16216 Baxter Rd., Ste. 205 Chesterfield, MO 63017 Fall 2011 For more information, call (636) 532-9188 or www.slbmi.com Volume 5 Issue 2 Letter from the Director Laura Huff, Ph.D. Treating Clients with Perfectionism By Patrice Ryan, PhD Please join us in our new office suite for a presentation: Medical Aspects of Eating Disorders for Adolescents Friday, December 2, 2011, 4 to 5 p.m. by our colleague Dianne S. Elfenbein, MD Professor of Pediatrics and Director of Adolescent Medicine, Cardinal Glennon Children's Medical Center at St. Louis Behavioral Medicine Institute at 16216 Baxter Road, Suite 205, Chesterfield, MO 63017 (An informal CEU certificate will be provided.) Space is limited for this presentation. Please register by e-mailing [email protected] or calling (636)532-9188. Refreshments will be provided after the presentation. Anxiety shares a high comorbidity with eating disorders, second only to mood disorders. When present, anxiety disorders are associated with increase in severity of eating disorder behaviors, overall lower adaptive functioning, poorer social functioning, treatment resistance, and suicide risk. Anxiety can complicate the recovery from an eating disorder and visa versa. Anxiety disorders are frequently reported to have developed prior to the eating disorder and will Laura M. Huff, Ph.D. likely persist and worsen upon onset of an Director of the Eating Disorders eating disorder. Therefore, effective treatand Autism Programs ment requires attention to both disorders. The beginning of the school year, with all the associated stressors, can elicit both anxiety and eating disorder symptoms. Perfectionism is a personality trait seen in both clinical populations, which rears its ugly head when students who are competitive in academics and sports shift into high gear. Adaptive behavior can turn pathological when rigid, extreme and unrelenting high standards for perfection are self-imposed. The relentless pursuit of thinness may be initiated when a goal weight is set by a person with perfectionism, which then becomes an unattainable moving target. This pursuit and the concomitant effects of semi-starvation that may accompany aggressive diet behaviors place students on a lethal race track. In this newsletter, Patrice Ryan, Ph.D., will discuss recommendations for working with perfectionism within eating disorder treatment. Dr. Ryan works with both eating and anxiety disorders and leads a focused group for anxiety, which further addresses such issues as perfectionism and anxiety that may interfere with recovery in some clients. We also feature the Institute’s Anxiety Disorder Center on page 3. Our Eating Disorder program greatly benefits from collaboration with our specialized team of anxiety disorder experts. The difference between striving for a personal level of excellence, which is at least attainable, and striving for perfection, which is unattainable can be the difPatrice Ryan, Ph.D. ference between healthy competition and life threatening behaviors in the eating disorder population. Perfectionism is a personality style in which the person is overly critical of his/her own performance and concerned about making mistakes or failing. Research tells us that perfectionism can contribute to the onset and maintenance of eating disorder behavior. These traits often predate the onset of symptoms of Anorexia and/or Bulimia and have a unique contribution to risk of development of eating disorders when compared to other psychiatric problems (Bulik, et. al., 2003). Thus, working through and correcting perfectionistic cognitions and behaviors is crucial for full recovery. Perfectionism is defined by behavioral and cognitive processes whereby one sets personal goals, sometimes with limited self-knowledge, to which he/she adheres rigidly, and where the fear of making misContinued on page 2 2 Eating Disorders Fall News 2011 Eating Disorders Fall News 2011 Treating Patients with Perfectionism continued from front page takes drives complex actions. The person demonstrated by the individual who with the perfectionistic style often equates also has high challenging goals, which mistakes as signs of personal failure or in- have been arrived at through assuming adequacy, from which cascades an array the values of a respected role model. of negative beliefs and subsequent ac- There may be little, if any, self-knowltions. The focus of attention is on achiev- edge that drove the selection of the ing and accomplishment. Often the goals goals, but rather an assumption that by that are selected are those of one’s family the accomplishment of them, the deor society, rather than sired approval will of the individual, and come. Individuals who “Given that are seen as the mechaexhibit clinical perfecperfectionism serves nism by which the pertionism overly value fectionist is valued by achieving and achieveto complicate and society. ment, (Flett & Hewitt, intensify clinical There are two types 2002). of perfectionism, problems in the eating Given that perfechealthy and unhealthy, tionism serves to comdisorder population, plicate and intensify or clinical. Healthy perit is crucial to assess clinical problems in fectionism is exemplified by an individual’s the eating disorder this variable early setting and diligently population, it is cruin treatment.” working towards high, cial to assess this varichallenging goals, able early in which are consistent with personal values treatment. This assessment can be done and desires. These goals are arrived at by including questions in the initial sesthrough an intimate awareness of one’s sion aimed at revealing rigidity of thinkown interests, skills, and knowledge of a ing and perfectionistic behavior field, as well as having a degree of under- patterns. We find that it is important to standing of the amount of effort and per- explore how black and white the client’s haps sacrifice that is required to attain thinking is, particularly in the areas of these goals. Thus, these goals are arrived achievement and making mistakes. Asat through personal introspection, self- sess also how much his/her personal knowledge, and some degree of inde- value resides in accomplishing goals and pendence from external influences. attempt to determine how functional Unhealthy, or clinical, perfectionism is this behavior pattern has become and at what costs. When there are signs of significant levels of clinical perfectionism, then this condition should be addressed in the conceptualization and focus of the patient’s treatment (Fairburn, 2008). A perfectionist’s