Tag Archives: Eating disorder

I can`t stop binge eating

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It Happened to Me: I Can’t Stop Binge Eating

No matter how careful I am during the day, in a cubicle, or in with a group of girlfriends at dinner, there is some part of me that knows when I am alone and I can and will buy and eat an entire box of Fig Newtons and a whole sack of Cheeze-Its.

Apr 30, 2012 at 1:00pm | 200 comments

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This is how I see myself. It’s probably how a lot of people see me, too.

If you’ve read a magazine intended for women in the past decade, you’ve probably come across an article by Geneen Roth. A smiling blonde rarely photographed below the shoulders (and always in a black, figure-concealing turtleneck so you aren’t tempted to compare your body against hers), she’s the print publishing world’s go-to expert in binge eating.

In the article I first (sorry for the word choice) devoured, Geneen talked about the broad spectrum of women she’d met in her workshops for binge eaters: wealthy women, broke women, fat women and women of average weight, happy women and depressed women, all of whom had realized that this one part of their lives was not healthy.

There were single women who didn’t date because they were afraid it would hamper their ability to binge, and married women who put locks on their refrigerators and begged their husbands to hide the key at night to prevent them from sneaking out of bed to binge.

I’d never thought I had an Eating Disorder before, but I suddenly saw myself in both of these scenarios.

At the time, I was co-habitating with a nice, slacker guy, one who wasn’t so much enabling as clueless. We moved in together after college, into my first real apartment, and it was the first time I ever really made food choices for myself. (In college, I was always broke, and on a meal plan. Even if I wanted to binge eat, it would be hard to do with $20 in my checking account and having to swipe my card at the commissary at prescribed mealtimes. )

I usually ate healthy, but he ate whatever he wanted. And when he was sleeping or out of the house, I would find myself consuming things like a woodchipper, feeding pretzel rods and barbecue potato chips into my mouth as fast as my teeth could make them into pulp.

When an entire box of Toaster Strudels or Girl Scout cookies went missing in the night, he would either not notice or make a joke of it. I think maybe he thought that this was just something women did, occasionally plunging face first into a Whitman’s Sampler in a tornado of chocolate wrappers and hands, like in the Cathy comics.

It didn’t happen every night — probably once every 10 days or so, depending. I was a careful eater, living in the big city where a size six was still not considered very “thin,” and always one week of low-fat cheese and controlled portions away from my “goal weight.” After a week of savoring vegetarian sushi and making elaborate, healthful salads, I might find myself in Whole Foods, knowing my boyfriend would be out for the night with his friends, and suddenly start filling my basket with wedges of brie, a loaf of zucchini bread, a bag of chocolate covered pretzels, peanut butter, and those Paul Newman cookies that taste extra good because the proceeds are going to charity.

Immediately following a binge, I’m filled with guilt over what I’ve just done to my body, but also because there are people out there who are starving and I have this horrendous compulsion to shove mac and cheese into my face so quickly I can’t taste it. I begin fantasizing about living in a place where somebody was making all  of my food choices for me — like jail.

It is a weird, automatic feeling — TV makes me think of someone having a “substance abuse episode” as something that happens suddenly, brought on my some inciting emotional incident. But like other “scoring,” binging often involves a certain amount of planning. I might have zero junk food in the house, and put off a binge as long as I could, reading quietly with a mug of tea, while secretly thinking Pizza, Pizza, Pizza knowing that in the next hour I would probably order an extra large pie and finish the whole thing.

When I lived with my boyfriend, I would put the evidence in a trash bag and take it to the dumpster behind my house, burying the whole thing under another bag in case my he should happen to go back and dig through the trash (not that he would, but you never know.)

While I had the vague feeling that this was all Bad, I never really thought of it as disordered eating. There wasn’t necessarily something that made me binge (a breakup or a bad week at work), I never thought, “I’m an emotional eater” or “I’m using food to cope.” I have the same kind of changeable moods and free-floating anxiety that all people in the world have. But I also have this habit, a routine I can’t seem to break even though it makes me feel sick and awful.

It’s also hard for me to say I have A Problem because like I said, it doesn’t happen all the time. And I never purge, which would be Really Bad instead of just Bad-Bad. I just feel like shit afterward, emotionally and physically. Sometimes, I never feel full, even after taking down eight tacos from the delivery Mexican place and washing them down with that old binger’s standby, a carton of ice cream.

If you’ve ever eaten too much candy too fast, you know the physical sensation. You can practically feel your organs trying to frantically keep up. I usually get headaches and intense nausea. I worry that this is actually bad for my body, that I’m going to get pancreatic cancer or Type II diabetes or just permanently “break” my body’s ability to feel normal feelings of hunger and fullness.

