Late spring 2015 LACPA Eating Disorder SIG meetings

Tuesday, April 14 6:30 pm

Presenter:  Stephanie Knatz, Ph.D.   2014_Stephanie&Colby_LaJollaengagementphotos-6 copy

Title:  Using neurobiology to improve treatment for anorexia

This presentation will focus on providing a brief overview of the neurobiology underlying anorexia and present new treatment methods developed and used to target the underlying neurobiology.

Location:  The office of Dr. Lauren Muhlheim (4929 Wilshire Boulevard, Suite 245, Los Angeles) – free parking in the lot (enter on Highland)

Bio: Dr. Stephanie Knatz is a clinical psychologist and program director for the Intensive Family Treatment Programs at the UCSD Eating Disorders Treatment and Research Center. Alongside colleagues at UCSD, Dr. Knatz is responsible for UCSD’s treatment development initiative to translate contemporary neurobiological findings into applied clinical treatment models. Through this initiative, Dr. Knatz and others at UCSD are in the process of developing a neurobiological framework for the treatment of anorexia. Dr. Knatz is currently overseeing the development, testing and implementation of a novel clinical treatment program for adults with anorexia and their family members, which integrates novel treatment strategies developed at the clinic. In addition to her clinical research, she also directs UCSD’s Intensive Family Treatment Program (IFT), a family-based treatment program for adolescents with eating disorders.

Thursday, May 14 7:00 pm

Presenter:  Jaeline Jaffe, Ph.D., LMFT DrJJaffe

Title:  What Eating Disorder Clinicians Need to Know About Misophonia 

This presentation will discuss the condition called Misophonia (or 4S – Selective Sound Sensitivity Syndrome), what is known about it at the present time, what theories might explain the condition, how it often relates to OCD, and how it might also relate to eating disorders. Included will be some tools and strategies that are often very helpful with misophonia patients, which might also be useful for ED clinicians. Following the presentation, there will be time for discussion and group-think to explore the possible applications of this information in working with ED patients.

Jaelline Jaffe, PhD, is a California Licensed Marriage and Family Therapist in practice since 1976. Over the past several years, she has developed a sub-specialization in working with the emotional aspects of medical conditions, including Tinnitus and Misophonia. She has presented at all the Misophonia Conferences ever held to date (three International Conferences for Audiologists, and two for patients and families, with the third one coming in October), and is working with probably more misophonia patients, both in-state and across the country, than any other therapist. Using CBT and DBT, she works in person or online to help patients manage the stress of their medical conditions, learn coping strategies, and improve the quality of their personal and family relationships.

Location:  LACPA Office, 17277 Ventura Blvd., #202, Encino, CA  91316, (At the corner of Ventura Blvd. and Louise)  Entrance is in the back of the strip mall and there is free parking in the lot after 5 pm

Please RSVP to drmuhlheim@gmail.com (2 H’s in Muhlheim)

March and April SIG meetings are open to all professionals.   During other months SIG meetings are open to all LACPA members.  Nonmembers wishing to attend may join LACPA by visiting our website www.lapsych.org

 

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Look before you leap: Binge Eating Disorder, Vyvanse, and evidence-based psychotherapies

Guest post by Elisha M. Carcieri, Ph.D. , who I am pleased to announce will be joining my practice in Los Angeles this summer.elisha color photo[1]

Binge eating disorder (BED) has been making headlines with the recent announcement that the FDA has approved lisdexamfetamine dimesylate (Vyvanse) for the treatment of BED.

So, what is BED, how is it treated, and what does this new treatment option mean for sufferers?

BED is a condition in which a person engages in recurrent episodes of binge eating at least once a week for three months1. Binge eating episodes typically involve eating rapidly until uncomfortably full, and eating when one is not necessarily hungry. Some individuals with BED report feeling unable to stop the episode, and describe themselves as being out of control during a binge. Binge eaters often binge alone and make efforts to hide their behavior from friends, partners, or family members. Episodes of binge eating often end in feelings of guilt, shame, and depressed mood. Unlike other eating disorders, such as bulimia nervosa, people with BED do not vomit or use other methods of compensation (such as excessive exercise or fasting) to shed calories or lose weight after a binge. It should be clear that this is a very different experience than, say, overeating on Thanksgiving, having a second piece of birthday cake, or eating foods that are outside of your normal pattern while on vacation.

Until 2013, BED was not a diagnosable eating disorder. It was instead grouped in with other unspecified eating disorders that didn’t quite meet criteria to be formally diagnosed. After much research, the most recent iteration of the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5), has included BED as a specific eating disorder distinct from other diagnoses.

Despite only recently being formally acknowledged, BED is the most commonly occurring eating disorder. Prevalence estimates vary, ranging from 1.6-3.5% of women, 0.8-2% of men, and 1.6% of adolescents.1, 2, 3 BED occurs as commonly among women from racial or ethnic minority groups as for white women, 1 and is often seen in people with severe obesity.1, 4 Up to 30% of people seeking bariatric surgery or other interventions for weight loss are suffering from BED5. While it is more common for women to meet all of the criteria for BED, men tend to engage in binge eating as frequently as women2. Like all eating disorders, the causes of BED are complex. There is evidence for genetic, biological, and environmental risk factors. BED is associated with significant chronic health problems. It is also common for individuals with BED to struggle with other mental health disorders at the same time, including depression, anxiety, and substance use disorders.

