Abstract

Introducing the Egyptian Eating Disorders initiative, the first online Eating Disorders program in the MENA region, offering multidisciplinary support for people living with Eating Disorders and body image concerns. EEDI ايدي is a program curated to provide evidence-based treatment to tackle the full scope of disordered eating, body image concerns, and eating disorders. The initiative is also committed to a mission of raising awareness and contributing to research and training around eating disorders in the Middle East, with a focus on creating content that is accessible to Arabic speakers as most if not all content coming out of the ME is in English.  Objectives and Background According to the National Eating Disorders Association, 7,000,000 people of both genders and of all age groups all around the world live with Eating Disorders. There has been a 4.4% increase in the global eating disorder prevalence, from 3.4% to 7.8% between 2000 and 2018 (The American Journal of Clinical Nutrition, 2019). When it comes to age groups affected, contrary to previous belief of Eating Disorders affecting mainly young women, studies show that 13% of women older than 50 experience disordered eating behaviors according to the International Journal of Eating Disorders, 2012. Moreover, the 2014 Eating Disorders Resource catalogue stated that 25% of those diagnosed with Anorexia are males. These statistical universal figures, together with the clinical rise in presenting cases in the past decade, the growing evidence in the field of research that suggests that social media plays an important role in the reported rise of eating disorders especially among adolescents and the dangers of eating disorders on life such as  Anorexia Nervosa being the mental illness of the highest mortality rate (Smink, F. E., van Hoeken, D., & Hoek, H. W., 2012), present us clinicians and researchers with a massive duty to give this underexplored or largely ignored mental health territory the attention and clinical dedication it deserves.  Moreover, screening studies coming out of Arab countries such as Saudi Arabia, are actually researched by respected Dutch clinicians for example, rather than actual local practitioners, which may leave a void in which certain sociological and cultural factors maybe missed or misread. As such, we, the Egyptian Initiative for Eating Disorders believe it's necessary to fill this void with clinicians with local back ground and understanding, who are willing to research, fully document and initiate a database, accessible to all mental health practitioners not only from Egypt but from all the Middle East through the online platform of O7therapy. The online platform, being set up with specific and validated Eating disorders screening tools and diagnostic scales like the EDEQ, the EAT, the SCOFF, the body appreciation scale and the body image in sexual context scale ensures efficient and accurate gathering of data in parallel to a treatment program integrating different evidence based individual and group therapy techniques targeting the complex and diverse eating disorders presentations.  Program methods and description  Following a full clinical, medical, psychological, screening and diagnostic scales(EDEQ, EAT, BAS, SCOFF, BISC) and ED presentation assessment , an interactive formulation that includes: a lifeline of the client's history, traumas, life changing events is done together with a family food script (NCFED assessment and formulation) and the 3Ps CBT formulation model (Fairborn) are done to guide the treatment plan that involves both individual and group sessions. This customized treatment plan will be made for clients falling into one of two tracks depending on degree of readiness to start tackling the eating issues. For those not ready to give up the dysfunctional eating behaviors as yet or at all, the exploration track will utilize interventions like: Motivational Interviewing, Emotional Focused Therapy for attachment injuries (attachment theory being one of theories of EDs), Psychoeducation, Medication Management and schema therapy techniques (schema theory being one of theories behind EDs). For those willing and ready to actively target the ED, the active treatment track, through a program subscription will offer a 5-month multidisciplinary and holistic program tailored to the client's needs. (Fairburn and Dalle Grave/ CBT weekly check list of Ricardo Dalle Grave as first research project studying efficacy of CBTE online over 20 sessions). Each stage of the Program is tailored to client's needs, integrating different therapy modalities and specialties. The core of the program is enhanced CBT CBTE (Fairburn) that expands into the broad CBTE type to include the tackling of ED maintaining factors like perfectionism (CBT perfectionism), self-esteem (CBT), mood intolerance (DBT groups on O7) and interpersonal effectiveness (DBT groups on O7). First stage is always psychoeducation and routine eating, then we will broaden the enhanced CBT or continue into stage 3 where we focus on Body Image issues and need to control issues via ERP or cognitive restructuring or EMDR if there is body image or eating trauma memory. In this stage we also utilize skills from Emotion Freedom therapy, Schema therapy or CBT-E, Emotion focused therapy, emotional resilience training, assertiveness training and positive psychology (all of which are recommended by NICE guidelines and accredited by NCFED as best evidence-based therapies for EDs).  The program offers regular check-in’s with clients' assessors', nutritionists and treatment plan adjustments as needed.  