black/white cognitive distortion sets up the expectation that therapy will require total and immediate change of all the maladaptive behaviors. Addressing these assumptions early on in the treatment process may reduce the resistance that most likely exists at treatment initiation based on this distortion. This expectation elicits fear of totally giving up beliefs that have been acquired, sometimes over years, and which served important functions to the client such as avoiding the ultimate discomfort of facing a less clearly defined and unpredictable reality. Although the obvious therapeutic goal is for the client to alter unrealistic self-imposed standards for achievement, this message may not be well received, even though the more mature eating disorder client will cognitively recognize that this is what ultimately needs to happen. Therapy is designed to assist the individual to develop skills of self-awareness and respect. Assignments that require the client to attune to, and qualitatively define his/her internal experiences without comparing him/her- Parent Intensive Workshops Begin January 2012: "Parenting Skills Needed for the World of Technology" I. II. III. IV. V. Communicating with Your Teen Boundaries and Consequences Individuation and Identity Blended Families and Parenting Addictions and Adolescence The goal of these intensive workshops is to raise emotionally intelligent children and to help develop resilient teens. The workshops teach open communication skills in a world of facebook, bullying, addictions, eating disorders and more as well as how to maintain a close bond with their teens in a world of overstimulation. Participants may attend any or all of the sessions. For information on fees and dates, please contact Dr. Laila Merz at (636) 532-9188. self to others, and without criticism, are examples of ways in which the client will discover preferences, limits, desires, and needs. Nancy Zucker, Ph.D., (20032004) recommends that we help our clients learn how to treat themselves as a caring parent does when the parent pays attention to, and is responsive to, the unique cues and expressions of the child. The therapy team can help the client to accomplish this highly anxiety provoking task by suggesting small incremental steps on a progression to the desired therapeutic outcome of balanced, healthy behavior and thoughts. The gradual implementation of flexible coping skills to manage reality based uncertainty will help a client embrace a more balanced lifestyle. References Bulik, C.M., Tozzi, F., Anderson, C., Mazzeo, S.E., Aggen, S., and Sullivan, P. F. (2003). The relation between eating disorders and components of perfectionism. American Journal of Psychiatry, 160, 366-368. Fairburn, C.G., (2008). Cognitive Behavioral Therapy and Eating Disorders. New York: Guilford. Flett, G.L. and Hewitt, P. L. (Eds), (2002). Perfectionism: Theory, Research, and Treatment. Washington, DC: American Psychological Association, 5-31. Zucker, N. (2003-2004). The many faces of perfectionism. Eating Disorders Recovery Today, Vol 2. ,No. 2, 1,8,9. For clients, we recommend: Antony, M. and Swinson, R. (2009). When Perfect Isn’t Good Enough, 2nd Edition. Oakland, New Harbinger. If you are interested in additional references on Anxiety and Eating Disorders and/or additional resources for your clients, please send us your e-mail at [email protected]. Patrice Ryan, Ph.D., a licensed as a Clinical Psychologist for 16 years, sees clients at both our Macklind Avenue and West County offices. In addition to her focus on anxiety, eating disorders and weight management issues, Dr. Ryan also sees clients for mood disorders, stress management; trauma; relationship issues; career and work-related problems; grief; infertility; and relaxation training. Dr. Ryan also is trained in Eye Movement Desensitization & Reprocessing (EMDR) therapy. For out of town clients, please inquire about housing options. The SLBMI Anxiety Disorders Center For those who suffer from an anxiety disorder and for those who live with them, an anxiety disorder becomes a powerful internal dictator. Anxiety can make individuals act in ways they know to be irrational. An anxiety disorder can occur when fear and anxiety disrupts everyday life, limits one's ability to work, socialize, perform, go to school or restricts a person's emotional and physical mobility. An untreated or under treated anxiety disorder can diminish quality of life and severely limit one's ability to freely participate in life. The SLBMI Anxiety Disorders Center (ADC) located at our St. Louis city location offers evidenced based treatment, consultation, and research for all problems that involve anxiety which include: obsessive compulsive disorder, social anxiety, phobias, post traumatic stress, generalized anxiety, panic, agoraphobia, trichotillomania, body dysmorphic disorder, childhood anxiety, body focus disorder, hypochondriasis, and all accompanying problems such as treatment avoidance, depression, relationships, and job disruption. Some clients are treated with traditional weekly outpatient therapy, however, for more severe anxiety problems, the nationally recognized ADC offers Intermediate Care / Intensive Outpatient and Partial Hospitalization Programs. This level of treatment is as an outpatient, and the number and content of treatment hours vary according to individual needs. Typically, treatment sessions are 2-4 hours a day, five to six days a week. Treatment is a combination of group, individual, and/or family sessions. Cognitive Behavior Therapy (CBT) and Exposure/Response Prevention (ERP) are utilized to provide a corrective learning experience. Anxiety management skills and behavioral skills also are a key component of treatment. Planned steps to accomplish desired behavior change are developed with the patient. Pharmacotherapy also is available. For those who are not yet ready to aggressively treat their anxiety, the ADC also offers a readiness group. C. Alec Pollard, PhD, is the Founder and Director of the SLBMI Anxiety Disorders Center since 1982. Dr. Pollard is the co-author of The Agoraphobia Workbook: A Comprehensive Program to End Your Fear of Symptom Attacks and Dying of Embarrassment: Help for Social Anxiety & Phobia as well as numerous internationally published journal articles on anxiety. For more information on the ADC or our groups on hoarding, social anxiety or the anxiety group for children please visit: www.slbmi.com/anxiety_center/index.htm email: [email protected] or call 877-245-2688 (toll free) or 314-534-0200 3