Discovery Guest Post: The NEW Definition of “Healthy” w/ Theresa Carmichael
The term “healthy” demands new perspective because it’s not about “good” and “bad” foods or your body weight anymore.
Well it’s February, and you know what that means? We survived diet month! Wahoo!! We know it all too well; the “New Year, New Me” mantra. Before the ball drops to ring in the New Year, diet program and weight loss commercials begin and gyms run specials on new memberships. People start scheming their next diet, workout regimen, and overall promises to improve “health”. Therefore, January became better known as diet month.
The marketing community is no stranger to this yearly spike in health consciousness amongst society, and they take FULL advantage of the opportunity. The dieting industry is a multibillion dollar industry and after all, it’s only smart business to take advantage of customers when they’re most vulnerable, right? However, regardless of these efforts, research shows 80% of New Year’s resolutions fail (1).
I feel now is the time to address “health”; to further discuss its true definition, and how far away we’ve strayed from it. I decided to recruit a friend and coworker, Theresa Carmichael, RD, to help me write this article. Theresa earned her Bachelor’s of Science in Food & Nutrition from San Diego State University. She later completed her dietetic internship with an emphasis in Clinical Nutrition through the University of Nevada Las Vegas. Theresa has been working with the eating disorder population since 2014 and loves helping clients overcome their struggles with food.
I chose to use air quotes around the word “health” or “healthy” in this interview-styled article to emphasize the wide variety of definitions associated with this word. My mission is to open your mind and stir your curiosity in redefining what “health” can mean to you. Here’s a peek at my interview with Theresa Carmichael on this controversial topic. I hope her answers may offer you more clarification in your journey to “health”:
What does “healthy” mean to you?
“Healthy is such a loaded word. And I feel like that is why it is used in so many different arenas. While many of us are focused on the term “healthy”, as if carries some type of moral value/worth for our lives, I have tokened the word “healthy” to encompass a holistic approach. “Healthy” may look different for each person, however overall it is a sense of well-being when it comes to their biology as well as their mental health. One is not more superior to the other.”
What are synonymous for “healthy”?
“Happy, present, and able.”
What are “healthy” meals? What makes a food “healthy”?
“Balanced (representative of all food groups- carbohydrates, protein, dietary fats, fruits, vegetables), nutrient-dense, enjoyable & fun!”
What does society say is “healthy”?
“As stated in the first question, healthy takes on a whole new meaning in our society. It is sad actually, as I often see the term healthy being used in a way to differentiate from those who are perceived as “unhealthy.” It is a comparison game. One that our society is lacking a compassionate approach, especially with nutrition and well-being.”
What does a “healthy” relationship with food look like?
“A healthy relationship with food does not have any food rules. You eat when you are hungry, and stop when you are satisfied. There are no extremes or any true “superfood.” All foods fit in variety, moderation and balance all while honoring our food preferences. Being able to identify the ‘7 Hungers’ and honoring them in a way that meets your needs in the moment is the key to a healthy relationship with food!”
What does a “healthy” body look like? What’s a “healthy” weight?
“HA HA HA! I laugh because as a dietitian, society may expect me to whip out the BMI calculator or scale… WRONG! A healthy body is a body that is taken care of in a compassionate way- gentle nutrition, without dieting and while engaging in joyful movement! The intuitive eater inside of all of us is going to be more accurate at determining what their individual “healthy” weight will be- even more accurate than a dietitian or physician calculating some algorithm to find an exact number. It just doesn’t work that way. A healthy body is one we can accept as ours, no matter what the number is on the scale. Research has shown that we can find health at every size, and that weight stigma may actually be the one doing a number on our health.”
What does a “healthy” relationship with your body look like?
“RESPECT! If you haven’t read ‘Body Respect’ by Linda Bacon you really should. When we respect our bodies, we are more likely to honor it with gentle nutrition and joyful movement. Be grateful for the amazing things your body can do for you.”
Is “healthy” the new “perfect”? Is perfectionism achievable?
“Oh my gosh what a great question! Perceiving things/people/food as “healthy” in many ways can set us up for failure as a society. What I see time and time again in my work as a dietitian is this comparison game I mentioned before. Labeling food as “healthy” or “unhealthy” can create black and white thinking- keeping us from the very beautiful things that can happen when we practice the grey area. When food is just food and furthermore imperfect. I cannot urge enough how important it is for all of us, including health professionals, to set feasible & attainable goals for improving disordered eating patterns. Focusing on the “perfect way to eat” can exacerbate feelings of shame that, unfortunately, we all succumb to in the world of diet culture and intense focus on body image.”
