ED

Person as Recovered: an Individual's Personal Perspective On Her Own Recovery

9-22-17

Person as Recovered

By an anonymous contributor

-my perspective/how does it feel to go through an eating disorder and see the other side…

 

Recovery is a long road, a winding rollercoaster with plenty of up and downs, twists and turns, but there are plenty of peaceful plateaus in which to focus on everyday life.  I am still whipping through the dramatic turns and dives as I confront my past and find peace in my present.  I am lucky; I have a wonderful child, a loving and supportive husband, and people that I can trust, including a support team.  I know that others do not have this.  Yet, I still need to ride the rails and learn to cope with the turbulence. 

Just in the past couple of weeks I have had a couple of tragic life setbacks.  Yes, they are the type of things that many others - with and without an eating disorder (ED) - hunkered down in their past, or present, experience.  For me they are compounded by the personal crisis dealing with the emotional and practical issues that helped trigger and strengthen my EDs.  At times the stress and anxiety can be too much to bear.  While it is important to address those issues that triggered and helped nurture my EDs, it has been a difficult journey to finally reach the point where I am ready to work with my therapist to confront and process those sources - those memories. 

This final big push to my long term recovery only started in the fall of 2015.  For me it all started with a dream.  (It is amazing the ways our minds and bodies operate when dealing with trauma.)  It was hard to confront what the dream/nightmare revealed, but soon afterwards my physical aches and pains began to diminish. Looking back, I realize that a great deal of my medical issues, fatigue, and emotional struggles, were symptoms of these childhood traumas. 

Hx:

My negative relationship with food started when I was very young.  By the time I was in middle school my ED was taking over, and by the time I was a freshman in high school I was hospitalized.

My family life was dysfunctional, and memories of sexual trauma and denial fueled my ED.  With the memories of the traumatic experiences suppressed, I could not understand the negative feelings and behaviors I was experiencing.  Yet now that I have begun to remember and process those ideas I am feeling better - emotionally and physically.  Recovery is a real thing.  It is obtainable.

During the height of my EDs’ reign, I could go two weeks without food or water.  While I still at times need to eat robotically with not much thought or enjoyment going into it, now I listen to what my body needs and I eat what I need to keep my body healthy.  I am rewarded by feeling better adjusting my diet to fit the needs of my body (i.e. increase my omega-3 fatty acids) when dealing with inflammation and drawing out the lactic acid with a couple shots of vinegar to deal with muscle pains.

While in the throes of my ED’s influence, I would purge to save myself from the possible harm I may have done by ingesting food.  Yet now I realize that the opposite was true and the food helps me do the things I love.  Play/work hard and eat well.  I am beginning to enjoy eating.

While I still have a long way to go to reach internal peace, my self-harming behaviors are in my past, as I have replaced them with alternate ways to deal with continuing struggles to come to terms with my past, make sure that I have a firm foothold in the present, and discover my potential future.

Helpful Suggestions: For Parents of Elementary Students

This article was written by Cortney Modelewski, MA, LPC professional counselor at Cognitive Behavior Solutions and an active member of SMEDA.

For Parents of Elementary Students:  Working to Create a Positive Relationship with Food

My daughter decided she didn't like jelly after coming home from a sleepover. Her friend declared hatred of all fruit-flavored spreads, and my daughter soon followed suit and has not eaten jelly, jam, preserves, or marmalade within the last three years.
    
She is eight, and she continues to struggle with the conflicts between her wariness of food, her environment, and her hunger. These challenges are typical of elementary age children, especially younger ones.  Dovey et al (2008) provided a review of the research on children's eating behaviors. They outline the difference between what people call “picky eating,” which is having inadequate variation in diet, and “neophobia,” which is refusal or reluctance to try new foods. Environmental (i.e. home, school, and culture) and genetic factors play roles in how and why children develop these eating behaviors.

While you can't change your child's genetics, you can make changes to their environment. Here are a few tips from my household, which consists of a couple of vegetarians and a meat-and-potatoes guy, who collectively have food neophobia, sensory processing issues, food intolerance, and a food allergy.

1.    Caretakers are role models. I am not a big fan of breakfast. My child has started to say she doesn't like breakfast. I decided to suck it up and eat some toast in the morning because I want my child to eat breakfast before going to school.
2.    Enlist authorities. Our pediatrician gave my child the same speech I had given, but my child responded to the pediatrician because she's a doctor. She also started eating red peppers after a dietitian came to her school and talked about how vegetables are awesome.
3.    Make food fun! Kids like to make their own creations, and also like it when they have surprises at mealtime.
4.    Negotiate packed lunch menus. Say, “Would you like baby carrots or cucumbers in your lunch?” If my daughter has a better idea, such as broccoli, I am all for it.
5.    Try to have everyone in the family eat the same things. My husband may throw some meat on his plate of spaghetti, but we're all still eating spaghetti. This ties into the first tip. Also, your family does not pay you to be a short order cook, so don't do it. It's more frustrating and reinforces problematic beliefs and behaviors your child may have.
6.    It's okay to be frustrated when your child doesn't eat, but try not to fight. I have had many dinner wars in my time as a parent, especially after a cooked meal has followed a twelve-hour workday. Not worth it. Ask your child to taste the food – which doesn't need to include chewing and swallowing – and then drop it for the night.
7.    Unless you have a specific diet due to religious beliefs, there is no reason to call food good or bad, and if a person in your family has a medical problem that restricts certain foods, giving the restricted menu to your entire family every so often may help the child and others in the family understand the need for meals.

