Wish you could've gone too, OneToughMama. Maybe you can represent on your side of the world.
I am "lucky" in that I have a license that requires me to have continuing ed and so I have an excuse to spend money and time going to stuff like this. I go to hear what is going on in the research and to have more insight into the treatment community. This conference delivered on both and the outcome was mixed. Below is a summary of what was presented along with lots of my own editorial comments and thoughts. I'd be glad to send more details if any one is looking for them. I'd love to hear what you think too.
Here's a summary of presenters:
1. Carlos Grilo, PhD, Yale University, Binge Eating Disorder: A new era of diagnosis and treatment
Dr. Carlos's work was very driven by research and by a desire to truly understand the experience of persons struggling with BED and how best to help them find healing. He explained that a key criteria of diagnosing BED is that binges that occur at least once weekly. AN and BN "trump" BED as a diagnosis if patients meet the criteria for both. The nature of the binge, the feeling of "being out of control" and experiencing "marked distress," as well as shame and guilt afterwards, matters more than the amounts consumed. Some patients present with average weights, though, if untreated, patients are likely to gradually gain weight over time. He found that patients desired a relief of symptoms much more than weight loss. Co-morbidities include anxiety disorders (65%), mood disorders (46%), impulse control disorders (43%), and substance abuse (23%). The most effective treatment they have found combines CBT and weight loss management (through a dietician). CBT alone led to a 50% success rate but did not assist with weight loss. They tested their approach with a low-income, Spanish speaking population and found that the success rates were the same. Research is being done on using the medication LDX for BED with some success. There is risk, though, as it is a stimulant with addictive qualities.
2. Nancy Zucker, PhD, Duke University/ Medical Center, The Phenomenology and Management of ARFID
The research they are doing at Duke on ARFID has brought out large numbers of adults who were previously undiagnosed. Their research challenged the notion that people would try new things if they did not have access to their safe foods and found that when people are anxious/ depressed/ stressed, they are more rigid and less exploratory. They will be more likely to not eat even if they are hungry. She found that ARFID sufferers expressed frustration that others saw their aversions as mere preference when, to them, they felt their aversions were driven by a "disgust" reaction. This is what makes it difficult for them to keep from gagging when trying new foods. Disgust leads to increased anxiety and resists extinction more strongly than a fear or phobia. Validation of their experience and consistent positive reinforcement made a difference. Clinicians validate the usefulness of the role of suspicion in trying new food and encourage participants to support each other while they go on "food adventures" that push their limits one small step at a time. I am not clear on what they offer in terms of inpatient care. They do offer outpatient, a parent intensive and have guided online groups so that participants can continue to support each other.
3. Martin M. Monotony, PhD, Ryerson University, Toronto, Nature and Treatment of Perfectionism
Differentiated perfectionism from ODPD (obsessive compulsive personality disorder). Research in genetics has shown moderate heritability. No research has been done in brain imaging/ neurotransmitters. This left him to mostly describe perfectionism as a "learned behavior" that can come out of a "chaotic home" or one that is too rigid (I guess parents have to be in the "just right" category to avoid being the cause). After these comments, I admit that I had a difficult time listening to the rest of what he had to say. The gist was that perfectionism is only a "problem" when it interferes with daily functioning and that CBT is the most effective treatment. When cost/ travel are barriers, group treatment and self-help books have also been shown to reduce symptoms.
4. Allison Kelly, PhD, University of Waterloo, Our Brains need compassion and so do our bodies: An examination of self-compassion's contribution to body image
Dr. Kelly began by basing her work on Paul Gilbert's work on the role of self-compassion in healing. She described three systems within us: the drive system, the soothing system, and the threat system. She also emphasized early life experiences as being the strongest effect on these systems and their ability to function, thus again giving life to the idea that parents are the ones causing their children's dysregulation. Anxious attachment and self-esteem also figured in. The idea of the treatment is to build up the functioning of the soothing system as a way of counteracting the revved-up state of the threat system. Her research was mostly done with college students and ED patients in an inpatient setting. It does seem that self-compassion is a helpful approach to be used as an adjunct therapy. My concern is that this research is not done with a biological understanding of ED as it's basis.
5. Ivan Eisler, PhD, Maudsley Hospital, London, Family Dynamics in Eating Disorders
Dr. Eisler is a key figure in Maudsley/FBT treatment and was a draw for me to attend the conference. He reviewed the professional field's changing understanding and approach to treating EDs and the process of how we got to the underpinnings of FBT. He also clarified that there are three manual-based treatment approaches that vary slightly from each other. They are FBT (Lock and LeGrange), one by Robin & Siegal (I did not get the name) and FT-AN/ FT-BN (Eisler and his colleagues). Eisler's differs in that it allows the first stage to focus on engaging the family and developing the therapeutic alliance. He feels that this step is not addressed fully in FBT and is necessary for improved outcomes. He presented a pie chart that showed the factors that effect treatment outcomes. In the chart was client differences (40%), therapist qualities (30%), technique/ approach (15%) and hope/confidence (15%). As an example, he noted that hope increases significantly when families believe that they are working with an expert. The overall idea was to show that establishing credibility and maintaining a therapeutic alliance together are even more important than using the best approach. He noted that the costs of treatment were cut in half when a family was immediately referred to a specialized provider rather than be treated by generalist. This was mostly due the increased need for hospitalizations.
I also attended a breakout session with Dr. Eisler. The one part that stood out for me is that he has switched to thinking about family work as empowering the parent to battle the ED to thinking about mobilizing both the parents and the child/teen to battle ED together. It is a subtle shift that he said has really helped with oppositional adolescents.
During the breakout session, a clinician who practices FBT and trained under LeGrange spoke up to debate with Dr. Eisler. She felt strongly that a large percentage of adolescents with ED have been mistreated by their families and that, in many cases, AFT (adolescent-focused therapy) is a better approach. I spoke up but not very effectively. Dr. Eisler engaged her but was not successful in changing her perspective. I hate that parents could think that they've found help in an FBT-trained practitioner only to find that this very same person is biased towards finding how they could have caused their child's illness.
My thought is that there is the big risk in taking an agnostic approach to the origins of ED. No one is really put at ease with this agnosticism. Practitioners, families and sufferers all continue search for an understanding of how they got to where they are. Agnosticism aims to neutralize but keeps the door of parent blame wide open. The best anecdote for this is to underpin treatment with a biological understanding of the disease and push more professional trainings to do the same. Otherwise those myths will just keep perpetuating themselves.