Learning to lower anxiety levels increases success in recovery
From their initial assessment through the end of their stay, Rogers Memorial Hospital’s patients identify situations related to their eating and anxiety disorders that provoke intense levels of anxiety and assign an anxiety rating (on a 0-7 scale) to each of these situations. The higher the anxiety rating, the more difficult it is for these patients to encounter that situation.

Exposure in a prolonged and repetitive manner
Treatment teams at Rogers Memorial approach anxiety-provoking situations gradually. When patients are exposed to challenging yet manageable levels of anxiety (denoted by a rating of 3 on the 7-point scale), they are better equipped to resist engaging in harmful eating disorder behaviors such as restricting, bingeing, purging, and compensatory exercise.

Some patients fear certain foods, like pizza or ice cream, and anticipate unrealistic weight gain as a response to the consumption of their feared foods. The treatment team finds ways to build an experience of gradual exposure. Depending on an individual’s level of anxiety, the food may only be present in the room at first, but later is held or on the table.

Ultimately, a patient learns to overcome their fear and incorporate their feared foods into their individualized meal plans using a modified version of the exchange system similar to the one developed by the American Dietetic Association.

Anxiety levels decrease
Rogers Memorial’s patients get used to, or habituate to, their anxiety when they are exposed to that situation in a repetitive manner. Their anxiety levels decrease over time, and they are able to see that what they feared would occur in a given situation did not happen.

This gradual exposure approach is called Exposure and Response Prevention Therapy (ERP), which is a specific type of Cognitive-Behavioral Therapy (CBT). ERP has been shown to be the most effective in treating Obsessive-Compulsive Disorder and other anxiety disorders. This therapy is used extensively at Rogers Memorial because it allows patients the opportunity to confront their anxiety at a manageable pace, thereby increasing their self-confidence to continue their treatment.

Inarguably, self-efficacy is one of the best things patients can take with them when they leave treatment and continue with their aftercare.

New location
This month’s meeting is being held at Children’s Hospital of Wisconsin located at 9000 W. Wisconsin Avenue, Children’s Hospital Clinics Building, Adolescent Medicine, Suite 165 (enter on 2nd floor).

This month we will discuss typical and atypical restrictive anorexia nervosa (AN) as described by authors Paolo Santonastaso, MD; Romina Bosello, MD; Paolo Schiavone, MSc; Elena Tenconi, PhD; Daniela Degortes, MSc; and Angela Favaro, MD, PhD.

Typical and Atypical Restrictive Anorexia Nervosa: Weight History, Body Image, Psychiatric Symptoms, and Response to Outpatient Treatment. (Int J Eat Disord 2009; 42:464-470)

Few studies have examined the characteristics of atypical restrictive anorexia nervosa (AN) with a well-powered design.  The study aims to explore this issue, with particular attention paid to psychopathology and response to outpatient treatment.

A light breakfast will be provided. Please confirm your attendance by Friday, February 19, so Children’s Hospital can plan accordingly for breakfast. RSVP to Leah via lschwechel@rogershospital.org. A copy of the article is available by request.

Journal club provides an opportunity for members of the greater Milwaukee area’s professional eating disorders treatment community to discuss recent developments or trends in the field and to provide an opportunity for informal networking.

This year’s schedule has been sent to current journal club participants. To receive future invitations or schedules, contact Leah Schwechel at lschwechel@rogershospital.org to be added to our list.

NORMAL in Schools is an organization dedicated to education about eating disorders. Ticket information and details about the evening’s events are available in a downloadable flier, or by visiting the organization’s Web site.

National Eating Disorders Awareness Week is Feb. 21 through  27, 2010.

Master’s-level art therapists help residents challenge their physical and emotional body image distortions.



 Being in a safe, functioning environment where the expectation is to share your feelings and to get your needs met by asking, brings negative thought patterns to the forefront where they can be addressed.

Some examples of these negative thought patterns:

• I don’t deserve to get what I want or need.
• It doesn’t really make any difference; I really don’t care.
• I should be willing to sacrifice my own needs for others.
• Being emotional means being out of control.
• Letting others know that I am feeling bad is weakness.
• I don’t want to hurt anyone.

Hearing a peer in group therapy share thoughts similar to one’s own pattern of thinking allows the individual in treatment to see how common disordered thought patterns can be separate from their own sense of self. For example, a group member may see the personal qualities of a peer and see how that peer’s perception of self is affected by eating disorder thoughts patterns.

