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									"Dialectical Behavior Therapy for Adolescent Bulimia Nervosa and Co-Occurring
                     Deliberate Self Injury and Depression" Sarah Fischer, Ph. D.



        Sarah Fischer, Ph. D. is an assistant professor of Psychology at the University of Georgia. She
completed her B. A. in Psychology at the University of Kentucky in 1999 and her Ph. D. in Clinical
Psychology at the University of Kentucky in 2007. Dr. Fischer completed her internship and postdoctoral
training at the University of Chicago Medical Center. Currently, she supervises a Dialectical Behavior
Therapy program at the UGA Psychology Clinic, with a focus on co-occurring Bulimia Nervosa, Borderline
Personality Disorder, and substance abuse.

        The focus of Dr. Fischer's program of research is on personality traits and psychosocial
factors influencing the maintenance of Bulimia Nervosa and co-occurring substance abuse and
dependence. Specifically, her research investigates how different aspects of the broad trait
impulsivity affect substance use and eating disordered behavior, such as binge eating and
purging. She is especially interested in how the personality trait of impulsivity affects these
behaviors in the context of negative mood states and in conjunction with outcome expectancies
for addictive behaviors. Current projects include a longitudinal study of the influence of negative
urgency and sexual assault on bulimic symptoms, alcohol abuse, and self harm behavior in
young adult women, and a cross sectional study utilizing fMRI to investigate differences in
reward processing of bulimic women, obese women, and non- eating disordered, normal
weight women under stress.

         While Bulimia Nervosa (BN) typically onsets in adolescence, only two randomized
controlled trials have been published which examine treatment for adolescent BN (Schmidt et
al., 2007; le Grange et al., 2007). BN symptoms in adolescence are often associated with
deliberate self harm, suicidality, and depression. While recent RCTs for adolescent BN are
promising, no published reports address management of co-occurring depression and self harm
in the context of treatment of BN. Dialectical behavior therapy is the most effective treatment to
date for recurring suicidality, deliberate self harm, and co-occurring Axis I disorders (Harned et
al., 2008). DBT targets reduction in specific behaviors, (i. e. self harm), while teaching emotion
regulation and distress tolerance skills. Components of DBT include individual therapy, group
skills training, and a 24 hour crisis paging system. It has been applied successfully in suicidal
adolescent populations and adult women with BN, Binge Eating Disorder, and co-occurring
eating disorders and Borderline Personality Disorder (Chen et al., 2008, Safer et al.,2001),
yielding significant reductions in symptoms. However, the effectiveness of DBT has not yet been
examined in adolescents with BN and co-occurring suicidal behavior. Our goal is to conduct a
pilot test of the effectiveness of a six month DBT program for adolescents with BN and co-
occurring deliberate self injury and depressive symptoms. Parent training will be included in
addition to the traditional components of DBT described above, with follow up assessments at
six months post-treatment. Our goal is to significantly reduce self harm and depressive
symptoms while successfully treating symptoms of BN.

								
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