Foundational Eating Disorder Training

Purpose & Values Statement

Expectations of the Program

About Inclusive Eating Disorder Education (IEDE) & Our Founders

Additional Contributors

There is No “One Right Way” to Treat EDs

Use of Language

The IEDS Training Program

Land acknowledgement: with appreciation to Roots and Wings Fest Austin

Learning Objectives

Introductory Foundations of Eating Disorder Treatment

White Supremacy Culture Underlies and Informs Eating Disorders

WSC Characteristics to be Aware of and Unlearn

Ethics in Eating Disorder Treatment

Cultural Diversity & Competency in Eating Disorder Treatment

Trauma-Informed Care

Adverse Childhood Experiences (ACEs) Questionnaire

Trauma & Eating Disorders

General Warning Signs of EDs

Eating Disorder Basics: Facts

General concepts and skills for ED treatment

Original ASDAH HAES® Principles

History of HAES®

Health at Every Size® Updates from ASDAH 2024

How do we collaborate with doctors who follow a conventional medical model?

HAES® and Eating Disorder Treatment

A Critical Comparison to Traditional Treatment Paradigms

Grounding in Liberatory Frameworks

Patient Bodily Autonomy

Informed Consent

Compassionate Care

Critical analysis, application, and execution of research & medical recommendations related to weight

Skills to provide compassionate care for fat people's bodies

Provider Roles and Responsibilities

Tools that support wellbeing and healing without contributing to oppression

Addressing Your Anti-Fat Bias

Addressing Systemic Anti-Fat
Bias

The Science of HAES®

Research Article: Weight Science: Evaluating the Evidence for a Paradigm Shift by Bacon & Aphramor (2011)

Research Article: Excess deaths associated with underweight, overweight, and ob*sity. By Flegal, Graubard, Williamson, Gail (2005).

Research Article: Rethinking ob*sity: An alternative view of its health implications by Ernsberger & Haskew (1987)

Research Article: Kalantar-Zadeh, Kovesdy, & Norris (2012)

Research Article: Ernsberger & Koletsky, 1999. Biomedical rationale for a wellness approach to obesity: An alternative to a focus on weight loss.

Research Article: Andres, Muller & Sorkin (1993). Long-term effects of change in body weight on all-cause mortality: A review.

Research Article: The weight-inclusive versus weight-normative approach to health: Evaluating the evidence for prioritizing well-being over weight loss. By Tylka, Annunziato, Burgard, Daníelsdóttir, Shuman, Davis, & Calogero (2014).

Research Article: Overview and findings from the Rush Memory and Aging Project by Bennett, Schneider, Buchman, Barnes, Boyle, & Wilson (2012).

Research Article: Wang, Li, Li, Hou, Zhu, Du, Zhou, & Zhu (2020).

Research Article: Fitness and fatness as mortality predictors in healthy older men by McAuley, Pittsley, Myers, Abella, & Froelicher (2009).

Research Article: Population-based study of social and productive activities as predictors of survival among elderly Americans by Glass, Mendes de Leon, Marottoli, & Berkman (1999)

Research Article:  Long-term effects of change in body weight on all-cause mortality: A review. Annals of Internal Medicine by Andres, Muller, & Sorkin (1993)

Research Article: Associations of change in body size with all-cause and cause-specific mortality among healthy older adults by Hussain, Newman, Beilin, Tonkin, Woods, Neumann, Nelson, Carr, Reid, Owen, Ball, Cicuttini, Tran, Wang, Ernst, & McNeil (2023)

Research Article: Birth cohort effect on the obesity epidemic in Denmark. Epidemiology by Olsen, Baker, Holst, & Sørensen (2006)

Research Article: Gonzalez & Riboli (2010). Diet and cancer prevention: Contributions from the European Prospective Investigation into Cancer and Nutrition (EPIC) study.

Research Article: Does social class predict diet quality? Darmon & Drewnowski (2008).

Research Article: The Honolulu Heart Program by Burchfiel, Sharp, Curb, Rodriguez, Hwang, Marcus, & Yano (1995)

Recovery Phases: A Perspective on ED Recovery

Stages of Recovery: A Perspective on ED Recovery

Conceptualizing Eating Disorder Recovery

Recovery Concepts: A Brief Introduction

RDs - Specific Recovery Concepts

Therapists - Specific Recovery Concepts

More Notable Recovery Concepts & Goals

Normalizing Lapses & Relapses in ED Recovery

Statistics on Prevalence, Relapse, and Recovery

Learning Objectives:

1. At the end of this presentation/module, the participants will be able to describe the three “E’s” of trauma.

2. At the end of this presentation/module, the participants will be able to explain the difference between weight neutrality and weight inclusivity.

