Back to Basics: Men And Eating Disorders

     This month’s article was written by Gary Snapper, LPC, LLP, an active SMEDA Board member.  He is a licensed Professional Counselor and a Limited License Psychologist who founded Cognitive Behavior Solutions in Kalamazoo. He specializes in the treatment of eating disorders, anxiety disorders, and personality disorders.

 Back to Basics:  Men and Eating Disorders

     Most people associate eating disorders with women; women with anorexia, women who binge and purge their food, women who binge eat. Many are surprised to learn that men are also susceptible to eating disorders.  Examples of men struggling with disordered eating have appeared in medical records over the centuries. The earliest recorded example of a man with anorexia is a commonly considered case from 1689. The English physician Richard Morton described the case of a male adolescent who began fasting at 16 years of age.   Dr. Morton described the trigger for the fasting as “studying too hard,” along with “the passions of his mind.”  Dr. Morton told the adolescent to abandon his studies, move to the country, take up riding and drink plenty of milk.  This change in lifestyle led to the young man recovering, “his health in great measure.” If only all treatments of anorexia could be accomplished so directly.

     Today, males are estimated to represent up to 25% of cases of anorexia, with only 5% of these seeking treatment.  As with females, stigma contributes to treatment avoidance in males with ED.  One study concluded that being labeled gay or feminine can act as a stigma in male eating disorders, preventing some males from seeking treatment.  Another source of stigma is the pervasive female focus in the literature, support services, research, and treatment options.  One survey concluded that over 99% of books published on eating disorders assume a female bias in pronoun, as well as in the topic focus. Males who start to search resources for ED treatment are likely to observe these biases, and may be reluctant to continue their exploration.

     Comparative analyses between male and female eating disorders are needed, including manifestations, treatment options, outcomes and stigma.  Initial studies suggest a number of gender-specific trends in eating disorders.  For example, mortality of eating disorders may be higher in men.   Another trend is that males with ED tend to have a higher incidence of overexercising than do females. A study comparing results between 108 men and women receiving residential treatment for eating disorders, identified that men scored lower (less intense) on questions regarding body dissatisfaction, bulimic behavior and drive for thinness. This supports the hypothesis that assessment tools may be more effective if created to be gender specific. Similarly, further research might help steer the development of gender- aware treatment protocols to enhance effectiveness of therapy options. 

     Unfortunately, as with treatment of eating disorders in women, men with eating disorders have limited options for evidence-based treatment.  For adolescent males and females with Anorexia, there is a research-supported treatment option termed Family Based Therapy (or the Maudsley approach).  This therapy approach includes three phases of treatment.  Phase I is focused on refeeding at home, with parents encouraging the teen to eat more food per meal with the goal of weight restoration. Phase II focuses on client empowerment, giving more control back to the teen and decreasing parental supervision over time. Phase III focuses on establishing a healthy adolescent identity (increased autonomy, developing healthy boundaries toward and from parents, and fostering increasing independence over time). Studies suggest that weight restoration occurs in 70-90% of both male and female participants, with 5-year weight retention.

     For adults of both genders, research continues to support the use of Cognitive Behavior Therapy (CBT), Dialectical Behavior Therapy (DBT), and Interpersonal Psychotherapy (IPT) as treatments of choice for Bulimia Nervosa, Binge Eating Disorder, and Anorexia Nervosa (mildly effective).  Unfortunately, as with all eating disorders, even the most effective treatments are not as effective for individuals with more intense symptoms of each type of eating disorder. Underfunding for research of treatments for eating disorders is yet another challenge to overcome.

     In summary, despite centuries-old records of males with eating disorders, research on males with eating disorders is and has always been limited.  The available research suggests that although current evidence-based treatments may be equally effective for both genders, males’ symptoms manifest differently and are less likely to be diagnosed than those of their female counterparts.  Males also avoid seeking treatment for different reasons than do females.   Attention to these differences and a more inclusive support environment are needed to help males get the treatments currently available that might benefit them.

References:

1)      Stanford, S.C. Volume 20, 2012 - Issue 5: Males and Eating Disorders. A Clinical Comparison of Men and Women on the Eating Disorder Inventory-3 (EDI-3) and the Eating Disorder Assessment for Men (EDAM). The Journal of Treatment and Prevention.

2)      Striegel RH, Bedrosian R, Wang C, Schwartz S: Why men should be included in research on binge eating: results from a comparison of psychosocial impairment in men and women. Int J Eat Disord. 2012, 45 (2): 233-240. 10.1002/eat.20962.

3)      Striegel-Moore RH, Leslie D, Petrill SA, Garvin V, Rosenheck RA: One-year use and cost of inpatient and outpatient services among female and male patients with an eating disorder: evidence from a national database of health insurance claims. Int J Eat Disord. 2000, 27 (4): 381-389.

4)      Zhang, Chengyuan. Journal of Eating Disorders 2104 2:138. What Can We Learn From the History of Male Anorexia Nervosa?

 

My Son Has an Eating Disorder

In the beginning...


by Lynne


As I sit here trying to write my first BLOG ever, I have all these emotions and feelings swirling around in my head. What do I say and where do I begin?


Four years ago my son, who was a freshman in high school, was diagnosed with an eating disorder. I was numb. How could this happen? What did I do wrong? He was always such a good kid. Well liked, good grades, thoughtful and honest. My happy go lucky kid never showed any signs of the turmoil that was brewing inside of him. I remember thinking "but he's a boy; this only happens to girls." I soon found out that ED has no gender preference and that there is a rise in eating disorders among males.


Our son came to me one day and told me that he thought something was wrong. Ever since watching the 2012 Summer Olympics, he had been cutting out fat and sugar from his diet in an attempt to become more healthy, but he was losing weight and strength. Tiny little hairs had appeared on his arms and the back of his neck. Apparently, this new hair, called lanugo, was a way for the body to keep warm. He also had patches of very dry skin.


After our conversation, I went on the Internet and did some research. As I researched, I realized that what my son was saying pointed to an eating disorder. I went into his room and told him that I looked online and that he should do the same. He was not very receptive and told me to leave. The next day he came to me and said he did look online and he realized that he had most of the symptoms of anorexia nervosa. We decided to visit his pediatrician. He referred us to a doctor who specialized in eating disorders. I now realize how important it is to have a good medical team consisting of a doctor, therapist, and a dietician. All three should specialize in eating disorders and communicate on a regular basis regarding the patient.


We were in the middle of baseball season and the end of soccer season. Watching my son struggle with running, kicking a soccer ball, catching and hitting a baseball was very hard to do. His body was deteriorating. He was always so strong and very athletic. Every movement he performed now seemed to be in slow motion. As parents, we all had to contribute to dinner for the team after games. Our son, who always ate anything, was now very picky and would not eat the dinners provided. He mostly stuck to granola bars. Later we found out that his baseball coach had provided him with an App to monitor fat and calories in foods. He had it on his phone and used it regularly to cut calories out of his diet. Other people noticed something was wrong. As parents, we decided to stop all sports. It was his idea to tell his coaches and team members what he was going through. We were so proud of him.


