Eating Disorders

Family Based Therapy (FBT), also known as the Maudsley Approach, is the leading evidence based treatment for eating disorders in adolescents and children. Studies of FBT for anorexia nervosa have demonstrated that approximately two thirds of adolescent anorexia nervosa patients are recovered at the end of FBT while 75–90 percent are fully recovered at their five-year follow-up. FBT has also shown efficacy for bulimia nervosa. In FBT, the parents are considered to be the best resource for their child’s recovery. Parents play an active and positive role in order to help their child to:

  • Return to a healthy weight and growth pattern
  • Resume normal eating
  • Resume age appropriate independence with eating
  • Return to normal development

Additional information on this treatment method is available at: www.maudsleyparents.org.

Cognitive Behavioral Therapy Enhanced (CBT-E) is the leading evidence based treatment for all eating disorder diagnoses in adults, and it can be adapted for use with adolescents. It is designed to produce changes in thinking (cognitive change), and focuses on what is keeping the eating problem going. The therapy is tailored to your specific eating problem. You and the therapist will become experts in your eating problem and what is keeping it going, and will work as a team to help you overcome your eating problem. You will be given tasks to complete between therapy sessions to assist you in making changes. Depending on your needs, you and the therapist may work on:

  • Over-evaluation of shape and weight
  • Dietary rules and under eating
  • Being underweight
  • Mood-related changes in eating
  • Low self-esteem
  • Perfectionism

Your family will be actively involved in helping you overcome your eating problem.

Interpersonal therapy (IPT) is a time-limited, focused therapy developed for the treatment of depression that has been adapted for eating disorders and a range of age groups including adolescents and adults. It recognizes the importance of current interpersonal relationships in the recovery process. Interpersonal therapy is recommended in the NICE guidelines for the treatment of depression and eating disorders.

Cognitive remediation therapy (CRT) has been described as “thinking about thinking” therapy. It was initially developed for patients with brain injuries. The therapy uses simple exercises to strengthen thinking skills. Research in patients with eating disorders has shown that these patients also have deficits in their thinking. In particular, patients with eating disorders tend to have inflexible thinking and difficulty seeing the “big picture.” CRT uses exercises and games to help patients improve their thinking and learn new strategies to solve problems.

JulieLesser

Julie Lesser, MD (medical director), a child, adolescent and adult psychiatrist, is trained and certified in two main evidence-based treatments for eating disorders: Family Based Treatment (FBT), Cognitive-Behavioral Therapy-Enhanced (CBT-E). She is the only person in Minnesota who is certified in FBT, and certified in CBT-E. In addition, Dr. Lesser is intensively trained in dialectical behavior therapy (DBT), an approach focused on building skills for patients experiencing emotional difficulties. Dr. Lesser is also a Clinical (Adjunct) Assistant Professor at the University of Minnesota.

BethBrandenburg

Beth Brandenburg, MD (associate medical director), specializing in adolescent and adult psychiatry, is certified in Cognitive Behavioral Therapy-Enhanced (CBT-E) for eating disorders and trained in Family Based Treatment (FBT) . She has particular interests in evidence-based treatments, research, eating disorders in athletes, and treating co-morbid psychiatric conditions including posttraumatic stress disorder and treatment resistant depression. Dr. Brandenburg is also a Clinical (Adjunct) Assistant Professor at the University of Minnesota.

Your treatment team, as an outpatient, may include: a psychiatrist, psychologist, medical provider, dietician and/or social worker. Your treatment team, as an inpatient, will include: a psychiatrist, psychologist, hospitalist, dietician, social worker, physical therapist, child life staff, nursing staff, and tutor. They will work collaboratively to form a treatment plan specific to you.

  • Psychiatrist: Consults with the hospitalist regularly to determine your overall plan of care and treatment goals. Also provides individual, family and group therapy and may prescribe medications for depression, anxiety or other psychiatric disorders
  • Psychologist: Provides individual, family and group therapy and collaborates with the team to form your treatment goals
  • Hospitalist: A doctor that works solely in the hospital providing medical care for children and adolescents and will see you daily for medical monitoring and helps determine when you’re able to go home
  • Dietician: Provides education about nutrition to you and your family. If you are in the hospital, they will plans meals and snacks based on your specific needs and assist at meal times.
  • Physical Therapist: Will work with you to help you regain strength and teach you about exercise and physical health
  • Social Worker: Provides support and resources to families in need. Leads therapy groups for patients in the hospital.
  • Child Life staff: Provide fun activities to help distract you from your eating disorder and will also assist with meals
  • Nursing staff: Check your weight and vital signs daily and monitor your progress; they are present in the hospital day and night to support you
  • Tutor: Works with your school to supply you the work you are missing while staying in the hospital and will be there to assist you when you have questions

