Background: Though eating disorders occur throughout life cycles, they generally begin during the period of rapid brain changes during adolescence. Understanding how brains respond to therapy, nutrition and medication can be complicated with a paucity of devoted research to this subject. This session explores challenges and opportunities present in developing brains.
I. Neurobiology of the developing brain
a. In-utero and early development
i. Genetics and temperament
ii. Environmental effects
b. Changes during puberty
i. Effects of estradiol and other hormones
ii. Pruning and specialization
c. Changes during adolescence and young adulthood.
i. Prefrontal lobe development and impulsivity
ii. Limbic system development and affect regulation
II. Neurobiology in developing comorbid psychopathology
a. Development of mood disorders
i. Genetic risk
ii. Environmental risk
iii. Brain regions affected
b. Development of anxiety disorders
i. Genetic risk
ii. Environmental risk
iii. Brain regions affected
c. Development of trauma/PTSD
i. Genetic risk
ii. Environmental risk
iii. Cortisol and brain regions affected
III. Neurobiology in the development of eating disorders
a. State and trait criteria
b. Developmental neurobiological considerations in anorexia
c. Developmental neurobiological consideration in bulimia
IV. Psychopharmacology and the developing brain.
a. Psychopharmacology of mood disorders
i. Serotonin, noradrenergic and dopamine systems
ii. Discussion of mechanism and impact of suicidal black box warning with antidepressants in adolescents
b. Psychopharmacology of anxiety disorders
i. Serotonin and noradrenergic systems
ii. Acute versus chronic management.
c. Psychopharmacology in PTSD
d. Psychopharmacology in ADHD
e. Psychopharmacology in Eating Disorders.
i. Psychopharmacology in Anorexia Nervosa
ii. Psychopharmacology in Bulimia Nervosa
iii. Psychopharmacology in Binge Eating Disorder
V. Clinical considerations in Development
a. Clinical correlates of development on diagnostic accuracy
b. Cognitive and developmental factors in choosing therapy
i. Factors for CBT, DBT, IPT and ACT
ii. Factors of consideration for FBT
iii. Factors of consideration for inpatient care.
VI. Nutritional considerations of development
a. Nutritional requirements of growth
b. Nutritional requirements of puberty
c. Nutritional requirements of teenage/young adulthood.
d. Nutrition and bone growth.
e. Nutrition and psychopathology.
f. Nutritional growth curves and predicting weight range.
VII. Audience Participation
a. Illustration of brain activity during development
b. Interaction on interviewing/evaluation skills during different phases of development and weight range determination.
The brain is an amazingly dynamic organ that begins a process of fulfilling genetic programming in an environment that shapes this journey even before an individual is born. Understanding development of neural systems and response of these systems to the complex environment in which it exists in is vital in understanding the pathogenesis of eating disorders and other comorbid psychiatric illnesses.
Eating Disorders, like a majority of psychiatric pathology, generally begins or worsens during the period of rapid changes in the brain that occur during adolescence. During this time there is a great shift in brain architecture that occurs with sexual maturity and chemical messengers such as sex hormones help to regulate this metamorphosis. These changes consist of dendritic pruning and the integration of limbic and prefrontal circuits, therefore moving the adolescent towards a more integrated and regulated “adult” brain. Unlocking these pathways and discovering what modulates them holds the hope to early intervention, better diagnosis, and improved understanding of psychiatric illness and eating related pathology.
The complexity of neural development in the developing brain highlights the challenges of child and adolescent psychopharmacology, where medicines meant to bring someone back from the depths of depression can sometimes paradoxically cause suicidality. This serious complication brings to light that children, teenagers and even young adults have different psychopharmacologic considerations than adult patients. These considerations are very rarely highlighted and discussed in the eating disorders field, and the hope of this session would be to bring clinicians to a better understanding of how and why psychopharmacological and other interventions are used during different phases of care in child and adolescent patients.
Finally, nutritional needs for developing patients with eating disorders are often a moving target challenging to both professionals and parents alike. Understanding how nutrition shapes the developmental process can help finding the golden “ideal body weight” throughout a period of expected growth. This presentation uses PowerPoint, animation, diagrams and audience participation to create an engaging way to understand developmental neurobiology, psychopharmacology and nutrition.
Dr. Moseman attended medical school at Texas A&M University and completed adult residency at the University of Arizona. He went on to do a fellowship in Child and Adolescent Psychiatry at Western Psychiatric Institute and Clinic where he served as chief fellow. Since completing fellowship in 2004, he has worked at the Laureate Eating Disorders Program on both an inpatient and outpatient basis and is currently Medical Director of the eating disorders program. Dr. Moseman is also an investigator at the Laureate Institute of Brain Research where he participates in studies using functional imaging to investigate eating related illnesses.
Leah Graves is manager of nutrition therapy for the Laureate Eating Disorders Program. She is a founding member of the Academy for Eating Disorders and has served on its Executive Committee, Board of Directors and honored as a Fellow. She served on the 2013 and 2014 National Eating Disorders Association Conference Committees. Ms. Graves has served as President of the Oklahoma Eating Disorders Association. She has presented at the International Conference on Eating Disorders, IAEDP Symposium, National Eating Disorders Organization Meeting and the American Dietetic Association Annual Meeting. Ms. Graves has published several articles pertaining to nutrition & eating disorders.
