The workshop discusses the prevalence of co-occurring anxiety disorders, particularly obsessive-compulsive disorder (OCD) and social phobia, in individuals with eating disorders, highlighting that many clients experience exacerbated symptoms and longer treatment stays. Exposure and Response Prevention (ERP) therapy, alongside Cognitive Behavioral Therapy (CBT), is presented as an effective treatment method to address both anxiety and eating disorder symptoms by helping clients confront their fears and regulate emotions. The document also outlines specific rituals and behaviors linked to eating disorders and OCD, emphasizing the importance of identifying and challenging cognitive distortions.

1. Preferred Provider Workshop Treatment of Obsessive Compulsive Spectrum Symptoms and Eating Disorders Saturday, July 16th Erin McGinty, LPC Castlewood Treatment Center for Eating Disorders 1260 St. Paul Road 636-386-6633 www.castlewoodtc.com

2. Prevalence of Co-Occurring Anxiety Disorders with Eating Disorders Kaye et al. (2004) studied the co-morbidity of anxiety disorders in an eating disorder sample, and found the following: Two-thirds of the subjects had one or more lifetime anxiety disorder A majority of the subjects reported that their anxiety disorders preceded the onset of the eating disorder The most common anxiety diagnoses were obsessive-compulsive disorder (OCD; 41%) and social phobia (20%)

3. Effects of a Co-Morbid Anxiety Disorder on Eating Disorder Symptomology Clients with co-morbidity experience both a longer length of stay and an exacerbation of eating disorder symptoms such as: Perfectionism Obsessionality Harm avoidance, including: Higher degrees of worry, or anticipatory anxiety Higher degrees of intolerance of uncertainty Higher degrees of fatigue Higher degrees of pessimism Body image dissatisfaction

4. Co-Occurring Anxiety Disorders and Emotion Regulation Individuals with anxiety disorders face many struggles in regulating emotion: Emotion misidentification Impaired understanding of emotions Increased negative responses to internal and external cues As a result, clients make attempts to regulate emotional experiences that exacerbate unwanted emotional states Social avoidance Experiential avoidance Eating disorder and other maladaptive behaviors

5. Obsessive-Compulsive Symptoms and Eating Disorders Preoccupation with weight, shape, and food mirror obsessions Eating disorder behaviors may be compulsions View of an eating disorder as an obsessive-compulsive spectrum disorder Cognitive behavioral therapy (CBT) and exposure and response prevention (ERP) therapy is the treatment of choice for anxiety disorders such as obsessive-compulsive disorder Initial studies suggest that utilizing ERP in the treatment of eating disorders is effective in reducing depressive, obsessive-compulsive, and eating disorder symptom severity

6. Exposure and Response Prevention Therapy Exposure Graduated, repetitive, and consistent exposure to situations and thoughts that provoke anxiety and distress Situational/In vivo exposure Imaginal exposure While performing the exposure, the client imagines the feared consequence(s) of the exposure The client remains exposed to the cue until the associated anxiety decreases Goal is to achieve habituation, or the decrease in anxiety due only to the passing of time Within-trial habituation Between-trial habituation

7. Exposure and Response Prevention Therapy

8. Exposure and Response Prevention Therapy Response Prevention Refraining from behaviors that are meant to reduce anxiety Behavioral rituals Mental rituals Avoidance Clients learn that feared consequences of exposure are irrational Example: Eat a feared food such as potato chips( exposure ), no purging/binging/exercise/restriction ( response prevention ).

9. Exposure and Response Prevention Therapy Psychoeducation Providing a rationale for the model Educating the client on the importance of follow-through with self-monitoring and exposure assignments Self-Monitoring Ban books Exposure and thought records Cognitive Therapy Identify cognitive distortions and feared consequences of exposure Based on the outcome, identify evidence for/against irrational belief Reframing of irrational beliefs

10. Target Symptoms in the Treatment of Obsessive-Compulsive Symptoms and Eating Disorders Body Image Clothing avoidance Mirror avoidance Body checking Femininity and sexuality Food Rituals Cutting of food Mixing of food Ordering and arranging of food on plate Eating foods in a certain order Counting rituals

11. Target Symptoms in the Treatment of Obsessive-Compulsive Symptoms and Eating Disorders Exercise Rituals Ordering of exercises in a particular fashion Specific number of calories burned, miles run, time exercised, repetition of weight exercises, etc. Rigidity around exercise Perfectionism Need for symmetry and exactness Ordering and arranging compulsions Concern over mistakes and the interpretation of mistakes as failures Doubts about the ability to accomplish tasks

12. Target Symptoms in the Treatment of Obsessive-Compulsive Symptoms and Eating Disorders Other Eating Disorder Rituals Calorie counting Avoidance Feared foods Binging Purging Rumination Chewing/spitting Laxative, diet pills, diuretic, ipecac abuse Restriction

13. Fear Hierarchy Formation Generate a list of external and internal triggers that provoke anxiety and induce urges to engage in behaviors Assess feared consequences if client was exposed to a trigger Assess responses to feared situations: Passive avoidance Behavioral rituals Mental rituals Generate a list of feared situations Ask the client to provide a subjective unit of distress (SUDS) rating for each situation

14. Fear Hierarchy Formation Examples of assignments to generate data: Assign clients to create a list of the following: “ Good/bad” foods Avoided foods Binge foods Assign clients to complete a an exhaustive list of their ritual behaviors at the table, and to identify what purpose these rituals serve Assign clients to write “A Typical Day… … in my eating disorder.” … in my exercise addiction.” … in my OCD.”

15. Fear Hierarchy Formation Assign clients to write “The Worst Day of My Eating Disorder” Assign clients to write out their exercise routine in exhaustive detail