Tamara Pryor - Academia.edu (original) (raw)

Papers by Tamara Pryor

Research paper thumbnail of Eating Disorder Behaviors and Psychological Characteristics: A Comparison Between Athletes and Nonathletes in a Partial Hospitalization Program

Research paper thumbnail of Bon Appetit! Connecting and Healing Through the Use of Therapeutic Meals

Research paper thumbnail of Altered fimbria-fornix white matter integrity in anorexia nervosa predicts harm avoidance

Psychiatry Research: Neuroimaging, May 1, 2011

Research paper thumbnail of Trait anxiety is associated with amygdala expectation and caloric taste receipt response across eating disorders

Neuropsychopharmacology

Anxious traits are elevated in eating disorders (EDs), are considered risk factors for ED develop... more Anxious traits are elevated in eating disorders (EDs), are considered risk factors for ED development, and trait anxiety has been linked to ED psychopathology. How trait anxiety relates to ED neurobiology is not well understood. In this study 197 individuals across the ED spectrum (anorexia nervosa n = 91; other specified EDs n = 34; bulimia nervosa n = 56; binge ED n = 16), and 120 healthy controls were assessed for anxious traits and learned to expect and receive caloric or neutral taste stimuli during brain imaging. Amygdala sucrose expectation response differed across groups (Wilk’s lambda = 0.945, p = 0.023), and was higher on the left in anorexia nervosa compared to healthy controls (p = 0.002). Expected sucrose receipt response across taste reward regions was not different between groups. In the ED sample, trait anxiety negatively moderated the relationship between amygdala expectation and right dorsal (p = 0.0062) and ventral (p = 0.0046) anterior insula receipt response. A ...

Research paper thumbnail of Brain reward response in adolescents and young adults with anorexia nervosa is moderated by changes in body weight and sweetness perception

International Journal of Eating Disorders

ObjectiveAnorexia nervosa (AN) is a severe psychiatric illness with complex etiology. Recently, w... more ObjectiveAnorexia nervosa (AN) is a severe psychiatric illness with complex etiology. Recently, we found elevated striatal brain response to sweet taste stimuli in adolescents and young adults with AN. Here, we tested the hypothesis that nutritional rehabilitation normalizes prediction error activation, a measure for dopamine‐related reward circuit response, to salient caloric taste stimuli in AN.MethodsA total of 28 individuals with AN (age = 16 ± 2 years; body mass index [BMI] = 16 ± 1) who previously underwent brain imaging while performing a taste prediction error task using sucrose as salient caloric stimulus, participated in a second brain imaging scan (BMI = 18 ± 1) after intensive specialized eating disorder treatment (41 ± 15 days). A total of 31 healthy controls (age = 16 ± 3 years; BMI = 21 ± 2) were also studied on two occasions.ResultsAt baseline, individuals with AN demonstrated an elevated salience response in bilateral caudate head and nucleus accumbens, and right ve...

Research paper thumbnail of Association of Brain Reward Response With Body Mass Index and Ventral Striatal-Hypothalamic Circuitry Among Young Women With Eating Disorders

Research paper thumbnail of Neural response to expecting a caloric sweet taste stimulus predicts body mass index longitudinally among young adult women with anorexia nervosa

Biological Psychiatry: Cognitive Neuroscience and Neuroimaging

Research paper thumbnail of The Assessment and Treatment of Bulimia Nervosa

Journal of Psychiatric Practice, 1998

Research paper thumbnail of The Complex Relationship Between Eating Disorders and Substance Use Disorders

Clinical Handbook of Complex and Atypical Eating Disorders, 2017

Eating disorders (ED) and substance use disorders (SUD) frequently co-occur but are rarely treate... more Eating disorders (ED) and substance use disorders (SUD) frequently co-occur but are rarely treated in a comprehensive integrated manner. This chapter elucidates the complex relationship between ED and SUD to help the treating professional create an integrated treatment plan that addresses both disorders and any other co-occurring conditions. Evidence-based treatments for each disorder are discussed, and recommendations on how to take “best practices” from both fields to formulate a treatment plan that addresses the specific needs of the patient are presented. The chapter includes case examples that demonstrate the importance of understanding the adaptive function of both disorders when developing an effective intervention.