3. At the end of this presentation/module, the participants will define the newly updated HAES® principles.

4. At the end of this presentation/module, the participants will define ethical principles.

5. At the end of this presentation/module, the participants will be able to prepare a relapse and prevention plan.

What are Eating Disorders?

General Risk and Mortality

Eating Disorder Diagnoses

Anorexia Nervosa & Subtypes

Types of Anorexia Nervosa

Anorexia Athletica

Atypical Anorexia Nervosa

Restrictive Type Anorexia Nervosa

Binge-purge Type Anorexia Nervosa

Orthorexia Nervosa

Bulimia Nervosa

Types of Bulimia Nervosa

Exercise Bulimia

Diabulimia

Binge Eating Disorder

ARFID - Avoidant Restrictive Food Intake Disorder

OSFED - Other Specified Feeding or Eating Disorder

UFED - Unspecified Feeding or Eating Disorder

Rumination Disorder

Pica

Night Eating Syndrome

Purging Disorder

Severe and Enduring Eating Disorders (SEED)

Common Co-occurring Diagnoses

Obsessive-Compulsive Disorder (OCD)

Obsessive-Compulsive Personality Disorder (OCPD)

Borderline Personality Disorder (BPD)

Generalized Anxiety Disorder (GAD)

Major Depressive Disorder (MDD)

Substance Use Disorder (SUD)

Post Traumatic Stress Disorder

General Risk Factors for Eating Disorders

Identifying Functionality of EDs in Treatment

Eating Disorders in Boys and Men

General Facts about Men & Boys Eating Disorders from Academy for Eating Disorders (AED)

Understanding and Addressing Eating Disorders in Boys and Men: adapted from Wright, Halse, & Levy (2023)

Understanding Differences in Eating Disorders Among Men and Women: adapted from Woodside, Garfinkel, Lin, Goering, Kaplan, Goldbloom, & Kennedy (2001)

Summary of Eating Disorders in Boys & Men

LGBTQIA+ Considerations for Eating Disorders Treatment

“Body Mass Index Requirements for Gender-Affirming Surgeries Are Not Empirically Based”

“Understanding the Nutritional Needs of Transgender and Gender-Nonconforming Students at a Large Public Midwestern University”

“Higher Rates of Lifetime Traumas and Current PTSD Among Sexual and Gender Minority Individuals in Residential Eating Disorder Treatment”

“Eating Disorders and Disordered Eating Behaviors in the LGBT Population: A Review of the Literature”

Trans and Nonbinary Experiences of Conformity, Coping, and Connection in Atypical Anorexia

“Transgender and Other Gender Diverse Adolescents with Eating Disorders Requiring Medical Stabilization”

Neurobiology & Eating Disorders

Medical Aspects of Eating Disorder Treatment

When To Worry?

Eating Disorder Treatment Guidelines

“Atypical” Anorexia Nervosa (Gaudiani, 2018)

Special Medical Considerations (Gaudiani, 2018)

ED Treatment Considerations (Medical Perspective)

Gastroenterology

Obstetrics and Gynecology

Psychiatry

Pediatrics

Sports Medicine

Extreme Presentations - Eating Disorders

Eating Disorder Behaviors: Symptoms & Indications

Further Medical Considerations Regarding Eating Disorders

Resources

Levels of Care: ED Traditional Treatment

Outpatient Level of Care

Intensive Outpatient Programs (IOP)

Partial Hospitalization Programs (PHP)

Residential Level of Care

Inpatient Hospitalization

Importance of Stepping Down Through Each Level of Care

Caution! Traditional Eating Disorder Treatment May Not Be For Everyone

Potential Barriers for Vulnerable Populations Seeking HLOC

Assessment

Assessment Items 1\

Eating Disorder Examination Questionnaire (EDE-Q 6.0)

Learning Objectives:

1. At the end of this presentation/module, the participants will be able to list the three types of Avoidant and Restrictive Food Intake Disorder (ARFID). 

2. At the end of this presentation/module the participants will be able to compare recovery rates for Anorexia Nervosa (AN), Bulimia Nervosa (BN), Binge Eating Disorder (BED), Otherwise Specified Feeding and Eating Disorder (OSFED).

3. At the end of this presentation/module, the participants will be able to identify the most common risk factor for developing Night Eating Syndrome.

4. At the end of this presentation/module, the participants will be able to assess differences in eating disorder presentations in men and women.

5. At the end of this presentation/module, the participants will be able to describe the relationship between borderline personality disorder (BPD) and eating disorders.

