Passing your National Licensing Exam
Getting licensed can open up incredible opportunities, but the exam can seem daunting. Our podcasts make passing more achievable and even fun. Dr Hutchinson and Stacy’s energy and passion for this content will get you motivated and confident.
We break things down in understandable ways - no stuffiness or complexity and focus on the critical parts you need so your valuable study time counts. You’ll come away feeling like, “I can do this!” Whether it’s nailing down diagnoses, theoretical approaches, or applying ethics in challenging situations, we help you get into a licensed mindset. Knowledge domains we cover in these podcasts include:
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Passing your National Licensing Exam
The Nuances of Eating Disorders: A Clinical Guide for Exam Preparation
Navigating the complex landscape of eating disorders requires precision and clarity, especially when preparing for licensure exams or working with clients. Dr. Linton Hutchinson and Eric Twachman deliver a masterclass in distinguishing between different eating disorders, offering essential knowledge that both clarifies exam material and enhances clinical practice.
We journey through the distinct worlds of anorexia nervosa, bulimia nervosa, binge eating disorder, and avoidant restrictive food intake disorder, highlighting the unique diagnostic criteria for each condition. From the significant weight loss and elaborate food rituals of anorexia to the normal-weight presentation and secretive behaviors of bulimia, we illuminate the sometimes subtle differences that make each disorder unique. The conversation takes a fascinating turn when we briefly reflect on our own relationships with food, demonstrating how common some problematic eating patterns can be.
Treatment approaches receive thorough attention, with evidence-based strategies tailored to each disorder. Family-based treatment shines for adolescents with anorexia, while various forms of cognitive-behavioral therapy prove effective across multiple conditions. We explore therapeutic techniques ranging from motivational interviewing and cognitive restructuring to exposure therapy and mindful eating exercises. The episode concludes with valuable information on assessment tools like the Eating Disorder Examination and the quick-but-effective SCOFF questionnaire. Whether you're studying for your licensing exam or looking to deepen your clinical understanding, this episode provides the knowledge you need to recognize, differentiate, and effectively treat eating disorders in your practice. Subscribe to our podcast for more exam-ready content that bridges theory and clinical application!
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Hi everyone and welcome to today's episode. I'm Dr Linton Hutchinson, joined by my amazing colleague, eric Tuchman. Together, we're looking at the world of eating disorders, breaking down the different types and exploring their unique nuances in a way that's clear and easy to understand. If you're preparing for your licensure exam, this episode is loaded with insights to help you understand this important topic. Let's get started.
ERIC:I'll tell you, linton, those exams love throwing curveballs, where you have to tell apart disorders that seem pretty similar at first. So today we're here to clear things up and give you tools to tell the difference on your exam and to help your future clients.
LINTON:All right, let's kick things off with anorexia nervosa. The DSM describes it as restricting intake so much that it leads to significantly low body weight. There's also an intense fear of gaining weight and a distorted way of seeing your body. These symptoms must occur for at least three months to diagnose it Now bulimia nervosa is a little different.
ERIC:It's all about those binge eating episodes followed by compensatory behaviors like vomiting, over-exercising or misusing laxatives. For a diagnosis, this needs to happen at least once a week for three months, and how clients see themselves is heavily tied to their weight and shape.
LINTON:Then there's binge eating disorder. This one involves binge eating without the purging or other compensatory stuff that you see in bulimia. It's about quickly eating a ton of food while feeling out of control Like the others. It must happen at least once a week for three months to meet diagnostic criteria.
ERIC:Another important disorder is avoidant restrictive food intake disorder. This isn't about body image concerns like anorexia or bulimia. It's more about avoiding certain foods because of sensory issues or fear of things like choking. This can lead to nutritional deficiencies or weight loss, but the motivation behind it is totally different.
LINTON:When it comes to what these disorders look like clinically. Anorexia often shows up with extreme weight loss, cold intolerance and amenorrhea. In females, these clients may wear loose clothes to hide their bodies and obsessively count calories or develop food rituals. These behaviors often stem from a need for control and can cause significant distress if interrupted. They may cut food into very small pieces, chew excessively, eat only one food group at a time, arrange food meticulously or let their food become soggy so it becomes unappealing.
ERIC:Bulimia can be tricky because clients usually have normal weight, but you might notice calluses on their knuckles, which is also known as Russell's sign, dental erosion from vomiting or swollen parotid glands. They often feel ashamed and work hard to keep their behaviors secret.
LINTON:Okay, so you're assuming I know what the parotid gland is? Give me a clue? No, problem.
ERIC:The parotid glands are salivary glands located on either side of your face and extend from the cheek to below the jawline. If they're swollen, you might consider bulimia. You also might see that description in a mental status exam, so it might be a clue to the diagnosis.