Within a few weeks, our son was hospitalized for 13 days. His heart rate and blood pressure were critically low. After his release, our real journey began. How do we help our son? What is the right thing to do? What should we do and what shouldn't we do? As a mom, I felt all alone in this process. My husband and my other son really didn't understand. I'm not sure if I understood either. All I knew was that this was very real to my son. It was really affecting his life. I missed the way he used to be and wanted to see him smile again. I read what I could on the Internet and books in search of coping skills. I had just started working a full time job and decided to go part time in order to allow me to be home more.


With summer just beginning, my son would be home all day. ED had also taken away his desire to be social. Before ED, he was always with friends and doing social things. Now he had no desire to do much of anything. Much of the day was spent in anticipation of the next time he would have to eat something. He always seemed to be in distress. Jigsaw puzzles and word puzzles helped him get through the time in between meals. I had to plan my day around being home for meals/snacks and doctor appointments. We had a meal plan to follow and he was not able, or allowed, to prepare them on his own. My whole world was now focused on getting calories and nutrition back into my son's body and getting him the psychological help he needed. I often wondered how long this journey would last. I needed to get a handle on this disorder and figure out the best way to help my son. I felt so alone and helpless. In looking back now, everything we went through was a necessary part of the healing process.

Recovery Heroes

by Aubrey Butts


An eating disorder is like a cocoon. Nothing can hurt you inside this cocoon. It’s the bargain that an eating disorder strikes to make giving literally everything else in your life. At least it won’t hurt. At least the outside world can’t touch you.


I’ve come to learn I’m what I call, a “feeler.” I feel things deeply, I feel things quickly, and I sometimes feel things so erratically, I can’t quite establish its root cause. For “feelers,” this cocoon is essentially a dream. I now had a “blanket” to hide away in and my extreme feelings were now numbed. I no longer identified as a “feeler.” In fact, I nearly felt downright psychopathic, lacking any sense of empathy or longing for human contact.


I lived like this for quite awhile. Nothing could touch me.  Of course, what they don’t tell you, is the larger your cocoon becomes, the smaller the contents inside become. Both literally and figuratively.


I no longer knew how to take up space. I was unquestionably terrified of it. My body became smaller. The way I sat took as little space as possible. Sorry’s ended my sentences like periods. My voice became quieter and quieter until I nearly lost it completely. But I was enmeshed so deeply in my cocoon, I couldn’t see this as a problem. It was, in my opinion, what I was supposed to do. Deserved to do.


The first chink into my cocoon came during my experience in a treatment center with a Skype call with my sister. Family therapy was a part of the treatment center’s program. My parents kindly drove up a few times for meetings, but my sister couldn’t. Instead, we were able to set up a Skype session with her to discuss her experience with my disorder, how it affected her and anything else that needed to be processed. In my worldview, my sister was Beyoncé.
I loved her with as deep a love as I feared and envied her. Things always seemed to be so easy and perfect for her, which I now realized was only with a lot of effort and strong work ethic. But in my disordered and damaged brain, she seemed to have a life I would kill for. Plus she was blonde, beautiful, had an incredible boyfriend and could eat and drink anything she wanted without fear.


As invincible as I felt, I knew she was more so. No way had my struggles affected her. She was hardly home when I was growing up…


And this, I learned was because of my disorder.


My disorder had become a fire that consumed all of the time, care and attention from my parents. The fires in our home burned my parents into ash, but my sister also smelled smoke. Instead, she fled the fire like any logical person would, building a world outside of the embers. Who could blame her? But I hadn’t realized how difficult and frightening this had all been for her.


Hearing her side of the last few years created a little crack into my cocoon. Suddenly the weight of what I had done wasn’t protected from me anymore.


The relationship with my sister has been complicated, to say the least. But the time I’m able to spend with her, the meals we’ve shared, the advice and support I’ve received, and the utter joy I get in seeing her life unfold has been one of the biggest motivators to me. Yes, she is the Beyoncé in my world, but just as Beyoncé is a role model and inspiration to so many (including me, duh…) so is my sister.


In honor of all of the important support people who have helped people during their recovery, NEDA, Project HEAL and Recovery Spark have created this wonderful video called Recovery Heroes for Eating Disorder Awareness Week. Check it out. And if you would like to contribute a blog post about and important support person who has helped you during your recovery or any other topic contact SMEDA at 123smeda@gmail.com.

Back to Basics: Eating 101

This month’s article was written by Trina Weber, MS, RD, an active SMEDA Board member.  She is a registered dietitian who specializes in the awareness, prevention, and treatment of eating disorders. She owns a private practice in Kalamazoo.

 Back to Basics: Eating 101

     Many in our society are afraid of food. There are numerous ways to eat – low-carb, gluten-free, lactose-free, Paleo, or raw vegan, to name a few. Some have genuine food allergies and sensitivities, but too many people cut out whole food groups because they are led to believe the popular myth that it's “better for you”.  If a plate containing a ham and cheese sandwich with lettuce, tomato, and mayonnaise, an apple, and some carrots was placed in front of most people, I wonder who would eat it? Some would ask: Is the produce organic? Did the ham come from a free-range pig? Can I get this on gluten-free bread?

      Grocery stores don't make it any easier. There are so many choices between brand names, organic vs. non-organic, flavors, and cost that it easily becomes overwhelming. I reviewed pasta sauces at my local grocery store. There were nine different brands to choose from, and each brand had between 3 to 6 different flavors to choose from. That's almost 50 choices for just ONE food! I assume most of us buy several food items when we're grocery shopping.

      So what do we do? We have to decide what is important and what is reasonable. If heart disease runs in your family, watch the sodium and saturated fat intake. If cancer runs in your family, eat a larger proportion of organic foods. If finances are tight, do the best you can with what you have. Be watchful that you are not cutting out too many food groups, decreasing variety, or becoming too rigid with food. If you want to be a vegan, aim for about 80% of your intake to be plant-based, but be open to animal products for the other 20%. Most of us get invited to parties and other social events that provide little to no vegan foods. Choose not to be so rigid that you “have to” bring only your own food, go hungry at the party because there is nothing you “can” eat, or, the worst decision of all, miss out on a fun social opportunity because there won't be any foods there you're willing to eat.

      Choose not to micromanage your food. Stay focused on the big picture, which is choosing moderation, balance, and variety to ensure you get the best nutrition for optimal body function. (Notice I didn't mention weight?) We're all a work-in-progress, and do our best given our circumstances each day. Don't worry - if you feel like you “messed up” at a meal, you'll have another meal opportunity in a few short hours.

 

 

Art Hop Series: Eating Disorders with Anxiety and Depression

The Art Hop exhibit countdown:  1 days left

Art Hop                                                                                                                                 February 3, 2017 5pm to 8pm                                                                                                             300 Portage Street (WMU Homer Stryker M.D. School of Medicine)

Lindsay P. South, MA/LPC, an active SMEDA Board Member and a Registered Play Therapist-Supervisor, has written this brief explanation about one way to manage anxiety and depression that may accompany an eating disorder.  Her piece will be displayed at the exhibit along with food play examples.  http://www.southwestmichiganeatingdisorders.org/directory/

 

Eating Disorders and Anxiety

Many individuals struggle with comorbidity:  co-occurring diagnoses.  Although malnutrition certainly makes anxiety and depression worse, sometimes even after weight is restored, it becomes clear that an anxious wiring system was present long before the eating disorder developed.  Restricting food, overeating, or purging just becomes another way of managing underlying anxiety.

