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Determining whether you have or someone you love has a problem with food or weight is complicated by the fact that many people have clinically significant symptoms of an eating disorder without a full diagnosis. Although their symptoms may not reach the level of a full diagnosis, many individuals with a partial diagnosis experience symptoms that affect their functioning in school, at work, or at home, and are deserving of treatment. In fact, partial manifestations of eating disorders are more common than full diagnoses. Because certain symptoms, such as occasional purging, can eventually evolve into a full-blown eating disorder early intervention is key. Moreover, early identification and treatment of eating disorders is associated with a good chance at long-term recovery. Fortunately, there are effective treatments for various stages of illness, and one should never lose hope. Anorexia Nervosa Anorexia nervosa is a deadly psychiatric illness that, albeit rare, boasts among the highest mortality rate of any other psychological disorder. Typically anorexia nervosa begins in adolescence (age 14-18). Although many girls and women have symptoms of anorexia nervosa (diagnoses are 9-10 times more common in females than in males), only 0.05 percent actually have the illness. Among those suffering from anorexia nervosa there is a 10 percent mortality rate, of which half die from medical complications associated with starvation and half from suicide. Symptoms are typically marked by a refusal to maintain body weight at or above a minimally normal weight for age and height. This is fortified by an intense fear of gaining weight or becoming fat. The undue influence of bodyweight/shape on self-evaluation often leads to a deterioration of self-esteem as the elusive self-defined target weight continues to plummet over the course of illness. For many individuals with anorexia nervosa, emaciation is a result of severe weight loss; however, young children with the disorder may simply stop gaining normal amounts of weight as they grow. Symptoms of anorexia nervosa include:
A subtype of anorexia nervosa is marked by episodes of foregoing stringent self-control and binge eating. Self-imposed repercussions may include self-induced vomiting or misuse of laxatives and diuretics. Physiological complications of anorexia nervosa, although frequently reversible (with appropriate intervention), often lead to hospitalization and can be fatal. These include:
Psychological problems, including depression and anxiety, are often found in individuals who are underweight and can manifest in a variety of ways such as social withdrawal, irritability, and insomnia. Effective interventions for anorexia nervosa include cognitive behavioral therapy and family-based treatment.The outcome of treatment for anorexia nervosa varies considerably. For some, a single course of treatment is effective, while other recovery paths are punctuated by shifts from weight gain and recovery to weight loss and relapse.
Bulimia Nervosa usually begins in late adolescence or early adulthood. Approximately 1 to 3 percent of adolescents and young adults develop bulimia nervosa, of which 90 percent are female. Bulimia nervosa is marked by a vicious cycle of extreme dieting, consequent uncontrolled episodes of overeating (binge eating), and extreme measures to prevent weight gain (e.g., fasting and/or purging). Although, like anorexic patients, individuals with bulimia nervosa suffer from concerns with body image, they tend to maintain a normal weight. Symptoms of bulimia nervosa include:
Bulimia nervosa includes a variety of medical complications that, although severe, are reversible with appropriate treatment. Symptoms can include:
Many individuals with bulimia nervosa also suffer from a variety of psychological problems including anxiety and depression. Effective interventions for bulimia nervosa include cognitive behavioral therapy and family-based treatment. The outcome of treatment for bulimia nervosa varies; some individuals have the illness for a long period of time while others alternate between recovery and intermittent binge eating and purging. Research however does show that over time symptoms appear to diminish. Binge Eating Disorder Binge eating disorder affects approximately 0.7-4.0 percent of the population, and is frequently associated with obesity. Binge eating disorder is marked by recurrent episodes of uncontrolled consumption of large amounts of food (binge eating); however, in contrast to bulimia nervosa, there is no inappropriate compensatory behavior (such as self-induced vomiting). In a culture preoccupied with thinness, the near-inevitable weight gain associated with binge eating triggers a great deal of anxiety that in turn can set off a cycle of dieting and overeating. Binge eating is associated with an array of behaviors, including:
