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Bulimia and Post-traumatic Stress Disorder (PTSD) frequently occur together, primarily when a stressful or traumatic event occurs.  Reactions can be overwhelming, and cause distress to the point of emotional impairment, dysfunction to daily life, and physical problems [1].

The Substance Abuse and Mental Health Services Administration (SAMHSA) states that trauma varies from person-to-person and reactions depend on 1) How impactful the event is, 2) The experience of the trauma and 3) The effects on the individual [1].

Individuals manage trauma in two ways. Either through avoiding or numbing the experience, or actively coping with the trauma.

Avoidant coping is when a person engages in unhealthy behaviors, such as eating disorders, self-harm, or numbing. Avoidance can also include shutting out thoughts and beliefs around the trauma. Often the sufferer’s thoughts are self-defeating.

Active coping is when a person engages in healthy coping skills and thinking to manage stress and trauma. This includes problem-solving and resiliency behaviors.

Past research has shown that those who struggle with eating disorders, especially bulimia, tend to be more sensitive to stress. In one study, it was seen that those with bulimia and anorexia had a higher rate of anxiety [1].

Further research also found that people with an eating disorder tend to perceive threats or conflict from others more acutely, exhibit higher levels of sensitivity to anxiety, and they are often concerned about negative consequences [1].

Those with bulimia also show exaggerated inhibition and anticipatory anxiety. They also tend to be more sensitive to change and struggle to see the big picture in situations or events.

PTSD

The American Psychiatric Association defines PTSD as a person experiencing the following after a traumatic event:

  • Symptoms of the trauma, such as flashbacks and nightmares
  • Hyperarousal symptoms
  • Avoidance of emotions or thoughts related to the trauma
  • Negative thoughts and moods that are associated with the trauma experience [1]
Maintaining Factors

PTSD is chronic, particularly if not treated. It can be challenging for individuals with an eating disorder and PTSD to get an adequate assessment and the proper treatment. Often untreated, PTSD can be a perpetuating factor in the continuation of the eating disorder.

In a major study that looked at the prevalence of bulimia and PTSD, researchers found that the highest rates of lifetime PTSD were 38% and 44% in bulimia nervosa groups [2].

When PTSD was included, over half of the individuals with bulimia had PTSD or significant PTSD symptoms.

Individuals who are traumatized tend to show higher levels of dissociative symptoms which may contribute to physical and medical negative consequences.

Purging tends to reduce the hyperarousal state and anxiety that typically comes with trauma. The binge eating symptoms of bulimia numb out and avoid the emotions and memories associated with the traumatic event.

Because of these reasons, it can be extremely challenging to break the cycle of bulimia. Treatment that includes therapy for both issues, especially trauma, has been shown to be highly effective [2].

Shared Features

Features of trauma and bulimia are shared. Emotional dysregulation, impulsivity, and alexithymia (difficulty in identifying and describing emotions) are prevalent in both disorders [2].

Individuals seem to over-regulate their emotional state through avoidance. Interoceptive awareness (the inability to identify the difference between feelings and sensations) are shared with both PTSD and bulimia.

Trauma-related disorders, especially sexual abuse, are coupled with a variety of disorders that affect eating, mood, anxiety, substance use, dissociative somatoform, impulse control, disruptive behavior, and personality [3].

Often the person will struggle with suicidal ideation and self-harm behaviors as well.  Other shared features such as dissociation, hyperactivation, and interpersonal relationships are mutual in this population.

Dissociation

Typically when a person is engaging in binging and purging behaviors, dissociation is common. In prior research, sufferers with bulimia who report abuse have higher rates of dissociation than those individuals who do not report abuse [3].

Higher rates of a loss of control over thoughts, behaviors, and emotions are also reported by this group, which pushes the individual to engage in disordered eating as a way to cope or survive with the trauma.

Hyperactivation

Numbing out emotions is also a part of eating disorders, and emotional reactivity is controlled through the bulimic behaviors. Self-harm is also used as a way to disrupt dysphoric affect states which feel unbearable.

This cycle continues as the individual tries to control their emotional reactions to the trauma and can produce a dissociative state and purging enables the person to regulate their emotions.

Interpersonal Relationships

Individuals struggle with healthy relationships and boundaries. Self-Concept identification is a struggle and eating disorder symptoms can be the transitional object for the individual for comfort and self-soothing.

Final Thoughts

PTSD and Bulimia are a specific sub-group of this population and understanding the maintaining factors, and unique symptoms of this group are essential for treatment.

The engagement of eating disorders with PTSD are typically a way to protect the person from an attachment injury or to survive during trauma and to continue to survive after the event [3].

The eating disorder acts as a way to help with relationships, functioning, and internal cohesion.

It is essential to be mindful of evaluating for both eating disorder and trauma, especially when working with sufferers of bulimia.

Accurate assessments are needed to be able to provide effective concurrent treatment to an individual struggling with co-occurring issues. Working with this population can be challenging, but recovery is possible.

About the Author: Libby Lyons is a Licensed Clinical Social Worker and Certified Eating Disorder Specialist (CEDS). Libby has been practicing in the field of eating disorders, addictions, depression, anxiety and other comorbid issues in various agencies. Libby has previously worked as a contractor for the United States Air Force Domestic Violence Program, Saint Louis University Student Health and Counseling, Saint Louis Behavioral Medicine Institute Eating Disorders Program, and has been in Private Practice.

Libby currently works as a counselor at Fontbonne University and is a Adjunct Professor at Saint Louis University, and is a contributing author for Addiction Hope and Eating Disorder Hope. Libby lives in the St. Louis area with her husband and two daughters. She enjoys spending time with her family, running, and watching movies.

References:

[1] Trauma, Posttraumatic Stress Disorder and Eating Disorders. (n.d.). Retrieved December 28, 2017, from https://www.nationaleatingdisorders.org/learn/general-information/trauma
[2] T. (2013, June 28). Comorbid PTSD and Eating Disorders: Can Treating One Improve The Other? Retrieved January 10, 2018, from http://www.scienceofeds.org/2013/06/28/comorbid-ptsd-and-eating-disorders-can-treating-one-improve-the-other/
[3] Strickler, H. L. (2013, December 27). The Interaction between Post-Traumatic Stress Disorders and Eating Disorders: A Review of Relevant Literature. Retrieved January 10, 2018, from https://www.omicsonline.org/open-access/the-interaction-between-posttraumatic-stress-disorders-and-eating-disorders-a-review-of-relevant-literature-2167-1222.1000183.php?aid=23401

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 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 February 17, 2018.
Reviewed By: Jacquelyn Ekern, MS, LPC on February 17, 2018.
Published on EatingDisorderHope.com

The post PTSD and Bulimia: Relational Statistics & Trends appeared first on Eating Disorder Hope.

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The Lunar New Year is the biggest and most important holiday of the year in Vietnam (and most East Asian countries). Imagine the renewal of New Year’s Eve, plus the meals of Thanksgiving, the presents of the Christmastime holidays, the strong religious ties of Easter, and the festivities of the Fourth of July, all combined into one.

In Vietnam, the Lunar New Year, which usually falls from late January to late February, is called Tết (short for Tết Nguyên Đán, or Feast of the First Morning of the First Day).