Anxious children can learn to manage their anxiety.  In her workbook, “What to do When You Worry Too Much,” Dr. Huebner helps kids externalize their anxiety with the creation of a worry monster.  Making these creatures and learning to talk back to them is a cognitive behavioral method of helping kids be in charge of their anxious thinking.

ART HOP Series: Food Play

The Art Hop exhibit countdown:  2 days left

Art Hop                                                                                                                                 February 3, 2017 5pm to 8pm                                                                                                             300 Portage Street (WMU Homer Stryker M.D. School of Medicine)

The exhibit is designed to not only share pieces that promote an emotional response and bring insight into what it is like to live with and recover from an eating disorder, but also to provide a greater understanding on treatment and how health care providers and parents play a role in the recovery process.  As part of that educational component...

 

Lindsay P. South, MA/LPC, an active SMEDA Board Member and a Registered Play Therapist-Supervisor, has written this explanation about how food play can be used to help children with an eating disorder.  Her piece will be displayed at the exhibit along with food play examples.  http://www.southwestmichiganeatingdisorders.org/directory/

FOOD PLAY

      Children struggling with eating disorders are often terrified of eating.  Certain foods are especially scary.  An essential part of recovery involves reclaiming all those foods which were lost and rigidly categorized as “unhealthy,”  “bad,” or “off limits.”  A nutritionist plays a key role in food restoration.  Parents and children work together to reintegrate all these eliminated foods.  This is a painful and lengthy process!

      As a therapist, I have found a playful way to handle these aversive foods:  we make and shape miniaturized play food out of brightly colored Sculpey.  The child gets to choose what challenging food to make.  Creating ice cream cones, peanut butter and jelly sandwiches, cookies, pizza and root beer floats helps kids make friends with foods they once enjoyed.

 

Art Hop Series: What About Males?

The Art Hop exhibit countdown:  3 days left

Art Hop                                                                                                                                 February 3, 2017 5pm to 8pm                                                                                                             300 Portage Street (WMU Homer Stryker M.D. School of Medicine)

 

Lindsay P. South, MA/LPC, an active SMEDA Board Member and a Registered Play Therapist-Supervisor, has written this reminder on males with eating disorders.  Her piece will be displayed on our information table at the exhibit.  http://www.southwestmichiganeatingdisorders.org/directory/

 

What about Males?

     This question is always asked at any gathering.   Although the ratio of men to women diagnosed with an eating disorder in the US is 1:2, many hypothesize that males may be underdiagnosed.    ED assessments using more female geared language, research focused on girls and women, as well as general difficulties males face for seeking psychological help, are some of the barriers boys and men face in being identified and treated (http://www.nationaleatingdisorders.org/research-males-and-eating-disorders).  It is not surprising that consciousness among healthcare professionals may follow suit.

     Interestingly, Mond (2014) found that  men possesses almost as many subclinical behaviors of disordered eating as women; episodes of binge eating, purging, laxative abuse and fasting for weight loss that did not meet criteria for a full blown eating disorder were just about as common among males and females.

     Men also face different pressures in terms of body image and advertising.  Whereas women’s magazines stress dieting for weight loss, men’s health and fitness magazines promote products, articles and incentives to mold body shape and enhance athletic performance.  Sometimes it is difficult to discern a fact-based article from an advertisement.  Products related to building muscles are paired with pictures of six (eight!) pack abs, a lean and mean physique, sculpted biceps, and an overall “ripped” appearance abound.  These increasingly “buff” men are coupled with a fast car, alcohol, and a sexy woman for an ever popular recipe for male success.

28 Things Gained in Recovery

by Aubrey Butts


And yes, the pun with the word gained is intended. Because here’s the thing, the importance of weight gain in recovery from an eating disorder is a given. Even in non-restrictive type eating disorder recovery, there may be some form of weight fluctuations or maintenance required. Another way to phrase this is that in losing the attachment to weight and any notion of controlling one’s body shape one gains life. For the sake of argument, this definition is the one I mean when I discuss “gaining weight.”


With Eating Disorder Awareness Week coming up in the month of February, I wanted to reflect on a year of what may arguably be my most solid time of recovery since developing an eating disorder at age nine. Had there been slips and lapses and more? Yes. This year,  although it had its weight fluctuations, meal plans, and other indicators traditionally thought of as parts of recovery, was marked more by living, the true measure of success in recovery from an eating disorder.


So, here they are: 28 things I gained in my recovery from an eating disorder. Some are general and may hopefully resonate with you; others are personal accomplishments that can be taken as examples of what the “other side” may look like. Consider using the days leading up to Eating Disorder Awareness Week to reflect on your own “gains,” regardless of what stage of recovery you, or your loved one is in.


    1.    Spring break trip to Austin, Texas full of tacos, tequila, pizza, yoga and dancing.
    2.    Establishing two weekly yoga classes to teach.
    3.    Giving the dream of being a roller derby girl a try.
    4.    Actually attempting to date.
    5.    Sitting with a “binge” or the discomfort of fullness and not engaging in compensatory behaviors.
    6.    Enjoying an ice hockey game with my best friend and not freezing the entire time.
    7.    Being around to see my hero and first female run for President.
    8.    Subbing for many yoga classes a week (being trusted to do so).
    9.    Visiting my sister and being able to go out for pizza and beer.
    10.    Waking up in the morning, enjoying the sunrise and not having my first thoughts being consumed with B/P behaviors.
    11.    Developing many self-care rituals.
    12.    Increasing communication with important individuals in both day to day interactions and high stress, high conflict scenarios.
    13.    Little moments of not just body peace, but body confidence.
    14.    Going to the beach in the summer and wearing a bikini.
    15.    Honesty in therapy.
    16.    Taking on a job in food service and not being fearful the entire time.
    17.    Learning to be a barista and being able to memorize complicated drink orders and manage stress and urges during a rush.
    18.    Having the strength to run and the awareness when the desire to run or workout is driven by my eating disorder.
    19.    Being asked to be my sister’s maid of honor.
    20.    Re-establishing my relationship with my sister.
    21.    Being honest about my past and current struggle with friends and on social media and getting the resounding sound of support.
    22.    Recognizing toxic or damaging relationships and beginning to believe I deserve better.
    23.    Gaining closure in a past toxic relationship, as well as being able to reestablish old friendships.
    24.    Going back to school after much anxiety and finally finding a program and plan that works for me.
    25.    Eating chocolate.
    26.    Food flexibility--knowing that I can choose what to eat and be radically okay with my choices (still a process daily).
    27.    A successful, behavior-free Thanksgiving spent with family and enjoying pumpkin pie.
    28.    Identifying as an optimist because I had seen the darkest of days, fallen too many times to count, but have seen the kindness in others and the way the sun always comes back, to believe there is another day to try and I choose to be around for it.