Binge eating can lead to obesity and severe medical complications such as heart problems and diabetes. Binge eating disorder can also be associated with psychological problems such as depression. There are a variety of effective treatments for binge eating disorder, including cognitive-behavioral therapy. These interventions help reduce or eliminate binge eating, but often additional techniques, such as those found in the LEARN® Program, are necessary to produce desired weight loss. Obesity For adults, obesity is defined as having a body mass index (or BMI-a measurement calculated by dividing weight in kilograms by height in meters squared) equal to or exceeding a value of 30. For children and adolescents, for whom healthy BMI varies by age, obesity is defined as a BMI above the 95th percentile for the age range in question. The Centers for Disease Control and Prevention report that, among adults, rates of obesity have doubled to nearly 30% in the last two decades. This trend has not spared the younger population. Across the age spectrum, obesity can lead to several serious medical conditions, including diabetes, heart disease, and sleep apnea. Moreover, while overweight status has become the norm for this society, its negative social stigma remains strong, and obese individuals often suffer from this prejudice. The clinical and research communities are in an ongoing search for the ever-elusive cure for obesity. Studies show, however, that for children and adolescents, effective treatment involves the family, particularly parents, in the weight loss process. For adults the LEARN® Program can help establish gradual and sustainable weight loss. Calculate your body mass index or BMI Special Populations Males: Although research suggests that a majority of those who suffer from eating disorders are female, a growing number of boys and men also experience eating disorder symptoms. However, the symptoms may take different forms among males, such as a desire for increased muscle mass and decreased body fat, or work to achieve a "ripped" physique. These symptoms may be associated with significant distress, use or abuse of a range of drugs or substances designed to control appearance, and excessive or compulsive forms of exercise. Males are also likely to experience two unique types of stigma because of their symptoms, including: (1) stigma associated with having an eating disorder, and (2) stigma related to being diagnosed with a disorder considered to be a "female" problem. In some instances, males may take anabolic-androgenic steroids, thyroid hormones, over-the-counter stimulants, non-steroidal anabolics (e.g., human growth hormone), and a range of other legal and illegal substances (termed "Appearance-and-Performance-Enhancing Drug Use) in order to achieve certain bodily ideal. While most media accounts of this form of drug use would suggest that they are used primarily for the goal of improved performance, most survey data suggests that males and females are primarily using these drugs to affect appearance. Use of these drugs is often medically unsupervised and can potentially lead to a range of negative psychological and physiological effects. Most dangerous are the mood effects which may include anger, depression, aggressiveness, irritability, and in some cases mania or the acute and long-term effects on cardiac function related to both steroids and stimulant use. Although little research exists on treatment of males with eating and body image based disorders, our clinic is committed to providing treatment for this growing problem. In particular, we have adopted existing treatments that work for women with eating disorders to address potential gender differences. Our clinic can offer experts in both the treatment of male body image and appearance and performance enhancing drug use. Athletes & Performers: Certain groups are prone to experiencing problems with eating, weight, and body image including individuals involved with athletics and other performance based professions or hobbies. Individuals from these groups appear to be at higher risk for developing either sub-threshold or full syndrome eating disorders. In many cases, setting appropriate treatment goals for individuals who also participate in athletics or performance arts can be complicated by fears that changes in eating, shape, or weight control will negatively impact the ability to compete or perform. For the majority of patients, our clinicians will work with identified coaches, sports medicine doctors, athletic departments, or other relevant individuals to offer a comprehensive team approach to the eating and weight related issues in efforts to return the individual to full participation in his or her identified sport/profession. In some cases, this may not be in the best interests of the client, and our treatment will also focus on the transition form athlete/performer to an identity that supports his/her long-term health and success. Upon restoration of athletic/performer roles, individuals may also participate in performance specific counseling. This may be as simple as providing feedback on mental skills based on an evaluation or as comprehensive as treatment for performance anxiety or injury rehabilitiation. |
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Against the backdrop of a culture that idealizes thinness, eating disorders are often initiated by seemingly innocent dieting, and depending on the above-mentioned factors, can ultimately evolve into chronically disordered eating. However, the relationship is not a simple one: initially, for example, a young woman with anorexia nervosa may be inspired by an ideal of thinness, yet admittedly becomes divorced from the issue of aesthetics as the illness progresses. Similarly, to conclude that dieting causes eating disorders is too narrow an explanation. |
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Fortunately, there are effective treatments for eating and weight disorders. Each patient we work with at the Mount Sinai program has a customized treatment plan modeled around the type and severity of the disorder, the stage of life (childhood, adolescence, or adulthood), and the existence of accompanying conditions, such as depression and anxiety. While gaining or losing the required weight is crucial as the starting point, the ultimate goal is to address the underlying behaviors and thinking patterns so as to prevent relapse. Family
