Georgia State University ScholarWorks @ Georgia State University Nutrition Masters Projects Department of Nutrition Summer 8-13-2020 The Multidisciplinary Approach in the Treatment of Eating Disorders Laura Brown Follow this and additional works at: https://scholarworks.gsu.edu/nutrition_mastersprojects Recommended Citation Brown, Laura, "The Multidisciplinary Approach in the Treatment of Eating Disorders." , Georgia State University, 2020. https://scholarworks.gsu.edu/nutrition_mastersprojects/21 This Project is brought to you for free and open access by the Department of Nutrition at ScholarWorks @ Georgia State University. It has been accepted for inclusion in Nutrition Masters Projects by an authorized administrator of ScholarWorks @ Georgia State University. For more information, please contact [email protected]. The Multidisciplinary Approach in the Treatment of Eating Disorders By Laura Lane Brown B.S., Middle Tennessee State University, 2004 M.B.A., Middle Tennessee State University, 2006 Committee Members: Jessica Todd, MS, RD, LD, Marci Soran, Linda Buchanan, PhD, Carrie Poline, DO, Christine Engstrom, MS, RD, LD, CEDRD-S 2020 Master’s capstone project submitted in partial fulfillment of the requirements for the Master of Science degree in Coordinated Program, Nutrition Byrdine F. Lewis College of Nursing and Health Professions Georgia State University Atlanta, GA Table of Contents Acronyms ................................................................................................................................... 4 Introduction ................................................................................................................................ 6 Eating Disorder Prevalence........................................................................................................ 6 Feeding & Eating Disorder Types .............................................................................................. 7 Risk Factors ............................................................................................................................... 8 Screening & Diagnosis ............................................................................................................... 9 Warning Signs & Symptomology ...............................................................................................10 Suicidality & Eating Disorders ...................................................................................................15 Neurochemistry .........................................................................................................................15 Metabolism ...............................................................................................................................17 Determining Levels of Care (LOC) ............................................................................................18 Inpatient Hospitalization ..................................................................................................................... 18 Residential Treatment ......................................................................................................................... 19 Partial Hospitalization Program .......................................................................................................... 19 Intensive Outpatient Program ............................................................................................................ 20 Outpatient Treatment ......................................................................................................................... 20 The Multidisciplinary Team........................................................................................................21 Physician ............................................................................................................................................. 21 Psychotherapist ................................................................................................................................... 22 Registered Dietitian ............................................................................................................................ 22 Other Coordinated Staff & Specialists ................................................................................................ 23 Family Members ................................................................................................................................. 24 Treatment Approaches ..............................................................................................................24 Cognitive Behavioral Therapy ............................................................................................................. 24 Interpersonal Therapy......................................................................................................................... 25 Dialectical Behavioral Therapy ............................................................................................................ 25 Acceptance & Commitment Therapy .................................................................................................. 26 Family-Based Therapy ......................................................................................................................... 26 Exposure Therapy ............................................................................................................................... 27 Narrative Therapy ............................................................................................................................... 28 Group Therapy .................................................................................................................................... 28 Intuitive Eating .................................................................................................................................... 28 Health at Every Size ............................................................................................................................. 29 Page 2 | 53 Pharmacology & Supplementation ............................................................................................30 Pharmacology ..................................................................................................................................... 30 Supplementation................................................................................................................................. 31 Other Medical & Nutritional Protocols .............................................................................................. 33 Coordination & Communication .................................................................................................35 Barriers to Treatment ................................................................................................................35 Medical Perspective ............................................................................................................................ 35 Dietitian Perspective ........................................................................................................................... 36 Patient Barriers ................................................................................................................................... 37 Financial Cost & Insurance .................................................................................................................. 38 Conclusion ................................................................................................................................38 Methods ....................................................................................................................................38 Appendix 1: LOC Guidelines .....................................................................................................40 Appendix 2: Video Screenshots ................................................................................................41 References ...............................................................................................................................48 Page 3 | 53 Acronyms ACT – acceptant and commitment therapy ALT – alanine aminotransferase AN-ERP – exposure response prevention for anorexia APA – American Psychiatric Association ARFID – avoidant/restrictive food intake disorder AST – aspartate aminotransferase AN – anorexia nervosa BED – binge eating disorder BMI – body mass index BN – bulimia nervosa BUN – Blood urea nitrogen CBT – cognitive behavior therapy CCK - cholecystokinin DA – dopamine DBT – dialectical behavior therapy ED – eating disorders ERP-B – exposure response prevention for binging ERP-P – exposure response prevention for purging FSH – follicle stimulating hormone GAPS – Guidelines for Adolescent Preventative Services HAES – health at every size HVA – homovanillic acid IBW – ideal body weight IE – intuitive eating IGF-1 – insulin-like growth factor 1 IOP – intensive outpatient program IPT – interpersonal therapy LH – luteinizing hormone LOC – levels of care MAOIs – monoamine oxidase inhibitors MED- DBT – multi-diagnostic complex eating disorder dialectical behavior therapy MRI – magnetic resonance imaging NICE – National Institute for Health and Clinical Excellence NPY – neuropeptide Y OCD – obsessive compulsive disorder OSFED – other specified feeding or eating disorder PHP – partial hospitalization program PYY – peptide tyrosine tyrosine PTSD – post traumatic stress disorder RANZCP –