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The Complexity of Eating Disorders

A Presentation by Mirasol Clinicians to the University of Arizona College of Medicine Psychiatry Grand Rounds.

Stephen Remolina, MD, Medical Director

Mirasol clinicians were recently featured at the University of Arizona College of Medicine Psychiatry Grand Rounds. Speakers included Medical Director Stephen Remolina, Executive Director Diane Ryan, Clinical Director Maeve Shaughnessy, Nutrition Director Anne Ganje and Trauma Therapist Ann Twilley Garcia.

The purpose of the Psychiatry Grand Rounds series is to provide mental health professionals with updates on psychiatric topics with the goal of increasing knowledge, competence and patient care. The full presentation is available on the Univeristy of Arizona's Biomedical Communications website at

Dr. Remolina shares some of his experiences in working with eating disorders, and demonstrates how complicated they can be by presenting case histories for bulimia nervosa, anorexia nervosa and binge eating disorder. He emphasizes that there is a great deal of overlap between the three diagnoses, as well as a high degree of comorbidity with personality disorder, substance abuse and OCD. Dr. Remolina also notes the prevalence of trauma in eating disorders.

"I look at eating disorders as a way of protecting the brain from having to process trauma," says Remolina. Similarly, substance abuse can be used as a way of achieving an altered state and not thinking about the underlying trauma.

Remolina advocates for limited and cautious use of pharmacology to avoid numbing the client to the point where he or she is unable to move forward in recovery. He believes the best approach is working with a team including a psychiatrist, a medical practitioner, a dietitian and a therapist. He reviews the advantages, risks and recommended dosages of common medications for each of the three disorders, and stresses the importance of "complex treatment for a complicated diagnosis".

More Videos in This Series

  • Diane Ryan What's New in Eating Disorder Research?
    Diane Ryan, LPC, MA, Executive Director
    Ryan highlights some of the latest research on eating disorders, especially binge eating disorder, which is in the spotlight right now because of its recent addition to the DSM-V
  • Maeve Shaughnessy Treating Eating Disorders: An Integrative Approach
    Maeve Shaughnessy, MS, LPC, Clinical Director
    Eating disorders rarely occur in a vacuum. They are frequently accompanied by anxiety, depression, PTSD, bipolar disorder or borderline personality disorder, so it's essential to treat the whole person — mind, body and spirit.
  • Ann Twilley Garcia EMDR in the Treatment of Eating Disorders
    Ann Twilley Garcia, MA, LPC, Trauma Therapist
    By accessing traumatic memories in a safe environment, EMDR enables clients to develop new and more positive associations between the traumatic memory and more adaptive memories or information.
  • Anne Ganje The Registered Dietitian's Role in the Treatment of Eating Disorders
    Anne Ganje, RD, Nutrition Director
    The dietitian's role is challenging because she is in charge of the clients' food. This can be very activating and stressful for clients, but it also provides many opportunities for the client to process anger.