Research paper thumbnail of Persistence, Reward Dependence and Sensitivity to Reward are Associated With Unexpected Salience Response in Girls But Not Adult Women - Implications for Psychiatric Vulnerabilities

Biological psychiatry. Cognitive neuroscience and neuroimaging, 2021

BACKGROUND Adolescence is a critical period for development of personality but also psychopatholo... more BACKGROUND Adolescence is a critical period for development of personality but also psychopathology. Those processes may be specific to sex and brain reward circuits may have a role. Here we studied how reward processing and temperament associations differ across adolescent and adult females. METHODS Twentynine adolescent girls and 41 adult women completed temperament assessments and performed a classical taste conditioning paradigm during brain imaging. Data were analyzed for the dopamine-related prediction error response. In addition, unexpected stimulus receipt or omission and expected receipt response were also analyzed. Heat maps identified cortical-subcortical brain response associations. RESULTS Adolescents showed stronger prediction error, unexpected receipt and omission responses (partial η2=0.063 to 0.166; p-values=0.001 to 0.043) in insula, orbitofrontal cortex (OFC), and striatum compared to adults. Expected stimulus receipt response was similar between groups. In adoles...

Research paper thumbnail of 24.3 Reward Processing and Behavior Traits in Female Youth: Implications for Psychiatric Vulnerabilities

Journal of the American Academy of Child & Adolescent Psychiatry, 2021

Research paper thumbnail of Association of Brain Reward Learning Response With Harm Avoidance, Weight Gain, and Hypothalamic Effective Connectivity in Adolescent Anorexia Nervosa

JAMA psychiatry, Jan 19, 2018

Anorexia nervosa (AN) is associated with adolescent onset, severe low body weight, and high morta... more Anorexia nervosa (AN) is associated with adolescent onset, severe low body weight, and high mortality as well as high harm avoidance. The brain reward system could have an important role in the perplexing drive for thinness and food avoidance in AN. To test whether brain reward learning response to taste in adolescent AN is altered and associated with treatment response, striatal-hypothalamic connectivity, and elevated harm avoidance. In this cross-sectional multimodal brain imaging study, adolescents and young adults with AN were matched with healthy controls at a university brain imaging facility and eating disorder treatment program. During a sucrose taste classical conditioning paradigm, violations of learned associations between conditioned visual and unconditioned taste stimuli evoked the dopamine-related prediction error (PE). Dynamic effective connectivity during sweet taste receipt was studied to investigate hierarchical brain activation across the brain network that regula...

Research paper thumbnail of Altered structural and effective connectivity in anorexia and bulimia nervosa in circuits that regulate energy and reward homeostasis

Translational psychiatry, 2016

Anorexia and bulimia nervosa are severe eating disorders that share many behaviors. Structural an... more Anorexia and bulimia nervosa are severe eating disorders that share many behaviors. Structural and functional brain circuits could provide biological links that those disorders have in common. We recruited 77 young adult women, 26 healthy controls, 26 women with anorexia and 25 women with bulimia nervosa. Probabilistic tractography was used to map white matter connectivity strength across taste and food intake regulating brain circuits. An independent multisample greedy equivalence search algorithm tested effective connectivity between those regions during sucrose tasting. Anorexia and bulimia nervosa had greater structural connectivity in pathways between insula, orbitofrontal cortex and ventral striatum, but lower connectivity from orbitofrontal cortex and amygdala to the hypothalamus (P<0.05, corrected for comorbidity, medication and multiple comparisons). Functionally, in controls the hypothalamus drove ventral striatal activity, but in anorexia and bulimia nervosa effective ...

