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NEDC e-Bulletin

Issue Two | August 2012


New resource: Journal of Eating Disorders


Journal of Eating Disorders is a new open access, peer-reviewed journal based in Australasia with a global reach of leading research in the science and clinical practice of eating disorders.

The journal encompasses all aspects of eating disorders namely their epidemiology, nature, determinants, neurobiology, prevention, treatment and outcomes. The scope includes, but is not limited to those with highest prevalence and burden, namely anorexia nervosa, bulimia nervosa, binge eating disorder, and eating disorder not otherwise specified. The journal also considers articles from related areas such as important co-morbidities, obesity, body image, appetite, food and eating. Articles about research methodology and assessment are welcomed where they advance the field of eating disorders.

Journal of Eating Disorders aims to disseminate research that provides answers to the important issues and key challenges in the field of eating disorders and to facilitate translation of evidence into practice. These aims are consistent with and supported by the NEDC.

All articles published by Journal of Eating Disorders are made freely and permanently accessible online immediately upon publication, without subscription charges or registration barriers.

There are now over 45 committed Editors from around the globe. In addition to NEDC Steering Committee members and working group chairs Stephen Touyz and Phillipa Hay as Editors-in Chief, Jeremy Freeman as Managing Editor, Daniel le Grange, Janet Treasure, Stephan Zipfel, Kathy Pike and Jon Mond are confirmed Associate Editors and Christopher Fairburn, Caroline Meyer, Garry Walter and Anthea Fursland. Several additional NEDC Steering Committee members are also on the editorial boards. Submissions have started and a new website has been launched.

More details on the journal, including details of how to submit papers can be found at the journal website. For enquiries contact Phillipa Hay at editorial@jeatdisord.com.

As part of our professional development initiative, the NEDC is providing a limited number of scholarships to support Australians who would like to contribute to the Journal of Eating Disorders. Please contact us at nedc@thebutterflyfoundation.org.au if you would like more information about this opportunity.

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Eating disorders online learning


The Centre for Eating and Dieting Disorders (CEDD) in partnership with NSW Health has developed an online learning program in eating disorders for health professionals. The interactive online course provides a comprehensive training in the medical, psychological and dietetic management of these mental illnesses.

This online training program provides relevant professional development in the area of eating disorders suitable for Medical Practitioners, Nurses, Dieticians, Psychologists and other allied health professionals. The course has been designed to meet the CPD requirements of the bodies governing these professional groups and is registered with a number of them. It offers a flexible and effective way to meet CPD requirements.

Learning occurs through five, self-paced modules. Each module equips participants with up-to-date knowledge, an understanding of the central issues in the field and the skills required in each step of the diagnosis, assessment and treatment of clients, for both children and adults, across all major eating disorder diagnoses.

 

A flexible learning format allows individuals to tailor their learning experience to a basic or more challenging level. Each module provides access to a range of learning formats, from interactive text, to lectures and role plays conducted by renowned Australian and international specialists in the field, as well as feedback from sufferers and their families.

Topics are varied and include:

  • Background and diagnostic issues
  • Medical, nutritional and mental health assessment and the considerations that are unique to the assessment process in eating disorders
  • Planning and preparation for treatment
  • The different techniques and treatments suitable for the Eating Disorders
  • Key concepts in treating clients in different service settings

Course content ranges from the introductory, for those who are new to the field, to the advanced for those wanting to consolidate and build on their existing abilities. Each module contains a Core curriculum, required to pass the quiz, an In Practice section offering a more in-depth view of the topic and clinical tools, and a Resources section with key readings and materials beneficial in your immediate practice, and to keep as a ongoing reference resource.

This program has been developed by the Centre for Eating and Dieting Disorders at the Boden Institute, University of Sydney in collaboration with and funded by NSW Health. For more information please go to http://www.cedd.org.au.

A key purpose of the e-bulletin is to help people to find eating disorders specific training and resources. If you are aware of any upcoming training or available resources, please contact us at nedc@thebutterflyfoundation.org.au.