therapy is a
highly effective treatment traditionally used among adolescents with anorexia
nervosa, and is now being used successfully among adolescents with bulimia nervosa. Parental involvement is also effective
in helping children and adolescents with obesity lose
weight. The success of family-based treatment in anorexia nervosa is
reflected in research demonstrating resolution of self-starvation, high
retention rates, and impressively low relapse rates. For example, one study
from the The Mount Sinai Eating and Weight Disorders Program uses a particular type of family-based therapy: the Maudsley approach, which includes techniques specifically designed to address eating problems. The emphasis is on the importance of the family as a vital component in the treatment process, rather than on the emotional roots of the disorder. Except in cases where the patient is in immediate medical danger, this treatment is administered on an outpatient basis and therefore avoids or limits the need for hospitalization. The Maudsley method consists of approximately 20 sessions, divided into three phases:
Cognitive-Behavioral Therapy (CBT) is a treatment that addresses the interplay between thoughts, feelings and behaviors as they contribute to the symptoms of eating disorders. Typically patients attend therapy individually but family members can be included as deemed appropriate (e.g., with adolescents). CBT works on the assumption that an individual has at least some control over thinking and behavior, but that emotions are relatively difficult to change quickly. Given that most individuals enter treatment to change how they feel, CBT targets thinking and behavior patterns in attempt to create an altered and stable change in affect which carries with it protection against relapse into prior eating disorder patterns. The particular type of CBT employed in our program is based on recent advancements in the field which have increased the scope of problems targeted in treatment. This form of CBT, referred to as CBT-Enhanced by its developers in the UK (see C.G. Fairburn (2008) Cognitive Behavior Therapy and Eating Disorders. Guilford Press, NY) targets core eating disorder pathology as well as other maintaining factors. These factors include clinical perfectionism, core low-self esteem, interpersonal problems, and difficulty tolerating changes in mood. Depending upon the individual, any or all of these additional areas may be addressed using CBT. The clinical recommendations and thus the typical course of treatment using CBT-E would be: The basic CBT-E model has four distinct stages:
These recommendations are independent of the eating disorder diagnosis (e.g., bulimia nervosa versus binge eating disorder versus anorexia nervosa). We stress that these are simply guidelines and treatment may take more or less than the recommended period of time depending upon the specific needs of the individual or family. However, we believe these guidelines are useful in determining an individual’s readiness to engage in treatment and are part of our commitment to keeping clients informed of the therapy process. Research has persistently demonstrated the effectiveness of CBT for bulimia nervosa, binge eating disorders, and other eating disorders. Our treatment approach builds upon these empirically supported treatments and extends it to the clinical realm where we can meet the needs of our clients. For instance, clients who wish to continue in treatment beyond the typical 20 or 40 sessions are welcomed depending upon the needs of the individual. The LEARN® Program addresses binge eating disorder and obesity and uses a collaborative, psychoeducational model of treatment which can be conducted as group or individual sessions. Meetings alternate short periods of didactic instruction with periods of discussion and problem-solving. LEARN is an acronym that represents the five essential components of the program: Lifestyle, Exercise, Attitudes, Relationships, and Nutrition. The five areas of the program complement each other, with an overriding purpose of making lifestyle changes that will support weight loss and maintenance. Each content area (exercise, nutrition, thinking, relationships) is taught with an emphasis on establishing gradual, sustainable, and permanent changes in the way individuals interact with the environment (and the food and physical activity aspects of the environment in particular). Relapse prevention is also addressed in the program. A special emphasis is placed on managing the environmental triggers to overeating and helping to reduce blame and stigma associated with weight status. The overall goal of this emphasis is to have each individual engage in healthy participation in his/her environment and to take the opportunity to change the environment when possible to support their individual and community’s overall health. As an add on to the LEARN program and in cases where there is evidence of strong physiological or emotional responses to food our group will use specific strategies developed from the substance abuse field to manage these cravings. This strategy is applied in a specific module termed “cue exposure” whereby we train individuals to maintain behavioral regulation in response to strong triggers, whether this be food, emotions, situations, or other specific circumstances. This may involve putting oneself in these situations or exposing oneself to these cues repeatedly until the psychological/emotional response is extinguished.