Research paper thumbnail of Understanding Neuronal Architecture in Obesity through Analysis of White Matter Connection Strength

Frontiers in human neuroscience, 2016

Despite the prevalence of obesity, our understanding of its neurobiological underpinnings is insu... more Despite the prevalence of obesity, our understanding of its neurobiological underpinnings is insufficient. Diffusion weighted imaging and calculation of white matter connection strength are methods to describe the architecture of anatomical white matter tracts. This study is aimed to characterize white matter architecture within taste-reward circuitry in a population of obese individuals. Obese (n = 18, age = 28.7 ± 8.3 years) and healthy control (n = 24, age = 27.4 ± 6.3 years) women underwent diffusion weighted imaging. Using probabilistic fiber tractography (FSL PROBTRACKX2 toolbox) we calculated connection strength within 138 anatomical white matter tracts. Obese women (OB) displayed lower and greater connectivity within taste-reward circuitry compared to controls (Wilks' λ < 0.001; p < 0.001). Connectivity was lower in white matter tracts connecting insula, amygdala, prefrontal cortex (PFC), orbitofrontal cortex (OFC) and striatum. Connectivity was greater between the...

Research paper thumbnail of Integrated Treatment Principles and Strategies for Patients with Eating Disorders, Substance Use Disorder, and Addictions

Eating Disorders, Addictions and Substance Use Disorders, 2014

Currently, there are no evidence-based treatments or established treatment protocols for patients... more Currently, there are no evidence-based treatments or established treatment protocols for patients that present with both eating disorders and substance use disorders/addictions. The lack of available integrated treatment programs, at all levels of care, has left the dually diagnosed patient vacillating between these two disorders. Eating disorder treatment programs frequently exclude patients with active substance use disorders, and addiction programs regularly exclude or do not effectively treat patients with eating disorders. Often, these patients are referred to addiction treatment programs prior to entering into eating disorder treatment. This approach is problematic, as both disorders are associated with high rates of relapse following treatment. Sequential treatments focus on the most acute disorder first, often utilizing multiple providers in different locations, with different theoretical orientations, staff training, and treatment protocols, which can make continuity of care quite difficult. Developing a comprehensive integrated approach to the treatment of comorbid patients will improve treatment delivery, reduce time in treatment, lower overall treatment costs, improve treatment outcome, and lessen consumer confusion. This chapter will provide a definition, rationale, and the basic principles of an integrated treatment model with applicability to those working to develop and provide integrated services for these dually diagnosed patients.

Research paper thumbnail of Orbitofrontal cortex volume and brain reward response in obesity

International journal of obesity (2005), 2015

What drives overconsumption of food is poorly understood. Alterations in brain structure and func... more What drives overconsumption of food is poorly understood. Alterations in brain structure and function could contribute to increased food seeking. Recently, brain orbitofrontal cortex (OFC) volume has been implicated in dysregulated eating but little is known how brain structure relates to function. We examined obese (n=18, age=28.7±8.3 years) and healthy control women (n=24, age=27.4±6.3 years) using a multimodal brain imaging approach. We applied magnetic resonance and diffusion tensor imaging to study brain gray and white matter volume as well as white matter (WM) integrity, and tested whether orbitofrontal cortex volume predicts brain reward circuitry activation in a taste reinforcement-learning paradigm that has been associated with dopamine function. Obese individuals displayed lower gray and associated white matter volumes (P<0.05 family-wise error (FWE)- small volume corrected) compared with controls in the orbitofrontal cortex, striatum and insula. White matter integrity ...

Research paper thumbnail of Introduction to Eating Disorders for Substance Abuse Specialists

Eating Disorders, Addictions and Substance Use Disorders, 2014

Eating disorders and substance use disorders co-occur frequently; however, at the present time th... more Eating disorders and substance use disorders co-occur frequently; however, at the present time there are no evidence-based treatments to guide the practitioner faced with this comorbid condition. Given the high rates of co-occurrence and the complex nature of these disorders, it is surprising to note that most substance abuse clinicians and treatment programs have not incorporated eating disorder protocols into their practices. Likewise, most eating disorder specialists are not adequately trained in the treatment of substance use disorders, and very few eating disorder treatment programs provide comprehensive, integrated services for these dually diagnosed patients. Consequently, clinicians presented with these patients tend to focus on their area of specialty without addressing directly the other comorbid condition. Inadvertently, this can prolong the patient’s suffering as they vacillate between their substance use disorder and their eating disorder. Additionally, outpatient clinicians needing to refer patients to a higher level of care or parents seeking treatment for their loved one with both disorders find locating providers or programs that effectively treat both disorders complicated and confusing. Should they seek a reputable substance abuse program or an eating disorder program? This chapter is designed for substance abuse specialists that have limited knowledge or expertise in the diagnosis, assessment, and treatment of individuals with ED. Cross-training between fields is the foundation to developing comprehensive and integrated programs for this population.