The good news is that there are established treatments that work for BED. Unfortunately, effective psychological interventions for eating disorders don’t get as much press as pharmaceuticals. Nevertheless, those suffering from BED should be aware of what is available.

Evidence-based psychological treatments are first-line considerations for the treatment of BED. A psychologist or other mental health professional qualified to treat eating disorders usually conducts psychological treatment for BED on an outpatient basis. Cognitive behavioral therapy (CBT) is the most well studied and established treatment for BED with demonstrated effectiveness.6 The treatment involves reducing episodes of binge eating using tools such as establishing regular eating patterns and self-monitoring of food intake and patterns of eating. CBT also addresses concerns about shape and weight, and examines and challenges patterns of thinking that may be keeping a person stuck in a pattern of binge eating. CBT for BED involves discussion and planning of how to maintain progress, and how to recognize and respond to relapse. Studies have demonstrated improvements lasting up to 12 months post-treatment with CBT.7 Interpersonal therapy (IPT) has also been proven effective for BED with strong research support.8 IPT involves more of a focus on interpersonal (relationship) difficulties with an understanding of how these problems may have precipitated BED, or how they might be keeping the BED going. Finally, there is evidence that dialectical behavior therapy (DBT), which focuses on mindfulness, emotion regulation, and distress tolerance, is effective at treating BED.9

In addition to psychological treatments, some antidepressants and anticonvulsants have proven helpful at reducing frequency of binge eating in patients with BED.6 The newest and only medication specifically approved by the FDA for BED is Vyvanse, a central nervous system stimulant that has been approved to treat ADHD in children and adults since 2007. The approval for BED came after clinical trials demonstrated that the average number of binge eating days per week among sufferers were decreased in those who took Vyvanse, compared to those who took a placebo.10 Sounds promising…but there are other considerations to keep in mind…side effects, long term use, and the question of whether a medication can address the complex nature of a serious eating disorder such as BED.

The potential side effects of Vyvanse include decreased appetite, dry mouth, increased heart rate or blood pressure, difficulty sleeping, anxiety, gastrointestinal problems, feeling jittery, and even sudden death among people with heart problems. The drug is also particularly risky for individuals with a history of seizures or mania. Vyvanse may cause psychotic or manic symptoms in people with no history of mental illness, and has high potential for abuse, dependence, tolerance, and overdose.

Vyvanse appears to decrease symptoms over a short period of time (about three months) while taking the medication. However, it is unlikely that the medication will result in long term changes in complex binge eating behavior once the drug is stopped, meaning that one might expect to take Vyvanse for the rest of their lives in order to keep BED at bay. This is problematic considering the chronic nature of BED, 2 and the fact that the negative emotion, distress, shame, and weight or shape concerns that are often related to BED would almost certainly remain unaddressed.

While there are no identified side effects to engaging in psychological treatment of BED, these treatments do take time (often around 20 weeks), and not every person will respond to an intervention the same way. It may take some trial and error to find the right therapist or treatment. However, psychological treatments are more equipped than medication alone to address the binge eating behavior itself, and the different ways binge eating relates to other areas of a person’s life and functioning. Rather than simply masking and reducing symptoms in the short term with a medication, completing a course of evidence-based therapy can provide the insight and tools needed for managing the patterns of disordered eating that are characteristic of BED for life. Many people with BED may benefit from trying a psychological approach before initiating treatment with a serious medication like Vyvanse.

All of these factors should be carefully considered when making a decision about treatment for BED. With all eating disorders including BED, it is important to get help sooner rather than later. For many people, turning to their primary care doctor is the first step. Patients should keep in mind that these conversations can be sensitive and difficult, and many providers may not be familiar with BED. Other providers may be familiar with the recent approval of a new drug, and will be eager to explore prescription medication options for treatment. There are some great tips on how to approach the topic with your doctor at bingeeatingdisorder.com.

If you aren’t getting anywhere with your doctor, it is always appropriate to ask for a referral to a medical provider who is more familiar with eating disorders. Your doctor may also be able to provide you with a referral to a mental health provider, such as a psychologist, who can provide one of the therapies discussed above, and to a nutritionist or dietician who specializes in eating disorders for even more comprehensive support. Remember that it is important to seek help from professionals qualified to treat eating disorders, and treatment decisions should be tailored to the unique needs of each person.

References

1. American Psychiatric Association. (2013). The Diagnostic and Statistical Manual of Mental Disorders: DSM 5. bookpointUS.

2. Hudson, J. I., Hiripi, E., Pope Jr, H. G., & Kessler, R. C. (2007). The prevalence and correlates of eating disorders in the National Comorbidity Survey Replication. Biological psychiatry, 61(3), 348-358.

3. Swanson, S. A., Crow, S. J., Le Grange, D., Swendsen, J., & Merikangas, K. R. (2011). Prevalence and correlates of eating disorders in adolescents: Results from the national comorbidity survey replication adolescent supplement. Archives of General Psychiatry, 68(7), 714-723.

