1. Eating Disorders: A Primer for School Providers Jess Luzier, Ph.D. Clinical Director, WVU-DECC WVU School of Medicine – Charleston Division Department of Psychiatry & Behavioral Medicine

2. Objectives 0 Disordered eating signs and symptoms 0 Review relevant evidence-based treatments 0 Recognize indicators that the child needs a higher level of care 0 Primary prevention of eating disorders

3. 0 Average model: 5’11”, 117 lbs 0 #1 wish of girls ages 11-17: to lose weight 0 ED’s 3 rd most chronic illness in adolescents 3

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8. Signs and Symptoms 0 Mirror time 0 Weigh frequently 0 Withdrawn 0 Avoid eating in public 0 Signs of purging 0 Avoid mirrors/scales 0 DIETING!!! 0 Skip meals 0 Strict exercise 0 Wear baggy clothing 0 Evidence of bingeing 0 Bathroom after meals 0 Fat talk

9. Signs and Symptoms PsychologicalPhysical 0 Depressed / irritable 0 Low energy 0 Poor body image 0 Anhedonia 0 Low self-esteem 0 Preoccupied with nutrition 0 Brittle nail/hair 0 Syncope 0 Russell’s signs 0 Dry skin 0 Cold! 0 GI pain 0 Weight fluctuations 0 Cavities

10. Evidence-Based Treatments 0 Very best evidence: 0 Family based therapy (Maudsley approach – for AN) 0 Cognitive behavioral therapy 0 Dialectical behavioral therapy 0 Some evidence: 0 Supportive therapy 0 Interpersonal therapy (BN, BED)

11. When to refer… 0 Inpatient: (or call 911) 0 <70% ideal body weight 0 irregular vitals/nutrient levels (tube feeding/intravenous fluids required) 0 not medically stable 0 Residential Treatment, PHP, IOP 0 Usually >70% of IBW 0 lower level of care failed 0 inability to control compulsive behaviors without supervision (i.e. purging, over-exercising) 0 Outpatient: 0 WVU Disordered Eating Center of Charleston (medical, dietary, psychological care in state) 0 WV Eating Disorder Network

12. Primary Prevention of ED’s 0 Create a culture of body acceptance 0 Staff modeling 0 Appropriate responses to body-related bullying 0 http://proud2bme.org/ 0 Focus on health behaviors, not weight (e.g., no calculating BMI’s, assigning kids to use myfitnesspal for a week, etc) 0 Adopt a “Health at Every Size” perspective

13. Resources for Providers 0 Treatment Manual for Anorexia Nervosa: A Family Based Approach (2 nd ed.) by Lock and LeGrange 0 Eating Disorders in Children and Adolescents: A Clinical Handbook, edited by LeGrange and Lock 0 Treating Bulimia in Adolescents: A Family Based Approach, by LeGrange and Lock 0 Certification in FBT: http://train2treat4ed.com/http://train2treat4ed.com/ 0 Academy of Eating Disorders (www.aedweb.org)www.aedweb.org 0 Fairburn, C.G. “Cognitive Behavior Therapy and Eating Disorders”. Guilford Press, New York, 2008. 0 Training in DBT: http://behavioraltech.org/http://behavioraltech.org/ 0 WVU DECC: http://charleston.hsc.wvu.edu/DECC/http://charleston.hsc.wvu.edu/DECC/

14. Join the WV Eating Disorder Network! Send me an email - jluzier@hsc.wvu.edu jluzier@hsc.wvu.edu