 

Why I Support This Cause--It's Personal

by Kristin Fiore, Down Dog Yoga Center


Yoga has provided me with a tangible tool to facilitate acceptance, self-love, and healing in my body. As Donna Farhi writes in her book Bringing Yoga to Life, “Through daily Yoga practice we become present to our own fundamental goodness and the goodness of others. It is the practice of observing clearly, listening acutely, and skillfully responding to the moment with all the compassion we can muster. And it is a homecoming with and in the body for it is only here that we can do all these things.” This connection of body, mind, and spirit is key as one begins to address different aspects of an eating disorder.


As a late teen suffering from an eating disorder, I found my way into treatment in a clinical setting where I sat in an examination room for medical tests or a chair for counseling sessions. In this way, I continued to feel detached from my body as there was a lack of physical participation in the process and I found it difficult to navigate the emotional connections I was making in counseling with the actual changing of habits in my body.


It wasn’t until I began practicing Yoga that the deeper process of healing and recovery began. I didn’t sit and talk about my feelings, I experienced them as I engaged my strength and stretched my limits. For the first time I had access to my thoughts and feelings through my body, not despite it. As movement connected with breath, I found a place inside of me that was always steady. As I developed greater awareness of the flow of prana within me, I began to feel empowered and beautiful. This quote from Nita Rubio’s essay in the book Yoga and Body Image sums it up nicely, “As you learn to move with the internal energies, you learn how to move with life’s flow. Beauty emanates from here because it is deeply rooted from within. This beauty is not one based on a standardized list of perfection. Nor does it reference an ideal. This beauty is based on feeling. Beauty is an experience.”


Yoga is an experiential practice that uses mindfulness techniques to bridge the gap between body and mind. As we begin to feel the connection between the different aspects of our being, we open ourselves up to process, change, surrender, and accept. The healing benefits of Yoga are many in my personal experience, and recent studies show Yoga may help relieve depression, anger, and anxiety and improve mood (Harvard Health Publications). Yoga also promotes greater self-awareness, self-esteem and positive body image through the cultivation of love, acceptance, non-violence, and unity. In addition, the physical poses of Yoga help the body build muscle, bone density, and aid in digestion which may be helpful during recovery from an eating disorder and for general overall health.


As we begin to explore the healing benefits of Yoga it is necessary to practice with compassion for what may arise and to seek guidance from a trusted and well informed teacher as needed. It is important to practice in a safe and non-competitive environment. Exploring the edge in a yoga pose in a healthy way, not by pushing the body but learning to stay with an uncomfortable sensation and find breath, may be useful when someone is feeling full and resisting the urge to purge or compensate or when they are experiencing strong emotion. Anastasia Nevin says, “Bringing yoga into eating disorder recovery is a way to access memories, messages, and wisdom stored in the body that are not always accessible in more traditional forms of talk therapy. The ultimate goal of recovery is in fact Yoga: re-connecting and integrating all parts of the self to live a more intuitive, peaceful, and soulful life.” (Live Fit article, “The Role of Yoga in Treating Eating Disorders”)


I have found that the routine practice of Yoga allows me to be consistent, loving, and stable in body, mind, and spirit. Throughout my years teaching and studying, I have worked with many others who also find it to be a useful therapeutic tool. Yoga poses can be modified to suit each individual’s needs depending on where one is in treatment or recovery of an eating disorder, and the use of breathing techniques, mindful meditation, and movement make this a great holistic treatment to compliment more traditional forms of therapy.


According to the National Eating Disorders Association, ten million females and one million males in the United States are struggling with an eating disorder. So what can you do? In the Kalamazoo area, SMEDA is trying to make a difference and you can support our upcoming Coffee + Compassion Fundraiser and get involved with this group. Please help us raise funds and awareness for this important cause! Share this post and feel free to reach out to me personally with any questions about SMEDA or how Yoga may be helpful in eating disorder recovery. Together we can make a difference!


Down Dog Yoga Center is selling tickets for Southwest Michigan Eating Disorders Association's fundraiser - a Coffee Tasting, Brunch, and Silent Auction on February 11 from 9:30am to Noon at the Kalamazoo Riverview Launch. Tickets are $35 and can be purchased at our front desk or online through the SMEDA website.

 

ED Therapy - Exposure and Response Prevention?

Corntney Modelewski, MA, LLPC, an active member of SMEDA and a Kalamazoo therapist that specializes in Cognitive Behavioral Therapy and DBT.  She has written this months blog article on Exposure and Response Prevention (ERP).  http://www.southwestmichiganeatingdisorders.org/directory/

     Exposure and Response Prevention (ERP) is a therapy for Obsessive Compulsive Disorder (OCD) that requires being in the presence of something that causes fear – exposure – and not avoiding the feared situation – response prevention. It can also be used during eating disorder treatment, with growing research to support its use in Anorexia Nervosa and Bulimia Nervosa. For example, in 2011 the International Journal of Eating Disorders published an article about data support ERP use to aid in weight restoration, fear of eating, learning to tolerate fear, and relapse prevention in those with Anorexia Nervosa when used as part of a treatment plan.

     With a licensed mental health therapist, a list called a hierarchy is made up of feared situations to be used as exposure tasks. Distress ratings on a scale of 0 – 100, called Subjective Units of Distress (SUD), are included on the hierarchy as well. The hierarchy gives the frame for treatment.

As an example...

Anorexia Hierarchy

Feared Situation                                                                    SUD (0-100)

Skip one day of exercise                                                                 55

Eat at a Chinese buffet restaurant                                                  95

Have friends over for dinner and eat in front of them                  100

Walk through a grocery store without buying anything                35

Fill pantry with canned food                                                           70

Eat apples with therapist                                                                 60

 

     It's common for individuals to have more than one mental health concern, especially anxiety or OCD. It helps to treat eating disorders and anxiety at the same time when doing ERP.  Kind of like killing two birds with one stone.

As an example...

Anorexia and OCD with Contamination Fear Hierarchy

Feared Situation                                                                                               SUD (0-100)

Eat sucker that has touched a grocery cart seat                                                     70

Hold a raw steak for five minutes before cooking                                                   75

Eat a bag of M&Ms off of therapist's office floor                                                     30

Eat an egg salad sandwich in the bathroom at home                                             45

Play with neighbor's dogs, eat meal without washing hands afterwards               80

 

Treatment structure will look like this:

  • One hour weekly appointments for 14 – 16 weeks.
  • Agreeing to one-half to two hours per day working on exposure tasks outside of session.
  • Getting hands-on help from the therapist to show how to complete the exposure tasks and prevent the person from trying to avoid fear.
  • Time to talk about feelings with the therapist after exposure tasks.
  • Exposure tasks outside of sessions may include help from friends, family, or members of the treatment team.
  • Tracking distress on a sheet of paper, including lessons learned from the activity, and other homework as assigned by the therapist and other treatment team members.
  • Repeating exposure tasks until SUDs go down.

     To sum it up, ERP is a process that addresses fears unique to the individual's needs. One of ERP's main goals is to help people learn skills to use when therapy is complete and encourage people to use their own ERP as needed. In other words, ERP is to help people with eating disorders to become their own ERP therapist.