This awareness, along with advice offered to peers, often leads the individual to conclude, “I need to be willing to follow my own good advice.”

Healthy boundaries around emotional and behavioral responsibility are developed. These new experiences support the individual’s ability to change their interpersonal patterns and develop new ways of interacting with others.

Some examples of changing thought patterns:

• My wants and needs are important.
• I really do care, about myself and others.
• When I take care of myself, I have more to give to others.
• Sharing emotions is part of developing intimacy in relationships.
• Letting others know how I am feeling is investing trust in our relationship.
• Being a compassionate person means I am sensitive to how others are feeling but I am not responsible for how they feel.

Many new participants who were initially anxious about group therapy find a sense of safety and support within this environment. It is a place where secret thoughts and behaviors are shared and a sense of understanding and acceptance is discovered. Not only is the diagnosis of illness shared, but the need and the ability to change thoughts and behaviors.

Many within the first few days of treatment in the group therapy model will say, “It is such a relief to know that I am not alone.”

This month’s meeting will feature a discussion of the classification and categories of eating disorders as proposed for the DSM-V in this article by B. Timothy Walsh, MD and Robyn Sysko, PhD.

Broad Categories for the Diagnosis of Eating Disorders (BCD-ED): An Alternative System for Classification from International Journal of Eating Disorders 2009; 42: 754-764.

Eating Disorder Not Otherwise Specified (EDNOS), a residual category in DSM-IV, is the most commonly used eating disorder diagnosis in clinical settings. A diagnostic scheme, termed Broad Categories for the Diagnosis of Eating Disorders (BCD-ED), is proposed to diminish use of the EDNOS category while preserving the existing eating disorder categories. The objective of this review was to examine the advantages and disadvantages of adopting this scheme for DSM-V.

A light breakfast will be provided. Please confirm your attendance by Friday, January 22, so Rogers Memorial Hospital can plan accordingly for breakfast. RSVP to Leah via lschwechel@rogershospital.org. A copy of the article is available by request.

Journal club provides an opportunity for members of the greater Milwaukee area’s professional eating disorders treatment community to discuss recent developments or trends in the field and to provide an opportunity for informal networking.

This year’s schedule will be sent to current journal club participants. To receive future invitations or schedules, contact Leah Schwechel at lschwechel@rogershospital.org to be added to our list.

A recent outing revealed the need for strong support in an environment that is meant to be enjoyable and relaxing.

Our treatment team had selected a chain restaurant with large food portions to help patients work through their anxiety about food and with learning appropriate portions.

When our waitress introduced herself and the restaurant she boldly proclaimed that each entrée contained “A pound and a half of pasta!” You can imagine the anxious and guilt-driven thoughts that ensued in our already apprehensive group.

Next, one of our patients asked if the restaurant had low-fat dressing for her house salad that she was going to have prior to her entrée. (We do encourage patients to order regular dressings to challenge the diet mentality, but ultimately patients make these decisions on their own).

Our waitress had no idea where we were from or that our group included several people with eating disorders.

The waitress’s response was, “Oh no, honey. There is nothing low fat in this place!” Her comment demonstrates the challenges our patients routinely face and why it’s necessary for us to provide them with these supported activities.

This encounter reinforced precisely why we value the effectiveness and importance of these meal outings to help our patients with the recovery process and learn how to manage the effects of an off-hand comment.

And, that night, that’s exactly what we did. Our group was able to process these experiences and successfully get through the meal, including dessert.

Male Eating Disorders: Why do males have eating disorders and how do they get better?
Presented by: Dr. Ted Weltzin and Melissa Schneider, MA
As society increases the messages to males that losing weight and having the perfect body is the key to happiness, it is not surprising that we have seen an increase of eating disorders in men. This presentation reviews risk factors, symptom characteristics, and treatment of males with eating disorders.

Anxiety and Eating: The importance of addressing anxiety symptoms in patients with eating disorders.
Presented by: Dr. Nicolette Weisensel and Erin McGinty, MS, LPC
Our understanding of eating disorders has evolved over the years and has included examining depression and anxiety disorders as obstacles to recovery. This presentation explores the relationship between anxiety symptoms and eating disorders, and reviews the literature in terms of specific treatments related to anxiety and its impact on treatment outcomes.

