Development and Use of an Eating Disorder Assessment and Treatment Protocol

Abstract

Counseling centers have been challenged to effectively treat the growing number of college students who struggle with disordered eating. In response to this critical issue, the authors have developed an Eating Disorder Assessment and Treatment Protocol (EDATP) to assist clinical disposition in the counseling center setting and identify treatment guidelines within a coordinated care approach. Practical applications of the EDATP and future research that can assess its clinical utility are addressed. Counseling centers have been challenged to effectively treat the growing number of students on university campuses who struggle with disordered eating. Among female adolescents ages 15-19, the age group representing high school into early college years, eating disorders have become the third most common form of chronic illness (Reijonen, Pratt, Patel, & Greydanus, 2003). In addition, several surveys (e.g., Gallagher, Golin, & Kelleher, 1992; Miller & Rice, 1993; Schwitzer, Berghold, Dore, & Salimi, 1998) have noted the high incidence of eating disorders and eating-related problems on campus. This subgroup of college students who present with severe disordered eating deserves special consideration, especially given the interaction between the college experience and the developmental nature of many eating disorders (e.g., Barth, 2003; Klein & Walsh, 2003). Challenges related to negotiating increased autonomy along with the stressful demands of college life can precipitate disordered eating behaviors. Eating disorders have a high comorbidity with other serious concerns, such as child sexual abuse and substance abuse (KashubeckWest & Mintz, 2001), complicating initial presentation, diagnosis, and treatment. For example, clients with disordered eating often present initially with other concerns, admitting and exploring the full extent of their caring issues only after a trusting relationship is established. In their review of eating disorders, Klein and Walsh (2003) defined anorexia nervosa (AN) and bulimia nervosa (BN) as the most widely recognized eating disorders and acknowledged the more recently identified phenomenon of binge caring disorder (BED). These patterns of eating behaviors, in addition to eating disorder not otherwise specified (EDNOS), are the primary diagnostic categories for disordered eating found in the latest edition of the Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.; DSM-IV-TR; American Psychiatric Association [APA], 2000). The DSM-IV-TR identifies the core feature of AN as the refusal to maintain a minimally normal body weight combined with an intense fear of gaining weight or becoming fat. It is estimated that the lifetime prevalence of AN among American women is 0.5%. AN typically develops during adolescence or young adulthood and rarely develops prior to puberty. BN is characterized by recurrent episodes of binge eating, combined with compensatory behaviors such as vomiting or overexercise. The lifetime prevalence for BN has been estimated at 1%-3% of women in the United States. BN also typically develops during late adolescence or early adulthood, often following episodes of dieting (Klein & Walsh, 2003). EDNOS refers to disorders of eating that fail to meet the criteria for AN or BN, such as meeting the weight loss requirements for AN but continuing to menstruate or lower frequency periods of binge eating and inappropriate compensatory behaviors than is found with BN. BED, identified by the DSM-IV-TR as a provisional diagnosis in need of further study, represents episodes of binge eating without compensatory behaviors. Given the seriousness and prevalence of these forms of disordered eating, the University of Utah Counseling Center (UCC) formed the Eating Disorder Assessment and Treatment Team (EDATT). The mission of the EDATT was to clarify and improve clinical services for eating disordered clients and to provide a structure for data gathering and decision making related to whom the counseling center can serve and under what conditions. …