NR606 / NR 606 Week 6| Latest 2026/2027 Edition | Diagnosis & Management in PMH II Practicum | Chamberlain | Practice Questions & Accurate Solutions

NR606 / NR 606 Week 6| Latest 2026/2027 Edition | Diagnosis & Management in PMH II Practicum | Chamberlain | Practice Questions & Accurate Solutions Types of Feeding and Eating Disorders -Anorexia nervosa -Bulimia nervosa -Binge eating disorder -Pica -avoidant/restrictive food intake disorder (ARFID) With repeated ingestion of a drug, the drug shows decreased effect. Increasing doses are required to achieve the effects noted with the original administration. Tolerance State of adaptation produced with repeated administration of certain drugs so that physical symptoms occur when the drug is discontinued abruptly. Dependence A change in behavior caused by biochemical changes in the brain after continued substance use characterized by preoccupation with and repeated use of a substance despite of negative outcomes. Addiction Physiological and psychological reactions that occur when the use of a substance is stopped abruptly. Withdrawal Condition following the ingestion of a substance resulting in changes in level of consciousness, cognition, perception, judgment, and behavior. Intoxication Feeding and Eating Disorders Background -severe, persistent disturbances in eating behaviors -approx. 9% of pop. in U.S. • costing $64.7 billion per year -second deadliest mental health condition, after opioid overdoses • approx. 10,200 deaths per year -typically develop in adolescence or young adulthood -more common in women -serious physical effects, contribute to psychological distress, disruptions in social functioning Feeding and Eating Disorders Risk Factors -Complex biopsychosocial factors -may experience neurobiological differences • serotonin and dopamine -Cultural norms • idealize a thin appearance -Genetics -Biochemical factors -Psychological factors -Trauma from abuse or bullying -Family dysfunction -Emotional needs not met -Cultural factors Which of the following factors impact the development of eating disorders? Select all that apply. parental attitudes to gender roles having a close relative with an eating disorder weight stigma in the culture trauma intense family expectations related to physical appearance having a close relative with an eating disorder weight stigma in the culture trauma intense family expectations related to physical appearance Rationale: Family history that includes a close relative with an eating disorder, weight stigma in the culture or family, trauma (especially physical or sexual abuse), and a history of being bullied about weight or physical appearance may increase the risk for eating disorders. Which of the following are common characteristics of individuals with eating disorders? Select all that apply. perfectionism low self-esteem high levels of responsibility narcissism perfectionism low self-esteem Rationale: Clients with eating disorders sometimes present with a negative, subjective appraisal of themselves, perfectionism, body image dissatisfaction, and a history of an anxiety disorder. Anorexia Nervosa -characterized by restrictive eating patterns, extremely low body weight, and an intense fear of gaining weight -may engage in excessive exercise as means of controlling weight -affects 1-2% of pop. • 0.3% of adolescents Anorexia Nervosa DSM-5-TR dx requires each of the following: -restriction of intake leads to significantly low body weight in the context of age, sex, developmental trajectory, and physical health -intense fear of gaining weight or of becoming fat or persistent behavior that interferes with weight gain -disturbance in the way in which one's body weight or shape is perceived, undue influence of body weight or shape on self-evaluation, or lack of recognition of the seriousness of the current low body weight severity of anorexia nervosa based on BMI: -Mild: Less than or equal to 17 kg/m2 -Moderate: BMI 16 to 16.99 kg/m2 -Severe: 15 to 15.99 kg/m2 -Extreme: Less than 15 kg/m2 anorexia nervosa medical complications impact most major organ systems -Cardiovascular • Structural changes • Functional changes -Gynecologic & Reproductive • Secondary amenorrhea, Decreased libido, pregnancy complications. -Endocrine • hypothalamic-pituitary abnormalities, contribute to severe bone loss -Gastrointestinal • diarrhea, constipation, elevated LFTs, SMA syndrome, pancreatitis, GERD, dysphagia -Renal & Electrolytes • Decreased GFR; diuresis, hyponatremia, dehydration -Pulmonary • dyspnea, pneumonia -Hematologic • Cytopenia, bone marrow changes -Neurologic • Wernicke encephalopathy, Korsakoff syndrome, brain atrophy, other brain structure changes -Dermatologic anorexia nervosa Dermatologic Cutaneous manifestations: -Xerosis (dry, scaly skin) -Lanugo-like body hair (fine, downy, dark hair) -Telogen effluvium (hair loss) -Carotenoderma (yellowing) -Acne -Hyperpigmentation -Seborrheic dermatitis (erythema and greasy scales) -Acrocyanosis (cold, blue, and occasionally sweaty hands or feet) -Perniosis (painful or pruritic erythema) -Petechiae -Livedo reticularis (reddish-cyanotic circular patches) -Paronychia (inflamed lateral and posterior nail folds) -Pruritus -Striae distensae (erythematous or hypopigmented linear patches) -Slower wound healing % of individuals with