title here · • feb 27:treating complex trauma: ... any severity rating e.g. depression, anxiety,...

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Tori VogtContinuing Education Host

The Rosewood Institute

• Original Founders had a dream for the Rosewood Treatment Centers…..

• An Education and Training branch of The Rosewood Centers for Eating Disorders

• The dream unfolded…….

What Does TRI Do?

• Continuing Education training (Internal & External)

– Approved Provider with: NBCC, NAADAC, CBBS and CDR

• Training professionals on the specifics of eating disorders/addictions and co-morbid complications

1. West Coast Symposium for Addictive Disorders

2. Cape Cod Symposium for Addictive Disorders

• Present/participate in eating disorder conferences

– IAEDP, AED, NEDA, BEDA, BFI

TRI Initiatives and Goals:

• Invite Guest Speakers to share their specialties with our treatment staff

• Monthly Webinars and On-demand trainings

• Co-Sponsor Workshops/events and present locally and nationally with fellow field professionals

• Outreach & Education Projects for K-12 Grades & College– Operation RecoverED, Shannon Hershkowitz

• Internship program and Curriculum – Dr. Dena Cabrera, Clinical Director

2015 Webinars At-A-Glance

• JAN 16: After the Binge: Using the Mindful-based Strategies to Treat Binge Eating Disorders by Nancy Romanick, RDN, MBA, MAPC, LAC

• FEB 27: Treating Complex Trauma: A SensorimotorPsychotherapy Approach by Holly Finley, LPC, CEDS

• MAR 27: Shaping Foundations: How Three Decades of Prevention Research has Transformed Education Outreach and Treatment of Eating Disorders by Dr. Michael Levine

• APR 24: Do no Harm-Ethics and Eating Disorder Treatment" / "The Implementation of Ethics and Eating Disorder Treatment by Dr. Jessica Rodriquez

• MAY 22: Nutrition Medicine: The Acute Care of Eating Disorders, Stabilization and Recovery by Megan Kniskern, RD, CEDRD

• JUNE 26: Does DSM-5 Really Change Anything? A New Look at Classifying Eating Disorders by Jessica Setnick, MS, RD, CEDRD

• JULY 24: Medical Complications of Anorexia Nervosa: Refeeding Syndrome, by Amelia Davis, MD

• AUGUST 21: Mirror, Mirror? Treating the Body Image Experience by Cheryl Musick, EAGALA Advanced Certified

• SEPTEMBER 18: Axis II: Treating the other 50%by Dena Cabrera, PsyD, CEDS

• OCTOBER 16: Being Whole Again: Keys to Families Gaining and Holding on to Recovery by Billie Church, MC, LPC

• NOVEMBER 13: The Diabetic Dilemma: Treating Eating Disorders in Diabetic Adolescents and Adults with Eating Disorders by Kim Vavrosky, MS, RD

• DECEMBER 11: Trends, Truths and Travesties: The Real Scoop on Food Allergies and Intolerances by Miriam Anand MD, FACP, FAAAI, FACAAI and Megan Kniskern MS, RD, CEDRD

Contact Information

Questions & Answers Email us at [email protected]

For Complimentary CE Webinars

Go To:

www.rosewoodinstitute.org

[email protected]

mailto:[email protected]

http://www.rosewoodinstitute.org

Does DSM-5 Really Change Anything?A New Look at

Classifying Eating Disorders

Jessica Setnick, MS, RD, CEDRDMeadows Senior Fellow

Source: Eating Disorders Eating Disorders Boot Camp™ Training Workshop for Professionals © 2013 Jessica Setnick

Changes to Diagnostic Criteria for Anorexia Nervosa

DSM-IV to DSM-5

Refusal to maintain 85% of “Expected”

weight ⇨ Weight is “Significantly Low”

or “Less Than Minimally Normal”

Intense Fear of Weight Gain ⇨

“Intense Fear” OR “Persistent Behavior” that prevents weight

gain

Amenorrhea ⇨ Removed as a criterion

"Non-purging" Type ⇨ Now called “Restricting” Type

No Severity Rating ⇨ Severity Rating



DSM-5 Anorexia Nervosa Severity Rating Based on BMI

• Weight in “normal range”• Weight in “normal range”Atypical Anorexia

(OSFED)

• BMI 17 or higher• BMI 17 or higherMild Anorexia

• BMI 16-16.99• BMI 16-16.99Moderate Anorexia

• BMI 15-15.99• BMI 15-15.99Severe Anorexia

• BMI <15• BMI <15Extreme Anorexia


Changes to Diagnostic Criteria for Bulimia

DSM-IV to DSM-5

“Purging” and “Non-purging” Subtypes ⇨ No subtypes

FrequencyRequirement of 2

Episodes per Week⇨ Frequency Requirement of 1

Episode per Week

No Diagnosis for Purging without

Bingeing⇨

“Purging Disorder” now an “Other Specified Feeding/Eating

Disorder”



DSM-5 Bulimia Severity RatingBased on Weekly Average of Past 3 Months

• Less than 1 Episode per Week or Less than 3 Months Duration

• Less than 1 Episode per Week or Less than 3 Months Duration

Bulimia of Low Frequency or Limited

Duration (OSFED)

