Week 8: Feeding and Eating Disorders, Somatic Symptom Disorders, and Other Related Disorders

Both eating disorders and somatic symptom disorders involve a mind-body relationship. However, those living with somatic disorders tend to be highly sensitized to their body experiences in a different way than those with eating disorders. While eating disorders can cause individuals to lose their interoceptive awareness of the body, those with somatic disorders tend to have a magnified awareness, often coupled with preoccupation and a high level of anxiety that is deemed to be excessive to the cause.

These spectrums of illness require that social workers take an early-intervention, multidisciplinary, and biopsychosocial approach to treatment to be successful in supporting recovery. Both require knowledge and extensive communication with medical providers and other specialists. That priority for interdisciplinary knowledge and teamwork increases in importance given the mortality rates of eating disorders and the mind-body factors in both.

This week you analyze the impact of living with an eating disorder and the problems (nutritional, medical, social, and psychological) in the recovery process. You also consider current societal influences that impact the onset, recognition, and recovery process for eating disorders and somatic symptom disorders.

Learning Objectives

Students will:

• Analyze the impact of the digital age and social influences on eating disorders
• Analyze biopsychosocial treatment strategies for eating disorders
• Apply advocacy strategies within an interprofessional treatment approach
• Analyze treatment strategies for clients with somatization disorders
• Analyze challenges with power and privilege during diagnosis

Learning Resources

Required Readings

American Psychiatric Association. (2013h). Feeding and eating disorders. In Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author. doi:10.1176/appi.books.9780890425596.dsm10

Khalsa, S. S., Portnoff, L. C., McCurdy-McKinnon, D., & Feusner, J. D. (2017). What happens after treatment? A systematic review of relapse, remission, and recovery in anorexia nervosa. Journal of Eating Disorders, 5(20), 1–12. doi:10.1186/s40337-017-0145-3

Lewis, B., & Nicholls, D. (2016). Behavioural eating disorders. Paediatrics and Child Health, 26(12), 519–526. doi:10.1016/j.paed.2016.08.005

American Psychiatric Association. (2013q). Somatic symptom and related disorders. In Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author. doi:10.1176/appi.books.9780890425596.dsm09

Brown, P., Lyson, M., & Jenkins, T. (2011). From diagnosis to social diagnosis. Social Science & Medicine, 73(6), 939–943. doi:10.1016/j.socscimed.2011.05.031

Kaltura Media Uploader (HTML)

Required Media

Accessible player –Downloads–Download Video w/CCDownload AudioDownload TranscriptLaureate Education (Producer). (2018d). Psychopathology and diagnosis for social work practice podcast: Feeding and eating disorder and somatic symptom disorders [Audio podcast]. Baltimore, MD: Author.

TEDx Talks. (2016b, June 29). Starving for the good: An anorexic’s search for meaning and perfection | Elisabeth Huh | TedxUChicago [Video file]. Retrieved from https://www.youtube.com/watch?v=GxI0ewBJdMo

TEDx Talks. (2013b, October 21). An epidemic of beauty sickness | Renee Engeln | TedxUConn 2013 [Video file]. Retrieved from https://youtu.be/63XsokRPV_Y

TED Conferences, LLC (Producer). (2016). What happens when you have a disease doctors can’t diagnose [Video file]. Retrieved from https://www.ted.com/talks/jen_brea_what_happens_when_you_have_a_disease_doctors_can_t_diagnose

Optional Resources

Axelsson, E., Andersson, E., Ljótsson, B., Finn, D. W., & Hedman, E. (2016). The health preoccupation diagnostic interview: Inter-rater reliability of a structured interview for diagnostic assessment of DSM-5 somatic symptom disorder and illness anxiety disorder. Cognitive Behaviour Therapy, 45 (4), 259–269. doi:10.1080/16506073.2016.1161663

Marzilli, E., Cerniglia, L., & Cimino, S. (2018). A narrative review of binge eating disorder in adolescence: Prevalence, impact, and psychological treatment strategies. Adolescent Health, Medicine and Therapeutics, 2018(9), 17–30. doi:10.2147/AHMT.S148050

Vartanian, L. R., Trewartha, T., & Vanman, E. J. (2016). Disgust predicts prejudice and discrimination toward individuals with obesity. Journal of Applied Social Psychology, 46(6), 369–375. doi:10.1111/jasp.12370

Document: Suggested Further Reading for SOCW 6090 (PDF)

Note: This is the same document introduced in Week 1.