Recommended YouTube video:

 

https://youtu.be/ZTwVb_3koCU

 

Sources:  (Many of these sources can be found in PubMed.)

Foa, Edna B., Elna Yadin, and Tracey K. Lichner. Exposure and Response (ritual) Prevention for Obsessive-compulsive Disorder: Therapist Guide. Oxford: Oxford UP, 2012. Print.


(Exposure and Response/Ritual Prevention for Obsessive-Compulsive Disorder: Therapist Guide, Edna Foa, Elna Yadin, and Tracey K Lichner, 2012)

Simpson, H. B., et al. (2013). Treatment of obsessive-compulsive disorder complicated by comorbid eating disorders. Cognitive Behaviour Therapy, 42(1), 64-76. doi:10.1080/16506073.2012.751124

(Treatment of Obsessive-Compulsive Disorder Complicated by Comorbid Eating Disorders, Cognitive Behaviour Therapy, 2013, Simpson, et al)

Steinglass, J. E., Sysko, R., Glasofer, D., Albano, A. M., Simpson, H. B. and Walsh, B. T. (2011), Rationale for the application of exposure and response prevention to the treatment of anorexia nervosa. Int. J. Eat. Disord., 44: 134–141. doi:10.1002/eat.20784

(Rationale for the Application of Exposure and Response Prevention to the Treatment of Anorexia Nervosa, International Journal of Eating Disorders, 2011, Steinglass et al)

Toro, J., Cervera, M., Feliu, M., Garriga, N., Jou, M., Martinez, E., & Toro, E. (2003). Cue exposure in the treatment of resistant bulimia nervosa. International Journal of Eating Disorders, 34(2), 227-234. doi:10.1002/eat.10186

(Cue Exposure in the Treatment of Resistant Bulimia Nervosa, International Journal of Eating Disorders, 2003, Toro, et al)

Art Hop News

Eligible individuals: Currently struggling with an ED, have recovered from an ED, family members that have been involved with the care and well being of a loved one during their struggle with an ED, and health professionals that are a part of ED care teams (The art and the accompanying paperwork needs to be submitted to one of the healthcare providers on your ED recovery team.)

Since we have extended the deadline for several projects, we are extending the deadline to everyone. (After all, it is only fair.) However, if you will need us to provide a temporary frame for the art exhibit it will need to arrive, with the filled out form, in the next two weeks. If your work is a digital arrangement, we will need it on a flash drive, with the accompanying software if needed (and the filled out form - which can be sent electronically - but not on the flash card) within the next three weeks to make sure that we have the time to prep. If your work will already be framed or does not need to be framed, please provide it and the required paperwork to your health professional (or have them confirm your status) no latter than January 20, 2017.

Mirror project: What we see in a mirror is a social construct. We will have a group piece comprised of individual submissions. If you are local and wish to be a part of the mirror collection, along with the authorization paperwork, you need to submit an altered/enhanced mirror with positive messages on the mirror, so that as you look at the mirror you see yourself and the messages that uplift and positively support you and the reflection you see in the mirror. Though it is a group project and therefore your name will not be posted for public viewing, it will be posted on the back of your mirror so that it may be returned. Consequently, it is still important to fill out the information on how you would like to be identified, so that those setting up and dismantlement the exhibit see the identifier you choose to use.)
http://www.southwestmichiganeatingdisorders.org/art-hop-2017

Art Hop Exhibit News: Special Deadline Extensions

Eligible individuals: Currently struggling with an ED, have recovered from an ED, family members that have been involved with the care and well being of a loved one during their struggle with an ED, and health professionals that are a part of ED care teams

(The art and the accompanying paperwork needs to be submitted to one of the healthcare providers on your ED recovery team.)

Since we have extended the deadline for several projects, we are extending the deadline to everyone. (After all, it is only fair.) However, if you will need us to provide a temporary frame for the art exhibit it will need to arrive, with the filled out form, in the next two weeks. If your work is a digital arrangement, we will need it on a flash drive, with the accompanying software if needed (and the filled out form - which can be sent electronically - but not on the flash card) within the next three weeks to make sure that we have the time to prep. If your work will already be framed or does not need to be framed, please provide it and the required paperwork to your health professional (or have them confirm your status) no latter than January 20, 2017.

Mirror project: What we see in a mirror is a social construct. We will have a group piece comprised of individual submissions. If you are local and wish to be a part of the mirror collection, along with the authorization paperwork, you need to submit an altered/enhanced mirror with positive messages on the mirror, so that as you look at the mirror you see yourself and the messages that uplift and positively support you and the reflection you see in the mirror. Though it is a group project and therefore your name will not be posted for public viewing, it will be posted on the back of your mirror so that it may be returned. Consequently, it is still important to fill out the information on how you would like to be identified, so that those setting up and dismantlement the exhibit see the identifier you choose to use.)

http://www.southwestmichiganeatingdisorders.org/art-hop-2017

Coffee + Compassion = Freedom from Eating Disorders

Saturday, February 11th

Just a quick shout out to our great fundraising team for creating this magnificent opportunity to drink great coffee and tea and learn more about both, while helping out our cause

"...to use education to prevent eating disorders among people in Southwest Michigan and to improve the identification of, and treatment outcomes for, those with eating disorders."

( http://www.southwestmichiganeatingdisorders.org/ )

Check out our big event...(In case you would like to give someone tickets for Christmas, you can already order the tickets.)

This is a coffee tasting event featuring some of our area’s premier roasters along with savory breakfast bites and a silent auction of fabulous themed gift baskets.


Join us for a wonderful winter warm up  where you will learn more about your favorite coffees (and teas) score a great  gift for a loved one( or yourself ) and help raise funds to support better educational outreach and treatment options for people suffering from eating disorders in southwest Michigan.
 

For more information about the event and to purchase tickets go http://www.southwestmichiganeatingdisorders.org/coffee-fundraiser/?rq=fund%20 .