4. Marcus, M. D., & Levine, M. D. (2005). Obese patients with binge-eating disorder. In The management of eating disorders and obesity (pp. 143-160). Humana Press.

5. Kalarchian, M. A., Marcus, M. D., Levine, M. D., Courcoulas, A. P., Pilkonis, P. A., Ringham, R. M., … & Rofey, D. L. (2007). Psychiatric disorders among bariatric surgery candidates: relationship to obesity and functional health status. The American journal of psychiatry, 164(2), 328-334.

6. Brownley, K. A., Berkman, N. D., Sedway, J. A., Lohr, K. N., & Bulik, C. M. (2007). Binge eating disorder treatment: a systematic review of randomized controlled trials. International Journal of Eating Disorders, 40(4), 337-348.

7. Wilson, G. T., Grilo, C. M., & Vitousek, K. M. (2007). Psychological treatment of eating disorders. American Psychologist, 62(3), 199.

8. Wilfley, D. E., Welch, R. R., Stein, R. I., Spurrell, E. B., Cohen, L. R., Saelens, B. E., … & Matt, G. E. (2002). A randomized comparison of group cognitive-behavioral therapy and group interpersonal psychotherapy for the treatment of overweight individuals with binge-eating disorder. Archives of general psychiatry, 59(8), 713-721.

9. Telch, C. F., Agras, W. S., & Linehan, M. M. (2001). Dialectical behavior therapy for binge eating disorder. Journal of consulting and clinical psychology, 69(6), 1061.

10. McElroy S. L., Hudson, J. I., Mitchell, J. E., et al. (2014) Efficacy and Safety of Lisdexamfetamine for Treatment of Adults With Moderate to Severe Binge-Eating Disorder: A Randomized Clinical Trial. JAMA Psychiatry.

Elisha Carcieri, Ph.D., is a licensed clinical psychologist (PSY #26716) practicing in the Los Angeles area. Dr. Carcieri earned her bachelors degree in psychology from The University of New Mexico and completed her doctoral degree in clinical psychology at Saint Louis University. During her graduate training, she conducted research focused on eating disorders and obesity, and was trained in using cognitive behavioral therapy (CBT) for eating disorders and other mental health disorders such as anxiety and depression. Dr. Carcieri completed her postdoctoral fellowship at the Long Beach VA Medical Center, where she worked with Veterans coping with mental illness, disability, significant acute or chronic health concerns, and chronic pain. In addition to cognitive behavioral strategies, she also incorporates alternative evidence-based approaches such as mindfulness, and acceptance and commitment-based strategies, depending on the needs of each client. Dr. Carcieri has experience working with culturally diverse clients representing various aspects of diversity including race/ethnicity, gender, age, disability, and size, and welcomes new clients from all backgrounds. She is a member of the American Psychological Association (APA), the Academy for Eating Disorders (AED), and the Los Angeles County Psychological Association (LACPA). 

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Spring 2015 LACPA Eating Disorder SIG events

Wednesday, February 11, 7:15 pm

Pia Guerrero

Pia Guerrero

Presenter:  Pia Guerrero

Title:  Adios Barbie: Body Image, Intersectionality, Healing and Advocacy

Location:  The office of Dr. Lauren Muhlheim (4929 Wilshire Boulevard, Suite 245, Los Angeles) – free parking in the lot (enter on Highland)

Bio:  Pia Guerrero  is a media literacy and youth development expert with a focus on body image, race, and representation in the media.  For the past 20 years she has led a number of youth development organizations and programs in the San Francisco Bay Area.  From Harlem to Hawaii, she’s  led presentations to thousands of teachers, youth workers, and youth on the impact the media has on young people, especially girls. Pia is also the founder and editor of Adios Barbie, the first body image website to expand the conversation beyond size to include race, age, ability, sexual orientation, and sexuality. As the first website of its kind, Adios Barbie has been mentioned in MSNBC, The New York Times, Forbes, Al-Jazeera, Glamour, among others. Pia has also appeared numerous times as an expert on CNN’s Headline News (HLN) and Huffington Post Live. Currently, Pia works as the Executive Director of SheHeroes, a non-profit that profiles exceptional career women for their accomplishments and character with the purpose of empowering girls to pursue rewarding careers.

Wednesday, March 4, 7:15 pm

Nikki DuBose

Nikki DuBose

Presenter:  Nikki DuBose

Title:  B.E.A.U.T.Y: Paint Me A Soul

The talk will reflect on my life struggles and will focus on the modeling and entertainment industries and how I believe they contributed to my eating disorders, addictions, and mental health issues.

Location:  The office of Dr. Lauren Muhlheim (4929 Wilshire Boulevard, Suite 245, Los Angeles) – free parking in the lot (enter on Highland)

Bio:  Nikki is a former fashion model, host, and commercial actress who recovered from a 17 year battle with anorexia and bulimia.  Writing for recovery turned into a full-time career for Nikki. She is working on her first book, detailing her life’s challenges, in an attempt to help others overcome their hardships as well.  She is an advocate for  the National Eating Disorders Association (NEDA), and the Project HEAL.

Tuesday, April 14 6:30 pm

Presenter:  Stephanie Knatz, Ph.D.   2014_Stephanie&Colby_LaJollaengagementphotos-6 copy

Title:  Using neurobiology to improve treatment for anorexia

This presentation will focus on providing a brief overview of the neurobiology underlying anorexia and present new treatment methods developed and used to target the underlying neurobiology.

