APNA 25th Annual Conference October 21, Session 3047

Transcription

1 Theoretical Concepts to Treat Individuals with Eating Disorders: An integrative approach Kris Vandenberg DNP, FNP-BC, PMHNP-BC Assistant Professor of Nursing This speaker has no conflict of interest to disclose Objectives Objective 1 : Discuss current research related to therapy needs for individuals with eating disorders Objective 2 : Identify evidence based strategies to integrate therapy modalities when caring for individuals with eating disorders Objective 3 : Discuss cultural and gender considerations when caring for individuals with eating disorders References Available as Handout Outline of Presentation 1. Introduction: DSM IV-TR criteria for eating disorders 2. Review of therapeutic treatment modalities 3. Review of current literature and integration of therapy 4. Cultural and gender considerations 5. Role and challenge of APRN 6. Conclusion: Q & A Vandenberg 1

2 Types of Eating Disorders Anorexia Nervosa Restricting Type Binge-eating/purging type Binge Eating Disorder Eating Disorder NOS Bulimia Nervosa Purging type Non-purging type Eating Disorders- DSM IV -TR Anorexia Nervosa Body wt. < 85% normal Intense fear of gaining g weight or becoming fat Body image disturbance Amenorrhea Bulimia Nervosa Recurrent binge eating Recurrent compensatory behavior to avoid wt. gain Occur at least 2x wk for 3mo Self evaluation is influenced by body shape & weight Eating Disorders- DSM IV -TR Eating Disorder NOS Eating Disorder that does not meet criteria for other eating disorder. (Examples): Anorexia with menses Bulimia with less frequency Chew & Spit Binge Eating Disorder Recurrent binge eating Binge is associated itdwith ith(3) or more specific criteria Marked distress due to binge Occurs at least 2 days/wk x 6 months Vandenberg 2

3 Predisposing Factors Social Society & Media emphasis Relationship strain with parents Strict athletic programs Psychological Obsessions & Anxiety Lack of autonomy Powerlessness, loss of control Overview Psychotherapeutic Models Cognitive Behavioral Therapy (CBT) Interpersonal Therapy py( (IPT) Family Therapy CBT & Eating Disorders Integrative cognitive techniques Identifying & blocking (4) negative thoughts Socratic questioning Homework Assumption Identification Vandenberg 3

4 IPT & Eating Disorders Bulimia Nervosa : Sensitivity to conflict Social Anxiety Negative Emotions Anorexia Nervosa : Grief Interpersonal disputes Role transitions Interpersonal Inventory History of interpersonal problems Interpersonal lformulation Theoretical understanding of the person Role- Playing Family Therapy & Eating Disorders Family Types: 1. Perfect Family 2. Overprotective Family Chaotic Family Emeshed dfamily 5. Disengaged Family Bowen Theory Open conflict Lower anxiety in family Maudsley dl Method hd Anorexia primarily 3 Phases of Treatment 1. Helping gain weight 2. Giving control 3. Maintaining 95% target weight Integration of Therapy Literature supports integration of IPT & CBT At termination of IPT- Begin family therapy Group Psychotherapy Need for CBT refinement & integrating other methods Vandenberg 4

5 Cultural & Gender Considerations Most information about Caucasian females Not limited the Caucasian race Cultural norms / Therapy Family therapy: roles of family Eye contact Disclosing personal information Homosexual Population Gay men: higher prevalence Lesbian women: lower prevalence APRN Role & Challenges Pharmacotherapy SSRI MAOI Referral for Therapy IPT Family Integrate CBT PHP and IOP setting Medical Complications Dual Certifications Limitations Med management role Billing Lack of adequate training Embrace integration Future Needs Paucity related to cultural/gender needs Advocating for APRN billing Pilot studies for integrative models Vandenberg 5

6 Questions & Discussion Kris Vandenberg Vandenberg 6