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Stress and Trauma Based Dysfunctional Eating Behaviors

The third category is when stress and trauma cause dysfunctional eating behavior.

I was recently following along with the NEDA/BEDA conference via social media.

There was a presentation that studied people who had food insecurity as a precursor to their dysfunctional eating behaviors.

That was shocking to me, as I felt like I’ve been talking about this for so long and no one was listening.

Obviously, someone else had the same idea – and I’m so glad that they’re doing research on it because, in my profession, which is dietetics, there seems to be a total misunderstanding that food insecurity leads to dysfunctional eating behaviors.

I feel like it is common to try to treat food insecurity without looking at the dysfunctional eating behaviors that it causes or to try to treat dysfunctional eating behaviors without looking at childhood feeding experiences of food insecurity.

Food insecurity isn’t always a childhood experience, of course, it’s something that occurs all the time. It can occur for someone who is confined, who’s in prison, someone who’s homeless, someone who’s just impoverished and lets their children have what little food they have as they go hungry.

There are a lot of food insecurity related stresses and dysfunctional eating behaviors.

There’s also chronic stress or trauma to consider.

All of these things, because they cause brain changes, can also cause an eating change.

An example is whenever a traumatic event happens to a community. You will hear “watch your children for any of these signs of stress or depression,” like not sleeping and not wanting to go to school, and crying.

Never once have I seen changes in eating behavior mentioned, which is clearly a response to stress.

Now, some people eat less when they are stressed, and some people eat more, but either way, stress-related dysfunctional eating behaviors are different than an addiction-related dysfunctional behavior and different from a biology-based dysfunctional eating behavior.

Jessica Setnick: Beyond DSM 5 A New Model of Dysfunctional Eating Behaviors - YouTube

Now, there’s obviously biology associated with trauma, so there’s some possible overlap here. And if the trauma is related to food, then we end up with an even more overlapping situation.

We have to treat the food trauma, and we have to treat the other trauma. We have to help someone in this situation get an appropriate relationship with food while also healing the traumatic experience that they’ve had.

This might look like PTSD, it may not look like PTSD, it may just look like someone who had a terrible experience and now, for whatever reason, doesn’t want to eat.

It could be someone specifically had an eating-related bad experience. Sometimes, we have kids who are afraid to throw up or afraid to swallow, appearing almost more like conversion disorder.

It could be a bad experience that happened totally unrelated to food.

There are a lot of times and ways that we humans inappropriately or incompletely process trauma and that unprocessed trauma can consciously or unconsciously change our eating behaviors.

Again, this is important because someone needs treatment for the underlying issues as well as the nutrition counseling and possibly the psych meds and counseling that they need to manage their eating.

Let’s say someone who has trauma-based dysfunctional eating behavior is put in the same group as someone who has a substance-related dysfunctional eating behavior.

They may not all be getting what they need because this person needs either crisis counseling or grief and loss counseling or EMDR for their underlying issues, not just talk therapy and not just nutritional counseling.

I believe that many, if not most, clinicians, dietitians, therapists, psychiatrists, nurses, and doctors who are really skilled at eating disorder treatment already do this.

We assess what it is that causes someone’s dysfunctional eating behavior.

Sometimes, someone thinks it’s something that it isn’t, “I developed my eating disorder when I didn’t make the soccer team,” when, really, they have mononucleosis, and that caused an autoimmune reaction in their brain, which causes their dysfunctional eating.

As such, sometimes, we have to be more of a detective because the person may not actually be able to verbalize what it is that causes their dysfunctional eating.

It may have been so long ago that someone doesn’t remember.

There are a lot of reasons for us to do very thorough assessments. This process lasts much more than the first session.

I do believe that this is what many in the eating disorder treatment field are doing, but, I believe that it is not what is being looked at when it comes to research.

The research is focusing on the outcome behavior and not the origin.

The problem being that they are different diseases.

Please See

Beyond DSM-5: A New Model of Dysfunctional Eating Behaviors – Part 1
Beyond DSM-5: A New Model of Dysfunctional Eating Behaviors – Part 2
Beyond DSM-5: A New Model of Dysfunctional Eating Behaviors – Part 3

Source:

Virtual Presentation by Dr. Nicholas Farrell in the Dec. 7, 2017 Eating Disorder Hope Inaugural Online Conference & link to the press release at https://www.prnewswire.com/news-releases/eating-disorder-hope-offers-inaugural-online-conference-300550890.html

About the Presenter:

Jessica Setnick, MS, RD, CEDRD-S envisions a world where all health professionals know how to help someone with an eating disorder. She created The Eating Disorder Clinical Pocket Guide and Eating Disorders Boot Camp to advance this vision, which she also does in her training workshops, phone coaching, and onsite training at hospitals and treatment programs. Reach Jessica at info@UnderstandingNutrition.com.

About the Transcript Editor: Margot Rittenhouse is a therapist who is passionate about providing mental health support to all in need and has worked with clients with substance abuse issues, eating disorders, domestic violence victims, and offenders, and severely mentally ill youth.

As a freelance writer for Eating Disorder and Addiction Hope and a mentor with MentorConnect, Margot is a passionate eating disorder advocate, committed to de-stigmatizing these illnesses while showing support for those struggling through mentoring, writing, and volunteering. Margot has a Master’s of Science in Clinical Mental Health Counseling from Johns Hopkins University.

The opinions and views of our guest contributors are shared to provide a broad perspective of eating disorders. These are not necessarily the views of Eating Disorder Hope, but an effort to offer a discussion of various issues by different concerned individuals.

We at Eating Disorder Hope understand that eating disorders result from a combination of environmental and genetic factors. If you or a loved one are suffering from an eating disorder, please know that there is hope for you, and seek immediate professional help.

Published on June 18, 2018.

Reviewed on June 18, 2018 by Jacquelyn Ekern, MS, LPC. 


Published on EatingDisorderHope.com

The post Beyond DSM-5: A New Model of Dysfunctional Eating Behaviors – Part 4 appeared first on Eating Disorder Hope.

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Addiction-Based Dysfunctional Eating Behaviors

The second type of dysfunctional eating behavior is addiction-based.

Addiction certainly has some biological components, and they definitely fall under some of the biological based dysfunctional eating behaviors, but I think that addictions have enough of their own individuality and symptomatology that they warrant a second section.

In referring to addictions, I include process addictions as well as anything that could be either an addictive substance or addictive behavior.

I’ll just use substance use disorder as a catch-all term, but the substance could be gambling, the substance could be sex, the substance could be a behavior.

Substance use disorder can lead to a dysfunctional eating behavior, or a dysfunctional eating behavior can lead to a substance use disorder. It is a chicken and egg question, and it may not even be important which one started because usually, they both have to be treated together.

Otherwise, someone switches to the other one when they can’t use whatever substance they are being treated for.

Now, is food an addictive substance?

I really don’t know.

I know that food is a mood altering chemical and we tend to sort of dismiss that when we talk about food not being addictive.

However, just because I’m not addicted to a food, why would I say that someone else can’t be?

If someone has been addicted to a substance and they describe their dysfunctional eating behaviors as feeling like an addiction, perhaps they could be treated with the same methodology that benefited them in their substance use addiction.

For example, if they benefited from 12-step or if they benefited from having a sponsor or whatever it is that they benefited from, that would be a skill that they could use to manage their dysfunctional eating behaviors properly.

Jessica Setnick: Beyond DSM 5 A New Model of Dysfunctional Eating Behaviors - YouTube

Now, there’s also the possibility that someone developed a substance use disorder coming from a dysfunctional eating behavior.

They have actually turned to a substance such as meth, heroin, or cocaine, diet pills, a stimulant – something that helps them not have an appetite.

They turn to a substance in order to help them with their already dysfunctional eating behavior or their distorted body image.

In that case, we have to help someone with education such as nutritional counseling to help them no longer need the substance.

If they become addicted to the substance, either psychologically or physically, they’re also going to need addiction treatment.

It is really important that we also add on eating disorders and dysfunctional eating treatment together with the substance use treatment.

That is something that we are lacking in our study of dysfunctional eating disorder treatment because a lot of people are eliminated from research if they have an addiction, or, sometimes even if they’re only taking medicine, they’re eliminated from research.

We have this whole population of individuals with both dysfunctional behavior and substance use behavior that we don’t have information on because they often mutually exclude each other in a research population.

Please See

Beyond DSM-5: A New Model of Dysfunctional Eating Behaviors – Part 1
Beyond DSM-5: A New Model of Dysfunctional Eating Behaviors – Part 2

Source:

Virtual Presentation by Dr. Nicholas Farrell in the Dec. 7, 2017 Eating Disorder Hope Inaugural Online Conference & link to the press release at https://www.prnewswire.com/news-releases/eating-disorder-hope-offers-inaugural-online-conference-300550890.html

About the Presenter:

Jessica Setnick, MS, RD, CEDRD-S envisions a world where all health professionals know how to help someone with an eating disorder. She created The Eating Disorder Clinical Pocket Guide and Eating Disorders Boot Camp to advance this vision, which she also does in her training workshops, phone coaching, and onsite training at hospitals and treatment programs. Reach Jessica at info@UnderstandingNutrition.com.

About the Transcript Editor: Margot Rittenhouse is a therapist who is passionate about providing mental health support to all in need and has worked with clients with substance abuse issues, eating disorders, domestic violence victims, and offenders, and severely mentally ill youth.

As a freelance writer for Eating Disorder and Addiction Hope and a mentor with MentorConnect, Margot is a passionate eating disorder advocate, committed to de-stigmatizing these illnesses while showing support for those struggling through mentoring, writing, and volunteering. Margot has a Master’s of Science in Clinical Mental Health Counseling from Johns Hopkins University.

The opinions and views of our guest contributors are shared to provide a broad perspective of eating disorders. These are not necessarily the views of Eating Disorder Hope, but an effort to offer a discussion of various issues by different concerned individuals.

We at Eating Disorder Hope understand that eating disorders result from a combination of environmental and genetic factors. If you or a loved one are suffering from an eating disorder, please know that there is hope for you, and seek immediate professional help.

Published on June 18, 2018.
Reviewed on June 18, 2018 by Jacquelyn Ekern, MS, LPC.


Published on EatingDisorderHope.com

The post Beyond DSM-5: A New Model of Dysfunctional Eating Behaviors – Part 3 appeared first on Eating Disorder Hope.

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Foundations of the Dysfunctional Eating Behaviors Model

The origins of the Dysfunctional Eating Behaviors Model takes into account that there are many different paths to dysfunctional eating behaviors, probably as many different paths as there are human beings because no two humans have the exact same experience, the exact same brain chemistry, the exact same genes, the exact same microbiome.

