Position Statement:
Eating Disorders and Occupational Therapy (2017)
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The Canadian Association of Occupational Therapists (CAOT) acknowledges the knowledge, skills and expertise that occupational therapists have to fulfill their roles in providing client services regarding the recovery process from eating disorders to encourage long term recovery in order to prevent relapse. Occupational therapists are an integral member of the healthcare team that are uniquely positioned to empower individuals through the recovery process and facilitate participation in everyday meaningful activities. Given the profession’s skills, education, clinical background and unique perspective of occupation, it uniquely positions occupational therapists to provide support through the recovery from an eating disorder.
Recommendations for Occupational Therapists
1. Collaborate with clients and other health care members to address the recovery process from an eating disorder from a multidisciplinary standpoint.
2. Engage in research and continue professional development to enhance skills and further understanding of the impact eating disorders have on health and well-being and the importance of the recovery process.
3. State and advocate for the role of occupational therapy in the treatment of eating disorders and the recovery process.
4. Acknowledge, respect, and understand the unique scope, expertise, and contribution of all professional groups and individuals involved.
5. Participate in continuing education and mentorship opportunities to share expertise, build workforce capacity, and develop best practices regarding eating disorders and the recovery process.
6. Consider and incorporate evidence-based research into practice in order to confidently seek out opportunities for leadership within the practice context.
7. Implement client-centered care in practice by adapting environments and occupations to best support participation in meaningful occupations as designed by the client.
CAOT Initiatives
To enable occupational therapists to develop and deliver quality services regarding eating disorders and the recovery process, CAOT will:
1. Support, produce, and aid in the discernment of peer-reviewed high-quality evidence to support best practice in occupational therapy interventions in the recovery process of eating disorders.
2. Continue to advocate and promote leadership within the field for occupational therapy and its vital role in the recovery and management of eating disorders through advocacy and education with health authorities, policy makers, health care teams, and stakeholders.
3. Offer continuing education opportunities on the assessment and management of eating disorders and the recovery process.
4. Work in collaboration with the profession and stakeholders that have a direct interest in the advancement of quality services for individuals with an eating disorder.
Background
Eating pervades our daily lives as it supplies our bodies with the necessary nutrients to survive and function optimally so that we are able to engage in the world we live in (Clark & Nayar, 2012). It not only involves the consumption of food, but also meal planning, shopping and preparing food and can be done in a variety of contexts, such as at home, the workplace or with others at a restaurant (Clark & Nayar, 2012). Eating has a global influence on an individual’s occupational functioning through their activities of daily living, socializing, self-care, and work (Bradford, Holliday, Schultz, & Moser, 2015). As humans, being able to feed oneself and prepare meals is an integral part to survival and when a person is unable to do so, it can severely impact the individual both physically and psychologically, affecting all key areas of occupational performance (O’Reilly & Johnson, 2016).
Eating disorders are complex conditions that produce cognitive distortions and interpersonal conflict, can impact an individual’s health and well-being and occupational performance; specifically negatively influencing occupations in self-care, productivity and leisure (Cockell, Geller, & Linden, 2003; Elliot, 2012; O’Reilly & Johnson, 2016). The prevalence of eating disorders in today’s society is increasing and is presenting with increased complexity and severity (Bradford, Holliday, Schultz, & Moser, 2015; O’Reilly & Johnson, 2016). As eating disorders become more prevalent, health care systems are drawing from all resources to help improve intervention outcomes (Bradford, Holliday, Schultz, & Moser, 2015). Due to the strong prevalence of eating disorders and increase in numbers of relapse, it raises the question of whether there is a role for occupational therapy working in the specialized field of eating disorder recovery (Clark & Nayer, 2012).
Eating disorders present in a number of ways depending on the individual’s experiences. Behaviors can be impulsive (i.e. eating behaviors, self-harm and substance use) or controlled (i.e. high anxiety, low mood and poor self-esteem) and characteristically, individuals become excessively preoccupied with the shape and weight of their body (Clark & Nayar, 2012). Symptoms, such as extreme weight loss, fatigue, weakness, sensitivity to cold, preoccupation with food, low mood and irritability can be exacerbated by the physical, cognitive, emotional, and behavioral effects of starvation (Bradford, Holliday, Schultz, & Moser, 2015; Clark & Nayar, 2012). Eating disorders are often co-occurring with a mental health condition (i.e. anxiety, depression, substance abuse, suicide attempts and personality disorders) and other physical conditions (i.e. chronic fatigue, insomnia, pain and migraines) (Johnson, Cohen, Kasen, & Brook, 2002). As occupational therapists have an established role within the mental health recovery practice, the profession is equipped to implement recommended treatment approaches to address the dietary imbalances of individuals living with an eating disorder.
