CAMS-UA 203 Advanced Seminar Eating Disorders Sara S. Weekly, MD, Clinical Instructor of Child and Adolescent Psychiatry, NYU Child Study Center, Department of Child and Adolescent Psychiatry Course Aims: Knowledge Students will learn about: 1. Key aspects of the development of eating disorders, including a. Historical context, b. Diagnosis and classification, c. Genetic and biological etiology, d. Social, cultural, and media-based contributors, e. Clinical course and natural history, f. Psychological and medical sequelae; 2. Current and sentinel research done in the field of eating disorders; and 3. Existing treatment options and preventative efforts. Skills Students will: 1. Demonstrate a comprehensive understanding of the biological, psychological, and social context of eating disorders via participation in class discussions and a written final examination; 2. Translate knowledge from readings and discussions into a creative group project focused on intervention, awareness, or treatment of eating disorders; 3. Develop presentation and leadership skills by effectively moderating one class discussion; 4. Demonstrate critical thinking and appraisal skills in class discussions, response papers, and an academic report; 5. Discuss controversies in the field and limitations to our current knowledge of eating disorders. Course Description The most basic, albeit complex, relationship that we negotiate throughout our lives is that with our bodies. Our outward appearance is the superficial form we present to the world, so naturally, it is deeply connected to our sense of identity. Childhood and adolescence are critical periods for the formation of our sense of self, occurring at a time when our bodies are progressing through rapid and incessant changes. Not surprisingly, this is when eating disorders typically present. This course seeks to address the questions of why disordered eating develops and what can be done both to prevent and treat these deadliest of psychiatric disorders. We begin with what it means both now and historically to have an eating disorder. We will then review the biological, developmental, and societal contributors to eating disorders, with final discussions and projects focused on treatment and prevention.
Session Topic and Description 1 History and Overview of Eating Disorders In this session, we will start with introductions and explore participants interest in the course and their expectations for learning. Course requirements will be reviewed, including an introduction to the group project and final paper, and grading and student evaluation will be explained. Then, historical cases and prior conceptions of disordered eating behavior will be presented. Class will conclude with a discussion of students reactions to this material and their thoughts on its relevance today. No assignments due. 2 By Definition: Anorexia Nervosa, Bulimia Nervosa, Binge Eating Disorder, and NOS We will begin by reviewing the DSM IV criteria for the categorization of eating disorders, including DSM V revisions. We will present and discuss the controversies surrounding these definitions and relate these to presented epidemiological data. This will include prevalence and demographic data, as well as a look at long-term outcomes and recidivism in patients with eating disorders. Assignment due: Reflection paper: Did anything surprise you about the diagnosis of eating disorders? Is there anything you would change about the criteria of any of the diagnoses?
3 Before Birth: Genetic and Brain Differences in Eating Disorders This class will focus on the field s posited theories about genetic and neurologic predisposition to eating disorders. We will review the basic neurobiological basis of hunger, satiety, growth, and appetite, as well as the primary brain regions involved with body image, self-awareness, and thought distortions that are considered hallmarks of anorexia and bulimia. Reflection paper: Write a profile of either a person who would be most at risk for or most protected from developing an eating disorder and explain why. 4 Bodily (Dys)functions in Eating Disorders Continuing with the biological and neurological themes of the previous session, we will delve into the physical changes that develop over the course of an eating disorder. We will then move to psychological patterns and profiles seen in eating disorders. During our discussion period, we will begin to consider the relative merits of nature versus nurture versus nature plus nurture arguments for the etiology of eating disorders. Reflection paper: Based on this week s readings, write a response to or revision of your paper last week. 5 Consequences and Co-morbidities We will begin this class by presenting the longer-term medical sequelae of anorexia, bulimia, and binge eating disorder and will talk briefly about medical treatment interventions to minimize morbidity from these disorders. We will then move into psychiatric co-morbidities, including anxiety, depression, substance abuse, self-harm behavior, and other diagnoses, discussing ways in which these disorders can overlap and interact. Reflection paper: Do you think there is a point at which an individual should lose his or her right to choose what or if to eat? 6 Let s Talk About Sex (and Gender) During this session, we will look at the ways that disordered eating and body image impact sexuality both biologically (via the endocrine axis) and psychologically. We will discuss the gender differences (and similarities) between males and females with eating disorders, as well as
