Unit 7: Eating Disorders (AOTA)

Question 1

As an occupational therapist, you may work with people who have mental health conditions in…

Answer 1

Any setting.

• You do not necessarily need to work in a psychiatric unit in order to work with people who have mental health conditions.
• We may directly or indirectly intervene in the area of mental health to improve occupational functioning, where the mental health condition is the primary or secondary diagnosis for which we were ordered

Question 2

As an occupational therapist, you will need to recognize…

Answer 2

The signs and symptoms of mental health conditions in your clients and know how to work with them appropriately.
-At times we may be the first professionals to recognize that one of our clients has a mental health condition that was previously undiagnosed.

Question 3

Occupational therapists may work with people who have mental health disorders in order to:

Answer 3

• Help develop skills
• Establish positive habits and routines
• Set appropriate goals
• Use cognitive behavioral techniques to improve functioning
• Address underlying physiological influences that are impacting performance
• Work on self-regulation strategies
• Develop appropriate social skills
• Address coping skills
• Teach stress reduction techniques
• Alter the context and environment to support participation
• Reduce seclusion and increase inclusion-appropriate activities

Question 4

Eating Disorders

Answer 4

Persistent disturbance of eating or eating-related behaviors, such as insufficient or excessive food consumption, resulting in physical impairment and psychological dysfunction

Question 5

Multidisciplinary Approach for Eating Disorders

Answer 5

OT’s can add greater depth and understanding of the functional performance of an individual with an ED, thereby identifying and addressing that person’s desired meaningful occupations, in contrast to the often unhealthy occupations, rituals, and values that have become central to that person’s perception of the world

• The vast understanding of person, environment, occupation, and performance establishes occupational therapy practitioners’ crucial role as members of the treatment team by supporting individuals in re-establishing meaningful roles, partaking in ADL and IADL tasks, fully engaging in social situations, and developing or re-asserting their desired identity.
• OT at John Hopkins created a program for patients addressing ADL and IADL needs

Question 6

Occupational Therapy Intervention Impact on Eating Disorders

Answer 6

As a result of occupational therapy’s broad scope of practice, coupled with the extensive effect of an ED on one’s life, occupational therapy intervention can help such clients in many ways
-One must consider the setting where therapeutic intervention occurs—as well as the other disciplines present and providing interventions—before establishing the primary occupational therapy goals.

Question 7

Acute occupational therapy treatment must prioritize the following equally important considerations, with the order in which they are addressed directly dependent on what is perceived as most meaningful to the client:

Answer 7

• Appropriate eating behaviors
• Client factors specifically related to triggers to engaging in ED behavior, warning signs of relapse, and positive coping strategies
• Balanced occupational engagement
• Desired role performance, in contrast to illness role performance
• Emotional regulation
• Self-esteem
• Environmental and contextual implications
• Impaired functional cognition related to malnutrition
• Performance patterns
• Interpersonal skills
• Overall health management

Question 8

Once medically stable, an individual with an ED would benefit from…

Answer 8

Additional occupational therapy intervention further addressing these factors as well as highlighting IADL performance deficits, such as planning menus, shopping for groceries and clothes, preparing and cleaning up after meals, and going out to a restaurant.

Question 9

Providing individuals with EDs the opportunity to engage in ADLs and IADLs in a non-disordered way before returning to their natural environment can…

Answer 9

Promote recovery, address environmental and contextual factors, identify relapse warning signs, and improve overall quality of life

Question 10

What is the relapse rate for individuals with eating disorders?

Answer 10

• Estimated to be between 30% and 50% and is greatly affected by whether the person was able to recover to an appropriate body mass index
• Individuals who initially were diagnosed with anorexia nervosa–restricting type are more than 50% likely to transition to anorexia nervosa–purging type or bulimia nervosa

Question 11

Statistics on recovery for Eating Disorders

Answer 11

• Controversial and vastly depend on the individual’s motivation to change, as ambivalence is a significant characteristic of EDs.
• Anorexia nervosa range from 20% to 70% and require an average of 57 to 79 months (a notably extensive period of time to commit to recovery for someone who is ambivalent about changing their behavior)
• Estimated for bulimia nervosa are slightly higher, at 50% to 70%, again affected by individual factors

Question 12

What psychiatric illness has the highest mortality rate?

Answer 12

• Eating Disorders (estimated to be at minimum 5% but significantly increases the longer an individual lives with an ED)
• Rates for individuals struggling with an ED for 20 years is 20%, and this number increases by 5% to 10% for each additional decade. Given the lethality associated with EDs
• Providing individuals with a holistic, multidisciplinary team addressing all aspects of their lives offers them an opportunity to better manage their health as well as successfully reintegrate into the community.

Question 13

Johns Hopkins Eating Disorder Program

Answer 13

• Developed through an analysis of evidence-based practice in conjunction with continual research seeking to identify the best treatments for maintained recovery
• Centralized around a protocol that is “behaviorally-based, lenient and staged, designed to achieve rapid weight restoration and to normalize eating behaviors and cognitions in patients with eating disorders”

Question 14

Specific occupational therapy interventions for Eating Disorders

Answer 14

Promote quality of life, community reintegration, balanced occupational engagement, and health management for this population target appropriate eating behaviors, improved role performance, self-esteem, emotional regulation, interpersonal skills, functional cognition, and performance patterns (ex. habits, rituals, routines)
Ex. meal planning, meal preparation, restaurant outings, and grocery shopping.