Then there is also The Guilt. I feel fat, disgusting and gluttonous. I feel like the Cathy comic, shoving food in my mouth until I physically cannot eat any more. I don’t have a bad life — I have friendly co-workers and good parents and lots of nice, supportive friends. If you met me and knew, you would wonder why I am doing this. I’m not the Type-A eating disordered girl from the studies and books who uses food to feel in control of her life.

Some of it is probably emotional, that I’m unthinkingly medicating with sugar and fat the same way some girls enjoy three glasses of wine in a bubble bath after a long week. I’m sure another part of it is my body craving this toxic crap when I’m being so good to give it its calories through stuff like tofu cutlets and baked yams.

I am hungry all the time, whether I’m watching what I eat or not. I grew up eating a mix of healthy and processed foods, begging for cookies but resigned to having a reasonable amount of them doled out by my parents after a balanced dinner. But left to my own devices, I can’t self-regulate. I might eat a nutritionist-approved breakfast of yogurt and fruit, a lunch of kale and brown rice and an orange, and grilled seitan and broccoli for dinner. Maybe my body gets scared that it’s never going to have a Dorito again, because after a week of being “good,” I’ll often find my face in a full-sized bag of Cool Ranch.

It’s a testament to the power of the pure-need part of the brain over the reasonable, thinking part that it is nearly impossible to say to myself, “Stop this. Don’t go to the store. Don’t buy the cookies. Don’t even put on your shoes to do it.”

No matter how careful I am during the day, in a cubicle, or in with a group of girlfriends at dinner, there is some part of me that knows when I am alone and I can and will buy and eat an entire box of Fig Newtons and a whole sack of Cheeze-Its.

I’ve been binging for several years now, and I probably won’t stop until someone figures out what I do and is horrified by it, too. I have told myself again and again that I’ll quit, that I’ll go to a Geneen Roth workshop, that I’ll start a journal, but I always go back. I wish it were as simple as filling the fridge with healthy alternatives, or freezing my credit card in a bowl of water, but somehow I always find a way around it, and there I am, a whole pizza gone, wanting to cry.

One look at Wikipedia and you’ll see why my problem is such a grey-area when it comes to treatment. The entry on binge eating disorder (or BED) begins by stating that it’s the most common eating disorder in the United States, and then the very next sentence admits that it’s not officially classified as an eating disorder.

I’ve considered OA and support groups, there’s still part of me that thinks I’m not “that bad,” and that I would feel like an interloper. I picture the people who are there who are actually killing themselves with food, and worry that all I could say would be, “I normally eat pretty healthy but every two weeks or so I eat so much I stand in front of a mirror calling myself a fucking fatass or dump dish soap into a box of brownie bites.”

I’d like to see a psychiatrist and a nutritionist and one of those hormone specialists who promises to test your blood and fix you with shots and patches and a custom diet. But right now, my insurance doesn’t cover mental health care, and I can’t afford to pay for excess private treatment.

It doesn’t help that I’ve known women who were anorexics or bulimics (who have an officially classified ED) who were turned away from private facilities for not being “severe” enough. So for now, it seems unlikely that I’ll seek treatment aside from being careful not to diet so severely that I “trigger” a binge, and to try not to be alone too much with the contents of my cupboards.

Because binge eaters aren’t always visibly affected weight-wise (mine falls someplace in the upper register of the “healthy” BMI for a 30-year-old woman of my modest stature), it’s unlikely that anybody will know unless I tell them or they look through my trash.

But I hope if you’re like me, this at least helps you to know that there are others of us out there, hiding their garbage, feeling equally clueless about the next step.

The anorexic brain

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The Anorexic Brain

Neuroimaging improves understanding of eating disorder

By Meghan Rosen

Web edition: July 26, 2013
Print edition: August 10, 2013; Vol.184 #3 (p. 20)

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Luke Lucas

In a spacious hotel room not far from the beach in La Jolla, Calif., Kelsey Heenan gripped her fiancé’s hand. Heenan, a 20-year-old anorexic woman, couldn’t believe what she was hearing. Walter Kaye, director of the eating disorders program at the University of California, San Diego, was telling a handful of rapt patients and their family members what the latest brain imaging research suggested about their disorder.

It’s not your fault, he told them.

Heenan had always assumed that she was to blame for her illness. Kaye’s data told a different story. He handed out a pile of black-and-white brain scans — some showed the brains of healthy people, others were from people with anorexia nervosa. The scans didn’t look the same. “People were shocked,” Heenan says. But above all, she remembers, the group seemed to sigh in relief, breathing out years of buried guilt about the disorder. “It’s something in the way I was wired — it’s something I didn’t choose to do,” Heenan says. “It was pretty freeing to know that there could be something else going on.”