It’s really a little hard to grasp the significance of Tết to the Vietnamese. One anthropologist describes celebrating Tết with family as “an essential part of what it mean[s] to be Vietnamese, to be a complete human being” [1].

Tết is a wonderful time of celebration and of giving thanks, of family and friends, of tradition and heritage, and as such, it’s also a holiday about food. In most of the cultural experience of the New Year, the “stories about eating something somewhere are really stories about the place and the people there” [2], but with an eating disorder, these meals—and other parts—of the festival season can be scary and overwhelming.

Here are some of the common parts of the Vietnamese Lunar New Year preparation and celebration that could be challenging with an eating disorder.

THE PREPARATION FOR THE LUNAR NEW YEAR

Part of the celebration of Tết happens in the preparation [3]. The actual New Year’s holiday may last for several days to several weeks, but preparations begin far in advance. Work may continue frantically right up until the New Year begins at midnight.

Cleaning the house

The entire house is cleaned and swept, sometimes meticulously, with great care given to the ancestral altars common in Vietnamese homes.

The house is decorated with potted chrysanthemums covered in yellow flowers, and long, unwieldy branches of golden apricot or rosy peach blossoms in tall vases. Discussions begin to turn to plans for the upcoming Tết, and memories of past years.

Eating disorders often involve obsessive thoughts about food, weight, and body shape, and repetitive behaviors, such as counting calories or weighing oneself, can seem to manage anxiety. With a major food-focused holiday approaching, the need for a clean house can mask an opportunity for an unhealthy level of focus on tidying up in an attempt to manage anxiety.

Buying new clothes

Just prior to Tết is considered a good time to purchase new clothes. Additionally, many families will visit one or more temples or churches on New Year’s Eve or New Year’s Day, and it is common for women to wear an áo dài (the traditional Vietnamese dress). Áo dài are tightly fitted, so often a tailor will take detailed measurements and the dress will be made-to-fit.

Going shopping for clothes can be particularly stressful during an eating disorder and well into recovery, but the process of having an áo dài made is a bit more like having a wedding dress fitted. In addition to the stress that being measured may easily cause, any weight gain or loss while the dress is being sewn are sure to show up when it is picked up just before Tết.

Buying fruits and food

To be sure, food and eating are central to Tết. When asking someone to visit during the festival, the invitation is even to “eat Tết” (ăn Tết)!

The house is prepared with an overflow of special fruits, sometimes a “five fruits plate” to match the five elements, or more recently, the Southern Vietnamese may arrange a tray of soursop, coconut, papaya, and mango ([mãng] cầu, dừa, đu đủ, xoài), which in Vietnamese sounds like “a wish to have enough” (cầu vừa đủ xài). Watermelons are also very common and are cut at midnight, with a sweet watermelon indicating a sweet or lucky year.

Beautiful, decorative trays of mứt, or dried, candied fruit, are purchased—the only time of the year that such a sweet fare is commonly seen in a Vietnamese house. Special steamed sticky rice cakes (bánh chưng and bánh tét) are only seen during Tết, and are an irreplaceable part of the holiday.

They are much heavier than the typical light Vietnamese foods, as are many of the foods eaten during the festival.

Eating disorders universally distort one’s relationship to food. Sharing the food that abounds during Tết is to share love, respect, and gratitude even more than nourishment, and the special foods of the festival are anxiously awaited. To turn down an offered plate of food is to turn away the deep love, respect, and warmth that making the food universally represents. For someone with an eating disorder, this can not only be terrifying but also a great pressure.

THE LUNAR NEW YEAR CELEBRATION

On New Year’s Eve, as the clock approaches midnight, many families hold a ceremony, often outdoors, to welcome deities and ancestors to their house.

Beginning with the head of the house and ending with the youngest child, they each light a stick of incense. As the smoke slowly spirals up, they pray in silence and deep respect.

A family may visit multiple temples or churches in succession to offer prayers and participate in New Year’s Day festivities. Community centers and organizations may host lion dances along with performances of traditional music or martial arts.

The next days are spent visiting relatives, teachers, and friends, always while sharing food—whether tea with candied fruit or something hardier.

Red envelopes of lucky money (lì xì) are exchanged with a thoughtful spoken wish for health and luck in the New Year, and gratitude for help in previous years.

Roasted watermelon seeds dyed red for luck sit on almost every table, just addictive enough to be an easy way to keep conversations going in this time of unity and kinship.

Maintaining Recovery

If you celebrate the Lunar New Year but are feeling overwhelmed, work with your treatment team and support system on the aspects that you find most challenging. Don’t be afraid to provide a little education on the importance and traditions of the New Year season, but be willing to listen to other’s thoughts on what is most appropriate at this point in your recovery.

Most of all, fight to take control back from the eating disorder so that you may again truly enjoy the connection, gratitude, and magic of the New Year.

References:

[1] Avieli, N. (2005). Vietnamese New Year Rice Cakes: Iconic Festive Dishes and Contested National Identity. Ethnology, 44(2), 167-187.
[2] Freidberg, S. (2003). Not All Sweetness and Light: New Cultural Geographies of Food. Social & Cultural Geography, 4(1), 3-6.
[3] McAllister, P. (2012). Connecting Places, Constructing Tết: Home, City, and the Making of the Lunar New Year in Urban Vietnam. Journal of Southeast Asian Studies, 43(1), 111–132.

About the Author:

Amelia Coffman, MA, is a Ph.D. Candidate in Social Psychology & Health at the University of Houston.
In addition to her research on the process of recovery in eating disorders, she feels honored to share her story of recovery with others who have come to believe, as she once did, that recovery is out of reach.

She has taken this message of hope to patients of all ages at residential and outpatient eating disorders programs, family and loved ones of those with eating disorders, as well as students, health professionals, and community members.

Amelia serves on the Academy for Eating Disorders’ Social Media Committee, the Program Committee for the Contemporary Relationships Conference, and the Advisory Board for Q Marriage Mentors. She celebrates Tết with her Vietnamese wife’s family and loves mứt, bánh tét, and áo dài.

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 February 16, 2018.
Reviewed By: Jacquelyn Ekern, MS, LPC on February 16, 2018.
Published on EatingDisorderHope.com

The post Eating Disorders and the Vietnamese Lunar New Year (Tết) appeared first on Eating Disorder Hope.

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Dialectical Behavioral Therapy (DBT) is a type of therapy that is used to treat mental health conditions to include eating disorders.

It works to help individuals learn healthy, adaptive ways to regulate emotions, analyze and restructure behaviors that are a result of emotional dysregulation and focuses on increasing mindfulness, and tolerate distress [1].

It’s Origins

Marsha Linehan, Phd., created DBT to help those individuals who are chronic suicidal and have urges for self-harm. Many of the individuals treated with DBT were diagnosed with Bipolar Personality Disorder.

DBT is also used to help other mental health issues such as eating disorders.

What it Is

Dialectic means that two opposite ideas can be correct at the same time [1]. Often in those with eating disorders, one struggle can be with all-or-nothing thinking and be able to use DBT means that they can feel and think two different thoughts about self or recovery at the same time.

Its development is based on the assumption that impulsive and self-destructive behavior is caused by an inability to self-regulate emotion.