anorexia nervosa excessively exercise 40-80% -behavior often described as compulsive -excessive exercise • interferes with important tasks • exceeds 3 hrs/day • causes distress if unable to exercise • done at inappropriate times/places, no attempt to stop • done despite serious injury, illness, medical complications • beyond amount of calories consumed that day excessive exercise short term issues dehydration fatigue chronic back pain injuries strains and sprains stress fxs excessive exercise long term complications osteoporosis degenerative arthritis inability to menstruate reproductive issues heart issues are common in individuals with anorexia nervosa mood swings -major changes in mood and personality • happy and energetic to listless in hours can be due to imbalance in serotonin, dopamine, oxytocin, cortisol & leptin Which of the following are DSM-5-TR diagnostic criteria for anorexia nervosa? Select all that apply. -refusal to maintain a minimal bodyweight -pathological fear of gaining weight -distorted body image in which clients continue to insist they are overweight even when emaciated -refusal to maintain a minimal bodyweight -pathological fear of gaining weight -distorted body image in which clients continue to insist they are overweight even when emaciated Rationale: Anorexia nervosa is an eating disorder where the main features include a refusal to maintain minimal body weight, a pathological fear of gaining weight, and a distorted body image in which sufferers continue to insist they are overweight. Which of the following symptoms is consistent with anorexia nervosa binge- eating/purging type? avoiding eating to help control weight gain not being bothered about weight gain regularly using laxatives eating only certain types of foods regularly using laxatives Rationale: Binge eating/purging type anorexia nervosa is a type of eating disorder that involves regularly engaging in purging activities, such as vomiting or the misuse of laxatives, diuretics, or enemas, to help control weight gain. Bulimia Nervosa -recurrent episodes of eating unusually large amounts of food paired with a feeling of lack of control of eating behaviors • compensate for overeating, engage in behaviors to prevent weight gain; self-induced vomiting, excessive use of laxatives/diuretics, excessive exercise, fasting, or combination -lifetime prevalence rate: 1.5% in women -Comorbidities: most experiencing one+ concomitant conditions, including depression, anxiety, & substance use disorder -significant % have symptoms that meet criteria for personality disorders, most especially borderline personality disorder DSM-5-TR diagnosis of bulimia nervosa requires each of the following: -recurrent incidents of binge eating characterized by: • eating an amount of food in a discrete period that is notably larger than what most individuals would eat in a similar time period, under similar conditions • lack of control of overeating behaviors during the episode, such as feeling that one cannot stop eating or control how much is eaten -recurrent inappropriate behaviors to compensate for overeating to prevent weight gain, including self-induced vomiting; misuse of laxatives, diuretics, or other medications; fasting; or excessive exercise -binge eating and inappropriate compensatory behaviors occur, on average, at least once a week for 3 months -body shape & weight unduly influence self-evaluation -disturbance does not occur exclusively during episodes of anorexia nervosa. bulimia nervosa Medical Complications Some r/t malnutrition, while others r/t purging behaviors -Dental • Enamel erosion • Hot/cold sensitivity • Discoloration • Dental caries • Gum disease -Endocrine • Menstrual irregularities • Osteopenia & osteoporosis • Diabetes -Gastrointestinal • Parotid and submandibular (salivary) gland hypertrophy, with puffy or swollen cheeks • Laryngopharyngeal reflux • Loss of gag reflex • Esophageal dysmotility • Abdominal pain and bloating • Mallory-Weiss syndrome (esophageal tears) • Esophageal rupture (Boerhaave syndrome) • Gastroesophageal reflux disease (GERD) • Barrett's esophagus • Gastric dilation • Diarrhea and malabsorption • Steatorrhea • Protein-losing gastroenteropathy • Hypokalemic ileus • Colonic dysmotility • Constipation • Irritable bowel syndrome • Melanosis coli • Cathartic colon • Rectal prolapse • Pancreatitis Renal & Electrolytes • Dehydration • Hypokalemia • Hypochloremia • Hyponatremia • Metabolic alkalosis • Hypomagnesemia • Hypophosphatemia Binge Eating Disorder (BED) -hallmark: episodes of the consumption of excessively large amount of food accompanied by a sense of loss of control over the experience -recurrent episodes of binge eating, along with distress or secrecy about eating or eating when not hungry -first described in the 1950s -added to DSM with 5th edition in 2013 -mean age of onset is 12.5 years -Prevalence rates: 2%-4%, equal between girls & boys -most common eating disorder among adolescents -often associated with obesity, no compensatory behaviors • consequences for both physical & psychological health Binge eating disorder (BED) DSM-5-TR criteria for the diagnosis: -episodes of binge eating are defined as consuming an excessive amount of food in a discrete period that is greater than what most people would eat in a similar amount of time