Caring for Chronic Eating Disorders in Outpatients

At the conclusion of this course, participants will be able to: 1. Discuss three prominent themes that emerge from recent empirical evidence regarding the treatment of Anorexia and Bulimia.

2. Identify twenty medical concerns associated with Anorexia and Bulimia, which will enhance the interface with medical providers.

3. Indicate thirteen metabolic and ten psychological effects of malnutrition and starvation.

4. Utilize four evidence-based behavioral techniques to construct data-driven treatment plans.

Given the prevalence of eating disorders, the ever-growing obsession with weight in the United States, and the pejorative meaning ascribed to being overweight in this country, a clinician might justifiably feel that eating-disordered patients, and/or their families, are practically guaranteed to present themselves in their practice. Whether it is a parent concerned about a child, or the eating disordered person themselves, how to best address and manage a home that has come to revolve around food continues to present a clinical challenge. Certainly, eating disorders have been well- documented in medical practices for many years and eating disorder referrals have increased in the past two decades around the world (e.g., Eagles, Johnston, Hunter, Lobban, & Harry, 1995). To illustrate, consider these notable, normative statistics (Maine, 2000; Academy of Eating Disorders, Home - Academy for Eating Disorders ):

• The #1 wish of girls 11-17 years old is to lose weight

• 42% of 1st-3rd grade girls want to be thinner

• 45% of boys and girls in grades 3-6 want to be thinner and 37% have already dieted

• 51% of 9-10-year-old girls feel better about themselves when dieting

• 9% of 9-year-olds have vomited to lose weight

• 81% of 10-year-olds are afraid of being fat

• 53% of 13-year-old girls are unhappy with their bodies

• 78% of 18-year-old girls are unhappy with their bodies

• 4 to 20% of young women practice unhealthy patterns of dieting, purging, and binge-eating

More than 33% Division 1 NCAA female athletes report attitudes and symptoms placing them at risk for anorexia nervosa While it may seem to the lay person that eating disorders are about rigid views of body size and shape, clinicians know that for the individual patient it often turns out that while the onset of the eating disorder may have been in the immediate service of body weight control, the symptoms often end up being more about the management of affect and the control of emotional, rather than biological, issues. In order to give up the habits of mind and behavior that constitute an eating disorder, patients must develop new, more appropriate coping skills. However, the process of therapeutic change can be a long and non-linear endeavor, especially among acute and/or chronic cases. Moreover, the psychological management of severe or chronic eating-disorder cases requires that the clinician be aware of the complex medical sequelae surrounding an eating-disorder diagnosis and prepared to interface with the patient’s medical team. Thus, how to manage issues of eating and weight stabilization can stress even an inexperienced outpatient provider. This course will provide an overview of the prevalence of, and diagnostic criteria associated with anorexia and bulimia. The concomitant medical complications frequently seen among eating- disordered patients will be discussed, including the metabolic, as well as psychological, effects of malnutrition and starvation. Lastly, evidence will be presented to guide the clinician in the construction of data-driven treatment plans and the clinical application of evidence-based behavioral techniques.