Years of psychological and behavioral research have helped scientists better understand some signs and triggers of anorexia. But that knowledge hasn’t straightened out the disorder’s tangled roots, or pointed scientists to a therapy that works for everyone. “Anorexia has a high death rate, it’s expensive to treat and people are chronically ill,” says Kaye.

Kaye’s program uses a therapy called family-based treatment, or FBT, to teach adolescents and their families how to manage anorexia. A year after therapy, about half of the patients treated with FBT recover. In the world of eating disorders, that’s success: FBT is considered one of the very best treatments doctors have. To many scientists, that just highlights how much about anorexia remains unknown.

Kaye and others are looking to the brain for answers. Using brain imaging tools and other methods to explore what’s going on in patients’ minds, researchers have scraped together clues that suggest anorexics are wired differently than healthy people. The mental brakes people use to curb impulsive instincts, for example, might get jammed in people with anorexia. Some studies suggest that just a taste of sugar can send parts of the brain barrelling into overdrive. Other brain areas appear numb to tastes — and even sensations such as pain. For people with anorexia, a sharp pang of hunger might register instead as a dull thud.

The mishmash of different brain imaging data is just beginning to highlight the neural roots of anorexia, Kaye says. But because starvation physically changes the brain, researchers can run into trouble teasing out whether glitchy brain wiring causes anorexia, or vice versa. Still, Kaye thinks understanding what’s going on in the brain may spark new treatment ideas. It may also help the eating disorder shake off some of its noxious stereotypes.

“One of the biggest problems is that people do not take this disease seriously,” says James Lock, an eating disorders researcher at Stanford University who cowrote the book on family-based treatment. “No one gets upset at a child who has cancer,” he says. “If the treatment is hard, parents still do it because they know they need to do it to make their child well.”

Pop culture often paints anorexics as willful young women who go on diets to be beautiful, he says. But, “you can’t just choose to be anorexic,” Lock adds. “The brain data may help counteract some of the mythology.”

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DIFFERENT WIRING
View larger image | Studies of the brains of people with anorexia have revealed a number of complex brain circuits that show changes in activity compared with healthy people.
Medical RF, adapted by M. Atarod

Beyond dieting

A society that glamorizes thinness can encourage unhealthy eating behaviors in kids, scientists have shown. A 2011 study of Minnesota high school students reported that more than half of girls had dieted within the past year. Just under a sixth had used diet pills, vomiting, laxatives or diuretics.

But a true eating disorder goes well beyond an unhealthy diet. Anorexia involves malnutrition, excessive weight loss and often faulty thinking about one of the body’s most basic drives: hunger. The disorder is also rare. Less than 1 percent of girls develop anorexia. The disease crops up in boys too, but adolescent girls — especially in wealthy countries such as the U.S., Australia and Japan — are most likely to suffer from the illness.

As the disease progresses, people with anorexia become intensely afraid of getting fat and stick to extreme diets or exercise schedules to drop pounds. They also misjudge their own weight. Beyond these diagnostic hallmarks, patients’ symptoms can vary. Some refuse to eat, others binge and purge. Some live for years with the illness, others yo-yo between weight gain and loss. Though most anorexics gain back some weight within five years of becoming ill, anorexia is the deadliest of all mental disorders.

Though anorexia tends to run in families, scientists haven’t yet hammered out the suite of genes at play. Some individuals are particularly vulnerable to developing an eating disorder. In these people, stressful life changes, such as heading off to college, can tip the mental scales toward anorexia.

For decades, scientists have known that anorexic children behave a little differently. In school and sports, anorexic kids strive for perfection. Though Heenan, a former college basketball player, didn’t notice her symptoms creeping in until the end of high school, she remembers initiating strict practice regimens as a child. Starting in second grade, Heenan spent hours perfecting her jump shot, shooting the ball again and again until she had the technique exactly right — until her form was flawless.

“It’s very rare for me to see a person with anorexia in my office who isn’t a straight-A student,” Lock says. Even at an early age, people who later develop the eating disorder tend to exert an almost superhuman ability to practice, focus or study. “They will work and work and work,” says Lock. “The problem is they don’t know when to stop.”

In fact, many scientists think anorexics’ brains might be wired for willpower, for good and ill. Using new imaging tools that let scientists watch as a person’s mental gears grind through different tasks, researchers are starting to pin down how anorexic brains work overtime.

Control signs

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FOOD ALERT
Images of high-calorie foods (left) switched on a self-control center in the brains of anorexic women. Pictures of objects on plates kept the control center quiet.
Courtesy of S. Brooks

To glimpse the circuits that govern self-control, experimental neuropsychologist Samantha Brooks uses functional magnetic resonance imaging, or fMRI, a tool that measures and maps brain activity. Last year, she and colleagues scanned volunteers as they imagined eating high-calorie foods, such as chocolate cake and French fries, or using inedible objects such as clothespins piled on a plate. One result gave Brooks a jolt. A center of self-control in anorexics’ brains sprung to life when the volunteers thought about food — but only in the women who severely restricted their calories, her team reported March 2012 in PLOS ONE.