Health isn’t about “good” and “bad” foods or your body weight. The term “health” demands new perspective instead. Health means having a mind clear of guilt and shame associated with your food selection; a mind rid of negative thoughts about your pants size. Health represents honoring your body’s intuitive cues, and concentrating on variety, moderation, and balance in all aspects of life. This includes feeding your hungry body food it’s craving, without judgement, until it’s satisfied. And, moving your body in joy-filled ways to celebrate what it’s capable of, without focusing on how to alter it physically. Health does not look a particular way. Society teaches us to judge one’s health like a book cover, when we haven’t even read a single chapter. I encourage you to pull away from the rigid, societal views of health, and replace them with individualized healthy behaviors of your own. Health is not one size fits all. Everyone’s journey with health appears different, and that’s okay! Health is overall well-being achieved through intuitive behaviors and mental clarity. Our bodies are constantly telling us what we need to be healthy, now all we have to do is listen and respect.
1. Luciani, Joseph. “Why 80 Percent of New Year’s Resolutions Fail.” US News, 29 Dec. 2015, health.usnews.com/health-news/blogs/eat-run/articles/2015-12-29/why-80-percent-of-new-years-resolutions-fail.
About the Author
Emily Travis, MPH, RDN, LD, earned a Bachelor of Science in Nutrition from Baylor University in 2014. She then completed her Dietetic Internship and customized Master’s degree with concentration in nutrition and focus in epidemiology from the University of Texas School of Public Health in 2016.
Emily obtained extensive training and experience in outpatient, intensive outpatient, and partial hospitalization eating disorder treatment throughout her dietetic internship. Emily also has experience working in private practice. Emily works with individuals to help them obtain a more positive body image, while overcoming their obstacles around food.
Four Ways to tell it is Time to Refer Your Eating Disorder Client to a Treatment Program
He or she has hit a plateau in therapy
Often eating disorder and disordered eating clients plateau in outpatient therapy alone because there is not a direct food and meal supervision component. The individuals often devote a large amount of energy to convince their therapist that he or she is doing well and progressing. Eating disorder clients are often people pleasers and seek validation for achievement. Without direct meal supervision, support with meal preparation, and working closely with a dietitian to identify consistent food recalls, it is often an insurmountable challenge for clients with eating disorders to make consistent gains in outpatient therapy alone.
The client pulls back at mention of a treatment center or program.
It is not common for the intervention of a higher level of care for eating disorder clients to be a tricky one, demanding both grace and firmness to support the scared client with making an accountable choice. I have supervised therapists who become entangled in countertransference with eating disorder clients. When we hear things like, “He/She trusts me a lot and trust would be broken if I referred to a treatment center” then we know the client is crafting a case to avoid the treatment setting. Removing obstacle to treatment is an important part of the therapist-client relationship.
The client is terrified to integrate a registered dietitian into treatment.
When clients are in the midst of disordered eating or eating disorder struggles, they often avoid dietitians and eating disorder specialists like the plague. My clients in recovery tell me that at the times when they were the most compromised, they sought out non-specialists and avoided dietitians. Therapy is only a piece of the treatment team and collaboration with a multidisciplinary team including medical doctor and registered dietitian are key components for recovery. Avoidance of talking about the food component is avoidance of what is needed to fully recover.
If you do not have current pounds or a weight on the client
One of the benefits of working with a multidisciplinary team is the ability to collaborate weekly and receive updates on the client’s weight and labs. Even the most adept clinician cannot tell visually if a client is doing damage to their body with purging, bingeing, or restricting behaviors. Potassium and other electrolyte imbalances are one of the most dangerous health consequences of an eating disorder, which are not visible upon physical assessment. Weekly, biweekly, or monthly “blind” weights are a good way to monitor behavioral trends that may be reflected in weight trends.
As a Certified Eating Disorder Specialist and designated CEDS -Supervisor through the International Association of Eating Disorder Specialists, I have worked with hundreds of outpatient therapists to understand the importance of understanding how to establish a multidisciplinary team in the outpatient setting, as well as how to initiate and hold a firm boundary with referring clients to an outpatient treatment program. Most treatment centers will offer a free phone or face to face eating disorder assessment and some organizations have online assessments available as well. Benefits of day treatment include, meal supervision, inclusive weekly counseling with a registered dietitian, support in monitoring labwork and collaborating with medical doctors, group therapy, support from peer community, family therapy and family support, and weekly collaboration with eating disorder specialists.
