Background: Clinical research and experience show that anxiety disorders in children increase risk factors for disordered eating, pursuit of a body image ideal and exercise compulsions. This seminar by experts in the comorbidity of severe anxiety disorders and eating disorders, will review why the underdeveloped and malnourished brain is help-rejecting, necessitating a Family Based Treatment approach. Interactive case studies and practice recommendations for children and adolescents will be provided.
Objectives: Objective 1: Participants will identify three reasons anxiety disorders predispose a child to the onset of disordered eating, including development of irrational food fears, pursuit of the body image ideal, and health anxiety. Objective 2: Participants will learn about the three behaviors that grow anxiety: avoidance, reassurance-seeking, and compulsions, and how this relates to the development of irrational food fears, body image distress, and excessive exercise. Objective 3: Participants will learn appropriate interventions for treating children and adolescents with comorbid anxiety and disordered eating, through three interactive case studies using the Family Based Treatment approach.
How the Anxiety-Disordered Brain Gets Stuck on Body Image, Food & Exercise During Adolescence
Content Outline
- Discuss research connection between ED’s and OCD, and why these disorders may be part of a common spectrum due to high co-morbidity rates (What is the association between obsessive-compulsive disorder and eating disorders?, Altman and Shankman, Clinical Psychology Review 29, 2009, 638-646).)
- Shared characteristics of OCD and eating disorders
- Co-morbidities also effect treatment approaches and outcomes
- Why it is important for providers not to get stuck on the root causes
- Traditional treatment approaches for eating disorders in children and adolescents versus Family Based Treatment (FBT)
A. Why the under-developed and malnourished brain is help rejecting and necessitates a Family Based Treatment approach
B. Incongruence with Family Based Treatment approach and waiting for child’s readiness (most important predictor for success in FBT is Parental Self-Efficacy in implementing the meal plan, rather than the child’s recovery-focus)
- Pre-existing anxiety disorders and predisposal to onset of disordered eating in childhood and adolescence
A. Behaviors that promote growth of anxiety: avoidance, reassurance-seeking, and compulsions
B. Relationship of anxiety to development of irrational food fears, pursuit of the body image ideal, and health anxiety
- Discussion of 3 case studies
A. “Tim” – 15-year-old male, low weight, purging behaviors, over-focus on appearance and clean eating; health anxiety
B. “Gracie” – 10-year-old female, reports gluten, dairy and fat are unhealthy; exercise compulsions; irrational fears related to media and technology
C. “Amber” – 19-year-old female college student, intense abdominal pain after eating, diagnosed with leaky gut syndrome; exercise compulsions; poor parental boundaries/accommodation
Dr. Kulberg is a clinical psychologist with 20 years of experience in treating eating disorders and severe anxiety disorders. She is an expert in exposure therapy (ERP) and as well as Family Based Treatment (FBT), and has enjoyed training experiences at such places as the Behavior Therapy Training Institute of the International Obsessive-Compulsive Disorder Foundation (IOCDF), as well as Eating Recovery Center of Denver's Child and Adolescent Eating Disorders Program, where she worked for two years as a primary therapist. She recently presented at the IOCDF annual conference and is currently the Clinical Direction at La Ventana Eating Disorders Treatment Program in Santa Barbara, California.
Shira Evans, MS, RD, CSSD, LD, has a wealth of knowledge and experience in the fields of both eating disorders and sport nutrition. Prior to joining the staff at Dartmouth College, Shira worked as a dietitian at Eating Recovery Center in Denver with both children and adults, and is particularly skilled at promoting recovery in those with co-morbid disordered eating and OCD. Today she oversees all of the eating disorder cases at Dartmouth College and provides individualized nutrition counseling to the 36 varsity athletic teams.
