LENSES
                         That bring eating disorder treatment into focus.

Friday, March 13, 2009
No Laughing Matter
Friday, March 13, 2009
Terry Schiavo
                               Ice Tea
                               Bulimia
                         Medic...
Major Diagnoses


              BED - Binge Eating Disorder

              AN - Anorexia Nervosa

              BN - Bulim...
BED - Depression, anxiety, adjustment disorder,
              dependency issues.

              AN - Obsessive Compulsive ...
ASSESS

              Anorexia Nervosa: Differential Diagnosis &
              Workup http://emedicine.medscape.com/
     ...
FOUR AREAS OF INTERVENTION

                    Eating and exercising behaviors.

                    Body image.

       ...
LENSES give:
                         clarity & focus


Friday, March 13, 2009
Friday, March 13, 2009
Binge Eating Disorder

              ABANDONMENT

                    Pleasant & compliant.

                    Distorted...
Binge Eating Disorder
              Diagnosis - Depression, anxiety, dependency issues & weight issues bring the
         ...
BED Treatment through the lens of
                                    ABANDONMENT

              Weight History to identif...
BED Treatment through the lens of
                                    ABANDONMENT

              Cognitive Behavioral Ther...
BED Treatment through the lens of
                                  ABANDONMENT

              Teach the use of mirror wor...
Anorexia

              CONTROL

              Severe Restricting or Cessation of
              Eating

              In T...
ANOREXIA

                 Diagnosis - client usually comes with suspicion of diagnosis from referring source.

          ...
AN Treatment through a lens of
                                          CONTROL



                Establish rapport usin...
AN Treatment - Continued

              NEVER pressure her to eat.

              Assist her in understanding why others a...
AN Treatment - continued

              Needs - help the client to realize it is acceptable to have needs.

              ...
AN Treatment - continued
              MOST IMPORTANT

              DON’T PANIC!!!!

              Working with anorexics...
The devestation of eating disorders.




              http://www.youtube.com/watch?v=I6e98OlDclU




Friday, March 13, 20...
Bulimia

              TRUST

              Bingeing & Purging

              Inconsistent

              Unreliable

    ...
BULIMIA
           Diagnosis - Client will come from other therapists and have seen many therapists.
           Client wil...
BN Treatment through a lens of
                                          TRUST


              Establish rapport. Remember...
BN Treatment continued

              Prescribe not bingeing, with permission to binge.

              Prescribe not purgi...
BN Treatment continued

              Recognize client’s loathing of her body.

              Recognize client’s suspicion...
BN Treatment continued

             Teach emotions 101. Dialectical Behavior Therapy is helpful. Clients have been
      ...
A
                         C
                         T



Friday, March 13, 2009
Abandonment
                           Control
                            Trust



Friday, March 13, 2009
Binge Eating Disorder
                           Anorexia Nervosa
                           Bulimia Nervosa




Friday, M...
Eating Disorders Cause Suffering and Death
                                       You Can Help
                           ...
Tish Vincent, MSW, LMSW, ACSW, CAAC
                             790 W. Lake Lansing Rd., Ste. 300
                       ...
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Eating Disorder presentation 03-13-09

