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CARING FOR ADOLESCENTS AND YOUNG ADULTS WITH DISORDERED EATING�-�A MULTIDISCIPLINARY TRAINING

ERICA GIBSON M.D.

DIVISION CHIEF, ADOLESCENT MEDICINE

MEDICAL DIRECTOR, ADOLESCENT MEDICINE OUTPATIENT EATING DISORDER CONSULT CLINIC (EDCC)

UNIVERSITY OF VERMONT CHILDREN’S HOSPITAL

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THE LOG – �A METAPHOR FOR EATING DISORDER RECOVERY

IMAGINE YOU ARE ON A RIVERBANK

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A STORM COMES UPON YOU AND YOU FALL INTO THE RAGING RIVER

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A LOG COMES ALONG THAT CAN KEEP YOU AFLOAT

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Dr. Anita Johnson PhD

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Eating in The Light of the Moon

https://dranitajohnston.com/about/

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THE LOG – �A METAPHOR FOR EATING DISORDER RECOVERY

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THE LOG CARRIES YOU TO A CALMER PLACE BUT YOU ARE UNABLE TO LET GO OF THE LOG

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YOU NEED TO BUILD STRENGTH AND CONFIDENCE IN SOME NEW SKILLS IN ORDER TO LET GO OF THE LOG

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PEOPLE ON THE SHORE ARE YELLING ADVICE BUT YOU NEED TO BUILD YOUR NEW SKILLS BEFORE LEAVING THE LOG

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Dr. Anita Johnson PhD

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Eating in The Light of the Moon

https://dranitajohnston.com/about/

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THE SHORE – �A METAPHOR FOR THE MULTIDISCIPLINARY CARE TEAM

DIFFERENT SKILLS TO OFFER

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EACH SWIMMER NEEDS SKILLS THAT WILL MEET THEIR NEEDS

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ULTIMATELY THE SWIMMER NEEDS TO LEAVE THE LOG ON THEIR OWN

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THE CARE TEAM CAN COLLABORATE TO OFFER THE SKILLS NEEDED

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HOW DO WE CURRENTLY CATEGORIZE �FEEDING AND EATING DISORDERS?

Anorexia Nervosa

    • Restricting Type
    • Binge-eating/Purging Type

Bulimia Nervosa

Binge-Eating Disorder

PICA

Rumination Disorder

Avoidant/Restrictive Food Intake Disorder (ARFID)

Other Specified Feeding or Eating Disorder

    • Atypical Anorexia Nervosa
    • Bulimia Nervosa (of low frequency and/or limited duration)
    • Binge-eating Disorder (of low frequency and/or limited duration)
    • Purging disorder

2013

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EATING DISORDERS HAVE INCREASED EXPONENTIALLY IN THE ERA OF COVID-19

Centers for Disease Control MMWR. Feb 2022. Pediatric ER Visits for Eating Disorders . Adolescents age 12-17 . 2019-2022

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CURRENT UNDERSTANDING IN BRIEF�

Interface:

    • Genetic and biological predispositions
    • Environmental and sociocultural influences
    • Psychological traits

Lifetime prevalence 0.6%-2.7%

Peak onset in adolescence/young adulthood

Majority have co-occurring mental health diagnoses: Anxiety most common

Does not discriminate, affect people of all:

    • Ages, genders, ethnicities, weights, shapes, sizes and socioeconomic status

Not caused by families, not chosen by patients

https://www.nimh.nih.gov/health/statistics/eating-disorders

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DISORDERED EATING IS A BRAIN DISORDER THAT AFFECTS THE BODY

FOOD IS THE MEDICINE FOR THE BODY AND THE BRAIN

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WHICH IN TURN BELONG TO A COMPLEX YOUNG PERSON WITH THEIR OWN SET OF EMOTIONS AND EXPERIENCES

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WHO USUALLY LIVES WITHIN A FAMILY SETTING AND OFTEN SPENDS MOST OF THEIR DAY AT SCHOOL

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SUCCESSFUL TREATMENT

  • Nutritional rehabilitation is an important factor in improving cognitions
  • Caregivers are critical allies
  • Individual and family therapy
  • Medical monitoring
  • Medications may be indicated
  • Complementary approaches may help

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BETTER PROGNOSIS FOR ANOREXIA

Early diagnosis and intervention

Shorter duration

Positive parent-child relationship

No purging

Less weight loss

No psychiatric co-morbidity

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APPROACHES TO CARE FOR DISORDERED EATING

