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The Disconnected Self:
Assessment and Treatment of
Eating Disorders
Tanja Haaland, LCPC
Program Director
Eating Disorder Center of Kansas City
True or False?
You can identify someone with an ED by looking at
their appearance and observing what they do or do
not eat
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•
•
•
Common assumption that only those who are visibly underweight have
EDs
About 70% of those with bulimia nervosa are normal weight
Just because you see a person eat does not mean that they don’t have
an ED
Individuals struggling with EDs can become very effective at hiding the
signs and symptoms
Haaland, 2016
Eating Disorder Center of Kansas City
True or False?
EDs are an attempt to call attention to oneself
•
•
Great lengths are often taken to conceal the ED due to feelings of shame
or desire to hold on to the illness and the perceived sense of control it
brings.
People do not choose to have eating disorders. They are the result of
complex biological, psychological, and socio-cultural factors.
Haaland, 2016
Eating Disorder Center of Kansas City
True or False?
EDs are caused by unhealthy, unrealistic images in the
media
• While these factors can contribute to the
development, the causes are multifactorial.
• EDs have been documented in the medical literature
since the early 1800s, when the “ideal” body shape
differed from today.
EDs are all about food and body image
• Though the illness may start out as a desire to lose
weight, they are mental illnesses that have little to do
with food, eating, or appearance.
• The eating symptoms and preoccupation with thinness
are only symptoms of deeper psychological issues.
Haaland, 2016
Eating Disorder Center of Kansas City
True or False?
Dieting is always harmless
•
Dieting is the #1 risk factor for developing an ED. Most EDs begin with a
weight-loss diet.
People can recover from an ED through willpower and
just eating normally/restoring weight
• Specialized ED treatment that incorporates medical, nutritional, and
psychological treatment is essential for full recovery.
• Early intervention with appropriate care can dramatically improve the
outcome.
Haaland, 2016
Eating Disorder Center of Kansas City
Prevalence
• Of patients coming to the attention of mental health
professionals 90% female, 10% male
• 90% of young women who develop an ED do so between
ages of 12-25
• Between 5-20% of college females have eating disorders
or disordered eating behaviors
• More than 10% of adolescent girls and 3% of boys binge
eat or purge at least once a week (Archives of Pediatric
and Adolescent Medicine, June 2008)
• Shame and secrecy of illness leads to denial,
underreporting, misdiagnosis, and inadequate treatment
Haaland, 2016
Eating Disorder Center of Kansas City
Types of Eating Disorders
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•
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Anorexia Nervosa (AN)
Bulimia Nervosa (BN)
Binge Eating Disorder (BED)
Other Specified Feeding & Eating Disorders
Haaland, 2016
Eating Disorder Center of Kansas City
Anorexia Nervosa
• Refusal to maintain body weight at or above a
minimally normal weight for the age and height
(e.g weight loss leading to maintenance of body
weight less than 85% of that expected; or failure to
make expected weight gain during period of
growth, leading to body weight less than 85% of the
expected).
• Intense fear of gaining weight or becoming fat,
even though underweight.
• Disturbance in the way in which one’s shape is
experienced, undue influence of body weight or
shape on self-evaluation, or denial of the
seriousness of the current low body weight.
• In postmenarcheal females,amenorrhea, I.e., the
absence of at least three consecutive menstrual
cycles. (A woman is considered to have
amenorrhea if her periods occur only following
hormone, e.g., estrogen administration).
Haaland, 2016
Eating Disorder Center of Kansas City
Anorexia Nervosa
• RESTRICTING TYPE:
During the current episode of Anorexia Nervosa,
the person has not regularly engaged in bingeeating or purge behavior (i.e. self-induced vomiting
or the misuse of laxatives, diuretics, or enemas).
• BINGE EATING/PURGING TYPE:
During the current episode of Anorexia Nervosa,
the person has regularly engaged in binge-eating
or purging behavior (i.e. self-induced vomiting or
the misuse of laxatives, diuretics, or enemas).
