What is an Eating Disorder
An eating disorder is a brain-based biological disorder. Meaning…it is not a choice. You didn’t raise your hand and say “sign me up for this”. Instead, a combination of genetic, social, cultural, and temperament vulnerabilities impacted the presentation of eating disorder symptoms or behaviors. There are many types of eating disorders – they all have a similar thread in that it is an abnormal relationship with food and/or the body. Some people with eating disorders have challenges with textures of foods, calorie content, or the type of food – while others may also struggle with their relationship with their body and feel as if what they see is significantly more ugly, fatter, bigger, or more unattractive than what others see. Some people struggle with their relationship with exercise or have perfectionistic characteristics. In essence, no two eating disorders are alike!
It is important when determining what type of eating disorder you or your loved one may have that they are evaluated by a doctor or therapist with experience in treating eating disorders. Unfortunately, many providers are not trained in eating disorders, and that can be dangerous for patients. It can delay diagnosis, increase the cost of treatment, delay vital and necessary treatment, and potentially provide contraindicatory information or harmful recommendations. Additionally, eating disorders are the second most deadly mental health issue (behind substance abuse), so it is imperative to get the expert care you need ASAP!
Medical Complications of Eating Disorders
Eating disorders are a complex mental and medical illness. There can be an abundance of co-occurring medical issues that can be present in mild to severe eating disorders. Some of those medical illnesses are hair loss, delayed growth, gastrointestinal issues (very common), low blood pressure, dizziness, hypothermia, poor concentration, cardiac symptoms, bone loss, fertility issues, fluid and cholesterol imbalances, dental problems, throat and esophageal problems, kidney and pancreatic problems, menstrual issues, etc. Whew! That’s a long list…and it’s not even complete. While those are some of the most common medical illnesses associated with eating disorders, there are even more that are not listed. Hopefully this gives some perspective on why it is important to find a provider that is experienced in treating eating disorders!
Treatment Team Approach
Eating disorders require a treatment team approach. This is similar to other medical problems such as cancer, where you would meet with an oncologist, neurologist, plastic surgeon, physical therapist, psychologist, psychiatrist, support group, family members, etc. As they say…”It takes a village”. The same is true for eating disorder recovery to be effective. Typical treatment teams consist of a primary therapist or psychologist, a registered dietitian, a psychiatrist, and a physician. Each team member has a specific role. The therapist or psychologist assists the patient in developing different strategies or coping skills to battle the eating disorder to reduce maladaptive or harmful behaviors. The registered dietitian works with the client with meal planning, food exposures, and proper education and nourishment for the brain and body. The psychiatrist helps more effectively treat underlying mental health issues such as depression and anxiety. And the physician monitors vitals and any other comorbid medical issues.
It is important that each provider on the treatment team is knowledgeable about eating disorders and works in an integrated manner with the team.
Types of Treatments for Eating Disorders
Treatment for an eating disorder needs to be individualized and specific to that particular client. Below are some of the types of treatments I tend to use with clients, which vary depending on their presentation or therapeutic goals.
- Cognitive Behavioral Therapy (CBT) – CBT works to supply clients with coping skills and cognitive strategies for changing the way they think and behave. It is a structured, skill-based treatment that works to improve social, cognitive, physical, emotional, and relaxation skills.
- Exposure Response Prevention (ERP) – ERP works by gradually introducing a feared stimuli. For example – if you’re scared of eating a cookie then we gradually introduce other foods that seek to eliminate the fear response.
- Radically Open Dialectical Behavior Therapy (RO-DBT) – RO-DBT is an evidence-based treatment for disorders of over-control, including anorexia nervosa, anxiety, depression, obsessive-compulsive personality disorder, autism, and maladaptive perfectionism. It works by targeting social signaling behaviors in an effort to increase flexibility, openness, and connection with others – areas that people with eating disorders often struggle with.
- Interpersonal Psychotherapy (IP) – IP examines mental health from a relational perspective by examining communication patterns, friendships, family history, and close personal relationships to identify patterns and areas of needed growth and development.
