Yellowbrick provides an Intensive Outpatient Eating Disorder Service for emerging adults within the Chicago area and from across the nation who suffer from Anorexia Nervosa, Bulimia Nervosa, and atypical eating disorder syndromes including some cases of Binge Eating Disorder. Yellowbrick is not a primary weight loss or obesity treatment center though we are skilled at managing weight loss and/or obesity as it presents with other psychiatric conditions. As the Eating Disorder Service is embedded in an intensive psychiatric treatment center, co-morbid psychiatric disorders and substance abuse in addition to the eating disorder can be addressed and treated within Yellowbrick.
Jesse Viner, MD (Medical Director), and Laura Viner, PhD (Director of The Assessment Center and Research & Training) are recognized national experts in eating disorders. Drs. Viner, and Director of The Residence Pam Tansey, RN, LCSW (licensed nurse/social worker), each have over 25 years of clinical experience with eating disorder patients. Registered Dietician Ilene Wynn RD, LD and Certified Art Therapist Betty Wolff MA, ATR each have worked with Dr. Jesse Viner for over 15 years. Craig Johnson, PhD, Chief Clinical Officer of Eating Recovery Center of Denver and Michael Strober, PhD, Director of the UCLA Eating Disorder Program and Editor of the International Journal of Eating Disorders, both international expert on eating disorders, are on the Yellowbrick Board of Advisors as consultants to the development of the eating Disorder Service.
Patients seeking treatment within the Eating Disorder Service are seen in consultation by a team of senior clinicians.. For all emerging adults, and occasionally spouses, Yellowbrick staff conducts a collateral family evaluation. A baseline nutritional assessment is established by Registered Dietician Ilene Wynn RD, LD. A comprehensive psychiatric evaluation is completed by Yellowbrick’s Staff Psychiatrist David Hamilton, MD. Consultation with the patient’s family physician and previous therapist is included. Previous testing and medical records are reviewed as available and psychological testing is performed as indicated. Patients are required to participate in written assessments evaluating their eating disorder, psychiatric and substance abuse difficulties. Daily journal logs of nutrition, activity and emotional experiences are integrated into the evaluation.
The Assessment Team, co-chaired by Drs. Viner, reviews and integrates the assessments and arrives at a diagnosis and treatment recommendations. These are discussed in a conference involving senior Yellowbrick staff, expert consultants as needed, the patient, and parents/spouse as indicated. Eating disorder, psychiatric and substance abuse diagnoses are presented along with an individualized treatment plan often combining multiple services.
Patients persistently unable to sustain supported meals for which family support is either not available or not indicated are referred to Evanston North Shore University Health System Eating Disorder Center. Patients, who are medically at risk, in severe denial, chaotically dysregulated, addicted to laxatives or without adequate social/family support are referred to supported apartment treatment centers with follow up by Yellowbrick upon discharge.
Dr. Jesse Viner, Dr. David Hamilton and Pam Tansey, RN, LCSW will assume certain aspects of medical evaluation and treatment, while collaborating with the patient’s personal physician. Yellowbrick also has a contractual relationship with Jeff Geohaus, MD, an internist at Evanston Hospital, an affiliate of the University of Chicago Medical School.. An initial evaluation includes a physical exam, complete blood count and chemistries/electrolytes, thyroid profile, hormone levels, lipid profile, urine analysis, toxicology screen and bone density scan. Patients who have ceased menstruating and/or demonstrate bone density loss are encouraged to begin calcium and hormone replacement. Patients who have reported vomiting blood are referred for endoscopy. Patients who vomit regularly are referred for dental evaluation.
Recovery is most often enhanced when patients journal their nutrition, activity and emotions. This assists the internalization of mindful connectedness and centering. These are reviewed individually within consultations with the dietitian, and with peers in the Goals and Strategies Dinner Group. Patients are weighed weekly. Weight restoration is defined as 95% of individually determined maintenance weight, as this also is associated with greater enduring recovery as well as improved fertility.
Weight restoration is achieved by collaboratively creating a stable structure for eating, broadening choices for comprehensive constituent nutrients and increasing calories in a challenging but not traumatic experience which builds confidence. Activity plans are formulated and strategies for tolerating disruptive experiences are developed.
Yellowbrick Eating Disorder staff and the patient will determine both goals and the pace to reach them, including minimum weight thresholds. The course of each patient and the functioning of the peer group within the Eating Disorder Service are followed in Rounds co-chaired by Associate Medical Director David Hamilton, MD. on a bi-weekly basis. Inability to meet goals and/or trespassing thresholds will trigger a conference within which alternative treatment strategies including referral will be considered. Weight restoration is considered a required yet insufficient component of an enduring recovery. Since lowered weight and nutrition impairs brain function and stimulates anxiety, insomnia and mood instability, weight restoration to a minimum of a BMI of 18.5 is seen as a priority early goal in treatment.
Persistence of behaviors such as restricting nutrition, food avoidance, feeding others, bingeing, vomiting, compulsive exercise, use of laxatives, diuretics and stimulants, social isolation and deception all contribute to sustaining the eating disorder illness. Research demonstrates continuation of these behaviors is correlated with poorer prognosis. Behavioral analysis attempts to identify which behaviors are central to the life of the eating disorder, with the subsequent negotiation of evolving different modes of adaptation which includes modifying existing patterns as well as introducing new strategies that compensate for the functions and satisfactions lost as the eating disorder behaviors are minimized. Yellowbrick’s staff collaborates in group to develop ED relapse prevention plans with all group members and these are followed up weekly with Ilene Wynn RD.
Eating disorders represent a maladaptive effort to cope with a troubled emotional life. Each individual’s troubles have roots and evolve from their unique genetic, biological, familial and personal contributions. Individual, family and group psychotherapies within the context of a supportive recovering community offer a safe, secure and affirming environment within which there is opportunity for personal reflection, exploration, struggle, and growth. Due to the entrenched, often chronic, presentation of an eating disorder, it is frequently necessary to provide intensive psychotherapy several times a week in multiple formats. Identification of core struggles and the assistance Yellowbrick provides enables patients to live through and beyond their struggles, bringing the deepest assurance of recovery, relapse prevention and the fulfillment of authentic personal ambitions and desires.
Family treatment is often necessary and helpful to address complications to the family of the eating disorder, support recovery and prevent relapse through addressing troubled family relationships, which interferes with facilitating emerging adult development.
EATING DISORDER GROUP PROGRAM
Research has clearly established the powerful value of group therapy for eating disorders. Due to anxiety, shame, the loss of perceived uniqueness and the threat of recovery, many patients struggle with the recommendation for group therapy. Once begun, however, patients come to appreciate the unique support that only peers with similar experience can offer. This often allows for a more honest and deep personal reflection. Patients visualize their eating disorder in action and how it affects relationships and other commitments. Groups offer the opportunity to witness others who have progressed in recovery, thus offering encouragement and hope.
The Eating Disorder Group Program requires a four-month commitment and insists upon absolute confidentiality. Patients may enroll in the Eating Disorder Group Program while receiving treatment services from other professionals in the surrounding community and Chicago area.
The Eating Disorder Group Program meets Thursdays in the late afternoon from 4:00-7:15 pm with the following format:
Parents as Partners Weekend (once every other odd numbered month)
Parents as Partners (every other odd numbered month)
Summary Of Eating Disorder Services
At Yellowbrick, emerging adults find their way home.
For more information, please contact Yellowbrick at 866.364.2300.