Haaland, 2016
Eating Disorder Center of Kansas City
Prevalence for Anorexia Nervosa
• 90% female
• .5-1% of women ages 15-35 yrs old
• Industrialized countries
Haaland, 2016
Eating Disorder Center of Kansas City
Course
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Full recovery
Relapsing course
“Normal Weight Anorexia Nervosa”
Chronic deteriorating course
Death
o Mortality rate >10% for individuals admitted to
University hospitals, and >20% on 20 year follow
up (Halmi)
o Death most commonly results from starvation,
suicide, or electrolyte imbalance
Haaland, 2016
Eating Disorder Center of Kansas City
Physical Exam Findings
 Normal response to starvation (famine)
Bradycardia
Hypotension
Hypothermia – cold intolerance
 Amenorrhea
 Osteoporosis
Low calcium intake and absorption
Reduced estrogen secretion
• Lanugo hair
• Carotenemia
• Refeeding Syndrome
Phosphorus
Liver function
Haaland, 2016
Eating Disorder Center of Kansas City
Bulimia Nervosa
• Recurrent episodes of binge eating. An episode of
binge eating is characterized by both of the
following:
(1). Eating, in a discrete period of time (e.g. within any
2-hour period), an amount of food that is definitely larger
than
most people would eat during a similar period of
time and under similar circumstances.
(2). A sense of lack of control over eating during the
episode
(e.g. a feeling that one cannot stop eating or
control what or
how much one is eating).
Haaland, 2016
Eating Disorder Center of Kansas City
Bulimia Nervosa
• Recurrent inappropriate compensatory behavior in
order to prevent weight gain, such as self-induced
vomiting; misuse of laxatives, diuretics, enemas, or
other medications; fasting; or excessive exercise.
• The binge eating and inappropriate compensatory
behaviors both occur, on average, at least twice a
week for 3 months.
• Self-Evaluation is unduly influenced by body shape
and weight.
• The disturbance does not occur exclusively during
episodes of Anorexia Nervosa.
Haaland, 2016
Eating Disorder Center of Kansas City
Bulimia Nervosa
• Purging Type:
During the current episode of Bulimia Nervosa, the
person has regularly engaged in self-induced
vomiting or the misuse of laxatives, diuretics, or
enemas.
• Non-Purging Type:
During the current episode of Bulimia Nervosa, the
person has used other inappropriate compensatory
behaviors, such as fasting or excessive exercise, but
has not regularly engaged in self induced vomiting
or the misuse of laxatives, diuretics, or enemas.
Haaland, 2016
Eating Disorder Center of Kansas City
Prevalance of Bulimia
Nervosa
• 2-5% of young adult females
• 29% of college students
Haaland, 2016
Eating Disorder Center of Kansas City
Course
• Usually begins in late adolescence or early adult life
• Often begins during or after a diet
• Secretive - may take years to come to medical
attention
• Intermittent vs. Chronic
Haaland, 2016
Eating Disorder Center of Kansas City
Physical Exam Findings
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Loss of dental enamel
Russel’s sign
Parotid enlargement “Chipmunk Cheeks”
Subconjunctival Hemorrhages
Esophagitis/Mallory Weiss Tears
Cardiac Arrhythmias
Ipecac Sequelae
Haaland, 2016
Eating Disorder Center of Kansas City
Laboratory Findings
• Electrolyte abnormalities
o K+, Na, Cl-
• Elevated Bicarbonate (metabolic alkalosis) through
vomiting
• Metabolic Acidosis with laxatives
• Elevated Serum Amylase (vomiting)
Haaland, 2016
Eating Disorder Center of Kansas City
Binge-Eating Disorder
• Recurrent episodes of binge eating. An episode characterized
by the following:
o Eating in a discrete period of time, an amount of food that is
larger than most people would eat in a similar amount of
time
o A sense of lack of control over the eating episode
 The binge episodes are associated with three or more of the
following:
• Eating much more rapidly than normal
• Eating until comfortably full
• Eating large amounts of food when not hungry
• Eating alone because embarrassed about how much is
being eaten
• Feeling disgusted with oneself, depressed, or very guilt
afterward
Haaland, 2016
Eating Disorder Center of Kansas City
Research—Best Practices for BED Patients
American Psychiatric Association:
• Shows 67% success rate with Cognitive Behavioral
Therapy (CBT) therapy guidelines along with dietary
support during active treatment.
