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Eating Disorder and Clinical?

Discussion in 'Psychology [Psy.D. / Ph.D.]' started by wunderwood, May 13, 2008.

  1. wunderwood

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    I am interested in getting into PhD Clinical psychology programs. I have also had an eating disorder for the past 7-10 years. I am miles better than I used to be, but I am not fixed. I still have "behaviors" and maintain a low weight. At the same time I am very accomplished in work and academics. I am mainly interested in research and an academic career.

    Can anyone give me any insight or thoughts about this? I don't want it to become an issue. Would I just have to disclose to the DCT so as to not have any clients with eating issues when I do have practicum?

    Thank you for any thoughts.
     
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  3. erg923

    erg923 Regional Clinical Officer, Cenpatico National
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    I would not disclose this information to any faculty or in your personal statements when applying. Unsolicited and inappropriate amounts of self disclosure are deemed unprofessional. As long as your issues are under control and you feel that they will not impair your judgment or ability to be a psychologist, there is no reason you would not be able to work with eating disordered patients. The request to avoid these patients is not something that will always be easily accommodated necessarily, and there is fine line between staying away from patients that make you uncomfortable, versus just being unable to treat. If you truly feel that this will create a situation that would provide suboptimal service to the patient (not just make you feel uncomfortable) then you can deal with that with a supervisor when the time comes. I would proceed with caution in that situation.
     
  4. EquestriAnn

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    I strongly disagree. As someone who has been there, I know that if I were a clinical psychologist I would never ever be able to see patients with eating disorders. An eating disorder never fully disappears from your life and being around patients with them would just be horrible, especially if you are not fully recovered like the original poster. In my opinion, you should be at a healthy weight and fully recovered before you begin your program, but obviously I can't tell you what to do. For the sake of being admitted, I definitely wouldn't mention it in your application, I think that is a pretty big red flag. If it had been when you were 10 years old and you were totally recovered and had done amazing things because of it, then I would mention it, but if you are still sick I think it will be really hard. If you are clearly very underweight you might get some suspicion at interviews....?
     
  5. WannaBeDrMe

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    agreed with the above poster...

    In my clinical practice, I have had to offer treatment to individuals with similar disordered thinking to my own. I don't see how anyone can escape this occurrence because no human experience is without common life themes.

    All of that being said, it needs to be stated that overall, this is a very triggering field. Avoiding a particular population entirely will be almost un avoidable bc clients do not always initially disclose their needs/symptoms at intake... a lot comes out in treatment.

    Social work ethics dictates that we refer a client to another clinician if our ability to serve in the client's best interest is impaired. I would guess psych ethics are similar and each case is handled as it arises and not with broad strokes.

    To minimally disagree with the above poster, I do feel like it is ok to self disclose about your ed... that was the purpose of our supervision. We were supposed to work through our issues... especially any counter transference or otherwise triggering crap and to learn about boundaries, limitations, and selfcare.

    In the real world, self disclosure seems to vary based on clinician but most of my co-therapists have embraced it as a tool. The key is boundaries...you aren't there to talk about you and you don't want to trigger your client... you already know that stuff though...

    I think you can be very successful with your program by minding your needs. Once you recognize a trigger, go to your supervisor, discuss, refer out, work through it, and move on. On a personal note, I too have a hx of ed and found myself surprisingly at ease working with that population despite my ongoing struggles. There was more professional separation present than I anticipated and most of my work focused on not discussing food anyway... so it was almost a non-issue. I did find myself terribly triggered by adolescent borderlines when I first began clinical work. I ended up adoring them and even running adolescent dbt for the last year... but not too many years ago I would lose my temper and tell them to ''get over it'' with no empathy, sympathy, or compassion. I dealt with it and became stronger as a clinician.

    hope this helps...typing from phone so can't really edit. sorry for any typos...thumbs are tired. be well and good luck
     
  6. WannaBeDrMe

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    and the minimally disagree was for the other poster above re...proceed with caution when talkin to a sup... I might have misunderstood...but I think disclosing to supervisors in this situation is a must if ther is any hint of doubt about level of care offered...
     
  7. erg923

    erg923 Regional Clinical Officer, Cenpatico National
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    This is your opinion as applied to yourself. It is up to the individual to make an appropriated judgment as to whether they would truly be unable to provide competent service, or if just makes them feel a little weird. You can't runaway from every patient that makes you uncomfortable.
     
  8. Therapist4Chnge

    Therapist4Chnge Neuropsych Ninja Faculty
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    I think there is a difference, as counter transference can be a HUUUUUUGE issue in this regard. The therapy is there for the patient, though if something hits too close to home, it may shift the goals and needs in the session elsewhere. I liken it to an alcoholic in recovery choosing not to work at a bar, as the surroundings may begin to feel too familiar and problems can ensue.