Self-Injury Awareness Day (SIAD), is an international awareness day that takes place every year on March 1 and is a day meant for learning about self-injury behaviors and for providing resources to those who are in need of help. An orange ribbon, representing a sign of hope for a misunderstood problem, symbolizes this awareness day. Self-injury, also known as self-harm, is the deliberate action of causing physical harm to oneself and is a very dangerous sign of emotional distress. According to the Statistical and Diagnostic Manual of Mental Disorders, Fifth Edition (DSM-5), self-harm is formally known as nonsuicidal self-injury disorder (NSSID) as these self-destructive behaviors are carried out without any intention of suicide. Adolescents are at the highest risk for self-harm injury as many studies state that roughly 15% of teenagers and 17-35% of college students have inflicted self-harmful behaviors on themselves. Males and females have comparable rates of self-harm behavior. Cutting, skin carving, self-medication, extreme scratching, or burning oneself as well punching or hitting walls to induce pain are examples of self injurious behavior. Other examples include ingesting toxic chemicals, extreme skin picking, hair pulling and deliberate interference with wound healing.
Taking a look at the statistics
Each year, one in five females and one in seven males engage in self-harm behaviors
90 percent of individuals who engage in self-harm begin during their teen or pre-adolescent years
Nearly 50 percent of individuals who engage in self-injury activities have been sexually abused
Females comprise 60 percent of individuals who engage in self-injurious behavior
Approximately 50 percent of those who engage in self harm behavior begin 14 years of age and continue into their 20s
Many individuals who engage in self-injury behavior report learning how to do so from their friends or pro self-injury websites or social media pages
Approximately two million cases are reported annually in the United States.
All of these self-injury statistics come from reliable sources however truly accurate rates and trends associated with self harm are difficult to come by because the majority of individuals who engage in self harm behavior conceal their activities. Their behaviors may never come to the attention of medical professionals or other social services.
What are the causes of self-harm?
The underlying causes of self-harm can be difficult to recognize without thorough assessment and therapy. Many adolescents who engage in self-harm behavior have severe underlying emotional pain and lack adequate coping skills. It is an impulsive act to regulate mood and attempt to overcome underlying anger, sadness, pain or frustration. Individuals most as risk for self-harm experienced trauma, neglect or abuse in the past and use this self-destructive behavior to hide or express their repressed emotions. Self-harm is strongly linked to other disorders, specifically, borderline personality disorder (BPD) and eating disorders such as anorexia and bulimia nervosa. Approximately 70% of individuals with borderline personality disorder and approximately 30% of females with eating disorders are known to participate in self-harm behaviors. Self-harm has also been linked to depression, anxiety and suicide however the statistics for these co-occurring disorders have not yet been set in stone.
Treatment for self-harm
If you know someone who is demonstrating self-harm, keep in mind that they most likely have a deep underlying disorder or additional signs of emotional distress. It is important to listen to them without judgment, express how much you care for them as a person and communicate that this behavior is not uncommon. There are many types of treatments available including psychotherapy and social support. Psychotherapy approaches include cognitive behavioral therapy (CBT) specifically dialectical behavioral therapy (DBT) to focus on controlling thoughts and impulses and to understand how individuals interact in their environments and relationships. Social support is extremely important in self-harm as it is necessary for individuals to receive comfort and love from friends and family. There is no specific medication used to treat self-harm however medications may be prescribed to treat the underlying psychological disorder such as depression or anxiety.
Between ages two to ten years old, a child will grow at a steady pace and a final growth spurt begins at the start of puberty, sometime between ages 9 to 15. Eating patterns can mirror these growth phases with children requiring more nutrients during a growth phase therefore eating more food throughout the day and during mealtimes. This is especially true if the child is extremely active in sports. As a parent, you may feel that your child is eating you out of house and home. It is common for children to have growth spurts and increasing appetites so how do you know then if your child is engaging in binge eating behaviors or has a normal developmental appetite? Children as young as seven years of age can be diagnosed with an eating disorder and the prevalence of eating disorders in young children have been increasing.
Defining binge eating disorder
Binge eating can be defined as when a person turns to food to cope with stressful situations. It is characterized by an unhealthy relationship with food and is associated with a lack of self-control. It is possible for an individual diagnosed with binge-eating disorder to consume as much as 3,400 calories in little more than an hour, and as much as 20,000 calories in eight hours. Unlike bulimia and anorexia nervosa, there is no compensatory purging such as self-induced vomiting, excessive exercise or laxative abuse associated with binge-eating disorder. In order for binge-eating disorder to be diagnosed an individual must partake in binging episodes on average at least once a week for a three-month duration, the individual must have feelings of marked distress over these binging episodes and have a loss of control over the amount of food they eat. Additionally, at least three of the following factors must be present:
Eating until feeling uncomfortably full
Feeling disgusted with oneself, depressed, or very guilty afterward
Eating alone because of feeling embarrassed by how much is being eaten
Eating large amounts of food when not feeling physically hungry
Children who engage in binge eating may begin to gain weight, but can sometimes be overlooked or undiagnosed due to normal weight gain among children and teens. Several signs can differentiate binge eating from healthy developmental eating.
