Eating Disorders Self-Help and Recovery Tips

Breaking Bulimia

Breaking Bulimia

We have all been there: turning to the refrigerator if feeling lonely or bored or indulging in seconds or thirds if strained. But if you suffer from bulimia, the from time to time urge to overeat is more like an obsession.

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Bulimia Help Method

Endorsed by University Professors, Eating Disorders Specialists, Doctors and former bulimics, the Bulimia Help Method is a proven & trusted approach to lifelong recovery from bulimia. The Bulimia Help Method home treatment program gives you the insight, skills and tools needed to break free from bulimia and to make peace with food and your body. You are guided step-by-step along the way so you always know what to expect and what to do next. A powerful audio program will help to reprogram your old eating habits at a sub-conscious level, speed up your recovery and help you feel more calm and grounded.

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Substance Abuse And Eating Disorders

Individuals with eating disorders (ANOREXIA and BULIMIA) abuse a number of drugs and alcohol. During the course of their lives, they often use agents to reduce weight, such as laxatives, emetics, diet pills, and diuretics. Of those individuals with eating disorders who seek psychiatric treatment, as many as 35 percent have a significant substance-abuse history. Alcoholism, particularly in bulimia and bulimic anorectic patients, appears to be common. Substance abuse in eating disorders is generally thought to convey a poor prognosis for recovery.

Mechanisms of cachexiaanorexia and their relationship with fatigue

Cancer-related cachexia anorexia is a multifactorial syndrome caused by both the presence of a tumour and the host response to that stimulus. A number of proinflammatory cytokines, probably in connection with neuroendocrine mediators and second messengers, generate an inflammatory state and changes in the central nervous system. This results in a marked loss of fat and lean body mass, diminished muscle function, and a number of severe signs and symptoms, such as anorexia, chronic nausea, cognitive changes, and fatigue (see Fig. 4.2). In acute inflammatory conditions, such as severe and prolonged sepsis, and chronic non-malignant inflammatory processes, such as infection, rheumatological disease (Roubenoff et al. 1997), chronic obstructive pulmonary disease (COPD) (Di Francia et al. 1994), AIDS (Thea et al. 1996), and chronic heart failure (CHF) (Levine et al. 1990), cytokines also seem to be associated with weight loss (Kotler 2000).

Smoking Habit And Eating Disorders

Acupuncture Points For Eating Disorders

The distribution of points in 25 subjects with obesity and eating disorders is quite different from that in smokers. ESRT shows three groups of sectors with significant differences two are the colon and the pituitary area, the third, on sectors 20 and 21, corresponds to the representation of the Chinese kidney (on the left of Fig. 7.12). It may be questioned whether the activation of the kidney area is concomitant with the low metabolism of these subjects or may depend, according to TCM, on a deficiency of Yin of Kidney which is accompanied by asthenia and psychologically by a loss of will. Fig. 7.12 Clusters of points with low ESR in 25 patients affected by obesity and eating disorders on the left cluster of tender points with PPT of the same patients on the right. The colored sectors correspond to a significantly higher concentration of points, respectively, for ESRT vs. PPT on the left side or for PPT vs. ESRT on the right side of the figure. Colored areas lateral surface blank...

Eating Disorders throughout History

Although eating disorders first came to widespread attention in the 1970s, self-starvation and other pathological eating practices are found throughout recorded history. Bulimia was widely known in both Greek and Roman societies and was recorded in France as early as the eighteenth century. Self-starvation for religious reasons became widespread in Europe during the Renaissance, as hundreds of women starved themselves, often to death, in hopes of attaining communion with Christ. During the nineteenth century, as corpulence stopped being viewed as a symbol of prosperity, self-starvation became common again. The incidence of eating disorders varies widely among cultures and time periods, suggesting that they can be encouraged or inhibited by social and economic factors. Eating disorders have most often been seen in affluent societies and are rarely reported during periods of famine, plague, and warfare. American Psychiatric Association (2001). Men Less Likely to Seek Help for Eating...

Gull Sir William Withy 181690 Known for naming the disease anorexia nervosa in 1874

M any credit Gull with the discovery of the disorder, which he described as emaciation as a result of severe emotional disturbance and a perversion of the ego. His article entitled Anorexia Nervosa (Apepsia Hys-terica, Anorexia Hysterica) was published in the Trans actions of the Clinical Society of London in i874 and was based on a speech he gave at Oxford in i868 (Gull 1896 205-14). The formulation anorexia nervosa, however, first appears in his i874 essay. It is clear that there was a complex history of the disease that reached back to the seventeenth century. Gull's contemporaries, many of whom he acknowledged, also sharpened the diagnosis in the nineteenth century. The French neu-ropsychiatrist Charles Lasegue (1816-83) developed a diagnostic category very similar to that of Gull at the same time and is often acknowledged as one of the creators of anorexia (Vandereycken and van Deth 1989). Both built on older discussions of the pathologies of eating. Gull's description was among...

Types of Eating Disorders

In general, there are higher rates of bulimia across the board. What I tend to see are people who are somewhere in between and that's true for all eating disorders. The largest diagnostic group of eating disorder groups is called eating disorder not otherwise specified (EDNOS), and it describes the way various symptoms of eating disorders can ebb and flow. What I see most is women desiring a very thin body, and coming at that desire through a variety of dangerous means. Extreme concern with body weight and shape Anorexia Nervosa Anorexia nervosa is characterized by self-starvation and excessive weight loss, and the following symptoms Bulimia Nervosa Bulimia nervosa is characterized by a secretive cycle of binge eating followed by purging. Bulimia includes eating large amounts of food more than most people would eat in one meal in short periods, then getting rid of the food and calories through vomiting, laxative abuse, or overexercising. The CDC report states that the central issue...

Self Help Bibliotherapy for Eating Disorders

Reading self-help books is commonly reported by women with eating disorders. Rorty, Yager, and Rossotto (1993) found that almost half (43 ) of women with eating disorders reported reading self-help books. The majority reported high levels of satisfaction with this approach. Although a number of studies examined self-help workbooks with modest therapist In 1993, Schmidt, Tiller, and Treasure evaluated a CBT-based self-help handbook with women with BN. Participants were assessed 4-6 weeks after the onset of treatment. The intervention was found to be effective in reducing bulimic symptoms and increasing nutritional knowledge. Participants significantly reduced binge eating and purging behavior but their weight and shape attitudes did not change significantly during treatment.

Triggers for boy anorexia

Many of my friends have asked me, 'Did you ever find out what caused Joe's anorexia ' The straightforward answer is no. However we have a few ideas about what could have been contributing factors He went through a very early puberty. It is no coincidence that many cases of anorexia start in puberty, both in boys and girls. With girls the reason seems more obvious as they look in the mirror and see a more rounded shape developing. Boys tend to be happier with their developing a more muscular physique, but if a boy has a very early puberty he might not appreciate the changes that are happening to his body and making him different from his peers. In addition, the raging hormones can trigger irrational behaviour in either sex. Joe was, and having recovered from his illness is still, a very talented sportsman. This is his explanation. I thought I would be an even better sportsman if I lost a little weight. I felt really good when I lost weight and to start with all my friends commented on...