• Best practice is non-diet approach to stop binge
eating and treat co-existing mental illness.
• A variety of SSRI’s and tricyclic antidepressants have
found to be associated with greater decreases in
binge frequency.
• Medication with CBT and nutritional counseling has
significantly more weight loss than either one alone
Haaland, 2016
Eating Disorder Center of Kansas City
Research—Best Practices for BED Patients
Kaiser Permanente Center for Health Research in
Portland, OR :
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•
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Combined CBT, guided self-help with nutritional and
therapeutic treatment for BED showed marked
improvement over general therapy.
63.5 percent of participants had stopped bingeing.
Six months later, 74.5 percent of program participants
abstained from bingeing, compared to 44.1 percent in
usual care.
Haaland, 2016
Eating Disorder Center of Kansas City
Binge Eating Disorder-Gastric Bypass
Results—Gurze Study
• GASTRIC BYPASS-8 YEARS LATER
• At least 50% had disordered eating patterns
reflective of BED.
• Slightly more than half of the patients reported
having disordered eating patterns.
• 44% stated they required more follow-up to
maintain weight loss through psychotherapeutic
support and dietary planning.
• At 8 year, authors reported successful and
unsuccessful patients reported similar rates of
problematic ED, depression and anxiety
Haaland, 2016
Eating Disorder Center of Kansas City
Other Specified Feeding & Eating Disorders
Significant eating disorder
Does not meet criteria for Anorexia, Bulimia or Binge Eating
Disorder
Purging Disorder
Recurrent purging behavior to influence weight of shape in
the absence of binge eating
Atypical Anorexia Nervosa
All of the criteria for AN are met except that despite
significant weight loss, the weight is within the normal range
Diabulimia (*not a DSM diagnosis)
Diabetics who intentionally omit or manipulate their insulin
intake in order to manage their weight
Haaland, 2016
Eating Disorder Center of Kansas City
Purging via Compulsive Over-exercise
•
Obligatory exercise to the point that it is unsafe and unhealthy
•
Some warning signs include:
• Constant preoccupation or intrusive thoughts about exercise
• Finding time at any cost to exercise
• Feeling overly anxious, guilty or angry if unable to exercise
• Lack of rest days from exercise even when injured and/or ill
• Driven primarily by a desire to control weight, shape and/or
body
• Exercising as punishment for eating “bad” foods or to purge
• Feelings about self become based on quantity and quality of
exercise
Haaland, 2016
Eating Disorder Center of Kansas City
Comorbidity
Drug and ETOH abuse
Shoplifting
Promiscuity
Spending Binges
Mood Disorders
-Unipolar
-Bipolar
• Personality Disorders
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•
Haaland, 2016
Eating Disorder Center of Kansas City
Co-Morbid Conditions seen with Eating
Disorders
DIAGNOSIS
Depression
Obsessive-Compulsive
Disorder
% CO-MORBIDITY RATES
50-75%
10-13% (up to 25% in AN)
Bipolar Disorder
12%
Anxiety Disorders
43%
Substance Abuse
12-18% (AN), 30-37% (BN)
Haaland, 2016
Eating Disorder Center of Kansas City
Eating Disorders in Men
 Bulimic symptoms and obsessive fitness practices more
common
 Body Image in Males
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Shape vs. weight focused
Compulsive over-exercise more common
Desire for thinness and increased muscularity = Double Bind
Increasing media messages regarding dieting, ideal of muscularity, and plastic
surgery options such as pectoral, calf, and buttock implants (Nemeroff et al.,
1994)
Haaland, 2016
Eating Disorder Center of Kansas City
Eating Disorders in Men
• Some Risk Factors
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Being overweight and being teased as a child
Delayed maturation
Gay male 12-23 yr olds 7x more likely to report bingeing and nearly 12x
more likely to report purging than heterosexual males (Journal of
Adolescent Health, September 2009)
• Prevalence?