Observing how much food is being eaten or is missing from the kitchen.
Assessing how much and how quickly your child eats as well as their pattern of eating, particularly around stressful situations, family conflict, peer rejection, or academic performance.
The child may feel ashamed or disgusted by the amount of food they eat.
Often, empty food containers or plates of food may be found in the child’s room.
There are noticeable irregular eating patterns that emerge.
The child seems to care more about his or her weight than before.
Treatment for binge eating disorder in children
Family centered interventions are most effective in younger children. “Family Based Therapy” (FBT) informed care is most the most widely used and appropriate treatment for children with eating disorders such as binge eating disorder. Therapists, nutritionists and other members of the treatment team collaborate closely allowing the parents to take charge of nutritional decisions and behavioral modification. They also work together in order to develop positive coping skills that can allow children to function normally in stressful situations so they don’t engage in unhealthy behaviors with food.
Disordered eating describes a variety of abnormal eating behaviors that do not yet fit the criteria for an eating disorder. The main difference between disordered eating and an eating disorder is the frequency and severity of the abnormal eating pattern. Studies have shown that up to 50% of individuals demonstrate problematic or disordered relationships with food, body and exercise. Disordered eating occurs when individuals eat for other reasons than hunger. Individuals with disordered eating eat when they are bored, eat out of stress, eat to cover up their emotions, may skip out on major food groups, eat the same thing everyday, may skip meals altogether or may even engage in binging and purging behaviors on a limited basis. Strict diets can be examples of disordered eating and many studies have shown that dieting can lead to disordered eating and eventually full-fledged eating disorders. How do I know if I should be worried? What if this gets worse? These are the thoughts and questions, not only for those concerned for their loved ones, but also for individuals who are unsure about what type of help they might need. There are three key factors: behaviors, obsession, and functionality. The following as are signs and symptoms associated with disordered eating:
Behavioral symptoms: Individuals whom engage in disordered eating will practice food restriction, binge eating, and purging can be a part of disordered eating patterns. Mental distress including low self-esteem and self-worth are key underlying triggers that lead to these behavioral symptoms associated with disordered eating.
Cognitive symptoms: Individuals will often develop negative thinking about types of food, quality of food, and fear that food eaten outside of the person’s control could be “contaminated” or unclean. There is often a significant fear of food having toxins, be a cause for disease development and other contamination fears. Other symptoms typically include thoughts that focus on body weight, shape, and size. More than often, an individual will body check, shame, and critique their self and compare themselves to others.
Self-perception: Individuals may have a different perception of the way they experience their bodies and may feel they are overweight even when they are not. Some individuals often follow an excessive or rigid exercise routine and may engage in calorie counting just to maintain their current body weight.
Mental health symptoms: Those with disordered eating tend to struggle with anxiety around food, may only eat specific foods, or be inflexible with eating resulting in an anxiety disorder such as generalized anxiety or obsessive-compulsive disorder. Depression and personality disorders are strongly linked to disordered eating.
Disordered eating can quickly turn into a full-fledged eating disorder. Recognizing the signs and symptoms of disordered eating and seeking treatment can help prevent the development of an eating disorder, which can be life threatening. Treatment aims at developing healthy coping skills to combat the negative thoughts and subsequent actions. Additionally treatment will enable you to recognize the underlying triggers that have caused these unhealthy behaviors and develop better communication skills, self-love and tools to strengthen your personal relationships with others all while simultaneously learning how to have a healthy relationship with food.
Super bowl weekend is rapidly approaching and even if you are not a fan of the popular American sport, it is almost impossible to escape it as many tune in just for the commercials, the half time show or the parties. Approximately 110 million individuals in the United States tune in every year to watch one of the biggest games in sports and the average 30-second commercial costs $4.5 million dollars. Last year, Lady Gaga, was the headliner Super bowl performer and became a well-known celebrity victim to body shaming as her body and appearance became the central focal point of discussion after the halftime show aired. In response to the body-shaming and critical comments about her appearance, Gaga took to her Instagram to respond, writing, “I heard my body is a topic of conversation so I wanted to say, I’m proud of my body and you should be proud of yours too. No matter who you are or what you do. I could give you a million reasons why you don’t need to cater to anyone or anything to succeed.” Justin Timberlake will be the headliner at the 2018 Super bowl performance, he was recently at the Golden Globes where he supported the #MeToo movement but dressing in black and wearing a pink marked by the well-known hashtag that stands against sexual harassment. The half-time show is not the only thing that invites body image triggers. Commercials during this big event are sure to ramp up their “sex factor” promoting thin women wearing barely anything to sell fast food, alcohol, clothing, cars, soft drinks and more. According to statistics 20 million women and 10 million men have an eating disorder in the United States and body shaming, low self-esteem, and the influence of the media all play a part in the development of an eating disorder.