Location:  The office of Dr. Lauren Muhlheim (4929 Wilshire Boulevard, Suite 245, Los Angeles) – free parking in the lot (enter on Highland)

Bio: Dr. Stephanie Knatz is a clinical psychologist and program director for the Intensive Family Treatment Programs at the UCSD Eating Disorders Treatment and Research Center. Alongside colleagues at UCSD, Dr. Knatz is responsible for UCSD’s treatment development initiative to translate contemporary neurobiological findings into applied clinical treatment models. Through this initiative, Dr. Knatz and others at UCSD are in the process of developing a neurobiological framework for the treatment of anorexia. Dr. Knatz is currently overseeing the development, testing and implementation of a novel clinical treatment program for adults with anorexia and their family members, which integrates novel treatment strategies developed at the clinic. In addition to her clinical research, she also directs UCSD’s Intensive Family Treatment Program (IFT), a family-based treatment program for adolescents with eating disorders.

Thursday, May 14 7:00 pm

Presenter:  Jaeline Jaffe, Ph.D., LMFT

Title:  Misophonia

Location:  LACPA Office (Encino)

Please RSVP to drmuhlheim@gmail.com (2 H’s in Muhlheim)

March and April SIG meetings are open to all professionals.   During other months SIG meetings are open to all LACPA members.  Nonmembers wishing to attend may join LACPA by visiting our website www.lapsych.org

 

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Radiant Sunbeams – guest post by Katie Grubiak, RD

sea lion

She sat there taking in the radiant sunbeams, soaking in every last ray upon her chest before the sun set on the first day of 2015.  The concepts of a New Year and its resolutions were non-existent, so she wasn’t genuflecting to the next 364 days ahead of her. She was just there, present to the sensations of her body gilded by the setting sun.  Yes, fully present she was in her beautiful bold black body on a rock.  As I stood on the Malibu shore looking out at this glorious being of nature on 2015’s first day, I was reminded of the power of our inner voice that can stand alone with valor.  Along side the negative thoughts of hating one’s body, dieting, and comparing one’s appearance and life to others is an inner voice that can lead us to follow a life of true balance and wellbeing.  We can have a loving dynamic with food and move through space (aka exercise) from a joyous, intuitive place.  By deeply listening to the body’s signals of hunger and fullness and what foods/nutrients are calling to us, we come closer to hearing the tones of the body’s fine tuning. Through breathing/stretching/moving mindfully, we can bring the body’s alignment, organs, and systems back into homeostasis. Believe that the body has biological intelligence far beyond what the mind can comprehend or control. Be the warrior, protecting the body from shame and allowing its intelligence to fully emerge and be seen.  How did our perceived value come down to meeting or not meeting a New Year’s resolution with a certain number on a scale or to looking like that image (probably photo shopped) in that magazine in order to be included in a supposed upper echelon?  Who tells us who we are? Well hopefully, it is our compassionate inner voice. She, the Sea Lion, has no shaming mind or shaming society.  She is who she is, allowing light to always come in. For us it’s a choice. What truth will you listen to? What voice will you speak from? Will you stand present on your own rock to allow the radiant sunbeams to come in…. harmonizing with the ones that radiate out from within you?

by Katie Grubiak, RDN, Registered Dietitian Nutritionist Specializing in Eating Disorders Dancer/Yogi/Mover & Believer of a life most beautiful

Katie Grubiak is a Registered Dietitian with a focus on blending Western & Eastern philosophies regarding nutritional healing.  In addition to nutritional counseling, Ms. Grubiak guides individuals through movement and breath techniques that open and warm the body and help with physical and emotional flexibility, strength, and self-acceptance/body image. For further information about her services, contact her at katiegrubiak@hotmail.com or 213-249-2110.

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Fall 2014 LACPA Eating Disorder SIG events

The Los Angeles County Psychological Association Eating Disorder SIG is kicking off the membership year with 2 great events.  Join LACPA now to take advantage of these and other events. 

1)  Date:  Thursday, October 23T-FFED

Time:  7- 8:30 pm

Presenter:  Dagan VanDemark

Title: TRANSforming Eating Disorder Recovery: Deconstructing the Overrepresentation of Eating Disorders in Trans and Gender Diverse Individuals, and How Healthcare Professionals Can Better Serve Our Communities

While under-treated and still under-researched, preliminary studies and countless anecdotes demonstrate that transgender people suffer from eating disorders disproportionately. This workshop will introduce how trans and gender-diverse people are vulnerable to and struggle with EDs, and conduct a basic training for health professionals looking to offer more trans-friendly, gender-literate and accessible care.  

Location:  The office of Dr. Lauren Muhlheim (4929 Wilshire Boulevard, Suite 245, Los Angeles)

Bio:  Dagan VanDemark is the Founder and Executive Director of the pending non-profit T-FFED: Trans Folx Fighting Eating Disorders, based in LA but quickly gaining national reach. Dagan, a genderqueer trans boi, battled bulimia/EDNOS for fifteen years. They have a B.A. in Gender Studies from CSULB, a certificate in Grant Writing and Administration from CSUDH, and they are enrolled in both the Non-Profit Management certificate program at UCLA and a transgender leadership initiative through Gender Justice LA. They speak on university panels about gender variance and sexual diversity, and write/blog extensively about transgender communities’ experiences with eating disorders.

