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Disentangling the Complexity of the Suicidal Client: Best Practices for Assessment and Treatment

Saturday, February 20, 2016: 3:15 PM-5:15 PM
Magnolia G (Omni Amelia Island Plantation)

Background: Clients with eating disorders are at high risk for suicide. Clinicians who treat eating disorders require repeated, high-level training in suicide assessment and intervention to achieve competence in this area. This dynamic didactic/experiential workshop will provide the latest advances in best-practice interventions for suicidality in eating disorder clients.

I.              Overview of Suicide in Eating Disorders

  A.   Prevalence of Suicide in Eating Disorders

      1.    Individuals with AN are 31 times more likely to make a fatal suicide attempt than the general  population (Arcelus et al., 2011)

      2.    Individuals with BN are 7.5 times more likely to die by suicide than general population (Chesney et al., 2014).

      3.    Rates of death by suicide among individuals with eating disorders are elevated compared to other mental health disorders (Chesney et al., 2014).

  B.   Understanding the Suicidal Mind

      1.    Individuals who are suicidal experience psychological pain, defined as psychache (Schneidman, 1996).

      2.    Individuals who are suicidal experience constricted thinking that narrows options in decision-making.

      3.    Individuals who are suicidal experience hopelessness that limits expectancies for the future.

  C.   Conceptualization of Suicide in Eating Disorders

      1.    Interpersonal Psychological Theory of Suicide (Joiner, 2005) posits that perceived burdensomeness, thwarted belongingness, and acquired capacity for lethality converge to place a person at risk for suicide.

II.            Best Practices in Suicide Risk Assessment

  A.   What not to do:

      1.    Self-report checklists

      2.    No Suicide Contracts

  B.   What to do:

      1.    Comprehensive Suicide Risk Assessment:

       a)    The Suicide-Risk Decision Tree (Joiner et al., 1999) assesses suicidal desire and ideation, resolved plans and preparation, and protective factors to comprise a risk-level designation.

      2.    Risk- Level Interventions for Acute Suicidality

       a)    No Risk or Low Risk without Suicidal Ideation

           i.        De-escalation Plan

       b)    Low Risk with Suicidal Ideation

           i.        Safety Plan

       c)    Moderate Risk

           i.        Safety Plan + Means Reduction

       d)    High Risk

           i.        Rule out imminent Risk/hospitalization

III.           Interventions for Chronic Suicidality

  A.   Conducting a Suicide Timeline Interview©

  B.   Ways to Discuss Suicidality with Clients

      1.    Use Appropriate Language

      2.    Provide Empathy

      3.    Avoid Romanticizing

      4.    Elicit Hope

  C.   Include Suicidality as its own area of focus on treatment plan

  D.   Advanced Techniques for Building Connection

      1.    Neutralizing Shame

      2.    Exposure + Response Prevention

  E.    Advanced Techniques for Unburdening

  F.    Advanced Techniques for Building Hope

  G.   Advanced Techniques for Building Resilience

       1.    Boost Positive Emotion

       2.    Increasing Flexibility

  H.   Advanced Techniques for Creating a Life Worth Living

IV.          Conclusion and Question/Answer

Individuals with eating disorders are at high risk for suicide. General practice clinicians report that suicidality is their greatest feared patient problem, yet the majority of providers have received less than two hours of training in suicide assessment and intervention. Additionally, approximately 50% of clinicians fail to conduct an adequate suicide assessment. Based on the high rate of suicide in eating disorders, providers treating eating disorder require more advanced training in suicide assessment and intervention to achieve competence in this area. It is our recommendation that eating disorder specialists receive recurrent advanced training in suicide assessment and treatment as an integral component of best practices for eating disorder treatment. Four years ago at the IAEDP Symposium we presented a brief overview (1.5 hours) of the relationship between eating disorders and suicide. We also provided an introduction to suicide risk assessment and an overview of therapeutic techniques for suicidal clients. This presentation will be an intensive advanced training in suicide assessment and intervention specific to eating disorders and will provide attendees with the most up-to-date best practices for treating suicidality in eating disorders. A brief overview of suicidality and eating disorders will be provided with an introduction to a conceptualization of suicidality in eating disorders. The results of our recent research investigating risk factors for suicide in an inpatient eating disorder sample will be discussed with recommendations for intervention based on the outcomes. The majority of the workshop will be centered on training in proficient and straightforward suicide risk assessment with evidence-based risk level interventions and innovative techniques to address both acute and chronic suicidality in eating disorder clients. The goal of the presentation is to equip and empower clinicians to address suicidality in eating disorders with competence, confidence, and compassion. Hands-on applications and video vignettes will be utilized to promote comprehension and integration. The material in this workshop will be presented in a dynamic and engaging style for which the presenters are known, so that attendees leave the presentation with a renewed sense of confidence and hope in treating this complex symptom profile in eating disorders.

Primary Presenter:
Nicole Siegfried, PhD, CEDS

Dr. Nicole Siegfried is a Licensed Clinical Psychologist and Certified Eating Disorder Specialist. She is a Clinical Director with Castlewood Treatment Centers. She previously served as an Associate Professor of Psychology at Samford University and is currently an Adjunct Associate Professor at University of Alabama at Birmingham. She is the current co-chair of the Suicide Special Interest Group for Academy of Eating Disorders. She is a researcher and international presenter in the area of suicide and eating disorders.

Mary Bartlett, PhD

Dr. Bartlett is an independent mental health consultant, researcher, trainer, and adjunct therapist at Castlewood at The Highlands Treatment Center. She is an authorized trainer for the Suicide Prevention Resource Center, is a qualified Master Resilience Trainer, is well published, and has extensive clinical experience in the areas of suicide, resilience, and various mental health related topics. She currently serves Department of Defense leadership on suicide and resilience related matters, is a member of the Workplace Postvention Task Force of the American Association of Suicidology, and is co-chair of the Suicide Special Interest Group for The Academy of Eating Disorders.

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