Binge eating and Super bowl parties
It is extremely difficult to attend a Super bowl party and not be tempted by the seven-layer dip, chips and guacamole, cupcakes, cheese and sausage plates, hotdogs and burgers, cookies and all the other savory snacks and sweets that are offered in large proportions. This food plethora can be extremely challenging for an individual who is in eating disorder recovery and as a result, knowing your triggers and having a back up plan beforehand can potentially save you from relapsing.
What is binge eating disorder?
Binge-eating disorder is characterized by eating an excessive amount of food within a 2-hour time period and is associated with an extreme lack of self-control and shame during this episode. It is possible for an individual diagnosed with binge-eating disorder to consume as much as 3,400 calories in little more than an hour, and as much as 20,000 calories in eight hours. Unlike bulimia and anorexia nervosa, there is no compensatory purging such as self-induced vomiting, excessive exercise or laxative abuse associated with binge-eating disorder. In order for binge-eating disorder to be diagnosed an individual must partake in binging episodes on average at least once a week for a three-month duration, the individual must have feelings of marked distress over these binging episodes and have a loss of control over the amount of food they eat. Additionally, at least three of the following factors must be present:
Eating until feeling uncomfortably full
Feeling disgusted with oneself, depressed, or very guilty afterward
Eating alone because of feeling embarrassed by how much is being eaten
Eating large amounts of food when not feeling physically hungry
Resisting the urge during the Super bowl
Hunger can be a powerful trigger. It is important to make sure that you are eating consistently throughout the day and following your meal plan can help you avoid a binge-purge episode. If you feel that you vulnerable to an episode try to avoid the foods that you feel might be triggering. If it gets to be too much step away from the party and meet up with a support person to be able to process the situations. One party is not worth a relapse in your recovery.
The LGBT community is at a greater risk of bullying and has even been the center points for violent attacks. Their oppression within the community can take a serious psychological toll and for many, engaging in eating disorders and self-harm behaviors are a way to suppress their emotions. The stereotype associated with eating disorders is a young, Caucasian thin female however this results in delaying the diagnosis for eating disorders in males, older people, and individuals who are in the LGBT community. According to the National Eating Disorders Association (NEDA), LGBT people can have a predisposition to eating disorders because of the stress of not being accepted by their families and peers, fear of coming out, discrimination, and violence. In transgender people, it can be exacerbated with body image issues.
Taking a look at the statistics
Unfortunately, not much research has been done on the prevalence of eating disorders in LGBT people. What is known is that LGBT people have a higher risk of binge eating and purging than their heterosexual peers.
Also, gay and bisexual boys are more likely to engage in food restrictive behaviors, self-induced vomiting, and laxative abuse and diet pill use in order to control their weight. Gay adult men are seven times more likely to report binging and 12 times more likely to report purging than heterosexual adult men. Many eating disorder therapists are not surprised when they see a male in eating disorder treatment that is gay. In fact, a large percentage of males in eating disorder treatment talk about their sexuality and many come out about their sexuality during their therapy sessions. Many of these individuals state that their eating disorder stems from their family not accepting them as a young child, which created years of trauma and low self-esteem. Research shows that lesbian women experience less body dissatisfaction overall, and shows that as early as 12, gay and lesbian and bisexual teens may be at a higher risk of binge-eating, and purging than heterosexual peers
Gender dysphoria and body image
In a 2010 study, researchers found that the average age for developing an eating disorder is 19 years old within the LGTB community compared to the national age of 12-13 years old. Eating disorders are typically about altering one’s body to look a certain way and those who are experiencing gender dysphoria (the feeling of one’s identity not aligning with their body) are at higher risk for developing an eating disorder. As a result, these individuals will try to change their physical appearance through dieting and exercise in order to resemble the gender they identify with internally. Individuals may try to stop, delay, or reverse puberty by fasting, over-exercising, or purging. Additionally the LGBT community is more at risk for mental health disorders such as depression and anxiety as well as substance abuse disorders.