Treatment is essential because eating disorders have a negative impact on psychological, social, and physiological functioning, and can even be life-threatening. In anorexia nervosa, the mortality rate is as high as 10%. Importantly, many of these complications are reversible with appropriate treatment. If left untreated, eating disorders can lead to:
Eating
disorders are often accompanied by psychological problems including
depression and anxiety which can be compounded by negative self-image and low
self-esteem. |
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The model for our clinical research program is to focus on the clinical phenomenon common to the clinical populations we treat and to approach scientific inquiry with three primary goals. (1) to understand the nuerobiological mechanisms that underlie clinical phenomenon, (2) to develop, test, and evaluate cutting edge treatments for individuals with eating, weight, and body image problems, and (3) to disseminate empirically supported treatments for these populations to the community through training, suppervision, and education. Anorexia Nervosa and Associated Illness One persistant question that remains about family therapy for this disorder is “why does it work”. Our group is intested in particular to study the mechanisms by which Family Therapy works compared to other treatments. We hope that this avenue of research will help us improve treatments and be more efficient in determining for whom different interventions (Family Therapy vs. Hospitalization vs. Individual Therapy etc.). Our extended research goals with this population are to determine the impact of gonadal hormones (e.g., estrogen vs. testosterone) and their metabolites on existing symptomology as well as to link this mechanism to the development and maintenance of these core eating disturbances. Bulimia Nervosa and Binge Eating Disorder Another interest of ours is pursuing the mood related disturbances found among men and women with these disorders. In particular, we are interested in how the brain processes emotional information and if there are certain commorbid personality characteristics that contribute to differences in emotional processing. Body Image and Related Areas of Disturbance We are also interested in developing a better neurobiological understanding of the experience of body image disturbance. While some degree of this is socially and culuturally determined, there appear to be a smaller few who develop severe and persistant disturbances around their appearance. Our group hopes to identify some of the nuerobiological vulnerabilities to as well as behavioral consequences of these body image disturbances. One component of body image that our group is particularly interested in studying is physical attractiveness. Linked to evolutionary and sociocultural theory, attractiveness plays a complex role in our day to day life. Among the many questions that we are currenlty researching are the presence of specific attractiveness standards among different audiences (e.g., heterosexual vs. gay, etc.) and how these standards are communicated in mass media. We are also interested in the social role of attractiveness, the ways in which males and females purposefully decieve each other about their appearance, and the impact of these social interactions on the development of body image problems. Appearance and Performance Enhancing Drug Use (e.g., Anabolic Steroids) We are currently developing a research interview designed to reliably assess the experiences of individuals who take these substances. Within this project, we also seek to understand if there are gender differences in the types, patterns, and consequences of APED use. Furthermore, we would like to know if certain patterns yeild specific consequences such as improved mood and self-esteem as well as less desirable effects such as aggression or impulsivity. In addition to developing appropriate assessment tools, we also are interested in developing a better understanding of the endocrinological impact of this form of drug use and how changes in amont these hormones affect certain behaviors. The results of this research we hope to help us better understand the role of gonadal hormones on mood, but also where the potential for damaging effects of these drugs exists. Finally, we are interested in the development of APED use among high risk individuals. The most common age of onset for most APED users exists in young adulthood. We are interested in knowing what leads to atypical onset such as high school or late adulthood. We also interested in determining if early or late onset use results in different levels of risk. Our Commitment to our Research Participants Study Treatments as Part of Research |
