Document 6481303

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
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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
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