Classification of Eating Disorders Obesity

Obesity can be classified as an eating disorder since, primarily or secondarily, obese patients eat Figure 1 Classification of eating disorders based on the interaction between the preoccupation with food and body weight and the self-control of hunger. 1999 Academic Press. Figure 1 Classification of eating disorders based on the interaction between the preoccupation with food and body weight and the self-control of hunger. 1999 Academic Press. inappropriately for their increased weight and because obese individuals tend to suffer also from the other eating disorders. Anorexia Nervosa Anorexia nervosa is usually seen in younger women who restrict their food intake and increase exercise, causing a voluntary, stubborn malnutrition. Bulimia People who cannot control their hunger over a long period of time tend to have secret binging episodes. This is followed by an overwhelming feeling of guilt and depression, which frequently leads to self-induced vomiting. For this reason, the terms...

What is anorexia and what are the effects

Anorexia nervosa is the best known of a range of illnesses classified as eating disorders. Anorexia nervosa literally means 'loss of appetite for nervous reasons'. The main diagnostic criteria for anorexia is that there is a weight loss leading to a body weight of at least 15 below the normal weight for height or age, although anorexia itself is much more complex than just loss of appetite or weight loss. Those with anorexia will deliberately starve themselves until they are very ill, and in a small number of cases until they die. Anorexics are terrified of gaining weight and if they feel they have eaten even a tiny morsel too much they will exercise obsessively to get rid of the calories. They are often obsessed with the amount of calories in each type of food. They will often encourage those around them to eat more, whilst continually cutting back on their food intake. Anorexics desperately want to be in control, and the one thing they feel they can control is their food intake....

Assisted Self Help Treatment for Eating Disorders

Several treatment studies examined the feasibility and effectiveness of guided self-help programs for the bulimic spectrum eating disorders, namely BN, binge eating disorder (BED), and EDNOS, with binge eating identified as the key feature but occurring at a subthreshold level. In the following sections, we review findings from these studies. See Table 8.1 for a summary of structured self-help interventions for the treatment of eating disorders. Table 8.1 Summary of Structured Self-Help Interventions for Bulimia Nervosa and Binge Eating Disorder Randomized to 3 groups, but no control group SH with 7 monthly reading SH + support from improved bulimic SH + support from cured bulimic Note. SH self help, WL wait-list, BN bulimia nervosa, BED binge eating disorder, EDNOS eating disorders not otherwise specified, BF binge frequency, CBT cognitive-behavior therapy. Excluding dropouts, 45 ceased vomiting, 51 ceased purging, and 33 had full remission. 80 reduction bulimic episodes, 70...

Professionally Assisted Self Help Treatment for Bulimia Nervosa

Using a similar approach, Cooper and colleagues (Cooper, Coker, & Fleming 1994) conducted an uncontrolled study to evaluate the effectiveness of a supervised CBT-based self-help manual for women with BN. For 4-6 months, participants completed the CBT manual, Bulimia Nervosa and Binge Eating A Guide to Recovery (Cooper, 1993) and received guidance from a social worker with no previous specialist training in the treatment of eating disorders. Guidance included 20- to 30-minute sessions for support and encouragement to continue applying the strategies in the self-help manual. At post-assessment, half of the participants had discontinued binge eating and self-induced vomiting. On average, the frequency of binge eating decreased by 85 and self-induced vomiting was reduced by 88 . Improvement on other key features including body shape and weight dissatisfaction and dietary restraint were also noted. In 1996, Cooper, Coker, and Fleming reported similar results using their structured...

Advantages and Disadvantages of Self Help Programs for Eating Disorders

Self-help approaches are not a panacea, however. Text-based interventions may require high levels of literacy. Credibility of content and credentials is difficult to determine on many commercial Web sites. Most structured programs for eating disorders require extensive self-monitoring and the ability to generalize self-monitoring data to multiple contexts in daily life can be difficult for people with limited psychological sophistication or motivation. Self-help approaches, as the initial treatment approach in stepped care models for eating disorders, are recommended by several experts who practice in the specialty area of eating disorders (Fairburn & Peveler, 1990 Garner & Needleman, 1996 National Collaborating Centre for Mental Health, 2004 Williams, 2003 Wilson, Vitousek, & Loeb, 2000).

Eating Disorders and Body Image

Eating disorders are nearly twice as common in young women with type 1 diabetes as their healthy peers. A nurse at Duke University says Another common theme relates to feeling ashamed or stigmatized about having diabetes. The attention to body, eating, and planning to eat required for good diabetes care may be in opposition to the eating disorder beliefs that bodily needs are shameful and that denying oneself of food is morally laudable. Joslin Diabetes Center, is an expert in the field of diabetes and eating disorders. She says EATING DISORDER STATiSTiCS FACTS The mortality rate from diabetes alone is roughly 2.5 percent annually. For anorexia nervosa, it is 6.5 percent. But patients with diabulimia which is referred to, in health care circles, as dual diagnosis have a mortality rate of 34.8 percent per year. The cycle of inexact insulin dosing can cause weight gain, which increases insulin requirements and resistance. And there's another factor at work The insulin-producing cells...

Do boys get other eating disorders

Anorexia is one of a range of eating disorders and boys are certainly prone to suffer from any of them. Whilst the different illnesses have different symptoms and effects, many of the approaches to self-help and treatment will be similar to those used for anorexics. At the end of the day the main aim for anyone suffering from an eating disorder is to reestablish healthy eating patterns, maintain a healthy weight and to regain self-confidence and self-esteem. Much of what is written in the self-help and treatment options section of this book should be useful for the carer of a boy suffering from one of these other eating disorders. I also recommend reading Fit to Die by Anna Paterson, published in 2004 by Lucky Duck Publishing. In this book the author draws the reader's attention to the characteristics of and special difficulties for men with eating disorders. Other eating disorders include bulimia nervosa, binge eating, compulsive exercising and 'ED-NOS'...

Dieting and Eating Disorders

11 is easy for anyone who has been exposed to mass and popular culture in the U.S.A. in the past twenty years to believe that dieting is an exclusively female activity and that eating disorders only affect woman. Advertisements for weight-loss companies such as Weight Watchers and Jenny Craig primarily feature women, and young women have also been, until recently, the primary focus of discussions about anorexia and bulimia. Since the 1990s, however, diet companies, doctors, and the media have discovered that men deal with body-image problems and struggle with overweight and disordered eating as well. While men have actually been dieting and struggling with eating disorders for centuries, an increasing number of popular and professional publications in the past fif teen years have focused on the unique problems of obesity in men, male dieting, and men with eating disorders. In twentieth-century Western culture, overweight and eating disorders have largely been perceived as a female...