and circumstances -during episodes, clients feel they lack control over their behaviors & experience distress -binge eating episodes occur, on average, at least once a week for three months & include 3 or more of the following: • eating more rapidly than normal • eating until feeling uncomfortably full • eating large amounts of food when not feeling physically hungry • eating alone because of embarrassment by the amount of food consumed • feeling disgusted with oneself, depressed, or guilty after overeating -no regular use of inappropriate compensatory behaviors (e.g., purging, fasting, or excessive exercise) as are seen in bulimia nervosa -binge eating does not occur solely with bulimia nervosa or anorexia nervosa Binge eating severity: is ranked based on the number of binge eating episodes that occur in a typical week -Mild: 1 to 3 -Moderate: 4 to 7 -Severe: 8 to 13 -Extreme: 14 or more Pica -persistent ingestion of nonfood items that do not contain nutritional value for at least one month -Commonly ingested substances vary with age and availability • clay, paper, soap, hair, soil, chalk, paint, metal, pebbles, ice. -pediatric pop; predominantly occurs in school-age children • prevalence approx. 5% • often in children who are otherwise developmentally typical -Risk factors: • neglect, lack of supervision, and developmental delay pica DMS-5-TR diagnostic criteria -specify that eating behaviors must not be developmentally appropriate or culturally or socially sanctioned practices -often occurs comorbidly with other medical and mental health conditions • these circumstances, pica must be severe enough to require clinical attention to receive a separate diagnosis -ind 2 eats 1+ nonnutritive, nonfood substances for a month+ and requires medical attention as a result Pica Medical Complications -intestinal obstruction • Consumption of abrasive items such as rocks might cause intestinal obstruction or tear -poisoning • Lead poisoning from excess consumption of paint flakes -medical emergencies -Infections from organisms and parasites that get inside the body from the consumption of dirt or mud -Infections may damage the liver or kidneys -Esophageal tears caused by sharp or harsh objects like metal scraps -Damage to the brain from eating lead or any other harmful substances -Constipation, bloody stool, or diarrhea -Mouth and teeth injuries deficiency anemia and deficiency may cause pica. Iron deficiency anemia and zinc deficiency may cause pica. eating corn starch can cause iron deficiency anemia -secondary to pica (eating corn starch) eating deodorant can cause iron deficiency anemia -has talc in them pagophagia ice eating various forms of pica have been associated with iron deficiency pica is more common among: -rural pregnant African American women -autistic children -institutionalized individuals with intellectual disability Which of the following are the most appropriate management interventions for Aniyah? Select all that apply. collaborate with medical providers to obtain complete blood count (CBC) and zinc levels collaborate with medical providers to obtain lead levels collaborate with medical providers to provide nutritional supplements such as Pediasure recommend that Aniyah's mother remove all pencil erasers from the home begin behavior modification therapy with Aniyah and her mother begin olanzapine 2.5 mg daily collaborate with medical providers to obtain complete blood count (CBC) and zinc levels collaborate with medical providers to obtain lead levels recommend that Aniyah's mother remove all pencil erasers from the home begin behavior modification therapy with Aniyah and her mother Rationale: Initial testing should include a CBC and zinc level. Iron deficiency anemia and zinc deficiency may cause pica. Lead testing is appropriate to ensure that Aniyah has not ingested nonfood items that contain elevated levels of lead; although she admits to eating pencil erasers, she may also consume other nonfood items in the home. Parents should remove the preferred nonfood items from the home, if possible, to help prevent ingestion. Behavior modification therapy using a rewards system is an appropriate treatment method for children with pica. Unless the client presents with nutritional deficits due to pica, nutritional supplements are not indicated. There are currently no medications approved to treat pica. Olanzapine may be prescribed off-label to reduce impulsive eating; however, medications are not considered first-line therapy and psychotherapy should be provided first. Aniyah is a 7-year-old who presents to the emergency department with complaints of abdominal pain. Her mother endorses a reduced appetite over the past three days, and she has not had a bowel movement in five days. Aniyah has no past medical history. She lives with her mother and older brother; her parents are separated, and her father moved out two months ago. Aniyah is in second grade; her developmental progress is age-appropriate. The medical team completed an assessment including an abdominal x- ray, which shows multiple rectangular radiopaque foreign bodies in the large intestine. After the x-ray was completed, Aniyah admitted to eating pencil erasers daily for the past two months. Which of the following is the most appropriate ICD-10-CM for Aniyah? F98.3 F50.8 F50.9 