Archive for July, 2010

Increase in Eating Disorders with Dual Diagnoses

July 30th, 2010

At Mirasol we have been admitting many more patients recently who are considered to be dual-diagnosis patients, meaning that they have more than one serious diagnosis. It is not uncommon for a patients to admit with not only an eating disorder, but substance abuse, post-traumatic stress disorder, depression, and accompanying anxiety.

The conventional way of thinking is to treat the substance abuse first, then address the eating disorder. At Mirasol, we have long believed that co-occurring conditions need to be treated simultaneously. If all the conditions are not treated at the same time, treatment outcomes are usually poor, and what would ordinarily be considered a small slip can turn into a cascading event, almost like a house of cards, with one slip triggering another one rapidly.

A strong connection between eating disorders and substance abuse has been long evident with a majority of women reporting binge eating and/or bulimia nervosa along with the substance abuse. Some 40-50% of all women who have an eating disorder will have a problem with alcohol and drugs either currently or at some time in their lives. The eating disorder and substance abuse are frequently accompanied with PTSD.

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Outcome Data Shows Dramatic Decrease in Depression Levels

July 28th, 2010

I have never wanted to play the game of outcomes. Statistics can be manipulated and when I hear someone claiming a success rate of 92% at a year, I know it’s not true.

However, I promised a team of surveyors from The Commission on Accreditation of Rehabilitation Facilities (CARF) that I would share some of our numbers with our stakeholders, and that includes you!

When a new client enters treatment, we do quite a lot of psychological testing. Two of the most important psychological instruments we administer are the Eating Disorder Inventory-III and the Beck Depression Inventory.

The Eating Disorder Inventory 3 (EDI-III) is the third edition of a test that reports in multiple scales. The test consists of 91 questions answered in terms of frequency of behaviors from “always” to “never”. Reports consist of 21 separate scales; three are validity scales, four are eating disorder risk and composite scales, nine are psychological scales, and five are psychological composite scales. Results are presented as percentiles for all, anorexia, bulimia, and EDNOS diagnoses.

For simplicity of reporting, percentiles of two risk scales/composite scores are used, each chosen for broad-based relevancy to Mirasol’s program, the Eating Disorder Risk Composite (ERDC) and the Global Psychological Maladjustment Composite (GPMC). In addition, the 9 psychological scales, including Low Self-Esteem (LSE), Personal Alienation (PA), Interpersonal Insecurity (II), Interpersonal Alienation (IA), Interoceptive Deficits (ID), Emotional Dysregulation (ED), Perfectionism (P), Ascetism (A), and Maturity Fears (MF).

These will all be compared for pre- and post-treamtnent scores for the total, anorexic, bulimic, and EDNOS populations.

The information presented in the following chart is based on residents who completed the program during the years of 2007, 2008, 2009, and through June 2010.

You can readily see the differences between the pre-scores and the post-scores. But look at the post scores for EDRC for 2007, then 2008, 2009, and finally 2010. You’ll see that the scores progressively get lower – meaning that our patients are getting a lot better!

Eating Disorder Risk Composite (ERDC)
Year Pre-Treatment Post-Treatment
2007 53.27 28.00
2008 54.06 21.50
2009 49.35 13.60
2010 46.10 11.82

Global Psychological Maladjustment Composite (GPMC)
Year Pre-Treatment Post-Treatment
2007 56.55 31.45
2008 54.44 25.21
2009 49.35 18.15
2010 44.00 10.27

Self Esteem
Year Pre-Treatment Post-Treatment
2007 56.5 30.6
2008 59.2 26.6
2009 47.8 17.7
2010 47.4 15.2

Personal Alienation
Year Pre-Treatment Post-Treatment
2007 53.6 31.0
2008 54.7 23.6
2009 53.1 18.9
2010 47.6 14.4

Interpersonal Insecurity
Year Pre-Treatment Post-Treatment
2007 451.2 432.8
2008 454.0 434.4
2009 446.5 427.8
2010 440.8 414.6

I also wanted to share the pre- and post- test scores for the Beck Depression Inventory. The Beck is one of my favorite tests. It’s short and very informative.

Beck Depression Inventory
Year Pre-Treatment Post-Treatment
2007 34.26 18.13
2008 31.50 13.03
2009 30.42 7.89
2010 29.83 10.5

The decrease in the levels of depression as evidenced by these scores is dramatic. They display a general trend of improvement of feelings of well-being.

I am happy to send anyone the full EDI-III report who is interested. I invite anyone to phone me with any comments or suggestions. I’m proud of the work our staff is doing – they are truly incredible as is our treatment model!