The control center, two golf ball–sized chunks of tissue called the dorsolateral prefrontal cortex, or DLPFC, helps stamp out primitive urges. “They put a brake on your impulsive behaviors,” says Brooks, now at the University of Cape Town in South Africa.

For Brooks, discovering the DLPFC data was like finding a tiny vein of gold in a heap of granite. The control center could be the nugget that reveals how anorexics clamp down on their appetites. So she and her colleagues devised an experiment to test anorexics’ DLPFC. Using a memory task known to engage the brain region, the researchers quizzed volunteers while showing them subliminal images. The quizzes tested working memory, the mental tool that lets people hold  phone numbers in their heads while hunting for a pen and paper. Compared with healthy people, anorexics tended to get more answers right, Brooks’ team wrote June 2012 in Consciousness and Cognition. “The patients were really good,” Brooks says. “They hardly made any mistakes.”

A turbocharged working memory could help anorexics hold on to rules they set for themselves about food. “It’s like saying ‘I will only eat a salad at noon, I will only eat a salad at noon,’ over and over in your mind,” says Brooks. These mantras may become so ingrained that an anorexic person can’t escape them.

But looking at subliminal images of food distracted anorexics from the memory task. “Then they did just as well as the healthy people,” Brooks says. The results suggest that anorexic people might tap into their DLPFC control circuits when faced with food.

James Lock has also seen signs of self-control circuits gone awry in people with eating disorders. In 2011, he and colleagues scanned the brains of teenagers with different eating disorders while signaling them to push a button. While volunteers lay inside the fMRI machine, researchers flashed pictures of different letters on an interior screen. For every letter but “X,” Lock’s group told the teens to push a button. During the task, anorexic teens who obsessively cut calories tended to have more active visual circuits than healthy teens or those with bulimia, a disorder that compels people to binge and purge. The result isn’t easy to explain, says Lock. “Anorexics may just be more focused in on the task.”

Bulimics’ brains told a simpler story. When teens with bulimia saw the letter “X,” broad swaths of their brains danced with activity — more so than the healthy or calorie-cutting anorexic volunteers, Lock’s team reported in theAmerican Journal of Psychiatry. For bulimics, controlling the impulse to push the button may take more brain power than for others, Lock says.

Though the data don’t reveal differences in self-control between anorexics and healthy people, Lock thinks that anorexics’ well-documented ability to swat away urges probably does have signatures in the brain. He notes that his study was small, and that the “healthy” people he used as a control group might have shared similarities with anorexics. “The people who tend to volunteer are generally pretty high performers,” he says. “The chances are good that my controls are a little bit more like anorexics than bulimics.”

Still, Lock’s results offered another flicker of proof that people with eating disorders might have glitches in their self-control circuits. A tight rein on urges could help steer anorexics toward illness, but the parts of their brain tuned into rewards, such as sugary snacks, may also be a little off track.

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SUGAR HIGH
When an anorexic woman unexpectedly gets a taste of sugar (yellow) or misses out on it (blue), her brain’s reward circuitry shows more activity than a healthy-weight or obese woman’s. Anorexics’ reward-processing systems may be out of order.
G. Frank et al/Neuropsychopharmacology2012

Sugar low

For many anorexics, food just doesn’t taste very good. A classic symptom of the disorder is anhedonia, or trouble experiencing pleasure. Parts of Heenan’s past reflect the symptom. When she was ill, she had trouble remembering favorite dishes from childhood, for example — a blank spot common to anorexics. “I think I enjoyed some things,” she says. Beyond frozen yogurt, she can’t really rattle off a list.

After Heenan started seriously restricting her calories in college, only one aspect of food made her feel satisfied. Skipping, rather than eating, meals felt good, she says. Some of Heenan’s symptoms may have stemmed from frays in her reward wiring, the brain circuitry connecting food to pleasure. In the past few years, researchers have found that the chemicals coursing through healthy people’s reward circuits aren’t quite the same in anorexics. And studies in rodents have linked chemical changes in reward circuitry to under- and overeating.

anorexiaTo find out whether under- and overweight people had altered brain chemistry, eating disorder researcher Guido Frank of the University of Colorado Denver studied anorexic, healthy-weight and obese women. He and his colleagues trained volunteers to link images, such as orange or purple shapes, with the taste of a sweet solution, slightly salty water or no liquid. Then, the researchers scanned the women’s brains while showing them the shapes and dispensing tiny squirts of flavors. But the team threw in a twist: Sometimes the flavors didn’t match up with the right images.