F32.9 F98.3 Rationale: Aniyah meets the diagnostic criteria for pica: persistent eating of nonfood substances for at least a month, inappropriate to developmental level, and not a part of a culturally supported practice. The ICD-10-CM code for pica in children is F98.3 and for adults is F50.8. Nichole is a 17-year-old who is 29 weeks pregnant with her first child. She has no past medical or psychiatric history. She was referred to the PMHNP (Psychiatric Mental Health Nurse Practitioner) by her obstetrician (OB) after she admitted to cravings for and consumption of paper on a regular basis. Nichole's OB ordered a complete blood count (CBC), comprehensive metabolic profile (CMP), and glucose tolerance test, all of which were normal. Nichole complains of mild heartburn and occasional constipation which she has been treating with over-the-counter antacids and laxatives. Nichole endorses eating about 3-4 sheets of copy paper each day, typically during her restroom breaks at school. She has been doing so for the past 8-10 weeks. She has not discussed this behavior with anyone other than her OB; she states that she finds the behavior "a bit weird and embarrassing." She states that other than eating paper, s no Rationale: Although Nichole believes her behavior is "weird and embarrassing," she does not meet the diagnostic criteria for pica. Although she has been consuming nonfood substances for over a month, her behavior is occurring in the context of her pregnancy and the ingestion of paper does not pose potential medical risks. Avoidant/restrictive food intake disorder (ARFID) -added to the DSM-5 in 2013 -reduced intake of food volume or variety due to: • fear of aversive consequences of eating • lack of interest in food or eating • sensory sensitivity to food -thought to be as prevalent as anorexia nervosa & bulimia nervosa -associated with nutritional, medical, and/or psychosocial impairment -Children with ARFID typically eat only a few preferred food items • do not meet nutritional needs • habitual food avoidance which affects their weight & nutritional health • mealtime often disruptive behaviors, spitting food out, batting it away, holding food in the mouth, refusing to swallow it, escapist actions increased risk for ARFID -Children with mental health conditions including: • anxiety disorders • OCD • autism spectrum disorder • ADHD • intellectual disabilities -presence of a maternal eating disorder -Hx of: • GERD • vomiting • other medical problems Avoidant/restrictive food intake disorder (ARFID) DSM-5-TR dx requires each of the following: -an eating or feeding disturbance that is not due to a food shortage or cultural practice and is associated with one or more of the following: • significant weight loss • significant nutritional deficiency • dependence on enteral feeding or oral nutritional supplements • impaired psychosocial functioning -does not occur exclusively during the course of anorexia nervosa or bulimia nervosa, and is not attributable to a concurrent medical condition or mental disorder. Lillian is a 9-year-old who presents with her mother after a referral from the pediatrician. Lillian is 54 inches tall and currently weighs 55 pounds (lbs). As a toddler, Lillian ate most of the foods offered to her. When she was 6, she witnessed her grandmother choke on a piece of meat and receive the Heimlich maneuver; her grandmother survived, but since then, Lillian refused to eat meat. Over the past three years, her eating has become more restricted; she will no longer eat anything that requires chewing. Her mother has been offering soups, purees, and nutritional supplements, but Lillian has failed to gain weight as she grows taller. Lillian endorses that she is frequently bullied at school for her refusal to eat at lunch and during classroom parties. Does Lillian meet the diagnostic criteria for ARFID? yes no unable to determine Yes Rationale: Lillian meets the diagnostic criteria for ARFID. She presents with avoidance of eating food based on the sensory characteristics of the food and failure to meet expected weight gain appropriate for age and height. The behavior interferes with her psychosocial functioning and is not better explained by cultural practice, lack of available food, or anorexia nervosa. David is a 14-year-old who presents with his mother who voices concerns about his behavior. David is 65 inches tall and weighs 102 lbs. David has been active in competitive wrestling since age 9 and dreams of joining the U.S. Olympic team. Since starting high school, David has become preoccupied with his body shape and body fat percentage. He constantly worries about "making weight" for wrestling meets. Rather than eating lunch at school, he goes to the weight room to exercise. David's mom endorses that when he gets home from wrestling practice, he eats "huge amounts" of food. Typically, David will eat an entire frozen pizza before dinner and then have second helpings during the family meal. He eats dessert and then "disappears" into the bathroom immediately following dinner. David's parents became concerned after hearing retching sounds in the bathroom. Upon interview, David admits that when he start bulimia nervosa Rationale: David meets the diagnostic criteria for bulimia nervosa. He eats excessive amounts of food in a discrete period and