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Research article review

Medical Providers’ Self Perceived Knowledge and Skills for Working With Eating Disorders: A National Survey


The National Eating Disorders Collaboration collects and provides the latest evidence based research and information available on eating disorders from Australia and around the world. The topics included in our Research and Resources section are wide ranging and recognise the physical, social and emotional aspects and the broad spectrum of eating disorders. All information has been sourced from the NEDC Resources Review, NEDC Evidence Review, books, fact sheets, treatment guidelines, manuals or programs, reports, web-based programs, multimedia, academic peer reviewed journals and individuals working within the eating disorders sector.

Each month in the e-Bulletin we will be highlighting some of the research and information uploaded regularly on our website.

Despite the increasing prevalence of eating disorders, recent data indicates that many who suffer are going untreated. Past research has shown that in the years preceding an eating disorder diagnosis, patients consult their general practitioners more frequently than those without an eating disorder. But despite these consultations, only one-third of patients with symptoms of bulimia were overtly asked about problems with their eating by their healthcare provider (Mond, Myers, Crosby, Hay, & Mitchell, 2010).

Detection of an eating disorder is imperative to successful treatment, which indicates the need for medical providers to be knowledgeable and prepared to effectively screen and intervene when one of their patients presents with an eating disorder.

In order to examine where further specific training and eating disorder knowledge gaps exist for medical providers and to determine the type of training necessary to fill such gaps, Linville, Brown and O’Neil (2012) have conducted a national survey of medical providers’ self-perceived knowledge, skills and needs around eating disorder screening and intervention strategies.

In their study, 260 medical providers from across the United States completed and returned the survey. Consistent with other research findings, medical provider respondents felt ill prepared to assess for and intervene with disordered eating and eating disorders. Specifically, 68% indicated they did not think to screen for an eating disorder because it was not the presenting concern and nearly 59% of providers did not feel they had the skills necessary to intervene with patients who had eating disorders. Furthermore, 77% of respondents reported there were patients with eating disorders they could not treat, indicating time constraints and lack of skill as primary reasons for this response.

Study findings indicate that a well-validated, comprehensive, albeit brief screening tool for use by medical providers is essential for increasing early detection and treatment of disordered eating and eating disorders. Additionally, providers would need to have training on administration and interpretation of results, and access to resources related to appropriate treatment options and/or referrals for patients who screened positive for being at risk of an eating disorder. Moreover, a consideration of the format of this training (e.g. in person, online, large or small group) and what kinds of continuing education and programs to enhance medical providers confidence in detecting and treating an eating disorder is warranted.

This research article was published in Eating Disorders: the Journal of Treatment & Prevention and uploaded to our Recently Published Research page. If you are interested in approaches to screening for eating disorders you may like to read an article from the last edition of the e-Bulletin Identifying people at risk of eating disorders.

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Feature article: DSM V - A useful development for eating disorders or tinkering around the edges?

By Stephen Touyz & Sloane Madden


This article first appeared in the ANZAED 2011/2012 Summer Newsletter. It has been reprinted courtesy of the authors and ANZAED.

When DSM V is launched in early 2013 it will be almost two decades since DSM IV was introduced in 1994. In the two decades preceding DSM IV, Bulimia Nervosa had not yet been described, so what great developments in classification have the last two decades spawned? In essence DSM V represents a gradual evolution of the thinking presented in DSM IV rather than the seismic shift some were advocating”

So what’s new in DSM V?

Binge Eating Disorder
With DSM V now seeing Binge Eating Disorder graduating from the Appendix to the main body of the manual, this will hopefully drag some of the amorphous “NOS” hordes along with it. And surely it is a good thing to clearly recognise that people who have out-of-control binges with associated disgust, embarrassment &/or guilt and distress about this problem have a mental illness and should be treated as such – hopefully more helpfully than via obesity or weight control measures alone. 