2)  Date:  Wednesday, December 3Aimee Liu

Time:  7:15 – 8:45 pm

Presenter:  Aimee Liu

Title: The Stages of Recovery 

Location:  The office of Dr. Lauren Muhlheim (4929 Wilshire Boulevard, Suite 245, Los Angeles)

Bio:  Aimee Liu is the author of Restoring Our Bodies, Reclaiming Our Lives (Trumpeter Books, 2011), a benefit project for the Academy for Eating Disorders, and of Gaining: The Truth About Life After Eating Disorders (Wellness Central, 2007), a sequel to her acclaimed 1979 memoir Solitaire.  Her novels include Flash House (Warner Books, 2003), Cloud Mountain (Warner Books, 1997), and Face (Warner Books, 1994).  She also has co-authored more than seven nonfiction books and written numerous articles on medical, psychological, and political topics. She earned her MFA from Bennington College and now teaches in Goddard College’s  MFA in Creative Writing Program. 

More information is available at www.gainingthetruth.com

Please RSVP to drmuhlheim@gmail.com (2 H’s in Muhlheim)

SIG meetings are open to all LACPA members. Nonmembers wishing to attend may join LACPA by visiting our website www.lapsych.org

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Ten Facts About Weight Stigma – Guest post by Liliana Almeida, M.A.

As a follow-up to last week’s Weight Stigma Awareness Week, here are 10 facts about weight stigma.
Liliana Almeida, M.A.

By: Liliana Almeida, M.A.,

Registered Psychological Assistant to Lauren Muhlheim, Psy.D.

 

  1. Weight stigma is a bias or discrimination relating directly to weight. Despite the fact that more than half of U.S. citizens are overweight, our society holds a strong negative bias against fatness.
  2. The media reinforces weight stigma. The media, such as news media, displays obese persons in stigmatizing ways by depicting them sitting and eating unhealthy foods, wearing ill-fitting clothes, headless, or with their abdomens showing.
  3. Weight stigma is based on the belief that obesity is under one’s personal control. This belief suggests that obese persons are undisciplined and inactive. However,when obesity is attributed to uncontrollable factors such as diabetes or hypertension, people’s attitudes change. 
  4. Weight stigma exists in romantic relationships. Romantically,obese partners are less preferred.  They are less preferred in comparison to those who are in wheelchairs, mentally ill, or those who have sexually transmitted diseases.
  5. Weight stigma starts as early as preschool.  Children ages 3-5 negatively characterize overweight children as mean, ugly, stupid and sloppy.As children get older they start believing their overweight peers are lazy, less popular, and less happy. College students report that their overweight peers are lazy, self-indulgent, and less attractive, with low self-esteem and deserving less attractive partners.
  6. Teachers have a weight bias towards heavier students. They believe their overweight students lack self-control and are less likely to succeed.
  7. Health professionals are also biased. Health professionals treating individuals with eating disorders report believing that obese patients do not comply with treatment recommendations and perceive poor treatment outcomes. Those strongly biased believe obesity is due to overeating and lack of motivation.
  8. Overweight or obese individuals have internalized stigma. The most common anti-fat bias among overweight individuals is the belief that they are lazier and less motivated than thinner individuals. The failed attempts of overweight individuals to lose weight may cause them to begin to internalize society’s beliefs that they are lazy and lack will power.
  9. Weight stigma increases binge eating. Weight stigma causes psychological distress such as depression, anxiety, and low self-esteem. It is also associated with poor body image and increased fear of fat.
  10. Weight stigma experiences are as common as other forms of discrimination. In women, it is as common as racial discrimination. In some cases, it is more common than gender and age discrimination. 

Liliana Almeida, M.A., is a fourth year Clinical Psychology Ph.D. student at the California School of Professional Psychology at Alliant International University in Los Angeles. She received her M.A. from The New School and her B.A. from Rutgers University. During the last 7 years she has researched eating disorders, obesity, and weight stigma. Her clinical experience includes working with diverse clients in a community mental health center providing cognitive-behavioral and psychodynamic psychotherapy in English and in Spanish.

Liliana will be working under my supervision and is available to work with adult and adolescent clients with eating disorders, anxiety, and depression.  She will provide services in English and Spanish as well as her native Portuguese and will be able to provide some low-cost therapy to those in need.

If you are interested in more information, please visit Liliana’s website or contact me at 323-282-3572 or drmuhlheim@gmail.com

References 

Ashmore, J.A., Friedman, K.E., Reichmann, S.K., &Musante, G.J. (2008). Weight-based stigmatization, psychological distress, & binge eating behavior among obese treatment-seeking adults. Eating Behaviors, 9, 203-209.

Chen, Eunice & Brown, Molly. (2005). Obesity Stigma in Sexual Relationships.  Obesity Research, 13, 1393-1397.

Cramer, P., & Steinwart, T. (1998). Thin is good, fat is bad: How early does it begin? Journal of Applied Developmental Psychology, 19, 429-451.