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First, it is important to know that frequently, individuals with eating disorders resist the idea of help. This may be a function of shame, denial, and/or concern that treatment will trigger uncontrollable weight gain. If you are the parent of a child or adolescent with symptoms of anorexia nervosa or bulimia nervosa, you may need to mobilize treatment efforts without your child's complete cooperation. Statements such as "Because I love you, I want to find the help you need, even if that makes you angry," convey a message that blends firmness with kindness. Attempts to make your child as worried about him- or herself as you are (e.g., "Can't you see how thin you are?!") will likely fail. If you are the friend of a person with an eating disorder, first try addressing the problem directly with your friend, in private, specifying the behaviors about which you are concerned. If your friend is a child or adolescent, it may be appropriate to share your concerns with an adult, such as a teacher, school counselor, or parent. Remember, eating disorders are life-threatening illnesses. |
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Tom Hildebrandt, Psy.D. is the Director of the Eating and Weight Disorders Program at Mount Sinai and Assistant Professor of Psychiatry at the Mount Sinai School of Medicine. He completed his graduate training at Rutgers University and his post-doctoral fellowship in Eating Disorders at the Mount Sinai School of Medicine. He is currently oversees the development and execution of both the clinical and research programs. Dr. Hildebrandt’s research interests and clinical expertise include men with eating disorders, cognitive-behavioral therapy, Maudsley Family Therapy, behavioral weight loss treatment, and treatment of body image disturbances. Dr. Hildebrandt has stressed the applied nature of clinical research throughout his career and believes that this requires meeting the individual needs of a client while using existing research as a guideline to inform this process. Dr. Hildebrandt has co-authored many publications and presentations on body image, eating disorders, and obesity, and is the co-chair of the Male Special Interest Group and Special Interest Group Oversight Committee for the Academy for Eating Disorders. Selected recent publications include: Eating Disorders Hildebrandt, T., & Alfano, L. (in press). A review of men and boys with eating disorders: Working towards an empirically derived diagnostic system. International Journal of Child and Adolescent Health. Loeb, K. L., Hirsch, A., Greif, R., & Hildebrandt, T. (in press). Family-based treatment of a 17 year old twin presenting with prodromal anorexia nervosa: A case study using the Maudsely method. Journal of Child and Adolescent Psychiatry. Sysko, R., Hildebrandt, T., & Wilson, G. T. (in press). Cognitive-behavioral therapy for individuals with bulimia nervosa and a co-occurring substance use disorder. European Eating Disorders Review. Penas-Lledo, E. M., Loeb, K. L., Puerto, R., Hildebrandt, T., & Llenera, A. (2008). Subtyping undergraduate women along dietary restraint and negative affect. Appetite, 51(3), 727-730. Latner, J., Hildebrandt, T., Roswell, J. K., Chisholm, A. & Hayashi, K. (2007). Loss of control over eating reflects eating disturbances and general psychopathology. Behavior Research and Therapy, 45, 2203-2211. Hildebrandt, T., & Latner, J. (2006). Response of binge eating to self-monitoring: Does binge drift occur? European Eating Disorders Review, 14, 17-22. Body Image Hildebrandt, T., Shiovitz, R., Alfano, L., && Greif, R. (2008). Defining body deception and its role in social comparison theories of body dissatisfaction. Body Image: An international Journal of Research, 5 (3), 299-306. Hildebrandt, T., & Latner, J. D. (2008). The roles of stereotypes and group norms on perceptions of bodily attractiveness. In V. Swami & A. Furnham (Eds.), Body Beautiful: Evolutionary and Socio-cultural Perspectives. London: Palgrave McMillan. Hildebrandt, T. & Walker, D. C. (2006). Evidence that ideal and attractive bodies represent different constructs: A replication and extension of Fingeret, Gleaves, and Pearson (2004). Body Image: An International Journal of Research, 3, 173-182. Hildebrandt, T. (2005). A review of eating disorders in athletes: Recommendations for secondary school prevention and intervention programs. Journal of Applied School Psychology, 21, 145-167. Anabolic Steroids and Appearance and Performance Enhancing Drug use Langenbucher, J., Hildebrandt, T., & Carr, S. (2008). Medical consequences of anabolic-androgenic steroid use. In J. Brick (Ed.), Handbook of Medical Consequences of Drug Abuse. Hawthorn Press: Binghamton, NY. Hildebrandt, T., Langenbucher, J., Carr, S., & Sanjuan, P. (2007). Modeling population heterogeneity in appearance and performance enhancing drugs (APED) use: Applications of mixture modeling in 400 regular APED users. Journal of Abnormal Psychology, 116, 717-733. McCreary, D., Hildebrandt, T., Heinberg, L. J., Boroughs, M., & Thompson, J.K. (2007). A review of body image influences on men’s fitness goals and supplement use. American Journal of Men’s Health, 1, 307-316. Hildebrandt, T., Langenbucher, J., Carr, S., Sanjuan, P., Roth, S., & Park, S. (2006). Predicting short-term versus long-term Intentions for anabolic-androgenic steroid use: A covariance structure model. Psychology of Addictive Behaviors, 20, 234-240. Hildebrandt, T., Schlundt, D., Langenbucher, J., & Chung, T. (2006). Presence of muscle dysmorphia symptomology among male weightlifters. Comprehensive Psychiatry, 47, 127-135.
