Because eating disorders are common, all medical professionals will come across patients struggling with eating disorders and related problems. Eating Disorders are complex biologic based illnesses that are affected by cultural messages and behavioral experiments. Once established eating disorders effect not only emotional and social functioning but have a profound impact on physical health. Drs Guadiani and Bishop will provide video clips and clinical material describing typical presentations of psychological and physiologic symptoms common in patients struggling with eating disorders. Dr Powers will help professionals think about eating disorders in a medical framework, focusing on elements of clinical assessment, early stages of treatment, and barriers to appropriate care. Dr McCallum will describe both the cognitive styles which put patients at risk and the effects of starvation on brain and GI functioning. The implications of cognitive factors for treatment will be considered. Research based psychotherapy strategies will be described. Dr. Mickley will discuss treatment targets, mobilizing resources and management of complex and chronic cases. Treatment of special populations should be focused in a particular way. Dr Bermudez will review treatment considerations in children and adolescents, in men and in patients with additional medical comorbidity such as diabetes. Full program description and presenter bios at http://iaedp.confex.com/iaedp/2011/webprogram/Session1783.html

Presenting at the Grand Opening Banquet, Dr Carson is a recognized leader in the field of eating disorders treatment and a highly entertaining speaker. Dietary goals often start out as a simple desire for a healthy lifestyle or a means to overcome an existing medical condition. In rare cases, food concerns can escalate to narrow criteria of acceptable choices that become deeply rooted in wanting to purify the body. This phenomenon may be a condition of the 21st century where we are constantly bombarded with media messages of good and bad foods, conflicting nutritional information, food recalls, and elaborate food labels. For some, eliminating certain foods might provide a platform to be noticed, establish control or impress others. An increasing rigid pursuit of dietary purity can result into an intense compulsion. Even the slightest slip can generate genuine psychological distress. Today we are inundated with conflicting nutritional information, food recalls and media messages of good and bad foods. This can create problematic relationships with foods that can lead to both psychological and physical health challenges. The treatment options of this condition, recently coined orthorexia, include a heaping dose of common sense, moderation, balance and a sense of humor. There is a debate as to whether orthorexia is anything more than an obsession since currently it is not classified as a medical condition or eating disorder.

Dr. Carson has been involved in the clinical treatment of obesity and eating disorders for over 30 years. His unique background in medicine (BS Duke University and B. H. S. Duke University Medical School) coupled with nutrition and exercise (BS Oakwood College, Ph.D. Auburn University) has prepared him to integrate biophysiological intervention with proven psychotherapeutic treatment. He consults with eating disorder programs and presents at conferences around the world. Dr. Carson is an IAEDP board member. He has recently published Harnessing the Healing Power of Fruit.

Current conceptualizations of the etiology and treatment of eating disorders may worsen the mind body dichotomy that commonly occurs in patients with eating disorders. Use of medical metaphors and analogies may make it easier for patients, families, and health care professionals to understand these illnesses and take appropriate action. An example of a pertinent analogy is: "to call anorexia nervosa an eating disorder is to call cancer a cough". Metaphors and analogies relevant to diagnosis, treatment, and prevention will be presented. Dr. Pauline Powers is nationally recognized as an expert in the field of eating disorders. She was the Founding President of the Academy for Eating Disorders and is currently the director of the Psychosomatic Medicine Division within the Department of Psychiatry at the University of South Florida. She is the author of books about obesity and eating disorders and has written over 70 scientific Publications. She is a founding member of the Eating Disorders Research Society and is on the Editorial Boards of Eating Disorders: The Journal of Treatment and Prevention, Obesity Surgery, and the Eating Disorders Review. Dr. Powers is on the Scientific Board of Directors of the National Eating Disorders Screening Program. As an active board member for NEDA, she recently served as the President for 2005 and was awarded the Life Time achievement award in 2006. She is a member of the American Psychiatric Association Committee preparing Guidelines of the Treatment of Eating Disorders. Dr. Powers was recognized as the Outstanding Clinician in 2000, by the Academy for Eating Disorders. She is a past president for the National Eating Disorders Association.