Everyone is different.

If there are 7 billion people on Earth, there are 7 billion paths to dysfunctional eating behavior.

Even so, they seem to cluster into about four groups.

There are a lot of subgroups, but I’m going to put them into four main groups for ease of discussion.

Biology Based Dysfunctional Eating Behavior

Here, I’m specifically not saying genetic because genetics means different things to different people.

I’m an anthropologist by training, and so linguistics is part of anthropology, and the way we’ve used words is very significant to me.

Genes are of course part of biology. When we say genetics, I think we tend to think of something that’s inherited or in your DNA. Yet, we do know there’s a DNA related component of anorexia nervosa, that’s the only one that’s been identified so far.

Maybe not coincidence is that this happens to be related to the gene that codes for celiac disease, so, then we’ve got a possible link to an autoimmune component in eating disorders.

Those are biological predispositions or biological connections with eating disorders or dysfunctional behaviors.

There are other types of dysfunctional eating behaviors I can think of that are 100% biological, not just genetic.

However, one example that is a completely genetic dysfunctional eating behavior and that is called “Prader-Willi, which is a genetic disorder. It is something in someone’s genes that is a mutation, so it is not inherited.

It normally shows up around two years of age when a child will start to have an insatiable hunger and will eat basically almost anything, anytime.

Jessica Setnick: Beyond DSM 5 A New Model of Dysfunctional Eating Behaviors - YouTube

This is a child who is eating off other people’s plates, possibly eating out of the trash can, hungry all through the day and all through the night. It’s a very serious condition, and it is incurable.

Recently, treatments have started to look at genetics and trying to change the DNA, but it’s not completed yet so all that can be done up to now is behavioral training to help teach a child that this is a feeling that you are going to feel and you can’t eat every time you feel hungry.

Prader-Willi would look a lot like binge eating disorder, but it’s not. It’s not a behavioral condition that needs behavioral treatment, but it is a totally genetic, totally biology based dysfunctional behavior.

Another example is PANDAS which stands for Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infection.

PANDAS is when a child will have a strep infection; maybe they go to the doctor, maybe they don’t, maybe it’s not bad enough to even get treated. Then, six weeks or six months later, they wake up with full-blown symptoms of either anorexia nervosa, generalized anxiety disorder, or obsessive-compulsive disorder.

In the case of anorexia nervosa caused by PANDAS, that would be a child who doesn’t live in a weight-focused home or a child who hasn’t been preoccupied with body image before but just wakes up one day and suddenly will not eat because they don’t want to get fat.

They’re using words that sound a lot like what we associate with anorexia nervosa, but they have anorexia nervosa that’s caused by a strep infection. That infection has caused an autoimmune response that has damaged the child’s brain.

That is a 100% biology based dysfunctional eating behavior that is not genetic at all, while there may be a genetic underpinning that makes that child susceptible, but we don’t know about that currently.

There are other infections besides streptococcal infection that can also cause this syndrome so many may refer to PANDAS as PANS, which stands for Pediatric Autoimmune Neuropsychiatric Syndrome.

These are some examples of solely biologically based functional eating behaviors, but there are a lot more that may be partially biology based or are majority biology based.

That would include some other autoimmune diseases like diabetes, which could be Type 1or Type 2. We know there’s such a pronounced overlap between dysfunctional eating behavior and Type 1 diabetes that the American Diabetes Association recommends that all teenagers with Type 1 diabetes be assessed for an eating disorder.

We know that dysfunctional eating behaviors often predate the development of diabetes type 2.

There’s also MODY, Maturity Onset Diabetes of Youth. Other autoimmune conditions can also prompt development of an eating disorder.

There are other biological precursors of eating disorders besides autoimmune responses. We also know that a concussion can lead to dysfunctional eating behavior.

It may be easy to say, “Well, an athlete who experienced a concussion and isn’t able to compete may stop eating because, now that they’re not competing, they don’t want to eat because they’re afraid they’ll gain weight.”

That’s possible and would be a behavioral connection, but there’s also a biological connection. A concussion is an insult to the brain, a closed head injury.

In some cases, an individual with a concussion will develop dysfunctional eating behaviors and, as the brain heals over time, the dysfunctional eating behaviors tend to step away.

In some cases, they don’t, and they’re permanent and need a different kind of treatment.

Any kind of illness that alters brain function, or even something that alters metabolism or body weight, such as hypothyroidism, hyperthyroidism, PCOS, hormonal problems, there’s even been a connection between cancer and eating disorders.

The connection between cancer and eating disorders is when someone loses weight due to cancer and then is concerned about gaining the weight back. This may sound a little bit controversial, but it absolutely has happened.

There’s also the possibility that some innate personality traits may contribute to dysfunctional eating behavior, such as perfectionism. It’s unclear how much of that is inborn versus environmental, but either way, there are biological underpinnings as far as how the brain works.

We don’t really know what all of these things are, but we do know that genes are biology and that genes interact with the environment, so, there is gene susceptibility that is separate from environmental biologic interference.

We know there’s at least one type of autoimmune eating disorder connection. Therefore, it’s possible that there might be more.

I would also add psychiatric issues here in the biological category, such as anxiety, depression, bipolar depression, schizophrenia and obsessive-compulsive disorder. I would include these as biology-based illnesses that can cause biology-based dysfunctional eating behaviors.

The reason this is important, of course, is not just because now we can say “okay, yes, you may have a biology-based dysfunctional eating behavior,” it’s that recognizing this helps us to see how we need to treat it.

Clearly someone with hypo or hyperthyroidism needs to be treated differently than someone with anxiety or depression or OCD or a concussion or diabetes or celiac disease or Prader-Willi or PANS.

Individuals need to be treated appropriately for the biological origin of their dysfunctional eating behavior.

This condition-specific treatment could be medication, psychotherapy, cognitive behavioral therapy in some cases, nutrition restoration and nutritional counseling probably in most cases. It would probably involve exposure and response prevention if it’s an anxiety-related biology-based dysfunctional eating behavior.

It might even include some brain treatments that haven’t even been invented yet. Some people have found relief with transcranial magnetic stimulation or implants in the brain that was developed to manage seizure. Meditation, neurofeedback – there are so many things that can help with brain training that may influence some of these behaviors.

Then, on top of that, there may be actual psychoactive medication or non-psychoactive medication such as insulin or Synthroid, something that actually treats the precursor of the dysfunctional behavior.

I’ve even heard from my dermatologist about someone who developed anorexia after having been diagnosed with eczema all over the body. After that eczema was treated, she no longer had anorexia.

I don’t know the connection or how it all works, but I can tell you that there are definitely connections between biology and eating disorders.

We don’t know what all of them are, but if we don’t accept that some of these things are interconnected then we’re only studying the biology of the eating disorder, and it is important to study the biological impact of the earlier or concurrent issue as well.

Please See

Beyond DSM-5: A New Model of Dysfunctional Eating Behaviors – Part 1

Source:

Virtual Presentation by Dr. Nicholas Farrell in the Dec. 7, 2017 Eating Disorder Hope Inaugural Online Conference & link to the press release at https://www.prnewswire.com/news-releases/eating-disorder-hope-offers-inaugural-online-conference-300550890.html

About the Presenter:

Jessica Setnick, MS, RD, CEDRD-S envisions a world where all health professionals know how to help someone with an eating disorder. She created The Eating Disorder Clinical Pocket Guide and Eating Disorders Boot Camp to advance this vision, which she also does in her training workshops, phone coaching, and onsite training at hospitals and treatment programs. Reach Jessica at info@UnderstandingNutrition.com.

About the Transcript Editor: Margot Rittenhouse is a therapist who is passionate about providing mental health support to all in need and has worked with clients with substance abuse issues, eating disorders, domestic violence victims, and offenders, and severely mentally ill youth.

As a freelance writer for Eating Disorder and Addiction Hope and a mentor with MentorConnect, Margot is a passionate eating disorder advocate, committed to de-stigmatizing these illnesses while showing support for those struggling through mentoring, writing, and volunteering. Margot has a Master’s of Science in Clinical Mental Health Counseling from Johns Hopkins University.

The opinions and views of our guest contributors are shared to provide a broad perspective of eating disorders. These are not necessarily the views of Eating Disorder Hope, but an effort to offer a discussion of various issues by different concerned individuals.

We at Eating Disorder Hope understand that eating disorders result from a combination of environmental and genetic factors. If you or a loved one are suffering from an eating disorder, please know that there is hope for you, and seek immediate professional help.

Published on June 18, 2018.
Reviewed on June 18, 2018 by Jacquelyn Ekern, MS, LPC. 


Published on EatingDisorderHope.com

The post Beyond DSM-5: A New Model of Dysfunctional Eating Behaviors – Part 2 appeared first on Eating Disorder Hope.

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Why We Need to Change the Way We Diagnose & Treat EDs

We have a huge problem in the eating disorder treatment field.

It is vital that we change the way we are describing dysfunctional eating behavior.

I have a real sense of loss that the research that we’re doing is so separated from the actual human experience of eating disorders and it all stems from the diagnostic criteria.

My goal is to present a different way of looking at things which are actually the way that many, if not most, clinicians in clinical practice actually look at eating disorders.

However, because the Diagnostic and Statistical Manual of Mental Disorders (DSM) is the basis for all research, any research done on eating disorders is only based on the diagnostic criteria.

Therein lies the problem: everything that we do when we talk about an eating disorder diagnosis (anorexia nervosa, bulimia nervosa, binge eating disorder, avoidant or restrictive food intake disorder, night eating syndrome, or any other disorder), we’re describing symptoms.

We’re describing the symptoms of not eating enough to sustain life, or we’re describing the symptoms of eating and then feeling the need to get rid of the food.

What we’re doing when we describe eating disorders with those names is we’re describing the symptoms that someone is experiencing, not the actual disease.

Of course, the problem is that we don’t know what the disease is.

We don’t know if bulimia is actually a hormonal disease, a brain chemistry disease, a brain morphology, or a genetic disease.

We don’t have the information about what these diseases are so we describe them based on their symptoms.

The problem with that is that we probably have more than one disease that causes, let’s say bulimia nervosa. Yet, when we research bulimia, we are putting people in groups based on their symptoms which may be adding people with different diseases into the same research protocol.

For example, let’s consider a totally made-up study. A hundred people, let’s think women because, for a long time, all of our eating disorder research was on women even though men have eating disorders at almost the same rate, which doesn’t even include individuals who are gender non-conforming. That’s a whole other issue that I won’t address but I just want to mention.

Continuing with our hypothetical example, let’s say we have 100 women who all meet the criteria for a diagnosis of bulimia nervosa. Going off of the diagnostic criteria, they’re all eating large quantities of food within a discrete period of time.