Seeking treatment for eating disorders in the LGBT community
Eating disorder treatment is the same for an LGTB individual as it is for a heterosexual individual however in the LGTB community, the therapist will most likely have to assess underlying triggers such as trauma. Unfortunately not all eating disorder treatment centers are LGTB friendly meaning that even though they say they do not discriminate, there are plenty of reviews and personal accounts of individuals who felt ostracized in treatment because of their sexual orientation. As a result, it is extremely important to choose an eating disorder treatment facility that is professional, compassionate and has experience treating the LGBT community. The primary goal of eating disorder treatment is weight restoration followed by teaching the individual to have a healthy relationship with food and their body. Center For Discovery is a leading treatment center that has locations across the United States and treats individuals of all ages, genders, ethnicities and sexual orientations.
Eating disorders such as anorexia nervosa, binge eating disorder and bulimia nervosa have been around for centuries, but medical professionals have only recently recognized them as true mental health disorders. The first description of anorexia nervosa in the Western culture dated back to the 12th and 13th centuries where Saint Catherine of Siena denied herself food as part of her spiritual denial of self. There were several other clinical summaries of “wasting disease” throughout the 1600’s and into the 1800’s and in the early 1900’s, anorexia was classified as an endocrine disorder and was treated with pituitary hormones. Bulimia nervosa was first described in the Middle Ages in which members of the upper class would vomit after their meals so they could consume more food and the first clinical paper on bulimia nervosa was published in 1979 by Gerald Russell. Binge eating disorder, characterized by eating an excessive amount of food in a short period of time in the absence of compensatory behaviors including purging or restricting, has also been around for centuries and was recognized as subtype of bulimia nervosa in the Diagnostic of Static Manual in 1987 and was only recently categorized as a distinct eating disorder in most updated version of the Diagnostic and Statistic Manual of Mental Disorder, (DSMV), which was published in 2013.
Eating disorder research
Over the years, new eating disorders have been recognized and treatment modalities have changed dramatically. With more research, awareness and funding and a decrease in stigma, formal eating disorder treatment is becoming more popular throughout the Western world and studies have shown that clinical treatment does work. Over the years, research supports that there is a neurobiological basis for eating disorder behavior and the release of specific neurochemicals is associated with increased anxiety and food-avoidance behaviors in anorexia nervosa. Additionally, research by Dr. Walter H. Kaye at UCSD School of Psychiatry suggests that temperament based traits such as rigidity or an enhanced ability to delay reward may lead to the sustained eating disordered behaviors observed in our loved ones. Through understanding the biological basis and the underlying triggers associated with eating disorders, treatment modalities have been molded over the years according to this extensive research and evidence.
Hurdles to eating disorder treatment
Despite a 200-year medical history and a detailed classification and description of these eating disorders, the National Association of Anorexia Nervosa and Associated Disorders has recently stated, “many physicians and other health professionals have not been trained to recognize or treat anorexia.” The current challenge is not in understanding these illnesses but in providing comprehensive medical services to those affected by eating disorders. Unfortunately most insurance companies only allot a life-threatening illness such as anorexia nervosa “30 days per year” of inpatient hospital coverage when such limitations do not apply to other serious illnesses, such as ischemic heart disease. Medical complications of eating disorders create a significant risk of mortality as well as long-term morbidity and many experts agree that eating disorder treatment is usually longer than 30 days for those that have been deemed life threatening.
Anorexia nervosa and other eating disorders were thought to be disorders only associated with teenagers, and even today, many still believe that. Eating disorders affect both men and women of all ages, ethnicities, and social status.
A brief history of eating disorder treatment
In 1873, esteemed English physician–and Queen Victoria’s personal doctor, Sir William Withey Gull described his eating disorder treatment plan for the first patient to be diagnosed with anorexia nervosa in a paper entitled “Anorexia Nervosa (Apepsia Hysterica, Anorexia Hysterica).” He believed that his patient’s disease was not a condition of marked insanity and could be treated outside of the mental asylum. It is important to note that many physicians before this believed that eating disorders were the mark of a hysterical woman and as a result many patients were given concoctions such as iodine, mercury and other harmful substances and placed in an insane asylum. Sir William Withey Gull provided at-home care for his patient for two years and placed her on a strict re-feeding regimen where she was hand fed by a nurse and eventually gained 26 pounds. He paved the way for treatments today such as family therapy, cognitive behavioral therapy, dialectal behavioral therapy and other very recent advancements in eating disorder treatment such as eye movement desensitization and reprocessing (EMDR), all of which are used at Center For Discovery, a renowned eating disorder treatment center with locations across the United States.
