Background: This workshop will focus on individuals who develop a severe and enduring form of anorexia nervosa. The presentation will comment on current treatment approaches for these individuals. Also, a brief discussion of civil commitment will be presented as a way to assist maintaining treatment adherence. This workshop will discuss how Psychiatric Advanced Directives might play a role or be a model to help these individuals maintain quality health care and quality of life.
Objectives: 1. Participants will understand the concept of severe and enduring anorexia nervosa 2. Participants will be able to identify different approaches to treatment for these individuals 3. Participants will have a basic understanding of the nature and use of Psychiatric Advanced Directives
A. A comprehensive review of 119 studies of 5590 people with anorexia nervosa with a follow-up of 1 – 29 years reported approximately 14% (range 0-79%) developed a chronic eating disorder
B. Longitudinal analyses suggest that the likelihood of change after 5–7 years of eating disorder symptoms is significantly reduced.
C. First, at a behavioral level, chronicity implies an absence of change. However, an absence of change is a complex concept.
II. Comment on current treatment models
A. The American Psychiatric Association (APA 2006) treatment guidelines suggests efforts to understand the unique plight of these patients.
B. Engage them in the therapeutic alliance, which may allow for nutritional rehabilitation.
C. Focus on fewer relapses and smaller weight restoration.
D. Psychotherapeutic measures are needed to engage and motivate and failing that develop compassionate care. Consider this a sub-group of a poorly understood patients
III. Present Psychiatric Advanced Directives as a potential or novel model to assist in maintaining adherence to treat.
A. Psychiatric advanced directives (PAD) are one potential mechanism available to persons with anorexia nervosa to help minimize many of the ambiguities commonly associated with mental health crises.
B. PADs are legal documents that allow competent individuals, through advance instructions, and or designation of a Health Care Agent, to declare preferences for future mental health treatment
Wayne Bowers is Full Clinical Professor in the Department of Psychiatry at the University of Iowa and Clinical Director of the Eating Disorder Program. He has worked with adults and adolescents suffering from eating disorders since 1977 and other disorders since 1976. His principal clinical work within the eating disorders program includes group and individual therapy across a continuum of care that includes inpatient, partial hospital and outpatient treatment. He has written book chapters, review and research articles with a emphasis on treating eating disorders on an inpatient and partial hospital level and the use of Cognitive Therapy.
Taylor Ford works on the eating disorder service in the Department of Psychiatry at the University of Iowa. She is involved with inpatient, partial hospitalization, and outpatient care. Taylor also co-leads the Eating Disorder Program Aftercare/Relapse Prevention Group. She graduated with a BA from The University of Iowa School of Social Work in 2013 and received her Master of Social Work with a concentration in mental health from Washington University in St. Louis in 2014. She is an adjunct clinical professor at The University of Iowa School of Social Work and a Diplomate through The Academy of Cognitive Therapy.