• 1-3 Episodes per Week• 1-3 Episodes per WeekMild Bulimia

• 4-7 Episodes per Week• 4-7 Episodes per WeekModerate Bulimia

• 8-14 Episodes per Week• 8-14 Episodes per WeekSevere Bulimia

• More than 14 Episodes per Week


Extreme Bulimia


Changes to Diagnostic Criteria for Binge-Eating Disorder

DSM-IV to DSM-5

InvestigationalDiagnosis Status

(Research Criteria)⇨ Diagnosis Status

(Diagnostic Criteria)

FrequencyRequirement of

2 Episodes per Week⇨ Frequency Requirement of

1 Episode per Week

Duration Requirement of

6 Months⇨ Duration Requirement of

3 Months



DSM-5 BED Severity RatingBased on Weekly Average of Past 3 Months

• Less than 1 Episode per Week or Less than 3 Month Duration

• Less than 1 Episode per Week or Less than 3 Month Duration

Atypical BED (OSFED)

• 1-3 Episodes per Week• 1-3 Episodes per WeekMild BED

• 4-7 Episodes per Week• 4-7 Episodes per WeekModerate BED

• 8-13 Episodes per Week• 8-13 Episodes per WeekSevere BED



Extreme BED


Changes to Diagnostic Criteria for Feeding Disorders

DSM-IV to DSM-5

“Feeding Disorders of Infancy and

Childhood”⇨ “Avoidant/Restrictive Food Intake

Disorder” (ARFID)

No Mention of Body Image Disturbance ⇨ Absence of Body Image

Disturbance

6 Years of Age or Under ⇨ No Age Limit

Pica as a SeparateDiagnosis ⇨ Pica and Rumination Disorder as

Separate Diagnoses


OSFED and UFED

• Other Specified Feeding/Eating Disorders– Atypical Anorexia (weight above normal)

– Bulimia of Low Frequency or Limited Duration

– BED of Low Frequency or Limited Duration

– Purging Disorder

– Night Eating Syndrome (NES)

• Unspecified Feeding/ Eating Disorder– Limited information to make specific diagnosis

– Eating dysfunction causing distress & impairment


DSM-5 Failings

• Does not differentiate between anything except symptoms – symptoms are not the disease

• Severity ratings are unifocal and inappropriate, do not measure severity at all –how does BMI truly predict severity of illness, need for treatment, or prognosis?

• What about medical stability, concurrent problems – medical & psychiatric?


Better ED Severity Factors:

• ED + Medical Diagnosis?

• ED + Nutritional Diagnosis?

• ED + Mental Health Diagnosis?

• ED + Social/Environmental Distress?

• ED + Financial Distress?

• ED + Personality Disorder?


ED + Personality Disorder?


DSM-Future Wish List

• Genetic/DNA info, neurochemistry, lab tests Etiology

• Subjective and Objective Measures (patient, family member, clinicians)

• Not based solely on symptoms

• No weight requirement, base severity on intake

• Include concurrent medical & psychiatric issues in any severity rating e.g. depression, anxiety, substance abuse, OCD, PTSD, self-harm


Eating Disorders Categorized by Etiology of Dysfunctional Eating Behavior (DEB) Rather than Symptoms

Biology-Based DEB

Caused by genes, genes interacting with

environment, illness that causes brain damage

Look like/Co-occur with: OCD, Anxiety, ADD,

Depression, PANDAS, PCOS, Hypothyroid

Treatment is Pharmacology specific to co-occurring condition,

Brain-based interventions not

invented yet, Nutritional Restoration (Intake-

based not weight-based, CBT

Addiction-Based DEB (Biology

Subtype?

Caused by Alterations in brain chemistry due to substance use, and/or genetic pre-disposition

Look like/Co-occur with: Substance Abuse or

Heavy Use, Self-Harm, Process Addictions,

Addicted Family Members

Treatment is 12-Step, Support groups, with

Pharmacology specific to addiction, Nutrition

Education & Counseling and Abstinence Model based on behaviors not substances, AA, ABA, Al-

Anon, ACOA

Trauma/Stress-Based DEB

Caused by Alterations in brain function resulting

from major trauma, chronic stress, etc.

Looks like PTSD, Trauma History, Chronically Stressful Childhood,

Dysfunctional Caregiving Environment (Neglect,

Abandonment, Disruption, etc.)

Treatment is Pharmacology for

concurrent conditions, Nutritional Counseling,

EMDR, DBT, Talk Therapy, Support

Groups, Grief/Loss, Rape Crisis Counseling, etc. as

appropriate

Social/ Environmental

DEB

Caused by Thin Ideal, Dieting, External locus of

weight control such as Athletic Weight

Requirements, etc.

Looks like Chronic Dieting, Binge-Eating,

Binge-Drinking, Weight Fluctuations, Low Self-

Esteem

Treatment is Nutrition Education & Counseling,

Media Literacy, Anti-Bullying Education, Self-

esteem work

Thank youfor

all that you do!

Continuing Education Certificate

1. Within a few hours following this Webinar you will receive an email with an Evaluation Form and Post-Test survey link attached.

2. Complete all questions in the SurveyMonkey survey (which contains Evaluation Form and Post-Test surveys

3. Upon receipt of the Post-Test and Evaluation Form, and successful completion of the post-test (score of

80% or better), a CE Certificate will be sent to you.

Questions & Answers

Send questions or slide requests to:

[email protected]

For additional information visit us at:

www.rosewoodinstitute.org

mailto:[email protected]

http://www.rosewoodinstitute.org

title here · • feb 27:treating complex trauma: ... any severity rating e.g. depression, anxiety,...

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