Anorexia Nervosa
Some small changes in diagnostic criteria should have some significant impact on clinical diagnosis.

Amenorrhea is gone as an inclusion category. This category was unhelpful in relation to males, pre-pubescent or menopausal females and women menstruating solely through being on the contraceptive pill. Amenorrhoea is simply one of many markers of malnutrition and in many ways was superfluous given the weight related criteria incorporated in the diagnosis of AN.

“Refusal to maintain weight” is replaced in DSM V by “Restriction of energy intake relative to requirements”. The term refusal was thought to imply a deliberateness to an individual’s action, requiring the clinician to have a clear understanding of a persons motivation to make a diagnosis of AN. As any clinician knows this is not only difficult but has the capacity to imply blame. The ability to make this judgement on the basis of both behaviour and corroborative history represents a significant move forward and matches the way clinicians using the diagnostic criteria for their patients

Weight Criteria
DSM IV refers to non-“maintenance of body weight at or above a minimally normal weight for age and height”, It gives examples of “weight loss.. or failure to make expected weight gain…leading to body weight less than 85% of expected”.

DSM V simply states “weight that is less than minimally normal, or, for children and adolescents, less than that minimally expected”, omitting the example/guideline of 85% bodyweight. In contrast, ICD10 is more specific, requiring body weight in AN to be of at least 15% below the normal or expected weight for age and height.

This loosening of weight criteria in DSM V has a number of possible ramifications. It does leave more responsibility on the clinician to make the judgement about how critical the low weight is, which may be a problem for less experienced clinicians, greater flexibility does allow criteria such as weight history, body type, physical compromise to be more seriously considered as decision points.

This is particularly helpful in children where amount and rate of weight loss predict risk of severe medical complications rather than absolute weight. Similarly it is psychological pathology (abnormal body image and fear of weight gain) which are generally better predictors of severity than weight at presentation. It may have been useful for DSM V to include stage of illness as a factor, to discriminate between conditions of initial onset, recovery, relapse and chronicity.

Neveretheless, it is likely that the lack of strict weight criteria will increase the number of people diagnosed with AN in lieu of EDNOS.

Bulimia Nervosa
Frequency of Binging: Binge eating and inappropriate compensatory behaviours need only occur at least once a week (DSM V) rather than twice a week (DSM IV) over a 3 month period. This adjustment is based on research evidence that people who binge once a week have the same level of, eating disorder pathology, the same level of functional impairment, similar rates of psychiatric comorbidity and the same response to treatment as people who binge/purge more often. This criterion will probably increase the numbers of people diagnosed as BN.

The subtyping in DSM IV (Purging vs non-purging) is gone. This should not be of great consequence, as the non-purging subtype is rarely seen and indeed has received relatively little attention in the literature. If anything the non-purging subtype more closely resembles Binge Eating Disorder…

EDNOS
This category, renamed Feeding and Eating Conditions Not Elsewhere Classified, (FECNEC?), has a number of informal subcategories described for possible future inclusion. These include: Atypical Anorexia Nervosa (higher weight), Subthreshold Bulimia Nervosa (low frequency or limited duration), Subthreshold Binge Eating Disorder (low frequency or limited duration), Purging Disorder (in the absence of binge eating), Night Eating Syndrome, and the even more residual category Other Feeding or Eating Condition Not Elsewhere Classified.

Many expect and indeed hope that the prevalence of EDNOS/FECNEC will reduce due to the changed criteria in AN, the loosening of binge criteria in BN and the inclusion of BED. However in contrast, others such as Chris Fairburn often talk about the large group of “transdiagnostic” individuals who inevitably will vacillate between symptom patterns, and for whom a more specific diagnosis such as AN or BN is neither possible nor helpful.