LINTON:Binge eating disorder, however, looks different. Clients might be overweight or obese, but not always. They often talk about eating until they're uncomfortably full, embarrassed about eating alone and guilty afterward. Unlike bulimia, there's no purging involved. Eric, I've been thinking about how we all have different relationships with food and I wanted to ask you something. In another podcast you mentioned going to buffets and sometimes eating until you're uncomfortably full. I wonder if you ever feel awkward eating so much and alone at the buffet, or maybe even feel guilty afterward.
ERIC:That's an interesting question, linton. But now that you bring it up, I do notice that sometimes I eat until I'm stuffed. Part of it is wanting to get my money's worth, but afterward I do feel kind of bad, like maybe I overdid it. And yeah, if I'm eating alone I sometimes feel a little self-conscious, like people might be watching me. There's definitely some guilt that comes with it too.
LINTON:That makes sense and, honestly, you're not alone in feeling that way. I think it's something both of us can work on. Speaking of food challenges, have you ever heard of avoidant restrictive food intake disorder?
ERIC:Sure have Lintz Avoidant. Restrictive food intake disorder stands out because there's no distress about body shape or weight. Instead, clients avoid certain foods because of sensory issues or fears like choking. This can cause weight loss or nutritional problems like anorexia, but for totally different reasons when it comes to treatment for anorexia.
LINTON:family-based treatment, also known as the Maudsley approach, works really well for teens, it puts parents in charge of refeeding. For adults, enhanced cognitive behavioral therapy CBT focuses on challenging those intense concerns about shape and weight.
ERIC:Bulimia responds well to CBT-E2. It targets what keeps the disorder going and works for most people. Interpersonal psychotherapy can also help if relationship issues are fueling the behavior's.
LINTON:For binge eating disorder. Cbt is super effective in that it helps clients figure out what triggers their binges and teaches them healthier coping strategies. And don't forget that dialectical behavior therapy can also work well if emotional struggles are driving the binging.
ERIC:Treatment for avoidant, restrictive food intake disorder often uses adapted CBT approaches that gradually expose clients to feared foods while teaching them how to manage anxiety around eating. Sensory integration techniques can also be helpful when sensory issues are part of the problem.
LINTON:No matter which disorder you're treating, keeping an eye on medical stability is crucial. Working with a physician, dietitian and sometimes a psychiatrist as part of a team is key, for anorexia especially. Getting weight back up is often step one before engaging in deeper psychological work.
ERIC:Motivational interviewing can be helpful, since recovery ambivalence is common with eating disorders. Instead of pushing too hard against resistance, roll with it and help clients connect with values beyond their appearance, across all eating disorders.
LINTON:Cognitive restructuring is huge. Helping clients challenge distorted thoughts like thin equals happy by having the client look at evidence for and against those beliefs.
ERIC:Exposure therapy is another approach, whether it's eating feared foods, tolerating fullness sensations or looking at their body in the mirror, you'll gradually guide them through these steps, while teaching them how to manage anxiety.
LINTON:Food journaling can be really eye-opening. It helps clients track what they eat, along with their thoughts and feelings, so they can spot patterns and triggers.
ERIC:Body image work might involve mirror exercises where clients describe their body neutrally instead of critically or questioning assumptions like my worth depends on how I look.
LINTON:Mindful eating exercises are great for reconnecting with hunger and fullness, cues that might have been ignored for years. Starting with simple foods like raisins helps them slow down and notice textures and tastes without judgment For binge eating and bulimia.
ERIC:Especially emotion regulation skills are key, helping clients identify emotions, tolerate distress without turning to food and find healthier ways to self-soothe when they're upset.
LINTON:When it comes to assessments, the eating disorder examination is indicated. It looks at behavioral and psychological features over the past month and gives valuable diagnostic information.
ERIC:The eating disorder inventory is another great tool. It's a self-report measure that digs into traits like drive for thinness or body dissatisfaction.
LINTON:If you need something quicker for screening purposes, check out the SCOFF questionnaire. It's just five questions, but super effective in spotting potential issues early on.
ERIC:The eating attitudes test is another solid option. It flags symptoms characteristic of eating disorders when scores hit a certain threshold.
LINTON:Body checking behaviors like obsessively weighing yourself or looking in mirrors can keep someone stuck in a preoccupation with their weight or shape On the flip side body avoidance, like wearing baggy clothes or avoiding mirrors altogether, also reinforces those negative thoughts tied to eating disorders reinforces those negative thoughts tied to eating disorders.
LINTON:Well, my wonderful therapists, I know we've covered a lot today, but the beauty of podcasts is that you can listen to this episode as many times as you need, whether you're making dinner, taking a shower binge, watching your favorite Korean drama, rolling on the mat with your jujitsu partner or driving to your next therapy appointment. Whatever you're up to, keep these episodes playing in the background. Trust me, when it's time for your licensing exam, you'll realize it's in there.