They’re all using inappropriate compensatory measures after eating to get rid of the food; they have body image distortion that has been going on for a certain period of time. This is the diagnosis of bulimia nervosa.

Jessica Setnick: Beyond DSM 5 A New Model of Dysfunctional Eating Behaviors - YouTube

So, 100 women with bulimia nervosa are all administered an anti-depressant medication in an effort to see if it improves their symptoms.

Perhaps, the study found that 50 people get better and 50 people have no change or get worse. As such, the results of our study are now going to be published that this certain anti-depressant has a 50% effective rate in treating bulimia nervosa.

However, maybe bulimia that’s caused by a depression has a 100% effectiveness rate being treated with an antidepressant.

But, the 50 people with bulimia that was caused by a terrible traumatic event that happened in their life which triggers their bulimia are not going to get any relief from an anti-depressant because they don’t have depression, they have post-traumatic stress.

This is not meant to be a realistic example; it’s just to say that we are grouping people into the categories based on their eating disorder diagnosis that aren’t necessarily suffering from the same disease.

This is similar to saying that three people are coughing, we give them all a cough drop. One gets better, one stays the same, one dies, yet we still ask “Why? we gave them all the same treatment!” Essentially, we give everyone with an eating disorder the same treatment.

We give them nutritional counseling, psychoactive medication, individual counseling, possibly group therapy, possibly nutritional restoration depending on their needs.

We give everyone the same treatment, but not everyone gets better.

How do you explain that?

One person had a sore throat, and a cough drop solved the problem.

One person had tuberculosis, so the cough drop does nothing for them.

Finally, one person was already choking on a cough drop so giving them another cough drop was the end for them.

That’s what I’m talking about: if we are just looking at the outward symptoms of someone’s eating disorder and treating that, we are not treating the underlying cause of the disease, and it’s very challenging to treat the underlying cause if we don’t actually know what it is.

The solution is a middle ground where, instead of just looking at someone’s diagnosis, we look at a comprehensive picture of their dysfunctional eating behaviors.

Dysfunctional Eating Behaviors

I say behaviors because, usually, someone doesn’t participate in only one dysfunctional eating behavior.

Dysfunctional eating behaviors is a different way of looking at eating disorders rather than eating disorders diagnoses.

Dysfunctional eating behaviors are really on a continuum.

The same person who is diagnosed with anorexia might have binge eating and purging behaviors or just purging or just bingeing. We know this to be true, so, why do we put them in a box labeled anorexia nervosa?

Simply because they’re underweight?

Someone with binge eating disorder might also have periods of restriction. Why can we not label them with anorexia?

It doesn’t make a lot of sense if you think about trying to pigeonhole someone into one individual behavior.

We’ve all had patients who have restricted, binged, purged, cut, over-exercised, maybe even all in the same day, so, it doesn’t make sense to put people in boxes based on which behavior they’re doing now. They may need treatment for each individual behavior.

This new model is not specific about which dysfunctional eating behaviors someone is participating in now or this month or this week.

The idea being that we all have dysfunctional eating behaviors as human beings, meaning we all sometimes do things with food that are for a purpose other than fueling.

The significance is more whether your dysfunctional eating behavior is neutral in your life, are they damaging your life, are they destructive to your life, or are they threatening your life?

That’s the continuum that we’re seeing in our offices and our treatment centers.

We aren’t usually seeing people who have a positive relationship with food in our treatment. It’s people who are on that continuum of negative feedback or dysfunctional behavior.

This model focuses not on which behavior someone has but it focuses on the origin of the dysfunctional eating behavior, and that’s what, as I said before, most clinicians are actually doing already.

Most are actually assessing what’s behind someone’s dysfunctional behaviors but our research doesn’t support that, and we don’t have treatment protocols based on the origins of dysfunctional eating behavior.

The only treatment protocol is based on: if someone is doing this behavior with their food, they need this treatment.

We are confounding our research when we do that because we’re putting people with different diseases in the same research population.

I do believe that what we call anorexia nervosa probably has several different subtypes.

There’s probably a terminal version of anorexia nervosa; this is a patient who is not going to get better.

I hate thinking about it, honestly, because it’s depressing to think we may have no treatment for this person who is unintentionally using their eating disorder as a way to end their life. The person who will mess with their tube fitting or, if you give them a PICC line, they’ll contaminate it.

With these, I mean to say that this is a person who doesn’t want or cannot voluntarily accept treatment.

There are people, of course, who have terminal anorexia who do want treatment and that may be a different disease state or a different strain or strand or type of the disease.

It may be the same disease in a different type of person.

There are also types of anorexia nervosa that come from an autoimmune reaction.

There are types of anorexia that may be innate or inborn.

They may be related to puberty, which may mean that they’re hormonal.

We know that boys who have a female twin have a higher chance of developing anorexia than boys who have a male twin, so, is it something estrogen or testosterone related?

We really don’t know, but these may be very different diseases that all look like anorexia.

When we call all the diseases anorexia nervosa, we end up clumping people together who actually have different diseases.

Similar to saying, “all of these people are coughing” and to quarantine all of them, we’re not helping those people because someone might have seasonal allergies and they just need a Claritin, someone else might be choking on a chicken bone, and they need the Heimlich maneuver.

To just say they’re all coughing, so they all need the same treatment is just absurd, yet, we do it with people who have dysfunctional eating behaviors.

Source:

Virtual Presentation by Dr. Nicholas Farrell in the Dec. 7, 2017 Eating Disorder Hope Inaugural Online Conference & link to the press release at https://www.prnewswire.com/news-releases/eating-disorder-hope-offers-inaugural-online-conference-300550890.html

About the Presenter:

Jessica Setnick, MS, RD, CEDRD-S envisions a world where all health professionals know how to help someone with an eating disorder. She created The Eating Disorder Clinical Pocket Guide and Eating Disorders Boot Camp to advance this vision, which she also does in her training workshops, phone coaching, and onsite training at hospitals and treatment programs. Reach Jessica at info@UnderstandingNutrition.com.

About the Transcript Editor: Margot Rittenhouse is a therapist who is passionate about providing mental health support to all in need and has worked with clients with substance abuse issues, eating disorders, domestic violence victims, and offenders, and severely mentally ill youth.

As a freelance writer for Eating Disorder and Addiction Hope and a mentor with MentorConnect, Margot is a passionate eating disorder advocate, committed to de-stigmatizing these illnesses while showing support for those struggling through mentoring, writing, and volunteering. Margot has a Master’s of Science in Clinical Mental Health Counseling from Johns Hopkins University.

The opinions and views of our guest contributors are shared to provide a broad perspective of eating disorders. These are not necessarily the views of Eating Disorder Hope, but an effort to offer a discussion of various issues by different concerned individuals.

We at Eating Disorder Hope understand that eating disorders result from a combination of environmental and genetic factors. If you or a loved one are suffering from an eating disorder, please know that there is hope for you, and seek immediate professional help.

Published on June 18, 2018.
Reviewed & Approved on June 18, 2018 by Jacquelyn Ekern, MS, LPC


Published on EatingDisorderHope.com

The post Beyond DSM-5: A New Model of Dysfunctional Eating Behaviors – Part 1 appeared first on Eating Disorder Hope.

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To summarize, I want to describe a couple of case examples that will help to bring these two behavioral treatment strategies, Exposure-Based Treatment and Behavioral Activation Therapy, to life.

These case examples were derived from the patients that we treated right here in our eating disorders program at Rogers.

I’ve obviously changed the names and any other identifying information but, in large part, these case examples were taken from real-life practice.

Eric

This first case example we will call Eric for a pseudonym.

When Eric came into treatment, he was 28 years old and a graduate student.

He had described a really significant history of a lot of perfectionistic tendencies from early in his life he and he described that his family always focused on eating only healthy food selections.

He described cutting food items out of his diet that the family perceived to be bad or unhealthy.

In adolescence, Eric developed researching tendencies where he’d look up a lot of the ingredients of various food items that he was eating and the effects that they could have on the body.

What this led to was a really increasingly rigid pattern of avoidance surrounding “bad” foods and, throughout adolescence and into early adulthood, the extent of his restraint or cutting certain foods out of his diet became so significant that his diet became whittled down to only a very narrow range of foods that he deemed to be acceptable.

As you can imagine, this contributed to major disruptions not only in his educational endeavors but also his social life.

The course of treatment for Eric involved pinpointing some of the critical safety behaviors that Eric was encouraged to begin preventing engagement in such as doing food-related research as well as reading labels and then making food selections based only on what he deemed to be a “safe food choices.”

Unique Features and Effective Strategies in Treating Males with Eating Disorders - YouTube

Eric was encouraged to gradually do away with these safety behaviors throughout the course of treatment.

Exposure-related activities that we encouraged this individual to engage in gradual inclusion of certain foods he had previously deemed to be bad into his diet such as processed foods or foods that included sugars.

We also encouraged buying any new foods that he was unfamiliar with without doing a lot of his typical researching of the ingredients, caloric content or any of the effects that the food might have on his body.

From a behavioral activation standpoint, some of the activities that this individual was encouraged to increase throughout the course of treatment included greater engagement in certain social activities that had been previously very important to him as a consistent source of positive mood as well as gradually beginning to resume his educational pursuits.

To discuss a bit more in-depth, we began at the bottom of Eric’s exposure hierarchy, doing some gradual exposure to certain food items that he deemed to be kind of unacceptable or unhealthy.

In level two, we asked him to merely dip his fingertip in a little sugar bowl and then just lick the few fine granules of sugar that had stuck to his fingertip.

We then worked up to a level four, where he was encouraged to eat several pieces of candy throughout the day.

From there, we moved all the way up to a level seven whereby the end of treatment we were able to help this guy successfully be eating multiple dessert items throughout the course of a week.

Alex

We’ll call this second case example Alex, who was a 22-year-old when he came to our program.

He was not working at the time and living at home with his parents.

Alex described that, as a child, he was labeled as overweight by his family physician and was a significant target for bullies at his school because of this.

At the age of 14, he developed a bad bout of mono, and this led to dramatic weight loss.

As such, unintentionally, he received a lot of positive feedback. People just assumed that his weight loss was intentional and he got a lot of “wow look at you!” or “what great willpower you have!”

This contributed to him becoming a lot more focused on the ideal male athletic physique that I described earlier throughout his adolescence.

Coupled with that, he began to develop some really extreme compulsive routines around exercise as a means to try to bring about this extremely athletic physique.

Alex described weighing himself excessively and as a result of whatever the number was on the scale, developing really restrictive dieting habits, following even nominal weight gain.