Question 15

Individual and Group Sessions (John Hopkins OT program for ED’s)

Answer 15

• Provided on acute inpatient unit through weekday group session as one on one session to address specific client needs
• Weekday group sessions address topics including but not limited to client factors (ex. values, beliefs, mental functions); interpersonal skills; environmental/contextual factors; and performance patterns (ex. habits, routines, rituals, roles
• Clients also have weekly meal planning and prepping activities to address appropriate eating behavior and ADL/IADL performance

Question 16

Special Features of Program (John Hopkins OT program for ED’s)

Answer 16

Clothing Shopping: Promote self-efficacy, self-esteem, and body image, and to reduce anxiety related to eating and/or social settings

• Program gradually provides them with opportunities to practice learned skills with decreased supervision from staff
• After 2 successful tray checks, clients are given a meal “off” to independently prepare and eat meals
• Serves as a stepping stone towards full days off

Question 17

Models that Support John Hopkins OT program for ED’s

Answer 17

Model of Human Occupation (MOHO), the Canadian Model of Occupational Performance (CMOP), the Person–Environment–Occupation (PEO) Model, the Person–Environmental–Occupational–Performance (PEOP) Model, and the Ecology of Human Performance (EHP) Model.
-Using MOHO as a framework for treating individuals with ED has been highlighted throughout the literature

Question 18

MOHO for ED

Answer 18

Crucial to analyzing the treatment of eating disordered behavior (i.e., activity). The occupation(s) involved must be assessed to address problem behavior, the motivations behind it, and the cyclical nature involved.

Question 19

CMOP for ED

Answer 19

Further evidenced by its wide presence within mental health literature

• The CMOP’s contributions when discussing the “interdependence between a person, environment, and occupations”
• Notably, the OTs at Hopkins regularly implement the Canadian Occupational Performance Measure the CMOP’s assessment tool during initial evaluation to best address each client’s subjective meaningful occupations and evaluate illness insight.

Question 20

PEO, PEOP, EHP for ED

Answer 20

Facilitate this examination of the interactions between a person, their environment, the desired occupation, and quality of performance.

• One’s behavior cannot be assessed apart from consideration of the occupation, personal factors, and environmental contexts
• Therefore, all these models provide additional support to occupational therapy’s role in treating EDs.

Question 21

PEO Model for ED

Answer 21

• Assumes that the relationship between occupational performance, person, occupation, and environment is dynamic and interlinked
• This concept is especially crucial when treating an individual with an ED secondary to the altered perspectives affected by their figured world
• Figured worlds affect one’s personal identity through an “interpretive lens by which life is perceived [and] realized through the interaction of objects, rituals, traditions, and occupational and interpersonal roles of members”
• Therefore, while portioning out a meal for an individual without an ED might be a task completed automatically and without much thought, this action may involve a strict pattern of rituals, specific utensils, and inner drive to push oneself to have even less food on the plate than with previous meals for a person with an ED.

Question 22

PEOP for ED

Answer 22

Highlights not only the interdependence between occupation and performance, but also the consequential effect on a person’s life roles

• This relationship is part of what makes it so critical for occupational therapy to be involved in treating ED, as the disordered behavior(s) has a direct effect on that person’s life roles.
• Occupational therapy is distinctly qualified to address this dynamic relationship between role performance and occupational engagement.

Question 23

EHP for ED

Answer 23

Similar to the PEO and PEOP models in concept, it also provides guidance for five specific intervention strategies not addressed in the PEO and PEOP models.

• These interventions were designed to address the environmental effect on occupational performance: establish/restore, adapt/modify, alter, prevent, and create
• Establish/restore interventions, often used when treating individuals with EDs, include establishing appropriate eating behaviors, normalizing eating in social settings, and teaching individuals how to portion appropriate serving sizes and use various cooking/baking equipment.

Question 24

Adapt/modify Interventions for ED

Answer 24

Commonly used; however, rather than changing the task (i.e., eating), the environment is addressed.

• For instance, the social/cultural environment surrounding the food situation can be altered to promote social support, task completion, and appropriate eating behavior.
• Specific examples reflecting social and cultural environmental interventions are eating with supportive friends and family, and setting a specific time for meals to occur.

Question 25

Prevention interventions for ED

Answer 25

Crucial aspects of occupational therapy treatment when working with individuals who have an ED because of the high relapse rate as well as the necessity of breaking the disordered behavioral cycle.
-The EHP views prevention interventions as strategies for “chang[ing] the course of events when a negative outcome is predicted” or in this case, an eating disordered behavior.

Question 26

The relationship between EDs and rituals, habits, and routines provides…

Answer 26

The perfect avenue for identifying risk situations and potential responses, thereby giving clients an opportunity to problem-solve alternative, nurturing responses to the situation before exposure.
For example, it might be advantageous for an individual to create a menu plan before going on a restaurant outing to decrease anxiety related to eating in a social setting and ensure that they select a meal that supports their nutritional needs.