Research paper thumbnail of Introduction to Substance Use Disorders for the Eating Disorder Specialist

Eating Disorders, Addictions and Substance Use Disorders, 2014

Substance use disorders and eating disorders co-occur frequently; however, currently, there are n... more Substance use disorders and eating disorders co-occur frequently; however, currently, there are no evidence-based treatments to guide the practitioner faced with this comorbid condition. Very few eating disorder programs have incorporated substance abuse protocols into their programs, and likewise, few substance abuse programs can effectively treat the patient with a serious eating disorder. Consequently, clinicians presented with these patients tend to focus on their area of specialty without addressing directly the other comorbid condition. Inadvertently, this can prolong the patient’s suffering as they vacillate between their substance use disorder and their eating disorder. The intention of this chapter is to provide a brief overview of substance use disorders for students, clinicians, and researchers in the health and mental health field. It was specifically designed for the eating disorder specialist that has limited knowledge of the psychoactive properties of drugs of abuse, the clinical characteristics of individuals with alcohol and drug abuse problems, the philosophy and/or vernacular of abstinence-based models (e.g., Alcoholics Anonymous [AA], Narcotics Anonymous [NA], or Cocaine Anonymous [CA]), and other evidence-based models/approaches for the treatment of substance use disorders.

Research paper thumbnail of White matter integrity is reduced in bulimia nervosa

International Journal of Eating Disorders, 2013

Research paper thumbnail of Heightened fear of uncertainty in anorexia and bulimia nervosa

International Journal of Eating Disorders, 2011

Research paper thumbnail of Eating Disorder Behaviors and Psychological Characteristics: A Comparison Between Athletes and Nonathletes in a Partial Hospitalization Program

Research paper thumbnail of Bon Appetit! Connecting and Healing Through the Use of Therapeutic Meals

Research paper thumbnail of Altered fimbria-fornix white matter integrity in anorexia nervosa predicts harm avoidance

Psychiatry Research: Neuroimaging, May 1, 2011

Research paper thumbnail of Trait anxiety is associated with amygdala expectation and caloric taste receipt response across eating disorders

Neuropsychopharmacology

Anxious traits are elevated in eating disorders (EDs), are considered risk factors for ED develop... more Anxious traits are elevated in eating disorders (EDs), are considered risk factors for ED development, and trait anxiety has been linked to ED psychopathology. How trait anxiety relates to ED neurobiology is not well understood. In this study 197 individuals across the ED spectrum (anorexia nervosa n = 91; other specified EDs n = 34; bulimia nervosa n = 56; binge ED n = 16), and 120 healthy controls were assessed for anxious traits and learned to expect and receive caloric or neutral taste stimuli during brain imaging. Amygdala sucrose expectation response differed across groups (Wilk’s lambda = 0.945, p = 0.023), and was higher on the left in anorexia nervosa compared to healthy controls (p = 0.002). Expected sucrose receipt response across taste reward regions was not different between groups. In the ED sample, trait anxiety negatively moderated the relationship between amygdala expectation and right dorsal (p = 0.0062) and ventral (p = 0.0046) anterior insula receipt response. A ...

