(PS7-D96) Necessity and Innovation: A Case of Eating Disorder Treatment in Primary Care

Eating disorders are notorious both for the danger they pose to patients and their resistance to treatment (Kaplan & Garfinkel, 1999). For this reason, Spotts-De Lazzer and Muhlheim (2016) call for specific competence standards over and above basic therapist training for clinicians who will treat eating disorders, and Hunter and colleagues (2022) suggest that patients presenting with eating disorder behaviors are more appropriate for specialty mental health treatment than the primary care setting. The present paper details the successful treatment of a teenage male from a low-income, linguistically-diverse household presenting with atypical anorexia nervosa within the primary care setting after the patient’s family’s unsuccessful attempt to get the patient into specialty treatment.

Treatment initially focused on psychoeducation about eating disorders, nutrition, exercise and recovery, and the CBT model, distress tolerance skills, and behavioral activation. As the patient successfully engaged in behavioral activation and began to increase his daily caloric intake, the focus of treatment shifted to challenging thoughts that interfered with treatment adherence. Progress was measured through subjective reports of mood and functioning by both the patient and his mother, as well as objective monitoring of caloric intake and weight changes.  Implications for practice and access to care are discussed.

References

Hunter, C.L., Goodie, J.L., Oordt, M.S., & Dobmeyer, A.C. (2022). Integrated behavioral health in primary care: Step-by-step guidance for assessment and intervention (2nd ed.). American Psychological Association.

Kaplan, A.S., & Garfinkel, P.E. (1999). Difficulties in treating patients with eating disorders: A review of patient and clinician variables. Canadian Journal of Psychiatry, 44(7), 665-670.

Spotts-De Lazzer, A., & Muhlheim, L. (2016). Eating disorders and scope of competence for outpatient psychotherapists. Practice Innovations, 1(2), 89–104. https://doi.org/10.1037/pri0000021