When seeking insurance benefits for eating disorder treatment, a provider’s treatment records will be the foundation for establishing medically necessity for admission and continued treatment. Evidence-based treatment records must show plans of care, symptoms, and objective evidence that satisfy an insurance company’s criteria for admission and continued care. The presentation will review the criteria from insurance companies for treatment of eating disorders and explain how evidence-based treatment records can be documented to best maximize the client’s available insurance benefits.

At the end of this presentation, participants should have an understanding of:

Ms. Kantor is among only a few lawyers advocating for insurer reimbursement for clients with eating disorders. She has a number of significant wins, including eating disorder cases that have changed the law in California and the 9th Circuit. She is currently working with eating disorder professionals and facilities to determine what actions will change the insurance industry’s perception about care for eating disorders and what regulatory, legislative and class action litigation measures are necessary. Ms. Kantor has been a featured speaker at iaedp Symposium 2010 in Orlando, Florida, for the Los Angeles, Orange County and San Diego chapters of the International Association of Eating Disorder Professionals.

Skills training is an essential component of the initial stabilization phase of the psychotherapy of complex developmental trauma, including clients with comorbid eating disorders. Evidence-based skills and treatments such as Stress Inoculation Training (SIT), Cognitive Behavioral Therapy (CBT), Prolonged Exposure (PE), and Dialectical Behavior Therapy (DBT) skills are often utilized in these populations. However, many individuals with complex trauma-related disorders have been excluded from efficacy trials for evidence-based trauma treatments, and when they are included, drop out rates are exceedingly high (Spinazolla, Blaustein, & Van der Kolk, 2005). These individuals often require long term, carefully paced therapy that includes extensive stabilization phases. Because they have typically been traumatized over long periods of time and during critical developmental phases, the effects of trauma extend beyond posttraumatic stress symptoms. Many of these individuals struggle with an extensive array of problems, including depression, anxiety, substance abuse and self-harm, suicidality, eating and sleep problems, self dysregulation, attachment disturbances, and broad symptoms of executive dysfunction. Most importantly, many of these symptoms have a dissociative underpinning. Though dissociation is often acknowledged as a trauma symptom, it is rarely a treatment target. However, it often remains a hidden problem that maintains and reinforces dysfunction and disturbance. Clients with complex developmental trauma disorders generally require both more diverse and more specific skills than the short term treatment options provide. I will describe additional types of skills that must be mastered as part of a successful therapy, and describe early research efforts to establish the effectiveness of these skills, including mentalizing, self and relational regulation, compensating for executive dysfunction, developing inner empathy, resolving phobias of inner experience, and overcoming dissociation. Individual and group approaches will be described.

Kathy Steele, MN, CS is Clinical Director of Metropolitan Counseling Services, a nonprofit, low cost psychotherapy and training center, and is in private practice in Atlanta, Georgia. She is a Past President of the International Society for the Study of Trauma. Kathy is a frequent international presenter and has authored or co-authored numerous publications on trauma and dissociation, and has received several international awards for her work.

Trauma is neither a disease nor a disorder, but is rather an injury caused by fright, helplessness and loss. By engaging the innate capacity of the body/mind to self-regulate high states of arousal and intense emotions, trauma can be transformed. When (and to what degree) children are neglected, abused and traumatized, the basic instincts of survival and sexuality become distorted. This leads to disembodied sexuality, a lack of capacity for self-regulation and alienation from the living-sensing-feeling body which can lead to various eating disorders. Traditionally, therapies have attempted to change perceptions of the world by means of reason and insight: with conditioning and behavior modification, along with drugs and medications. However, perceptions remain fundamentally unchanged until the internal experience of the body changes. Even after abuse, neglect, the death of a loved one, physical injury, rape or assault, people can learn to have new bodily experiences and can then come to heal and accept what has happened and create new lives imbued with positive self-image, vitality and resilience.

Dr. Levine was a Stress consultant for NASA for the early space shuttle flights. He served on the International Initiative on responding to large scale disasters and ethno-political warfare. His internationally bestselling book, Waking the Tiger, Healing Trauma, (published in 22 languages) introduces the somatic approach to trauma that he has developed over the past 40 years. His recent interests include prevention of trauma in children.