Other types of treatment include Mindfulness, Dialectical Behavior Therapy, Art Therapy, Body-Based or Movement Therapy – all of which can be included in an individualized treatment plan.
Levels of Care
There are five levels of care when it comes to the treatment of eating disorders. Treatment recommendations are often made based on the severity of physical and mental symptoms. It is common for clients with eating disorders to need a “higher level of care” – this section will help you understand what that means.
- Inpatient Hospitalization – This is the highest level of care for eating disorders. Inpatient is for clients who are medically unstable – meaning their vital signs are cause for such concern that they need to be monitored in a hospital. If your loved one is in inpatient hospitalization it is likely that they have a severe eating disorder and they will need intensive and ongoing treatment once discharged in order to fully recover.
- Residential – Residential treatment consists of living at a treatment facility 24 hours per day. There is typically a schedule or structure to the day such as morning vitals, breakfast, group, snack, individual therapy, lunch, school/relaxation, group, snack, group, dinner, evening group. Groups consist of support group, skills group, process group, art therapy, nutrition therapy, meal planning, outings, equine therapy, yoga, etc. Each treatment center has different amenities.
- Partial Hospitalization Program (PHP) – more recently referred to as Day Treatment – This has a similar schedule to school or work – such as treatment from 9-5pm. Think of all the benefits of residential treatment, but you sleep at home at night instead of at the treatment center.
- Intensive Outpatient Program (IOP) – IOP is typically 3-5 hours of therapy and meal support 3-7 days per week. Structure typically has a group, meal, then another group.
- Outpatient Treatment – This is the lowest level of care for patients with eating disorders. It involves seeing your treatment team anywhere from 1-2x per week to 1x per month – again, depending on the level of need of the patient.
Eating Disorder Support Groups for Patients
The Tampa Bay area has two current support groups for people with eating disorders:
- The Alliance For Eating Disorder Awareness: Bayshore Presbyterian Church 2515 Bayshore Blvd. Tampa,FL 33629: Every Monday from 7-8:30pm, cost: free, Ages: 18+, gender-inclusive. Led by two eating disorder therapists.
- Center For Discovery: 2111 W Swann Avenue, Suite 202, Tampa, FL 33606: Every Thursday from 7-8pm, cost: free, all ages, gender-inclusive. Led by two eating disorder therapists.
Support Groups for Parents & Loved Ones
There is also an eating disorder support group for parents and loved ones seeking more information, support, or guidance on how to help their loved one.
- The Alliance for Eating Disorder Awareness: Woodlawn Presbyterian Church, 2612 12th Street North, St. Pete, FL 33704, Wednesdays 7-8:30pm, cost: free. Led by two eating disorders therapists and a mom whose daughter recovered from an eating disorder. The entrance is on the west side of the church, side door.
Treatment Centers In Tampa Bay
Navigating the world of eating disorders can be confusing and overwhelming. Thankfully there are multiple treatment centers in Tampa Bay that help clients with their eating disorder treatment. In this section, I will specifically discuss those centers with IOP, PHP, or residential treatment options.
Center For Discovery: Located in South Tampa, Center for Discovery has PHP and IOP treatment options for children (as young as 10 years old), adolescents and adults. Center for Discovery treats all types of eating disorders. They are a great general eating disorder program, meaning they cover everything from body image, to balanced exercise, nutrition, medications, family therapy, and weight restoration. They are also skilled at treating comorbid conditions such as anxiety, depression, bipolar disorder, personality disorders, and trauma.
Rogers Behavioral Health: Rogers Behavioral Health is also located in south Tampa. They have eating disorder PHP and IOP programs for children, adolescents, and adults struggling with eating disorders. I find their program is particularly skilled at working with clients with high anxiety, OCD, or ritualistic or compulsive behaviors related to their eating disorder. These behaviors include counting, measuring, tracking, obsessing, etc.
Fairwinds Treatment Center: Fairwinds is the only residential treatment center for children, adolescents, and adults with eating disorders in Tampa Bay. The residential program and PHP programs are both located in Clearwater, and their IOP program is located in Tampa. They specialize in treating complex eating disorder cases, hard to treat cases, and chronic cases, as well as patients with co-occurring eating disorder and substance use disorders.