Optional Media

Sagey, L., & Blair, R. (Producers). (n.d.). Anorexia: What therapists and parents need to know [Video file]. Retrieved March 22, 2018, from http://www.psychotherapy.net.ezp.waldenulibrary.org/stream/waldenu/video?vid=386

Discussion: The Complexity of Eating Disorder Recovery in the Digital Age

Through this week’s Learning Resources, you become aware not only of the prevalence of factors involved in the treatment of eating disorders, but also the societal, medical, and cultural influences that help individuals develop and sustain the unhealthy behaviors related to an eating disorder. These behaviors have drastic impacts on health. In clinical practice, social workers need to know about the resources available to clients living with an eating disorder and be comfortable developing interdisciplinary, individualized treatment plans for recovery that incorporate medical and other specialists.

For this Discussion, you focus on guiding clients through treatment and recovery.

To prepare:

• Review the Learning Resources on experiences of living with an eating disorder, as well as social and cultural influences on the disorder.
• Read the case provided by your instructor for this week’s Discussion.

By Day 3

Post a 300- to 500-word response in which you address the following:

• Provide the full DSM-5 diagnosis for the client. Remember, a full diagnosis should include the name of the disorder, ICD-10-CM code, specifiers, severity, and the Z codes (other conditions that may be a focus of clinical attention). Keep in mind a diagnosis covers the most recent 12 months.
• Explain the diagnosis by matching the symptoms identified in the case to the specific criteria for the diagnosis.
• Explain why it is important to use an interprofessional approach in treatment. Identity specific professionals you would recommend for the team, and describe how you might best utilize or focus their services.
• Explain how you would use the client’s family to support recovery. Include specific behavioral examples.
• Select and explain an evidence-based, focused treatment approach that you might use in your part of the overall treatment plan.
• Explain how culture and diversity influence these disorders. Consider how gender, age, socioeconomic status, sexual orientation, and/or ethnicity/race affect the experience of living with an eating disorder.    

Note: You do not need to include an APA reference to the DSM-5 in your response. However, your response should clearly be informed by the DSM-5, demonstrating an understanding of the risks and benefits of treatment to the client. You do need to include an APA reference for the treatment approach and any other resources you use to support your response.

By Day 6

Respond to at least two colleagues who identified a treatment strategy that differs from yours in the following ways:

• Explain whether you agree or disagree with your colleague’s treatment strategy.
• Explain additional cultural influences that your colleague should consider when addressing the specific eating disorder they identified.

Response 1

 Francisco Adame WK 8 DiscussionCOLLAPSE

(F50.02) Anorexia Nervosa, Binge-eating/purging type

(F33.0) Major Depressive Disorder, Mild, With anxious distress

(Z56.9) Other Problem Related to Employment

Karen meet the diagnosis for Anorexia Nervosa, Binge-eating/purging type based on the symptoms of frequent use of laxatives and purging to keep her weight down, has binged several times per month since she was 17 years old, constantly tries to keep her weight down and wants to not struggle with it, and there is lack of recognition of the seriousness of the problem as she says her weigh is monitored to make sure she remains healthy. She is displaying depressive signs and symptoms of depressed mood, anger, irritability, insomnia, and suicide risk is elevated in anorexia nervosa which she’s had ideation. Criteria for Major Depressive Disorder, Mild with anxious distress is met based on depressed mood, feeling of sadness and hopelessness, insomnia, irritability, diminished ability to concentrate, recurrent suicidal ideation without a specific plan or attempt and psychomotor agitations presented as feelings of restlessness. Other problems related to employment as she is having occupation problems in the work environment describing it as a stressful job, difficulty concentrating at work, and altercations with coworkers. 