When anorexics got an unexpected hit of sugar, a surge of activity bloomed in their brains. Obese people had the opposite response: Their brains didn’t register the surprise. Healthy-weight women fit somewhere in the middle, Frank’s team reported August 2012, in Neuropsychopharmacology. While obese people might not be sensitive to sweets anymore, a little sugar rush goes a long way for anorexics. “It’s just too much stimulation for them,” Frank says.

One of the lively regions in anorexics’ brains was the ventral striatum, a lump of nerve cells that’s part of a person’s reward circuitry. The lump picks up signals from dopamine, a chemical that rushes in when most people see a sugary treat.

Frank says that it’s possible cutting calories could sculpt a person’s brain chemistry, but he thinks some young people are just more likely to become sugar-sensitive than others. Frank suspects anorexics’ dopamine-sensing equipment might be out of alignment to begin with. And he may be onto something. Recently, researchers in Kaye’s lab at UCSD showed that the same chemical that makes people perk up when a coworker brings in a box of doughnuts might actually trigger anxiety in anorexics.

Mixed signals

Usually a rush of dopamine triggers euphoria or a boost of energy, says Ursula Bailer, a psychiatrist and neuroimaging researcher at UCSD. Anorexics don’t seem to pick up those good feelings.

When Bailer and colleagues gave volunteers amphetamine, a drug known to trigger dopamine release, and then asked them to rate their feelings, healthy people stuck to a familiar script. The drug made them feel intensely happy, Bailer’s team described March 2012 in the International Journal of Eating Disorders. Researchers linked the volunteers’ happy feelings to a wave of dopamine flooding the brain, using an imaging technique to track the chemical’s levels.

But anorexics said something different. “People with anorexia didn’t feel euphoria — they got anxious,” Bailer says. And the more dopamine coursing through anorexics’ brains, the more anxious they felt. Anorexics’ reaction to the chemical could help explain why they steer clear of food — or at least foods that healthy people find tempting. “Anorexics don’t usually get anxious if you give them a plate of cucumbers,” Bailer says.

Beyond the anxiety finding, one other aspect of the study sticks out: Instead of examining sick patients, Bailer, Kaye and colleagues recruited women who had recovered from anorexia. By studying people whose brains are no longer starving, Kaye’s team hopes to sidestep the chicken-and-egg question of whether specific brain signatures predispose people to anorexia or whether anorexia carves those signatures in the brain.

Though Kaye says that there’s still a lot scientists don’t know about anorexia, he’s convinced it’s a disorder that starts in the brain. Compared with healthy children, anorexic children’s brains are getting different signals, he says. “Parents have to realize that it’s very hard for these kids to change.”

Kaye thinks imaging data can help families reframe their beliefs about anorexia, which might help them handle tough treatments. He thinks the data can also offer new insights into therapies tailored for anorexics’ specific traits.

Sensory underload

One trait Kaye has focused on is anorexics’ sense of awareness of their bodies. Peel back the outer lobes of the brain by the temples, and the bit that handles body awareness pops into view. These regions, little islands of tissue called the insula, are one of the first brain areas to register pain, taste and other sensations. When people hold their breath, for example, and feel the panicky claws of air hunger, “the insula lights up like crazy,” Kaye says.

Kaye and colleagues have shown that the insulas of people with anorexia seem to be somewhat dulled to sensations. In a recent study, his team strapped heat-delivering gadgets to volunteers’ arms and cranked the devices to painfully hot temperatures while measuring insula activity via fMRI.

Compared with healthy volunteers, bits of recovered anorexics’ insulas dimmed when the researchers turned up the heat. But when researchers simply warned that pain was coming, other parts of the brain region flared brightly, Kaye’s team reported in January in the International Journal of Eating Disorders. For people who have had anorexia, actually feeling pain didn’t seem as bad as anticipating it. “They don’t seem to be sensing things correctly,” says Kaye.

If anorexics can’t detect sensations like pain properly, they may also have trouble picking up other signals from the body, such as hunger. Typically when people get hungry, their insulas rev up to let them know. And in healthy hungry people, a taste of sugar really gets the insula excited. For anorexics, this hunger-sensing part of the brain seems numb. Parts of the insula barely perked up when recovered anorexic volunteers tasted sugar, Kaye’s team showed this June in the American Journal of Psychiatry. The findings “may help us understand why people can starve themselves and not get hungry,” Kaye says.

Though the brain region that tells people they’re hungry might have trouble detecting sweet signals, some reward circuits seem to overreact to the same cues. Combined with a tendency to swap happiness for anxiety, and a mental vise grip on behavior, anorexics might have just enough snags in their brain wiring to tip them toward disease.