Dr. Loeb's current research interests include the early identification and treatment of eating disorders; the Maudsley method, an innovative family-based intervention for adolescents with eating and weight disorders; and pediatric obesity. She has co-authored many publications and presentations on anorexia nervosa, bulimia nervosa, binge eating disorder, and obesity, and has served as Co-Chair of the Eating Disorders Workgroup for the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR). Selected recent publications include: Loeb, K.L., Wilson, G.T., Pratt, E.M., Hayaki, J., Labouvie, E., Walsh, B.T., Agras, W.S., & Fairburn, C.G. (2005) Therapeutic alliance and treatment adherence in two interventions for bulimia nervosa: A study of process and outcome. Journal of Consulting and Clinical Psychology, 73, 1097-1107. Le Grange, D., Binford, R., & Loeb, K.L. (2005) Manualized family based treatment for adolescent anorexia nervosa: A case series. Journal of the American Academy of Child and Adolescent Psychiatry 44, 41-46. Wolk, S., Loeb, K.L., & Walsh, B.T. (2005) Assessment of patients with anorexia nervosa: Interview versus self-report. International Journal of Eating Disorders, 37, 92-99. Le Grange, D., Loeb, K.L., Van Orman, S., & Jellar, C.C. (2004). Bulimia Nervosa in Adolescents. Archives of Pediatrics Adolescent Medicine, 158, 478-482. Pike, K.M., Devlin, M.J., & Loeb, K.L. (2003). Cognitive behavioral therapy in the treatment of eating disorders. In J.K. Thompson (Ed.), Handbook of eating disorders and obesity. Washington, DC: American Psychological Association Press. Wilson, G.T., Vitousek, K., & Loeb, K.L. (2000). Stepped care for eating disorders. Journal of Consulting and Clinical Psychology, 68, 564-572. Loeb, K.L., Wilson, G.T., Gilbert, J.S., & Labouvie, E. (2000). Guided and unguided self-help for binge eating. Behaviour Research and Therapy, 38, 259-272.
Dr. Bacow, a Brown University graduate, received her doctorate in Clinical Psychology from Boston University. There, Dr. Bacow trained under David Barlow at the Center for Anxiety and Related Disorders, well-known for assisting individuals with a range of anxiety and mood disorders. Dr. Bacow completed her internship in clinical psychology at Long Island Jewish Medical Center on the Child and Adolescent Track, providing clinical services in several outpatient and inpatient rotations. Not only is Dr. Bacow considered an expert in working with children, adolescents and families, but also has therapeutic experience with adults, and her specialties include cognitive-behavioral therapy for mood, anxiety, and eating disorders. Her experience in treating clients with eating disorders include her time as a therapist in Eating Disorders Service for adolescents at LIJMC and in the Eating Disorders Program at Boston University working with college students. Bacow recently joined the faculty in the Eating and Weight Disorders Program at the Mount Sinai School of Medicine. She is a clinician for several grant-supported treatment studies examining interventions for anorexia nervosa and pediatric obesity. Her research includes investigating factors that contribute to the effectiveness of eating disorders treatment in youth, and she has published several papers related to child and adolescent issues. Dr. Bacow is a practicing clinical psychologist committed to utilizing treatments with supported efficacy with individuals of all ages, such as cognitive-behavioral therapy, schema therapy and family therapy. Dr. Bacow has also been a special lecturer for psychiatry residents at Mount Sinai in cognitive-behavioral therapy, and is recognized as one of few experts qualified to teach cognitive-behavioral therapy across the age spectrum. Click here to locate other specialists: Find a Doctor. |
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At Mount Sinai The Adolescent Health Center (AHC) Women's Health Services at Mount Sinai Further Reading Fairburn, C.G. (1997). Overcoming Binge Eating. New York, NY: Guilford Press. Lock, J., & Le Grange, D. (2005). Help Your Teenager Beat an Eating Disorder. New York, NY: Guilford Press. |
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To learn more about our services or to schedule an appointment, please contact us: Phone:
212-659-8724 e-mail: lauren.alfano@mssm.edu Click here for directions to Mount Sinai and a map. |
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