Q&A with Cris E. Haltom

Cris E. Haltom is the author, with Cathie Simpson and Mary Tantillo, of the new book Understanding Teen Eating Disorders: Warning Signs, Treatment Options, and Stories of Courage. She also has written A Stranger at the Table: Dealing with Your Child's Eating Disorder. A Certified Eating Disorders Specialist and a lecturer at Ithaca College, she's based in Ithaca, New York.

Q: Why did you and your colleagues decide to write this book about teen eating disorders?

A: We chose to write about teens with eating disorders because they continue to be an under-served population. Despite excellent new evidence-based treatments and prevention programs, rates of eating disorders have changed very little in the past two decades.

While the rate of full-blown eating disorders among teens remains at approximately 5-6 percent, more recent evidence indicates closer to 20 percent of teens engage in disordered eating behaviors like dieting, vomiting, and binge eating on a regular basis, posing significant risks to their health. 

Recent research indicates only one in five adolescents with eating disorders actually seek and receive treatment specifically for an eating disorder. 

The majority of eating disorders start in adolescence so early intervention is critical. Eating disorders tend to be a major threat to health with a relatively high mortality rate. And they tend to be enduring and difficult and costly to treat. As such they are a public health burden.

By writing our book, we hope to spread the word about the dangers of eating disorders and the importance of receiving evidence-based, multi-disciplinary treatment. 

Q: Who do you see as the audience for the book, and what do you hope readers take away from it?

A: Our book is directed toward both families and multi-disciplinary treatment professionals in order to promote evidence-based treatments for adolescent eating disorders and specialty training for clinicians. 

We recognize one size doesn't fit all when it comes to specialty treatment so we offer a look at a number of treatment options in the context of a variety of family circumstances.

Each chapter ends with a Q and A that reflects typical concerns of parents, loved ones and treatment professionals. It is our hope that carers of those with eating disorders will walk away inspired and motivated by the many treatment options and prevention strategies described in our book.   

Q: Most of the case studies you discuss involve girls. What are the statistics on girls and boys developing eating disorders?

A: This is a great question because recent evidence supports the notion that eating disorders occur across sex and gender-identity groups.  

Our book's case studies reflect the nature of our own cumulative clinical cases. They are not necessarily representative of national statistics about the sex and gender of teens with eating disorders. 

Old data suggested that the ratio of eating disorders in men compared to women was between 1:10 and 1:6.  However, more recent data suggests men and boys are less likely to be discovered to be ill, included by health care professionals, and less likely to come forward for treatment when compared to women.  

A better estimate for the rate of eating disorders among men compared to women is probably closer to 1:4. Further, when we broaden the definition of eating disorders to include sub-clinical eating disordered behaviors such as engaging in patterns of dieting, vomiting, using laxatives and diet pills to control weight, the National Eating Disorders Association estimates the rate of disordered eating may be similar for men and women.

When addressing sex and gender and eating disorders, we would be remiss not to point out statistics for eating disorders in a special population of transgendered youth. Recently, transgendered college students were found to be roughly four times as likely to report eating disorders as their cisgendered counterparts. 

Q: How did you choose the particular cases on which you focus in the book?

A: We chose cases that represent experiences and approaches consistent with adolescent eating disorder literature and our own clinical experiences. 

We selected cases that were rich with a variety of interpersonal and family dynamics, heritability factors, life stage variables, personality factors, motivational factors, medical issues, psychiatric co-morbidities and social-cultural influences.

In other words, we wanted a representative sample of varied biopsychosocial patient backgrounds combined with a diversity of best practices in child and adolescent eating disorder assessment, diagnosis and treatments options.

Q: What are you working on now?

A: I am currently working on an article tentatively entitled "Getting teens with eating disorders to specialty-trained treatment". 

This article was inspired by an alarming finding cited in our book - that is, only 20 percent of adolescents with eating disorders seek eating disorder-specific treatment.

I am reviewing a number of topics related to treatment-seeking including assessment and screening for teen eating disorders by health care professionals, public literacy about eating disorders and their treatment, availability and accessibility of eating disorder treatment, barriers to treatment such as societal stigma against both the diagnoses and treatment, motivation for treatment including attitudes toward treatment, and the role of co-morbidities in treatment-seeking.  

Dr. Mary Tantillo has extended and refined the Multifamily Therapy Group presented in our book and will soon be writing a new book, Multifamily Therapy Group for Young Adults with Anorexia Nervosa: Reconnecting for Recovery.

Her upcoming book targets clinicians and describes a new and innovative approach to treatment for young adults with Anorexia Nervosa. Multifamily Therapy Group’s innovation comes from its reframing eating disorders as Diseases of Disconnection.

The group model, described in Nick's story in our book, was developed in partnership with patients and families over a decade and is based on relational and motivational theories, research and clinical observation.

In this model, the group teaches patients and families that Anorexia Nervosa is characterized by intra- and interpersonal disconnections and that these disconnections can perpetuate the illness and obstruct recovery. The goal of group meetings is to identify these disconnections, repair them and restore connection with oneself and others.

Multifamily Therapy Group for Young Adults with Anorexia Nervosa: Reconnecting for Recovery will promote emotional and relational skills that foster relational repair and reconnection with the self and others.

Dr. Tantillo's book will include protocols, case vignettes, and other information that translate theory and research into practice, all things that are invaluable for clinicians.

She points out the majority of training programs across disciplines do not train professionals on multifamily therapy group, and Multifamily Therapy Group is not routinely included in family training.

Having accessible, practical and clinically relevant information available in a book of this type should be very helpful to clinicians. Many professionals are uncertain about what treatment to offer young adults/adults with Anorexia Nervosa because there is no definitive treatment yet.

Dr. Tantillo's new book provides an effective treatment option and one that can serve as an excellent adjunct treatment to individual or family therapy. Her book will remind us of the power of family work and the resources families bring to bear on treatment and recovery.

Q: Anything else we should know?

A: There are promising new treatments for teen eating disorders on the horizon related to the neuroscience of eating disorders, e.g., deep brain stimulation and cognitive training therapies.

We know the brain circuits of those with eating disorders don't work effectively. New treatments informed by recent scientific discoveries about the neurobiology of eating disorders may increase treatment effectiveness when added or adapted to more established treatment models described in our book. 

--Interview with Deborah Kalb