has a loss of sense of control over his eating. After bingeing, he purges and uses laxatives to prevent weight gain. His self-image is influenced by body shape and weight. Angela is a 15-year-old who presents for an evaluation due to recent weight loss. She is 63 inches tall and has lost 12 lbs. in the past 3 months. Her current weight is 89 lbs. Angela was active in several extracurricular activities, including soccer, choir, and cheerleading, until three months ago. She has become more withdrawn from social interactions with friends and, according to her parents, spends most of her time in her room sleeping. She refuses to join the family for dinner and instead takes a plate to her bedroom; her mother endorses that most of the food returns to the kitchen uneaten. Angela states that she skips breakfast and does not eat in the lunchroom at school, but she will take a sandwich into the girls' locker room and eat it in a stall during her lunch period. Angela states that she believes she is unattractive and admits she is probably too thin, but she does not care because she is too tired major depressive disorder Rationale: Angela meets the diagnostic criteria for major depressive disorder. She has withdrawn from extracurricular and social activities, lost a significant amount of weight, and displays hypersomnia. She has feelings of worthlessness and fatigue. Although Angela's BMI is in the 2nd percentile, she is aware that she is too thin and does not fear gaining weight; therefore, she does not meet the diagnostic criteria for an eating disorder. Ronnita is a 17-year-old who presents with her mother who voices concerns about her recent weight loss. Ronnita began the school year at 64 inches tall weighing 106 lbs. She joined the cross country team; initially, she practiced with the team and came home immediately after. Now, she runs an additional 6-10 miles per day after team practice and has lost 14 lbs. in 5 months. Her mother endorses that Ronnita makes daily comments about how fat she still is and how much more weight she needs to lose to get to her ideal body size. Although Ronnita is otherwise physically healthy, her pediatrician recommended a consultation with a mental health provider to assess for a possible eating disorder. Rather than eating at school, Ronnita tutors her peers in the student learning center during her lunch period. Ronnita's parents require her to sit at the table for dinner, but her mother endorses that she cuts her food into tiny anorexia nervosa, binge-eating/purging type Rationale: Ronnita meets the diagnostic criteria for anorexia nervosa, binge eating/purging type. She has a restricted food intake leading to significantly low body weight and fear of becoming fat. Her exercise regimen and eating behaviors interfere with weight gain even though she is already at a significantly low weight with a BMI of less than the 1st percentile for age. She has a disturbance in her evaluation of her body weight and shape, and she has engaged in recurrent episodes of purging behaviors as well. Preston is a 19-year-old college sophomore who presents with complaints of low mood and fatigue. Preston endorses having difficulty building a new social network since starting college; he lives on campus but spends most of his time outside of class alone in his single dorm room. He has an unlimited meal plan, and he buys food in the cafeteria and the campus convenience store to take back and eat in his room. When asked why he does not eat in the cafeteria, Preston states that he does not like others to watch him eat because he eats "too fast and too much." He notes that he usually eats until he feels overly full and then has no energy to do anything but lay down and play on his phone or sleep. He feels disgusted with himself on a regular basis because of this behavior but notes that he cannot seem to control his eating once he starts. Preston states that he has been overweight since he was a child; he endorses g major depressive disorder BED Rationale: Preston meets the criteria for BED, including consuming a large amount of food in a discrete period with a lack of control over his behavior. He eats more rapidly than normal and eats until he is uncomfortable. He feels disgusted with himself after overeating. He does not use inappropriate compensatory behaviors that would indicate bulimia nervosa. Preston also meets the diagnostic criteria for major depressive disorder: he has low mood, diminished pleasure in activities, fatigue, weight gain, and hypersomnia. Screening for Eating Disorders: SCOFF tool -five-item measure • Do you make yourself SICK because you feel uncomfortably full? • Do you worry you have lost CONTROL over how much you eat? • Have you recently lost more than ONE stone (14 pounds or 6.35 kg) in three months? • Do you believe yourself to be FAT when others say you are too thin? • Would you say that FOOD dominates your life? Screening for Eating Disorders: PARDI The Pica, ARFID, and Rumination Disorder Interview (PARDI) -clinical assessment tool -designed to assess & diagnose pica & ARFID -PARDI Parent/Carer 2-3 and Parent/Carer 4+ • modified for use with children and their caregivers -PARDI Self 8-13 and Self 14+ • used with adolescents -preliminary support for validity and reliability Anorexia Nervosa Tx -multidisciplinary • psychotherapy & pharmacological interventions -Tx goals • restoration of sufficient nutrition • return to a healthy weight • reduction of excessive exercise • elimination of binge-purge & binge-eating behaviors • primary goal in medically stable AN pt is weight gain -Psychotherapy is essential -family therapy & CBT are effective modalities, can be implemented with tx manuals specific to anorexia nervosa -Medications can help address comorbid psychopathologies: • depressive disorders, anxiety disorders, OCDs -Psychotherapy • outpatient setting, through partial hospitalization programs (day-treatment), or in residential tx settings -majority managed with outpatient therapy Anorexia: What Therapists and Parents Need to Know -Family Based Treatment (FBT) • Most successful therapy is based on parents helping their child • Twice as effective for recovery than ind. therapy • a quarter of the incidence of relapse *If you have an adolescent with anorexia nervosa who is medically stable, Family Based Treatment should be the first line tx Family-Based Treatment for Eating Disorders -one of the most successful treatments for eating disorders in children and teens with anorexia nervosa, bulimia nervosa, and other specified feeding or eating disorder (OSFED) -sometimes called "Maudsley Family Therapy," (development at Maudsley Hospital in London) -involves the whole family in solving their child's eating disorder -does not blame the family -prescribes family sessions with a therapist at first once a week, decreasing over the course of tx • typically at least one family meal at beginning of tx in therapist's office Bulimia Nervosa and BED Tx -combining antidepressant meds with psychotherapy • AVOID BUPROPION risk of seizures with active symptoms of bulimia nervosa -Lisdexamfetamine approved for moderate to severe BED in adults -no med FDA approved for children/adolescents with BED -CBT for bulimia nervosa and BED -Brief strategic therapy pharmacological tx for bulimia nervosa -1st line • fluoxetine -2nd Line • sertraline • escitalopram • fluvoxamine -3rd Line • tricyclic antidepressants • trazodone • MAOIs • topiramate Pica Tx -no gold standard tx -primarily behavioral tx's • noncontingent reinforcement, environmental enrichment, and overcorrection -Pharmacological interventions, typically not used, only address co-morbid conditions -surgical interventions when obstructions or perforations occur -No interventions proven efficacious for long-term tx ARFID Tx -limited literature about tx & no med is specifically indicated for use in this disorder -once medically stable • family-based therapy adapted specifically for clients with ARFID has demonstrated effectiveness Gender identity One's concept of oneself as male, female, a blend of both, or neither derived from an interaction of biological traits, developmental influences, & environmental conditions. -Transgender -Nonbinary -Cisgender -Agender Gender expression -external appearance or performance of one's gender. -may include clothing, behavior, other characteristics. -may be associated with masculine traits, feminine traits, both, or neither -may or may not conform to socially defined gender behaviors -does not necessarily reflect gender identity. • Feminine • Masculine • Androgynous • Gender-neutral • Gender non-conforming Sexual orientation -Enduring emotional, romantic, or sexual attraction to others • Heterosexual/straight • Homosexual/gay/lesbian • Bisexual • Pansexual • Asexual Assigned sex -Sex assigned to an infant at birth -based on visible sex organs & other physical characteristics • Male • Female • Intersex Children begin to become aware of the physical differences between boys and girls at approximately of age 2 years of age -By 4 most have an established gender identity Diagnosing Gender Dysphoria -when a person experiences clinically significant discomfort or distress from the misalignment of their gender identity & their assigned sex -often begin in childhood • may not experience symptoms until puberty or later -Dx criteria different for adolescents & adults -All ages: must experience significant distress or impairment in social, occupational, or other areas of functioning as a result of symptoms -dx typically req to receive gender-affirming care, including hormone therapy or surgical intervention consequences frequently experienced by transgender persons -80% trans students feel unsafe at school because of their gender expression -58.7% of gender non-conforming students have experienced verbal harassment in the past year because of their gender expression • compared to 29% of their peers -49% of trans ppl reported physical abuse (2007 survey) -50% of trans ppl have been raped or assaulted by a romantic partner (Gender, Violence, & Resource Access Survey) -Trans people of color are 6x more likely to experience physical violence when interacting with police than white cisgender survivors of violence -41% of trans ppl have attempted suicide -1/5 trans ppl have experienced homelessness at some point -1/8 have been evicted due to being trans Treatment for clients with gender dysphoria -highly individualized -supportive care environment that allows for the exploration of gender identity & expression is essential -Gender-Affirming Psychotherapy -Parental & Sibling coaching -Individual