The importance of the interprofessional approach in treatment is that her disorder can be addressed alongside a team. It is best practice to have collaborative care for eating disorders as it has become standard practice with the inclusion of nutritional rehabilitation, counseling, medical monitoring with an emphasis on good professional relationships, and open communication to seek common goals (Dejesse, & Zelman, 2013). Having the primary care provider, nutritionist as part of the team to consult regarding health can healthier ways a diet can prevent from affecting her phsyciological health. The family can be used as support through the process to encourage healthy eating, model behavior, and help her healthily manage her weight and diet.

A treatment approach would be Cognitive Behavioral Therapy – Eating Disorder (CBT-E) which utilizes specific strategies and a flexible series of sequence therapeutic processes to active at both cognitive and behavioral changes, as It modifies thinking rather than direct cognitive restructuring. It identifies the key aspects of the eating disorder and targets them to bring down those supporting aspects for the eating disorder through four defined stages (Murphy, Straebler, Cooper, & Fairburn, 2010). This modality is effective for eating disorders compared to others like family-based treatment (Craig, Waine, Wilson, & Waller, 2019). Additionally, CBT is effective in reducing depressive thoughts in major depressive disorder. This can be used to change the patters of behaviors regarding her eating disorder but also improve her depressive mood, improving her overall wellbeing in conjunction with other treatments. 

These disorders are present in culturally and socially diverse populations, Anorexia nervosa is most prevalent in post-industrialized, high-income countries like the Unites States appearing the lowest among Latinos, African Americans, and Asians. MDD has been a higher prevalence in females with a higher suicide attempt rate. (Markey, 2004) mentions family is the mechanism through which the majority of cultural lessons are learned, dietary norms are learned through interactions and eating behaviors are provided meaning. This culturally influenced familial context is defined by parents’ past experiences, traditions, and habits, with different cultural groups maintaining different patterns.

Reference:

Craig, M., Waine, J., Wilson, S., & Waller, G. (2019). Optimizing treatment outcomes in adolescents with eating disorders: The potential role of cognitive-behavioral therapy. International Journal of Eating Disorders, 52(5), 538–542. https://doi-org.ezp.waldenulibrary.org/10.1002/eat.23067

Dejesse, L. D., & Zelman, D. C. (2013). Promoting optimal collaboration between mental health providers and nutritionists in the treatment of eating disorders. Eating Disorders: The Journal of Treatment & Prevention, 21(3), 185–205. https://doi-org.ezp.waldenulibrary.org/10.1080/10640266.2013.779173

Response 2

  Meishalette Allen Week 8 DiscCOLLAPSE

Karen is a 23 year old single Caucasian female who lives in Las Vegas Nevada with her roommate. She has one sister. She has a bachelors degree in Art History and is employed by a hotel that has an art gallery. She was born and raised in Virginia but left do to a job in Las Vegas and she has been there for a year in a half. Her roommate suggested she go to therapy because something wasn’t right. Her roommate threatened to move out because of Karen’s actions. Karen has been been taking laxatives to keep her weight down since she has been seventeen. Her weight has been an issue with her for quite a long time. It appears that she once was bigger and does not want to get back that size.

Karen has been having difficulty concentrating at work. She states that her job has become stressful. Her co worker said something to her and she lost it. Karen reported that she was angry. She reported that she hit everything, holding back from hitting her co worker. Karen reported that she was stressed dealing with her school work and her boyfriend. Karen complained of depression with Insomnia and that she is only sleeping for a few hours each night. Karen admitted to suicidal ideation . She didn’t think she would have a future. She denies having history of flashback and nightmares but she feels she has PTSD.

Karen uses alcohol periodically but rarely. When Karen was younger her mother stated her personality changed and became stubborn and difficult. She would bite, having temper tantrums and became moody. Karen told the school counselor her mother was abusive toward her. While initiating the meeting with the counselor when she was in school she threw a temper tantrum. Karen was hyperactive and had difficulty in school.

