Program Design Supporting Emerging Eating Disorder Pathology in Children and Adolescents
Nationally recognized thought leader in the care of individuals with eating disorders, Ovidio Bermudez, MD, FAAP, FSAHM, FAED, CEDS, serves as Medical Director of Eating Recovery Center’s Child and Adolescent Services. In the Q&A below, Dr. Bermudez describes the pervasive gap in services that led to the creation of Eating Recovery Center’s Behavioral Hospital for Children and Adolescents and details the innovative program design that seeks to meet the distinctive needs of the young eating disordered population as the pathology of these illnesses continues to evolve. Q: Describe the challenges to effective treatment for children and adolescents. A: It seems to me that one of the challenges for the field of eating disorders is to better understand and address how eating disorders have been changing. These changes include demographic shifts, with the illnesses affecting both genders, all ages and people from all walks of life, as well as changing symptomatology such as growing creativity in ways of avoiding calories and in compensatory behaviors. These changes are particularly salient when it comes to the young, and we expect to see this salience more formally reflected when the DSM-V is rolled out in 2013. At that time, eating-related pathology in children will take a broader perspective than it has in the past to include what had been known as “eating disturbances of childhood” under the umbrella of eating disorders. In my opinion, this shift is a reflection of not just the growing number of children and young adolescents that we are seeing affected by eating disorders, but also of a broader depth and breadth of eating disorder-related symptomatology in this young and relatively poorly studied population. There has historically been a quantitative gap in services, as the number of available specialized beds in the United States for the severely ill young adolescents, and especially for children, has been limited. In addition to the ongoing quantitative gap in service delivery, I believe today we are also realizing the need to tackle the added challenge of a qualitative gap in services. As this pathology evolves, we see quite a number of difficult cases in children and young adolescents that require clinical expertise, creativity, conducive facilities and strong treatment teams to be able to address these cases in a meaningful way once this level of care is required. This is especially true in light of a general lack of evidence to guide us. Q: How did the gap in services in the treatment landscape inform the program design for Eating Recovery Center’s Behavioral Hospital for Children and Adolescents? A: To address the aforementioned gap in services, we opened the dedicated child and adolescent eating disorders treatment facility in January of this year. Months of meticulous planning yielded a program that acknowledges what we know to be true in regards to the evolving pathology of these illnesses in young people. Even so, we were surprised by the richness of clinical presentation in the young patients admitted to the center so far. This complexity includes varied family circumstances at play, as well as varied medical and psychiatric comorbidities like self-harm, oppositional defiant disorders, a wide range of food restrictions, diabetes and cystic fibrosis, among other. All of which are accompanied by the expected coexistence of significant clinical anxiety, fears and phobias and the movement-driven, compulsive exercising component. Fortunately, our program design anticipated and is capable of addressing many of these needs and by individualizing care are able to address the diverse array of clinical presentations. The program leverages creative approaches like the use of the small-team “village” structure to maintain a high staff to patient ratio, a family empowerment model and a strong psychotherapy component to address the specific needs of each patient and family. Another example of a creative approach is the use of “video game”-like biofeedback as an anxiety management tool, which has been very well received by our young patients and has served as a means for engaging them in their treatment plans. Optimal medical management and nutritional rehabilitation are also mainstays of the program. Q: Describe the concept of developmentally appropriate treatment plans for child and young adolescent patients? A: One of our focuses in assessing and working with readiness for change in the field of eating disorders treatment has been differentiating between willingness and ability. Many young people struggling with eating disorders also struggle with developmental issues like concreteness, alexithymia and acting out behaviors. Assessment and formulation of developmentally appropriate treatment plans is critical in addressing the needs of our young patients at Eating Recovery Center, and thus specialized tracks have been developed to address the developmentally young. It’s about meeting patients where they are at developmentally. I will be addressing the topic of readiness for change in eating disorders treatment in greater detail at the upcoming third annual Rocky Mountain Eating Disorders Conference, which will be held August 19-20, 2011 in beautiful Denver, Colorado. This year will be my third year in attendance and as a speaker, and I would highly recommend this conference to all professionals in the eating disorder treatment field for both its richness of content and outstanding networking opportunities. Click here for more information about Child and Adolescent Services at Eating Recovery Center.