So what other implications are there of these changes:

  • With changes to diagnostic criteria potentially altering the inclusion and exclusion criteria in research studies, the smallish changes to AN and BN should not make a huge differences while the two year roll-in will allow researchers time to prepare.
  • The increased definitions of the old EDNOS category should allow for greater tailoring of treatments, and facilitate the development of approaches for conditions such as purging disorders and night eating syndrome.

For more information visit the American Psychiatric Association website.

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Professional development events

Update on the Third Annual NEDC National Workshop

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As you are probably now aware, we are holding our Third Annual National Workshop on the 22nd & 23rd of August. Featuring international keynote speakers, evidence sharing, professional development and interactive workshops this is your opportunity to get involved.

Our National Workshop is free and available spots are filling up fast so it is important to book now to secure your space. Registration details can be found here.

About the keynote speakers

This year we are very privileged to have two international keynote speakers, Professor Howard Steiger and Professor Mimi Israel. 

 

Howard Steiger, PHD is Director of the Eating Disorders Program (EDP) of the Douglas University Institute in Mental Health, Professor of Psychiatry at McGill University and Associate Member in Psychology at McGill. He is an active clinician, researcher, and teacher, and has published numerous clinical, scientific and theoretical articles and book chapters on the Eating Disorders (EDs).

Steiger directs the only large-scale, specialized program for the treatment of adults suffering eating disorders in the Province of Quebec, a program offering a full range of Inpatient, Day Hospital/Day Program and Outpatient treatments. Through the research arm of the program, Steiger and his colleagues have recently been studying: a) Genetic and epigenetic processes thought to influence ED development and the expression of associated traits and symptoms. b) Factors that predict response during and after specialized treatments. c) The utility of neuro-modulation techniques in eating-disorder treatment.

Steiger is a recent Past President of the Eating Disorders Research Society (2007-2008) and past Board and Executive-Committee member of the Academy for Eating Disorders (AED: 2007-2009). He is currently Co-President of the Quebec Government’s committee to develop a “Charter for Healthy and Diversified Body Images”. He was recipient, in 2010, of the Academy for Eating Disorders’ Leadership Award for Clinical, Educational or Administrative Service.

Professor Steiger's keynote address Genes, Family and the Environment in Anorexia and Bulimia Nervosa: DNA, TLC or MTV? reviews evidence suggesting that chances of developing an ED (and associated symptoms) are influenced by effects of genetic factors, life stresses, psychological traits, and in the end—dieting. This talk is designed to introduce people (professionals and nonprofessionals alike) to the new science of Epigenetics, and to the contribution it can make to the understanding and treatment of eating disorders. For more details about Professor Howard Steiger's keynote presentation visit our event page.

 

Mimi Israël, MA, MD, FRCPC. Dr. Israël is chair of the Department of Psychiatry at McGill University, psychiatrist-in-chief of the Douglas Mental Health University Institute, attending psychiatrist for the Douglas Eating Disorders Program, and Associate Professor of Psychiatry at McGill. She has been a Royal College Examiner for Psychiatry, has chaired the Curriculum Committee for the McGill Department of Psychiatry and has been vice-president of the Regional Table of Medical Specialists of Montreal. In addition, she is now the president of the Association of Chiefs of Departments of Psychiatry of Montreal, and a fellow of the Academy of Eating Disorders.

A recipient of four McGill University teaching awards, including the 2004 McGill Department of Medicine Faculty Honour List for educational Excellence, she was also presented with the National Alliance for the Mentally Ill Exemplary Psychiatrist Award in 1998 and the 2006 grand prize from the Quebec Medical College of Physicians.

Her research interests have focused on the implications of temperamental traits and adverse life events on neurobiological indices, HPA axis function, and genetic variations in eating disorders. Other areas of interests within the field of Eating Disorders include the study of factors that determine treatment outcome, and determinants of the efficacy of different treatment techniques such as partial hospitalization. In addition, Dr. Israel has played a key role in the conceptualization and implementation of several changes that have had a significant impact on service organization and delivery in the institutions she serves. Her vision is to create structures that optimize clinical-research-teaching integration and that offer cutting edge evidence-based clinical care.