Individuals with an eating disorder struggle to cope with their daily activities, such as grocery shopping, organizing time or managing the demands of work or school (Lock, 2000). An eating disorder can be infused within these daily occupations through the meaning that an individual ascribes to the activities and becomes the lens through which they view the world (Elliot, 2012). In other words, the meaning that is associated with the everyday occupations they engage in, becomes the frame of reference that influences their behaviors and cognitions which then creates the eating disorder.
Occupational therapists can play a substantial role in the assessment and recovery of an eating disorder, as they possess the skills, relevant frames of reference and modalities to holistically evaluate how everyday functions are impaired by the disorder (Bradford, Holliday, Schultz & Moser, 2015). The main goal of occupational therapy is to develop the skills the individual needs to pursue occupations that will bring meaning to their life (Bradford, Holliday, Schultz, & Moser, 2015; Costa, 2009). Occupational therapists provide a unique contribution in the recovery process by acquiring the necessary tools to clearly translate information associated with healthy diet options and help individuals living an eating disorder develop skills to implement this knowledge into the daily lives (Gardiner & Brown, 2010; Williams, Magin, Sultana & Haracz, 2016). It is through the profession’s holistic lens, that they are able to identify supports and barriers to a client’s health, well-being and participation to demolish the cognitive distortions and improve eating habits of individuals with an eating disorder. Occupational therapists are able to increase dietary knowledge (i.e. daily nutritional requirements, nutrition values of different foods and portion sizes), aid in develop
ing skills for healthy eating (i.e. obtaining and preparing foods through meal planning, shopping, cooking and making appropriate choices as restaurants) and behavioral and self-management techniques (i.e. goal setting, self-monitoring and distraction techniques to alleviate distress post meal) (Williams, Magin, Sultana & Haracz, 2016). By identifying the supports and barriers to a client’s health, well-being and participation, occupational therapists are able to improve self-esteem and motivation to ultimately prevent and discourage relapse.
According to Sutton (2008), exploring the meaning of occupation is a crucial part of the recovery process. Participation in occupations has been repeatedly identified as the primary means by which clients develop their sense of self or identity in the world (Clark & Nayar, 2012; Krupa, et al., 2009; Sutton, 2008).
It is through the participation of occupations that occupational therapists can facilitate social engagement, support learning of skills to manage symptoms, address dealing with stigma and encourage clients to become functioning members of society; which is integral to occupational engagement and encompasses the core values of the recovery process (Clark & Nayar, 2012; Krupa, et al., 2009). By implementing the philosophical foundations of occupational therapy, occupational therapy interventions can enhance self-concept and self-efficacy through occupations to successfully carry out and produce long-term successful treatment for individuals with an eating disorder.
Eating disorders globally affect a person’s ability to perform and engage in occupations. The philosophical foundations of occupational therapy and focus on function are aligned with the elements of recovery. Therefore, occupational therapy has a key role in supporting individuals with an eating disorder through the recovery process.
Glossary
Occupation: “Activities of daily living that occupy one’s time and have attached meaning defined by the individual or their culture. Occupations can be categorized as self-care (activities to take care of one’s self), productive (activities that contribute economically or socially to one’s community), or leisure (activities that are for one’s enjoyment) Depicted as the bridge that connects person and environment indicating that individuals act on the environment through occupation”
(Townsend & Polatajko, 2013).
Occupational Performance: “The result of a dynamic, interwoven relationship between persons, environment, and occupation over a person’s lifespan; the ability to choose, organize, and satisfactorily perform meaningful occupations that are culturally defined and age appropriate for looking at after oneself, enjoying life, and contributing to the social and economic fabric of a community” (CAOT, 1997; 2002a).
Occupational Performance Issues (OPI): “Ability to choose, organize, and satisfactorily perform meaningful occupations” (CAOT, 1997; 2002a). “When solutions to choosing, organizing, and performing an occupation become a challenge it becomes relevant to occupational therapy” (Townsend & Polatajko, 2013).