B Treatment of Obese Individuals with Binge Eating Disorder

If a patient suffers from binge eating disorder (BED), consideration can be given to referring the patient to a health professional who specializes in BED treatment. Behavioral approaches to BED associated with obesity have been derived from cognitive behavior therapy (CBT) used to treat bulimia nervosa. 227 Among the techniques are self-monitoring of eating patterns, encouraging regular patterns of eating (three meals a day plus planned snacks), cognitive restructuring, and relapse prevention strategies. 581

Self Help Therapies for Eating Disorders

In this chapter, we present an overview of self-help approaches used in the treatment of eating disorders. We describe the types of self-help approaches currently available, outline the advantages and limitations of these approaches, and review what is known about the effectiveness of these approaches. This chapter concludes with recommendations for clinicians and a discussion of future directions for self-help treatments for eating disorders. Eating disorders, including subclinical disorders and disordered eating, are common psychiatric problems in women (Fairburn, Cooper, Doll, Norman, & O'Connor, 2000 Lewinsohn, Streigel-Moore, & Seeley, 2000). For example, between 1 and 2 of the young adult female population suffers from full syndrome bulimia nervosa (BN Fairburn & Beglin, 1990 Kjelsas, Bjornstrom, & Gotestam, 2004) and, depending on the diagnostic criteria used, between 1 and 14 meet criteria for an eating disorder not otherwise specified (EDNOS) or subclinical eating disorders...

Professionally Assisted Self Help Treatment for Binge Eating Disorder Primary Focus

To our knowledge, the most frequently evaluated self-help program for the treatment of BED has been Fairburn's Overcoming Binge Eating (Fair-burn, 1995). In 1997, Wells, Garvin, Dohm, and Striegel-Moore conducted an uncontrolled study to evaluate the feasibility of providing a self-help plus telephone guidance program for BED. The duration of the program was 3 months. For the self-help component, all women received Overcoming Binge Eating. Participants were instructed to complete daily self-monitoring logs. For the telephone guidance component, participants received 30-minute telephone sessions weekly for the first month and every other week for the following 2 months. Telephone sessions, conducted by a psychology graduate student, focused on the participants' progress with the self-help program. Reductions were observed on the Eating Disorder Examination Questionnaire (Beglin & Fairburn, 1992) total score and in the frequency of binge eating. Compliance with the program sessions...

Preventing Eating Disorders

Self-help interventions also have been applied to the prevention of eating disorders primarily with female adolescents and young adults. A number of studies evaluated these interventions using individual and group formats (Kaminski & McNamara, 1996 Zabinski, Wilfley, Calfas, Winzelberg, & Taylor, 2004 Zabinski, Wilfley et al., 2001). An exemplar of prevention programs can be seen in the work developed at the Stanford University Behavioral Medicine Media Laboratory. Named Student Bodies, the program targets young women with weight and shape concerns, as well as unhealthy eating attitudes and behaviors. Student Bodies has three central components and is divided into eight sessions. The components are psychoeducational readings, an Internet-based body image journal, and a moderated asynchronous electronic discussion group. The readings were selected to educate women about body image, healthy dietary and physical activity practices, and eating disorders. The body image journal allows...

Boys dont get anorexia do they

Anorexia is certainly more common in girls and one of the symptoms that GP's tend to look for, as an indicator of anorexia, is loss of periods. There is no such obvious indicator for boys. One of the main problems in recognising anorexia in boys is that lots of teenage boys go through stretch and grow phases in which they become extremely skinny despite still having a healthy appetite. Many boys are naturally very skinny even before entering puberty, but are in excellent health. When Joe first lost weight we thought he was simply going through a normal teenage stretch and grow phase, and my younger son is going through a very similar growth phase now that he is twelve. The big difference with Joe was that he didn't stop losing weight, he gradually ate less and less, he became very pale and was always cold, he became tearful and depressed, he became distant from his friends and much more clingy to me. This was a boy who had previously been full of vitality and energy, very popular with...

Hypothalamic Control of Hunger in Anorexia Nervosa

In normal individuals fasting and weight loss increase hunger by multiple mechanisms (decreased serum levels of leptin, insulin, and blood glucose and increased levels of ghrelin). At the level of the hypothalamus there is an increase in the potent orexigenic neuropeptide Y and other changes in neurotransmitters secondary to the fasting state. Some of these neurotransmitter changes may be the cause or a mechanism of anorexia nervosa, and for this reason they have received considerable attention in the past several years. It is important to understand that appetite control is a very complex hypothalamic function that involves many local and systemic neuropeptides, amines, and hormones. Abnormal serotonin activity has been found in the brain of women with anorexia nervosa. An area in the chromosome 1 (p36.3-34.3) that contains genes for the serotonin 1D receptor and for the opioid delta receptor was associated with patients with anorexia nervosa by linkage analysis. One polymorphism in...

Management of cancer anorexiacachexia syndrome with reference to cancerrelated fatigue

The management of CACS is a real challenge. As our understanding of the pathophysiology of this syndrome is clarified, potential new treatments appear. A comprehensive and multidisciplinary management approach is required to control all the factors related to cachexia and fatigue in cancer patients. Physical, psychosocial, and spiritual issues need to be considered, alongside pharmacological interventions and nutritional support. Specific pharmacological interventions for fatigue are not discussed in this chapter (see Chapter 12). Instead the aim is to identify interventions for used in the management of cancer cachexia that may also relieve CRF in this population. The purpose of the treatment is to control specific symptoms, such as asthenia, anorexia, chronic nausea, and pain and so improve QOL, if not life expectancy.

Depression And Eating Disorders

My dad's side of the family lived in Texas and ate traditional southern foods. I was the kid who would eat anything, and my family loved that about me. I spent summers with my dad in Texas and was living in this environment where everyone wanted me to eat, so this kind of set the stage for my eating disorder. My mom was initially really neurotic about my food until the doctors told her to relax. She would let me have treats on occasion, like cake on birthdays. She didn't keep stuff from me, but there was definitely a forbidden sense to food. In the 1st grade, I remember that I had to have a snack in my classroom. I sat at the table by myself while the other kids went out for recess. After a while, I started skipping the snacks and hiding them in my desk. One morning, I ended up having a seizure in class, and the teacher found the food I'd hidden and I got into trouble. I gained a lot of weight during the summer of 8th grade. When I returned home from camp, my mom said, What happened...