Due to the strong association between trauma, posttraumatic stress disorder (PTSD) and eating disorders in the literature, researchers have suggested that clinical interventions for traumatized eating disorder clients may benefit from treating PTSD symptomology. One such possibility for treating co-occurring trauma and eating disorders includes eye movement desensitization reprocessing (EMDR) therapy. Although EMDR therapy is not considered to have a direct benefit for people with eating disorders, it may be potentially useful for treating eating disorder patients if their behaviors were triggered by a traumatic event.
Cognitive behavioral therapy was first developed in the 1970’s and has since been used to help treat individuals with eating disorders, specifically binge eating disorder and bulimia nervosa. CBT includes educational components associated with eating disorder treatment and also the development of meal plans in addition to encompassing the psychological, societal and familial factors that are associated with the eating disorder development and management. Eating disorders are often caused by deep rooted underlying emotional and mental triggers such as trauma, low self esteem, personality disorders, poor relationships and devastating conflict resolution skills and cognitive behavioral therapy specifically works to help eliminate these negative aspects and develop positive coping skills by fixing abnormal thought processes.
Dialectical behavior therapy (DBT) is a type of psychotherapy that combines parts of cognitive behavioral therapy with principles of mindfulness. DBT has been proven as an effective approach to foster the necessary changes associated with binge eating disorder and therefore can be used as a formal binge eating disorder treatment strategy. Traditional dialectal behavior therapy focuses on concrete behavioral skills for four domains: emotional regulation, interpersonal effectiveness, distress tolerance, and mindfulness. In adapting traditional dialectal behavioral therapy to target binge eating disorder, it also includes developing an individualized food plan that will support the treatment goals.
Family-based therapy for anorexia nervosa, formally known as the Maudsley Approach, is an eating disorder treatment component where family members, particularly parents, are actively involved in their child’s eating disorder treatment and work with therapists to focus on weight restoration, returning control of eating to their child, and establishing their healthy self-identity. This is just one approach used by some treatment programs for eating disorders. Instead of the nurses feeding the individual back in the 1870’s during Sir William Withey Gull’s time, the Maudsley Approach encourages parents to feed their adolescent, administer medicine, and actively participate in their therapy as a substitute for hospitalization. This treatment approach for adolescents with anorexia nervosa was founded in the 1980’s at the Maudsley Hospital in London by a team of child and adolescent psychiatrists and psychologists. Treatment for bulimia nervosa is slightly different as individuals are usually older; more ready to engage in therapy and are more involved with the problem-solving phase of recovery. There are also other family therapy treatment strategies that are used to treat eating disorders including binge eating disorder and bulimia nervosa, regardless of the age of the individual. It is known that family support, whether it involves parents, siblings, spouses or children has a huge positive impact on eating disorder treatment and successful eating disorder recovery.
Eating disorder treatment is ever changing
Eating disorder treatments are constantly evolving overtime. Today, the stigma associated with eating disorders is decreasing however with all the new diet trends, it is still a common desire to be skinny and fit into a certain stereotype. With the development of new research and more access to funding, eating disorder treatments are becoming more widely accepted by insurance companies and many eating disorder treatment centers, specifically Center For Discovery, are constantly striving to practice the best treatment approaches according to the guidelines. Eating disorders have come along ways since the Middle Ages, however we still have a long ways to go.
National Drug and Alcohol Week is an awareness week that was started by the National Institute on Drug Abuse (NIDA) in 2010 to raise awareness for teenagers about the myths and dangers of alcohol and drugs. This campaign focuses on using science to educate young minds how drugs and alcohol affect both the mind and the body. From January 22-28th 2018, there will be educational events, activities, and online events to break down unhealthy and incorrect perceptions regarding drugs and alcohol. Any community organization, school or local area can become involved in National Drug and Alcohol Week by hosting an event in there are during this week. The NIDA website offers a toolkit on how to plan events and there are plenty NIDA employees available to answer any questions.
There will be a Chat Day during this week where students can ask questions that will be answered by professionals. Last year 52 schools participated and over 10,000 questions were submitted during this online event.
There are already over 440 registered worldwide community events already set-up on the NIDA website for the 2018 dates.
Schools and educators can visit the website and download free curriculums about drug use and addiction.
Other materials available for free on the website are “SHATTER THE MYTH” booklets that answer some of the most commonly asked questions by teens about drugs, alcohol, and addiction
Teen alcohol abuse
Alcohol is the most commonly abused substance among teenagers in the United States. Excessive drinking is responsible for more than 4,500 deaths among underage youth each year, and costs the United States $24 billion each year on average and although drinking under the age of 21 is illegal, individuals 12 to 20 years of age drink 11% of all alcohol consumed in the United State with more than 90% of this alcohol consumed in the form of binge drinking. Alcohol is known to lessen inhibitions resulting in risky and even illegal behaviors among teenagers potentially leading to violence, drug abuse and incarceration.
