Instilling Hope: Brainstorming Eating Disorder Treatment Options in College Counseling Centers Purdue University Counsel

1. Instilling Hope: Brainstorming Eating Disorder Treatment Options in College Counseling Centers Purdue University Counseling & Psychological Services Lisa Werth, LCSW Staff Therapist Jenn Hommerding, MA Predoctoral Intern

2. Lisa Werth, LCSW, CADACII Staff Therapist Education: Marywood University CEDS Candidate Jenn Hommerding, MA CAPS Predoctoral Intern Education: MN School of Prof. Psychology Eating Disorders Concentration Introductions

3. Program Objectives • Complete a comprehensive eating disorders assessment and formulate appropriate diagnoses. • Identify empirically based treatment approaches for individuals diagnosed with eating disorders. • Analyze how each treatment approach is applicable for a college counseling center setting. • Assess the strengths and challenges in their own programs with respect to eating disorders treatment. • Design more creative programming for students with eating disorders while facing restricted resources and more complex diagnoses.

4. Program Overview • Participant/School Introductions • Purdue CAPS eating disorder treatment • National and Purdue Statistics • Assessment, Diagnosis, & Treatment • What’s working and what’s not? • How do we remain hopeful?

5. Eating Disorders inCollege Students • Dove's Campaign for Real Beauty • Statistics at Purdue (N=5285) • 6% undergraduate • 7% graduate • National Statistics (among adult females) • AN: 0.9 % • BN: 1.5% (Hudson et al., 2007) • Severity of EDs at Purdue

6. Purdue CAPS EatingDisorder Treatment • Multidisciplinary approach • ED Treatment Team • Clinician • Dietician • Physician • Psychiatrist • Collaboration with athletics • Individual and group psychotherapy

7. Purdue CAPS EatingDisorder Treatment • Use of Contracts • Sample contract • Ethical Concerns: What about students who don’t disagree or follow through with agreement? • Issue with community resources (or lack thereof) • What’s working for Purdue’s CAPS? What’s not working?

8. Eating Disorder Assessment • Weight history • Binging behaviors • Purging behaviors • Restriction behaviors • Emotional eating behaviors • Exercise (frequency & type) • Daily caloric intake • Fear of weight gain • Use of diuretics, laxatives, Syrup of Ipecac, diet pills, stimulants, enemas • Family history • Body image assessment • Medication history • Medical/Developmental history (including menstrual history if applicable) • Trauma history • Past treatment & hospitalizations • Comorid disorders • Social history

9. DSM-IV-TR Diagnosis: 307.1 Anorexia Nervosa A. Refusal to maintain body at or above a minimally normal weight for age and height B. Intense fear of gaining weight or becoming fat even though underweight C. Disturbance in the way in which one’s body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or denial of the seriousness of the current low body weight D. In postmenarcheal females, amenorrhea (absence of at least 3 consecutive menstrual cycles or only following hormone administration) Subtypes: Restricting or Binge Eating/Purging

10. DSM-IV-TR Diagnosis:307.51 Bulimia Nervosa • Recurrent episodes of binge eating, defined as: • Eating, in a discrete period of time (e.g., 2-hour period), an amount of food that is definitely larger than most people would eat during a similar period of time & under similar circumstances. • A sense of lack of control over eating during the episode. • Recurrent, inappropriate compensatory behavior in order to prevent weight gain (self-induced vomiting; misuse of laxatives, diuretics, enemas, or other medications; fasting; or excessive exercise). • Binge eating and inappropriate compensatory behaviors both occur, on average, at least twice per week for 3 months. • Self-evaluation is unduly influenced by body shape and weight. • Does not occur exclusively during episodes of Anorexia Nervosa. Subtypes: Purging and Non-purging type.

11. DSM-IV-TR Diagnosis:307.50 ED NOS • Any disorder of eating that does not meet the criteria for a specific eating disorder. Examples: • Females: All criteria of AN met except amenorrhea. • All criteria for AN met except weight is in normal range. • All criteria for BN met except that binge eating and compensatory mechanisms occur less frequently than twice per week over the course of three months. • Regular use of inappropriate compensatory behaviors after normal consumption. • Repeatedly chewing and spitting out large amounts of food. • Binge Eating Disorder: Binge eating in the absence of inappropriate compensatory behaviors.

12. DSM-IV-TR Diagnosis:300.7 Body Dysmorphic Disorder A. Preoccupation with an imagined defect in appearance. If a slight physical anomaly is present, the person’s concern is markedly excessive. B. The preoccupation causes clinically significant distress or impairment in social, occupational, or other important areas of functioning. C. The preoccupation is not better accounted for by another mental disorder (e.g., dissatisfaction with body shape and size in Anorexia Nervosa).

13. Empirically BasedTreatment Approaches • Evidence Based Treatment? • No evidence-based data for university treatment programs • Individual & group work • AN: No specific treatment is superior, Maudsley and family-based recently popular • BN & BED: CBT, less DBT & IPT • Brief therapy models vs. ED treatment and recovery • 76% AN reach full recovery 10-15 years • 5-6 years to reach partial recovery (Strober, Freeman, & Morell, 1997) • Advantages and Disadvantages of each approach in UCC

14. Sustaining Hope and Energy • Small group discussion • What’s working in your counseling center? What’s not? • Alternative treatment ideas • How do you remain energized in this work? • Think outside of your office!

15. Programmatic Ideas at Purdue:Thinking Outside of the Office • Dining Hall interventions • Outreach • Prevention • Greek system, QRC, and residence halls • Physical fitness facilities • Athletic department • Building relationships with referral sources • Collaboration with ODOS

16. Questions &Contact Information Purdue University CAPS 765-494-6995 lwerth@purdue.edu jhommerd@purdue.edu

17. References Hudson, J. I., Hiripi, E., Pope, H. G., & Kessler, R. C. (2007) The prevalence and correlates of eating disorders in the national co morbidity survey replication. Biological Psychiatry, 61, 348–358 Strober, M., Freeman, R., & Morrell, W. (1997). The long-term course of severe anorexia nervosa in adolescents: Survival analysis of recovery, relapse, and outcome predictors over 10-15 years in a prospective study. International Journal of Eating Disorders, 22(4), 339-360. Yager, Z., & O’Dea, J.A. (2008). Prevention programs for body image and eating disorders on university campuses: A review of large controlled interventions. Health Promotion International, 23(2), 173-189.