EATING DISORDER TREATMENT Toulany, A., Wong, M., Katzman, D. K., Akseer, N., Steinegger, C., Hancock-Howard, R. L., & Coyte, P. C. (2015). Cost analysis of inpatient treatment of anorexia nervosa in adolescents: hospital and caregiver perspectives. CMAJ open, 3(2), E192.

EATING DISORDER BEHAVIORS & THEIR FUNCTION

EATING DISORDER BEHAVIORS & THEIR FUNCTION A transdiagnostic view is taken. • Problems with separate diagnostic categories include: Clients "migrate" between diagnoses • Some clients with behavioral patterns do not fit into diagnostic • criteria • Implications of separate diagnostic categories is that separate treatment approaches are developed for each disorder • Eating disorders are viewed as a single diagnostic category with common maintaining mechanisms. Over-evaluation of shape and weight and their control as main • mechanism Fairburn, C. G. (2009). Cognitive behavior therapy and eating disorders.

EATING DISORDER BEHAVIORS & THEIR FUNCTION Overeating behaviors • Binge-eating: specific episode of eating an objectively large amount of food where the individual experiences a sense of loss of control. • Subjective binge: a binge in which the amount consumed does not meet the normal standards of a binge, but is perceived by the individual as a binge. • Grazing: the tendency to eat continuously at food over a longer duration of time than experienced in a binge. Fairburn, C. G. (2009). Cognitive behavior therapy and eating disorders.

EATING DISORDER BEHAVIORS & THEIR FUNCTION Restrictive behaviors • Calorie-counting: the act of monitoring the caloric intake of food to keep a running total. • Debting: creating a caloric deficit to accommodate for later eating • Delayed eating: prolonging eating as a means of weight control • Dietary restraint: limiting the amount of food consumed • Dietary restriction: true under-eating in a physiological sense • Dietary rules: highly specific dietary goals • Food avoidance: limiting specific types of foods because of a perception that they will break dietary rules Fairburn, C. G. (2009). Cognitive behavior therapy and eating disorders.

EATING DISORDER BEHAVIORS & THEIR FUNCTION Compensatory behaviors • Excessive exercise: exercising to an extent that energy needs are not met • Self-induced vomiting: a type of voluntary purging behavior; can be done as a non-compensatory behavior • Laxative misuse: a purging behavior involving the use of laxatives, usually stimulant type Fairburn, C. G. (2009). Cognitive behavior therapy and eating disorders.

EATING DISORDER BEHAVIORS & THEIR FUNCTION Shape control behaviors • Body Image Disparagement: viewing oneself as disgusting or loathsome • Body Dissatisfaction: a more common experience of disliking one’s appearance or body • Body checking: the act of checking features of the body through methods such as pinching, excessive weighing, mirror checking, measuring, etc • Body avoidance: the avoidance of situations that one may experience body image disparagement Fairburn, C. G. (2009). Cognitive behavior therapy and eating disorders.

EATING DISORDER BEHAVIORS & THEIR FUNCTIONS Wedig, M.M. & Nock, M.K. (2010). The functional assessment of maladaptive behaviors: A preliminary evaluation of binge eating and purging among women. Psychiatry Research, 178(3), 518-524.

EATING DISORDER BEHAVIORS & THEIR FUNCTION Wedig, M.M. & Nock, M.K. (2010). The functional assessment of maladaptive behaviors: A preliminary evaluation of binge eating and purging among women. Psychiatry Research, 178(3), 518-524.

EATING DISORDER BEHAVIORS & THEIR FUNCTION • Core psychopathology impacts the over-evaluation on shape and weight: • Perfectionism • Low self-esteem • Interpersonal problems Fairburn, C. G. (2009). Cognitive behavior therapy and eating disorders.

INFORMATION TO OBTAIN IN ASSESSMENT

INFORMATION TO OBTAIN IN ASSESSMENT • A typical evaluation for the treatment of eating disorders includes: Clinical Interview ● Objective Measures ● Nutrition Assessment ● Medical Evaluation ● Family Assessment ●

INFORMATION TO OBTAIN IN ASSESSMENT Topics Addressed in the Initial Evaluation Interview 4. Development and evolution of the problem 1. What the client would like to be different 5. Co-existing psychiatric and general medical problems 2. Current problems with eating (as perceived by client and others), including: 6. Brief personal history 1. Eating habits 7. Family psychiatric and general medical history 2. Methods of shape and weight control 8. Personal psychiatric and general medical 3. Views on shape and weight history 3. Impairment resulting from the eating problem 9. Current circumstances and plans 1. Psychosocial impairment 10. Attitude to attendance and treatment 2. Physical impairment Fairburn, C. G. (2009). Cognitive behavior therapy and eating disorders.

INFORMATION TO OBTAIN IN ASSESSMENT Measure Constructs Assessed Scoring & Interpretation Eating Attitudes Test (EAT -26) Anorexia Nervosa symptoms Responses ranging from "never" (Garner Olmsted, Borh & - Dieting to "always" rates on 6-point Likert Garfinkel, 1982) - Bulimia scale; Cutoff > 20 indicative of - Oral Control eating disorder Eating Disorders Examination Global Eating Disorder Severity 36 items with response ranging Questionnaire (EDE-Q) (Fairburn - Restraint from 0 "never" to 6 "every day" & Beglin, 1994) - Eating Concern over previous 28 days; items - Shape Concern scores averaged; Scores between - Weight Concern 4 and 6 are considered clinically significant Clinical Impairment Assessment Secondary Psychosocial 16 items with responses ranging (CIA) (Bohn & Fairburn, 2008) Impairment from 0 "not at all" to 3 "a lot" over previous 28 days; item scores Grilo, C. M., & Mitchell, J. E. (Eds.). (2011). The treatment of eating disorders: A clinical handbook . Guilford Press. averages

INFORMATION TO OBTAIN IN ASSESSMENT Measure Constructs Assessed Scoring & Interpretation Eating Disorders Inventory (EDI- Eating Disorder Risk Scales Cutoff of 14 for Drive for 3) (Garner, 2004) - Drive for Thinness Thinness recommended for - Bulimia screening purposes - Body Dissatisfaction Psychological Scales - Low Self-Esteem - Personal Alienation - Interpersonal Insecurity - Interpersonal Alienation - Introceptive Deficits - Emotional Dysregulation - Perfectionism - Asceticism - Maturity Fears Garner, D. M. (2004). EDI 3: eating disorder inventory-3: professional manual . Lutz, FL: Psychological Assessment Resources.

INFORMATION TO OBTAIN IN ASSESSMENT Medical evaluations may include (particularly in 5. Thyroid function tests (T3, T4, and TSH) AN): 6. Albumin, transferrin 1. Vital signs (pulse, blood pressure, 7. BUN/creatinine temperature, respirations) 8. Urinalysis, stool guaiac 2. Electrolytes, glucose, calcium, magnesium, phosporus 9. Liver function tests (SGOT, SGPT, bilirubin) 3. Amylase 10. Bone density scan 4. Complete blood count with differential 11. Electrocardiogram Grilo, C. M., & Mitchell, J. E. (Eds.). (2011). The treatment of eating disorders: A clinical handbook . Guilford Press.

LEVELS OF CARE & WHEN TO REFER

LEVELS OF CARE & WHEN TO REFER • Consider three factors when referring: • When a higher level of care is recommended (see following slides) • When you are unable to coordinate care (see following section) • When you have treatment interfering beliefs, biases, or behaviors