Now, Kaye’s group hopes to tap neuroimaging data for new treatment ideas. One day, he thinks doctors might be able to help anorexics “train” their insulas using biofeedback. With real-time brain scanning, patients could watch as their insulas struggle to pick up sugar signals, and then practice strengthening the response. More effective treatment options could potentially spare anorexics the relapses many patients suffer.

Heenan says she’s one of the lucky ones. Four years have passed since she first saw the anorexic brain images at UCSD. In the months following her treatment, Heenan and her family worked together to rebuild her relationship with food. At first, her fiancé picked out all her meals, but step by step, Heenan earned autonomy over her diet. Today, Heenan, a coordinator for Minneapolis’ public schools, is married and has a new puppy. “Life can be good,” she says. “Life can be fun. I want other people to know the freedom that I do.”


Searching for treatments

The bowl of pasta sitting in front of Kelsey Heenan didn’t look especially scary.

Spaghetti, chopped asparagus and chunks of chicken glistened in an olive oil sauce. Usually, such savory fare might make a person’s mouth water. But when Heenan’s fiancé served her a portion, she started sobbing. “You can’t do this to me,” she told him. “I thought you loved me!”

Heenan was confronting her “fear foods” at the Eating Disorders Center for Treatment and Research at UCSD. Therapists in her treatment program, Intensive Multi-Family Therapy, spend five days teaching anorexic patients and families about the disorder and how to encourage healthy eating. “There’s no blame,” says Christina Wierenga, a clinical neuropsychologist at UCSD. “The focus is just on having the parent refeed the child.” Therapists lay out healthy meals and portion sizes for teens, bolster parents’ self-confidence and hammer home the dangers of not eating. Heenan compares the experience to boot camp. But by the end of her time at the center, she says, “I was starting to see glimpses of what life could be like as a healthy person.”

Treatment options for anorexia include a broad mix of behavioral and medication-based therapies. Most don’t work very well, and many lack the support of evidence-based trials. Hospitalizing patients can boost short-term weight gain, “but when people go home they lose all the weight again,” says Stanford University’s James Lock, one of the architects of family-based treatment. That treatment is currently considered the most effective therapy for adolescent anorexics.

In a 2010 clinical trial, half of teens who underwent FBT maintained a normal weight a year after therapy. In contrast, only a fifth of teens treated with adolescent-focused individual therapy, which aims to help kids cope with emotions without using starvation, hit the healthy weight goal.

Few good options exist for adult anorexics, a group notorious for dropping out of therapy. New work hints that cognitive remediation therapy, or CRT, which uses cognitive exercises to change anorexics’ behaviors, has potential. After two months of CRT, only 13 percent of patients abandoned treatment, and most regained some weight, Lock and colleagues reported in the April International Journal of Eating Disorders. Researchers still need to find out, however, if CRT helps patients keep weight on long-term. —Meghan Rosen

CITATIONS

U. F. Bailer et al. Amphetamine induced dopamine release increases anxiety in individuals recovered from anorexia nervosa. International Journal of Eating Disorders. Vol. 45, March 2012, p. 263. doi: 10.1002/eat.20937. [Go to]

S. J. Brooks et al. Subliminal food images compromise superior working memory
performance in women with restricting anorexia nervosa. Consciousness and cognition. Vol. 21, June 2012, p. 751 doi: 10.1016/j.concog.2012.02.006. [Go to]

S. J. Brooks et al. Thinking about eating food activates visual cortex with reduced bilateral Cerebellar Activation in Females with Anorexia Nervosa: An fMRI Study. PLOS ONE. Vol. 7, March 2012, p. 1. doi: 10.1371/journal.pone.0034000. [Go to]

G. K. W Frank et al. Anorexia Nervosa and Obesity are Associated with Opposite Brain Reward Response. Neuropsychopharmacology. Vol. 37, August 2012, p. 2031. doi: 10.1038/npp.2012.51. [Go to]

J. Lock et al. Aberrant brain activation during a response inhibition task in adolescent eating disorder subtypes. American Journal of Psychiatry. Vol. 168, January 2011, p. 55. doi: 10.1176/appi.ajp.2010.10010056. [Go to]

J. Lock et al. Is outpatient cognitive remediation therapy feasible to use in randomized clinical trials for anorexia nervosa? International Journal of Eating Disorders. Published online April 29, 2013. doi: 10.1002/eat.22134. [Go to]

T. A. Oberndorfer et al. Altered Insula Response to Sweet Taste Processing After Recovery From Anorexia and Bulimia Nervosa. American Journal of Psychiatry. Published online June 4, 2013. doi: 10.1176/appi.ajp.2013.11111745. [Go to]

I.A. Strigo et al. Altered Insula Activation during Pain Anticipation in Individuals Recovered from Anorexia Nervosa: Evidence of Interoceptive Dysregulation. International Journal of Eating Disorders. Vol. 46, January 2013, p. 22. doi: 10.1002/eat.22045. [Go to]

