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Sharon L. Mitchell
Althea Maduramente
Jessalyn Klein
University at Buffalo
• Anorexia Nervosa - self-starvation, excessive weight loss, and
refusal to maintain a weight which is normal for one’s height and
age. These individuals often perceive themselves as being fat even
though they are extremely thin.
• Bulimia Nervosa: a cycle of bingeing and compensatory behaviors
such as vomiting, laxative and diuretic misuse, and excessive
exercise.
• Eating Disorder Not Otherwise Specified: sporadic or chronic
disordered eating patterns. However, these patterns do not meet
the clinical criteria for AN or BN.
– Binge Eating Disorder, also known as compulsive eating
• 25% of college students attempt to control their
weight using behaviors associated with Bulimia
Nervosa (Renfrew Center Evaluation, 2003)
• Nearly 91% of female college students use dieting
as a weight-control mechanism (Shisslak, et al.,
1995).
• 5% to 20% of college females and 1% to 7% of
college males have eating disorders (Johnson &
Connors, 1987)
• In a national survey, 15% of college men and
27% of college women reported that it had
been traumatic or difficult to handle their
personal appearance in the past 12 months
(ACHA, 2012)
• In a national survey of college counseling
center clients, 27% of females and 13% of
males reported a high level of distress related
to Eating Concerns (CCMH, 2013)
• Restore the person to a healthy weight
• Treat the psychological issues related to the
eating disorder
• Reduce or eliminate behaviors or thoughts
that lead to insufficient eating or overeating
• Prevent relapse
Individualized but often include:
• Individual, group, and/or family
psychotherapy
• Medical care and monitoring
• Nutritional counseling
• Medications
Based on the American Psychiatric Association
Standards (2006)
1. Outpatient
2. Intensive outpatient
3. Partial hospitalization (full-day outpatient
care)
4. Residential treatment center
5. Inpatient hospitalization
• Eating disorders are both psychological and medical
conditions, thus care should address both.
• The EDT team consists of mental health professionals,
physicians, and a dietitian who collaborate to provide
appropriate assessment, intervention, and support to
students with eating disorder concerns.
• The EDT team assists students in need of more intensive
services in finding these services in the community.
• The EDT Team continues to assess a student's progress and
make updated recommendations based on the student's
progress and level of functioning.
• To monitor physical health by checking vital signs.
• To draw blood or take urine samples, if necessary, to make
sure the chemicals in the body are balanced.
• To order tests to monitor heart rhythm, bone density or if
osteoporosis (thinning of the bones) is present or developing.
• To offer suggestions for achieving weight goals, calcium and
vitamin supplements, exercise, hormone replacement, and
possibly medication for anxiety or depression.
• To help determine the need for hospitalization & manage
medical complications (e.g., arrhythmias, amenorrhea,
osteoporosis, and electrolyte abnormalities).
• To refer to another specialist, if necessary
• To help create a healthy eating plan
• To answer any questions about food.
• To discuss the harmful myths and confusing
messages about food and diets.
• To provide nutrition counseling that includes
teaching clients about what types of food their
body needs, and how much food their body
needs.
• To help their clients begin to incorporate
challenging foods into their diets and learn to
listen to physical signals of hunger and satiety.
• To improve self-esteem, body image, and confidence.
• To teach healthy ways to manage emotions and
stressful situations.
• To address other emotional problems that may be
related to the eating disorder, such as depression,
anxiety, obsessive-compulsive disorder, or substance
abuse.
• To provide a safe place to experience feelings of
sadness, anxiety, anger, etc.
• To help clients learn how to challenge disordered
eating thinking and behaviors, and teach strategies to
become mentally healthy.
• Points of entry: Health, Counseling & Wellness
• Consent form includes ability to consult with
Health or Wellness
• Counselors explain the team concept
• Chair of ED team is informed of clients
referred to the team
• Bi-weekly meetings
• ED consultation note is added to client file
“Client feels that purging to avoid weight gain is
not working for her and is motivated to make
changes.”