I gathered a lot from this case. I feel that a social worker would be needed for Karen. The interprofessional approach is needed and required for atypical anorexia nervous according to Lewis & Nicholls (2016). Being that Karen take laxatives to maintain her wait I would say a nutritionist would be needed so Karen is able to take in the right amount of nutrition that she needs. The social worker comes in to play with helping Karen to get healthier eating habits in place while also doing treatment. Family support would be needed since she has had depression and suicidal ideation. Individual therapy with family would be much needed.

F50.01 Anorexia Nervosa

F32. Major Depressive Disorder

Z60.9 Unspecified problem related to social environment

References:

American Psychiatric Association. (2013). Somatic symptom and related disorders. In Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author

Lewis, B., & Nicholls, D. (2016). Behavioural eating disorders. Paediatrics and Child Health, 26 (12), 519-526. Statiscal manual of mental disorder (5th ed.). Arlington, VA; Author.

300.02 (F41.1) Generalized Anxiety: difficulty concentrating and staying on task.

307.51 (F50.2) Bulimia Nervosa (Mild): Purging since age of 17 years

Z63.0 Relationship Distress with Intimate Partner.

Note: You are required to create a thread for your initial Discussion post before you will be able to view other colleagues’ postings in this forum. If you have not yet visited the weekly resources and assignments, you should visit that area now to access the complete set of directions and guidelines for this discussion.

Submission and Grading Information

Grading Criteria

To access your rubric:
Week 8 Discussion Rubric

Post by Day 3 and Respond by Day 6

To participate in this Discussion:
Week 8 Discussion

Assignment: Somatic Symptom Disorders

Individuals with somatic symptom disorders tend to have considerable difficulty with how they experience and appraise their bodily symptoms. The illness and the dysfunctional focus and behavior around the illness can assume a central role in the person’s life.

Somatic symptom disorders were originally thought of as “hysterical,” without legitimate medical causation, or as hypochondriasis. Though thinking has changed, negative judgments about unfounded illnesses can still be attached to individuals with these disorders. The boundary between medical and emotional problems can be further blurred. In some cases, an individual labeled with one of these illnesses may simply be experiencing a developing medical condition that has not yet been well defined. For all of these reasons, social workers need to take particular care in diagnosing somatic symptom disorders and in providing a fully biopsychosocial and multidisciplinary approach.

In this Assignment, you describe what that approach might look like for one client.

To prepare:

• Imagine that Jennifer Brea, whose TEDTalk (TED Conferences, LLC, 2016) you watched, is referred to you for ongoing supportive therapy when her psychiatry consultant decides that she does not have a conversion disorder. Despite the psychiatrist’s opinion, her primary care physician ignores that consult and labels Jennifer with the conversion disorder anyway. Be sure to investigate what the ‘conversion’ diagnosis means when responding.
• Record your presentation using Personal Capture (record audio, video, and screen). See Kaltura Media Uploader in left-hand navigation menu in course for directions on recording and uploading media.

By Day 7

Submit a 5-minute recorded PowerPoint (5–7 slides) in which you address the following:

• Explain in a concise professional manner how you would conduct your first meeting with Jennifer. Identify specific steps you would take to understand her circumstance and needs.
• Explain how you would proceed with her medical team in terms of advocacy for her as a client believed to have this condition.
• Explain why you would need to take a biopsychosocial approach to her ongoing care.
• Explain what social, family, vocational, Internet, and medical supports you would explore to help with her longer-term stabilization.
• Analyze the controversy in diagnosing a mental disorder based on unexplained physical symptoms. Within your analysis, consider how power and privilege influence who provides the diagnoses and which groups are more likely to be diagnosed with certain disorders. Explain your thoughts on this debate.

Support your presentation with research and references to scholarly literature.

Include a transcript and/or edit closed captioning in your presentation to ensure your presentation is accessible to colleagues of differing abilities.

Submission and Grading Information