Background: The diagnosis of an eating disorder can be challenging due to the complexity of medical and psychological symptoms. A multidisciplinary panel will decode case studies that present with a “zebra diagnosis” and offer explanations as to what makes ED patients clinically and ethically complex.
Content Outline: Eating disorders are among the most common psychiatric problems and these conditions impose a high burden of morbidity and mortality. Unfortunately, the diagnosis of an eating disorder can be elusive and go undetected.
Difficult cases pose clinical and ethical challenges. The complexity of medical and psychological consequences can be attributed to numerous other disease states and thus move the care provider to an incorrect or incomplete diagnostic pathway and treatment intervention. Often such cases become the hallmark of treating the symptoms and not the cause. Aggressive intervention regarding osteoporosis, GI dysfunction, amenorrhea, electrolyte imbalance, depression, anxiety, perceived loss of control etc. without the consideration and assessment for an eating disorder can lead to ineffective short term outcomes. The DSM-V has enhanced the categories of eating disorders to cover the cases that do not directly match up with the classic Anorexia Nervosa or Bulimia Nervosa patient. Binge Eating Disorder (BED), Avoidant /Restrictive Food Intake Disorder (ARFID), Other Specified Feeding or Eating Disorder, or Unspecified Eating Disorder offers physicians, therapists, dietitians and professional clinicians a screening tool to open the possibility of the ED diagnosis and pursue this evaluation with the appropriate medical, psychosocial and nutritional assessments. This panel will present 2-3 challenge cases that have been preselected by the panel participants and reviewed prior to the presentation with “zebra diagnosis”. The moderator will lead the discussion and focus on the following areas:
- Initial clinical and behavioral assessment
- Patients relevant history
- What intervention was being recommended by the professional
- What intervention took place
- Evaluation of the intervention from a clinical and ethical perspective
- Was the intervention overall effective
- What was the correct diagnosis
- What could have been done differently
Eating disorders are among the most common psychiatric problems and these conditions impose a high burden of morbidity and mortality. Unfortunately, the diagnosis of an eating disorder can be elusive and go undetected. Difficult cases pose clinical and ethical challenges. The complexity of medical and psychological consequences can be attributed to numerous other disease states and thus move the care provider to an incorrect or incomplete diagnostic pathway and treatment intervention. Often such cases become the hallmark of treating the symptoms and not the cause. Aggressive intervention regarding osteoporosis, GI dysfunction, amenorrhea, electrolyte imbalance, depression, anxiety, perceived loss of control etc. without the consideration and assessment for an eating disorder can lead to ineffective short term outcomes. The DSM-V has enhanced the categories of eating disorders to cover the cases that do not directly match up with the classic Anorexia Nervosa or Bulimia Nervosa patient. Binge Eating Disorder (BED), Avoidant /Restrictive Food Intake Disorder (ARFID), Other Specified Feeding or Eating Disorder, or Unspecified Eating Disorder offers physicians, therapist, dietitians, and professional clinicians a screening tool to open the possibility of the ED diagnosis and pursue this evaluation with the appropriate medical, psychosocial and nutritional assessments. This panel will present challenge cases with “zebra diagnosis”. A directed discussion of the cases will review the initial clinical and behavioral presentation of the patient and history. Intervention recommendations and results of treatment will be evaluated and critiqued by the panel with insightful indicators of clinical and ethical effectiveness.
Dr. Boyers graduated in Psychology at the University of Pennsylvania, then completed Master’s and Doctoral Degrees in Clinical Health Psychology at the University of Miami. She completed internships at the UM Counseling Center, UM Department of Psychology and Renfrew Center. Currently in private practice since 2001, she specializes in women’s health, EDs, anxiety/mood disorders, and behavioral medicine. She is Director of Adolescent Services for Oliver Pyatt Centers, founded the IAEDP Miami Chapter and is serving her second term as President. She has co-authored articles in professional psychology journals and frequently presents on the topics of stress, trauma, and eating disorders.
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Bryan Gusdal, MA
Bryan Gusdal did his graduate studies in Psychology at the University of Saskatchewan. After graduation, he spent 26 years as a Clinical Psychologist at the Brandon Mental Health Centre, before going on to found the Westwind Eating Disorder Recovery Centre in Brandon, Canada, where he served as director for 15 years. He served a decade on the Manitoba Psychological Society's Board of Directors, for which he is a past President. He is a member of the Academy for Eating Disorders. He has been active as a clinician with adults and adolescents, treating individuals with eating disorders for over thirty years.
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Edward P. Tyson, MD
Treating EDs for over 25 years in academic and private practice; numerous presentations nationally and internationally on medical & insurance issues, athletes w/ EDs; Recent publications: E Tyson. “Medical Assessment of Eating Disorders.” Treatment of Eating Disorders: Bridging the Research-Practice Gap. Maine M, Bunnell D, McGilley B, (Eds.). New York: Elsevier; 2010. O Bermudez, K Bertou, M Devlin, K Katzman, M Krohel, B McGilley, E Rome, E Tyson, M Warren. “Eating Disorders—Critical Points for Early Recognition and Medical Risk Management in the Care of Individuals with Eating Disorders.” Academy for Eating Disorders Medical Care Standards Task Force. 2011
and
Jennifer L. Guadiani, MD, CEDS
Dr. Jennifer L. Gaudiani, MD, CEDS, is the Associate Medical Director of ACUTE and is an Associate Professor of Medicine at the University of Colorado School of Medicine. She oversees the clinical, strategic, and administrative management of ACUTE and attends on the service. She completed her undergraduate degree at Harvard College, earned her medical degree from Boston University School of Medicine, and completed her residencies of Internal Medicine at Yale. Dr. Gaudiani has published and lectured extensively on the medical complications of EDs. She is on the national board of IAEDP as well as medical liaison for her local chapter.
Karen Beerbower, MS, RD, LD is a licensed, registered dietitian with a Masters degree in Medical Science from Indiana University School of Medicine. She is co-owner and Clinical Director of Blue Horizon Eating Disorder Services, LLC. She is the President of the private practice firm, Nutritional Guidance, Inc. Karen is a Board Member of the Eating Disorder Network of Central Florida and a member of the ADA, Orlando Dietetic Association, IAEDP, NEDA, Academy of Eating Disorders, National Association of Anorexia Nervosa and Associated Disorders, Sports Cardiovascular & Wellness Nutritionists and Nutrition Entrepreneurs.