Comfort and Joy

by Angela Morris

One of the most heartbreaking aspects of having a loved one with an eating disorder is watching them suffer the many mental and physical pains and afflictions both large and small that this cruel disease visits on a person. So in this season of hope and new beginnings a number of caregivers in the area created this list of items that provide some measure of what we are calling “comfort and joy.” These are the items that come out of our bag of tricks to help make things more bearable, to create distractions during times of anxiety,  and to bring some comfort.
The first category of items are helpful for distraction. They include games like Uno, Bananagrams, Scategories, and Monopoly. In our home the game of choice was Bananagrams. We played it after mealtime as a distraction. Eventually no one wanted to play Bananagrams with my daughter because they knew she always won. Other helpful distractions include listening to music and watching television. A number of caregivers mentioned that coloring was a terrific distraction. All those “adult coloring books” on the market can serve as a distraction as well as a great calming activity. Artistic activities are a great ways to distract as well as express feelings. We bought our daughter a box of art supplies that she used for a variety of art projects. Suggestions for an art box include sharpie pens, playdough or modeling clay, paper, and collaging supplies. Another helpful activity is writing or journaling. Having a blank journal to write in is much appreciated, but there are also some nice books like The Ritteroo Journal for Eating Disorders Recovery that provide jumping off topics for journaling towards recovery.
Note that if you or a loved one has created a piece of art through their stages of recovery we would like to exhibit it during our upcoming Art Hop in February. For more information on exhibiting your art work click here.
Besides distraction there is the desire to provide some level of comfort for a loved one suffering from an eating disorder. Some of the big issues during recovery are discomfort during “re-feeding” and also the inability of the body to stay warm. Try extra warm and cuddly clothing as well as electric blankets and heating pads.  Electric blankets and heating pads provide both warmth and can be soothing for the stomach pain during re-feeding. Massage is also very soothing.
The idea of massage brings me to what I would consider the next level of comfort or care. As a caregiver or loved one of someone who suffers from an eating disorder knows there can be a great deal of self-loathing and feelings of unworthiness. I have seen this translate into a hesitation to be touched or to allow anyone to show affection and a lack of caring for oneself. So I view the acceptance of a massage or other “self-care” activities as progress towards recovery and healing. Talking to my daughter, she found helpful activities during the early part of her recovery included taking the time to paint her nails, face masks and wearing small “trinkets” or pretty pieces of jewelry especially bracelets or rings. All of these were pretty pick-me-ups and reinforced that she deserved to do nice things for herself, but they had the secondary reinforcement of serving as physical reminders to resist eating disorder behaviors.
Finally, I want to touch on joy. I know that individuals struggling with an eating disorder, as well as their family and friends, probably can’t even imagine the concept of “joy” but I want to provide a small glimmer of hope that joy does exist and will continue to grow stronger every day. Two things my daughter said to me recently resonate as I think about finding joy. The first was that at her sickest moments, she said that she felt so diseased, loathsome and foul that she did not want anyone near her because she was afraid she would contaminate them somehow. I imagine that is a common thought and the result was desperate loneliness that was very hard to break through. As I think back over the things that brought some joy, there were things that could break through that tremendous isolation and suffering… one of those things was animals. I think that may have been because an animal never judges them and somehow does not conform to the “rules” of their disease. The other thing my daughter recently said was that she felt like much of her childhood was stolen by her eating disorder. So now here is my secret weapon: find something that allows your loved one to fully be a child or to be a child again. For us it was a trip to Disney. We found that you just cannot stress about what you are eating when Pooh is there to hug you. So much better than any treatment center we have been to!
So that is our list and we want to wish you and your family much comfort and joy this holiday season. If you do decide to make any purchases this holiday season please consider using the SMEDA Amazon Smiles link here for Amazon purchases. That way your purchases help support better treatment, outreach and education for eating disorders.
Remember if you wish to be in direct contact with a Caregiver Mentor for advice and support contact 123smeda@gmail.com and you will be put in contact with a mentor.
If you are interested in writing a guest blog as a caregiver or survivor, please contact 123smeda@gmail.com

 

Yoga as an ED Recovery Tool

  Thank you, Kristin Fiore, for providing us with this insiteful article on yoga as a part of ED recovery.

Kristin Fiore, RYT 500, is a member of the SMEDA Board, and active in helping other professionals and their clients incorporate yoga into the recovery process.    http://downdogyogacenter.com/teaching-staff/

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   Yoga has provided me with a tangible tool to facilitate acceptance, self-love, and healing in my body.  As Donna Farhi writes in her book Bringing Yoga to Life, “Through daily Yoga practice we become present to our own fundamental goodness and the goodness of others. It is the practice of observing clearly, listening acutely, and skillfully responding to the moment with all the compassion we can muster. And it is a homecoming with and in the body for it is only here that we can do all these things.” This connection of body, mind, and spirit is key as one begins to address different aspects of an eating disorder.

As a late teen suffering from an eating disorder, I found my way into treatment with a counselor and a medical doctor.  These professionals saw me independently of each other in a clinical sitting where I sat in an examination room for medical tests or in a chair for counseling sessions. In this way, I continued to feel detached from my body as there was a lack of physical participation in the process and I found it difficult to navigate the emotional connections I was making in counseling with the actual changing of habits in my body. 

It wasn’t until I began practicing Yoga that the deeper process of healing and recovery began.  I didn’t sit in a chair and talk about my feelings, I experienced them as I engaged my strength and stretched my limits. For the first time I had access to my thoughts and feelings through my body, not despite it. As movement connected with breath, I found a place inside of me that was always steady. As I developed greater awareness of the flow of prana (life force or energy) within me, I began to feel empowered and beautiful.  This quote from Nita Rubio’s essay in the book Yoga and Body Image sums it up nicely, “As you learn to move with the internal energies, you learn how to move with life’s flow. Beauty emanates from here because it is deeply rooted from within. This beauty is not one based on a standardized list of perfection. Nor does it reference an ideal. This beauty is based on feeling. Beauty is an experience.”

Yoga is an experiential practice that uses mindfulness techniques to bridge the gap between body and mind.  As we begin to feel the connection between the different aspects of our being, we open ourselves up to process, change, surrender, and accept.  The healing benefits of Yoga are many in my experience, and recent studies show Yoga may help relieve depression, anger, and anxiety and improve mood (Harvard Health Publications). Yoga also promotes greater self-awareness, self-esteem and positive body image through the cultivation of love, acceptance, non-violence, and unity. In addition, the physical poses of Yoga help the body build muscle, bone density, and aid in digestion which may be helpful during recovery from an eating disorder and for general overall health.

As we begin to explore the healing benefits of Yoga it is necessary to practice with compassion for what may arise and to seek guidance from a trusted and well-informed teacher as needed. It is important to practice in a safe and non-competitive environment.  Exploring the edge in a yoga pose in a healthy way, not by pushing the body but learning to stay with an uncomfortable sensation and find breath, may be useful when someone is feeling full and resisting the urge to purge or compensate or when they are experiencing strong emotion.  Anastasia Nevin says, “Bringing yoga into eating disorder recovery is a way to access memories, messages, and wisdom stored in the body that are not always accessible in more traditional forms of talk therapy. The ultimate goal of recovery is in fact Yoga: re-connecting and integrating all parts of the self to live a more intuitive, peaceful, and soulful life.” (Live Fit article, “The Role of Yoga in Treating Eating Disorders”)

     I have found that the routine practice of Yoga allows me to be consistent, loving, and stable in body, mind, and spirit.  Over the years of teaching and researching Yoga, I have worked with many others who also find it to be a useful therapeutic tool.  Yoga poses can be modified to suit each individual’s needs depending on where one is in treatment or recovery of an eating disorder, and the use of breathing techniques, mindful meditation, and movement make this a great holistic treatment to compliment more traditional forms of therapy. 

List of Resources:

Farhi, Donna. Bringing Yoga to Life: The Every Day Practice of Enlightened Living. San Francisco: HarperSanFrancisco, 2003. Print.

Klein, Melanie, and Anna Guest-Jelley. Yoga and Body Image: 25 Personal Stories about Beauty, Bravery & Loving Your Body. Llewellyn Publications, 2014. Print.