SUGGESTED READING

Eating Disorders Center for Treatment and Research at the University of California, San Diego: [Go to]

L. Sanders. Extreme eaters show abnormal brain activity. Science News. Vol. 181, May 5, 2012, p. 13. Available online: [Go to]

B. Bower. Starved for Assistance: Coercion finds a place in the treatment of two eating disorders. Science News. Vol. 171, January 20, 2007, p. 38. Available online: [Go to]

B. Bower. Wasting Away: Prozac loses promise as anorexia nervosa fighter. Science News. Vol. 169, June 17, 2006, p. 374. Available online: [Go to]

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Inspiration: Movies about mental illnesses

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– submitted by Ruth Levine, MD, University of Texas Medical Branch, Galveston

Black Swan (2010), Darren Aranofsky

Brilliant psychological movie. Dissociation?

 

Anxiety and Anxiety Disorders Bipolar Disorder/Mania
Copycat (panic/agoraphobia) Mr. Jones
As good as it gets (OCD) Network
The touching tree (Childhood OCD) Seven Percent Solution
Fourth of July (PTSD) Captain Newman, MD
The Deer Hunter (PTSD) Sophieís Choice
Ordinary People (PTSD) Sheís So Lovely
Depression Psychosis
Ordinary People Shine
Faithful I Never Promised You a Rose Garden
The Seventh Veil Clean Shaven
The Shrike Through a Glass Darkly
Itís a Wonderful Life (Adjustment disorder) An Angel at my Table
The Wrong Man (Adjustment disorder) Personal
Dissociative Disorders Man Facing Southwest
The Three Faces of Eve Madness of King George (Psychosis due to Porphyria)
Sybil Conspiracy Theory
Delirium
The Singing Detective
Substance Abuse
The Long Weekend (etoh) The Days of Wine and Roses (etoh)
Barfly (etoh) Basketball Diaries (opiates)
Kids (hallucinogens, rave scenes, etc.) Loosing Isaiah (crack)
Reefer Madness Under the Volcano
Long Day’s Journey into Night Ironweed
The Man with the Golden Arm (heroin) A Hatful of Rain (heroin)
Synanon (drug treatment) The Boost (cocaine)
The 7 Percent Solution (cocaine induced mania) Iím Dancing as Fast as I can (substance induced organic mental disorder)
Eating Disorders
The Best Little Girl in the World (made for TV)-Anorexia Kateís Secret (made for TV)-Bulemia

Axis II Disorders

Personality Pathology
Cluster A Cluster B
Remains of the Day- Schizoid PD Borderline PD
Taxi Driver-Schizotypal PD Fatal Attraction
The Caine Mutiny- Paranoid PD Play Misty for Me
The Treasure of Sierra Madre -Paranoid PD Frances
After Hours
Cluster C Looking for Mr. Goodbar
Zelig-Avoidant PD
Sophieís Choice-Dependent PD Histrionic PD
The Odd Couple-OCPD Bullets over Broadway
Gone with the Wind
A Streetcare Named Desire
Antisocial PD
A Clockwork Orange
Narcissism Obsession
All that Jazz Taxi Driver
Stardust Memories Single White Female
Zelig The King of Comedy
Jerry Maguire Triumph of Will
Alfie
Shampoo Mental Retardation
American Gigolo Charly
Citizen Kane Best Boy
Lawrence of Arabia Bill
Patton Bill, On His Own

Miscellaneous Issues

Family Early Adult Issues
Ordinary People Awakenings
The Field The Graduate
Kramer vs Kramer Spanking the Monkey
Diary of a Mad Housewife
Betrayal Latency and Adolescent Issues
Whoís Afraid of Virginia Woolfe Stand by Me
The Stone Boy Smooth Talk
The Great Santini
Doctor/Patient Relationship Boundary Violations
The Doctor The Prince of Tides
Mr. Jones
Idealized “Dr. Marvelous” Psychotherapy
Spellbound Suddenly Last Summer
The Snake Pit Captain Newman, MD
The Three Faces of Eve Ordinary People
Good Will Hunting

Steve Hyler directs an APA course on this topic, and
would be a good person to check with.
For more details, you can call me (409) 747-1351. Hope to see you in Maine!

Ruth Levine
University of Texas Medical Branch


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Presenting our new contributor

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We have so far gotten about 5-6 guest bloggers who publish posts for us sometimes. The blog owner is very thankful for this, and am now happy to introduce another guest-blogger who works with a lot of different patients groups.

She is an emergency room togethersocial worker (LMSW) with a background in child protective services, eating disorder studies, bipolar studies, and CBT/DBT.