Dr. Israël's keynote address How person-centered approaches can transform health-care service organization and delivery for Eating Disorders discusses how a person-centred approach can be used to develop an integrated network that addresses the complex needs of people with Eating Disorders (ED), and their families. The proposed model advocates for close collaborations between first-line services, specialized programs, and community-based organisations to create a system that optimizes prevention, early detection, and evidence-based treatment for EDs. For more details about Professor Mimi Israel's keynote presentation visit our event page.

 
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National Workshop afternoon sessions

The afternoon sessions will provide an opportunity to work more closely with the keynote speakers, Howard Steiger and Mimi Israel, applying their knowledge of what works to the realities of preventing and treating eating disorders in Australia.

Stream A: Preventing eating disorders
Howard Steiger together with Susan Paxton from the NEDC Steering Committee will lead a workshop on issues in prevention based on both Canadian and Australian experience. Discussion will focus on strategies for the Australian context which can:

  • Improve community and professional awareness and knowledge of eating disorders
  • Integrate prevention strategies into existing school practices
  • Provide alternative prevention strategies for other professional settings such as sport, recreation and weight loss initiatives
  • Promote screening for eating disorders in high risk populations
  • Coordinate health promotion messages about the shared risk factors between eating disorders, obesity, body image, and other mental health issues

Stream B: Individual, multi-disciplinary treatment approaches
Mimi Israel together with Phillipa Hay, Deputy Chair of the NEDC, will lead a workshop on treatment approaches based on both Canadian and Australian experience.Discussion will focus on strategies for the Australian context, including rural and regional areas, which can:

  • Offer individual treatment approaches
  • Translate principles for safe multi disciplinary treatment into practice in general and primary health care
  • Coordinate multi disciplinary treatment between physical and mental health services and public and private health providers – at the practice level and at the governance level
  • Support Federal Teleweb initiatives as one approach to tertiary consultation
  • Make sure that families have access to education and support regardless of the type of treatment they receive or their geographic location
  • Translate research evidence into practice guidelines and resources that health professionals will use

More details about the National Workshop can be found on our workshop page.
More details about the professional development workshops on day two can be found on our professional development page.

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Event: 10th Annual ANZAED Conference


Following the NEDC National Workshop the Australia & New Zealand Academy for Eating Disorders (ANZAED) will be holding their own annual conference so attendees will have the option of coming for an extended conference on eating disorders. Running from the 23rd to 25th August, also at the Crowne Plaza, ANZAED's workshop schedule is below.

Thursday 23 August: Training Day & Pre-conference Workshops

9.00 am – 5.00 pm  PTSD and Eating Disorders
Carolyn Black-Becker

9.00 am – 12.30 pm  Introduction to Eating Disorders
Tracey Wade & Simon Wilksch

1.30 pm – 5.00 pm  Developing a Day Program
Chris Thornton, Susan Hart, Linsey Atkins, Stephen Touyz

Friday 24th August: Workshops

Media Smart: School-based eating disorder prevention for young adolescents
Dr Simon Wilksch, School of Psychology, Flinders University

Schema therapy for eating disorders
Virginia McIntosh, Jenny Jordan, Janet Carter, Kathryn Taylor, University of Otago, Christchurch, New Zealand

Cognitive remediation therapy
Karin Tobias, Annabel Izumi, Uli O'Sullivan, Julie McCormack, Eating Disorders Program, Princess Margaret Hospital, Perth

Building body acceptance – Research Evidence and Strategies in Action
Susan Paxton, Sian McLean, Latrobe University
Beth Shelton, Centre for Excellence in Eating Disorders

Feminist therapy approaches to eating disorders: Four decades on, still going strong
Naomi Craft, Rebecca Wickham, "Fed Up?"
Desi Achilleos, Eating Disorders Association Resource Centre
Amanda Dearden, Isis, The Eating Issues Centre
Deb Schwartz, Eating Difficulties Education Network (EDEN)