•
•
10% (Wolf,1991; Fairburn & Beglin, 1990).
Less likely to pursue treatment
Haaland, 2016
Eating Disorder Center of Kansas City
Medical Consequences
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Dry skin and dehydration
Hair loss/thinning
Lanugo
Low Blood Sugar
Electrolyte Imbalance
Cramps
Impaired renal
function/kidney infections
Constipation
Loss of muscle mass
Low heart rate and BP
Shortness of Breath
Cold extremities
 Dental problems
 Rupture of esophagus
 Swollen glands
(“Chipmunk cheeks”)
 Bloodshot eyes
 Damage to stomach
lining
 Weakened immune
system
 Loss of menstrual cycle,
infertility
 Loss of bone density,
Osteoporosis
 Heart arrhythmias and
heart attack
 Coma and Death
Haaland, 2016
Eating Disorder Center of Kansas City
What Could Possibly Go Wrong?
Anorexia has the highest mortality risk
of any psychiatric disorder
• Death rates can equal or higher than that of
melanoma, prostate, testicular CA: 10-15%!
• Many other serious complications short of
death can occur
• Yet, medical complications often not
prevented or go unrecognized, untreated
• Starvation affects every organ system
o Nothing is spared
• Clinicians should anticipate dysfunction of
every organ system and evaluate indicators
of those systems
Haaland, 2016
Eating Disorder Center of Kansas City
Eating Disorders--Definitions
-From a medical perspective• Restriction (AN, ED-NOS) has its set of
potential medical complications
o Cardiac--bradycardia, QTC, PVCs, dysrhythmias, CHF, impaired
structure & function, pericardial effusions, etc.
o Dehydration, electrolyte disorders, hypothermia
o Gastroparesis, SMA syndrome
o Osteoporosis/osteopenia/growth delay
Haaland, 2016
Eating Disorder Center of Kansas City
Eating Disorders--Definitions
-From a medical perspective• Purging (including exercise) (BN, AN w/
purging, ED-NOS) has its set of potential
medical complications
o GI Bleeding (stomach, esophagus, pharynx)
o Boorhave’s S., Mallory-Weiss tears
o GERD, ?Barrett’s esophagus & CA
o Constipation
o Intestinal paralysis (from laxative abuse)
o Electrolyte disorders, dehydration
o Aspiration, pneumothorax
o Stress fxs, overuse syndromes w/ poor
recovery
• Limited “spare parts” for repair
Haaland, 2016
Eating Disorder Center of Kansas City
Brain/Neurologic Dysfunction
• Psychiatric
• Emotion--labile, blunted, or unable to describe it
• Mood, affect
• Personality
o More OCD, BPD-like
o “Unlike themselves”; “Used to be so pleasant, sweet”
• Attention
o ?ADD
• “Can’t be sure what’s wrong in their head until
they’re fed”
Haaland, 2016
Eating Disorder Center of Kansas City
Abuse-Mediated Vulnerability in
the Development and Maintenance
of Eating Disorders
Extrinsic Factors
Child Abuse
•Sexual
•Physical
•Psychological
•Other
General Family
Dysfunction
•Chaotic
•Conflict Laden
•Enmeshed
•Rigid
Specific
Environments
•Familial/Peer
•Overconcern
•Teasing regarding weight
•Appearance and Dieting
Ongoing Development of Self Concept
Temperamental
Low resilience, mood labile
Other focused
Ongoing Vulnerability
Deficits in Affect
Regulation
Eating Disorders
Comorbid
Conditions
Intrinsic Factors
Haaland, 2016
Eating Disorder Center of Kansas City
Genetic Studies
• Individuals with a mother or sister who had
suffered from Anorexia Nervosa are:
o 12 times more likely to develop Anorexia
Nervosa
o 4 times more likely to develop Bulimia Nervosa
Haaland, 2016
Eating Disorder Center of Kansas City
Single Genes vs. Multiple Genes
• Anorexia & Bulimia Nervosa are complex disorders
• Likely to be caused by multiple genes and
