Comprehensive Treatment of Binge Eating Disorder- Katie Thompson, LPC

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Katie Thompson presents on the comprehensive treatment of Binge Eating Disorder. This presentation explores combining the theories of DBT, ERP, IFS and Experiential approaches.

Text of Comprehensive Treatment of Binge Eating Disorder- Katie Thompson, LPC

  • Creating an Innovative and Effective TreatmentPlan for Binge Eating Disorder; Moving Beyond Traditional Approaches with IFS, Experiential,and Exposure & Response Prevention Therapies Castlewood Treatment Center Webinar February 20, 2013 Katie Thompson, MS, LPC, NCC Castlewood Treatment Center for Eating Disorders www.castlewoodtc.com katie.thompson@castlewoodtc.com
  • FOOD AS PROTECTION?As long as my attention was consumed by what I ate, what sizeclothes I wore, how much cellulite I had on the backs of my legs, andwhat my life would be like when I finally lost the weight, I could notbe deeply hurt by another person. My obsession with weight wasmore dramatic and certainly more immediate than anything thathappened between me and a friend or lover. When I did feel rejectedby someone, I reasoned that she or he was rejecting my body, notme, and that when I got thin, things would be differentthewonderful thing about food is that it doesnt leave, talk back, or havea mind of its own. The difficult thing about people is that they do. ~Geneen Roth
  • LETS BREAK IT DOWN The reality of Binge Eating Disorder Identify components of the treatment process and conceptualizing a BED case. The Binge in detail: functions, triggers, interventions, Anatomy of a Binge and Types Identify traditional & necessary treatment Identify innovative & crucial treatment Miscellaneous concepts & approaches Questions, questions, questions, discussion!
  • THE SIZE AND COST OF BINGES:Typical: Between 1,000-2,000 calories consumed.25% of Binges included consumption of > 2,000 caloriesSubjective Binges: average or small amounts of foodconsumed in a binge; identified as a binge due to thesense of the loss of control.Objective Binges: truly large amounts of foodconsumed. Some binges can be 15,000-20,000 calories
  • THE SIZE AND COST OF BINGES:In 2009 a study reported the average, cost for bingefood was around $30.5 a week, which adds up to almost$1,600 a year. Some participants reported spending as much as$3,500 on binge food a year.Totals including compensatory items used in the EDranged from roughly $360 to almost $8,000 annually.By all accounts, this is grossly under-reported. Someclients report accruing $25,000 of debt in 1-3 years onbinge food and other binge purchases.
  • Necessary Components for Treatment Gather a Thorough History and Assess Client a. Physical, Risk, Dx, Comorbity, ED bx b. Hx of ED, family hx, Cognitions/Beliefs, TIBs c. Psychosexual, trauma hx, treatment hx d. Motivation, attachment, support system Establish Safety, Collaboration and Rapport Integrate History/Data with Theory to Conceptualize Case a. Transdiagnostic Approach b. Collaboration and Supervision
  • Necessary Components for Treatment Provide Psycho-Ed and Anticipatory Guidance Symptom Containment and Introduce Relapse Prevention Functions of the Eating Disorder & other Bx Correlating how Food/Body became objects Identifying unmet needs & addressing IDing relationship between Cognitions, Emotions, Behaviors and Sensations
  • Necessary Components for Treatment IDing & addressing unresolved trauma, beliefs, unfinished business Seeing the ED as a protector, healing Exiled parts protected by ED & healing Protectors. Identifying & working with Legacy Burdens Work with support systems Behavioral Intervention for rituals/behaviors Body Image/Affect/Cognitions/Sensations
  • Necessary Components for Treatment Revising Relapse Prevention; building interventions and adaptive coping mechanisms Addressing Sexuality & gender issues Developing Earned Secure Attachment Creating Balanced Living with life skills & autonomy Integrating recovery into life & adjusting Building relationships with others
  • FUNCTION OF THE BINGE: Survival Strategy Rebellion Provides comfort Coping mechanism Inability to express internal Substitute for distress to others. relationship/intimacy Call for Help An OCD ritual Fear of responsibility and Covers horrific memories growing up Manifestation of a parents Manifestation of unresolved unfinished business trauma and deprivation A need to care for someone and Having something that is ones escape at the same time own, not controlled by others. A way to be out of control Numbing privately Substitute for Relief for depression & distress love/attachment/affection Keeps others away
