Special CME Issue - West Virginia State Medical Association

We seek to help the patient discover
the weight that will naturally occur
when they are eating normally
(i.e., not obsessing about foods
or manipulating foods for weight
control), having regular menses,
and no longer have physical signs
and symptoms of malnutrition.
The Team Psychologist/
Social Worker
The mental health professional
is the primary team member
responsible for diagnosing an eating
disorder, as well as any comorbid
psychological problems. Team
psychologists and social workers
provide psychotherapy for the
patient and her/his family. Eating
disorder specific psychotherapy
is the core treatment in AN and
BN, and is focused on the initial
psychological factors that led to
the development of the eating
disorder, as well as the factors
that currently maintain it. 12 First,
a strong therapeutic relationship
with the patient is essential. 13 This
may be difficult to achieve since
patients are often ambivalent or
intensely resistant to change. The
therapist uses various techniques
to build rapport with the patient,
including validation, empathy, and
motivational interviewing, working
collaboratively in an age-appropriate
manner with the patient to develop
treatment goals and methods to
achieve them. For AN the clinician
utilizes a detailed treatment contract,
specifying for example daily
calorie goals and weekly weight
goals along with contingencies for
meeting and not meeting those
goals. The psychologist or social
worker has primary responsibility for
negotiating the terms of the contract
with the patient. Research evidence
supports a number of treatment
modalities for psychotherapy of
eating disorders, and three such
treatments are described in Table 5.
The team psychologist / social
worker stays in close contact with the
other clinicians to ensure that patients
are receiving consistent messages
regarding recommendations and
expectations, to prevent the patient
from “splitting” the treatment team,
and to monitor progress toward
goals. While the team physician
and nutritionist play key roles in
developing the individualized
treatment goals for the patient, the
therapist is the primary team member
charged with helping the patient
make the necessary emotional,
cognitive, and behavioral changes to
achieve the treatment goals. 12 Patients
can make progress on physical goals
but still hold eating disordered
attitudes and beliefs. For instance, a
patient with AN may gain enough
weight to no longer meet criteria
in the DSM-IV but still have longstanding
body image disturbances.
Negative body image at the end of
treatment substantially increases the
risk of relapse. The mental health
clinician is responsible for assessing
and addressing the various factors
that increase the risk of relapse.
The WVU Disordered Eating
Center of Charleston
(WVU‐DECC)
Given the significant prevalence
of disordered eating behaviors and
attitudes in state and the scarcity of
treatment resources, we developed
and then launched the WVU-DECC
in 2010. This is a multi-disciplinary
outpatient program designed to
treat patients with disordered eating
across the spectrum, and includes
WVU physicians specializing
in adolescent medicine, internal
THE ART, SCIENCE AND ETHICS OF PREVENTION | Vol. 108 39