Components

This therapy focuses on several elements for the participant:

  • Individual therapy
  • Skills training groups
  • Telephone coaching by the person’s therapist when the person is in crisis.

Four skills training are also involved which are:

  • Mindfulness
  • Emotional regulation
  • Interpersonal effectiveness
  • Distress tolerance.

Both of the person’s sessions and group modules are completed weekly. Therapy focuses on gaining healthy skills and strategies to cope with day-to-day functioning.

Mindfulness is when a person focuses their attention on the present without judgment. It can be challenging for those with an eating disorder to focus on the here-and-now.

With the numbing effect of eating disorder behaviors, it can be scary for a person to work on mindfulness. This skill can aid in the individual learning to be aware of triggers and symptoms, providing insights into their thinking and behavior.

Interpersonal effectiveness is learning how to communicate and act in relationships with others. It is common for people to pull away from loved ones or withdraw from social situations for fear of being rejected by others.

Learning how to identify healthy relationships and keep healthy relationships is essential in this process.

Distress tolerance is about coping with a crisis or stressful situations without engaging in unhealthy behaviors. It is about learning how to deal with the pain of the situation and how to radically accept the reality of what is occurring, without judgment and then to move forward.

Emotional regulation is teaching the person to observe and describe what emotions they are feeling and how to understand them without judgment. Individuals are learning how to hold onto and process the feelings rather than suppress or reject the feelings.

Emotional Dysregulation

Experiencing frustration, anger, and disappointment are all emotions. Most people can identify and manage these negative feelings through self-care or healthy expression [2].

For those with eating disorders, it can be challenging to know what they are feeling and how to express them outside the eating disorder.

Shame and anxiety often come with these emotions, and emotional dysregulation is when an individual has a chronic issue coping with unpleasant feelings or overwhelming emotions.

For these people, overwhelming emotions lead to self-destructive behaviors, like binging and purging, or restriction of food.

For others, these feelings may trigger chaotic and situationally inappropriate behaviors.

Emotional dysregulation is believed to have origins in the relationship between the environment and biology.

Some researchers think that some people are more sensitive to their emotions from birth and as this intensifies it can lead to eating disorder symptoms [2].

This is considered an ‘invalidating environment’ within DBT. These environments teach people that their feelings and experiences are incorrect, unwanted, and inappropriate.

They may be punished or ignored when they do express emotion, causing the person to doubt their gut reaction to a situation.

Parts to DBT

DBT includes individual therapy on a once-a-week basis for the sufferer. The therapist and client work together to focus on life goals and self-destructive behaviors and behaviors that interfere with treatment.

Next, the person attends skills training group therapy once-a-week to learn skills of distress tolerance, interpersonal effectiveness, and mindfulness. Included in treatment are skills coaching by telephone with their therapist.

This allows the individual to practice skills in real-life and contact their therapist if they need too.

DBT and ED

Because DBT focuses on emotional dysregulation, it makes a fantastic approach for treating eating disorders. Individuals with an eating disorder tend to report that they have significant difficulty describing, expressing, and tolerating their emotions [2].

Eating disorder symptoms can become worse if emotional dysregulation skills are not acquired. Binge eating, purging, and restricting foods are all ways the person is trying to self-soothe from painful emotions.

It can be a way to escape or provides temporary relief from the discomfort they are feeling.

DBT can help with commitment and motivation for treatment [2]. Typically for eating disorder clients, they often feel ambivalent about therapy at first.

With the balance of acceptance and change-based strategies in DBT, it can aid in continual commitment to learning how to accept self non-judgmentally.

DBT has been shown to increase self-confidence and self-esteem in eating disorder clients [2]. Through the teaching of life building skills, and the supportive nature of the therapy it can boost the feelings of self-worth.

About the Author: Libby Lyons is a Licensed Clinical Social Worker and Certified Eating Disorder Specialist (CEDS). Libby has been practicing in the field of eating disorders, addictions, depression, anxiety and other comorbid issues in various agencies. Libby has previously worked as a contractor for the United States Air Force Domestic Violence Program, Saint Louis University Student Health and Counseling, Saint Louis Behavioral Medicine Institute Eating Disorders Program, and has been in Private Practice.

Libby currently works as a counselor at Fontbonne University and is a Adjunct Professor at Saint Louis University, and is a contributing author for Addiction Hope and Eating Disorder Hope. Libby lives in the St. Louis area with her husband and two daughters. She enjoys spending time with her family, running, and watching movies.

References:

[1] Company, I. G. (2013, Nov. & dec.). Dialectical Behavioral Therapy for Eating Disorders — Therapeutic Tool of Acceptance and Change . Retrieved December 28, 2017, from http://www.socialworktoday.com/archive/111113p22.shtml
[2] Federici, PhD, A. (n.d.). Dialectical Behaviour Therapy for the Treatment of Eating Disorders. Retrieved December 28, 2017, from http://nedic.ca/dialectical-behaviour-therapy-treatment-eating-disorders

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 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 February 15, 2018.
Reviewed By: Jacquelyn Ekern, MS, LPC on February 15, 2018.
Published on EatingDisorderHope.com

The post DBT & Eating Disorder Treatment: What You Need to Know appeared first on Eating Disorder Hope.

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Cognitive Behavioral Therapy (CBT) is an evidence-based practice that has been used for decades to treat mental health conditions and more recently, eating disorders.

Initially, it was designed for the treatment of depression and anxiety but is currently used more widely with other mental issues.

CBT: What It Is

There are three phases of treatment with CBT. The behavioral phase, cognitive phase, and maintenance/relapse phase [1]. The behavioral phase is where the client and clinician build therapeutic rapport and trust.

Typically an individual talks about issues and problems at hand and learn to identify negative patterns in thinking, emotions, and behaviors. Together, a treatment plan is created by the clinician and client to progress forward in treatment.

Within the therapeutic process, the therapist-client will address and reduce negative behaviors that are associated with the eating disorder. The clinician will provide education and awareness to healthier eating, behaviors, and cognitive processes.

Coping strategies are typically developed for managing negative emotions. Usually, distraction, prolonging urges, and stopping thoughts are some of the skills taught to cope with overwhelming triggers and feelings [1].

The cognitive phase involves cognitive restructuring technique where individuals are encouraged to challenge their internal thought process and identify unhealthy treatment-interfering thoughts. New, healthy thoughts replace unhealthy ones to help shift perspectives.

CBT requires being able to overcome distorted thoughts about self, body image, and self-esteem and how it relates to the eating disorder.

It also involves changing interpersonal relationships and how thoughts and emotions affect communication with others. Hope is a part of CBT as it helps identify positive changes and strengthens motivation for recovery.

The last phase, the Maintenance and Relapse Prevention phase, focuses on the skills learned in previous stages and create a comprehensive relapse and recovery plan.

This plan involves improving self-confidence as individuals become more comfortable with learned skills and being able to identify triggers to help prevent deterioration.

Another part of the CBT process is nutritional counseling. It is a necessary part of eating disorder treatment and education around nutritional needs, as well as planning for and monitoring food choices [2].

CBT: What Treatment Looks Like

Treatment teams typically involve a nutritionist, therapist, physician, and psychiatrist. For some, treatment can be done on an outpatient basis, but most often, individuals need a higher level of care at some point in the recovery process.