Drug abuse in teenagers
The most commonly abused drugs by adolescents include alcohol, marijuana, prescription drugs (benzodiazepines, Adderall, and opioids) and hallucinogens. According to research, Almost 50% of high school seniors have abused a drug of some kind. According to research, by 8th grade 15% of kids have used marijuana, over 60% of teens report that drugs of some kind are kept, sold, and used at their school, 64% of teens say they have used prescription painkillers that they got from a friend or family member, over 5% of 12th graders have used cocaine and over 2% have used crack and more teenagers die from taking prescription drugs than the use of cocaine and heroin combined
Psychotherapy treatment for alcohol and substance abuse disorders in teens
Behavioral therapy, family based approaches and recovery support systems such as Assertive Continuing Care, Mutual Help Groups, Peer Recovery Support Services and Recovery High schools are the mainstay of psychotherapy approaches used for alcohol treatment in teens. Behavioral therapy focuses on identifying the negative feelings, thoughts and emotions driving the teen to use alcohol and uses positive behavior approaches, coping skills and problem solving techniques to prevent these thoughts and negative behaviors. Family therapy approaches are used to provide education to the family as a unit about addiction and focus on family stressors and negative behaviors that may be present triggers for the teen’s behavior.
Valium, diazepam, is a long-acting benzodiazepine, that is often used, against recommendation, to treat anxiety disorders such as panic disorder. Benzodiazepines commonly referred to as “nerve pills” have been widely used since the 1960’s for alcohol withdrawal, anxiety, insomnia, and seizures, however are now known to be extremely dangerous and addictive and therefore are recommended only for certain refractory cases. Their withdrawals alone can result in seizures and even death and therefore individuals taking benzodiazepines usually need to be slowly weaned in order to prevent deadly withdrawals. Valium was the fourth most-prescribed benzodiazepine in the US, as 15 million prescriptions were written, as per the Drug Enforcement Administration and large amounts of this drug are sold illegally on the streets, in order to turn an even greater profit. Valium and other benzodiazepines, specifically short-acting agents, can be helpful in certain short-term situations such as to relieve anxiety before an invasive medical or dental procedure, to relieve acute symptoms of anxiety and fear after a traumatic event and to help treat insomnia; however it is important to practice caution when using these medications and they have a very high addiction potential. Some effects from Valium abuse include the following:
Impaired ability to perform typically enjoyable physical activities.
Mood swings and episodes of depression.
Memory loss and poor concentration.
Aggression and violence.
Respiratory problems and reduced blood pressure.
Fatigue and grogginess.
Physical and psychological dependence accompanied by severe withdrawal symptoms when suspending usage.
Panic attacks mimic life-threatening situations where the individual feels they are dying. They will often present with chest pain and shortness of breath that typically peaks within 10 minutes. Panic disorder is diagnosed when individuals experience recurrent panic attacks followed by at least one-month duration of having a fear of an oncoming panic attack. Studies have shown that approximately 2%-6% of adults in the United States will be diagnosed with panic disorder in their lifetime and nearly half of panic disorders diagnosed in adults in a 12-month period are considered severe. Panic disorder often coexists with mood disorders, and mood symptoms potentially follow the onset of panic attacks. Lifetime prevalence rates of major depression in panic disorder may be as high as 50-60%. The following symptoms are seen in panic disorder:
Shortness of breath
Feelings of choking
Chills or heat sensations
Numbness or tingling sensations
Being detached from oneself
Fear of losing control
Fear of dying
Treatment for panic disorder
The American Psychiatric Association (APA) recommends treating patients with panic disorder when symptoms cause dysfunction or significant distress in aspects of an individual’s life as their such as work, family life, social obligation, and leisure activities. Benzodiazepines such as Valium are not a first-line recommended treatment approach for individuals with panic disorder and are only recommended for individuals who have panic disorder that has not been successfully treated with any other psychotherapy or pharmacological treatment. The first-line treatment for panic disorder is cognitive behavioral therapy with or without medication. Medications that are recommended include antidepressants, specifically selective serotonin reuptake inhibitors (SSRIs)
Treatment for benzodiazepine addiction
Benzodiazepine addiction, like alcohol, is usually treated with a slow taper of benzodiazepines to prevent seizures. Depending on the severity of the addiction and if there are co-occurring mental health conditions present, the duration and level of care may vary from inpatient hospitalization to outpatient therapy. Psychotherapy is needed in order to address the underlying behaviors leading to the addiction and to teach individual’s self-care and how to control their triggers and cravings.