Learn how to treat eating disorders in nutrition therapy within multiple levels of care

Includes initial sessions through later stages of work

Learning Objectives:

1. At the end of this presentation/module, the participants will be able to identify the overall goal of nutrition therapy for eating disorders.

2. At the end of this presentation/module, the participant will be able to list the macronutrient ranges recommended for clients.

3. At the end of this presentation/module, the participants will be able to describe why humans need carbohydrates.

Introduction to Therapy Modalities for Eating Disorders (EDs)

Fundamentals in Eating Disorder Treatment

The Therapeutic Alliance in Eating Disorder Treatment

Identity & Eating Disorder Recovery: An Introductory Overview

Treatment Interventions for Identity Reclamation & Reconstruction

Ambivalence in Eating Disorders: Introduction, Overview, & Clinical Interventions

Treatment Interventions for Ambivalence

Dissociation In Eating Disorders

Developing Emotional Competency in Eating Disorder Recovery

Autonomy

Dialectical Behavior Therapy (DBT)

Core Principles of DBT

Techniques & Skills

DBT for Eating Disorders

Examples of how the approach may be integrated into clinical practice

Case Study: Using DBT to Treat Bulimia Nervosa

Contraindications & Limitations of DBT for Eating Disorders

Learn More guide

Radically Open Dialectical Behavior Therapy (RO-DBT)

Basic Concepts and Assumptions of RO-DBT

RO-DBT versus DBT

RO-DBT & Eating Disorders

Theory of Change

The Primary Mechanism of Change: Social Signaling

Application in Therapy

Treatment Protocols and Delivery

Treatment Strategies

Specific Skills & Concepts in RO-DBT

Mindfulness

Radical Openness

Behavioral Activation

Cognitive Flexibility & Dialectical Thinking

Skills Training

Applying RO-DBT to the Treatment of EDs

Last Notes on Providing RO-DBT with Clients

Learn More guide

Acceptance and Commitment Therapy (ACT)

Foundational Premises: ACT

Treatment Strategies - Techniques, Principles, Style

Six Core Strategies of ACT

How to integrate into clinical practice (Harris, 2009)

ACT and Eating Disorders

Case Study

Contraindications & Limitations for ACT (Harris, 2009)

Learn More guide

Emotion Focused Therapy (EFT)

Overview of the EFT Philosophy & Model

Emphasis on Emotional Awareness

EFT & Eating Disorder Treatment

Primary Emotions

Secondary Emotions

Transformation of Emotions & Clinical Interventions

EFT and Attachment in Eating Disorder Recovery

Attachment Styles and Their Impact

More Therapeutic Interventions Involving Attachment in EFT

Contraindications and Limitations of EFT

Learn More guide

Exposure and Response Prevention (ERP) in the Treatment of Eating Disorders

Obsessive Compulsive Disorder and Eating Disorders

Overview of Exposure and Response Prevention (ERP) Therapy (Ruscitti, 2023; Foa et al., 2012)

Components of ERP (Foa et al., 2012; Becker et al., 2020)

The Function of Exposure Therapy in ED treatment (Becker et al., 2020)

ERP in Clinical Practice

Step 1: Assessment (Foa et. al., 2013)

Step 2: Hierarchy

Step 3: First Exposure (critical step) (Tsao et. al., 2023)

Step 4: Repeated, gradual progression through hierarchy (Foa et. al., 2012)

Food and Eating Exposures (Becker et al., 2020)

Body Image Exposures (Becker et al., 2020)

Mirror Exposures

Cue Exposure for Binge Eating (Becker et al., 2020)

Exposure Work with Avoidant/Restrictive Food Intake Disorder (Thomas & Eddy, 2019)

Limitations of Applying CBT and Exposure work to ARFID (Thomas & Eddy, 2019)

Contraindications and Limitations of Exposure Therapy for EDs (Rieger et al., 2011; Waller et al., 2007; Fairburn, 2008

Motivational Interviewing

Overview of Philosophy and Theory of Change

Integration and Treatment Strategies

Techniques: Motivational Interviewing

Contraindications & Limitations (Walsh, 2013)

Where To Learn More

Harm Reduction

Key Aspects of Harm Reduction in Eating Disorder Treatment

Six Key Principles of Harm Reduction In Healthcare Settings

1. Humanism

2. Pragmatism

3. Individualism

4. Autonomy

5. Incrementalism

6. Accountability without Termination

Treatment Strategies

Tips: How to Integrate Harm Reduction into Clinical Practice

Readiness for Change

Client Autonomy & Clinician Bias

Eating Disorder Behavior Monitoring

Case Study

Where to Learn More

Contraindications & Limitations

Cognitive Behavioral Therapy (CBT)