Different clinicians at any level use various therapies for treatment. Each treatment works differently for each person depending on their stage of recovery. The primary first goal at the start of treatment is to reduce the eating disorder symptoms.

CBT: Eating Disorders

CBT helps to normalize eating behaviors and responses to food [3]. It helps with regulating thoughts, emotions, and actions when eating disorder symptoms are present.

It can improve a person’s self-esteem, perfectionistic tendencies, mood shifts or intolerance, and interpersonal difficulties.

CBT works by setting short-term goals and modifying as needed until each goal is reached. It is typically 20 weeks in duration and focuses on both the behavioral and cognitive changes to create healthy functioning.

Use of homework, assignments, and worksheets are assigned during and outside of session.

Most clinicians ask for a thought log to be kept to help identify any distorted thoughts or critical thinking. Sessions are active in nature as well as engaging.

CBT: CBT-E

Enhance Cognitive Behavioral Therapy (CBT-E) is best used with sufferers who are at a minimal weight of their body weight range or higher. The therapeutic process involves an initial assessment, followed by 20 sessions over 20 weeks.

If a person is coming to CBT-E with Anorexia and is underweight, sessions can go for 40 weeks, depending on the needs of the person [4].

CBT-E is individualized and is designed for the person and their progress. Four stages are a part of this therapy:

  • Stage 1: Focus is on a mutual understanding of the eating disorder and modifying and stabilizing eating patterns. There is psychoeducation about eating disorder pathology, and often sessions are twice a week at this stage.
  • Stage 2: Progress is reviewed during this stage, and treatment goals are set
  • Stage 3: Weekly sessions are held, and the focus is on the eating disorder behaviors and symptoms. Work is concentrated on daily functioning and moods.
  • Stage 4: focuses on the future and managing setbacks. Typically relapse prevention plan is completed during this final stage.
CBT: Levels of Treatment

Treatment includes various levels. An individual will often shift between the phases of care as treatment progress or worsens.

Residential treatment is the highest level, and the person stays at the facility and receives 24-hour support.

Partial Hospitalization Program (PHP) treatment is when a person gets all the benefits of residential treatment but is allowed to go home at night.

All meals for both levels are provided, and the individual will meet with their therapist, psychiatrist, nutritionist weekly and engage in group therapy.

Intensive Outpatient Program (IOP) is therapy designed for the person who is ready to step down from a higher level of care. They attend group therapy up to 6 days per week for 3 hours at a time.

Meals are provided by the individual but checked by the facility staff to ensure it meets their nutritional guidelines. Treatment duration can last varying amounts of time depending on the progression of recovery.

Overall, CBT and CBT-E are evidence-based therapies that are effective for eating disorders. Many clinicians use this type of treatment to help promote increased well-being among clients and promote freedom from eating disorder behaviors.

About the Author: Libby Lyons is a Licensed Clinical Social Worker and Certified Eating Disorder Specialist (CEDS). Libby has been practicing in the field of eating disorders, addictions, depression, anxiety and other comorbid issues in various agencies. Libby has previously worked as a contractor for the United States Air Force Domestic Violence Program, Saint Louis University Student Health and Counseling, Saint Louis Behavioral Medicine Institute Eating Disorders Program, and has been in Private Practice.

Libby currently works as a counselor at Fontbonne University and is a Adjunct Professor at Saint Louis University, and is a contributing author for Addiction Hope and Eating Disorder Hope. Libby lives in the St. Louis area with her husband and two daughters. She enjoys spending time with her family, running, and watching movies.

References:

[1] Cognitive Behavioral Therapy & Binge Eating Disorder: 8 Key Treatment Benchmarks. (n.d.). Retrieved December 27, 2017, from https://www.waldeneatingdisorders.com/cognitive-behavioral-therapy-binge-eating-disorder-8-key-treatment-benchmarks/
[2] Treatment. (n.d.). Retrieved December 27, 2017, from https://www.nationaleatingdisorders.org/learn/general-information/treatment
[3] Cognitive behavior therapy for eating disorders versus normalization of eating behavior. (2017, March 16). Retrieved January 08, 2018, from https://www.sciencedirect.com/science/article/pii/S0031938416308824
[4] What Is CBT-E? (n.d.). Retrieved January 11, 2018, from http://www.credo-oxford.com/4.1.html

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 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 February 14, 2018.
Reviewed By: Jacquelyn Ekern, MS, LPC on February 14, 2018.
Published on EatingDisorderHope.com

The post CBT & Eating Disorder Treatment: What You Need to Know appeared first on Eating Disorder Hope.

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Recovery happens over a duration of years. It can be a challenge to enter real-life after treatment to overcome an eating disorder.

Signs of Relapse

Eating disorder relapse can be a slow progression. It may begin with fleeting thoughts of food, dieting, or weight. Being dishonest with the treatment team, or a fear that you may be losing control over areas in your life can also signal a potential relapse.

For some, a return to unhealthy exercising or dieting is the start of a relapse.

A constant feeling of needing to have the perfect body, or keeping your appearance perfect, or a lack of stress relievers are other signs of relapse [1].

An individual may obsess about weight loss and state a fear of becoming fat. Friends and loved ones may comment on behaviors or changed appearance. A person will body check and start skipping snacks or meals.


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Restriction can lead to missing several meals or snacks or going days without eating [1]. The individual can become irritable around food and express feelings of guilt, shame, or embarrassment when eating.

Social isolation and withdrawal are common during relapse. A person may begin to stay away from others due to an adverse body image perception, fear-foods, or heightened anxiety.

Tips to Remember

Relapse does not indicate failure, but it is something that has been experienced before. Recovery is possible for any sufferer of an eating disorder, but one needs compassion and acceptance for oneself as the recovery process begins.

Have an open dialogue with loved ones, supportive friends, and the eating disorder treatment team about relapse signs and symptoms.

Accept that everyone has limitations and relapse does not define who a person is or can be. Practicing the skills learned in treatment and aftercare can help slow down or stop the relapse until treatment is obtained.

It can help during the process to take a moment and remember to:

  • Redevelop a compassionate inner dialogue with yourself
  • Practice self-acceptance
  • Breathe and utilize mindfulness skills
  • Get out the treatment skills binder and use skills and techniques gained from previous treatment
  • Feel your emotions
  • Get back on a meal plan and gather friends and family to engage in supportive meals

Relapses are common and natural during the recovery process. It is a way to learn and grow from triggers that have yet to be identified. It is helpful to remind a sufferer that if the disorder has been chronic, it is more likely that they will relapse than someone who has had a shorter duration of the illness.

Underlying issues such as body image, self-esteem, self-worth, and trauma are concerns that take much longer to process than eating disorder behaviors [2]. Triggers or reminders of these issues can start an eating disorder relapse.

Risk Factors for Relapse

Continuing with exercise after treatment can trigger a relapse to occur. Obsessing thoughts around calories burned, duration of exercise and body comparison can be quickly turned into eating disorder symptoms.

The age of onset also plays a role in relapse. If a person is older when the eating disorder begins, relapse is higher [2]. This can be due to stronger development of beliefs, values, and self-worth tied to the disorder as a person ages.