As an example, he might weigh himself in the morning and, even if he had gained a fraction of a pound from the previous morning’s weight, he might subsequently skip breakfast that morning.

As you can imagine, given the extensive preoccupation surrounding body image and food intake, he became very much impaired, had to drop out of college due to his inability to complete his coursework, his being consumed by those really compulsive exercise routines, and rigid dietary patterns.

As a result, Alex lost out on a lot of the friendships that he had and also became very significantly depressed.

Some of the critical safety behaviors that Alex was encouraged to gradually fade, and eventually eliminate, included those extreme compulsive exercising behaviors as well as engaging in that excessive weighing process and subsequent dietary restriction.

For exposure-related activities that we encouraged him to engage in, this boiled down to having a well-balanced meal plan without consideration of just nominal fluctuations and his weight as well as gradual engagement in less strenuous, less intense, and, most importantly, less compulsive types of exercise.

For him, this might have included going for a jog for a much shorter duration of time and with a lot less intensity than was previously typical.

From a behavioral activation standpoint, to address his depression and disconnection from important life activities, Alex was encouraged to begin to reach out and reconnect with some of his old friendships that had fallen by the wayside as well as developing some more leisurely outlets for physical activity that included his friends.

The key here was physical activity that was done in a way that was more leisure-focused as opposed to calorie burning or trying to add muscle mass.

At the bottom of Alex’s behavioral activation activity hierarchy, we included just some researching of recreational sports activities as well as simple steps to trying to reach out and rekindle some of those old friendships.

Then, higher up in the hierarchy we included more involved activities with friends where he was getting together with them several times a week and even got to a point where this individual was successful in trying to bring together a recreational sports team that he and a lot of his friends play.

It was also an opportunity for him to meet some new people as well.

In closing, let’s review some of my key points.

There’s a really high degree of stigma amongst males with eating disorders, and we have found, in our successful work at Rogers treating these males, is that engaging them in a lot of behavioral therapy exercises and activities is one way to navigate that stigma successfully.

For whatever reason, treatment approaches that involve active things such as being up and out of the chair and doing things that are consistent with values resonate more with these men as opposed to simply sitting and talking about problems that one is experiencing.

I would encourage any clinicians who routinely treat males with eating disorders in their practice to give consideration to enveloping these strategies and interventions into your practice routinely.

Please See Eating Disorders in Males

Prevalence & Features of Eating Disorders in Males – Part 1
Prevalence & Features of Eating Disorders in Males – Part 2
Prevalence & Features of Eating Disorders in Males – Part 3
Prevalence & Features of Eating Disorders in Males – Part 4
Prevalence & Features of Eating Disorders in Males – Part 5
Prevalence & Features of Eating Disorders in Males – Part 6
Prevalence & Features of Eating Disorders in Males – Part 7
Prevalence & Features of Eating Disorders in Males – Part 8

Source:

Virtual Presentation by Dr. Nicholas Farrell in the Dec. 7, 2017 Eating Disorder Hope Inaugural Online Conference & link to the press release at https://www.prnewswire.com/news-releases/eating-disorder-hope-offers-inaugural-online-conference-300550890.html

About the Presenter: Dr. Nicholas R. Farrell, Ph.D. is a licensed clinical psychologist who directs and supervises the treatment of patients in eating disorder programs at Rogers Memorial Hospital. Dr. Farrell specializes in the use of empirically-supported cognitive behavioral therapy (CBT) treatment strategies that are used to help patients in our eating disorders programs.

Additionally, Dr. Farrell is a regular contributor to scientific research on the effectiveness and dissemination of CBT for eating, anxiety, and mood disorders and has published over 20 peer-reviewed journal articles and book chapters. Dr. Farrell has been the gracious recipient of federal grant funding to study the role of social stigma in the context of eating disorders.

About the Transcript Editor: Margot Rittenhouse is a therapist who is passionate about providing mental health support to all in need and has worked with clients with substance abuse issues, eating disorders, domestic violence victims, and offenders, and severely mentally ill youth.

As a freelance writer for Eating Disorder and Addiction Hope and a mentor with MentorConnect, Margot is a passionate eating disorder advocate, committed to de-stigmatizing these illnesses while showing support for those struggling through mentoring, writing, and volunteering. Margot has a Master’s of Science in Clinical Mental Health Counseling from Johns Hopkins University.

The opinions and views of our guest contributors are shared to provide a broad perspective of eating disorders. These are not necessarily the views of Eating Disorder Hope, but an effort to offer a discussion of various issues by different concerned individuals.

We at Eating Disorder Hope understand that eating disorders result from a combination of environmental and genetic factors. If you or a loved one are suffering from an eating disorder, please know that there is hope for you, and seek immediate professional help.

Published on June 18, 2018.
Reviewed on June 18, 2018 by Jacquelyn Ekern, MS, LPC


Published on EatingDisorderHope.com

The post Prevalence & Features of Eating Disorders in Males – Part 9 appeared first on Eating Disorder Hope.

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As I mentioned before, behavioral activation is a very effective treatment for depression and other related mood problems.

Now, let’s talk about why we know that behavioral activation is a particularly good fit in the context of eating disorders.

First of all, we talked before about the significant overlap and comorbidity between depression and eating disorders.

We also know that, even if an individual who is struggling with an eating disorder isn’t experiencing mood-related difficulties that meet the diagnostic threshold for major depressive disorder or a different mood disorder, there’s still often very pronounced, mood-related disturbances.

In the context of eating disorders, we haven’t talked about this feature, but how we can go about addressing the extreme degree of overemphasis that we often see in terms of body shape and weight and eating disorders is to help one diversify their engagement in a good variety of different life activities such that their array of activities do not all center around the topic of body image.

It can also be helpful to counteract a lot of the significant functional impairment that we see as a common consequence of one being preoccupied with eating disorder related thoughts and worries as well as the engagement and a lot of those rituals or safety behaviors around eating.

We see that behavioral activation can be helpful in addressing that functional impairment finally and this is particularly helpful with our male patients.

When we see higher rates of excessive or compulsive exercising, behavioral activation can be a nice framework to go about trying to establish a more moderate healthy routine with regard to exercise and other forms of physical activity.

Behavioral Activation Treatment Steps

For treatment steps, we’ll start with a functional assessment, talk about some different ways that patients can engage in self-monitoring, and then move on to how we go about developing an activity hierarchy. We then progress through that hierarchy.

This process is similar to how we begin exposure-based therapy behavioral activation and, as such, again begins with a very careful functional assessment where we look at a couple of important different domains.

First, we want to look at how the patient may avoid, so, we want to ask questions such as:

  • How do you respond to negative emotions when you’re experiencing them?
  • How do you go about coping with negative life events when they occur?
  • What types of ways do you avoid?

We also look at what types of important life activities the patient was more consistently engaged in prior to the onset of the difficulties that they’re having. To do this, we ask questions such as:

  • Before you began to struggle with your depression or developed difficulties with your eating disorder what kind of life activities, what things, or what people were important to you?
  • What were you doing more often prior to the onset of these difficulties?
  • What kind of things add meaning to your life?
  • What is it that really matters to you?
  • In what direction do you want your life to be headed?

Finally, we want to assess any kind of current life stressors that may require some problem-solving. Essentially, what we’re looking for are current problems that may be standing in the way of the patient being able to activate himself more.

We’re encouraging them to engage in more enjoyable activities that current life stressors might prevent the patient from doing.

Unique Features and Effective Strategies in Treating Males with Eating Disorders - YouTube

This is, consequently, how we can go about helping the patient in circumventing those stressors in the future.

Self-monitoring on the part of the patient is a very important component of behavioral activation. Our overarching goal is to help patients gain an improved awareness and understanding of a couple of important features.

First of all, we want patients to gain a better awareness of some of the avoidant patterns that they notice.

Another thing that can be really helpful that self-monitoring helps to facilitate is a better understanding of the relationship between the patient’s level of activity and the subsequent effect that this has on their mood.

There are a few different forms of self-monitoring and this gets back to the TRAP-TRAC Model that I described before.

There’s specific TRAP-TRAC monitoring that can be done with patients to help them understand how they might avoid different patterns.

Let’s talk about a log of what this might look like. The patient is asked to maintain a daily log where they identify different TRAP patterns. That is, instances wherein a Trigger occurs, and the individual engages in an Avoidance Pattern of coping.

This can also help the patient brainstorm where there may be more helpful TRAC responding that they could engage in as an alternative. This is where some of the more active forms of coping may come in handy

Let’s consider an example of this.

The triggering negative life event could be failing an exam, and it’s natural that one’s emotional response was feeling sad and somewhat hopeless about doing well on future exams.

One might respond to this negative life event by engaging in an Avoidant Pattern such as staying in one’s room, sleeping a lot more often, giving up on studying, not answering the phone, not getting together with friends

Now let’s consider the TRAC response in which the individual could engage.

Using Active Coping, the individual could respond to the same negative life event, failing an exam, and, though they feel sad and hopeless about doing well on future exams, they could work one-on-one with a tutor, go and speak with the professor about what was missed or what areas of the exam this individual really struggled with or finding a study partner.

This form of active coping might lead to a different response in the individual. By virtue of engaging in this more active form of coping, they might feel less depressed, might experience a greater sense of mastery over their behaviors, and ultimately might lead to a very different outcome next time.

As such, the next outcome might be that the individual improves and gets a better grade on the next exam. This is likely to be met with a very different emotional response, perhaps one of joy and mastery.

That emotional response, in-and-of-itself, is going to be reinforcing of the more active coping strategies, thereby making active coping much more likely and a more go-to response in the future.

A second type of patient self-monitoring, which we frequently use in the context of behavioral activation, involves activity monitoring.

This is as straightforward as the patient keeping a daily and hourly log of the relationship between the activities that they’re engaging in and their subsequent mood

Again, this helps to accomplish the goal of a patient gaining a better awareness of when their mood improves and when this is a result of increased activation.

In one of these logs, the left-hand column lists the different hours of the day and the right-hand column lists two things: the activity that they were engaging in during that hour of the day and a mood rating on a 0 to 10 depression scale, with 0 being the least depressed that an individual could feel and 10 being the most depressed that an individual could feel.

Let’s consider an example of an individual’s day.

They may log that the first two hours, from 8 to 10 a.m., their primary activity was laying in bed they reported feeling a nine on that zero to 10 depression intensity scale.

Then, as this individual took steps to activate themselves from 10:00 to 11:00 a.m., they talked on the phone with a friend. From 11:00 to 12:00, they got up and showered and brushed their teeth and then spent some time from 12:00 to 1:00 reading a mystery novel.

In these activities, the intensity of the depression seemed to lessen. It went to a six then up a little bit to a 7.5 and then all the way down to a 5.