Clinicians Guide to Binge Eating Disorder

Incidence of Binge Eating Disorder (BED) appears to be on the increase. Treating it and overcoming it is all the more difficult, especially for those living in a culture that has an intense body image focus. A Clinician's Guide to Binge Eating Disorder educates the reader about its triggers and behaviors, and describes steps to treat it and resume a full and productive life. Evidence-based research outcomes provide the framework and foundation for this book. First-person case studies bring application of this science to life to help close the gap between research and treatment care, and the importance of clinicians developing a therapeutic relationship as a healing tool with their client is discussed, recognizing that medical and psychological dimensions are inextricably intertwined. June Alexander is an Australian writer and journalist with a particular focus on eating disorders. Andrea B. Goldschmidt is Assistant Professor on the Eating Disorders Program at the University of...

What is Eating Disorder Not Otherwise Specified NOS

Does not meet criteria for Anorexia or Bulimia. This includes Anorexia criteria without amenorrhea Restricting type anorexia without significant weight loss (ie, no binge eating purging to meet bulimia criteria) Bulimia criteria except at a lower frequency than required for diagnosis

Bulimia nervosa

The term bulimia nervosa literally means 'the hunger of an ox'. It is only since the 1970s that it has been recognised by the medical community. Sufferers are caught in a cycle of eating huge quantities of food (binge eating) and then getting rid of that food by vomiting, taking laxatives and diuretics, excessive exercising or a combination of any of these. It is thought that male sufferers are more likely to exercise excessively to get rid of the calories, whilst female sufferers are more likely to vomit. Sufferers often eat very quickly, almost in a panic, and their eating is out of control. They feel incredibly guilty after each binge, which is why they will then purge. Like anorexics they have a fear of being fat, are often deeply unhappy about some aspect of their life and have low self-esteem. Despite this they are often high achievers and from the outside can appear to be outgoing and self-assured. Unlike anorexics, sufferers of bulimia often have a normal body weight and this...

Anorexia Nervosa

Anorexia nervosa is a disease approaching epidemic proportions in the United States. It is estimated that as many as 7 million women and 1 million men have the condition. It affects minorities and people of all socioeconomic levels. According to the National Association of Anorexia and Associated Disorders (ANAD), 86 of people with anorexia report that the condition began before they reached age 20, and 10 reported onset before 10 years of age. Two-thirds of sufferers say that it lasts up to 10 years. Outpatient treatment may exceed 100,000 per case. The person who has anorexia may be described as a perfectionist. Everything must be perfect for that person, especially the way his or her body looks. To that person, the body can never be too thin, and, in fact, he or she will view the body as overweight when it is obviously not. In the face of real starvation, the person is always hungry, frequently obsessed with food, but fights the impulse to eat. That person may prepare fancy meals...

Eating disorders

Due to the demand for tremendous beauty among celebrities, severe extremes are often sought in order to attain specific beauty standards. Among various celebrities, the pressures to maintain a low weight in Hollywood have led to the occurrence of eating disorders. The scrutiny of weight in Hollywood among celebrities has no doubt transferred onto pop-culture followers. At the same time, celebrities who have publicly spoken about their personal battles with eating disorders have often helped those out of the limelight who suffer. While many models claim their waif-like bodies are natural and a result of a fast metabolism, current plus-size model Kate Dillon was never part of that crew. As a child, Dillon was always overweight, with the nickname, Overweight Kate. This all changed starting at age twelve, when Dillon watched a television movie, ironically called, Kate's Secret, which, for Dillon, glamorized anorexia (NOVA online). From that point on, until age nineteen, Kate continuously...

Anorexia

T he medicalization of disorders of eating begins in the seventeenth century. The Christian tradition of self-abnegation meant that fasting became a common form of religious practice in the Middle Ages with spiritual rather than pathological implications (Ove 2002). In the course of the nineteenth century, self-imposed starvation came to be a syndrome clearly delineated by physical signs and symptoms and which was understood to have a psycho-genic origin. This idea that food had a special status was uncontested. Some theoreticians saw the manipulation of the middle-class family by their daughters as the place where rebellion could most meaningfully take place (Brumberg 1988). Yet anorexia nervosa, a name coined by William Gull in 1868, was still a rare and therefore clinically fascinating aberration. In the 1920s, the view of Morris Simmonds dominated Anorexia was the result of a lesion of the pituitary gland. This endocrinological definition of radical thinness fitted well with the...

Alison E Field and Kendrin R Sonneville

Binge eating disorder (BED) is more common than bulimia nervosa (BN) and anorexia nervosa (AN). Although the prevalence of BED is higher in women than men, the gender difference in prevalence is smaller than that for BN and AN (Hudson et al. 2007 Swanson et al. 2011). Despite the higher incidence of BED, public health efforts and targeted prevention programs focused on preventing the onset of binge eating are lacking. As such, greater attention to eating disorder prevention is warranted. Relatively little is known about the risk factors for binge eating disorder. Most studies have been cross sectional, had treatment-seeking samples, or used a broader outcome definition (i.e., binge eating, disordered eating, etc.). Nevertheless, a handful of risk factors have been identified. In treatment seeking samples the binge eating onset, as well as the risk factors, must be recalled, and so this type of research is highly susceptible to recall bias. Moreover, since only the minority of people...

Michael J Devlin Stephen A Wonderlich B Timothy Walsh and James E Mitchell

The following dialogue takes place in an eating disorders clinic at an academic Assistant Hello, Eating Disorders Treatment Research Program, RA speaking. so long. I'm happy to say that the situation has indeed improved. For starters, we now have a name for what you have. It's called binge eating disorder, or BED, and we've developed a number of different treatment approaches, including different forms of psychotherapy, medication, and even self-help approaches. We'll need to meet with you to find out exactly what your goals are and what type of approach would be most helpful. Studies of the psychopathology characterizing BED have significantly clarified the nature of this relatively new eating disorder. We have acquired a clearer understanding of the nature of binge eating, the importance of loss of control of eating, and the distress surrounding binge eating episodes in individuals suffering from BED. We believe that several psychopathological concepts will continue to generate...

Cynthia M Bulik and Sara E Trace

Eating disorders like anorexia nervosa and bulimia nervosa, but this was the first I had heard about BED. To be honest, I couldn't believe there was a name for what I was experiencing The therapist explained that my description of both my mother and me sounded like binge eating. She said it was not uncommon for these things to run in families and that genetic factors might be involved. She has helped me completely rewrite my own script about what was going on. I had thought I was a bad person who had no willpower, but now I have a better understanding of what this is, and I have hope that it is treatable. I have kept seeing my therapist and we have worked on both depression and BED. I have also used my experience to help educate my adult children about BED. My son has always been a stress eater, so I let him know about my BED and the successes I have had with treatment. The role of genetic factors in the development of eating disorders, including binge eating disorder (BED), has...