If you are looking for a treatment center outside Tampa Bay, please contact the Alliance For Eating Disorder Awareness – a nonprofit that provides support, education, and information. Visit www.findEDhelp.com or call them at (866) 662-1235.
Eating Disorder Treatment Team Experts in Tampa Bay
Forming an outpatient eating disorder treatment team can be challenging. It is important to work with clinicians and providers that are skilled in both the medical and mental health aspects of the disease. Here are some helpful resources in Tampa Bay:
|Location||ED Therapists||ED Dietitians||ED Psychiatrists||ED Physicians|
|St. Pete||Samantha Winton, Ph.D., CEDS||Jacquelyn Supplee, MPH, CEDRD, RDN, LD/N, ATC||Jacqueline Hubbard, M.D., ABPN||Jasmine Reese, MD|
|Beatriz Mann, Ph.D.||Brenna Denhardt, RD, LD/N||Beth Tumarkin, MD|
|Samantha Turetsky, Psy.D.|
|Jenna Elwart, Psy.D.|
|Pinellas Park||Melissa Marciano, LMHC, NCC|
|Largo||Heather Pugh, LMHC, SAP, CAP|
|Pamela Paul, NCC, LMHC, CFT, RRCA, CFT, DSc|
|Clearwater||Mari Broome, MSW, LCSW, RYT-200, RCY3, CST||Kourtney Gordon, MS, RD, LD/N, CEDRD|
|Deborah Day, MA, LMHC, NCC, CP|
|Suzan Alexander, MSW, LCSW|
|Tampa||Susan Mullins, LMHC, TEP, CEDS||Kristie Salzer, MS, RDN, LDN||Jillian Glass, MD||Amy L. Weiss, MD, MPH|
|Krista Miles, LMHC, E-RYT||Michelle M. Albers, PHD, RD||Megan Toufexis, DO||Brian Knox, MD|
|Heidi Petracco, MSW, LCSW, BCD, Certified RO-DBT Senior Clinician and Trainer||Pauline Powers, MD||Denise Edwards, MD|
|Andrea Friedman, PHD|
|Mario Rodriguez, PHD|
|Perry Kaly, PHD|
|Karen Milo, PHD|
|Kristi Weiner, PHD, PA|
|Sarasota||Diane A. McKay, PSYD|
|Karen R. Koenig, LCSW, MEd|
|Courtney Davenport, LCSW|
|Isa Van Helden, LMHC|
|Andrea Verier, MA, MS, LMHC|
|Trinity||Joy Davis, LCSW, CEDS||Christina Oiler, MEd, RDN, CEDRD, LD/N|
|Madeline Altabe, PHD|
|Patricia Casanas, LMHC|
|Wesley Chapel||Cindy Floyd, PSYD|
|Jeneva Barber, MA, LMHC, CCTP|
Contact information for each provider may be found on www.findEDhelp.com
Integrated Care Clinic’s Approach
At Integrated Care Clinic we provide specialized eating disorder care to clients of all ages. We have multiple treatment providers that work with clients with eating disorders. Let’s take a look at our team:
Samantha Winton, Ph.D., CEDS – As a licensed psychologist and certified eating disorder specialist, Dr. Winton nearly exclusively treats eating disorders, body image concerns, and food-related anxiety. She has been working in the field of eating disorders and body image since 2006. Dr. Winton has worked in all levels of care from inpatient hospitalization to outpatient. She completed her residency at Stanford University in California where she received training on Family Based Treatment (FBT), and has subsequently completed an advanced FBT intensive workshop. Dr. Winton has recently begun the process of becoming a certified Radically Open – Dialectical Behavior Therapist (RO-DBT), the only evidence-based treatment for adults with anorexia nervosa.