unique issues facing the LGBT population. Reflection paper: Pick one reading from those listed below that particularly impacted you and reflect on your reaction. 7 Families and Trauma: When Others Take Control Trauma, in its many forms, will be the focus of this session. Beginning with attachment and parenting styles, we will talk about the many ways relationships with primary caregivers influence eating behavior, selfesteem, and children s perceived locus of control. Next, we will move into more overt forms of trauma and discuss sexual and physical abuse as contributors to eating disorders. Reflection paper: Is trauma necessary for the development of an eating disorder? Is it sufficient? 8 An Unintended Education: What Happens at School? Our goals during this session will be to investigate and discuss the ways in which the middle and high school milieus impact the development of eating disorders. Specifically, we will present current research in the field related to the impact of athletic teams, uniforms, bullying, and health and body image-focused programming at school. Discussion will center on students analysis of this evidence and exploration of their own observations and experiences. Reflection paper: How have you seen school, family, or athletics impact you or your peers eating patterns? 9 Made in the USA: Social and Media s Impact on the Development of Eating Disorders This section will look at a wide variety of media images and clips from television, magazines, and other pop culture references. Largely discussion based, this class will also consider some of the published opinions on how American culture perpetuates and glamorizes disordered eating, as well as arguments against this theory. We will also think together about the recent explosion of social media sites and the impact that websites like Facebook and Twitter have had on and could have on the incidence of eating disorders.
Reflection paper: Bring in an image from the media that you think might be triggering to a child with poor body image or vulnerability to eating disorders and explain why you feel that way. Also, proposals for creative projects must be e-mailed prior to this class period, and project as well as group selections will be completed during this class period. 10 Cross-cultural Perspectives and the Global Impact We will explore the ways eating disorders present in other cultures both within and outside of the United States. We will learn about the historical context of the changing global nature of these problems and discuss students impressions of their own culture s approach to these issues. Reflection paper: Describe your thoughts or experiences with how your culture(s) relate to eating habits or eating disorders. 11 Modalities of Treatment Most of this session will be spent outlining the major treatment modalities available in the treatment of eating disorders and the evidence supporting (or not supporting) them. This will include pharmacotherapy, various forms of therapy, and other family and systems work, such as the Mosley Method. Reflection paper: Propose a treatment regimen for a teen with either anorexia, bulimia, or binge-eating disorder using the evidence you read about this week. 12 Policy and Prevention We will discuss past and present advocacy efforts to identify and prevent disordered eating. We will also review existing and proposed policy in the United States as well as other nations and non-governmental regulatory bodies that relate to eating disorders. Reflection paper: Do you think that the government should take responsibility by using policy to try to prevent and/or mitigate the effects of eating disorders?
Also, students should have discussed their final research paper topic by this class period. 13 Research and Future Directions This session will be focused on the frontiers of current research and proposed directions for the future. We will also invite current clinicians from a variety of professional backgrounds to participate on a panel discussing student-generated questions. Assignment Due: Final Research Reports will be due on this date. Also, each student will be asked to formulate 2-3 questions for our presenters. 14 Final Exam, Wrap-Up, and Selected Presentations This session will begin with a 1.5 hour written examination, including multiple-choice and short answer responses. Following a short break after the test, we will reconvene to debrief how the course went for students and address any outstanding questions or concerns. We will also plan to invite 1-3 students with outstanding research projects and 1-3 groups who completed outstanding original projects to briefly present their work. Reflection paper: Reflect on your time during this course. What did you learn that surprised you? What do you wish we had spent less or more time on? What would you like to learn next? Readings: Students will be expected to review their course syllabus and materials from the semester in preparation for their examination. Books To Be Purchased By Students: 1. Arnold, C. (2013). Decoding Anorexia. New York, NY: Routledge. 2. Keel, P. (2005). Eating Disorders. Upper Saddle River, NJ: Pearson Education, Inc. 3. Liu, A. (2007). Gaining. New York, NY: Hachette Book Group USA. 4. Martin, C. (2007). Perfect Girls, Starving Daughters. New York, NY: Berkley Books.