CBT Treatment

Phase One

Phase Two

Phase Three

Dysfunctional Thinking Patterns: Examples

ABC Monitoring

Phase Four

Case Study

Contraindications and Limitations

Where to Learn More

Family Based Treatment (FBT)

Five tenets of FBT

FBT Treatment Involves Three Phases

1. Phase 1: Psychoeducation and weight restoration

2. Phase 2: Returning control to the adolescent

3. Phase 3: Consolidation and relapse prevention

6 Stages of Growth of Family Members Regarding the Eating Disorder

The Debate About FBT

Pros & Cons

Learn More guide

Learning Objectives:

1. At the end of this presentation/module, the participants will be able to apply a harm reduction method when treating eating disorders.

2. At the end of this presentation/module, the participants will explain the appropriate treatment for a client with Severe and Enduring Anorexia Nervosa.

3. At the end of this presentation/module the participants will be able to describe the process for Exposure and Response Prevention (ERP).

Overview: Compulsive Exercise

Compulsive Exercise Defined

Exercise Dependence Defined

Excessive Exercise Defined

The Invisible Behaviors in Compulsive Exercise

Causes: Compulsive Exercise

Prevalence: Compulsive Exercise (CE)

Functionality of Compulsive Exercise (CE)

Dissociative Processes

Emotion Avoidance

Avoidance of Physiological Sensations

Stored, Unprocessed Trauma

Response to Obsessive, Intrusive, or Distressing Thoughts

Body Image Distress

Exercise as Identity

Inability to be Still

Fitness Culture

Diagnostic Considerations

Body Dysmorphic Disorder (BDD)

OCD/OCPD in Compulsive Exercise

Risks: Compulsive Exercise

Symptoms: Compulsive Exercise

CE Triggers

Assessment: Compulsive Exercise

Assessment Questions and Themes

CE Assessment Tool Options

Exercise Dependence Scale (EDS)

Compulsive Exercise Test (CET)

Treatment: Compulsive Exercise

A Word of Caution in Incorporating Exercise into Eating Disorder Treatment

A Brief History of Incorporating Exercise in Eating Disorder Treatment

Overview: CE Treatment Modalities

Psychoeducation

Exposure and Response Prevention

Cognitive Behavioral Therapy

Dialectical Behavior Therapy (DBT)

Harm Reduction

Safe Exercise at Every Stage (SEES)

Treatment Considerations for Compulsive Exercise in EDs

Athletes and Compulsive Exercise

Treatment Strategies for Athletes & CE (Martenstyn, Jeacocke, Pittman, Touyz, & Maguire, 2022)

Recovery from Compulsive Exercise

Intuitive Movement or Intuitive Exercise

CE Treatment Team Roles

Learn More from Ragen Chastain

Learning Objectives:

1. At the end of this presentation/module, the participants will be able to define Compulsive Exercise (CE)

2. At the end of this presentation/module, the participants will be able to describe treatment for Compulsive Exercise (CE) based on the level of care

3. At the end of this presentation/module, the participants will be able to identify the risks of Compulsive Exercise (CE).

Body Image Defined

Theoretical Perspectives

Body Image Distress or Body Shame

Individual and Developmental Factors

External and Societal Factors Contributing to Body Shame

White Supremacy Culture (WSC)

Thin-Privilege, Drive for Thinness, & Muscularity

Social Media/Media Literacy

Health-Care/Medical Community

Body Image in the LGBTQIA+ Community

Body Image in BIPOC community

Clinician Self-Work & Self-Reflection

Activity - The Clinician’s Own Body Image

Body Image & Eating Disorders

Body Image in Specific Diagnoses

Clinical Interventions: Body Image Spectrum, Healing Stages, & Techniques

Address the Functions of Body Image Distress

Body Image Healing Continuum

Body Dysmorphic Disorder

Body Dysmorphic Disorder (BDD) Assessment

Common Behaviors

Related symptoms

Key differences between BDD and Other diagnoses

Risk Factors

BDD Treatment

Best Practices for BDD

CBT-BDD

CBT-BDD Treatment model with Techniques: Case Example

ERP for BDD

ERP Case Examples

Contraindications, Limitations, & Considerations

Learning Objectives:

1. At the end of this presentation/module, the participants will be able to describe theoretical perspectives of body image.

2. At the end of this presentation/module, the participants will be able to Assess the impact of external and societal factors on body image distress.

3. At the end of this presentation/module, the participants will be able to identify common symptoms of Body Dysmorphic Disorder (BDD).