Beatriz Mann, Ph.D. – Dr. Mann is a licensed psychologist who specializes in working with eating disorder clients of all ages, however is particularly skilled at working with young people, including high school students, college students, and transgender individuals. Dr. Mann is in the process of becoming certified in Trauma-Focused Cognitive Behavioral Therapy (TF-CBT). She also wrote her doctoral dissertation on the impact of childhood maltreatment and the brain. Her experience in trauma, neurology, and eating disorders make her a unique fit for patients with simple or complex trauma histories. She has also begun the process of becoming a Radically Open Dialectical Behavior Therapist (RO-DBT) and co-leads the RO-DBT Skills Class with Dr. Winton.
Samantha Turetsky, Psy.D. – Dr. Turetsky is a postdoctoral fellow under the supervision of Dr. Samantha Winton. Dr. Turetsky carries a caseload of approximately 5-10 eating disorder clients. Dr. Turetsky is a Cognitive Behavioral Therapist (CBT) and is skilled at working with clients with eating disorders that have very high anxiety. Social anxiety, OCD, and generalized anxiety are all common comorbid conditions with patients with eating disorders and Dr. Turetsky’s expertise in CBT allows her clients to obtain skills quickly to decrease their eating disorder behaviors so they may live life more authentically with less panic, stress, and compulsive behaviors.
Rebecca Crecraft, Psy.D. – Dr. Crecraft is a postdoctoral fellow under the supervision of Dr. Samantha Winton. Dr. Crecraft is a more psychodynamically informed therapist and utilizes Interpersonal Psychotherapy (IP) to decrease eating disorder behaviors by focusing on the relational aspects of the disease. She works with adults and also has extensive experience in treating trauma cases, specifically sexual trauma. Dr. Crecraft completed her doctoral dissertation on college sexual assaults and developed materials to train providers on how to appropriately treat survivors.
Kimberly Hubinger, Psy.D. – Dr. Hubinger is a postdoctoral fellow under the supervision of Dr. Samantha Winton. Dr. Hubinger completed her doctoral dissertation on the treatment of eating disorders using mindfulness approaches, tools, and techniques. Dr. Hubinger’s approach to eating disorder treatment involves integrating the mind and body. Often clients who struggle with eating disorders become disconnected from the feelings and sensations of their body. Dr. Hubinger seeks to reconnect those two through mindfulness approaches, intuitive eating, and balanced authentic living.
Jacqui Supplee, MPH, CEDRD, RDN, LD/N, ATC – Jacqui is a registered dietitian nutritionist and certified eating disorder registered dietitian. She works with clients of all ages with eating disorders and is particularly skilled at helping clients with high comorbid mental health issues including anxiety, autism, OCD, depression, or substance use. She splits her time between Integrated Care Clinic and Center For Discovery as East Coast Supervisor of Outpatient Dietary Services. She has worked in residential eating disorder treatment centers, PHP, IOP, and sees patients on an outpatient basis at Integrated Care Clinic.
Brenna Denhardt, RD, LD/N – Brenna is a registered dietitian nutritionist and works with all ages of eating disorders. Brenna splits her time between Integrated Care Clinic and Johns Hopkins All Children’s Hospital as one of the inpatient eating disorder dietitians as well as working with Dr. Jasmine Reese’s outpatient eating disorder clinic. Brenna’s training lends herself to be a good fit for children, adolescents, and college students with moderate to severe eating disorders. She also works with clients who struggle with complex medical conditions that affect their nutrition such as cancer, diabetes, or renal disease.
The most important part of eating disorder treatment is starting the process, and being willing to call a provider or go to treatment. It is possible to completely recover from an eating disorder, and having a treatment team to support you or the recovery of your loved one is vital to their survival. Think of an eating disorder like cancer – it is a disease that has taken over and needs specialized, intensive treatment to be able to be cured.
I treat eating disorders because I have a passion for helping people live life authentically in a connected way with others. Eating disorders, anxiety, depression and other mental health issues seek to separate us from others – due to stigma, the disease itself, or additional factors that impact our cognitions, actions, and emotions.
Please know that there is help out there and you or your loved one can recover. If you have more questions or would like a complimentary 15-minute consultation, please give us a call!