Continued negative life experiences or trauma can trigger a relapse. If a person leaves treatment, and trauma continues, or adverse life events occur, it can trigger a return to disordered eating behaviors. If the situation becomes overwhelming, it acts as a means to self-soothe in a time that no other skill of intervention does.

Health can also trigger a relapse. It is common for individuals to experience physical consequences of the eating disorder, even after recovery is achieved.

A change in health can shift behaviors and thoughts to give the person a sense of control over the situation.  Underlying co-occurring mental health disorders such as depression, bipolar disorder, anxiety, and post-traumatic stress disorder can trigger a relapse, or even continue the disorder.

What to do if Relapse Has Occurred

Recovery looks different for everyone and includes overcoming physical, mental, and emotional barriers to restore healthy eating patterns, thoughts, and behaviors [4].

Recovery includes ending the cycle of obsessiveness or attitudes around self and food. For others, healing can be establishing a healthy physical self or returning to the normal social functions and gaining a sense of purpose.

Recovery has no timeline. It can take years to reach full recovery. It heavily depends on your treatment team, therapy, support system, and the sufferer’s commitment.

Utilizing resources learned during successful times and during times of relapse can aid in sustained recovery.

During treatment, it is essential for the sufferer to surround themselves with those who support treatment and recovery. This support can decrease feelings of isolation and increase feelings of hope.

Hope is powerful and can increase treatment motivation. Building sources of hope, whether through religion, spirituality, other sufferers, or quotes, can aid in recovery success.

Acknowledging setbacks as a natural process is part of the recovery. Denying it is happening can worsen behaviors. Relapse is not a step back to square one but is a step up to working through new issues or ways in dealing with stress.

Lastly, keeping engaged in activities that bring purpose and joy is vital. Getting outside of oneself and connecting with humanity can aid in seeing the bigger picture.

It allows the person to be able to connect with their world and remember who they are outside of the eating disorder.

Relapsing can be scary, but with the right tools, support, and treatment, it can be a stepping stone up in the recovery process. Learn to embrace the challenge of a relapse and know that no one person is alone.

About the Author: Libby Lyons is a Licensed Clinical Social Worker and Certified Eating Disorder Specialist (CEDS). Libby has been practicing in the field of eating disorders, addictions, depression, anxiety and other comorbid issues in various agencies. Libby has previously worked as a contractor for the United States Air Force Domestic Violence Program, Saint Louis University Student Health and Counseling, Saint Louis Behavioral Medicine Institute Eating Disorders Program, and has been in Private Practice.

Libby currently works as a counselor at Fontbonne University and is a Adjunct Professor at Saint Louis University, and is a contributing author for Addiction Hope and Eating Disorder Hope. Libby lives in the St. Louis area with her husband and two daughters. She enjoys spending time with her family, running, and watching movies.

References:

[1] Slips, Lapses and Relapses. (n.d.). Retrieved January 12, 2018, from https://www.nationaleatingdisorders.org/slips-lapses-and-relapses
[2] Relapse and recurrence. (n.d.). Retrieved January 12, 2018, from http://www.nedc.com.au/relapse-and-recurrence
[3] Phases of Recovery From An Eating Disorder Part 1. (n.d.). Retrieved January 12, 2018, from https://www.edinstitute.org/paper/2012/11/23/phases-of-recovery-from-an-eating-disorder-part-1
[4] Understanding Recovery. (n.d.). Retrieved January 12, 2018, from http://www.nedc.com.au/recovery

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 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 February 16, 2018.
Reviewed By: Jacquelyn Ekern, MS, LPC on February 16, 2018.
Published on EatingDisorderHope.com

The post Relapse & Seeking Eating Disorder Treatment Again appeared first on Eating Disorder Hope.

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Working with a therapist can help reduce eating disorder behaviors and symptoms, and get you moving toward recovery. One way therapists work on reducing symptoms is through Acceptance Commitment Therapy (ACT).

What It Is

ACT helps individuals to reduce eating disordered thoughts, feelings, and symptoms. The focus is typically on what the person can control, which is one’s thoughts, feelings, and behaviors [1].  ACT is a therapy which has roots in Cognitive Behavioral Therapy (CBT) and many therapists who were solely using CBT, have moved into using ACT with eating disordered patients.

Acceptance Commitment Therapy uses metaphors to teach and emphasize strategies that help cope with and manage eating disorder symptoms. The focus is on identifying one’s values and then to consciously act in a way that is in-line with those values and purposes.

One metaphor used is called Passengers on the Bus. In this technique, you visualize traveling through life as the driver of a bus. The passengers are noisy and distracting, and each passenger represents an eating disorder thought.

Through the use of this metaphor, clients learn that as the driver, they can still work toward their goals and purpose even with the ‘noise’ by not engaging the passengers.

Research to Support ACT

Empirical support for ACT has shown that it is a positive therapy for individuals with an

.0eating disorder [1]. First, individuals who have utilized ACT, have demonstrated improved functioning and decreased disordered eating behaviors.

Secondly, with the use of ACT, individuals have stated greater satisfaction in one’s self-esteem and appearance when practicing therapeutic skills, and they reported a significant reduction in eating disorder thoughts and behaviors.

The Process

ACT works to decrease maladaptive coping mechanisms, such as restriction, binge-purge cycles, binge eating, over-exercising, and body checking. It also works to move a person from rigid behaviors and thoughts to ones that are more flexible.

Six different processes are used to accomplish these goals. These are Defusion, Acceptance, Mindfulness, Detaching, Clarity, and Action-Focused.

1. Fusion to Defusion

Using defusion, a person learns to defuse from unhealthy eating disorder thinking. With fusion, the eating disorder thoughts seem like the absolute truth that need to be followed.

The clinician and patient can work to find alternate ways to reframe these unhealthy thoughts, feelings, or behaviors.

Defusion works to let the individual see their thoughts as sensations, streams of words, sounds, and images [1].

Some techniques may be taking a thought and saying it out loud in a funny voice or accent or song to disempower the significance of the thought. These tools help increase a person’s flexibility to their thoughts and feelings.

2. Acceptance

ACT works to help a person move from experiential avoidance to acceptance of thoughts and feelings. Typically eating disorder behaviors are a way to escape or avoid painful emotions. Metaphors are used to show how avoidance is not a long-term solution.

Through acceptance, the individual learns that they create internal and emotional space for recovery [1]. This is done through exposure work conducted in and outside of sessions to practice acceptance and tolerance of behaviors and emotions.

3. Mindfulness

Mindfulness is the third process used in ACT. This allows a person to be invested in the present moment with their thoughts, sensations, emotions, and environment. The eating disorder is an expert at taking away mindfulness, and individuals learn to pay attention to the present moment without judgment.

4. Detaching

Fourth, the disorder will have their own story of who they are which is typically unhealthy and unlovable. This therapy uses the idea of the “observing-self” to teach individuals that they are not their thoughts nor are they defined by them. The goal is to change the beliefs and create new, healthy ones.

5. Clarity

Fifth is the clarification of values. Individuals typically get stuck in eating disorder values, and many feel that their disorder is their core identity. ACT works to help each person identify and clarify who and what they would like to be. They work on developing their own set of values and standards for self.

6. Action-Focused

Lastly, ACT focuses on taking action to stay committed to one’s values. Many individuals will put all of their energy toward the eating disorder and cease engaging in behaviors that lead to a meaningful life.

