online conference transcript
Bob McMillan is the moderator.
Bob M: Good evening everyone. I'm Bob McMillan, the moderator for tonight's eating disorders conference. Our topic tonight is Eating Disorders Diagnosis and Treatment. Our guest, Dr. David Garner, designed the test. He is the Director of the Toledo Center for Eating Disorders and a well-known researcher and treatment expert in the U.S. Dr. Garner is also one of the founding members of the Academy of Eating Disorders. Good evening Dr. Garner and welcome back to. Can you please start by telling us a bit more about your expertise in the area of eating disorders and then we'll move on from there?
Dr. Garner: Hello. I have had about 20 years experience in research as well as clinical practice in the area of eating disorders.
Bob M: What does a clinician like yourself do to determine whether a person actually has an "eating disorder" or whether they have some disordered eating behaviors that aren't all that significant?
Dr. Garner: The key way to determine if someone has an eating disorder is by a careful clinical interview with questions directed at the main symptom areas.
Bob M: As you can imagine, several hundred people have already taken the Eating Attitudes Test on our site and they report back that the test indicated they have a significant area of concern. Is that all it takes?
Dr. Garner: The Eating Attitudes Test (EAT test) does not give a diagnosis, but it does provide valuable information on the levels of eating concerns typical of an eating disorder.
Bob M: For those just coming into the conference room: Our topic tonight is Eating Disorders diagnosis and treatment. Our guest is Dr. David Garner, Director of the Toledo Center for Eating Disorders. Dr. Garner is a highly respected professional in his field and has been involved in research as well as treatment of all eating disorders--anorexia, bulimia, compulsive overeating. There are many people who are self-diagnosed with an eating disorder. How important is it to get a professional evaluation?
Dr. Garner: A professional evaluation is essential, particularly a professional who has experience in the diagnosis and treatment of eating disorders.
Bob M: Dr. Garner can only be with us for about an hour tonight...so if you have a question or comment for him about any eating disorders related topic, please submit it now. I know the Toledo Center for Eating Disorders is an out-patient eating disorders treatment center. One question I always get is: what is the big difference, treatment wise, between in and out-patient. And how do you know which one to pick?
Dr. Garner: Inpatient provides complete structure and 24 hour supervision. Intensive Out-patient is about 35 hours a week at our center. There are advantages and disadvantages to both. I think that you want to pick the type of eating disorders treatment that is sufficient to get control over symptoms, but not more than you need. The advantages of an intensive outpatient program, IOP, is that it is less expensive and it provides practice every day with living in the real (non-hospital) world. In an IOP, you have 7 hours of treatment, but you also have time outside of the clinic setting to address the "out of hospital" world.
Bob M: The Toledo Center for Eating Disorders sponsors us. We asked them to sponsor the site because many of you, our visitors, asked for professional treatment, but wanted a great place to go at a more affordable cost. The Toledo Center for Eating Disorders is just that. They are located in Toledo, Ohio. If you go there, they can hook you up with some affordable housing during your stay. Here are some audience questions, Dr. Garner:
LOSTnSIDE: For someone who is an abuse survivor, is it at all possible to gain control of an eating disorder without having to bring up the misery of your past? Is it true that you can't fix one without the working on the other?
Dr. Garner: I have seen abuse survivors whose recovery is dependent on dealing with the abuse and others who really do not require delving into this issue. It may be important in its own right, but not essential to recovery from the Eating Disorder. This is a great question and the answer is that both approaches are sometimes best.
mleland: What are the strengths of the Toledo Center for Eating Disorders? (I've been to Laureate)
Dr. Garner: Laureate is an excellent program. We are smaller and provide a somewhat different orientation to treatment. The Toledo Center for Eating Disorders has a broad cognitive behavioral orientation as well as a strong family therapy component. We also emphasize nutritional counseling and a strong focus on group psychotherapy. And we don't use a "cookie cutter" approach of "one treatment fits all."
shade123: I have a daughter who is anorexic. How do I get her to consent to help? She is 36 and is severely underweight right now, in a lot of emotional trauma.
Dr. Garner: The best that you can do is to tell her that it is your view that she should absolutely seek treatment. However, she is an adult and she has to make the decision. Sometimes it is useful to think of how you would convince someone to seek treatment if they suffered from another disorder like alcoholism. Sometimes it helps in thinking through what you might do.
Bob M: We have nearly 100 people in the room right now. I'm going to set a one question per person limit.
chrissyj: Could you please give a little overview of an average out-patient day for a purging and restricting bulimic?
Dr. Garner: The average day consists of a review of the evening before, preparation of lunch with staff, group treatment, possibly a brief individual meeting to identify important issues, another group with a different theme, snack, dinner and perhaps some movement therapy- yes a lot of structured eating and a lot of therapy.
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