Loss of control and binge eating in children and adolescents

Full-syndrome binge eating disorder (BED) is rarely diagnosed among children and adolescents. Yet episodes of loss of control (LOC) eating are often reported by youth (Tanofsky-Kraff et al. 2004). As described more fully in the first part of this chapter, when children and adolescents report experiencing an inability to stop eating once started, the eating can be characterized as a LOC episode, which can occur irrespective of amount of food consumed. In other words, children experience LOC with or without consuming an unambiguously large amount of food, so including both large episodes of binge eating and not large episodes. Given the psychological (e.g. depressive symptoms), social (difficult relationships), and health (obesity) problems associated with LOC eating in youth (see the first part of this chapter), it is crucial for clinicians to assess for the presence of LOC eating and to implement interventions focused on reducing LOC eating and associated problems, such as excessive...

Kay E Segal Sarah E Altman Jessica A Weissman Debra L Safer and Eunice Y Chen

Dialectical Behavior Therapy (DBT) represents an example of one of the new-wave behavior therapies that integrate mindfulness practice into the treatment of Binge Eating Disorder (BED), e.g. acceptance commitment therapy (Lillis et al. 2011) and mindfulness-based cognitive therapy (Kristeller and Wolever 2010). DBT is an outpatient cognitive-behavioral therapy originally developed by Linehan (1993a, 1993b) for women with extreme emotion dysregulation and recurrent suicidal behavior i.e., borderline personality disorder (BPD). A comprehensive skills-based treatment, DBT integrates change-based behavioral strategies (e.g. problem-solving and contingency management) and crisis intervention with strategies derived from acceptance-based practices such as Zen and contemplation practice (e.g. mindfulness and validation). These strategies are integrated within a dialectical framework, emphasizing wholeness, interrelatedness, and process, and utilizing persuasive dialogue and the therapeutic...

Kelly C Berg and Carol B Peterson

The accurate assessment and diagnosis of binge eating disorder (BED) can have enormous benefits for the process and outcome of treatment as well as clinical rapport (Peterson 2005). Assessment is the foundation of ongoing treatment because it can be used to inform diagnosis, identify treatment priorities, and measure treatment progress and outcome. Moreover, when psychosocial assessments are conducted effectively, the assessment process can facilitate trust, enhance clinical rapport, and reduce the likelihood of attrition (Peterson 2005). The use of structured assessment tools in conjunction with clinical interviews can improve the reliability of self-reported data and ensure that the assessment is comprehensive. Section I Diagnostic criteria for binge eating disorder The Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision (DSM-IV-TR) (American Psychiatric Association 2000) did not formally recognize BED as a full-threshold eating disorder (ED). Rather,...

Debra L Franko Meghan E Lovering and Heather Thompson Brenner

Introduction to ethnicity and binge eating disorder Binge eating disorder (BED), first introduced as a diagnostic concept in the DSM-IV, is characterized by recurrent, uncontrollable eating with little or no compensatory behavior (American Psychiatric Association 1994). BED is the most commonly diagnosed eating disorder (ED) (Greenberg et al. 2005 Hudson et al. 2007) and is associated with serious distress and impairment (Grilo 2003). Unique among the eating disorders is that BED appears to be equally represented across racial ethnic minority groups in the United States (Alegria et al. 2007 Marques et al. 2011), as evidenced by data documenting the high frequency of this disorder among African American, Asian, and Hispanic Latino Americans (Gayle et al. 2004 Mazzeo et al. 2005 Sanchez-Johnson et al. 2003 Striegel-Moore and Franko 2003). However, studies suggest that underrepresented minority groups are less likely to receive treatment for EDs than Caucasians, due to lower...

Jonathan Mond Anita Star and Phillipa

Comorbidity refers to physical or mental health problems that co-occur with a condition of interest. Like most mental disorders, binge eating disorder (BED) is associated with increased risk of other mental health problems, poor physical health, and stigma. However, the strongly aversive nature of uncontrolled binge eating and the strong association between BED and obesity are such that people with BED may be susceptible to high levels of both physical and mental health impairment. Conclusions about the characteristics of people with bulimic-type eating disorders (namely, bulimia nervosa BN , BED and variants of these disorders not meeting formal diagnostic criteria) based on treatment-seeking samples may be particularly problematic, given that many people with these disorders do not seek mental health care (Fairburn et al. 1996 Mond et al. 2007a Wilfley et al. 2001). Further, there is good evidence that for people with bulimic-type eating disorders, like those with other mental...

Marney A White and Loren M Gianini

This case study demonstrates several important themes in understanding patients who struggle with binge eating disorder (BED). Most notably, BED is frequently associated with substantial weight gain, which can lead to obesity and various physical and psychological health problems. This chapter will focus on complications that arise due to concurrent obesity in BED, and will describe treatment approaches for the obese patient with BED. When looking at the demographic profiles of obese people with BED and obese people who do not binge eat, several differences emerge. On average, BED adults tend to be younger than NBO adults (Kolotkin et al. 2004). This difference may be especially pronounced among obese people presenting for treatment. Among obese treatment-seekers, women are about 1.5 times more likely to have BED than men, and this disparity is found in non-treatment seeking populations as well (Spitzer et al. 1992). Therefore, the gender difference in BED is much less pronounced than...

Scott Engel and James E Mitchell

Considerable empirical evidence suggests that severely obese patients seeking bariatric surgery commonly engage in problematic eating behaviors such as over-eating, binge eating, and eating with a sense of loss of control. Additionally, these patients are much more likely to meet criteria for binge eating disorder (BED) when compared to less severely obese individuals who are not candidates for bariatric surgery. Further, binge eating and BED diagnosis have been studied to determine the extent to which these behaviors predict outcome after bariatric surgery. Finally, while post-bariatric surgery patients may not be able to binge eat as they did before surgery because of the limited remaining gastric volume, some evidence suggests that they are at increased risk for other addictive behaviors after surgery. This chapter examines the empirical evidence related to the issues outlined, and discusses relevant conceptual issues to guide clinicians and researchers interested in this area....

Cognitive behavioural therapy CBT

CBT treats emotional disorders by changing negative patterns of thought. It is now well established as a key method of helping overcome psychologically based disorders such as anorexia nervosa. Unlike other therapies CBT is very scientific and its approach suits many anorexics for two reasons In CBT the patient and therapist will work together to identify problem areas such as the patient's belief that he is fat and stupid. His belief that he is fat and stupid is likely to make him feel low in mood and to withdraw socially. As he becomes more and more withdrawn there is no one to challenge his negative beliefs even if they are not at all true and in reality he is very thin and very clever. It is a vicious circle which, over time, lowers the patients self-esteem and leads the patient to seek more and more comfort from his anorexia. In addition negative thoughts tend to lead to negative feelings, which in turn lead to negative behaviour. Here are three examples

No sport and lots of tender loving care

Meanwhile, Joe's condition continued to deteriorate and on 7th March I was back on the phone to our doctor who gave us an emergency appointment that day. He had the results of the blood tests, which were all essentially normal, but Joe's heart rate was still slow and by this stage Joe had virtually stopped going to school because he was so weak. Joe was spending much of each day curled up in front of the TV, doing his compulsive exercising, going for short walks with me in the park and eating enough to keep a sparrow alive. I had learned that there was an excellent eating disorder unit for children at Great Ormond Street hospital, and so I asked if it would be possible for Joe to be referred there for an assessment. The doctor agreed to look into this. In addition, after consultation with another paediatrician, he organised for Joe to have an abdominal ultra-sound scan and x-ray to rule out the possibility of any abdominal abnormality or blockage, that could be causing Joe's constant...