With ACT this process works to empower clients to take specific steps to achieve their values. This final stage helps individuals practice what they have learned and developed in their sessions.

Regardless of how you define ACT, whether as processes or areas of fusion, the goal is to be presently focused in the moment, aware of your core values and goals, and take committed action to achieve them.

It is about cognitively and behaviorally making a change to let go of the eating disorder and working to create a meaningful and purposeful life.

About the Author: Libby Lyons is a Licensed Clinical Social Worker and Certified Eating Disorder Specialist (CEDS). Libby has been practicing in the field of eating disorders, addictions, depression, anxiety and other comorbid issues in various agencies. Libby has previously worked as a contractor for the United States Air Force Domestic Violence Program, Saint Louis University Student Health and Counseling, Saint Louis Behavioral Medicine Institute Eating Disorders Program, and has been in Private Practice.

Libby currently works as a counselor at Fontbonne University and is a Adjunct Professor at Saint Louis University, and is a contributing author for Addiction Hope and Eating Disorder Hope. Libby lives in the St. Louis area with her husband and two daughters. She enjoys spending time with her family, running, and watching movies.

References:

[1] Acceptance and Commitment Therapy (ACT) in the Treatment of Eating Disorders. (n.d.). Retrieved December 27, 2017, from https://www.mirror-mirror.org/act-eating-disorder-treatment.htm
[2] Acceptance Commitment Therapy in Eating Disorders. (2017, November 24). Retrieved December 27, 2017, from http://theprojectheal.org/act-eating-disorders/

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 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 February 13, 2018.
Reviewed By: Jacquelyn Ekern, MS, LPC on February 13, 2018.
Published on EatingDisorderHope.com

The post ACT & Eating Disorder Treatment: What You Need to Know appeared first on Eating Disorder Hope.

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97% of dieters regain all of the weight they lose within three years [1]. Further, losing weight doesn’t actually improve health biomarkers such as blood pressure, fasting glucose, or triglyceride levels [1].

Despite these facts, diet fads continue to exist, now adapting to the new “health and wellness” movement by calling diets “lifestyle changes.”

It’s all the same diet culture negativity with a shiny new package, and it makes interpreting eating behaviors difficult.

Someone may believe that they are successfully adhering to a “clean eating” diet when they are actually showing symptoms of orthorexia.

Individuals following the ketogenic diet likely have no idea that ketosis itself is a life-threatening condition that indicates insufficient carbohydrate intake.

With this “rebranding,” how do we tell the difference between these extreme diets or disordered eating?

Below are three hallmarks of both dieting and disordered eating behaviors. The severity of each can mean the difference between a diet or an eating disorder.

Shame & Guilt

As one clinician aptly observed, “issues of self-image, self-concept, body image, self-worth, and self-doubt are extensively grounded in the domain of shame [2].”

Insofar as diets are concerned, we are incessantly inundated with images and products that tell us we are not enough, activating within us the shame and guilt that will motivate us to do whatever necessary to fulfill society’s expectations.

The same shame that motivates people to diet becomes increasingly dangerous as it is fed.

For those with an ED, shame is their constant companion, whispering hurtful and harmful reminders in their ear that they need to take their dieting behaviors further and further to become valuable.

Food Rules

Food rules are also hallmarks of both dieting and eating disorders. By their very nature, both involve adhering to specific “do’s and don’ts” regarding food.

With diets, individuals may engage in specific food rules to adhere to the program they’re using.

For an individual with an ED, these food rules are often self-imposed and have higher stakes attached. The ability to follow these regulations is tied to the individual’s self-worth. Coming back to the first point, what follows is immense shame and guilt.

You or your loved one may have ventured into ED territory if following food rules begins to feel more like a compulsion or a test of character than adhering to instructions.

Life Interference

Again, both dieting and eating disorders involve a lifestyle shake-up, but to what degree?

Dieting indeed involves changing what foods you are eating and may also require an adjustment to sleep or exercise.

A diet has gone too far and may be morphing into an ED when these changes go from small alterations to big ones.

A diet has become a disorder when it interferes with an individual’s ability to live their lives. If your relationships, career, or ability to function with the outside world are impaired, it is time to examine your behaviors and seek help.

Your Safest Bet

When it comes to disordered eating or dieting, they genuinely aren’t that different. Both involve unhealthy and unsustainable behaviors that are physically and mentally harmful.

Instead of attempting to determine the difference between the two, simply avoid both. Diets make seemingly innocent promises that can quickly become an ED.

When diet culture throws a new fad your way, consider if any of the “red flags” above are present. If so, call it out for the unhelpful and negative nonsense that it is and don’t waste your time on it.

About the Author: 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.

References:

[1] Brown, H. The weight of the evidence. Slate. Retrieved on 03 January 2018 from http://www.slate.com/articles/health_and_science/medical_examiner/2015/03/diets_do_not_work_the_thin_evidence_that_losing_weight_makes_you_healthier.html
[2] Burney, J., Irwin, H. J. (2000). Shame and guilt in women with eating-disorder symptomatology. Journal of Clinical Psychology, 56:1, 51-61.

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 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 February 12, 2018.
Reviewed By: Jacquelyn Ekern, MS, LPC on February 12, 2018.
Published on EatingDisorderHope.com

The post The Difference Between an Utter Eating Disorder and Dieting? appeared first on Eating Disorder Hope.

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Tolerating uncomfortable emotions can be difficult at times. It is about being able to identify feelings, process them, and coping with them as they arise. Often our society teaches us to push down negative emotions and show only positive ones.

We are taught that certain emotions are not appropriate to share or express. Being unable to identify and process our feelings can limit our self-awareness and restrict our ability to experience our lives.

Emotions are Guideposts

Emotions help tell us what is going on in our environment, both internally and externally.

They allow us to understand and process people around us, ourselves within a situation, and even danger within our environment [1].

Emotions can be overwhelming, bursting, joyful, adaptive, and exploratory. We can feel many feelings at the same time. Emotions can derive from primary or secondary reasons.

Primary emotions are often healthy and adaptive and usually help us to survive and thrive. Secondary emotions are often a result of the judgments and internalized negative thoughts and beliefs that we internalize from when we are young [1].

Emotions are a Process

Many times we try to control our feelings rather than feel and process them. Emotion-Focused Therapy is a type of therapy that focuses on the processing and feeling of emotions.

This kind of therapy is to help individuals accept, express, regulate, understand, and transform their emotions.

Dr. Leslie Greenberg, one of the primary developers of Emotion-Focused Therapy states that “Emotion is not opposed to reason….emotions guide and manage thought in a fundamental way, and complement the deficiencies of thinking” [1].

When we learn to process emotions and to tolerate uncomfortable feelings, it can allow us to be more resilient. We are not necessarily born with the natural ability to regulate emotions, but instead, we learn from caretakers and parents.

If our first models do not have their coping strategies to regulate and process emotions, then we are not able to learn healthy and adaptive skills.

How to Tolerate Uncomfortable Emotions

Being able to sit with emotion is essential. It can help with learning to tolerate uncomfortable feelings and start to understand where it originates from and how it feels in your body and mind.

When an emotion is first felt, a person may go straight to an unhealthy skill to avoid or numb it out, especially if the feeling is uncomfortable. Working with a therapist is helpful when first starting this process.