If you are concerned about your child's eating habits, do not be afraid to make an appointment with their primary-care provider to discuss these concerns.  UWHealth (2014) notes some red flags including weight loss, choking on food, frequent complaints about stomach pain, vomiting or diarrhea after eating, and moodiness. Your child may have a treatable eating disorder, anxiety disorder, or medical condition.

References and Resources

Terence M. Dovey, Paul A. Staples, E. Leigh Gibson, Jason C.G. Halford, Food neophobia and ‘picky/fussy’ eating in children: A review, Appetite, Volume 50, Issue 2, 2008, Pages 181-193, ISSN 0195-6663, http://dx.doi.org/10.1016/j.appet.2007.09.009.

University of Wisconsin Hospitals and Clinics Authority [UWHealth] (2014). Health facts for you.  https://www.uwhealth.org/healthfacts/parenting/518.pdf

We Can! Ways to Enhance Children's Activity and Nutrition. https://www.nhlbi.nih.gov/health/educational/wecan/index.htm

Helpful Suggestions: Going Back to School for Middle and High School Students

This article was written by Cathy Cook, LLPC, TLLP, RD Nutritional Therapist at Life Coach Psychology and an active member of SMEDA.

Going Back to School for Middle and High School Students

     The start of middle and high school brings excitement to see old friends, meet new friends, and the possibility to learn new material and succeed. The new school year can also bring anxiety ridden thoughts of “will I fit in?”, “can I succeed in school?” and “where will I sit for lunch and with who?” Going back to school can be an exciting, hopeful time but can also be a dreadful, anxious time, especially with an eating disorder.

      Before getting into tips with the transition, it’s important to understand an aspect of adolescence. All adolescents experience to some degree aspects of egocentrism which was first discussed by psychologist David Elkind. He described two related beliefs of natural self-centered behavior, which can be seen in the late tween and teen years:   the “imaginary audience” which includes a belief that peers are watching and critiquing their every move, and the “personal fable,” a belief that they are somehow special, unique and invincible. Why am I bringing this into a discussion of eating disorders in middle and high school? Because this is the target age of those thoughts and behaviors that can exacerbate eating disorder behaviors, and keeping them in mind may provide an opportunity for discussion and understanding.  

      Knowing your child, and considering normal adolescence, here are some thoughts to help ease the transition:

1)    Start the new school routine a few days or week ahead including sleep patterns and meal times.  

2)    Discuss expectations of meals including morning breakfast, snacks and lunch, monitoring to ensure a balanced meal is prepared including a protein source, carbohydrates, fruits and vegetables.

3)    Talk about possible triggers exploring the obvious and unseen, considering friends and fitting in, bullying, boyfriends and girlfriends, drive to succeed and possibilities of failure.

4)    Consider after-school activities which your child would enjoy, as this is a time when kids who are home before their parents may binge or engage in eating disorder behaviors.

5)    If there is an active eating disorder, consider meeting with the school counselor or nurse to discuss monitoring mealtime intake, snacks and activity level during the day. It may be necessary to arrange meals to be eaten with the counselor, however be aware that friends may question this and want to be included.

6)    With an active eating disorder or recovery, be firm with ground rules and willing to implement if needed. If a meal is skipped or weight is not being maintained, have an alternate plan in place such as eating with your child at school or being sidelined from sports. Being clear and communicating ground rules is a must.

     Good communication, a plan, and knowing where to go for help if needed can help ease the transition back to school. Remember, being confident about your child’s recovery can increase both their confidence in their own recovery and in school.

 

Sources:
Lock, J., & Le Grange, D. (2015). Help your teenager beat an eating disorder (2nd ed.). New York, NY: The Guilford Press.

What is Adolescent Egocentrism. (2017). https://www.verywell.com/
     definition-of-adolescent-egocentrism-3287985

Helpful Suggestions: Eating Disorder Symptoms and the Transition to College

This article was written by Victoria Cane, Ph.D, LP, a member of SMEDA.  She is a licensed psychologist with a focus on treatment of eating disorders and emotion-regulation disorders for over 10 years.

Eating Disorder Symptoms and the Transition to College.