This is helpful on a number of fronts.

First of all, you can see that the first two hours of this day is where we see the baseline data. We want to look closely for avoidance behaviors. Laying in bed seemed to be one way that this l particular patient went about avoiding.

Secondly, this can serve, in-and-of-itself, as good motivation to increase the patient’s engagement in different in life activities.

Hopefully, from this five-hour span of time, the patient would have gathered that “the more I activate, the less depressed I feel.”

We can use this information to relate back to the Behavioral Activation Model. This experience shows that, the more that we activate ourselves and the more effort we put forth to stay engaged with activities that are personally relevant, meaningful, and fulfilling to us, the more that we experience a more consistent positive mood.

Similar to Exposure-Based Therapy, in doing Behavioral Activation, we develop and implement what we call an “activity hierarchy.”

Our major objective here is to create a rank-ordered list of activities that the individual will engage in throughout the course of treatment.

We try to begin with assignments or different behavioral activation tasks that are going to be appropriate for a patient’s current functional level.

Expecting too much or having the patient take on too much early in the course of treatment might backfire and the patient might become overwhelmed and just throw in the towel and give up.

Throughout the course of treatment, we try to gradually increase the difficulty of moving through the hierarchy, encouraging greater and greater levels of activation.

As we’re moving through the hierarchy, we try to ensure a relative balance between the activities from the three different domains that we spoke of before: routine life activities, pleasurable or enjoyable activities, and value-driven activities

Our core objective here is to facilitate an increasingly diverse and stable source of positive reinforcement.

We want the activities to be things that are good from a variety standpoint and things that a patient can have access to and can implement in a stable fashion over the course of time.

In a completed activity hierarchy, the patient will hypothetically provide ratings on a zero to seven scale, zero being the least anticipated difficulty or distress and seven being the most anticipated difficulty or distress.

Similar to how we work through the exposure hierarchy, we start lower in the hierarchy and work our way up.

So, with the individual we mentioned earlier, we may get the ball rolling with behavioral activation by encouraging them to take on the following assignments:

  • Getting out of bed every day at 8:30 a.m.
  • Having a shower every morning
  • Calling his best friend once a week

As the individual experiences greater mastery of these activities throughout the course of treatment, greater and greater levels of activation are sprinkled in.

For example, the individual might be willing then to spend five minutes a day picking up the bedroom or be willing to get out of bed an hour earlier in the morning.

It naturally follows that we just work upward through the hierarchy.

Maybe the individual takes on tasks like working on a college application or watching some kind of sporting event with friends, gradually working through so that most, if not all, of the activity hierarchy, is completed throughout the course of treatment.

Please See Eating Disorders in Males

Prevalence & Features of Eating Disorders in Males – Part 1
Prevalence & Features of Eating Disorders in Males – Part 2
Prevalence & Features of Eating Disorders in Males – Part 3
Prevalence & Features of Eating Disorders in Males – Part 4
Prevalence & Features of Eating Disorders in Males – Part 5
Prevalence & Features of Eating Disorders in Males – Part 6
Prevalence & Features of Eating Disorders in Males – Part 7

Source:

Virtual Presentation by Dr. Nicholas Farrell in the Dec. 7, 2017 Eating Disorder Hope Inaugural Online Conference & link to the press release at https://www.prnewswire.com/news-releases/eating-disorder-hope-offers-inaugural-online-conference-300550890.html

About the Presenter: Dr. Nicholas R. Farrell, Ph.D. is a licensed clinical psychologist who directs and supervises the treatment of patients in eating disorder programs at Rogers Memorial Hospital. Dr. Farrell specializes in the use of empirically-supported cognitive behavioral therapy (CBT) treatment strategies that are used to help patients in our eating disorders programs.

Additionally, Dr. Farrell is a regular contributor to scientific research on the effectiveness and dissemination of CBT for eating, anxiety, and mood disorders and has published over 20 peer-reviewed journal articles and book chapters. Dr. Farrell has been the gracious recipient of federal grant funding to study the role of social stigma in the context of eating disorders.

About the Transcript Editor: Margot Rittenhouse is a therapist who is passionate about providing mental health support to all in need and has worked with clients with substance abuse issues, eating disorders, domestic violence victims, and offenders, and severely mentally ill youth.

As a freelance writer for Eating Disorder and Addiction Hope and a mentor with MentorConnect, Margot is a passionate eating disorder advocate, committed to de-stigmatizing these illnesses while showing support for those struggling through mentoring, writing, and volunteering. Margot has a Master’s of Science in Clinical Mental Health Counseling from Johns Hopkins University.

The opinions and views of our guest contributors are shared to provide a broad perspective of eating disorders. These are not necessarily the views of Eating Disorder Hope, but an effort to offer a discussion of various issues by different concerned individuals.

We at Eating Disorder Hope understand that eating disorders result from a combination of environmental and genetic factors. If you or a loved one are suffering from an eating disorder, please know that there is hope for you, and seek immediate professional help.

Published on June 18, 2018.
Reviewed on June 18, 2018 by Jacquelyn Ekern, MS, LPC


Published on EatingDisorderHope.com

The post Prevalence & Features of Eating Disorders in Males – Part 8 appeared first on Eating Disorder Hope.

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Exposure-Based Therapy & Eating Disorders – Exposure Hierarchy Examples & Coaching Techniques for Eating Disorders in Males

Let’s discuss a few examples of what a couple of hierarchies might look like. What’s important to point out is that these hierarchies don’t have to focus on just one kind of feared area or domain. We can include multiple domains within the same hierarchy so the

The first example is of a hierarchy that is simultaneously addressing a patient’s fear of eating dessert-related foods as well as wearing more form-fitting types of clothing items.

You can see that, from the bottom of this list to the top, the nature of the exposure activity becomes increasingly a revoking based on the fear rating that the patient has hypothetically provided in the column on the right.

This patient might work up from something beginning at a lower level, such as having just one spoonful of ice cream after dinner then work up to the top of the hierarchy.

All the way at the top, at a level seven, this patient might be encouraged to gradually work toward the goal of being able to go out and eat ice cream with friends following dinner.

One of the things that I neglected to mention before, about the fear rating scale, is that we ask patients to score the degree of anxiety or fear that would be present with these exposure activities ranging from zero to seven, zero being the least possible anxiety that one could imagine and seven being the most intense anxiety or fear that one could imagine.

One more example is a hypothetical hierarchy that’s been created to simultaneously address fears of another person, or other people seeing one’s stomach, as well as binge eating cues.

Unique Features and Effective Strategies in Treating Males with Eating Disorders - YouTube

First, looking at the exposure that’s listed at the level three fear rating is just to sit with and hold an open package of cookies, these being a common binge queue.

Then, at level seven, is doing that same activity: holding an open package of cookies but while the individual is significantly upset.

Here, they were pairing an environmental cue which has been a cue for binge eating in the past, being in the presence of an open package of cookies, and pairing that with another environmental cue, feeling intensely upset or a really intense negative emotion.

We know that being able to pair those two cues together is a very potent exposure strategy. When we create the exposure hierarchy, before we go about even beginning with active exposure exercises, patients have to be reminded of the importance of doing away with and eventually eliminating, safety behaviors.

Patients are encouraged, throughout the course of this treatment, is to completely abstain from safety behavior usage to the best of their ability.

In a lot of cases, it is a little unrealistic to expect that a patient is going to be completely willing to forego any and all safety behaviors from day one.

In those cases, we may have to take a more gradual, fading approach in the course of doing this treatment.

It is common that we have to prioritize some of the higher risk behaviors such as self-induced vomiting, laxative abuse, or extreme or intense forms of exercise.

This is particularly important for those patients who are at risk for significant injury if they continue in that extreme form of exercise.

In prioritizing some of the higher risk behaviors, we really encourage the patient and develop a plan to move towards elimination of these behaviors as soon as possible.

One of the things that we know to be helpful in the safety behavior prevention process is using daily monitoring systems whereby patients can, on a daily basis, track their progress. This doesn’t have to be anything elaborate.

It can be as simple as keeping a little notebook or even a sheet of paper or note card in one’s pocket where they keep a running tally of how often they notice that they’re engaging in safety behaviors and how often they notice that they’re able to successfully prevent a safety behavior when they experience an urge to engage in one.

What’s nice about this process is that, as patients make progress and achieve prevention of safety behaviors, a majority report noticing that the overall urge that they experience to continue using or relying on safety behaviors tends to gradually fade and decrease over time.

What we explained to patients at the outset of treatment, again, before any active exposure activities have been initiated, is that each of the safety behaviors that we’re asking them to put forth the effort to prevent is something that we know to be directly involved in the maintenance of the eating disorder.

It naturally follows that eliminating the use of these safety behaviors is going to contribute greatly to eating disorder symptom relief in the long term.

Conducting & Coaching Exposure

In terms of how a clinician goes about their role of implementing and coaching exposure-therapy activities, again, when we have the exposure hierarchy completely formulated and ready to go, we tend to begin with exposure activities on the hierarchy that are identified by the patient as ones that would be challenging yet manageable.

What this gets at is, for this treatment to be effective, we know that the exposure has to be accompanied by some anxiety and fear, but we don’t want to completely throw the patient to the wolves or overwhelm them from day one.

So, we try to begin at a place in the hierarchy that largely comes down to what the patient views as an appropriate place to begin challenging themselves in a manageable way.

The patient is encouraged, in each exposure activity that they complete, to remain engaged in the situation and to stay in confrontation with the fear until their peak fear reduces by at least 50%.

So, again, on that zero to seven scale, if the individual notices that, when they’re engaged with the exposure activity, their fear peaks at a four, we want them to stay engaged in that until the fear is reduced by at least 50%, in this case to a two.

Whenever possible, we want the exposure tasks to be repeated consistently so, day-after-day, multiple times a day as well as in a variety of different contexts.

As you can imagine, this is a treatment approach that involves a good deal of homework activities that the patient is encouraged to complete independent of their therapy sessions with you.

The role of the clinician during exposure activities is to serve as coach and cheerleader, offering consistent praise and encouragement throughout the exposure activity and using several different strategies to hold the patient’s attention in the situation.

Rather than just sitting in complete silence, you want to be asking the patient about their unique experience that they’re having in the exposure activity. Questions such as:

  • What is it like?
  • What are you noticing as you taste this food or try on that clothing that fits your body a little bit more uncomfortably than you would like.
  • Tell me what the experience is like.
  • What thoughts are going through your head?
  • Where do you feel the anxiety?

Of course, as clinicians, we want to be discouraging the use of safety behaviors or even more subtle such as encouraging tuning out cognitively or emotionally. It all comes back to wanting to hold our patients’ attention in the situation.