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  • Lenses 03 10 09 Linen

    1. 1. LENSES That bring eating disorder treatment into focus. Friday, March 13, 2009
    2. 2. No Laughing Matter Friday, March 13, 2009
    3. 3. Terry Schiavo Ice Tea Bulimia Medical Negligence 1 Million Dollars Friday, March 13, 2009
    4. 4. Major Diagnoses BED - Binge Eating Disorder AN - Anorexia Nervosa BN - Bulimia Nervosa Friday, March 13, 2009
    5. 5. BED - Depression, anxiety, adjustment disorder, dependency issues. AN - Obsessive Compulsive Disorder. Family frustrations and fears, physician’s referral due to weight loss. Client feels nothing is wrong. BN - Personality disorder, extreme depression. Referral from therapist colleague, self-referral. “I believe you are the only person who can help me!” Friday, March 13, 2009
    6. 6. ASSESS Anorexia Nervosa: Differential Diagnosis & Workup http://emedicine.medscape.com/ article/286063-overview (in handout) Michigan Eating Disorder Screening Instrument (MEDSI) Friday, March 13, 2009
    7. 7. FOUR AREAS OF INTERVENTION Eating and exercising behaviors. Body image. Emotions. Relationships. Friday, March 13, 2009
    8. 8. LENSES give: clarity & focus Friday, March 13, 2009
    9. 9. Friday, March 13, 2009
    10. 10. Binge Eating Disorder ABANDONMENT Pleasant & compliant. Distorted Body Image Use Eating as Source of Comfort & Distraction Friday, March 13, 2009
    11. 11. Binge Eating Disorder Diagnosis - Depression, anxiety, dependency issues & weight issues bring the client to treatment. Referral Nutritionist Overeaters Anonymous (12 Step group for compulsive eating) Group therapy addressing BED. Medications from Primary Care Physician or Psychiatrist Exercise Classes for Large Bodied People Friday, March 13, 2009
    12. 12. BED Treatment through the lens of ABANDONMENT Weight History to identify pertinent themes. Teach methods of postponing a binge and becoming more aware of feelings. Encourage engaging in activities of interest that one is putting off until thinner. Cognitive Behavioral Therapy to challenge distortions. Trauma therapy. Process the client’s efforts to be compliant and agreeable with the therapist. Teach emotional awareness, acceptance, containment and communication. Give permission to client to experience and express anger. Friday, March 13, 2009
    13. 13. BED Treatment through the lens of ABANDONMENT Cognitive Behavioral Therapy to challenge distortions. Trauma therapy for dissociative symptoms. Solution Focused Therapy. Process the client’s efforts to be compliant and agreeable with the therapist. Challenge compliance gently as a wish to maintain what the client experiences as a fragile connection. Teach emotional awareness, acceptance, containment and communication. Create a predictable safe therapeutic environment while encouraging client to differentiate, express anger and declare expectations. Friday, March 13, 2009
    14. 14. BED Treatment through the lens of ABANDONMENT Teach the use of mirror work to recognize and accept body as it is not as client imagines it is. Encourage involvement in exercise. Encourage forms of bodywork with appropriate practitioners such as massage and yoga. Teach the use of the hunger scale. Teach methods of limiting food, such as choosing small portions of three types of food and eating them slowly then choosing more. Doing a food history with foods a person feels is an inevitable binge food. Friday, March 13, 2009
    15. 15. Anorexia CONTROL Severe Restricting or Cessation of Eating In Therapy Against Their Will Terrified of Eating and of Gaining Weight Distortion Believing They Are Fat Despite Emaciation Friday, March 13, 2009
    16. 16. ANOREXIA Diagnosis - client usually comes with suspicion of diagnosis from referring source. Assemble treatment team. Nutritionist, IMMEDIATELY!!!!! Psychiatrist & Primary Care, SOON! Evaluate for immediate hospitalization in eating disorder unit. Eating disorder group, if one is available. Continue evaluating need for hospitalization throughout treatment. Friday, March 13, 2009
    17. 17. AN Treatment through a lens of CONTROL Establish rapport using Motivational Interviewing strategies. Explain relationship between restricting and an effort on client’s part to establish control over something. Wonder about what she feels out of control of together. Weight History to begin the detective work of understanding. Establish and maintain an aura of acceptance of the symptoms and recognition that others are freaking out about her eating. Friday, March 13, 2009
    18. 18. AN Treatment - Continued NEVER pressure her to eat. Assist her in understanding why others are frightened for her. Invite family members in for family therapy and extract their commitment to not pressure her in her presence. Conduct ongoing family therapy to assist the family in learning appropriate communication strategies and boundaries. Friday, March 13, 2009
    19. 19. AN Treatment - continued Needs - help the client to realize it is acceptable to have needs. Needs - help the client to sort out how to get some of their needs met. Fear of Being Fat - This fear exists at delusional proportions. Discuss meanings client has attached to body size. Explain that angst about life has gotten displaced onto body size. Cognitively challenge this as a distortion and teach client to do the same. Friday, March 13, 2009
    20. 20. AN Treatment - continued MOST IMPORTANT DON’T PANIC!!!! Working with anorexics is frightening. The therapist will feel overwhelmed and experience extreme helplessness. Reach out to knowledgeable colleagues. Persevere. As you learn to contain your helplessness and hopelessness and proceed your client will learn to do the same and you will be on your way to recovery. Friday, March 13, 2009
    21. 21. The devestation of eating disorders. http://www.youtube.com/watch?v=I6e98OlDclU Friday, March 13, 2009
    22. 22. Bulimia TRUST Bingeing & Purging Inconsistent Unreliable Risk of Premature End to Therapy Loathing of Body, Emotions and Need for Closeness Friday, March 13, 2009
    23. 23. BULIMIA Diagnosis - Client will come from other therapists and have seen many therapists. Client will present as personality disordered, borderline, histrionic or even bipolar. Referral Nutritionist. Medication consult with psychiatrist. Primary care physician. Couples therapist. Possible need for referral to inpatient trauma unit. Friday, March 13, 2009
    24. 24. BN Treatment through a lens of TRUST Establish rapport. Remember this person has extreme issues with trust. Do an extended and careful history of all previous treatments and predict that the client will have a strong impulse to prematurely terminate this treatment. Obtain client’s promise to discuss this impulse with you before acting on it. Explain and educate that bulimia develops when certain individuals are subjected to extremely untrustworthy people or environments. Pay careful attention to issues of timing, phone calls, and other contact. Development of trust is built on therapist acting in predictable ways. Friday, March 13, 2009
    25. 25. BN Treatment continued Prescribe not bingeing, with permission to binge. Prescribe not purging, with permission to purge. Refer to nutritionist and maintain regular contact with the nutritionist to discuss client progress and compare notes. Develop an understanding that bingeing and purging are symbolic for how difficult it is for client to take good things in and keep them. Friday, March 13, 2009
    26. 26. BN Treatment continued Recognize client’s loathing of her body. Recognize client’s suspicion about caring. Weight History to understand weight fluctuations and changes in eating behaviors along with stresses and betrayals in life. Encourage physical self care: appropriate exercise, massage, use of lotions, and safe, nonsexual touch. Friday, March 13, 2009
    27. 27. BN Treatment continued Teach emotions 101. Dialectical Behavior Therapy is helpful. Clients have been traumatized by emotions of others and are often fearful of their own emotional experience. Trust is the belief in another person’s integrity. Help client hope that as they integrate they will choose more trustworthy people to relate with. Conduct limited family sessions for the purpose of education about the eating disorder and refer to colleague for more extensive work. Friday, March 13, 2009
    28. 28. A C T Friday, March 13, 2009
    29. 29. Abandonment Control Trust Friday, March 13, 2009
    30. 30. Binge Eating Disorder Anorexia Nervosa Bulimia Nervosa Friday, March 13, 2009
    31. 31. Eating Disorders Cause Suffering and Death You Can Help Please Do! Friday, March 13, 2009
    32. 32. Tish Vincent, MSW, LMSW, ACSW, CAAC 790 W. Lake Lansing Rd., Ste. 300 East Lansing, MI 48823 517.332.2433 (phone) 517.332.4311 (fax) TVinc1988@gmail.com Friday, March 13, 2009

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