    I do research in the ED area, and though recovery can and does happy for many people, the ED can be a life-long tug of war, and I think it is asking for trouble to jump back in the arena for someone else's cause. I guess what I often here is that people want to go into the area once in recovery, and I think there is a part looking for more answers (for oneself) and that can cause problems. Someone in recovery can offer great insight, though I'm not sure if that outweighs the risks. Just my 2 cents.

    Btw...my comments were more towards working with the ED population as a primary population. Much like substance abuse, ED and ED-symptomatology will pop-up across populations, so I wouldn't say not to see the person, but just have an awareness of counter-transference and the like.
     
  9. blindchaos

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    I agree with the first segment to a certain extent. I'm not saying you have to avoid the ED population at all cost, but it seems like this could *potentially* be a huge trigger and/or traumatizing for you as you may likely hear about issues and "behaviors" similar to your own current and/or past issues and behaviors. This is strictly my perspective, it just seems to me like there would be a LOT of red flags to deal with should you encounter ED clients. Not saying it's impossible or anything of the sort, I would just have a number of concerns both for you and the client(s) should this situation arise.

    As to the last piece quoted, I definitely agree that if you are very underweight, it could easily arouse suspicion at interviews regardless of if questions are asked or not. I can recall one interviewee I saw who appeared to be VERY underweight and it certainly brought up questions in my mind (no idea if she was directly questioned about it or if she brought it up with anyone in the program, just my observation of N=1). There are certainly numerous reasons why someone may appear underweight (ED, non-ED medical issue, lengthy illness, thyroid condition, born very early/premie, etc) so I suppose people could jump to non-ED conclusions as well or just assume that everything is fine unless told directly otherwise (depends on the persons perspective and how underweight someone appears to be,etc).

    Anyway...that's my 2 cents :p
     
  10. paramour

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    This (Allow Experiences to Influence Research/Work Area) seems relevant.

    And somewhat off-topic: This is not directed at any one particular individual, but I am tired of witnessing people judge whether someone has an eating disorder based solely upon how they look, i.e., they "look" underweight. Not everyone who is underweight or who looks extremely thin has an eating disorder. Particularly when a careful review of the APA Code of Ethics clearly indicates that making any such diagnosis without assessment of the individual (or of the individual's records in some cases) is a violation of the Code. Goldwater Rule anyone?

    And, no, I'm not in denial. :D
     
  11. michalita

    michalita New Member
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    THANK YOU!!! :D

    I worked for a year at a residential treatment center for girls with eating disorders (mostly anorexia, some bulimia, some ED NOS) and you really can't tell by how someone looks whether or not she has an eating disorder (or *he* -- it does happen among men as well). Eating disorders are not about the weight (in terms of illness) -- it's about the behaviors and the thinking, the obsessing and compulsivity and the tendency to use behaviors to manage emotions. Some very thin women have anorexia, some do not. Bulimia is even more difficult to assess just by appearance. - which is why we don't do that.

    To the OP: I urge you to seek treatment and get to a place where you feel strong and able to cope with difficult emotions without using behaviors before pursuing this path. As with other types of hx (i.e. trauma, substance abuse, depression) it is vital to deal with your own issues before you're really able to deal with others' without overidentifying. It can really get in the way. Even if you don't specialize in treating individuals with eating disorders, there are a lot of comorbid d/o that you may be treating and it could come up -- including the three I mentioned above. :luck:
     
  12. Ollie123

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    I know what you mean by this so I don't want to nitpick, but it IS about the weight officially since you cannot be diagnosed with anorexia untl you are at 85% or less of expected body weight. That doesn't mean anyone below that level is anorexic, but you can't technically be anorexic at a normal weight.

    That being said, I bring this up not because I think you don't know this, but because I think its diagnostically stupid and I want to backhand whoever decided that should go in the DSM.
     
  13. Therapist4Chnge

    Therapist4Chnge Neuropsych Ninja Faculty
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    Obviously weight is a criteria, but I think one of the challenges is that the general public thinks ED = Anorexia, and often downplay/forget Bulimia, ED-NOS (overeating, etc). Heck, if you tell the average person that men can have an ED they may not believe you, or think that it only happens to male dancers or something.
     
  14. Ollie123

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    Also true, I was just ranting about that diagnostic criterion because it came up in one of my classes first semester, and we all thought it was stupid;)

    I'm hoping for DSM-V they give overeating its own category and don't lump it into the NOS group. Its such a common problem it seems ridiculous to not have a formal category for it.
     
  15. Therapist4Chnge

    Therapist4Chnge Neuropsych Ninja Faculty
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    That was under considering IIRC. It was either Overeating and/or Emotional Eating....I forget. ED-NOS definitely needs a bit of parsing out.
     
  16. PsychappA

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    I agree, I feel like EDNOS is such a trashbin diagnosis. The way you treat BED (binge eating disorder) is going to be way different than the way you treat someone with subthreshold AN, who doesn't meet diagnostic criteria only because she is not amennorheic. And I believe the vast majority of eating disordered patients in the typical outpatient practice, at least, fall into the EDNOS catagory. My hope is that with DSM-V BED will get it's own catagory and the amennorhea criterion will be removed from teh anorexia diagnosis. There is pretty good evidence supporting those moves and it would be a good start to parsing out EDNOS.