About Hayleybug

You don’t often get a do-over in life.  This time I’m following a dream.  I’m following my gut.  And I’m gonna love every minute of it.

Join me and Elliot as we chase our dreams (and more often our tails) in the great state of New York.  This Bug is finally where she’s supposed to be.  🙂

Personal: Battle with an Eating disorder

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Why I Can Now Thank My Battle With an Eating Disorder

 

eating disorder
Photo by daniellehelm

By

The happiness of your life depends on the quality of your thoughts. – Marcus Aurelius

I still remember the day I forced myself to throw up for the first time.

I was sitting at home on the couch watching my favourite TV show at the time ‘Home and Away’. I was 13 and there was a young girl on the screen not much older than me who was anxious about her weight. It had just been someone’s birthday on the show and there was a giant chocolate cake in the fridge which she took to her room and engulfed. Ashamed, she quickly ran to the bathroom, stuck her fingers down her throat and forced every last bit back up again.

As ridiculous as it seems now, it’s like a light bulb went off in my mind that day. I thought to myself, ‘If she can eat delicious sweets and still stay thin by forcing herself to throw up then, that’s what I will do too.’ And so I did.

That day lead to me to an extremely lonely 10 year battle with bulimia. I spent my days pretending I was happy, healthy and confident yet, at night and on the weekends, I would waste hours binging on any junk food I could get my hands on – chips, packets of biscuits, cake and giant bowls of granola smothered in all of my favorite toppings.

I thought I was so clever and I got away with it, so it happened over and over and over.

Post binge, I’d wake up feeling disgusted with myself. ‘How could I have possibly let it happen again.’ I’d start each day by vowing to myself that I was going to consume no more than 1200 calories that day (because to me, 1200 was the magic number). Yet, by 3 O’clock in the afternoon, I was already planning my next binge. Dreaming of all of the delicious foods I was going to pig out on as soon as I go home from work.

It was like there were 2 different people living inside of me. The rational, smart, I have my life together character and then this monster who would snatch away any last scrap of self control I had, leaving me a broken down, helpless little girl.

There were times when I thought the relentless cycle would never end. It’s hard to imagine a life any different when you’re gripped by a disease so tight that it consumes your every waking thought.

Overtime, I began to realize how damaging my behavior was. The years of pounding headaches, dizziness, mood swings and stomach cramps were a constant reminder.

And, what about when I wanted to have kids, what kind of an example was I setting for them?

I knew that peace with myself had to come from within. No one else could help me if I didn’t want to help myself first. So, with that in mind, I slowly began to take the steps I needed to heal.

How I changed my life

Due to the complex nature of eating disorders, there is no one size fits all cure so, I had to figure out what worked for me.

I started by working on the relationship I had with myself and the relationship I had with food. Finally, I began to see that food was not the enemy. It was there to nourish and support me, not to act as the source of endless misery.

I read books, I journaled and I went to see a hypnotherapist who worked to re-train my subconscious mind. I started doing things from a place of love instead of fear. I stopped forcing myself to exercise for hours to make up for all of the bad food choices I’d made. I adopted a diet full of real, whole foods and I started exercising because I enjoyed it and it made me feel good.

Through the healing process I became more mindful and grew to be more compassionate toward myself and toward others. Louise Hay’s affirmation ‘I love and accept myself’ became my mantra and I would repeat it in my mind whenever negative thoughts tried to take over.

Today, I can see that my struggles of the past were a gift. Through my recovery I learned more about myself than I ever knew possible and if I didn’t experience what I did, I wouldn’t have grown into the happy, healthy person that I am today.

How you can change

1. Stop letting your negative thoughts and beliefs hold you back.

Your inner critic will try to convince you not to change. It will try to convince you that it’s easier to stay where you are and you will stay miserable. Only you have the power to shut that voice out.

2. Think about the life you truly want.

Where do you want to be 5 or 10 years from now? Picture yourself there – are your current behaviours guiding you in that direction?

3. Choose one small thing you can take action on today

What is one thing you can do that will bring you one step closer to where you actually want to be? Start now. Small actionable steps are what it will take. It won’t be easy, but it will be worth it, it will SO be worth it.

 

 

 

About Tegan Westra

Tegan Westra is a writer, holistic health coach and whole food fanatic. She gets a kick out of teaching women how to fall in love with themselves through nourishing their bodies from the inside out . When she’s not whipping up nutritious snacks in the kitchen or guzzling a green juice, you’ll find her chatting about her most recent health and wellness discovery with anyone who will stop by long enough to listen. You can download her Free E-Guide ’12 steps to Your Happy Healthy Dream Life’ HERE or connect on Facebook with her HERE.

Have you or someone you know had an eating disorder? Please share your experiences in the comments below.

reblogged from: Why I Can Now Thank My Battle With an Eating Disorder (thechangeblog.com)