Research paper thumbnail of Brain reward response in adolescents and young adults with anorexia nervosa is moderated by changes in body weight and sweetness perception

International Journal of Eating Disorders

ObjectiveAnorexia nervosa (AN) is a severe psychiatric illness with complex etiology. Recently, w... more ObjectiveAnorexia nervosa (AN) is a severe psychiatric illness with complex etiology. Recently, we found elevated striatal brain response to sweet taste stimuli in adolescents and young adults with AN. Here, we tested the hypothesis that nutritional rehabilitation normalizes prediction error activation, a measure for dopamine‐related reward circuit response, to salient caloric taste stimuli in AN.MethodsA total of 28 individuals with AN (age = 16 ± 2 years; body mass index [BMI] = 16 ± 1) who previously underwent brain imaging while performing a taste prediction error task using sucrose as salient caloric stimulus, participated in a second brain imaging scan (BMI = 18 ± 1) after intensive specialized eating disorder treatment (41 ± 15 days). A total of 31 healthy controls (age = 16 ± 3 years; BMI = 21 ± 2) were also studied on two occasions.ResultsAt baseline, individuals with AN demonstrated an elevated salience response in bilateral caudate head and nucleus accumbens, and right ve...

Research paper thumbnail of Association of Brain Reward Response With Body Mass Index and Ventral Striatal-Hypothalamic Circuitry Among Young Women With Eating Disorders

Research paper thumbnail of Neural response to expecting a caloric sweet taste stimulus predicts body mass index longitudinally among young adult women with anorexia nervosa

Biological Psychiatry: Cognitive Neuroscience and Neuroimaging

Research paper thumbnail of The Assessment and Treatment of Bulimia Nervosa

Journal of Psychiatric Practice, 1998

Research paper thumbnail of The Complex Relationship Between Eating Disorders and Substance Use Disorders

Clinical Handbook of Complex and Atypical Eating Disorders, 2017

Eating disorders (ED) and substance use disorders (SUD) frequently co-occur but are rarely treate... more Eating disorders (ED) and substance use disorders (SUD) frequently co-occur but are rarely treated in a comprehensive integrated manner. This chapter elucidates the complex relationship between ED and SUD to help the treating professional create an integrated treatment plan that addresses both disorders and any other co-occurring conditions. Evidence-based treatments for each disorder are discussed, and recommendations on how to take “best practices” from both fields to formulate a treatment plan that addresses the specific needs of the patient are presented. The chapter includes case examples that demonstrate the importance of understanding the adaptive function of both disorders when developing an effective intervention.

Research paper thumbnail of Persistence, Reward Dependence and Sensitivity to Reward are Associated With Unexpected Salience Response in Girls But Not Adult Women - Implications for Psychiatric Vulnerabilities

Biological psychiatry. Cognitive neuroscience and neuroimaging, 2021

BACKGROUND Adolescence is a critical period for development of personality but also psychopatholo... more BACKGROUND Adolescence is a critical period for development of personality but also psychopathology. Those processes may be specific to sex and brain reward circuits may have a role. Here we studied how reward processing and temperament associations differ across adolescent and adult females. METHODS Twentynine adolescent girls and 41 adult women completed temperament assessments and performed a classical taste conditioning paradigm during brain imaging. Data were analyzed for the dopamine-related prediction error response. In addition, unexpected stimulus receipt or omission and expected receipt response were also analyzed. Heat maps identified cortical-subcortical brain response associations. RESULTS Adolescents showed stronger prediction error, unexpected receipt and omission responses (partial η2=0.063 to 0.166; p-values=0.001 to 0.043) in insula, orbitofrontal cortex (OFC), and striatum compared to adults. Expected stimulus receipt response was similar between groups. In adoles...

Research paper thumbnail of 24.3 Reward Processing and Behavior Traits in Female Youth: Implications for Psychiatric Vulnerabilities

Journal of the American Academy of Child & Adolescent Psychiatry, 2021

Research paper thumbnail of Association of Brain Reward Learning Response With Harm Avoidance, Weight Gain, and Hypothalamic Effective Connectivity in Adolescent Anorexia Nervosa

JAMA psychiatry, Jan 19, 2018

Anorexia nervosa (AN) is associated with adolescent onset, severe low body weight, and high morta... more Anorexia nervosa (AN) is associated with adolescent onset, severe low body weight, and high mortality as well as high harm avoidance. The brain reward system could have an important role in the perplexing drive for thinness and food avoidance in AN. To test whether brain reward learning response to taste in adolescent AN is altered and associated with treatment response, striatal-hypothalamic connectivity, and elevated harm avoidance. In this cross-sectional multimodal brain imaging study, adolescents and young adults with AN were matched with healthy controls at a university brain imaging facility and eating disorder treatment program. During a sucrose taste classical conditioning paradigm, violations of learned associations between conditioned visual and unconditioned taste stimuli evoked the dopamine-related prediction error (PE). Dynamic effective connectivity during sweet taste receipt was studied to investigate hierarchical brain activation across the brain network that regula...

