The idea for a special section on eating disorders in adolescents emerged from the collaborative conversations and enthusiasm for learning that characterized the March 2011 ASAP meeting in New York City: 9-11 to 2011, A 10-year update on Adolescent Psychiatry. The focus of the conference and this special section is on the bridge from research to clinical practice. We stand at a unique moment in time with the treatment of eating pathology. For the first time since the codification of these illnesses in the medical literature (Gull, 1874), the treatment literature has made strides to provide clinicians with a clearer path on the ways to manage these disorders. Nowhere has this advancement been as great as in the treatment of children and adolescents. Fortunately, we stand in a position today to assist our youngest patients make strides toward recovery, even cure.
Despite advances in treatment, the dissemination of these strategies to front-line clinicians and care workers continues to lag behind. Clinicians must flexibly attend to the needs of individual patients and families in a multitude of settings, while a plethora of available treatment options compete for attention. Effective clinical practice rests on the clinician%apos;s desire and ability to seek out support for nascent skills and new learning opportunities. Studies of dissemination and implementation, such as the work of Beidas and Kendall, 2010, outline important questions about how to bring information from research centers to clinicians and about how the training experience and organizational factors impact the implementation of interventions. While the gold standard for evidence- based practice in psychotherapy remains a scientifically evaluated protocol with a treatment manual, training workshop and supervision, it is clear that active learning is essential for clinicians to be able to deliver key interventions and develop the level of competence and skill required to improve outcomes for patients.
Adolescent psychiatrists are uniquely positioned to take a leadership role in implementing effective treatments for patients with eating disorders. Clinical expertise in working with teens and families with comorbid disorders including anxiety, depression, and substance use disorders, combined with a flexible, positive attitude toward taking on challenges in treatment is a natural fit for training in eating disorder treatment protocols. Many clinicians are already familiar with training formats available for cognitive behavior therapy through places such as the Beck Institute, where Dr. Judith Beck uses role-plays and other techniques to promote active learning, and Dr. Aaron Beck demonstrates goal setting and other interventions during a clinical interview, followed by an open format for questions from workshop participants. Treatment manuals, intensive training and regular consultation are elements of an adherent protocol in dialectical behavior therapy. In the treatment of eating disorders, clinicians now have ready access to treatment manuals, workshops and supervision for two main empirically supported treatments: Lock and LeGrange's Family Based Treatment (FBT or “Maudsley” at http://www.Train2Treat4ED.com) and Fairburn's Cognitive Behavior Therapy-Enhanced: (http://www.psychiatry.ox.ac.uk/research/researchunits/credo/ forthcoming-training-workshops).
Learning from mentors and gaining new skills informs not only specific areas of expertise but provides skills that may be generalized and applied across a wide range of disorders and practice settings. Perhaps training is best thought of as a parallel process to the treatment alliance, with bonding (maintaining an atmosphere of mutual positive regard), goals, and steps to achieving goals. Representing one such alliance, we (Drs. Kara Fitzpatrick and Julie Lesser), the two guest editors of this special section on eating disorders, worked together first as supervisor and supervisee in the training program for Family Based therapy for eating disorders. In putting together this special section on eating disorders in adolescents, the ingredients were in place for a synthesis and collaboration that spans disciplines, institutions, health care settings and generations. The aim was to bring together articles that inform the treatment of eating disorders from various perspectives, building upon current knowledge and interpreting well-known techniques in the treatment of eating disorder symptoms. The broad clinical utility of these skills are presented with a goal of encouraging clinicians to consider the significant rewards of working with eating disorder patients and their families.
Fitzpatrick leads the section with an overview of FBT for children and adolescents with eating disorders. She gives an update on the clinical outcomes and research findings with this approach. In the paper, she outlines the forms of family based treatment and key interventions. Strategies to help empower families in refeeding while learning to separate the eating disorder thinking and illness from the child are described. Family based treatment has been successfully implemented in younger patients and in eating disorders with comorbid conditions. Despite the empirical support for the approach, there is still a shortage of trained clinicians.
In the second paper, Dr. Beth Brandenburg and colleagues discuss the approach to psychopharmacological interventions in adolescents with eating disorders, an area where the research findings are sparse. The adolescent psychiatrist must draw upon clinical expertise in treatments for adults and adolescents with comorbid disorders. Special attention is directed to coordinating care with a primary medical physician, and other members of a multidisciplinary team. The paper presents guidelines for monitoring medications, the medical and safety status, and nutritional needs of the patient. The authors discuss the treatment targets, and potential side effects, risks and benefits of psychotropic medications in this population. Medication use is integrated with the primary psychotherapy treatment, with a careful eye on maintaining the treatment alliance, and knowing when to recommend a higher level of care.....