As an eating disorder treatment provider working with clients who are transitioning to college, my first thoughts aren't always welcome ones. If someone is struggling with symptoms like inability to sustain weight or general management of nutrition, or has not achieved abstinence from behaviors like bingeing/purging, it is hard to give support to taking on something as stressful as leaving home to start college life. And it is stressful. I recall my first semester at NYU and I'm really proud I made it through. There were times I wasn't sure I was going to. There was just so MUCH to take in and acclimate to. I had no idea I would become a psychologist back then (my major was drama) but I do recall the girl I met during that first week and being truly baffled that she would consider broccoli and a gallon of diet coke to be dinner when there was so much else to choose from at the cafeteria.

Parents/loved ones of those who have struggled with an eating disorder often find themselves paralyzed at the thought of not supporting the move to college. After all, it represents growth, progress, a natural next step in life development. My point as a provider, however, is that some of those growth markers, both literal and figurative, need to be in place first. This is where full participation in recovery-oriented treatment is so important. Although one study indicates that the transition doesn't necessarily trigger the onset of symptoms (the study found that most eating disorder symptoms were present before college), it also found that body image disturbance may worsen and symptoms were certainly not helped (Vohs, 2001).  One on-line resource very clearly calls for symptom absence before transitioning.

Assuming that the student has indeed engaged in their own recovery and symptoms are not acute at the time of transition, I begin to talk about transition management, including: finding mental health and medical resources beforehand and signing appropriate releases, identifying ways of staying accountable including weight checks if applicable, identifying other potential supports like student groups, and have a solid plan for what we call "cope-ahead" strategies; that is, rehearsing stress management skills before they are needed. We may also make a plan to check in and/or return to regular contacts when the student is on break.

In the type of therapy I rely on most often in the treatment of eating disorders, Dialectical Behavior Therapy (DBT), the provider hopes and "shoots" for the desired outcome at all times, while simultaneously being prepared for and helping the client prepare for set-backs. We do not "expect" set-backs, but should they occur, we make every attempt to correct them as quickly as possible. When a client leaves for college I wish them well and cheer for them. I think of them as fall gets colder, and I hope they are okay. Should they need to take a break to focus on health, and they seek my help, my immediate questions return to "what are the goals?" and "what is needed for recovery?"

 

On-line resource: http://www.mirror-mirror.org/transitioning-to-college.htm

Other resources:

Anonymous. (2012). Life Transitions May Trigger Eating Disorders. U.S. News and World Report. Retrieved September 18th 2013 from: http://health.usnews.com/health-news/news/articles/2012/04/25/life-transitions-may-trigger-eating-disorders

Strober, M., & Johnson, C. (2012). The Need for Complex Ideas in Anorexia Nervosa: Why Biology, Environment, and Psyche All Matter, Why Therapists Make Mistakes, and Why Clinical Benchmarks Are Needed for Managing Weight Correction. International Journal of Eating Disorders, 45, 155-178.

Vohs, K.D., Heatherton, T.F. and Herrin, M. (2001), Disordered eating and the transition to college:  A prospective study. Int. J. Eat. Disord., 29:  280-288. doi:  10.1002/eat.1019

 

 

 

 

Helpful Suggestions: Road Trip Tips

     This 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.

 

Road Trip Tips


     The end of summer is the time for road trips. Whether we are visiting family on the other side of the state, traveling to the beach, forest, or mountains, or simply packing up and going somewhere new, we need to eat during the trip.

     Eating during road trips brings its own set of challenges. Boredom can lead to eating more than we typically do. Apparent lack of healthy options can lead to eating more “junk” food. Escaping our day-to-day routine when leaving home can trigger additional escape urges, including escaping our healthy eating routines.

     A handful of simple strategies can help us cope with these and other food -related challenges that we face during summer road tripping:

  1. Packing some portable healthy foods and snacks can help us stick to the routines that we have worked hard to adopt at home. Some examples are trail mix, bagged vegetables, and hummus.
  2. Planning occasional stops at grocery stores can allow us to restock those healthy items during our travels.
  3. Eating frequently and in smaller amounts can address boredom, reduces the risk of binges, and helps ensure that you use up the food that you bring on the trip.
  4. Limit or avoid substances that are more likely to make us feel bad such as alcohol, deep fried foods, and refined carbohydrates.
  5. Choose water as your primary source of fluid during the trip. Many drinks on the market today provide little nutrient value and are overflowing with sugar, caffeine, alcohol, or synthetic sweeteners, none of which our bodies are designed to process effectively. These additives may diminish our sense of well-being.
  6. Don’t forget to enjoy the journey along the way. Prioritize physical-activity breaks several times per day while on the road. Packing Frisbees, soccer balls, and/or walking shoes help you to engage in light activities at rest stops or parks along the way.  Activity helps our bowels function, increases our metabolism, and increases absorption of the nutrients that food offers us.
  7. When you choose to sample local fare, make it worthwhile. Mindfully focus on the value of the foods chosen for flavor or novelty, and try to avoid food choice just due to convenience.
  8. Don’t be so rigorous in your food choices that you forget to have fun on the trip.  Be kind to yourself if you do opt for some unhealthier items while on the road.  Remind yourself that perfection is not the goal, but mindful eating is.


 

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?

 

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.

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)

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.

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.