An artistic excursion into the body and eating
Tracey Wade School of Psychology, Flinders University 

Saturday 25th August: Workshops

Schema Therapy for Complex Eating Disorders: Working with emotional change techniques
Susan Simpson, School of Psychology, Social Work & Social Policy, University of South Australia

The mindful therapist
Caroline Costin, Monte Nido & Affiliates Eating Disorder Treatment Center, USA

Augmenting Maudsley Family Based Treatment: Strategies and ideas for when the manual doesn’t have the answers
Andrew Wallis, Colleen Alford, Averil Cook, The Children's Hospital, Westmead

Working with clinical perfectionism
Tracey Wade, School of Psychology, Flinders University

An evidence-based guide to treating co-morbid psychiatric disturbances in people with eating disorders
Howard Steiger, Eating Disorders Program, Douglas University Institute; Psychiatry Department, McGill University

For more information on ANZAED's conference schedule please visit their website.

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Event: Improving Body Image and Preventing Eating Disorders - An Evidence Based Approach


Carolyn Black Becker, PhD, FAED
20th August 2012, 9am-4pm, Princess Margaret Hospital, Subiaco, WA

This workshop will provide participants with a general background regarding research in the prevention of eating disorders, and specifically cognitive dissonance-based prevention, which has been found to reduce onset of eating disorders. Because dissonance-prevention targets body image, it also benefits those who are not at risk for developing full syndrome eating disorders.

Participants will not only learn about the development of dissonance prevention and the research supporting it, they also will experientially participate in a number of dissonance-based activities so as to gain a greater clinical understanding of this
intervention.

Dr. Carolyn Black Becker is a Professor of Psychology at Trinity University in San Antonio, US. The primary focus of Dr. Becker’s teaching, research, and clinical work is the implementation of scientifically supported prevention and treatment interventions in clinical and real world settings.

For more details visit our events page.

 

Have your say: opportunities to get involved


e-Network question of the month

Every month we use our Professional Collaboration Network to address specific questions for the 2012 Gap Analysis Report. This report will play an essential role in identifing any priority gaps or opportunities for further development of the eating disorders sector in Australia. If you are a professional in clinical practice with an interest in eating disorders and haven't joined our e-Network yet we would love to have you involved. Signing up is simple: to participate you will need to create a linkedIn profile. Then follow this link, click join and your membership will be processed shortly.

This month's question is:

Information and professional development needs - what do you need to know to take action?

Join now to participate in this and other discussions with other clinical professionals. We look forward to seeing you on the network!

Gap analysis surveys

Survey: Do you work with children or young people?
If you work with children or young people in education, sport, dance or recreation then the NEDC wants to hear from you. Please help us and young people with eating disorders by taking 10-15 minutes to complete this survey.

The peak period for the onset of eating disorders is between the ages of 12 and 25 years, although children as young as 6 have been diagnosed with an eating disorder. Education and recreational settings play a very important role in supporting school-aged children and young people to develop good physical, mental and social health and identifying concerns and risks. As part of a gap analysis of the services and resources that are available now and that need to be available in the future, the NEDC is surveying people who work with children and young people about the resources they have access to, to promote healthy attitudes towards nutrition and body image and respond to related issues like eating disorders.

To start this survey please visit our Gap Analysis page.

Survey: Clinician’s experience with eating disorders
We would like to invite clinicians to complete this brief survey to assist us in identifying what is available in Australia to support clinicians to respond to eating disorders and related issues of health and well-being.

The information you provide will help inform the federal government and eating disorders services’ approach to professional development and supports that will help health professionals to address these issues with their clients.

To start this survey please visit our Gap Analysis page.

Website feedback

Our website has been live for four months now and our aim is to build it into the best resource possible for practitioners and those touched by eating disorders in Australia. To further improve our service it would be much appreciated if you could complete our short feedback survey.

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