The 23rd annual Renfrew Center Foundation Eating Disorders Conference will begin Friday Nov. 8 and run through Nov. 10 here in Philadelphia.  Diane Girardot, a Chester County based psychotherapist and health care journalist, will blog daily from the conference that this year focuses on complex patients, treatment variations, and the essential role of wisdom within the therapeutic relationship.

Everybody knows eating disorders can kill, but did you know one size does not fit all when it comes to treating them?

Co-occurring conditions like depression or anxiety can erupt into self harm or substance abuse or both creating another layer of distress. And, just short of causing death, disordered eating can promote strokes or seizures that impair the patient and derail standard treatments.  These behavioral and medical complications along with culture, resistance, nutritional barriers, even the onset of unrelated diseases like a cancer can make a seemingly straightforward diagnosis jump the track.

Simply tagging food restricting as Anorexia or binging and purging as Bulimia followed up with a cookie-cutter treatment protocol would not be doing a patient justice, especially within an evolving field of research into eating disorders.  Not that dyed-in-the-wool, evidence-based treatments like Cognitive Behavioral Therapy for Bulimia or Family Based Therapy for Anorexic adolescent teenager girls aren't sound - they certainly are.

But, complex patients crop up frequently and present the most challenges to clinicians, says Judi Goldstein, chair of the Renfrew Center Foundation’s 23rd Annual Eating Disorders Conference slated this weekend in Philadephia.  Goldstein describes the 2013 “training” agenda as an integration of therapies old and new ready to be tailored by clinicians for those clients that confound them.

Goldstein and the staff at the Renfrew Foundation selected the topic of integration because research continues to burst through layer after layer of what we know about eating disordered pathology.  Renfrew itself has 13 treatment locations throughout the United States and many of those are involved in research.  

Innumerable obstacles resulting from a malnourished body muddle treatment and recovery. Medical findings related to the physical aspects of eating disorders will be presented the first day of the conference to put the most dangerous complications such as seizures and heart arrhythmias on the table first and foremost.   A starved brain is equally as devastating and problematic for clinicians. Brain-based research also to be presented Friday will help clinicians craft therapies around deficiencies by helping them understand potential origins as well as responses to the activation of the eating disordered mechanism because of starvation or trauma.

While the empirical can’t be replaced, experiences can’t be ignored.  “What is happening in the field as well as in therapists’ offices,” Goldstein insists, is vital information that when blended produces the best outcomes.

Clinical wisdom itself - which cannot be measured - will be validated at the conference beginning with a keynote presentation by a panel of “master clinicians and scientist-practitioners” who already integrate empirically supported treatments with clinical decisions that sometimes must go beyond the scope of current guidelines.  Gaps exist in treatment models for many eating disorder sufferers including older adults, binge eaters, males, people with varied cultural and ethnic backgrounds, and those who simply do not respond to traditional treatments.  

“Treatment obviously has to be adjusted for the non-compliant patient who has a 10 year history of the disease and has been to five treatment centers,” Goldstein explains. Same for short-term disordered eaters or the self-harming/suicidal patient who is being bullied as part of a fat prejudice culture, she adds. Approaches need to be varied to address each facet of the disorder as it emerges.  Do you focus first on the self-harm, the eating patterns or the bulling? And which approach is best?  
Integrating subtle “experiential” treatment variations like Yoga, symbolic expression through art and dance, spirituality, and even humor to traditional therapies is another option available to clinicians tailoring treatment for their clients.  Several workshops will demonstrate these healing practices aimed at engaging the conscious and unconscious mind for insight and recovery.

As a preemptive type of treatment, Goldstein says Saturday’s keynote speaker, best-selling author Jennifer Weiner, will add her “voice” to the conference as a modern day cultural icon speaking out for women as heroines within their own lives as well as within her best-selling books. Weiner, who grew up in a larger body with a plus size mom in her corner, continues to expose sexism and size-ism via social media and the publishing/television production world creating strong female protagonists who don’t fit into skinny jeans.  

Goldstein says Weiner is known for empowering women to be authentic, recognize their value and potential and not lose themselves in the “be all, do all” culture that influences a woman’s mental health.  “If people suppress themselves, there will be underlying stress and emotion,” Goldstein explains. “Developing courage to speak out can help a young woman be true to herself, increase confidence and strength, and represent herself.”

Just as the illness and treatment are multi-faceted, so is recovery.  Again, one size does not fit all, and conference attendees Sunday will have access to the recovery perspective of clinicians and patients.  Testaments from the mouths of survivors can often nourish hope that has to underly any variation of treatment and recovery no matter what the diagnosis.  

Additional resources for current research/treatment:

The Academy for Eating Disorder <>
National Eating Disorders Association <>
International Association of Eating Disorders <>

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