  Nevin, Anastasia. "The Role of Yoga in the Treatment of Eating Disorders." Sonima Live Fit. 2 July 2015. Web.

"Yoga for Anxiety and Depression - Harvard Health." Harvard Health.  Apr. 2009. Web.

Resources and Tips

by Beth Van den Hombergh

Hi Everyone, Here are some resources and tips that our family have found helpful. Click here for a 2 page PDF copy.
On-line Resources:
    •    Southwest Michigan Eating Disorders Association http://www.southwestmichiganeatingdisorders.org
    •    Around the Dinner Table, www.aroundthedinnertable.org (international support group, lots of YouTube clips, books, personal stories, what worked, what didn’t.) My favorite
    •    (F.E.A.S.T.) Families Empowered & Supporting Treatment of Eating Disorders (international support group) http://members.feast-ed.org/members/group.aspx?id=121202
    •    ANAD (Anorexia Nervosa and Associated Disorders) http://www.anad.org/forum/viewtopic.php?id=1466 Topic: When someone you love has an eating disorder: How to help an anorexic… by an anorexic.
    •    ANAD (Anorexia Nervosa and Associated Disorders) http://www.anad.org/forum/search.php?search_id=468911715 Topic: When someone you love has an eating disorder: What I wish they could know….
Books: (Phase I)
    •    Throwing Starfish Across the Sea: A pocket-sized care package for the loved ones and caregivers of someone with an eating disorder. Written by Charlotte Bevan and Laura Collins. My favorite, played a huge role in moving from phase I to phase II of recovery.
    •    Brave Girl Eating: A Family’s Struggle with Anorexia by Harriet Brown
    •    Help Your Teenager Beat An Eating Disorder by James Lock, MD, Ph.D. and Daniel Le Grange, Ph.D.
    •    Off the Cuff:  Therapist recommended and well received by other SMEDA caregivers. I liked the book and chose not to purchase it because I was already sifting through so many resources, and using strategies. The book can be ordered directly from Duke University at http://www.dukeeatingdisorders.com/#!parent-resource/xspz4
    •    Finding your Voice Through Creativity:  The art and journaling workbook for disordered eating by Mindy Jacobsen-Levy and Maureen Foy-Tourney. My friend's daughter who had an ED and recovered found this book to be a favorite.
    •    The Dialectic Behavior Therapy Skills Workbook for Bulimia by Ellen Astrachan-Fletcher and Michael Maslar
    •    The Secret Language of Eating Disorders byPeggy Claude-Pierre
Books: (Phase II)
    •    Why she feels fat by Johanna Marie McShane and Tony Paulson
    •    Talking to Eating Disorders: Simple Ways to Support Someone with Anorexia, Bulimia, Binge Eating, or Body Image Issues  by Jeanne Albronda Heaton, and Claudia J. Strauss
* Please be very selective about the books and resources your loved one may have access to because they may inadvertently provide strategies for becoming better at hiding their eating disorder and/or engaging in additional self-harm.
Tips & Strategies:
    •    Medical doctor who specializes in and/or has a proven track record in the eating disorders community, for working with the age and gender of your loved one.
    •    Therapist who specializes in the treatment of individuals with anorexia, preferably one with a proven track record in the eating disorders community, for working with the age and gender of your loved one.
    •    Dietitian who specializes in the treatment of individuals with anorexia, preferably one with a proven track record in the eating disorders community, for working with the age and gender of your loved one. If your dietitian is not providing you with meal plans, specific details regarding options and portion sizes, please seriously consider working with another dietitian. Your insurance company will most likely not cover this, and finding a good dietitian has been critical in our daughter’s recovery process. It was the best $125 we’ve ever spent, and we experienced significant results after one appointment.
    •    Counseling for self: Seeking this service for yourself may seem like an unnecessary arduous hurdle, especially in the beginning stages of managing an eating disorder diagnosis. The therapy I have received to help me assist our daughter and other family members in understanding the illness and facilitating recovery has been immeasurable, and has played a pivotal role in our daughter’s recovery progress.
YouTube: (short videos)
    •    Eating Disorders Meal Support: chapter one (Introduction) https://www.youtube.com/watch?v=SnyIF750w5U&list=PL21D7E85D804263B2
    •    Eating Disorders Meal Planning: chapter two https://www.youtube.com/watch?v=Q0vjhmSbgjc&list=PL21D7E85D804263B2&index=2
    •    Eating Disorders Meal Preparation: chapter three   https://www.youtube.com/watch?v=QL1-1M50hys&list=PL21D7E85D804263B2&index=3
    •    Eating Disorders Meal Support: chapter four https://www.youtube.com/watch?v=l7gyifpv4o4&index=4&list=PL21D7E85D804263B2
    •    Eating Disorders Post Meal: chapter five https://www.youtube.com/watch?v=40hDoISrNw4&list=PL21D7E85D804263B2&index=5
    •    Eating Disorders Conclusion: chapter six https://www.youtube.com/watch?v=i3CYEG-pHtg&list=PL21D7E85D804263B2&index=6

 

Tips for Eating with Ease

Southwest Michigan Eating Disorders Association members suggest several strategies for enjoying/handling your holiday meals/gatherings:

 

Cathy Cook, LLPC, TLLP, RD Nutritional Therapist at Life Coach Psychology:

When attending parties or family events during the holiday season have a "support buddy." This is someone whom you 'Identify' and 'Ask' to help meet your planned goals before, during and after meals or eating events. Create a plan with the "support buddy" so they are prepared to divert triggering conversations, are ready and committed to go for a walk or participate in a planned activity after eating to combat unpleasant body sensations, and mainly a support person to help you lead a healthy life during the holiday season and beyond.

 

Cortney Modelewski, MA, LLPC, CBT Therapist at Cognitive Behavior Solutions:

Coping Cards are easy and effective way to help you stay on track. Write down techniques you plan to use, positive self-statements, your goals, or anything that will help you feel motivated and confident on an index card before a holiday event. You can make as many cards as you would like. Read your cards 2 - 3 times per day or any time you feel the urge to act on eating disorder thoughts and emotions. If you don't like using index cards, you can use notebook paper, a small notebook, sticky notes, your phone - anything that can fit in your pocket or purse discretely.

 

Kristin Fiore, Yoga Instructor and Owner of Down Dog Yoga Center:

Before a Meal:

Take a few moments to do some gentle twisting and slow, diaphragmatic breathing (inhale and count your natural breath, extend your exhale by the count of two) before you attend a holiday gathering.

During a Meal:
Eat slowly and mindfully, putting down your fork between bites and taking a few breaths - remember to chew 10-30 times for each bite.

After a Meal:
Do alternate nostril breathing (inhale through the left nostril, exhale through the right, inhale back up the right nostril and exhale out the left - repeat for at least 9 rounds) to de-stress and re-balance after a meal.


Sit and notice thoughts and urges while maintaining a focus on the natural breath. Tell yourself all is well~ all things arise and pass.