therapy Why support for trans youth matters -Trans Youth with Supportive Parents • 77% reported life satisfaction; 33% reported dissatisfaction • 70% described mental health as very good or excellent; 15% described their mental health as poor • 23% report suffering depression; 75% report not suffering depression -Trans Youth with Unsupportive Parents • 64% reported low self-esteem; 13% reported high self-esteem • 0% faced no housing problems; 55% faced housing problems. • 4% did not attempt suicide; 57% attempted suicide Some clients will share information about their sexuality or gender identity with providers that they have not yet shared with parents or guardians; these disclosures must be confidentiality, maintained. . of The Trevor Project -leading suicide prevention & crisis intervention nonprofit organization for LGBTQ young people. -provide information & support to LGBTQ young people 24/7, all year round. It Gets Better Project -mission is to uplift, empower, and connect lesbian, gay, bisexual, transgender, and queer (LGBTQ+) youth around the globe. Parents and Friends of Lesbians and Gays (PFLAG) -creating a caring, just, and affirming world for LGBTQ+ people and those who love them. -support and resources Family Acceptance Project -research, intervention, education & policy initiative to prevent health & mental health risks & to promote well-being for lesbian, gay, bisexual, transgender and queer- identified (LGBTQ) children & youth • including suicide, homelessness, drug use and HIV • in the context of their families, cultures & faith communities LGBTQ+ Health Disparities and Providing Equitable Care -Provider awareness, recognizing personal biases, and community outreach are all important steps in eliminating healthcare disparities for the LGBTQ+ community -provide support and acceptance to all clients -establish a non-discrimination policy • language about sexual orientation, gender identity, & gender expression. -create an open office environment • using inclusive language • both chosen name & legal name on assessment forms, blank space for gender • spaces in EMR & paper forms to allow pts to identify appropriately -pediatric pt, have boxes for "Parent 1 & Parent 2" instead of "mother" & "father". -non-gendered bathrooms -educational materials with health information relevant to LGBTQ+ clients -posters that display racial, ethnic, and sexual diversity -provider and staff training Substance Use Disorders in Adolescents -Substance use often begins in adolescence • when 1st signs of other mental illnesses commonly appear -Much of brain development occurs in adolescence -Executive functioning & impulse control tend to occur in late adolescence-early adulthood • vulnerable to substance use & development of a SUD -By adulthood, 50% have tried illicit substance, 80% used alcohol -alcohol, marijuana, tobacco are substances adolescents used most freq. Annual Prevalence of Use of Various Drugs for Grades, 8, 10, and 12 Combined: 38.3% will use alcohol 24.6% will use marijuana 27.1% will vape or smoke cigarettes 9.2% will use illicit drugs other than marijuana Diagnosing SUDs in Adolescents -recurrent use of a substance, such as alcohol or drugs, causes clinically significant impairment • health problems, disability, or failure to meet responsibilities at home, work, or school -not all who experiment with substances will meet criteria SUD -adolescents may experience (-) social & health consequences • can affect growth & development of the brain & increase freq of risky behaviors Early drug use is a risk factor for: later development of a SUD & other mental health conditions SUDs Common Comorbidities -other mental health conditions • Anxiety disorders • Depression • Bipolar disorder • Psychotic illness • Borderline personality disorder • Antisocial personality disorder Individuals with untreated are at particular risk for developing a SUD ADHD Adolescent substance use Screening -American Academy of Pediatrics (AAP) recommended universally screening all adolescents for substance use during routine healthcare visits • using a Substance Use Screening, Brief Intervention, & Referral (SBIRT) approach -commonly used SBIRT tool is the CRAFFT screening tool • recommended by the AAP Bright Futures Guidelines for preventative care screenings. CRAFFT tool • C: Have you ever ridden in a Car driven by someone, including yourself, who was "high" or had been using alcohol or drugs • R: Do you ever use alcohol or drugs to Relax, feel better about yourself or fit in? • A: Do you ever use alcohol or drugs while you are by yourself (Alone)? • F: Do you ever Forget things that you did while using alcohol or drugs? • F: Do your Family or Friends ever tell you that you should cut down on your drinking or drug use? • T: Have you ever gotten into Trouble while you were using alcohol or drugs? *2+ yes answers suggest a significant problem SUD screening tools to use with adolescents 12-18 years -Screening to Brief Intervention (S2BI) -Brief Screener for Tobacco, Alcohol, and other drugs (BSTAD) Drug testing -AAP supports the use of drug testing in: • emergencies • on a voluntary basis as part of a full assessment of behavioral or mental health symptoms • as part of therapy or monitoring of a client with an identified substance use disorder -the use of "suspicionless" drug