Learn more

If you are interested in learning more about these presentations, our programs or just need information about eating disorders, please contact Leah Schwechel in our  Outreach Department and someone will be in touch with you soon.
To start a referral, call Rogers Memorial Hospital at 800-767-4411. We can provide free telephone screenings or additional information about our specialized programs. We also offer an online screening.

The meeting will be held at Children’s Hospital, Room 455A from 8 to 9 a.m. on  Wednesday, Oct. 28th.

The journal club will be discussing the following articles both from Diabetes Spectrum, Volume 22, Number 3, 2009

Eating Disorders and Diabetes: Screening and Detection

The medical risks associated with eating disorders in diabetes are significant. Clinicians working with patients who are at risk for eating disorders should be cognizant of patterns that might indicate the presence of disturbed eating behaviors in their patients. This article discusses the warning signs, screening tools, and diagnostic criteria associated with eating disorders in type 1 diabetes.

Outpatient Management of Eating Disorders in Type 1 Diabetes

Disturbed eating behaviors are common in adolescent girls and young women; however, these behaviors are significantly more common in those with type 1 diabetes than in the general population. Long-term treatment of patients with eating disorders and type 1 diabetes (ED-DMT1) often occurs in outpatient settings. This article reviews the clinical issues and strategies relevant to the outpatient treatment of ED-DMT1.

Please RSVP if you will be attending by Friday, Oct. 23rd. The journal club us a monthly gathering that brings professionals together to talk about the latest trends in eating disorders treatment.

Did you know that football and rowing also have weight restrictions? Youth football leagues typically put caps on weights for entering the league and for certain positions. For instance, in certain leagues you must weigh 80 pounds to carry the football, and you cannot carry the ball if you weight over 100 pounds. Football and other sports typically have weight limits for safety reasons, however, in certain situations these types of weight restrictions can be detrimental to children’s health.

This is particularly true for kids who may be pursuing a certain position within a sport, or become obsessed with reaching a target weight for the sport in order to participate. This ultimately can lead to unhealthy weight loss, poor nutrition, disordered eating habits, and eating disorders.

Kids may restrict their food intake, increase their activity level, and exercise more to reach a desired weight to get a desired position. These behaviors become dangerous when they lead to dehydration, unnatural weight loss, and possibly abnormal body functions including low potassium.

These days our children have vast opportunities to participate in sports, whether it’s through school, local parks or recreations departments, sports leagues or athletic clubs.   There are also multiple levels of sports in which children and teenagers compete including recreational, intramural, league, and even select. This is all in an effort to keep kids active with their peers, within their community, and for their health. What a wonderful thing!

Here’s some advice for moms and dads…

Listen to your kids!  Talk to coaches if you have concerns. Watch your child’s eating, sleeping, and activity patterns. Allow one activity per semester so kids don’t get too overwhelmed.  Remember, health comes first!

What to watch for:

1. Increasing discussion about weight limits in sports. This may come up as a nonchalant topic after a weight check at the doctor’s office, or a health check. Ask questions and get a good understanding of your child’s thought process.
2. Changing habits – changes in eating patterns: eating less, paying close attention to calories or food labels, restricting intake, avoiding certain high fat/carb/calorie foods, restricting/over eating cycle, laxative use, or purging.
3. Obsessing: Frequent weighing of self or obsessions regarding a certain measurement.
4. Over-exercising: your child/teen should not have to exercise much more above and beyond their athletic practice times. If you notice that they are exercising before and/or after their practices, a red flag should go up!

What to do:

1. Talk with your child and get a good idea of what is going on.
2. Call your primary health care provider and schedule an appointment.
3. If you have concerns that your child has an eating disorder, call Rogers Memorial Hospital at 800-767-4411. We can provide free telephone screenings or additional information about our specialized programs. We also offer an online screening.

The study set out to examine the course of Eating Disorder NOS (EDNOS) compared with anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED), via a prospective study of 385 participants meeting DSM-IV criteria for AN, BN, BED, and EDNOS at three sites.

From the abstract:

EDNOS remitted significantly more quickly that AN or BN but not BED. There were no differences between EDNOS and full ED syndromes, or the subtypes of EDNOS, in time to relapse following first remission. Only 18% of the EDNOS group had never had or did not develop another ED diagnosis during the study; however, this group did not differ from the remaining EDNOS group.

You can download the complete text of the article.  Eating disorders treatment professionals are asked RSVP for this meeting by contacting Leah Schwechel.  This is a CE article, to earn credit visit: http://www.ce-credit.com for additional information.