Another aspect of learning to tolerate uncomfortable feelings is to practice slow and regulated breathing. As you breathe, focus on accepting what you are feeling.

Remember that it is alright to feel anger, sadness, or pain. Try to resist the urge to judge your emotions or label them. The longer you practice sitting with your feelings, the better you will be able to do so, and the more comfortable you will become with them.

Another essential step is to not judge your emotion as ‘bad’ or ‘wrong.’

Feelings are sensations, a cue to your past, present, and future thoughts or memories. Try not to engage the emotions being felt.

It may only exaggerate the emotions and create a stronger urge to use maladaptive coping skills. Try to stay objective with your feelings by asking yourself questions such as, ‘where do you feel the emotion in your body,’ or ‘what emotion are you feeling.’

As you work with your therapist on processing and tolerating uncomfortable emotions, you will be able to understand better what emotions you are feeling and how it can drive maladaptive behaviors within your disorder.

There are various therapies and techniques that clinicians use to help individuals identify and feel their emotions.

Emotion Processing Therapy

Emotion Processing Therapy (EPT) is a type of therapy that works to help people learn to understand and process emotions from their past and present.

It works to help individuals explore their emotion-processing style, works to help move them toward a healthy processings style, and use it to work through past or present trauma or stress to resolve issues [2].

When a person is working through EPT, they start by identifying past and current issues that have created unhealthy behaviors, and that is affecting daily functioning.

It could be a marital issue, relationship stress, trauma or death, or could be from childhood. This type of therapy works to explore and identify how the individual processes these emotions and what maladaptive tools are used to process them or avoid them.

From here, an emotional processing scale is created to identify strengths and weakness and assist with treatment goal planning. Additional therapies can be used to help determine unhealthy thinking and behaviors that are contributing to the issues at hand.

Other types of therapies include Cognitive-Behavioral Therapy, Dialectical Behavioral Therapy, and Trauma Therapy [2]. Each of these focuses on various aspects of a person’s thinking, behaviors, and triggers.

Very simply these therapies can be explained. In cognitive-behavioral therapy, therapist and client work to change the way a person thinks and processes an emotion to a situation.

From that, they can change reactions and behaviors to events that occur. In dialectical-behavioral therapy, a person can learn to identify emotions, practice distress tolerance in high-stress situations, as well as practice mindfulness and emotional regulation.

Trauma Therapy is about being able to process and move traumatic images, memories, and emotions to non-traumatic ones.

Working through emotions can take time and eating disorders, addictions, and other issues can be a part of avoiding and numbing past and current memories.

Being able to access counseling and working with a professional team can help you learn how to understand, identify, and process your emotions as well as sit with uncomfortable ones.

About the Author: Libby Lyons is a Licensed Clinical Social Worker and Certified Eating Disorder Specialist (CEDS). Libby has been practicing in the field of eating disorders, addictions, depression, anxiety and other comorbid issues in various agencies. Libby has previously worked as a contractor for the United States Air Force Domestic Violence Program, Saint Louis University Student Health and Counseling, Saint Louis Behavioral Medicine Institute Eating Disorders Program, and has been in Private Practice.

Libby currently works as a counselor at Fontbonne University and is a Adjunct Professor at Saint Louis University, and is a contributing author for Addiction Hope and Eating Disorder Hope. Libby lives in the St. Louis area with her husband and two daughters. She enjoys spending time with her family, running, and watching movies.

References:

[1] Firestone, L. (2016, January 25). Should You Feel or Flee Your Emotions? Retrieved December 27, 2017, from https://www.psychologytoday.com/blog/compassion-matters/201601/should-you-feel-or-flee-your-emotions
[2] The Therapy. (2017). Retrieved December 27, 2017, from http://emotionalprocessingtherapy.org/the-therapy/

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 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 February 11, 2018.
Reviewed By: Jacquelyn Ekern, MS, LPC on February 11, 2018.
Published on EatingDisorderHope.com

The post Processing Emotions and Learning to Tolerate Painful Feelings appeared first on Eating Disorder Hope.

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Overwhelming stress and pressure seem to be ingrained in the American lifestyle. In fact, in 2015, the American Psychological Association found that the majority of Americans report moderate or high levels of stress [1].

For those that hold a leadership position, this stress is often heightened and chronic. After all, these individuals are tasked with ensuring the success and well-being of the company they work for as well as its employees.

While some claim that this pressure brings out the greatness in leaders, there is no doubt that this overwhelming responsibility and chronic stress can take its toll.

One study found that 25% of chief executives aged 50 or younger had higher levels of depression and anxiety and believe they were at risk from job burnout [2].

Another showed that many CEOs are showing increased signs of stress, with the main issues being the job interfering with family and personal lives due to enhanced workloads, work-related traveling, and weekend working [3].

Chronic Stress

The consequences of holding a position of power are also physical. Severe stress leads to increased cortisol production. “Prolonged exposure to cortisol is highly toxic, wreaking havoc on the cardiovascular and immune systems, affecting the brain and memory, and probably impairing the ability to assess risk [4].”

This may explain why individuals holding leadership positions engage in dangerous and unhealthy coping mechanisms such as alcoholism, drug abuse, or disordered eating.

“Chronic life stress is associated with greater engagement in ‘comfort eating,’ or the consumption of high fat, high-sugar, or high-calorie ‘comfort food’ concurrent with an emotional state [1].”

Further, chronic psychological stress to due to workplace hassles is associated with increased consumption of high-fat/high-sugar [1].

Recall that a study mentioned above found increased instances of depression and anxiety in chief executives. Studies have also shown that these negative mood states are related to increased food-seeking behaviors.

Only 30% of the population decrease their food intake when stressed, with the other, larger, portion instead increasing their food intake considerably [5].

It is theorized that individuals engage in comfort eating in to reduce the aversive feeling associated with stress. While this may not be the sole connection between individuals in leadership positions and comfort eating, it seems clear that this is a viable explanation.

For those that hold positions of power, be aware of these pitfalls. Research indicates that comfort eating does buffer feelings of perceived stress but only in individuals without elevated levels of perceived stress [1].

All-around, however, comfort eating has been found to be an ineffective and temporary solution to chronic problems. Engaging in comfort eating puts individuals at risk for developing feelings of shame and guilt afterward which could lead to bulimia nervosa or binge eating disorder.

To efficiently cope with workplace stress, engage in nourishing and healing behaviors that restore the body and mind and allow you to feel at peace.

Your mental and physical well-being should always be valued over career success. If your job is causing you distress and putting your health at risk, consider speaking with a therapist or life-coach about making a more positive change in your life and career.

About the Author: 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.

References:

[1] Finch, L. E., Tomiyama, A. J. (2015). Comfort eating, psychological stress, and depressive symptoms in young adult women. Appetite, 95, 239-244.
[2] Sutherland, V. J., Cooper, C. L. (1995). Chief executive lifestyle stress. Leadership & Organizational Development Journal, 16:7, 18-28.
[3] Cooper, C. L., Sutherland, V. J. (1991). The stress of the executive lifestyle: trends in the 1990s. Employee Relations, 13:4, 3-7.
[4] Ogden, J. (2015). Leadership: stress and hubris. Progress in Neurology and Psychiatry, 14-16.
[5] Pool, E., Delplanque, S., Coppin, G., Sander, D. (2015). Is comfort food really comforting?mechanisms underlying stress-induced eating. Food Research International, 76, 207-215.