 

Trina Weber, MS, RD, LLC, registered dietitian & owner of private practice:

Choose not to compensate before or after the Thanksgiving meal. It could be served at a time you do not normally eat, which can throw off your regular meal plan times. You might be tempted to skip breakfast and snacks before the meal, purposely eat until you get sick, significantly reduce what you normally eat afterwards, or abuse exercise. This will only lead to more eating disordered behaviors. Be flexible with your meal plan. For example, if the meal is being served at 2:00 PM, eat your regular breakfast and have a snack at around 11:00 AM. You can have some dinner around 7:00 PM. Remember that these few days are only a tiny part of your overall eating picture.

 

Practice Owner, Lindsay P. South, MA/PLCC & Associates, Registered Play Therapist-Supervisor:


Plan ahead for activity after the holiday meal. Ask your guests ahead of time to bring walking shoes so you can take a stroll around the neighborhood or on a nearby trail after the meal. If the weather is too cold or snowy for a walk, play board or card games. Getting involved with your guests doing something fun and interactive can help you enjoy the holiday more fully and ease feelings of physical or social discomfort.

 

From all of us at SMEDA, have a happy, peaceful holiday season!

Successful Food Strategies for Holiday Nourishment

We want to wish you a successful and happy holiday by offering some helpful tips.  Thank you Kendall Dick, Nutrition Intern for AB Nutrition Solutions for providing us with this week's article and our professional members that vetted it.

The holiday season is a wonderful and magical time that can often be equally as stressful. For many, the stress of being in containment with certain relatives for long periods of time is quickly alleviated by the thought of the secret family recipe they bring to the table. But for those suffering or recovering from an eating disorder, the cornucopia of food that feeds the holiday season only adds another helping of stress to their plates.

For those who are overcoming disordered eating, the holidays bring more challenges than varieties of Christmas cookies, but they are NOT insurmountable. When food is front and center for what seems like a never-ending season, those confronted with extra calories and extra tensions struggle against retreating into former patterns of restriction, purging, and extreme anxiety.

Individuals recovering from anorexia nervosa will likely experience quite a bit of anxiety over the quantity of rich and indulgent food which they typically restrict themselves from eating. For those with bulimia nervosa and binge eating disorder, the day is filled with persistent temptation to overindulge. These temptations can often lead to loss of control and subsequent feelings of shame or guilt.

To overcome all of these temptations and anxieties, a game plan must be prepared to make it through the twilight zone looming between the candy craze of Halloween and the midnight suppers of New Year’s Eve. Here are four tips on how to survive the holidays with an eating disorder:

  1. Plan ahead. More planning equals less stress and anxiousness about eating. Remember to stay hydrated throughout the day and eat regularly scheduled meals before a party so you don't show up overly hungry and irritable. Think about where and what foods will be available, portions, and how to stop eating when it’s time. In some cases, skipping an event altogether to avoid temptation or stress may be the safest option.
  2. Have a support system. Positive support from a trusted someone can reduce likeliness to eat in an unhealthy way. Before the holiday chaos ensues, enlist a confidant who will be around. Suggest that they assume the role of plate monitor, don’t allow any disappearances to the bathroom, and deflect comments from oblivious or overly concerned relatives.
  3. Stay in touch with your registered dietitian nutritionist, therapist, and doctor. Talking to them about food concerns is a healthy way to cope with holiday pressure. If travel demands mean missing an appointment, be sure to stay connected by phone or email. Accountability is the key to success.
  4. Shift the focus onto people and relationships rather than food. Think of parties and meals as opportunities to connect with others instead of fixate on food. The holiday season is a great time to enjoy relationships with loved ones, be thankful for blessings received, and to give back through loving service to others. These practices will help properly feed your soul, as well as your body.

Slowing down, soaking in the love of the season, and celebrating accomplishments of another year past can be an encouragement to pursue health and wellness in the upcoming year. Not only can these practices inspire a New Year’s resolution, but they also relieve stress and provide comfort in the current season. Even if all of this is easier said than done, the important thing to remember is that it can be done. And with persistence and support, it will be done.

 

 

ED Therapy - DBT?

This month's blog article was written by Gary Snapper, LPC, LLP, a member of the SMEDA Board and a founder of Cognitive Behavioral Solutions in Kalamazoo.  http://www.southwestmichiganeatingdisorders.org/directory/

DBT History

Marsha Linehan, creator of DBT therapy, described DBT as “a multimodal cognitive-behavioral treatment originally developed to treat chronically suicidal individuals meeting BPD criteria.”  Since DBT’s inception in the 1990s, researchers and clinicians have experimented with broadening the application of DBT to multiple mental-health disorders including OCD, Bipolar Disorder, Substance Abuse Disorders, Depression, and Eating Disorders.

 DBT Components

DBT is a high-intensity treatment program that combines aspects of Cognitive Behavioral Therapy with the concepts of Dialectics and Mindfulness.

 Dialectics is the concept that two apparently polar opposites can be true concurrently.  Dialectics help clients to avoid all-or-nothing thoughts and actions. For example, a person can be doing the best they can AND need to try harder.

 Mindfulness is associated with Eastern Religions, and portions of it have been described in most major religions.  Mindfulness is the nonjudgmental awareness of one’s internal and external experiences and states. This also can be explained as follows:  Attempting to be aware of one’s focus and gentle re-directing of the mind to the present when one notices one’s mind drifting towards judgmental thoughts or over-focusing on past or future worries.   Research has shown Mindfulness helps to reduce anxiety and to increase a sense of balance.

 DBT implements these concepts through a comprehensive regimen that requires all of the following:  1) Individual therapy, 2) Skills training,  3) After hours skills-based phone support, and 4) Weekly DBT team consultation meetings.

 DBT Theory and Eating Disorders (ED)

A cornerstone of DBT theory is that emotion dysregulation contributes to many disorders, including EDs.  Difficulty regulating intense emotions can lead to avoiding  “emotion experiencing”.  Emotions that are avoided may lead to ED symptoms, including food restriction, binging, purging, and over-exercise. DBT provides specific skills to cope with intense emotions in tandem, with a forum to learn, practice, and apply the skills.  This helps the client to replace ED behaviors with effective coping strategies. In essence, DBT teaches the ED client a new language that allows for skills-based emotion regulation in place of ED behaviors.

 Along with new coping strategies, DBT’s use of Mindfulness techniques, Dialectics, and after-hours Coaching, all apply to the treatment of ED’s, and has become a comprehensive approach for treating Eating Disorders.

 Although none of the researched eating disorder treatments are as effective as we would like them to be, research suggests that DBT rivals and/or surpasses the effectiveness of traditional CBT, which has been considered the Gold Standard for treatment of eating disorders in adults.

 A simple 8-minute video describing DBT for Adolescents can be found at: https://youtu.be/Stz--d17ID4?list=PLV9RJQek2bix34tBuHaOp12gt-sHf32yV  .

 Sources:

 Linehan, Marsha, M., (1993).  Cognitive-Behavioral Treatment of Borderline Personality Disorder.  New York: Guilford Publications.

 Linehan, M. and Chen, E. (2005). Dialectical-Behavior Therapy for Eating Disorders. In Freeman, A. Encyclopedia of Cognitive Behavior Therapy. (pp168-171). New York: Springer.