environmental factors with varied effects
• Similar to obesity
• For Anorexia nervosa high risk genes most probably
include traits such as:
o Perfectionism
o Orderliness
• Low tolerance for new situations
• Maturity fears
• Low self-esteem
• Overall anxiety
Haaland, 2016
Eating Disorder Center of Kansas City
Twin Studies Consistently Show:
• A substantial genetic
contribution to Anorexia
Nervosa and Bulimia
Nervosa, as well as the
traits associated with
these disorders
• Unique environmental
influences (e.g. trauma,
participating in sports
that emphasize thinness)
have more significance
than the shared
environmental effects
(e.g. socioeconomic
status, religion, general
parenting style)
Haaland, 2016
Eating Disorder Center of Kansas City
Single Genes vs. Multiple Genes
• Anorexia & Bulimia Nervosa are complex disorders
• Likely to be caused by multiple genes and
environmental factors with varied effects
• Similar to obesity
• For Anorexia nervosa high risk genes most probably
include traits such as:
o Perfectionism
o Orderliness
• Low tolerance for new situations
• Maturity fears
• Low self-esteem
• Overall anxiety
Haaland, 2016
Eating Disorder Center of Kansas City
However, even if an individual was at high genetic risk she
might never develop Anorexia Nervosa if she:
o Did not live in a culture such as ours which
emphasizes dieting and thinness
o Go on a diet herself
o Have a high risk environmental influences
Haaland, 2016
Eating Disorder Center of Kansas City
It’s NOT just about food/body image:
Some potential “adaptive” functions
EDs function as coping tools for more serious and painful
underlying issues and feelings:
• Control
• Comfort; soothing; nurture: secure attachment
• Numbing; sedation; distraction
• Discharge of tension; anger; rebellion
• Predictability; structure
• Self-Punishment
• Avoidance of intimacy
• Avoiding maturation
• Feelings of inadequacy and desire for mastery
• Fear of success and/or failure
• Unresolved grief
• Identity and lack of self-awareness
Haaland, 2016
Eating Disorder Center of Kansas City
Psychodynamic Functions of ED Symptoms
Maine, McGilley, Bunnell, 2010
 Rebel against a strict caregiver/superego and express
autonomy
 Test the therapist to see if he or she will respond in the same
way
 Displace anxiety or shame onto fears of weight gain or hatred
for the body
 Avoid recovery because it is perceived as resulting in
overwhelming demands for performance
 Avoid recovery because it is equated with becoming a
narcissistic extension of the therapist
 Substitute self-destructiveness related to the ED for suicide
 Rid the self of an intrusive and/or abusive caregiver
 Preserve the relationship with the caregiver
 Defend against feelings of powerlessness and ineffectiveness
Haaland, 2016
Eating Disorder Center of Kansas City
Predisposing Factors
Biological & Psychological Factors:
• Genetic Predisposition
• Early onset puberty
• Increased BMI prior to onset
• Co-morbid Psychological Disorders
• Traumatic Event
• Stressors/change
• Temperament
Social/Environment Factors:
• Family/relationship dynamics
• Family hx of severe dieting/exercise, negative body image (modeling)
• Competitive academic/social environment
• Sports that require a specific body type/weight
• Cultural pressures for extreme thinness / hyper-muscular physique
• Media messages and dieting culture
Haaland, 2016
Eating Disorder Center of Kansas City
Treatment
Haaland, 2016
Eating Disorder Center of Kansas City
SYMPTOM IS FUNCTIONAL
SYMPTOM IS THE SOULUTION!