Occupational Imbalance: “Based on the reasoning that human health and well-being require a variation in productive and leisure occupations” (Townsend & Polatajko, 2013).
Health: From an occupational perspective, health includes “having choice, abilities, and opportunities for engaging in meaningful patterns of occupation for looking after self, enjoying life, and contributing to the social and economic fabric of a community over the lifespan to promote health, well-being, and justice through occupations” (Townsend & Polatajko, 2013).
Meaningful Occupations: “Occupations that are chosen and performed to generate experiences of personal meaning and satisfaction individuals, groups, or communities” (CAOT, 1997; 2002a).
Recovery: “A deeply personal, unique process of changing one’s attitudes, values, feelings, goals and roles. It is a way of living a satisfying, hopeful, and contributing life even with the limitations caused by illness. It involves the development of new meaning and purpose in one’s life as one grows beyond the catastrophic effects of illness” (Clark & Nayer, 2012).
Occupational Therapy: The practice of “enabling engagement in everyday living” (Townsend & Polatajko, 2013, p.27). It is the art and science of enabling engagement in everyday living, through occupation; of enabling people to perform the occupations that foster health and well-being; and of enabling a just and inclusive society so that all people may participate to their potential in the daily occupations of life.” (Townsend & Polatajko, 2007).
Client-Centered Care: “Based on enablement foundations and employs enablement skills in a collaborative relationship with clients to advance a vision of health, well-being, and justice through occupation.” (Townsend & Polatajko, 2007) “Client- centered occupational therapists demonstrate respect for clients, involve clients in decision making, advocate with and for clients’ needs, and otherwise recognize clients’ experience and knowledge” (CAOT, 1997; 2002a).
References
Canadian Association of Occupational Therapists. (1997; 2002). Enabling occupation: An occupational therapy perspective (1st Ed.). Ottawa, ON: CAOT Publications ACE.
Clark, M. & Nayer, S. (2012). Recovery from eating disorders: A role for occupational therapy. New Zealand Journal of Occupational Therapy, 59(1), 13-17.
Bradford R., Holliday M., Schultz A., & Moser, C. (2015). The role of the occupational therapist in the treatment of children with eating disorders. Journal of Occupational Therapy, Schools, & Early Intervention, 8:3, 196-210, DOI: 10.1080/19411243.2015.1077053
Elliot, M. L. (2012). Figured world of eating disorders: Occupations of illness. Canadian Journal of Occupational Therapy, 79, 15-22. doi: 10.2182/cjot.2012.79.1.3
Gardiner C., Brown N. (2010). Is there a role for occupational therapy within a specialist child and adolescent mental health eating disorder service? British Journal of Occupational Therapy, 73(1), 38-43.
Johnson, J. G., Cohen, P., Kasen, S., & Brook, J. S. (2002). Eating disorders during adolescence and the risk for physical and mental disorders during early adulthood. Archives of General Psychiatry, 59(6), 545-552. doi: 10.1001/archpsyc.59.6.545
Krupa, T., Fossy, E., Anthony, W., Brown, C., & Pitts, D. (2009). Doing daily life: How occupational therapy can inform psychiatric rehabilitation practice. Psychiatric Rehabilitation Journal, 32(3), 155-161.
Lock, L. (2000). Reoccupying the preoccupied: Occupational therapy for su erers of eating disorders. In T. Hinmarch (Ed.), Eating disorders: A professional approach (pp. 70-87). London, UK: Whurr Publishers.
O’Reilly, Cl., & Johnson, L. (2016). Working with people with eating disorders. In J. Clewes & R. Kirkwood (Ed.), Diverse roles of occupational therapists (Rev. ed., pp. 251-277 ). Cumbria, CA: M&K Update Limited.
Sutton, D. (2008). Recovery as the re-fabrication of everyday life: Exploring the meaning of doing for people recovering from mental illness. Unpublished doctoral thesis. Auckland University of Technology, Auckland.
Townsend, E. A., & Polatajko, H. J. (2013). Enabling occupation II: Advancing an occupational therapy vision for health, well-being, & justice through occupation (2nd ed.). Ottawa, ON: CAOT Publications ACE
Williams, L., Magin, P., Sultana, J., & Haracz, K. (2016). The role of occupational therapists in the provision of dietary interventions for people with severe mental illness: Results from a national survey. British Journal of Occupational Therapy. Vol. 79(7), 442-449, DOI: 10.1177/0308022615620680