“Client went to hospital emergency room for a
GI bleed related to her purging. She has been
bingeing and purging 1-4 times a day for the
past 4 years and has struggled with her ED since
age 12. She is also depressed and anxious.
.Physician started her on Prozac and will see her
weekly. Patient is medically stable to receive
care at UB at this point.”
Gender
%
Male
12%
Female
88%
Academic Status
Heterosexual
83%
Caucasian
77%
LGBTQ
15%
Asian
9%
Unknown
2%
Black
6%
Hispanic
3%
Mean = 22.2
Multiracial
3%
Range = 17-46
Native American
2%
Age
63%
Graduate
37%
%
%
%
Undergraduate
Race/Ethnicity
Sexual
Orientation
Previous Counseling = 67%
• No specific criteria for referral to the team
• About 1/3 of ED clients were referred (n =66)
– 55 clients actually discussed at EDTT
• No significant demographic differences
between those referred to the team vs. those
who were not (e.g. race, age, gender, sexual
orientation, academic status, diagnosis, initial
GAF score)
• People who were referred to the team were much more likely to
have been in counseling before.
– 77% of those referred had previous counseling as compared to 60% of
those that were not referred.
• Graduate students with ED diagnosis were more likely to be
discussed in EDTT than Undergraduate students
– 48% of graduate students were discussed compared to 30% of
undergraduate students
•
Type of Diagnosis
– 79% of those diagnosed with Bulimia Nervosa were referred to the
EDTT
– 43% of those diagnosed with Anorexia Nervosa were referred to the
EDTT
– 39% of those diagnosed with an Eating Disorder NOS were referred to
the EDTT
• Explored comorbid diagnoses including
Adjustment, Anxiety, Mood, Psychosis,
Substance, Sleep, Childhood, Medical,
Impulse, Sex/Gender, Somatoform, and
Personality Disorders.
– Only comorbid diagnosis significantly correlated
with being referred to the EDTT was Personality
Disorders (N=30).
– Of those diagnosed with a Personality Disorder,
73% were referred to the EDTT.
• In comparison to their female counterparts, male
counselors were less likely to refer to the team.
– Male counselors referred only 6% of their clients
compared to the 49% of clients referred by female
counselors
• Of those 66 people referred to the EDTT, 62 were
referred by their primary counselor
– Senior staff were most likely to refer to the team
(62%).
– Doctoral level psychology interns referred 31% and
part time trainees referred 8%.
• Those receiving the highest level of care tend to
stay in therapy longer:
– Attended 14.6 more individual sessions, 4.6 more
group sessions, and 19.2 more total sessions than the
those clients receiving only group or individual
counseling.
– Attended 10.7 more individual sessions and 14.6
more total sessions than just consulting and meeting
with the physician.
– Attended 10.5 more individual sessions than those
who were discussed in the EDTT but didn’t meet with
either the MD or nutritionist
• Those receiving just the EDTT consultation
attended 4.3 more group sessions than the
control group (not discussed at EDTT)
• 60% of people referred to the EDTT had planned
terminations compared to only 30% of people
who were not referred to EDTT
• People referred to EDTT were more likely to be
referred to a group
– 73% of EDTT clients vs. only 28% for non-EDTT clients
• EDTT creates an environment that supports
students staying treatment longer and ending in a
planned fashion
• Staff, particularly, male staff may need more
training regarding the benefits of the team
approach
• May need to develop criteria for referral to the
team to increase appropriate referral
• May need to require referral to the team given
it’s efficacy over psychotherapy alone
• Look more closely at treatment outcomes via
symptom reduction on the CCAPS
– Depression, Generalized Anxiety, Social
Anxiety, Academic Distress, Eating Concerns,
Family Distress, Hostility, Substance Use, Distress
Index
– Administered at intake, 4th, 8th, & 12th sessions
• Perhaps administer the EDI -2 with all ED
clients