The Center for the Treatment of Eating Disorders is the only hospital-based program in the Twin Cities to offer immediate access for medical stabilization coordinated through the center or, after hours, through our emergency department. Children's is able to offer expert care for medical stabilization with 24/7 hospitalists, telemetry monitoring, nutritional rehabilitation, high staff to patient ratios and access to specialists. Our inpatient program provides evidence-based eating disorder treatment for patients up to age 24 (based on developmental level).

Inpatient Treatment Goals

  • Restore physical health
  • Attain healthy body weight
  • Decrease eating disorder behavior and thoughts
  • Prepare for outpatient treatment
  • Empower you and your family to make positive changes at home

What a typical day is like:

  • Weight and vitals checked each morning to monitor your physical health
  • Daily rounds with the team to see how you’re doing and talk with you and your family about your care plan
  • 3 meals (breakfast/lunch/supper) and 2 snacks (afternoon/evening) as a group and with either a dietician or child life staff member
  • Group activities which may involve psychotherapy or physical therapy: talking about how eating disorders affect your body or your emotions, making collages, listening to music or painting
  • Meet with a psychologist or psychiatrist individually or with your family to discuss how you’re doing
  • Physical therapy groups
  • Time to work with a tutor and do your homework
  • Time for visiting with family

What we expect of you as an inpatient and active member of your recovery:

  • Attend and participate in all groups and appointments
  • Have your weight and vital signs checked everyday
  • Follow your individualized treatment plan, which includes eating all meals and snacks
  • Work with your family who will help you sustain your recovery after you leave the hospital
  • Maintaining a positive environment on the unit without counterproductive behaviors (such as: vomiting, unsupervised exercise, negative talk, etc.)

Our outpatient clinic provides evidence-based eating disorder treatment for patients of all ages. The primary treatments are Cognitive Behavioral Therapy-Enhanced and Family-Based Therapy. Initially, the patient and family are evaluated by a psychiatrist and medical provider to determine the appropriate treatment approach and setting (inpatient vs. outpatient). The team of providers will coordinate with your primary care provider or pediatrician for medical monitoring.

Outpatient treatments are typically time limited, and the family is asked to attend appointments with their child/adolescent. If outpatient treatment is not effective or the patient becomes medically compromised, inpatient treatment may be recommended. Our outpatient team has immediate access to hospitalists for inpatient admission as well as all medical specialties for consultations.

Anorexia Nervosa

Behavioral signs:

  • Eating tiny portions, refusing to eat, not being hungry
  • Avoiding fat, sugar and meat
  • Intense fear of being or becoming fat
  • Feeling fat even though thin
  • Unusual eating habits
  • Exercising too much
  • Depression and low self-esteem
  • Withdrawing from family or friends
  • Perfectionism
  • Feeling “huge” after eating small portion and possibly purging

Physical symptoms:

  • Unhealthy weight loss (more than 15% of body weight or much weight loss in a short span of time)
  • Stomachaches, headaches, dizziness
  • Feeling cold much of the time
  • Constipation
  • Loss of muscles
  • Loss of menstrual periods
  • Weakening of bones
  • Heart rate, blood pressure, and body temperature below normal
  • Brittle hair and nails, hair loss

 

 

Bulimia Nervosa

Behavioral signs:

  • Binge eating followed by purging
  • Unusual food choices or cravings
  • Vomiting, laxative use, or diuretic use
  • Disappearing after eating, often to bathroom
  • Excessive exercise to “get rid of” calories
  • Shame or guilt after eating
  • Feeling out of control about eating
  • Eating secretly or hiding food
  • Obsession about appearance and body
  • Depression and low self-esteem
  • Poor self-control in areas other than eating

Physical symptoms:

  • Frequent changes in weight
  • Stomach pain
  • Muscle weakness, tiredness
  • Constipation or diarrhea
  • Loss of dental enamel
  • Irregular menstrual periods
  • Enlargement of cheeks and neck
  • Changes in blood chemistry
  • Sore throat, swollen glands