Friends are so important

A welcome break from the highly charged family situation, and help keep some sort of normality in your life. I went to see Monica, who was not only a very good friend, but also the mum's representative for Joe's class at school. Talking to Monica for the next two hours was akin to having a verbal massage. She reassured me that I was doing all the right things and sympathised with the agony we must be going through. Two cups of tea and much discussion later we were on to much more light hearted topics and I felt normality returning to my mind albeit for a short period of time. I gave Monica a letter to distribute to all the other mums in the class. Monica had been inundated with calls enquiring after Joe. Monica was not sure how much to give away, so the easiest thing was for me to write a letter stating all the facts. It seems that there is still a fear of eating disorders and for some it is a taboo subject. As you have all observed, Joe's health has deteriorated dramatically over the...

Trisha M Karr Heather Simonich and Stephen A Wonderlich

About 695,000 children within the United States (US) experience some form of child maltreatment in a given year (Administration for Children and Families 2010). This statistic is limited to cases reported to and investigated by child protective services and is therefore likely to be a gross underestimate. Early studies in the eating disorders suggested that prevalence rates of child maltreatment among eating disordered individuals were higher than those expected in the general population (Steiger and Zanko 1990 Vanderlinden et al. 1993). These observations led to a series of empirical studies over the past 20 years which examined the relationship between child abuse and eating disorders in research designs with rigorous measurement and adequate control groups. The general consensus of these studies has been that child maltreatment, particularly childhood sexual abuse (CSA), is associated with eating disorders, especially when there is a binge-purge component (Smolak and Levine 2007...

What happens at an adolescent unit

In this session we were all given a booklet providing essential and useful information for young people admitted to The Great Barn and their families or guardians. Among other things it described the daily routine, the rules, the staff and what to do if things go wrong. The unit is operated by the local Community Health Care Trust (i.e. part of the NHS) and has live-in space for ten young people who are experiencing some emotional, personal or family difficulties, within the age range of 11 to 17 years. Everyone is encouraged to participate in the day-to-day running of the unit and to share responsibility for domestic duties. The aim is for each patient to stay as short a time as possible before being reintegrated back into his or her normal family and school routine. We were soon to discover that whilst some patients might be admitted for a few weeks, others might stay for many months, depending on the problems they were having and the success of their treatment. When Joe was...

Tuesday 12 March 2002

Joe started moving around his room at 5.30 am. Since his weight had dropped below 36 kg I knew he hadn't been sleeping very well. I am a light sleeper myself and was on a high state of alert to any sounds in the night from my eldest son. His weight had dropped from 42 kg to 32 kg in just four months, and he was in a constant state of agitation and anxiety. We were still awaiting the results from endless blood tests, and had yet to rule out a seemingly endless list of terrible diseases that could be the root cause. I had lain awake night after night considering illnesses ranging from leukemia, and stomach cancer, to thyroid problems, and glandular fever. But in my heart of hearts I knew my son was suffering from an acute case of anorexia, and as every day passed it was taking a firmer grip. find this calmed him down. He couldn't walk very far and we walked slowly, with Joe dragging his left foot along the ground as though he was somehow crippled, but this was just another of the habits...

Therapy therapy therapy

Many people have never taken part in any therapy or counselling sessions and many are very sceptical about the benefits of talking things through with someone who, at least initially, is a complete stranger. However, there is no doubt that one of the most effective and long-lasting treatments for an eating disorder is some form of therapy or counselling, coupled with careful attention to medical and nutritional needs. Ideally, this treatment should be tailored to the individual and will vary according to both the severity of the disorder and the patient's individual problems, needs and strengths. This chapter provides an overview of some of the types of therapy available to young people suffering from an eating disorder. The general aims of therapy for a young person with an eating disorder are to explore the thoughts and feelings that led to the eating disorder As well as one-to-one counselling and psychotherapy, many therapies are used in the treatment of eating disorders. The main...

The youth section of the EDA

The EDA youth team aims to offer help, advice and support to young people who are 18 years of age and under. If you can persuade your son to make contact with the team this could be a first important step towards recovery. The EDA has produced a booklet entitled Information About Eating Disorders, A Guide For Young People. It is a very welcoming introduction to the youth section of the EDA and what it has to offer. It explains what eating disorders are and how to get help. It also gives information on a young person's entitlement to confidentiality. Importantly it contains several pictures of young boys acknowledging that boys get eating disorders too YoungMinds is a national charity committed to improving the mental health of all children and young people. YoungMinds produces leaflets and booklets to help young people, parents and professionals to understand when a young person feels troubled and where to find help. YoungMinds have recently published a booklet entitled Worried About...

The first parentscarers meeting

Naturally we ended up talking to the parents of two anorexic girls who had been at The Great Barn for several months already. They had very similar stories to tell. Both families had found it extremely difficult when the girls had been allowed home. They explained that the girls became very nervous and agitated when they left the restrictive boundaries of The Great Barn for the first time. It became even more difficult once the girls were allowed to have meals at home and that that is when the battle against anorexia really begins. Can your child manage to eat a proper meal in a normal family environment At The Great Barn they have no choice. They sit at the re-feeding table supervised by two members of staff and there is the peer pressure of seeing other patients with the same illness eating their meals without a fuss. It is a very different scenario at home and both sets of parents relayed stories of the various battles they had had and the tricks that the girls had played to try to...

Suggested Reading List

There is so much written about eating disorders in general that when you first look you don't know where to start. My child psychiatrist made a couple of recommendations and I found the EDA list very useful (see below). Understanding Eating Disorders (Dr Bob Palmer, The British Medical Association) - you can buy this in most chemists, it is one of the 'Family Doctor Series' and provides an excellent introduction to the world of eating disorders. Anorexia and Bulimia (Dr Dee Dawson, Vermilion) - this is a parent's guide to recognising eating disorders and taking control. Dr Dee Dawson is Director of Rhodes Farm, the London clinic that has helped hundreds of children with eating disorders. This book provides lots of useful information about eating disorders and treatment options. It also describes what to expect from a specialist in-patient unit. This book prepared me for all the horrors of anorexia and gave me hope that we as a family would pull through it. Anorexia and Bulimia in the...