  • Function of the Binge: Substitute for LoveIn that moment of spectacle my Will will stand paralyzed. In an instant Ill be drawn into the reality of how empty my heart is, drawn instantly into a desperate part who believes no person is willing to fill my heart, the heart that swallows everything as I had just swallowed the meat. The meat eating is a metaphor for how vicious I feel inside. Im desperate. I need nourishment. My binge part has ripped through mountains of food, searching for nourishment, searching for satiation, frantic for love.
  • Function of the Binge: Unfinished Business/Coping MechanismThe messages such as you are bad respected no boundaries. They enveloped me and I felt abused and exhausted by them. So, I developed a mechanism to protect myself. I asked myself to believe that my self-loathing could live in food instead of inside of me; eventually the food became my self-hate. By creating this scenario, I could evade my inherent lacking by avoiding a vessel that carried hurtful messages. Ironically, I had decided to evade something essential to my survival so my plan backfired when I started to crave nutrition. I began craving food and eventually started bingeing, which fueled my hatred for the food; bingeing highlighted how unsafe food is. Bingeing meant that eating will surely possess me with self- hate; eating is something to be feared and avoided.
  • Function of the Binge: Manifestations of Unresolved DeprivationThe physical deprivation/psychological deprivation binge happens for me under various circumstances. I can be especially drawn to a binge if I have successfully eaten according to my eating disorders strict orthorexic rules for a number of days. Forbidden foods become more alluring and I feel ashamed that I want them. My eating disorder is sure that my body doesnt need them. There have been few times in the past few years that Ive attempted to eat a small amount of a forbidden food. I tell myself that one to three bites are okay because they illustrate to other people that I dont have a problem with food, that I dont have an eating disorder
  • Function of the Binge: Relieve StressTypically, before I know it Im eating much moreforbidden food than I had intended, I berate myselffor doing so and I realize that Im going to have to getit out. This happens commonly at restaurants.Sometimes Ill eat more than one piece of breadfrom the bread basket or I will eat more than 1-3bites of a dessert, which means that Ive broken myrule. Those extra bites usually happen not because Iam physically deprived but because I am frustratedby having to follow such rigid rules, tension buildsand I snap.
  • Function of the Binge: To Keep Others AwayWhen stress is added to [the] pot, bingeing was occurring because on top of my physical deprivation and strict rule following, I had no emotional regulator. Schoolwork and studying were enormous triggers for me. Anticipating social interaction was a trigger as well. I worried about being awkward and the bingeing and purging process would sooth the emotions I could not regulate and would eliminate my incessant what-if-ing about the future social situation. The bingeing and purging could also give me an excuse to skip the social situation all together. I feel sick. I feel tired. Look at how disgusting my face is now that Ive binged and purged? My stomach feels upset and my body feels bloated.
  • Function of the Binge: To Escape Responsibility Real or ImaginedI internalize interpersonal conflict that isnt actually happening because when I was young and wondered if it was happening, I didnt have a viable adult to ask because my role in the family required that I take self-responsibility and also feel responsible for other peoples emotions. I wonder what I have done wrong when another person is not happy. So, unhappy people can trigger me to binge if I am not successfully able to gain reassurance that I did not cause the trouble.
  • Function of the Binge: To NumbMy perfectionism and self-criticism are always high, so I was constantly finding fault within myself; this necessitated the bingeing. I couldnt handle how hard I was on myselfWhat the fuck was wrong with me I