testing as a means of screening for drug use is not useful for both practical & ethical reasons -parents may request that a provider drug test their child • AAP cautions against the use of involuntary drug testing on a mentally competent adolescent AAPs position on drug testing at home and in schools video Adolescent SUDs Tx -Behavioral treatments • most prevalent interventions for adolescent SUDs • CBT, group therapy, contingency management, motivational interviewing -12-step programs or peer-to-peer programs -Residential treatment • clients who require stabilization, present a danger to themselves or their families, or present a public safety risk -family involvement is often integral • tx plan may include family therapy -Multidimensional Family Therapy • may be an alternative to residential tx for substance use & co-occurring mental health disorders -Medication-assisted treatment (MAT) is less likely to be used with adolescent clients -Community Reinforcement and Family Training (CRAFT) tx strategy • increase motivation & communication skills within a family impacted by addiction SCOFF tool screen clients for eating disorders What are the 5 item SCOFF tool questions Do you make yourself Sick because you feel uncomfortably full? Do you worry you have lost Control over how much you eat? Have you recently lost more than One stone (14 pounds or 6.35 kg) in three months? Do you believe yourself to be Fat when others say you are too thin? Would you say that Food dominates your life? What clinical assessment tool is designed to assess and diagnose pica and ARFID scroff ARFID avoidant/restrictive food intake disorder Which of the following factors impact the development of eating disorders? Family history that includes a close relative with an eating disorder, weight stigma in the culture or family, trauma (especially physical or sexual abuse), and a history of being bullied about weight or physical appearance may increase the risk for eating disorders Clients with eating disorders have what characteristics? Low self esteem and perfectionism Anorexia nervosa is an eating disorder characterized by restrictive eating patterns, extremely low body weight, and an intense fear of gaining weight Initial testing for PICA CBC and Zinc First line therapy for PICA Psychotherapy What medication may be prescribed for impulsive eating? Olanzapine DSM-5-TR criteria for ARFID an eating or feeding disturbance that is not due to a food shortage or cultural practice and is associated with one or more of the following: 1. significant weight loss, ficant nutritional deficiency, dence on enteral feeding or oral nutritional supplements, 4. impaired psychosocial functioning, does not occur exclusively during the course of anorexia nervosa or bulimia nervosa, and is not attributable to a concurrent medical condition or mental disorder. Children with mental health conditions including anxiety disorders, obsessive- compulsive disorder, autism spectrum disorder, attention-deficit/hyperactivity disorder (ADHD), or intellectual disabilities are at risk for what eating disorder ARFID Annual Prevalence of Use of Various Drugs for Grades, 8, 10, and 12 Combined 38.3% will use alcohol 24.6% will use marijuana 27.1% will vape or smoke cigarettes 9.2% will use illicit drugs other than marijuana What is the percentage of adolescents in community-based substance use disorder treatment programs meet the diagnostic criteria for another mental health condition 60% What are the common comorbidities of SUD? Anxiety disorders Depression Bipolar disorder Psychotic illness Borderline personality disorder Antisocial personality disorder Individuals with untreated attention-deficit/hyperactivity disorder (ADHD) are at particular risk for developing what mental health condition? SUD What approach does the American Academy of Pediatrics (AAP) recommend using in the universally screening of all adolescents for substance use during routine healthcare visits Substance Use Screening, Brief Intervention, and Referral (SBIRT) approach CRAFFT tool questions C: Have you ever ridden in a car driven by someone, including yourself, who was "high" or had been using alcohol or drugs R: Do you ever use alcohol or drugs to relax, feel better about yourself or fit in? A: Do you ever use alcohol or drugs while you are by yourself (Alone)? F: Do you ever forget things that you did while using alcohol or drugs? F: Do your family or friends ever tell you that you should cut down on your drinking or drug use? T: Have you ever gotten into trouble while you were using alcohol or drugs? Two or more "yes" answers suggest a significant problem. What SBIRT tool is recommended by the AAP Bright Futures Guidelines for preventative care screenings. CRAFFT screening tool What are are the most prevalent interventions for adolescent clients with substance use disorders. Behavioral treatments Common types of Behavioral treatments for SUD cognitive behavioral therapy, group therapy, contingency management, and motivational interviewing WHAT KIND of treatment is recommended for clients who require stabilization, present a danger to themselves or their families, or present a public safety risk Residential Treatment or alternate is Multidimensional Family Therapy Which SUD treatment is not recommended for adolescents? MAT