Research paper thumbnail of Altered structural and effective connectivity in anorexia and bulimia nervosa in circuits that regulate energy and reward homeostasis

Translational psychiatry, 2016

Anorexia and bulimia nervosa are severe eating disorders that share many behaviors. Structural an... more Anorexia and bulimia nervosa are severe eating disorders that share many behaviors. Structural and functional brain circuits could provide biological links that those disorders have in common. We recruited 77 young adult women, 26 healthy controls, 26 women with anorexia and 25 women with bulimia nervosa. Probabilistic tractography was used to map white matter connectivity strength across taste and food intake regulating brain circuits. An independent multisample greedy equivalence search algorithm tested effective connectivity between those regions during sucrose tasting. Anorexia and bulimia nervosa had greater structural connectivity in pathways between insula, orbitofrontal cortex and ventral striatum, but lower connectivity from orbitofrontal cortex and amygdala to the hypothalamus (P<0.05, corrected for comorbidity, medication and multiple comparisons). Functionally, in controls the hypothalamus drove ventral striatal activity, but in anorexia and bulimia nervosa effective ...

Research paper thumbnail of Understanding Neuronal Architecture in Obesity through Analysis of White Matter Connection Strength

Frontiers in human neuroscience, 2016

Despite the prevalence of obesity, our understanding of its neurobiological underpinnings is insu... more Despite the prevalence of obesity, our understanding of its neurobiological underpinnings is insufficient. Diffusion weighted imaging and calculation of white matter connection strength are methods to describe the architecture of anatomical white matter tracts. This study is aimed to characterize white matter architecture within taste-reward circuitry in a population of obese individuals. Obese (n = 18, age = 28.7 ± 8.3 years) and healthy control (n = 24, age = 27.4 ± 6.3 years) women underwent diffusion weighted imaging. Using probabilistic fiber tractography (FSL PROBTRACKX2 toolbox) we calculated connection strength within 138 anatomical white matter tracts. Obese women (OB) displayed lower and greater connectivity within taste-reward circuitry compared to controls (Wilks' λ < 0.001; p < 0.001). Connectivity was lower in white matter tracts connecting insula, amygdala, prefrontal cortex (PFC), orbitofrontal cortex (OFC) and striatum. Connectivity was greater between the...

Research paper thumbnail of Integrated Treatment Principles and Strategies for Patients with Eating Disorders, Substance Use Disorder, and Addictions

Eating Disorders, Addictions and Substance Use Disorders, 2014

Currently, there are no evidence-based treatments or established treatment protocols for patients... more Currently, there are no evidence-based treatments or established treatment protocols for patients that present with both eating disorders and substance use disorders/addictions. The lack of available integrated treatment programs, at all levels of care, has left the dually diagnosed patient vacillating between these two disorders. Eating disorder treatment programs frequently exclude patients with active substance use disorders, and addiction programs regularly exclude or do not effectively treat patients with eating disorders. Often, these patients are referred to addiction treatment programs prior to entering into eating disorder treatment. This approach is problematic, as both disorders are associated with high rates of relapse following treatment. Sequential treatments focus on the most acute disorder first, often utilizing multiple providers in different locations, with different theoretical orientations, staff training, and treatment protocols, which can make continuity of care quite difficult. Developing a comprehensive integrated approach to the treatment of comorbid patients will improve treatment delivery, reduce time in treatment, lower overall treatment costs, improve treatment outcome, and lessen consumer confusion. This chapter will provide a definition, rationale, and the basic principles of an integrated treatment model with applicability to those working to develop and provide integrated services for these dually diagnosed patients.

