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Soma Self/Eating Disorders Program

Eating Disorders/Soma Self IOP

Soma Self/Eating Disorder Services at Yellowbrick with Ilene Wynn, RD, LDN

Level 1: The Assessment

Patients seeking treatment within the Eating Disorder Service are seen in consultation by a team of senior clinicians. For all emerging adults Yellowbrick staff conducts a collateral family evaluation. A baseline nutritional assessment is established by Registered Dietician Ilene Wynn RD, LD. A comprehensive psychiatric evaluation is completed by Yellowbrick’s Staff Psychiatrist David Baron, MD. Consultation with the patient’s family physician and previous therapist is included. Previous testing and medical records are reviewed as available and psychological testing is performed as indicated. Patients are required to participate in written assessments evaluating their eating disorder, psychiatric and substance abuse difficulties. Daily journal logs of nutrition, activity and emotional experiences are integrated into the evaluation.

The Assessment Team, co-chaired by Jesse Viner MD and Laura Viner PhD, reviews and integrates the assessments and arrives at a diagnosis and treatment recommendations. These are discussed in a conference involving senior Yellowbrick staff, expert consultants as needed, the patient, and parents/spouse as indicated. Eating disorder, psychiatric, and substance abuse diagnoses are presented along with an individualized treatment plan often combining multiple services.

Patients who are persistently unable to sustain supported meals for which family support is either not available or not indicated are referred to Evanston North Shore University Health System Eating Disorder Center. Patients, who are medically at risk, in severe denial, chaotically dysregulated, addicted to laxatives, or without adequate social/family support are referred to supported apartment treatment centers with follow-up by Yellowbrick upon discharge.

Level 2: Medical and Nutritional Stabilization

An initial evaluation includes a physical exam, complete blood count and chemistries/electrolytes, thyroid profile, hormone levels, lipid profile, urine analysis, toxicology screen, and bone density scan. Patients who have ceased menstruating and/or demonstrate bone density loss are encouraged to begin calcium and hormone replacement. Patients who have reported vomiting blood are referred for endoscopy. Patients who vomit regularly are referred for dental evaluation.

Recovery is most often enhanced when patients journal their nutrition, activity, and emotions. This assists the internalization of mindful connectedness and centering. These are reviewed individually within consultations with the dietitian, and with peers in the Goals and Strategies Dinner Group. Patients are weighed weekly. Weight restoration is defined as 95% of individually determined maintenance weight, as this also is associated with greater enduring recovery as well as improved fertility.

Weight restoration is achieved by collaboratively creating a stable structure for eating, broadening choices for comprehensive constituent nutrients, and increasing calories in a challenging but not traumatic experience that builds confidence. Activity plans are formulated and strategies for tolerating disruptive experiences are developed.

Yellowbrick Eating Disorder staff and the patient will determine both goals and the pace to reach them, including minimum weight thresholds. The course of each patient and the functioning of the peer group within the Eating Disorder Service are followed in Clinical Rounds on a bi-weekly basis. Inability to meet goals and/or trespassing thresholds will trigger a conference within which alternative treatment strategies including referral will be considered. Weight restoration is considered a required yet insufficient component of an enduring recovery. Since lowered weight and nutrition impairs brain function and stimulates anxiety, insomnia, and mood instability, weight restoration to a minimum of a BMI of 18.5 is seen as a priority early goal in treatment.

Level 3: Stabilization of Behavioral Problem

Persistence of behaviors such as restricting nutrition, food avoidance, feeding others, bingeing, vomiting, compulsive exercise, use of laxatives, diuretics and stimulants, social isolation, and deception all contribute to sustaining the eating disorder illness. Research demonstrates the continuation of these behaviors is correlated with a poorer prognosis. The behavioral analysis attempts to identify which behaviors are central to the life of the eating disorder, with the subsequent negotiation of evolving different modes of adaptation which includes modifying existing patterns as well as introducing new strategies that compensate for the functions and satisfactions lost as the eating disorder behaviors are minimized. Yellowbrick’s staff collaborates in groups to develop ED relapse prevention plans with all group members and these are followed up weekly with Ilene Wynn RD.

Level 4: Psychological Treatment & Support

Eating disorders represent a maladaptive effort to cope with a troubled emotional life. Each individual’s troubles have roots and evolve from their unique genetic, biological, familial, and personal contributions. Individual, family, and group psychotherapies within the context of a supportive recovering community offer a safe, secure and affirming environment within which there is an opportunity for personal reflection, exploration, struggle, and growth. Due to the entrenched, often chronic, presentation of an eating disorder, it is frequently necessary to provide intensive psychotherapy several times a week in multiple formats. Identification of core struggles and the assistance Yellowbrick provides enables patients to live through and beyond their struggles, bringing the deepest assurance of recovery, relapse prevention, and the fulfillment of authentic personal ambitions and desires.

Family treatment is often necessary and helpful to address complications to the family of the eating disorder, support recovery, and prevent relapse through addressing troubled family relationships, which interferes with facilitating emerging adult development.

 

Soma Self/Eating Disorder Services at Yellowbrick with Ilene Wynn, RD, LDN

 

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Yellowbrick collaborates with adolescents and emerging adults, ages 16-30's, their families and participating professionals toward the development and implementation of a strategic “Life Plan.” An integrative, multi-specialty consultation clarifies strengths, limitations, and risks, and defines motivations, goals and choices.

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