We don’t want or have to turn a blind eye to any sort of cognitive or emotional avoidance; we want our patients to be as engaged with the experience as they can be.

Immediately following the completion of each exposure activity, can be helpful for the clinician to facilitate a brief review of the outcome, helping the patient identify areas of progress that they’ve accomplished, helping them to see whether or not the feared assumption that they had anticipated at the outset of exposure was violated.

And, helping patients to gather from their experience that they are able to better tolerate or endure the distress and anxiety they encountered better than they anticipated at the outset.

In terms of how we progress throughout the hierarchy during one’s course of treatment, when a patient completes exposure activities repeatedly and experiences that fear reduction between different exposure activities, we then move up and initiate some of the more difficult or higher up exposure activities on the hierarchy.

This often begs the question, “at what point has a patient’s fear sufficiently reduced? At what point is it safe to make that upward step in the hierarchy?”

There really isn’t a great answer to this but below are a couple of guiding principles:

  1. If the exposure activity that the patient is engaged in is consistently only causing the minimal fear on that zero to seven scale, around the mark of one or two, that’s a good indication it’s time to take that next step upward in the hierarchy.
  2. In a lot of cases, we see that the patients themselves are endorsing not only increased or improved capability at being able to tolerate the anxiety they’re experiencing, but that, coupled with the willingness on the patient’s part to go ahead and move up to the next level in the hierarchy to take on that more challenging exposure activity.

The goal throughout the course of treatment is to gradually move throughout the entirety of the hierarchy such that, by the end, we’ve completed all of the activities on the hierarchy, including those that were identified as the most anticipated fear at the outset of treatments, then, being coupled with complete, maximal, elimination of engagement and safety behaviors.

Please See

Prevalence & Features of Eating Disorders in Males – Part 1
Prevalence & Features of Eating Disorders in Males – Part 2
Prevalence & Features of Eating Disorders in Males – Part 3
Prevalence & Features of Eating Disorders in Males – Part 4
Prevalence & Features of Eating Disorders in Males – Part 5

Source:

Virtual Presentation by Dr. Nicholas Farrell in the Dec. 7, 2017 Eating Disorder Hope Inaugural Online Conference & link to the press release at https://www.prnewswire.com/news-releases/eating-disorder-hope-offers-inaugural-online-conference-300550890.html

About the Presenter: Dr. Nicholas R. Farrell, Ph.D. is a licensed clinical psychologist who directs and supervises the treatment of patients in eating disorder programs at Rogers Memorial Hospital. Dr. Farrell specializes in the use of empirically-supported cognitive behavioral therapy (CBT) treatment strategies that are used to help patients in our eating disorders programs.

Additionally, Dr. Farrell is a regular contributor to scientific research on the effectiveness and dissemination of CBT for eating, anxiety, and mood disorders and has published over 20 peer-reviewed journal articles and book chapters. Dr. Farrell has been the gracious recipient of federal grant funding to study the role of social stigma in the context of eating disorders.

About the Transcript Editor: Margot Rittenhouse is a therapist who is passionate about providing mental health support to all in need and has worked with clients with substance abuse issues, eating disorders, domestic violence victims, and offenders, and severely mentally ill youth.

As a freelance writer for Eating Disorder and Addiction Hope and a mentor with MentorConnect, Margot is a passionate eating disorder advocate, committed to de-stigmatizing these illnesses while showing support for those struggling through mentoring, writing, and volunteering. Margot has a Master’s of Science in Clinical Mental Health Counseling from Johns Hopkins University.

The opinions and views of our guest contributors are shared to provide a broad perspective of eating disorders. These are not necessarily the views of Eating Disorder Hope, but an effort to offer a discussion of various issues by different concerned individuals.

We at Eating Disorder Hope understand that eating disorders result from a combination of environmental and genetic factors. If you or a loved one are suffering from an eating disorder, please know that there is hope for you, and seek immediate professional help.

Published on June 14, 2018.
Reviewed on June 14, 2018 by Jacquelyn Ekern, MS, LPC


Published on EatingDisorderHope.com

The post Prevalence & Features of Eating Disorders in Males – Part 6 appeared first on Eating Disorder Hope.

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Liana:

In 2008, Christina and I started Project HEAL which is a non-profit organization that raises money for working with others who can’t afford treatment.

To give you a little history of why we started Project HEAL, Christina and I met in treatment. We helped each other recover, but there are a lot of things that we saw that were wrong with the recovery system.

We were fortunate that we were able to get treatment and that our insurance coverage was able to cover most of it and, the rest of it, our parents will able to afford.

Unfortunately, many people with English service don’t get the help that they need.

90% of people with eating disorders don’t get help.

To be honest, we would both tell you that, when we were in treatment, we weren’t motivated. We didn’t want to get better but we were in treatment with so many people that wanted the help, but they were being kicked out because of insurance and they didn’t have the finances.

Another thing was this idea of how much we helped each other in our recovery and how that support really helped us get to the place where we are today of being fully recovered and having someone that understands what you’re going through but is able to push you and keep you accountable is so important.

We also noticed that there were really no role models for us when we’re going through this and that was really difficult.

It was this idea of “what am I recovering from?”

“Is recovery even possible?”

We wanted to become role models and those faces of recovery.

We’ve done this many ways. For example, Eating Disorder Hope has so graciously promoted our book of different stories of recovery and what it means to different people.

It was an amazing experience that we had on social media where everyone shared different reasons for what recovery is and what it looks like to them.

Project HEAL, as a whole, is promoting this idea that full recovery is possible and that you can go on to do incredible things.

We also provide treatment grants for those who can’t afford it.

We just sent ten people to treatment this quarter, so that brings the number to approximately 90 people! I can’t even keep count anymore, and they’re all doing so incredibly well!

Kristina will take it from here to talk about where we’ve grown.

Our organization is going to be 10 years old this year, so we have a lot to celebrate but still a lot more work to do!

Kristina:

We’ve experienced so much exciting growth and what’s really cool to point out is that the growth of Project Heal has been almost entirely organic.

The fact that we had 40 chapters before we hit a single staff member really shows how many people care about this issue and really wanted to get involved with us and loved our mission that full recovery was possible and they can show others how it does it.

I would say definitely the major growth has been in the past three years since we’ve actually hired full-time staff.

We actually grew this year to six full-time staff members, which is amazing!

Even more awesome is that 5 out of the 6 of them are fully recovered from eating disorders, which is cool. They’re really passionate people who are doing this work with us.

We’ve seen the groundswell of grassroots support as we, frankly, have grown up in this field.

We started this at 15-year-old and have gotten to, firsthand, witness some of the beautiful parts of the field and some of the real challenges and things that may not be going so well.

We came together about a year-and-a-half ago and realized, “we have the potential to do a lot more.”

One of the cool things about Project HEAL is that, from a very early stage, we’ve been connected with the leading eating disorder researchers and treatment centers across the country who have really helped to inform what we’re doing at our program.

Last August, we gathered together all of the leading clinicians in the field and the former director of the National Institute of Mental Health for a big picture strategy meeting where we said, “We have the potential to raise a lot of money, mobilize a lot of people. We’re going to expand our mission, what needs to happen? What do we have to do?”

Obviously, there are a lot of gaps in this field, but one of the biggest that we all identified was the need to strengthen lower-levels of care.

I’m sure those watching this know that this is a crucial need. As Liana identified, the majority of people with eating disorders don’t get treatment and, then, even for those who do, we treat it like an acute illness.

They may go to residential or inpatient treatment for 30 or, if they’re lucky, 60 days and are treated with really intensive, 24/7 treatment, and then are discharged with very little support.

The relapse rate in that first year following treatment is upwards of 50%.

We had seen this firsthand, people just going in-and-out, in-and-out of treatment from the age of 15 and we still have people that we met ten years ago who are still doing that cycle and that dance.

Meanwhile, spending hundreds of thousands of dollars to do it.

There is certainly a need for support there.

All of three of us could tell you; recovery was not two months, recovery was a really long time.

I always say it took me probably two full years until, weight-wise and behaviorally, I felt like “oh, this is recovery.”

It takes a long time.

Knowing that from our own perspective, we spent last Fall conducting a series of interviews with our chapter members, people from all over the country at different levels of recovery, different diagnoses, ages, a very diverse group of folks.

We asked them questions like, “what was really important to you in recovery? What was the most helpful thing? What was the most harmful thing?”

The biggest themes that came out of that were:

  1. The challenge of believing that recovery is possible
  2. The importance of having recovered role models to show that it is possible and worth it.

People who really understand how hard the process is but are also uniquely positioned to push you forward. That can be a real game-changer.

With that in mind, we thought, “peer support is this well-established, clinically validated model in a number of other mental health fields.

When you think about something that is cost-effective and easy to disseminate to all different groups and populations, especially those who lack access to treatment, it’s a no-brainer!

Why has this not been done in eating disorders, especially when part of the reason eating disorders are so hard to treat it is because of that lack of belief in recovery and for the ambivalence about the motivation to get better?

So, we decided to do it and start the first eating disorder peer support program.

We were very lucky to have Grace come into our lives and be the strategic mastermind behind this whole program.

I just couldn’t be more excited about it!

Grace:

I feel lucky to be in your lives as well!

I joined Communities of HEALing just a couple of months ago, though it feels like it’s been
forever as we are totally at home.

This program, Communities of HEALing, really grew out of responsiveness both to our grassroots community and to thought leaders in the field about what we need more of in supporting folks in recovery.

So, I came to communities of healing from a very grounded personal experience of other people in recovery making a huge difference to my own progress and, so, feel deeply personally connected to the work as well as being organizationally connected to the work.

Communities of HEALing has two pieces.

The first is open support groups where anybody, in any stage of recovery, can come and hear from other folks who are also in recovery. Those are facilitated by our peer mentors who are folks who have been recovered at least two years.

They are trained by us to facilitate that conversation, to make sure that folks are coming to group looking for support and getting the support that they need there.

Group is a really beautiful experience, and these folks can say more about why but it’s just incredibly powerful to be in a room of people who understand your brain.

That’s not to say that everybody’s recovery looks the same right, there are as many different recoveries as there are human beings.

It is not a linear path, and there’s no one way that folks move through and so one of the
things that’s beautiful about group is having a variety of different experiences in the room.

No single coping skill is going to work for everybody, no single strategy, no single recovery is the same, right? No single person is going to have an identical experience to anyone else.

Part of what’s beautiful about being a group is that there are a variety of different experiences in the room so when someone brings a concern around feeling really exhausted and unmotivated, there are six or seven people sitting there who have been there before, have been exhausted
and unmotivated and have six different ways of moving through that experience.