Research paper thumbnail of Orbitofrontal cortex volume and brain reward response in obesity

International journal of obesity (2005), 2015

What drives overconsumption of food is poorly understood. Alterations in brain structure and func... more What drives overconsumption of food is poorly understood. Alterations in brain structure and function could contribute to increased food seeking. Recently, brain orbitofrontal cortex (OFC) volume has been implicated in dysregulated eating but little is known how brain structure relates to function. We examined obese (n=18, age=28.7±8.3 years) and healthy control women (n=24, age=27.4±6.3 years) using a multimodal brain imaging approach. We applied magnetic resonance and diffusion tensor imaging to study brain gray and white matter volume as well as white matter (WM) integrity, and tested whether orbitofrontal cortex volume predicts brain reward circuitry activation in a taste reinforcement-learning paradigm that has been associated with dopamine function. Obese individuals displayed lower gray and associated white matter volumes (P<0.05 family-wise error (FWE)- small volume corrected) compared with controls in the orbitofrontal cortex, striatum and insula. White matter integrity ...

Research paper thumbnail of Introduction to Eating Disorders for Substance Abuse Specialists

Eating Disorders, Addictions and Substance Use Disorders, 2014

Eating disorders and substance use disorders co-occur frequently; however, at the present time th... more Eating disorders and substance use disorders co-occur frequently; however, at the present time there are no evidence-based treatments to guide the practitioner faced with this comorbid condition. Given the high rates of co-occurrence and the complex nature of these disorders, it is surprising to note that most substance abuse clinicians and treatment programs have not incorporated eating disorder protocols into their practices. Likewise, most eating disorder specialists are not adequately trained in the treatment of substance use disorders, and very few eating disorder treatment programs provide comprehensive, integrated services for these dually diagnosed patients. Consequently, clinicians presented with these patients tend to focus on their area of specialty without addressing directly the other comorbid condition. Inadvertently, this can prolong the patient’s suffering as they vacillate between their substance use disorder and their eating disorder. Additionally, outpatient clinicians needing to refer patients to a higher level of care or parents seeking treatment for their loved one with both disorders find locating providers or programs that effectively treat both disorders complicated and confusing. Should they seek a reputable substance abuse program or an eating disorder program? This chapter is designed for substance abuse specialists that have limited knowledge or expertise in the diagnosis, assessment, and treatment of individuals with ED. Cross-training between fields is the foundation to developing comprehensive and integrated programs for this population.

Research paper thumbnail of Introduction to Substance Use Disorders for the Eating Disorder Specialist

Eating Disorders, Addictions and Substance Use Disorders, 2014

Substance use disorders and eating disorders co-occur frequently; however, currently, there are n... more Substance use disorders and eating disorders co-occur frequently; however, currently, there are no evidence-based treatments to guide the practitioner faced with this comorbid condition. Very few eating disorder programs have incorporated substance abuse protocols into their programs, and likewise, few substance abuse programs can effectively treat the patient with a serious eating disorder. Consequently, clinicians presented with these patients tend to focus on their area of specialty without addressing directly the other comorbid condition. Inadvertently, this can prolong the patient’s suffering as they vacillate between their substance use disorder and their eating disorder. The intention of this chapter is to provide a brief overview of substance use disorders for students, clinicians, and researchers in the health and mental health field. It was specifically designed for the eating disorder specialist that has limited knowledge of the psychoactive properties of drugs of abuse, the clinical characteristics of individuals with alcohol and drug abuse problems, the philosophy and/or vernacular of abstinence-based models (e.g., Alcoholics Anonymous [AA], Narcotics Anonymous [NA], or Cocaine Anonymous [CA]), and other evidence-based models/approaches for the treatment of substance use disorders.

Research paper thumbnail of White matter integrity is reduced in bulimia nervosa

International Journal of Eating Disorders, 2013

Research paper thumbnail of Heightened fear of uncertainty in anorexia and bulimia nervosa

International Journal of Eating Disorders, 2011