Friedman, K., Reichmann, S., Costanzo, P., Zelli, A., Ashmore, J., & Musante, G. (2005). Weight stigmatization and ideological beliefs: relation to psychological functioning in obese adults. Obesity Research, 13, 907–916.

Latner, J., Wilson, T., Jackson, M., & Stunkard, A. (2010). Greater history of weight-related stigmatizing experience is associated with greater weight loss in obesity treatment. Journal of Health Psychology, 14, 190-199.

Puhl, R., Andreyeva, T., & Brownell, K. (2008). Perceptions Of Weight Discrimination:Prevalence And Comparison To Race And Gender Discrimination In America. International Journal of Obesity, 992-1000.

Puhl, R., & Latner, J. D. (2007). Stigma, obesity, and the health of the nation’s children. Psychological Bulletin, 133, 557-580.

Puhl, R., Latner, J., King, K., & Luedicke, J. (2013). Weight bias among professionals treating eating disorders: attitudes about treatment and perceived patient outcomes. International Journal of Eating Disorders, 1-11.

Puhl, R., Lee Peterson, J., DePierre, J., & Luedicke, J. (2013). Headless, hungry, and unhealthy: A video content analysis of obese persons portrayed in online news. Journal of Health Communication, 1-17.

Stice, E., Presnell, K., & Spangler, D. (2002). Risk factors for binge eating onset in adolescent girls: a 2-year prospective investigation. Health Psychology, 21, 131-138.

Tiggemann, M., & Wilson-Barrett, E. (1998). Children’s figure rating: relationship to self-esteem and negative stereotyping. International Journal of Eating Disorders, 23, 83-88.

Wang, S. S., Brownell, K. D., &Wadden, T. A. (2004). The influence of the stigma of obesity on overweight individuals. International Journal of Obesity, 28, 1333-1337.

 

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LACPA Eating Disorder SIG upcoming events (Fall 2014)

I am excited to announce the next 3 upcoming meetings of the Los Angeles County Psychological Association Eating Disorder Special Interest Group (LACPA ED SIG).  We have amazing speakers lined up.  The LACPA membership year begins in September, so now is the time to join or renew to maximize your benefits.  SIG events are open only to LACPA members, but are FREE.  For information on membership, see the LACPA website. www.lapsych.org.  One does not need to be a psychologist to join LACPA; other professionals may join as well.

Slide1

Dr. Stacey Rosenfeld

Date: Thursday, August 28th

Time: 7-8:30

Title: Does Every Woman Have an Eating Disorder? Challenging Our Nation’s Fixation with Food and Weight

Presenter: Stacey Rosenfeld, Ph.D.

Location: The office of Stacey Rosenfeld, PhD (2001 S. Barrington Avenue, Suite 114, Los Angeles)

BIO: Stacey Rosenfeld, PhD, is a clinical psychologist, licensed to practice in New York and California, who treats patients with eating disorders, anxiety/depression, substance use issues, and relationship difficulties. A certified group psychotherapist, she has worked at Columbia University Medical Center in NYC and at UCLA in Los Angeles and is a member of three eating disorder associations. The author of the highly-praised Does Every Woman Have an Eating Disorder? Challenging Our Nation’s Fixation with Food and Weight, inspired by her award-winning blog of the same name, she is often interviewed by media outlets as an expert in the field.

Dr. Rosenfeld is also the founder of the LACPA ED SIG but will be leaving the group in the fall due to relocation.  This will be a unique opportunity to hear her speak and also to acknowledge the contributions she has made to the Los Angeles community during her fruitful three years here.

Baumann113lo-res

Maggie Baumann, MFT, CEDS

Date: Tuesday, September 16th

Time: 7-8:30pm

Title: Pregnancy & Eating Disorders: Journey Through the Facts and Recovery

Presenter: Maggie Baumann, MFT, CEDS

Location: The office of Stacey Rosenfeld, PhD (2001 S. Barrington Avenue, Suite 114, Los Angeles)

Bio:  Maggie Baumann is a psychotherapist in Newport Beach who specializes in treating people struggling with eating disorders, including pregnant women and moms with eating disorders. She is a former board member for the Orange County Chapter of the International Association of Eating Disorder Professionals (IAEDP) and serves as a committee member on the national IAEDP certification board.

Maggie has been a featured guest on nationwide talk shows and TV segment profiling pregorexia and moms with eating disorders. She was a mental health blogger for Momlogic.com, where she shared her own story of suffering from pregorexia over twenty-five years ago. Additionally, Maggie serves as a guest eating disorder expert for KidsinTheHouse.com, a video parenting resource. She is also authoring a chapter on eating disorders and pregnancy for an upcoming book on Eating Disorders in Special Populations (publication date: 2015). Now, Maggie has partnered with Chicago-based residential treatment center, Timberline Knolls, in hosting their Lift the Shame eating disorder support group the first web-based support group for pregnant women and moms with eating disorders. Lift the Shame, is a free group and has members from across the US and abroad.