It is pretty incredible to be a part of the group!

The other piece of the program is a one-on-one mentorship experience.

This part of the program is under work we’ve currently got a partnership with the Columbia University’s Center for Eating Disorders.

These are some of the leading researchers in the field, and they’re working with us to evaluate the mentorship part of the program so any participant in that piece will be a participant in this randomized controlled trial which will tell us what works and what doesn’t as part of this program.

We’re committed, we know from personal experience that community and eating
sort of recovery is a game changer, but we don’t want to take our own words for it.

We want to make sure that we have a solid, evidence base that tells us which pieces of it are most effective.

In order to do that, we’re providing all sorts of resources both to these open support groups as well as a variety of different kinds of mentorship experiences.

One of these is peer mentorship, in which the same folks that facilitate group meet with a mentee one-on-one.

These are folks who have been recovered at least two years, and they talk about all sorts of things to what we’re really committed.

We’re committed to asserting that we are not a replacement for treatment, we are supplemental.

Communities of HEALing is something different, and we are really committed to focus not just on how folks can reduce behavior use but also on the whole person, building the life that they want in recovery.

Sometimes this may mean talking about how to move through hard, triggering moments. Sometimes, that will simply mean talking about job stress or going through a break-up.

Any number of things that will help support folks in having the joyful, wonderful life that those of us who have recovered know is possible.

The other kind of mentorship is social support. This is similar in that folks meet with someone once a week for about an hour, but it is also different because those mentors haven’t lived the experience of an eating disorder, they’re just really nice people very excited to be supporting folks in recovery.

So, the content of those meetings is less about “here’s how I move through my eating disorder” and “what are strategies that you can employ.” They’re deliberately much more social. They are going to a movie, playing cards, flying a kite.

Folks in this are getting support in their recovery but, by the end, we will know a little bit more about whether building relationships, in general, is the most meaningful or specifically building relationships with folks who have been there before.

Project HEAL Questions:

Q: How does one become a member of Community of HEALing:

A: Grace:
There are two pieces of the program so, if you are someone who has recently (past six months) stepped down from a higher level of care, you may be eligible to be a mentee and a participant in this study.

On our website, under “Mentee Information” there is more clarity on how to get engaged.

Again, it is being a part of the study so you’ll be in touch with our research team.

Also, we have our open support groups which will begin in the next couple of weeks in San Francisco, Pittsburgh, Philadelphia, Boston, and New York City.

If you are in one of those places and are currently living with an eating disorder, you are welcome to one of our weekly support groups.

Long-term we want to be anywhere where folks who are recovered are committed to helping someone else in their recovery.

We want to expand to other new places as soon as possible!

If you’re thinking you want Communities of HEALing to your community, the first step is signing up to develop a Project HEAL chapter within your community.

Q: How can folks on support Project HEAL’s overall financial needs? Can they donate specifically to Communities of Healing separate from the scholarship funding or is it all-in-one?

A: Kristina:
They can absolutely donate specifically to communities of healing and, in fact, it is a pretty low-cost program. It is mostly volunteer-run, so it costs us about $25,000 to bring Communities of HEALing to a new location.

Again, for any of you on the ground who are thinking “I really want this,” we can pretty easily bring it to you with a chapter and with $25,000.

We have done an incredible job of centralizing a lot of the work. Grace has developed an amazing training, we have an amazing supervision process, and all of that happened internally.

Q: What is the best way to get in touch with you guys?

A: Liana:
The best way to get in touch with us is through our website, on social media we have a huge following, and we’re really this premiere voice that full recovery is possible you

There is one other thing I wanted to add about Communities of HEALing that I think is really cool. One of our former grant recipients as a mentor and I think that just shows how full-circle Project HEAL is. I think that most of our grant recipients will end up being mentors because they have a desire to give back and show that recovery is amazing.

It is a community that pushes you forward.

Source:

Virtual Presentation by Dr. Nicholas Farrell in the Dec. 7, 2017, Eating Disorder Hope Inaugural Online Conference & link to the press release at https://www.prnewswire.com/news-releases/eating-disorder-hope-offers-inaugural-online-conference-300550890.html

Authors:

Kristina Saffran is the co-founder and executive director of Project HEAL: Help to Eat, Accept and Live: the largest non-profit in the US delivering prevention, treatment financing, and recovery support to people suffering from eating disorders. Kristina and her cofounder Liana started HEAL at 15 years old in recovery from anorexia; they now have 40 chapters across the globe and have become the premier voice of recovery, with over 30k followers on Facebook and Instagram. Kristina was named a 2017 Forbes 30 under 30 social entrepreneur, and has been profiled in The New York Times, Fast Company and People Magazine. She’s spoken across the country –Stanford Medical School, Harvard College, The International Conference of Eating Disorders, and more – on eating disorders, recovery, and launching a successful social entrepreneurship as a teen. Kristina graduated from Harvard College with a bachelor’s degree in psychology in May of 2014.

Liana Rosenman is a co-founder of Project Heal. Project HEAL: Help to Eat, Accept and Live (www.theprojectheal.org) is a 501(c)3 not-for-profit organization that raises money for people with eating disorders who are not able to afford treatment, promotes healthy body image and self-esteem, and encourages all people to believe that full recovery from an eating disorder is possible. The founders of Project HEAL, Liana Rosenman, and Kristina Saffran, met while undergoing treatment for anorexia nervosa when they were just 15 years old. Liana currently works as a 5th grade NEST teacher in New York City and is earning her master’s degree in Special Education at Hunter College. She believes an education should empower a child and help him or her make a positive contribution to our world.

Grace Patterson is the Director of Communities of HEALing, Project HEAL’s brand new pilot program that connects those new in recovery to support and mentorship. An accomplished trainer, organizer, and strategist, Grace has supported hundreds of leaders in more than 15 countries, helping to develop their skills in intercultural engagement, strengthen their theories of impact, and effectively communicate their visions. Grace brings both her professional experience in program management and training, as well as her personal experience of the transformative power of being in community with those working toward active recovery from an eating disorder, to her work training the amazing Peer Mentors of Communities of HEALing.

About the Transcription Editor: Margot Rittenhouse is a therapist who is passionate about providing mental health support to all in need and has worked with clients with substance abuse issues, eating disorders, domestic violence victims, and offenders, and severely mentally ill youth.

As a freelance writer for Eating Disorder and Addiction Hope and a mentor with MentorConnect, Margot is a passionate eating disorder advocate, committed to de-stigmatizing these illnesses while showing support for those struggling through mentoring, writing, and volunteering. Margot has a Master’s of Science in Clinical Mental Health Counseling from Johns Hopkins University.

The opinions and views of our guest contributors are shared to provide a broad perspective of eating disorders. These are not necessarily the views of Eating Disorder Hope, but an effort to offer a discussion of various issues by different concerned individuals.

We at Eating Disorder Hope understand that eating disorders result from a combination of environmental and genetic factors. If you or a loved one are suffering from an eating disorder, please know that there is hope for you, and seek immediate professional help.

Published on June 14, 2018.
Reviewed on June 18, 2018 by Jacquelyn Ekern, MS, LPC.

Published on EatingDisorderHope.com

The post Project HEAL: Giving Back in Recovery: Communities of Healing appeared first on Eating Disorder Hope.

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Exercise is a crucial component to good health, but when exercise is taken to an extreme, it can negatively impact one’s health and well-being. This is often the case when considering the role of compulsive exercise in Anorexia Nervosa (AN).

AN is an eating disorder characterized by weight loss; difficulties maintaining an appropriate body weight for height, age, and stature; and, in many individuals, distorted body image. Typically, people who struggle with AN restrict the amounts and types of food they eat.

Additionally, some individuals with AN engage in maladaptive behaviors as a means to regulate weight and/or manage difficult emotions like anxiety and depression. These behaviors include compulsive exercise, purging (for example, vomiting or use of laxatives), and/or binge eating. [3, 5]

What is compulsive exercise?

Exercise is defined as any physical activity undertaken with a specific objective such as the improvement of fitness, health, or physical performance. For individuals who have a healthy relationship with exercise, exercising is a source of fun, pleasure, and connection. They “want to” exercise for these internal, joy-based motivating factors. [1, 4]

On the other hand, those struggling with compulsive exercise as a part of AN experience a much different relationship with exercise. In these individuals, exercise is often seen as obligatory or feeling like they “have to” exercise for reasons such as physical appearance, weight loss, or self-worth.

For those who struggle with AN, compulsive exercise is characterized by extreme concerns about the perceived negative consequences of stopping or reducing exercising, dysregulation of affect (that is, they may experience emotional distress if they do not exercise), and inflexible exercise routines. [1, 3, 7]

Common Warning Signs and Symptoms of Compulsive Exercise: [3, 6, 7]

  • Exercise that significantly interferes with important activities, occurs at inappropriate times or in inappropriate settings, or when the individual continues to exercise despite injury or other medical complications
  • Intense anxiety, depression, irritability, feelings of guilt, and/or distress if unable to exercise
  • Unrealistic worry that an immediate and unpleasant change in appearance will occur if an exercise session is missed
  • Maintains excessive, rigid exercise regimen – despite weather, fatigue, illness, or injury
  • Discomfort or emotional distress with rest or inactivity
  • Exercise is used to manage or regulate emotions
  • Exercise as a means of purging (needing to “get rid of” or “burn off” calories)
  • Exercise as permission to eat
  • Exercise that is secretive or hidden
  • Feeling as though you are not good enough, fast enough or not pushing hard enough during a period of exercise; overtraining
  • Social isolation, withdrawal from friends and family

Health Consequences of Compulsive Exercise: [6]

  • Bone density loss (osteopenia or osteoporosis)
  • Loss of menstrual cycle (in women)
  • Female Athlete Triad (in women)
  • Relative Energy Deficiency in Sport (RED-S)
  • Persistent muscle soreness
  • Chronic bone & joint pain
  • Increased incidence of injury (overuse injuries, stress fractures, etc.)
  • Persistent fatigue and sluggishness
  • Altered resting heart rate
  • Increased frequency of illness & upper respiratory infections

Recovery From Compulsive Exercise

Addressing compulsive exercise in AN is essential in fully recovering from the eating disorder. Like eating disorder recovery, recovery from compulsive exercise is possible. Key components of compulsive exercise recovery include: [1, 2, 3]

  • Stable and adequate nutrition to support exercise
  • Close medical monitoring
  • Addressing unhealthy thoughts and relationships with exercise
  • Attunement and connection to the body during exercise (awareness of how one’s body feels during exercise; recognizing feelings of muscular exertion from pain and/or injury; identifying safe heart and breathing rates; appreciation of recovery, rest, and body acceptance)
  • A slow, progressive exercise program that begins with extremely small amounts of low-intensity exercise and slowly increases intensity, duration, and frequency over an extended period of time
  • Education on how to do exercise, the appropriate use of exercise for health benefits, and how to recognize when exercise is becoming problematic
  • Utilization of a multidisciplinary team approach to recovery that includes providers who specialize in eating disorder and exercise recoveries, such as therapists, physicians, athletic trainers, and dietitians

Exercising is an essential part of life. It helps keep you fit, but when it is used as a way to contribute to Anorexia Nervosa, it makes recovery that much more difficult because you need to exercise to maintain your health.