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 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 February 10, 2018.
Reviewed By: Jacquelyn Ekern, MS, LPC on February 10, 2018.
Published on EatingDisorderHope.com

The post The Fat CEO: Why Many in Leadership Roles Are Comfort Eating appeared first on Eating Disorder Hope.

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Eating disorders are all too common among adolescents. Often we think of anorexia or bulimia as the most common types of EDs and do not frequently think of obesity as being a symptom of binge eating disorder.

These issues affect both males and females, and in past research, it has been shown that teens who are overweight, obese, or engage in dieting behavior are at a higher risk to develop an eating disorder [1].

Obesity and Eating Disorder Research

Eating disorders are reported to be the third most common chronic condition in teens, after obesity and asthma.

Between 2000-2011 20.5% of 12 to 19-year-olds were obese and the rates of obesity among adolescents had quadrupled over the past thirty years [1].

Eating disorders typically start around pre-teen and teenage years. It is often more common in girls, and some children as young as 6 and 7 are being diagnosed with eating disorders. In research, teens who are overweight have reported using self-induced vomiting or laxatives more frequently compared to peers who were not obese [1].

Behavior Risks for Obesity and ED

There have been some behaviors that are associated with both obesity and eating disorders. One such response is dieting.

In one study, 2500 teens enrolled in Project Eating Among Teens (Project EAT) and were followed for five years. The results found that dieting behaviors were associated with a higher risk of becoming overweight and developing binge eating disorder [1].

Engaging in family meals has been associated with a positive change in diet and lifestyle. Eating together as a family can provide a healthy way of modeling positive food behaviors by parents. Having family meals together can protect teens from developing disordered eating patterns.

Weight talk is another behavior that contributes to obesity and eating disorders. Family members, peers, or siblings can be harmful to a child’s perception of self and weight, shape, and size.

Previous studies have found that regardless of the type of weight talk discussed, it is linked to being overweight and a factor in the development of eating disorders [1].

Included in weight talk is also teasing or bullying of a teens weight, shape, and size. Being able to target bullying behavior at home, in schools, and within the community can help reduce the stigma and development of eating disorders.

A Word From the APA

According to the American Academy of Pediatrics (APA), parents need to stop focusing on their teen’s weight and shape to help prevent both obesity and eating disorders [2].

Recommendations include a 5-point evidence-based strategy that both pediatricians and parents can use to help prevent obesity and eating disorders among adolescents.

Three of the recommendations are to avoid specific behaviors. The APA states that parents and physicians not to encourage dieting behaviors, avoid weight talk about their weight and the child’s weight, and avoid weight-teasing.

The other two recommendations focus on practices that promote a healthy body image and lifestyle.

These include families eating together at family meals, and encouraging healthy body image and a healthy lifestyle [2].

Defining Obesity and Eating Disorders in Teens

Obesity in children can be described as weighing at least 10% higher than what is recommended for height and body type. Often, obesity begins around age 5-6 through adolescence and studies have shown that when a child is obese between the ages of 10-13, there is an 80% chance of them becoming obese as an adult [3].

There are many reasons for obesity, including genetic factors, biological reasons, behavioral and cultural factors.

If one parent is obese, then there is a 50% chance that their child will become obese and if both parents are obese, there is an 80% chance that their child will become obese [3].

Often causal factors of obesity in teens are due to poor eating habits, overeating or binging behaviors, lack of body movement or exercise, and a family history of obesity.

Other reasons typically include medical illness such as endocrine or neurological disorders, medications being taken by the child, stress, or family and peer problems.

Low self-esteem, depression, and other mental health disorders can also be a reason for the development of obesity and eating disorders.

Other Eating Disorders

Other eating disorders include anorexia nervosa and bulimia nervosa in teens. Anorexia can be defined as being unable to remain at an ideal body weight range, struggle to eat a wide range of foods, and have an intense fear of becoming fat even if they are underweight or at a healthy weight range.

Anorexia can also include fasting, significant restriction in food and liquids, aversion of various foods that once enjoyed, and engaging in exercise or over-exercise.

With bulimia nervosa, an individual will engage in cycles of binge eating and purging. Often the purging is self-induced vomiting but can include diuretic and laxative abuse.

The teen will partake in secretive eating where they will eat more than what is considered normal for their age in a period of two hours or less. Often parents will notice food missing or find food wrappers or container hidden.

Other behaviors include frequent trips to the bathrooms, especially after meals, or longer-than-normal showers where purging might occur.

What You Can Do

Early intervention is critical in helping your teenager recover from developing an eating disorder. Encourage your child to be active and eat a wide range of healthy and nutritious foods. It is essential to refrain from weight teasing or shaming and weight-related talk around your teen.

Being able to work with your pediatrician, a clinician who specializes in eating disorders, and dietician is essential to recovering from an eating disorder. These professionals can help your teen and family learn healthy eating and lifestyle behaviors.

They also can work on self-motivation, increasing self-esteem and self-confidence with your teen and teach healthy coping skills that they can use throughout their life.

About the Author: Libby Lyons is a Licensed Clinical Social Worker and Certified Eating Disorder Specialist (CEDS). Libby has been practicing in the field of eating disorders, addictions, depression, anxiety and other comorbid issues in various agencies. Libby has previously worked as a contractor for the United States Air Force Domestic Violence Program, Saint Louis University Student Health and Counseling, Saint Louis Behavioral Medicine Institute Eating Disorders Program, and has been in Private Practice.

Libby currently works as a counselor at Fontbonne University and is a Adjunct Professor at Saint Louis University, and is a contributing author for Addiction Hope and Eating Disorder Hope. Libby lives in the St. Louis area with her husband and two daughters. She enjoys spending time with her family, running, and watching movies.

References:

[1] Golden, N. H., Schneider, M., Wood, C., Nutrition, C. O., Adolescence, C. O., & Obesity, S. O. (2016, August 22). Preventing Obesity and Eating Disorders in Adolescents. Retrieved December 27, 2017, from http://pediatrics.aappublications.org/content/early/2016/08/18/peds.2016-1649
[2] Digitale, E. (n.d.). One approach can prevent teen obesity, eating disorders, new guidelines say. Retrieved December 27, 2017, from https://med.stanford.edu/news/all-news/2016/08/new-guidelines-offer-one-approach-to-prevent-teen-obesity-eating-disorders.html
[3] A. (2016, April). Obesity In Children And Teens. Retrieved January 04, 2018, from https://www.aacap.org/aacap/families_and_youth/facts_for_families/FFF-Guide/Obesity-In-Children-And-Teens-079.aspx
[4] NEDA. (n.d.). Child Obesity and Eating Disorder Guidelines. Retrieved January 4, 2018, from http://nedawareness.org/sites/default/files/guides/obesity_ed_guide.pdf

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 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 February 9, 2018.
Reviewed By: Jacquelyn Ekern, MS, LPC on February 9, 2018.
Published on EatingDisorderHope.com

The post Teens, Eating Disorders, and Obesity appeared first on Eating Disorder Hope.

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