T-FFED

T-Ffed: Trans Folx Fighting Eating Disorders

Date:  Thursday, October 23

Time:  7- 8:30 pm

Title: TRANSforming Eating Disorder Recovery: Deconstructing the Overrepresentation of Eating Disorders in Trans and Gender Diverse Individuals, and How Healthcare Professionals Can Better Serve Our Communities

Presenter:  Dagan VanDemark

Location:  The office of Dr. Lauren Muhlheim (4929 Wilshire Boulevard, Suite 245, Los Angeles)

Bio:  Dagan VanDemark is the Founder and Executive Director of the pending non-profit T-FFED: Trans Folx Fighting Eating Disorders, based in LA but quickly gaining national reach. Dagan, a genderqueer trans boi, battled bulimia/EDNOS for fifteen years. They have a B.A. in Gender Studies from CSULB, a certificate in Grant Writing and Administration from CSUDH, and they are enrolled in both the Non-Profit Management certificate program at UCLA and a transgender leadership initiative through Gender Justice LA. They speak on university panels about gender variance and sexual diversity, and write/blog extensively about transgender communities’ experiences with eating disorders.

Please RSVP for any or all of the 3 events to drmuhlheim@gmail.com

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Parental direction works, but don’t expect your kid to be happy about it: Research on The Family Meal in FBT

Slide1Parents charged with helping their children to recover in Family-Based Treatment often wonder 1) how to actually get their children to eat and 2) whether they will harm their children or the parent-child relationship by requiring them to eat. A recent study addressed these concerns by looking at the family meal.               

How do parents of adolescent patients with anorexia nervosa interact with their child at mealtimes? A study of parental strategies used in the family meal session of family-based treatment

Hannah J. White BSc (Hons), Emma Haycraft PhD,*, Sloane Madden MD, Paul Rhodes PhD, Jane Miskovic-Wheatley DCP/MSc, Andrew Wallis MFAMTher, Michael Kohn MD and Caroline Meyer PhD (Article first published online: 26 JUN 2014)

The above study in the International Journal of Eating Disorders looked at the family meal in Family-Based Treatment (FBT), the best-researched outpatient treatment for adolescent anorexia. In FBT, the family plays a central role in treatment. Parents take responsibility for weight restoration and interruption of eating disorder behaviors, and family meals are an essential part of this process. Typically the second session of Family-Based Treatment is a family meal in which the family brings a picnic meal to the therapist’s office. The goal of the session is for the therapist to empower the parents to get their child with anorexia to eat one bite more than the child was prepared to eat.

The strategies used during mealtimes by parents of adolescents with anorexia have not been previously documented. Some believe that the eating habits of these adolescents have regressed and that the adolescents should be viewed as younger children who need more feeding assistance from their parents. Thus, parental strategies used to encourage eating would be similar to the strategies used by parents of younger children with and without feeding problems, which have been studied: these parents have been noted to use both encouragement and pressure to eat. Little is known about the response of adolescents with anorexia to their parents’ attempts to get them to eat.

The purpose of this study was to examine the strategies used by parents and the results. The study included 21 families with children between the ages of 12 and 18 who were undergoing FBT for adolescent anorexia.

The main aims of the study were:

1)   to identify mealtime strategies used by parents during the family meal session of FBT.

2)   to explore the relationships between these strategies and parental ‘success’ in encouraging eating.

3)   to explore the relationships between these strategies and their results with the emotional tone of the mealtime.

While this research was conducted in an artificial setting – a therapist’s office and in the presence of the therapist – the findings should be applicable to family meals occurring in the home.

Specifically, the researchers found:

1)   parents used a variety of strategies to prompt the child to eat: direct eating prompts (e.g., “You’ve got to eat all your eggs” or “Pick it up and eat it”), non-direct eating prompts (e.g. “Keep going” or “Why don’t you eat some more pasta?”), physical prompts (e.g., pushing a plate of food towards the adolescent), autonomous comments (e.g., “Do you want another one?” or “Which one do you want?”) and information provision (e.g., “Your body needs the calcium” or “This will make your bones strong”).

2)   direct, non-direct, and physical prompts were more successful in getting adolescents to eat than providing information about the food or offering food-related choices to the adolescent.

3)   in general, the more the parents prompted the child to eat and the more successful they were, the more negative the adolescents became. It makes sense that attempts to encourage eating, which contradict the anorexic tendencies, would cause psychological distress and a more negative emotional tone.

The authors conclude “It is interesting that a behavioral focus on eating (i.e., verbal and physical prompting) was associated with parental success as opposed to other strategies such as offering choices to the adolescent or consequences. This indicates that parents implementing a direct focus on food may be central to eating behavior and supports the emphasis on behavioral change rather than insight which is central to FBT.”

Keeping in mind that this is only one small study, the results are consistent with my observations of family meals in my practice and reports from parents refeeding their adolescents:

  1. parents need to directly prompt or pressure their child with anorexia to eat.
  2. offering choices and providing information is generally less effective in getting children with anorexia to eat.
  3. the more the parents pressure the child and the more the child eats, the more negative and upset the child becomes.

This study highlights the paradox parents face in implementing FBT. When a child is in distress, the parental instinct is to try to soothe them. Intentionally upsetting the child runs counter to a parent’s nature. However, for children with anorexia, food is medicine. The best measure of the parent’s success in FBT is the amount of food consumed. Parents should expect that their child will have a negative reaction to both pressure to eat and the eating itself. This negativity is not a sign of failure, but a reaction to a treatment that is working.