Distorted Survival Strategies
(Perceived Safety)
Haaland, 2016
Eating Disorder Center of Kansas City
Challenges in the Treatment
of EDs
 Finding substitute coping strategies
to replace eating disorder
behaviors
 Harm avoidant temperament
 Rigidity and difficulty making shifts
in thinking and behaving
 Alexithymia
 Identity linked to disorder
 Need for control
 Perfectionism interferes with trying
new ways
Haaland, 2016
Eating Disorder Center of Kansas City
Where to begin
Where to begin
 Establishment of trust
 Get addiction under control
 not as responsive to psychotherapy when in active
addiction
 Normalizing brain function is necessary for effective
psychotherapy and antidepressant efficacy
 “First we eat, then we talk.” –Walter Vandereycken
 Refeeding: significantly alleviates mood and anxiety
regulation, allows antidepressants to work, and allows
psychological issues to rise and be clarified (Brewerton,
2014)
Haaland, 2016
Eating Disorder Center of Kansas City
Requirements of effective psychotherapy
 Grossly intact brain function
 Ability to attend
 Ability to learn
 Motivation, willingness/readiness to change
 Supportive relationship(s)
Body-oriented and mindfulness exercises are
often a first step
(Brewerton, 2014)
Haaland, 2016
Eating Disorder Center of Kansas City
BEWARE: Symptom substitution!
Whack-a-mole!
Binge to restrict, restrict to purge, SUD
Goal of therapy:
Take the rejected
and disconnected
aspects of the Self,
and work to form
an authentic whole.
Haaland, 2016
Eating Disorder Center of Kansas City
• Learning to contract
o Power and control/dependence and mastery:
avoid becoming the clients external locos of
control, and help the client use contracts to selfregulate arousal and impulsivity
o Commitments to recovery are more helpful than
contracts “to” the therapist
o Time-limited contracts are more helpful than
general ones
o Coping commitments are more helpful
o A commitment must always be honored or a new
commitment negotiated; ignoring broken
commitments is “re-enactment behavior” on both
the part of both the client and the therapist
Haaland, 2016
Eating Disorder Center of Kansas City
Lifetime PTSD in Subjects with Eating Disorders in
the National Comorbidity Survey Replication
(Huson J, et al., Biological Psychiatry 2007; 61:348)
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AN 10%
BN 44%
BED 25%
Other Specified Feeding/ED 16%
Brewerton, 2014
Haaland, 2016
Eating Disorder Center of Kansas City
Primary or Secondary
Trauma Condition?
Primary:
• The onset of the eating disorder symptoms—
restricting, purging, binge eating—follows a
traumatic experience
• The roots of the eating disorder are directly
related to the trauma/abuse
Secondary:
• The onset of the eating disorder precedes
the traumatic experience
Haaland, 2016
Eating Disorder Center of Kansas City
Trauma Treatment
1) Stabilization and managing responses
o Establishing safety (physical and psychological)
o Psychoeducation
o Managing trauma responses (skills)
2) Processing and grieving traumatic memories
o cognitive-behavioral therapy (CBT)
o eye movement desensitization reprocessing therapy (EMDR)
o body-psychotherapy and Sensorimotor Psychotherapy
3) Reconnecting with the world
Haaland, 2016
Eating Disorder Center of Kansas City
Trauma Reenactment
• Client attempts to work through the trauma
because of three specific unrealized objectives (on
a subconscious level):
1)Trying to understanding the experience
2)Trying to mastery the experience
3)Trying to distraction or manage mood with a
stimulating but less threatening type of similar but
controlled trauma
(Van der Kolk, 1987)
Haaland, 2016
Eating Disorder Center of Kansas City
Trauma Reenactment
Through ED Behaviors
• Bingeing until nauseous or gagging
• Threw up after abuse
• Engaging in behaviors that feel
shameful or secretive
• Creating a dissociative experience
Haaland, 2016
Eating Disorder Center of Kansas City
Common mistakes made by therapists
working with self-destructiveness
o Not understanding the degree of relief
associated with self harm
o Not understanding that the care of the body is
not a priority: when our body only matters as a
vehicle for discharging tension, it’s care
becomes meaningless
o Not understanding that post-traumatic shame
and secrecy make it feel “normal” to hide the
extent of the self-harm even from the therapist
o Becoming engaged in a struggle with the client
around issues of safety in which the therapist
becomes the spokesperson in favor of safety and
the client the spokesperson in favor of self-harm,
thereby neglecting the task of helping the client
struggle with her own internal conflict
Haaland, 2016
Eating Disorder Center of Kansas City
Reframing the meaning of symptoms
o Purpose of ED behavior: start with assumption that every symptom is a
valuable piece of data
o Look for what the symptom is still trying to accomplish: i.e. chronic suicidal
feelings might offer comfort or a “bail-out” plan, cutting might help
modulate arousal, social avoidance could be an attempt to avoid
“danger”
o Once it is clear what the symptom is trying to accomplish the therapist
and the client can then work together to find other ways to accomplish
the same goal in a context that describes the client as an ingenious and
resourceful survivor, rather than as a damaged victim
Celebrate the symptom!