The good thing is that you can recover from both compulsive exercise and Anorexia.

About the Author:

Chelsea Fielder-Jenks is a Licensed Professional Counselor in private practice in Austin, Texas. Chelsea works with individuals, families, and groups primarily from a Cognitive Behavioral Therapy (CBT) and Dialectical Behavior Therapy (DBT) framework. She has extensive experience working with adolescents, families, and adults who struggle with eating, substance use, and various co-occurring mental health disorders. You can learn more about Chelsea and her private practice at ThriveCounselingAustin.com.

References:

  1. Cook, B. (2018, May). Recommendations for the progression of exercise in eating disorders treatment. Presentation at the Central Texas Eating Disorder Conference, Austin, TX.
  2. Cook, B. (2017, Feb). A Brief Review of Exercise in Eating Disorders Treatment. National Eating Disorder Information Centre Bulletin. 31(1), ISSN 08366845.
  3. Cook, B., Hausenblas, H., & Freimuth, M. (2014). Exercise Addiction and Compulsive Exercising: Relationship to Eating Disorders, Substance Use Disorders, and Addictive Disorders. In T. Brewerton, & A.B. (Eds.), Eating Disorders, Addictions and Substance Use Disorders: Research, Clinical and Treatment Perspectives. (pp. 127-144). New York, NY: Springer.
  4. Garber, C.E., Blissmer, B., Deschenes, M.R., Franklin, B.A., Lamonte, M.J., Lee, I., Nieman, D., & Swain, D.P. (2011). Quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults: Guidelines for prescribing exercise. Medicine and Science in Sports and Exercise, 43(7), 1334–1359.
  5. National Eating Disorder Association. Learn: Anorexia Nervosa. Retrieved from: https://www.nationaleatingdisorders.org/learn/by-eating-disorder/anorexia on May 23, 2018.
  6. National Eating Disorder Association. Learn: Compulsive Exercise. Retrieved from: https://www.nationaleatingdisorders.org/learn/general-information/compulsive-exercise on May 23, 2018.
  7. Young, S., Touyz, S., Meyer, C., Arcelus, J., Rhodes, P., Madden, S., Pike, K., Attia, E., Crosby, R., Hay, P. (2018). Relationships between compulsive exercise, quality of life, psychological distress and motivation to change in adults with anorexia nervosa. Journal of Eating Disorders, 6(1), 2. DOI 10.1186/s40337-018-0188-0

The opinions and views of our guest contributors are shared to provide a broad perspective of eating disorders. These are not necessarily the views of Eating Disorder Hope, but an effort to offer a discussion of various issues by different concerned individuals.

We at Eating Disorder Hope understand that eating disorders result from a combination of environmental and genetic factors. If you or a loved one are suffering from an eating disorder, please know that there is hope for you, and seek immediate professional help.

Published on June 14, 2018
Reviewed on June 14, 2018 by Jacquelyn Ekern, MS, LPC

Published on EatingDisorderHope.com

The post Adults & Compulsive Exercise: A Symptom of Anorexia Nervosa? appeared first on Eating Disorder Hope.

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Exposure-Based Therapy & Eating Disorders – Functional Assessment

Below are a few different treatment steps that we use in implementing Exposure-Based Therapy.

First is the Functional Assessment. This is very important as it kicks off treatment and gets things started and moving in the right direction.

Our major objective in completing the functional assessment is to gain a good working understanding, with help from the patient, of some of the specific cognitive and behavioral features relating to their eating disorder.

What this gets at is trying to understand three key areas:

  1. What are the types of cues or triggers that evoke fear in the patient? In other words, what stimuli evoke eating disorder related anxiety or fear.
  2. What are the consequences or feared outcomes that the patient anticipates upon exposure to those feared cues?
  3. Finally, how does the patient try to cope with their fear ineffectively?
  4. What are they doing desperately to try to prevent those consequences from occurring

What I’m getting at here is:

What are the eating disorder specific safety behaviors that the patient engages in?

We start with assessing what the specific feared cues are.

Some common areas that we look to assess this can include a variety of certain foods or eating scenarios that the patient might fear.

Again, body image related activities or cues, even something as straightforward as seeing one’s reflection in the mirror, wearing more form-fitting clothing items, engaging in athletic activities that one might perceive as putting body image or physique under the microscope, even just having the body in a certain unflattering posture or position such as sitting slouched over in a way that might let the flesh on the stomach roll or collect a little bit more.

One of the things we’ve come to learn about using Exposure-Based Treatment in individuals with eating disorders is that we might need to do a lot of exposure to the internal private stimuli that a patient might experience.

This stimuli is really distressing and can include feelings of fullness, feeling hunger cues, even something as simple as warmth can be a significant fear cue for these patients.

We’ve had patients tell us that they construe warmth as an indication that they have over-eaten and will subsequently gain too much weight.

In terms of assessing the anticipated consequences of exposure to these feared cues, we then ask follow-up questions such as:

  • What is it that concerns you about that specific feared cue?
  • What is it that concerns you about eating fried foods?
  • What do you fear will happen if you go to the beach and wear a swimming suit and hang out with your friends?
  • What do you fear will happen if you experience intense hunger or feel particularly full after a larger meal?

Finally, when we’ve gotten the patient to articulate what are some of the feared consequences that they anticipate, we assess the safety behavior.

So, what are the types of things that you do to try to prevent the onset or the realization of this feared consequence? How do you try to make yourself less anxious if you’re in that type of situation?

Prevalence & Features of Eating Disorders in Males – Part 1

So, those are the three key areas that we address in the context of the functional assessment.

Doing a careful a functional assessment is so important because, as you’ll see, it’s going to directly contribute to the types of Exposure-Based therapeutic activities that you encourage the patient to engage in throughout the course of the rest of the treatment

Developing the Exposure Hierarchy

Once the functional assessment is complete, we move on to developing what we call an “exposure hierarchy.”

Our goal here is to create a rank-ordered list of different exposure activities that the patient will be completing in succession throughout the course of his treatment.

This creates a nice systematic roadmap that will be traveled throughout the course of treatment arranged in order from activities that evoke lower levels of fear and anxiety to activities that the patient anticipates to evoke higher levels of fear anxiety.

What these exposure activities need to be directly designed to target are the very feared cues that were identified in the course of your functional assessment with the patient such as the feared foods that you may have identified in the course of the functional assessment.

What that leads to in developing the exposure hierarchies is creating exposure activities that will see the patient gradually introduced to increasing fear of Oken foods into his diet.

From a body image perspective, Exposure Based activities that would be included in the hierarchy might include prolonged exposure to one’s body shape or physique in the mirror, engaging in a number of fears evoking activities such wearing a swimming suit to a public beach or a swimming pool, something of that nature.

In terms of how we do exposure to binge eating cues, this might include things like the types of food items that one has typically had difficulty with binging on in the past.

It can often include a lot of the environmental antecedents to binge eating, which, in many cases, is a lot of the intense negative emotions that are often present immediately prior to the occurrence of a binge eating episode.

However, it can include any environmental cue that serves to contribute to an individual’s binge eating cravings.

One specific example of this came from a recent patient of ours, albeit a female patient.

A significant queue for her that contributed to the onset of her binge eating episodes, given that she wanted to do a lot of this binge eating in secret due to the shame she experienced, she would often wait until the evening, before her husband was going to go into the shower.

As such, the environmental cue that started to provoke binge eating cravings for her was something as simple as seeing her husband going to get a fresh towel from a towel closet or something like that.

Just that environmental cue of seeing, “okay, my husband is about to begin his shower routine,” is what evoked pretty intense binge eating cravings for this patient.

So, binge eating cues can really include just about anything under the Sun but the key is that these are the environmental cues that are present immediately prior to the onset of a binge eating episode.

Please See

Prevalence & Features of Eating Disorders in Males – Part 1
Prevalence & Features of Eating Disorders in Males – Part 2
Prevalence & Features of Eating Disorders in Males – Part 3
Prevalence & Features of Eating Disorders in Males – Part 4

Source:

Virtual Presentation by Dr. Nicholas Farrell in the Dec. 7, 2017 Eating Disorder Hope Inaugural Online Conference & link to the press release at https://www.prnewswire.com/news-releases/eating-disorder-hope-offers-inaugural-online-conference-300550890.html

About the Presenter: Dr. Nicholas R. Farrell, Ph.D. is a licensed clinical psychologist who directs and supervises the treatment of patients in eating disorder programs at Rogers Memorial Hospital. Dr. Farrell specializes in the use of empirically-supported cognitive behavioral therapy (CBT) treatment strategies that are used to help patients in our eating disorders programs.

Additionally, Dr. Farrell is a regular contributor to scientific research on the effectiveness and dissemination of CBT for eating, anxiety, and mood disorders and has published over 20 peer-reviewed journal articles and book chapters. Dr. Farrell has been the gracious recipient of federal grant funding to study the role of social stigma in the context of eating disorders.

About the Transcript Editor: Margot Rittenhouse is a therapist who is passionate about providing mental health support to all in need and has worked with clients with substance abuse issues, eating disorders, domestic violence victims, and offenders, and severely mentally ill youth.

As a freelance writer for Eating Disorder and Addiction Hope and a mentor with MentorConnect, Margot is a passionate eating disorder advocate, committed to de-stigmatizing these illnesses while showing support for those struggling through mentoring, writing, and volunteering. Margot has a Master’s of Science in Clinical Mental Health Counseling from Johns Hopkins University.

The opinions and views of our guest contributors are shared to provide a broad perspective of eating disorders. These are not necessarily the views of Eating Disorder Hope, but an effort to offer a discussion of various issues by different concerned individuals.

We at Eating Disorder Hope understand that eating disorders result from a combination of environmental and genetic factors. If you or a loved one are suffering from an eating disorder, please know that there is hope for you, and seek immediate professional help.

Published on June 10, 2018.
Reviewed by Jacquelyn Ekern, MS, LPC on June 10, 2018.

Published on EatingDisorderHope.com

The post Prevalence & Features of Eating Disorders in Males – Part 5 appeared first on Eating Disorder Hope.

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