    If you can't tell, eating disorders are my main population of interest. :D

    To the OP: When it comes down to it, this is ultimately your decision, so I don't say this to be preachy, but I have to say I agree with other posters who suggest getting yourself as healthy as possible before applying. I think you owe it to yourself to go into the application process with your best foot forward, and with confidence in yourself, and that's hard to do when you are still struggling against something as demanding as an eating disorder. I actually decided to take an extra year myself because I was dealing with some life stresses and issues and am so glad I did because had I applied last year instead of this year, I don't think I could have handled the stress of applications/interview, and I'm not sure I would have presented myself as well. Anyway, recovery is a work in progress, and only you know when you feel solid enough to move forward, but don't be afraid to take a little extra time to take care of yourself. Just my 2 cents. :)
     
  17. RayneeDeigh

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    You don't need to disclose that kind of info, that's your private stuff. However, it's been my experience that clinical psych programs tend to feel like reaaaaally small towns. People find out everything somehow. So, that's one good reason to try to get as healthy as possible before embarking on the journey of grad school.

    Another reason is that grad school is a HUGE transition that is stressful even under the best conditions. It's kind of like a marriage, you want to make sure you're going into it as healthy as possible so you have a better chance of getting through the bumps in the road.
     
  18. PSYDR

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    i would see no reason why you would want to disclose health information until such time as it becomes a problem.


    I would especially avoid this in classes.
     
  19. michalita

    michalita New Member
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    Oh yes, I do know what the DSM says. However (and I noticed the discrepancy), the girls we treat are still dx'd with anorexia even after they achieve their "goal weight" (which is higher than just the minimual normal BMI at this particular residential). I agree... I guess they think it's not dangerous until someone is at 85% or less of their expected body weight? Just a gander but I think it's pretty silly.
     
  20. michalita

    michalita New Member
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    Agreed. Find a way to manage this in your personal life and if/when you realize it is affecting your work, do the right thing until you are better.
     
  21. michalita

    michalita New Member
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    Oh yes! On both counts...

    And how they love to talk...
     
  22. WaitingKills

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    Sounds like this poster is coming from a social work framework. Be very careful with doing this type, and this much, disclosure in a clinical psych program. It'll most likely be deemed as highly inappropriate.

    In regards to your original question (coming from someone who's in recovery), I would take time off and work on yourself until you are in a place that you can say that you are in recovery. Maybe not recovered, but in recovery, stable and at a decent weight. Grad school is extremely stressful and if you aren't in a strong enough place mentally and/or physically you could be at risk.

    I agree with the other posters to not make this an issue in your personal statement. Honestly, it's no one's business unless you want it to be their business, or if it is affecting your treatment/interaction with clients. You would not say things in your application like... that you're an alcoholic, or that you smoke, or that you randomly have sex with meaningless guys 3 times a week, or that your brother is a cocaine dealer etc... (I would hope people wouldn't either). Why would having an ED be any different? As long as you believe that you are in a healthy enough space mentally and physically, that is your private life.

    As for disclosing to supervisors about not working with ED patients while doing practicums, I tried to do this at the beginning of my degree. I would not take those clients that were known to have a full ED (eg. diagnosed), but it was impossible to avoid them all. For example, there were several times that I had people come for seemingly unrelated issues (depression, anxiety, trauma) and then the reason they came into deal with those issues was really cause they were driving their ED. Now I'm working in addictions (residential women's centre) and I'd say about 15-20% of the women that come through have some pretty significant food issues. In the job I'm in, I HAVE to work with them. Luckily I'm in a place when it doesn't really effect me anymore. I'm ok with being bigger because I am happy and know that I never truly want to go back, so the triggers aren't really there like they used to be.

    Ok, now that I've gone on and on and on, you will have to decide for yourself how you handle this. I just suggest that you take sometime and get yourself well before you try to make other's well.
     
  23. Demosthenes

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    And let's not forget that the general public think they know what anorexia "looks" like -- the extreme cases that are sometimes shown on TV, those weighing in at about 50% of normal. 85% of normal? That doesn't even look all that thin on a lot of people. Even a lot of MDs think they can identify AN by sight -- often without even looking at weight/height information on the chart.

    And normal weight bulimics are even harder to identify. Thank goodness dentists are now trained to look for signs, and next how about training them to have a little compassion when they see them.

    The working group for DSM V is looking at dropping the amenorrhea requirement, which will increase prevalence rates of AN and reduce EDNOS dxs. BED is supposed to be a new stand alone dx. And some say they're looking at doing away with weight criteria for AN -- although I don't see how they can do that.

    As for the OP, I'm in the "take care of your own needs first, get treatment first -- then decide" camp. Grad school is too stressful for someone who's trying to recover -- and that stress makes for a great excuse NOT to address your disorder. Good luck, whatever you choose to do.
     

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