Returning to normal life

Unfortunately it is not quite as simple as that. The process of recovery from anorexia is very complex and often quite lengthy. It's a little like learning to drive. You have an intense period of driving lessons, you learn the highway code inside out, you know that lots of people fail their test at the first attempt and you are delighted when you pass at the second attempt. However, you don't really learn to drive properly until you are out on the road on your own. The driving lessons and the test have prepared you for many eventualities, but once you are out on the road on your own you suddenly find yourself being faced with many different situations that you haven't seen before. You have to use your common sense and instinct to know how to react. Occasionally you might make a mistake, but within a year of driving on your own you are likely to be a much more competent driver. Recovering from anorexia can be a similar process. Each case is different and every family is different so...

What are the specialist treatment options

Each case is different and there are many different treatment options. What is clear is that the earlier anorexia is recognised and treated, the quicker and less painful the route to recovery. Most patients may be successfully treated as out-patients, using some form of counselling approach and lots of family support. Depending on where you live and your son's physical and mental state your GP might refer your son to a Paediatricians are medical doctors who specialise in diagnosing and treating illnesses in children and teenagers. The paediatrician will be able to give your son a thorough check-up and assess whether his eating disorder has caused, or is likely to cause, any medical problems. The paediatrician can also carry out a wide range of other tests to rule out any other illnesses. Once the paediatrician has diagnosed anorexia he is likely to refer your son to a child psychiatrist for further assessment. If your son is very ill he might recommend an emergency in-patient...

No room at the adolescent unit

Made him feel very full and uncomfortable, and he explained that after eating or drinking he felt absolutely compelled to exercise to get rid of the bloated feeling. While Dr Cornwall listened very carefully to Joe's responses, she also made a note of his outward appearance. His fingernails were very bitten and the skin on his hands was very dry. During the meeting he chewed on his nails and knuckles constantly. She noted that he had fine lanugo hair on his arms and face. During the meeting he also displayed obsessive tendencies he was counting constantly on his fingers, moving his leg up and down, and had an alternate blinking tic of each eye. Of course these are all classic signs of anorexia and severe malnutrition. after his long trip, and very worried about Joe. All I could say was that I was doing everything in my powers to get Joe back on the road to recovery and that I hoped that my ex husband would support me, rather than fight me in achieving that aim. Steve had clearly been...

Mummy they keep you here too long

Joe had come to sit with me because he wanted to address the issue of how much weight he would be expected to put on. I simply didn't have an answer for this question as the dietician had not yet come up with a target weight for Joe. This would be done over the next few days. Joe said he knew that he had to put quite a lot of weight back on to be healthy, but was clearly worried that he might be forced to put too much weight on. At this stage he hadn't realised that many of the patients had illnesses other than eating disorders.

Living with an anorexic boy

The Preface describes a day in the life of our son when anorexia had taken over his life. He was obsessed with rituals, he could only eat and drink tiny amounts, he could hardly walk up the stairs and he couldn't think straight. One day is bad enough but when it goes on day after day you start to think your life is never going to return to normal. Luckily my husband was extremely supportive, but I could see the effect it was having on my younger son. He was becoming more and more withdrawn and his schoolwork was suffering. His school knew about the problems at home but they couldn't do anything to improve his concentration at this difficult time. As a family we felt incredibly isolated having an anorexic boy in our midst. Everyone knows about teenage girls getting anorexia, but don't understand that boys can suffer too. I scoured the Internet for books, but I couldn't find any literature on eating disorders in teenage boys. I found some American books about eating disorders in men,...

Involvement of parentscarers in the treatment of young people

Before describing the specialist treatment options it is worth considering the issue of how involved parents carers should be in the treatment of young people with eating disorders. All too often parents are actually excluded, or feel that they are being unnecessarily excluded, from their child's treatment regime and the EDA help-line receives many calls from frustrated parents on this subject. Different therapy teams have different views on how involved parents should be. In particular, therapy teams who are not used to dealing with young people with eating disorders may not appreciate how important it is for the family to be involved in the treatment and recovery process. Some therapy teams hide behind the issue of confidentiality and seek to exclude the parents in order to protect their patient's confidentiality. The NICE guideline supports involving families and carers, but it does point out that every individual has rights of confidentiality. Young people with eating disorders...

My other child has become very withdrawn

This is a natural response to a sibling's anorexia and my younger son did exactly this. Siblings will probably notice at an early stage that their brother is not his usual self. They will probably have picked up that their mother is anxious and their father is cross. They may also feel that the anorexic son

Help if your son is an athlete

In recent years there has been a growing recognition that young athletes can be susceptible to developing eating disorders. Certainly Joe felt that if he restricted his diet he would become an even better athlete. The EDA, in conjunction with the Runner's World Buddy Scheme, has put together a series of leaflets on eating disorders in athletes, which are available from the EDA. There are three leaflets in the series aimed at

Dysfunctional family situation

Not surprisingly, at a later stage, many observers also suggested that Joe's illness was caused by the fact that we were such a complicated family. Of course family issues are extremely important when trying to establish triggers for an illness like anorexia, and what did become clear later on was that Joe felt immense pressure being the eldest child in a complex family situation. Not only did he have to deal with his very excitable and sometimes challenging younger brother Tom, but also with his three younger stepsiblings every other weekend and his two younger half siblings whenever he visited his father. Joe must sometimes have felt that all these younger children were grabbing all the attention, leaving him to fend for himself as he entered that very confusing prepubescent stage. It is important to note however that anorexia is not just a feature of complex family situations. Anorexia can also affect children from all types of family situation.

Effects on the family

Anorexia is a very manipulative illness, and families that try to ignore its existence can soon find that the anorexia is controlling the lives of all the individuals within the family. By working together, a family unit can be very successful in taking control of the anorexia and helping the sufferer overcome his difficulties with eating. I mention later on that family therapy often forms a key part of a successful treatment programme. The main carer is very often the mother, but could be the father, an older sibling or another close relative. For the purposes of this section I have assumed it is the mother. It is likely that the main carer will have been proactive in finding out more about eating disorders, and whilst this has inevitably created a feeling of panic, she is more able to understand the feelings her son might be having. This may not be the case for other members of the family. Because all families are different I cannot cover every possible effect that anorexia is...

Angry Anna and Raging

We all felt that the most important thing was to keep calm and to be consistent in terms of response. There was absolutely no point in making promises you couldn't keep. There was no point being angry or shouting back. Sometimes it was worth pointing out how hurtful or unreasonable the child was being and very often this led to some sort of apology later on. We all agreed it was very important to let the child know that you loved them very much, but that you didn't like the effect anorexia was having on them. We all agreed that however much you knew your child was going to be unreasonable and aggressive, it didn't make it any easier to cope with. Sessions such as these parent carer meetings are very useful, but it is

Our second parentscarers meeting

The other two girls had still not reached their target weight and their parents fully expected their daughters to be at The Great Barn for some time to come. We talked about several things during the course of the meeting, but the two issues I found most useful that we discussed were the anger and aggression of anorexia, and family therapy.