VARY EVEN WITHIN DISCIPLINES

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RESEARCH IS STRONG IN SOME AREAS AND WEAKER IN OTHERS

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WE HAVE MANY GENERAL GUIDELINES BUT NOT WIDELY ACCEPTED STRICT PROTOCOLS

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ALLOWS US TO PROVIDE INDIVIDUALIZED APPROACHES BUT CAN BE CHALLENGING AND FRUSTRATING

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THERE ARE COMMON THREADS BUT ONE SPECIFIC APPROACH DOES NOT ALWAYS FIT ALL

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A MULTIDISCIPLINARY TEAM BUILDS A COMMUNITY OF CARING AND CONNECTION THAT INCLUDES THE YOUNG PERSON AND THEIR FAMILY

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POTENTIAL TEAM MEMBERS

Young Person

Caregivers

Primary Care Provider/Medical Home

Primary Care Coordinators/Social Workers

Eating Disorder Specialists

Individual Therapists

Family Therapists

Registered Dieticians

School Staff

Community Based Agency Staff

Complementary Medicine Providers

Community

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DISORDERED EATING EXISTS �ON A CONTINUUM

Normal Eating

Worried Eating

Disordered Eating

Eating Disorder

Smaller team may suffice

Larger team may be needed

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LEVELS OF CARE: ALL MULTIDISCIPLINARY

    • Primary Care Provider (PCP) and collaborative team

Outpatient

    • 20 hours of treatment per week

Intensive Outpatient Day Treatment (IOP)

    • 8 hours of treatment per day, 5 days per week

Partial Hospitalization Programs (PHP)

    • 24 hour care, 7 days per week

Residential

    • Intensive specific inpatient care

Inpatient Treatment

    • Medical/Psychiatric instability, crisis care

Inpatient Medical Stabilization

AVAILABLE IN VERMONT

AVAILABLE IN VERMONT:

UVMMC and DHMC

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DEFINITION OF RECOVERY

Physical

Nutritional

Behavioral

Psychological

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RECOVERY GOALS: MOST AGREE

Appropriate weight in alignment with normal maturation and development

Physical growth and pubertal patterns should be restored

Menses should return, linear growth improve, organ damage reverse

Nutritional/Behavioral recovery:

    • Normalizing eating
    • Return of flexibility in eating
    • Eat varied balanced diet

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RECOVERY GOALS: MOST AGREE

Psychological Recovery

    • Improved self-esteem/self-compassion
    • Age appropriate interpersonal, psychological and occupational function

Weight and body shape should no longer have an undue influence on self-evaluation

"Externalize" the eating disorder in the same way we do cancer and other illnesses

Re-assessment of level of care periodically

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SOME THOUGHTS FROM A PARENT

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COLLABORATION BENEFITS ALL

TOGETHER WE CAN PROVIDE THE DIFFERENT APPROACHES THAT ARE NEEDED

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WE CAN SUPPORT EACH OTHER IN ADDITION TO SUPPORTING YOUNG PEOPLE AND FAMILIES

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WE CAN LEARN FROM EACH OTHER AND LEARN TOGETHER

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GROUP AGREEMENTS AS WE EMBARK ON THIS DAY OF LEARNING

  • Care for self and others
  • What’s offered is an invitation; you choose how you participate.  Take care of your own needs.  Take a break when you need one.

 

  • Hold confidences and take the learning.
  • Share what you learn. Respect others by not sharing their stories.

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  • Stay curious
  • Assume good intentions, honor impact. Notice, then set aside, judgement or defensiveness. Listen deeply & ask “ I wonder what brought her to this belief?” “I wonder what he’s feeling right now?” “I wonder what my reaction teaches me about myself?” 

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  • Speak your truth in ways that respect other people’s truth.
  • Our views of reality may differ.  Avoid correcting or debating.  Use “I” statements that speak from your own experience.  Make space for all voices.

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Andrea Nicoletta, Education Program Manager, Planned Parenthood New England

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THANK YOU

FOR BEING HERE TODAY

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FOR YOUR COLLABORATION

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THERE ARE TOO MANY PEOPLE AND ORGANIZATIONS TO THANK!

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DMH AND VDH LEADERSHIP

UVMMC,UVMCH,EDCC

COMMUNITY BASED ORGANIZATIONS

PRIVATE PRACTITIONERS

SCHOOL STAFF