101702: Breaking the Maintenance Cycle of Eating Disorders

About the Course:

Audio presentation from the 2009 International Association of Eating Disorders Professionals Symposium.
Note: For this course there is a small additional fee to obtain the audio presentation. Please see the “Get Course Materials” link in the right sidebar for details.

Eating disorders have proven to be highly refractory to treatment in as many as a third of the patients seen in therapy. There have been a number of attempts to define what maintains a eating disordered behavior even in the face of therapeutic zeal. Most models of eating disorder maintenance, including cognitive-behavioral and psychosocial, omit critical facets of these problems. Using a psychobiological approach, this presentation offers a model of how eating disorders become stably persistent and how elements of newer therapies derived from contextual psychology and attachment theory can intervene to break the maintenance cycle of eating disorders.

Content Outline:

I. Introduction

II. Models of maintenance of eating disorders

A. Cognitive behavioral

B. Sociocultural

C. Functional contextualist

D. Psychobiological

III. The eating disorder maintenance cycle

A. Elevated emotional drives

B. Unreliable discrimination of safety and danger

C. Chronic anxiety

D. Decreased mentalization and awareness of intrinsic values

E. Increased negative emotions and decreased positive emotions

F. Low self-directedness and emotion-dependent behavior

G. Habitual modulation of emotions with eating disorder

H. Reinforcement of chronic anxiety

IV. The need to elevate character

A. Regulation of emotional drives is a function of character

B. Elevation of character correlates with self-awareness

C. Emotional intelligence correlates with elevation of character

D. Eating disorders impede character growth

V. Values awareness

A. Values provide life direction

B. Values provide a context for actions

C. Values provide a context for emotions

D. Values help determine the utility of emotions and thoughts

E. Self-directedness is difficult, if not impossible, without awareness of values

F. Negative experiences are not tolerated well without a values context

VI. Intrinsic versus instrumental values

A. Intrinsic values are core values emanating from our human nature

B. Instrumental values are a means to getting something else

C. Instrumental values do not pass the “isolation test”

D. Most eating disorder values are instrumental relating to management of negative emotions

VII. Values assessment

A. Intrinsic values are the source of positive emotions

B. Intrinsic values reflect the information already within us (our own nature)

C. Intrinsic values relate to our intuitive senses

D. Values are hierarchical

VIII. Mentalizing—having mindsight

IX. What does non-mentalizing look like?

A. Excessive detail to the exclusion of motivations, feelings, or thoughts

B. Focus on external social factors, such as the school, the government, the neighbors

C. Focus on physical or structural labels

D. Preoccupation with rules, responsibilities, “should” or “should nots”

E. Denial of involvement in problems

F. Blaming or fault finding

G. Expressions of certainty about the thoughts or feelings of others

X. Mentalizing stance of therapy

XI. Summing up Breaking the Maintenance Cycle of Eating Disorders

Authors

Emmett R. Bishop, MD, FAED, CEDS (presenter); Kenneth L. Weiner, MD, FAED, DFAPA (presenter)

About the Authors:

Dr. Bishop has over 25 years experience in the treatment of eating disorders and is with Eating Recovery Center, Denver, Colorado where he is the Director of Research and Outpatient Services. He was the Medical Director of the Clark Center Eating Disorders program in Savannah, Georgia from 1986 to 1996. Serving on the board of directors of the International Association of Eating Disorders Professionals since 1993, he is currently the immediate Past President. He is a Fellow of the Academy for Eating Disorders and is also on the editorial board of Eating Disorders: Journal of Treatment and Prevention.

Dr. Weiner has been treating eating disorders for over 25 years and is currently Medical Director of the Eating Recovery Center, Denver, Colorado. He created and directed the Eating Disorder Center of Denver from 2001-2007. Dr. Weiner is Assistant Clinical Professor of Psychiatry at the University of Colorado Health Sciences Center and received the prestigious Gold Apple Teaching Award, as well as being named a Fellow of the Academy of Eating Disorders and a Distinguished Fellow of the American Psychiatric Association. A dedicated clinician and teacher Dr. Weiner has co-authored numerous articles on eating disorders.

Recommended For:

This course is recommended for health care professionals, especially psychologists, therapists, and counselors who seek to update their research knowledge and competency in treating patients with eating disorders, increase and acquire new skills, learn new intervention strategies, and obtain continuing education credits. It is appropriate for professionals at all levels of knowledge.

Course Objectives:

1. Following this presentation, participants will be able to explain how temperament elevates emotional drives.

2. Following this presentation, participants will be able to explain mentalization.

3. Following this presentation, participants will be able to describe the eating disorder maintenance cycle.