While these interactions often lead to more short-term conflict and distress, parents must persist and weather the storm in order to support their child’s recovery.  Over time, this persistence will challenge the anorexia and encourage change and recovery.

 

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Katherine Grubiak, RD

Katherine Grubiak, RD

Katherine Grubiak, RD

On the occasion of the one year anniversary of my affiliation with the awesome, Katherine (Katie) Grubiak, RD, I want to highlight her fabulous work and contribution to my practice.

Eating disorders are best addressed by a multidisciplinary approach.  Thus, I was extremely excited when, one year ago, I moved to a larger space and arranged an affiliation with Katherine Grubiak, RD, who works part-time in my suite.  Ms. Grubiak brings a wealth of experience with eating disorders in both adolescents and adults, and her approach is consistent with the latest evidence-based treatments.

Our clients benefit from our integrated approach for eating disorders and we tailor treatment to each client or family.  Additionally, we offer services as a team or individually. This benefits our clients who already have a dietitian or therapist and are seeking to add one member to their treatment team.

Ms. Grubiak, in addition to nutrition counseling sessions at the office, also provides additional support to those seeking help with preparing, portioning, or eating meals.  These may occur in the client’s home, office, school, or location of choice (restaurant, supermarket, etc.).  

Katherine Grubiak, RD/Biography

Katherine Grubiak is a Registered Dietitian with a focus on blending Western & Eastern philosophies regarding nutritional healing.  She graduated from the University of Texas at Austin and first pursued a career in public health surrounding herself with different cultures and a mission to honor all those seeking healthcare nutritional support.

Ms. Grubiak began her Nutrition career working in Maternal Child Health Nutrition with a focus on Gestational Diabetes Management & breastfeeding support as a Certified Lactation Educator (CLE).  She later became a dietitian for the UCLA Arthur Ashe Student Health & Wellness Center seeing students with various medical issues.  In this position, she worked closely with the UCLA Counseling and Psychological Services Center to provide treatment for college students with eating disorders and was involved with the Health Center’s Weight Management and Diabetic Programs.

This experience led Ms. Grubiak to pursue her next position as full time Registered Dietitian and Director of Clinical Services for California Center for Healthy Living, an innovative and comprehensive center promoting healthy relationships with food, fitness, and body image for children, teens, and adults of all ages. The focus here was on prevention and treatment of eating disorders and family involved therapy.  She enjoys working within a multi-disciplinary team believing that holistic care means having all areas of health supported.

Ms. Grubiak also has a professional dance background and taught for the non-profit dance school Everybody Dance in Los Angeles.  She utilized nutrition and alternative medicine including yoga to heal herself from dance injuries and spread the word to her students.

Ms. Grubiak’s belief is that a practitioner needs knowledge, compassion, patience, and creativity to inspire change.  The practitioner must honor the individuality and goals of each person who enters her care. There should be no limitations on their journey or their healing.  She has experience working with clients of all ages and across the spectrum of weight and wellness.  She is available to work with adults, adolescents, families, and parents.

She can be reached at 213-249-2110.

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Psychological assistant providing low cost treatment for eating disorders

I remain committed to the practice of and dissemination of evidence-based treatments. To that end, I am excited to announce that I have added a registered psychological assistant to my practice in Los Angeles:

Liliana Almeida, M.A, Clinical Psychology Ph.D. Student, PSB-94020579

Liliana Almeida, M.A.

Liliana Almeida, M.A.

 

Liliana Almeida, M.A., is a fourth year Clinical Psychology Ph.D. student at the California School of Professional Psychology at Alliant International University in Los Angeles. She received her M.A. from The New School and her B.A. from Rutgers University. During the last 7 years she has researched eating disorders and obesity. Her clinical experience includes working with diverse clients in a community mental health center providing cognitive-behavioral and psychodynamic psychotherapy in English and Spanish.

Liliana will be working under my supervision and is available to work with adult and adolescent clients with eating disorders, anxiety, and depression.  She will provide services in English, Spanish, and Portuguese and will be able to provide some low-cost therapy to those in need.

Portuguese

Eu sou uma assistente de psicologia (PBS-94020579) para Lauren Muhlheim, Psy.D., psicóloga clínica especializada no tratamento cognitivo-comportamental de perturbações alimentares. Como assistente de psicologia, eu forneço psicoterapia cognitivo-compartamental em Português sob a licença da Dra. Muhlheim (PSY 15045) para adolescentes e adultos que sofrem com depressão, ansiedade e pertubações de o comportamento alimentar.

Spanish

Soy una asistente de psicología (PBS-94020579) para Lauren Muhlheim, Psy.D., una psicóloga clínica especializada en el tratamiento cognitivo-conductal de los trastornos alimentarios. Como asistente de psicología yo proveo terapia cognitivo-conductal en Español bajo la supervision y licencia de la Dra. Muhlheim (PSY 15045) para adolescentes y adultos que sufren de la depresión, ansiedad y de los trastornos de la conducta alimentaria.

If you are interested in more information, please visit Liliana’s website or contact me at 323-282-3572 or drmuhlheim@gmail.com or Lilian directly at lilyalmeida85@gmail.com

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