ocd spectrum symptoms and ed
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Preferred Provider WorkshopTreatment of Obsessive Compulsive Spectrum Symptoms
and Eating DisordersSaturday, July 16th
Erin McGinty, LPCCastlewood Treatment Center for Eating Disorders
1260 St. Paul Road636-386-6633
www.castlewoodtc.com
Prevalence of Co-Occurring Anxiety Disorders with Eating Disorders
Kaye et al. (2004) studied the co-morbidity of anxiety disorders in an eating disorder sample, and found the following:
• Two-thirds of the subjects had one or more lifetime anxiety disorder
• A majority of the subjects reported that their anxiety disorders preceded the onset of the eating disorder
• The most common anxiety diagnoses were obsessive-compulsive disorder (OCD; 41%) and social phobia (20%)
Effects of a Co-Morbid Anxiety Disorder on Eating Disorder Symptomology
Clients with co-morbidity experience both a longer length of stay and an exacerbation of eating disorder symptoms such as:
• Perfectionism
• Obsessionality
• Harm avoidance, including:
– Higher degrees of worry, or anticipatory anxiety
– Higher degrees of intolerance of uncertainty
– Higher degrees of fatigue
– Higher degrees of pessimism
• Body image dissatisfaction
Co-Occurring Anxiety Disorders and Emotion Regulation
Individuals with anxiety disorders face many struggles in regulating emotion:
• Emotion misidentification
• Impaired understanding of emotions
• Increased negative responses to internal and external cues
As a result, clients make attempts to regulate emotional experiences that exacerbate unwanted emotional states
• Social avoidance
• Experiential avoidance
• Eating disorder and other maladaptive behaviors
Obsessive-Compulsive Symptoms and Eating Disorders
• Preoccupation with weight, shape, and food mirror obsessions
• Eating disorder behaviors may be compulsions
• View of an eating disorder as an obsessive-compulsive spectrum disorder
• Cognitive behavioral therapy (CBT) and exposure and response prevention (ERP) therapy is the treatment of choice for anxiety disorders such as obsessive-compulsive disorder– Initial studies suggest that utilizing ERP in the treatment of eating
disorders is effective in reducing depressive, obsessive-compulsive, and eating disorder symptom severity
Exposure and Response Prevention Therapy
Exposure• Graduated, repetitive, and consistent exposure to situations and
thoughts that provoke anxiety and distress– Situational/In vivo exposure
– Imaginal exposure
• While performing the exposure, the client imagines the feared consequence(s) of the exposure
• The client remains exposed to the cue until the associated anxiety decreases
• Goal is to achieve habituation, or the decrease in anxiety due only to the passing of time– Within-trial habituation
– Between-trial habituation
Exposure and Response Prevention Therapy
Exposure and Response Prevention Therapy
Response Prevention
• Refraining from behaviors that are meant to reduce anxiety– Behavioral rituals
– Mental rituals
– Avoidance
• Clients learn that feared consequences of exposure are irrational
Example: Eat a feared food such as potato chips(exposure), no purging/binging/exercise/restriction (response prevention).
Exposure and Response Prevention Therapy
Psychoeducation• Providing a rationale for the model
• Educating the client on the importance of follow-through with self-monitoring and exposure assignments
Self-Monitoring• Ban books
• Exposure and thought records
Cognitive Therapy• Identify cognitive distortions and feared consequences of exposure
• Based on the outcome, identify evidence for/against irrational belief
• Reframing of irrational beliefs
Target Symptoms in the Treatment of Obsessive-Compulsive Symptoms and Eating Disorders
Body Image• Clothing avoidance
• Mirror avoidance
• Body checking
• Femininity and sexuality
Food Rituals• Cutting of food
• Mixing of food
• Ordering and arranging of food on plate
• Eating foods in a certain order
• Counting rituals
Target Symptoms in the Treatment of Obsessive-Compulsive Symptoms and Eating Disorders
Exercise Rituals• Ordering of exercises in a particular fashion
• Specific number of calories burned, miles run, time exercised, repetition of weight exercises, etc.
• Rigidity around exercise
Perfectionism• Need for symmetry and exactness
• Ordering and arranging compulsions
• Concern over mistakes and the interpretation of mistakes as failures
• Doubts about the ability to accomplish tasks
Target Symptoms in the Treatment of Obsessive-Compulsive Symptoms and Eating Disorders
Other Eating Disorder Rituals• Calorie counting
• Avoidance– Feared foods
• Binging
• Purging
• Rumination
• Chewing/spitting
• Laxative, diet pills, diuretic, ipecac abuse
• Restriction
Fear Hierarchy Formation
• Generate a list of external and internal triggers that provoke anxiety and induce urges to engage in behaviors
• Assess feared consequences if client was exposed to a trigger
• Assess responses to feared situations:– Passive avoidance
– Behavioral rituals
– Mental rituals
• Generate a list of feared situations
• Ask the client to provide a subjective unit of distress (SUDS) rating for each situation
Fear Hierarchy Formation
Examples of assignments to generate data:
• Assign clients to create a list of the following:– “Good/bad” foods
– Avoided foods
– Binge foods
• Assign clients to complete a an exhaustive list of their ritual behaviors at the table, and to identify what purpose these rituals serve
• Assign clients to write “A Typical Day…– … in my eating disorder.”
– … in my exercise addiction.”
– … in my OCD.”
Fear Hierarchy Formation
• Assign clients to write “The Worst Day of My Eating Disorder”
• Assign clients to write out their exercise routine in exhaustive detail
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