~Sincere letter of gratitude
Haaland, 2016
Eating Disorder Center of Kansas City
Narrative Story Telling: NST
• Repeated narration
o Organization of trauma memory
o Fear Reduction through habituation
• Meaning analysis/contextualization
o Revision of beliefs about self and others (trauma schemas are part of past
versus present)
o Integration of trauma memory into a life history
o Exploration and resolution of feelings other than fear, shame, guilt, anger,
and loss
Haaland, 2016
Eating Disorder Center of Kansas City
Art Therapy
o Creates transitional object between
self and therapist
o Creates concrete awareness of the
relationship between the trauma
and the disorder eating
symptomology
o Provides a means to “tell” and
externalize shameful material
o Provides distance from the
traumatic material
o Enables identification, expression,
and containment of emotions,
Haaland, 2016
thoughts, and impulses
Eating Disorder Center of Kansas City
Difficulty in Assessing ED’s:
Not always readily “seen”
Normalization of behaviors
Functioning well in other areas of their lives
Denial, secrecy, lying, and shame
Requires ongoing assessment as behaviors may
change
 Careful assessment of self-harm, multi-impulsive
behaviors and suicidal ideations (23x more likely to
commit suicide)
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Haaland, 2016
Eating Disorder Center of Kansas City
It Takes a Team:
Collaboration between Professionals
 Psychiatry
 Individual psychotherapy
 Dietary
 Medical
 Family therapy
 Group therapy
 Milieu therapists (higher levels of care)
Haaland, 2016
Eating Disorder Center of Kansas City
Levels of Care
• Level 1: Outpatient
• Level 2: Intensive Outpatient (IOP)*
• Level 3: Partial Hospitalization (PHP)*
o 6 days/week, 8-10 hours/day
• Level 4: Residential Treatment Center
• Level 5: Inpatient Hospitalization
• Level 6: Acute Medical ICU
*offered at EDC-KC
Haaland, 2016
Eating Disorder Center of Kansas City
In Closing…
• Eating disorders are complex disorders that are
often invisible
• Accompanied by significant medical and
psychosocial costs
• Understanding what lies beneath the struggle
empowers action
• Early intervention is key & recovery is possible with
proper treatment
Haaland, 2016
Eating Disorder Center of Kansas City
EDC-KC is Partial Hospitalization Program
o 6 days a week, 8-10 hour days, 2-3 meals a day
o Sessions with:
• Primary Therapist (2 x week),
• Family Therapist (1 x week),
• Psychiatrist (1 x week),
• Primary Care Physician (1 x week),
• Dietitian (1 x week),
• Nurse Practitioner (daily),
• Cooking Class with Chef,
• And 55 hours of programming with MA level clinicians
(including Art Therapist and Yoga/Movement Therapy)
Apartment available for out of town patients
Haaland, 2016
Eating Disorder Center of Kansas City
Questions?
Tanja Haaland, LCPC
Program Director
EDC-KC: 844.845.3922
Direct Line: 913.945.1282
[email protected]