Background: Somatic symptoms in eating disorders often leave providers anxious and stuck, and can make nutritional rehabilitation and utilization of evidenced-based treatment difficult. Presenters will offer a model and treatment approach, strategies for working with medical providers and managing impact on patient milieu, and considerations of cultural and trauma-related factors.
Somatic Symptom and Related Disorders in Patients with Eating Disorders
- DSM-5 Introduction
- What are somatic symptom disorders?
- Typical diagnostic features, development, course,
- Culture-related issues in considering somatic symptoms
- What do we know about the prevalence of these conditions among patients with eating disorders?
- How do somatic symptoms present in clinical settings?
- Patients who do not identify with eating disorder and attribute weight and eating issues to medical conditions
- Patients whose eating disroders are initiated by or exacerbated by comorbid medical conditions
- Patients who develop somatic symptoms in the course of eating disorder treatment
- Patients who report severe food allergies or present with allergic symptoms despite lack of established allergy, which can make nutrition decisions challenging
- Patients whose somatic symptoms are so significant it is challenging to manage the symptoms in outpatient setting
- Patients who may have been subject to Factitious Disorder by Proxy
- What are the potential links between these conditions and eating disorders?
A Model of Relationship Between Somatic Symptoms and Eating Disorders
- How can we conceptualize these challenges in a way that allows us as clinicians to be compassionate and effective?
- Introduction and discussion of a conceptualization of somatic symptoms and eating disorders
- How do somatic symptoms and eating disorders form a feedback loop?
- How do we avoid getting “stuck” in the symptoms?
Differential Diagnosis
- How do we rule out medical conditions potentially responsible for symptoms
- Commonly under-diagnosed medical conditions in patients with eating disorders
- How do we establish food or other allergies?
- How do we determine psychological correlates?
Treating Patients with Somatic Symptoms
- Presentation of two case studies
- Considerations for the clinician – team approach, therapeutic style, types of sessions, managing anxiety about liability/safety, cultural considerations
- Considerations for level of care
- Presentation of a Care Plan for treatment
- Considerations for the milieu in higher levels of care
- How do you talk with a patient about somatic symptoms?
- How do you intervene with family in cases where family plays role?
Clinicians treating individuals with eating disorders are frequently faced with triaging complex physical symptoms in the context of eating symptomology. These cases can leave clinicians feeling anxious and stuc, particularly when the symptoms make the nutritional rehabilitation and recovery process more challenging.. Clinicians are faced with symptoms for which there are no determinable etiology or that make utilizing our evidenced-based interventions more challenging. Examples of this can include significant food allergies, asthma, psychogenic seizure activity, COPD, or gastrointestinal issues. These symptoms can pre-date or co-develop with the eating disorder symptomology, or may even develop in the course of treatment.
There is reason to believe that patients with eating disorders present with a higher than average frequency of somatic symptoms. Disorders of somatization occur to a greater degree in females, as well as those with histories of sexual and physical trauma, affective disorders, and anxiety disorders. Often somatic symptoms play a significant role in the course of the illness, and patients with somatic symptoms may require a longer duration of treatment. There is evidence to suggest that the clinical presentation of these individuals may be unique as well. Further, these situations can create anxiety regarging liability and safety for practitioners and concerns for ability to treat the patient in certain settings. Given this and the frequency of these symptoms occurring in the most difficult-to-treat situations, clinicians would greatly benefit from better understanding how to conceptualize and intervene in these cases.
Through didactics, discussion, case presentation, and experiential exercises, this presentation will provide participants a model to better conceptualize the various relationships between somatic symptoms and eating disorders, thereby allowing clinicians to be more compassionate and effective in their work. It will highlight how clinicians and medical providers can work together to help rule out various medical conditions and communicate with the patient and family most effectively in this process. The presentation will highlight ideas for assessment tools and interventions to manage these symptoms in individual, family, and group-milieu contexts. It will offer strategies for clinicians on how to structure treatment and utilize a therapeutic approach that minimizes potential frustration and anxiety.
Dr. Solomon serves as the Executive Clinical Director of the Eating Recovery Center of Ohio, which she helped launch in 2015. Prior to the center's opening, Dr. Solomon served as a clinical leader at Insight Behavioral Health Centers where she oversaw eating disorder services in Chicago. She is passionate about creating opportunities for lasting recovery in her community. She is an active member of eating disorder advocacy organizations and serves as the Social Media Committee Co-Chair for AED and Conference Committee Chair for BEDA. Her research interests are in media literacy and the use of social media in recovery.
Dr. O'Melia is a Triple Board certified physician, with certifications in Pediatrics, General Psychiatry and subspecialty certifications in Child & Adolescent Psychiatry and Psychosomatic Medicine. She has been listed in “Best Doctors in America” every year for the past seven years. Prior to joining Eating Recovery Center’s Adult Services, Dr. O’Melia served as Medical Director for the following: the Eating Disorders Program at the Lindner Center of HOPE, Cincinnati Children’s Medical Center Inpatient and Partial Hospitalization Eating Disorders Program, Primary Children’s Medical Center Psychiatry Consult Liaison Service and Eating Disorders and the Youth Services Programs at the University Neuropsychiatric Institute.
and
Heather A. Dlugosz, MD
Dr. Dlugosz, an Eating Recovery Center of Ohio staff psychiatrist, is a board certified in Adult and Child and Adolescent Psychiatry and is a Fellow of the American Psychiatric Association. She earned her M.D. from the University of Cincinnati College of Medicine, completed her adult psychiatric residency at University Hospital in Cincinnati and her Child and Adolescent Psychiatry Fellowship at Cincinnati Children’s Hospital Medical Center where she served as Chief Resident. Dr. Dlugosz previously served as a supporting physician and then Interim Medical Director of the Harold C. Scott Eating Disorders Program at the Lindner Center for HOPE.