Psychological Scales to be used all throughout the treatment and a database is formed to offer different research opportunities for Mental health specialists in the Middle East. The online platform will also offer training opportunities for anyone interested in EDs, whether on interventions as CBTE or topics needs tackling as the treating perfectionism workshop planned for January in collaboration with esteemed international trainers and platforms. The initiative created an Instagram page: Eating Disorders Egypt, dedicated to posting written and video Psychoeducation material covering all aspects and presentations of EDs in Arabic. The aim of the initiative on Instagram is raising awareness about this important mental health issue. This is why the description in Arabic is:  المبادرة المصرية للتعريف باضطرابات الأكل The initiative is headed by myself Dr Sally Moore and our team of specialists (working online and in clinics) is a multidisciplinary team of Psychiatrists, clinical Psychologists and clinical Nutritionists using Multiple evidence based Therapy Types mentioned above, like CBT-E, Psychoeducation, Emotion Focused Therapy techniques (EFT), Emotion Focused Family Therapy (EFFT) mixed with Family Based Therapy techniques to support families struggling with EDs, DBT groups, EMDR, Schema therapy approaches and Medication Management. Treatment is offered for children, adolescents and adults struggling with EDs. I am currently shooting the whole psychoeducation course for all ED presentations with O7Therapy. The course will be used to aid therapists working on stage 1 or any Psychoeducation stage. The opportunity to present The EEDI initiative would like to have the honour of presenting at the Egyptian Group therapies Conference. We would like to introduce our program and network with our colleagues about EDs for further training/researching opportunities and clinical referrals. We would like to present our journey and objective of having a holistic online program accessible to all Arabic speakers all over the world.  The presentation should cover:  *Quick ED knowledge, diagnostic criteria and common presentations. *Theories behind EDs guiding treatment. *The need for holistic program. *Why online *The house of cards analogy for treatment of EDs tackling predisposing and maintaining factors. *Program details of all therapies provided. *Group therapies on program *Measuring scales for monitoring and guidance through-out tx from assessment till follow up. *Psychoeducation channels *The issue with nutritionists not EDs informed. *Special points on Anorexia *Special points on BN and group DBT therapy *Special points on binge eating and blood sugar regulation *Obesity and EDs My Bio: I am a British-Egyptian Psychiatrist (Kasr Al Ainy, Cairo University) with a Master's degree in Cognitive Behavioural Therapy for Complex Disorders from the UK. I spent several years lecturing at Oxford University while working at Cotswold House (Oxford Eating Disorders Unit). I am the head of the Eating Disorders Unit at O7 Therapy. I have completed the NCEFD masterclass in ED treatments with the brilliant Deanne Jade and should receive the masterclass diploma in January. I have headed Médecins du Monde's Mission to Egypt as its Medical Coordinator in Egypt. I focused on designing, advocating, and implementing mental health integration into primary health services through a stepped-care approach. I have trained medical staff and psycho-social workers of both the Ministry of Health and a range of national and international NGOs on psycho-social interventions within the community. I consult with several national and international NGOs working with refugees, and victims of gender-based and sexual violence, among other vulnerable populations. I currently work in several 'community care' private mental health clinics offering individual, couples, and group sessions. I have a particular interest, focus, and extensive experience, working with people struggling with eating disorders, as well as women survivors of violence, and in areas of women's rights generally. I work with emotional regulation, relationship challenges, and empowerment from a Humanistic Eclectic perspective. As head of the Eating Disorders Unit, I lead a team of mental health specialists from different schools of therapy who have come together in a multidisciplinary holistic program for those struggling with eating disorders and body image concerns. I see the treatment of eating disorders as a house of cards, so I tailor treatment plans with a team and a stepped-care approach based on the underlying and maintaining factors to their challenges. I use interventions including CBT-E, Emotion-Focused Family Therapy, EMDR, and DBT for Eating Disorders. I also have a deep passion for working with clients living with PTSD, sexual disorders, and personality disorders using adopted, integrated, and tailored techniques. Some of the Eclectic Therapy Techniques she focuses on are Emotional-Focused Therapy based on attachment theory for both individuals and couples, DBT combined with a Psychodynamic Approach for personality disorders, especially Borderline Personality Disorder (individuals and groups), Trauma Therapy, Sex Therapy for sexual and gender challenges, and Dance Therapy. I believe in a Holistic, Eclectic, and Humanistic Integrative approach to therapy (combining psychotherapy techniques, psychopharmacology, art therapy and working in a multidisciplinary manner) that ensures and enables people's development in all aspects of their lives. I believe therapy is not only a journey of self-discovery but also the mastering of various skills we need to cope with life's challenges. You are not alone.