Joes first weekly review

After the carers' meeting, Amanda talked James, Steve and me through Joe's first proper weekly review. These occurred every Wednesday and the patients were often very nervous about them. Each patient's consultant, case manager and key worker would meet to discuss his or her progress. Those with eating disorders would be weighed and decisions would be made about such things as observation levels, bed-rest, appropriate activity levels, home visits etc. Joe had missed his review meeting the previous week because he had been rushed back into hospital, so this was a big day for him.

Discussion

After the meeting I reflected that recovering from anorexia was a bit like learning to drive. Joe had done everything he needed to do to pass his test and to be let out on his own. In the next few months he would face many new challenges and would have to learn to cope with difficult situations that he hadn't faced whilst in the security of The Great Barn. We would support him as best we could. It felt as if we had been preparing for this day for a long time. Now we, as a family, were about to face the real test. Could we prevent Rex from rearing his ugly head in our house again

Chevese Turner

A radio interviewer asked me if it is true that a majority of Americans have binge eating disorder. Surely , the interviewer speculated, if we have an obesity epidemic in our country and around the world, then binge eating disorder must be rampant. Another common conversation takes place during Binge Eating Disorder Association (BEDA) outreach and educational work. People usually say something like this I definitely have an eating disorder. I eat too much and love food. I am an emotional eater and I need to stop. They usually goes on to inquire how BEDA can help them stop overeating and usually there is a request to suggest a diet and exercise regime that will result in permanent weight loss. Clearly there are multiple layers of misunderstanding and complexity around this particular eating disorder that must be addressed. Emotional and overeating are not BED. The general public is uneducated about eating disorders in general and even further behind the curve when it comes to what...

Marian Tanofsky Kraff

Loss of control eating is one of the most commonly reported eating disorder behaviors among children and adolescents. Given its associations with adiposity, psychosocial impairments such as depression and anxiety symptoms, and the development of exacerbated obesity and full-syndrome eating disorders, this behavior is of considerable public health significance. Loss of control (LOC) while eating refers to the sense that one cannot control what or how much one is eating (American Psychiatric Association 2000), and may or may not be accompanied by the consumption of unambiguously large amounts of food (i.e., binge eating). LOC eating is among the most commonly reported eating disorder behaviors in children and adolescents (Goldschmidt, Aspen et al. 2008). Youth reporting LOC eating often present with psychosocial impairments (Glasofer et al. 2006 Goldschmidt, Jones et al. 2008 Tanofsky-Kraff et al. 2004) as well as obesity and excess body fat (Tanofsky-Kraff et al. 2004). Moreover,...

Lynn Grefe

With the addition of Binge Eating Disorder (BED) to the Fifth Edition of the Diagnostic and Statistical Manual of Mental Illnesses (DSM-5) (American Psychiatric Association 2012), I am cautiously reminded of that kind of misinformed thinking which dangerously conflates two very different issues. We as a field face the challenge of showing the distinction between a serious mental disorder diagnosis of BED, and the much-debated weighty problems of an obesity epidemic (our society's words, not mine). The distinction is a whole lot more than lipstick, with many people already confusing a mental health problem with a weight status. In 2012, I attended the conference of the International Association of Eating Disorders Professionals (iaedp) in Charleston, South Carolina. Hundreds of clinicians specializing in eating disorder treatment were there to receive information and updated training, inspiration and, of course, the support and hope we all share for better outcomes among those...

Amy Pershing

Binge Eating Disorder (BED) has myriad causal factors. Biology, genetics, weight stigma and weight-related bullying, cultural pressures to be thin, a history of trauma, and family dynamics may all play a part. We know, too, that the specific combination of these factors varies a lot from person to person. Clinically we see some specific psychological factors that present with particular frequency in the adult population of patients with BED. Problematic attachment styles and an inability to set and maintain appropriate relational boundaries are often of particular concern. Somatic disconnection and dissociative behavior is also common especially for survivors of abuse, powerful feelings of shame may elicit use of food to disconnect. In these cases, BED is often a powerfully protective mechanism, and one that patients quite wisely do not give up easily. In the therapy office, BED patients often present with exceptional affective attunement to other . Where some eating disorders can be...

Carrie Arnold

When I began treatment for my eating disorder, I didn't know that science had a place in my therapist's office. My therapist's office held the therapist (obviously), me, a couch, and maybe a few bookshelves. None of the therapists I saw mentioned the research that supported their recommendations - not that I would have listened, anyway, not with my eating disorder firmly in charge. Science was for academia, for people in white lab coats. Strange things like Tukey's post-hoc test and ANOVA (Analysis of Variance) didn't seem to have anything to do with my recovery. Although I didn't suffer from BED, many of the thoughts and feelings that accompanied my eating disorder were eerily similar to many of the BED sufferers I have met. Many of the eating disorder symptoms I found distressing - the constant obsession with food, feelings of hopelessness, and loss of self-worth -were as much a result of the disorder as they were a cause of behaviors. Treat the eating disorder, I found, and the...

What to look out for

As I have already mentioned, one of the key difficulties in diagnosing anorexia in boys is that lots of boys go through extremely skinny phases whilst maintaining a healthy appetite. If you suspect that your son is suffering from an eating disorder, it is an invaluable exercise to note down any changes to his behaviour however small they might seem at the time. As the weeks go past you may well forget that he didn't used to have some of these funny habits. Another key difficulty is that many of the changes in behaviour could easily be caused by the onset of puberty. However, as the list starts to grow you will soon sense that something else is having a profound effect on your son.

Treatment options

The UK Government confirmed its commitment to providing better treatment services for eating disorder sufferers when it commissioned the National Institute for Clinical Excellence (NICE) to produce guidelines for the treatment of eating disorders, based on the best available researched evidence and expert opinion. The guideline was published in January 2004 and has set the standard for NHS treatment. Whilst there are still huge variations in the availability of specialist treatment in different areas around the country, this was a major step forward in establishing acceptable treatment regimes for eating disorder sufferers. I refer to the guideline throughout this chapter. There is a wide range of treatment options. While many young people with anorexia respond well to out-patient care, in-patient care is necessary when an eating disorder has led to physical problems that may be life-threatening, or when an eating disorder has reached a level where psychological or behavioural...

The first diagnosis

The paediatrician was very professional and we quickly ran through Joe's background. Having established the history he undertook a full medical examination of Joe. Joe's weight had indeed plummeted to 32.6 kg (5 stone 2 lbs), now just above the 10th centile on the weight charts, whilst his height of 149 cm was exactly on the 50th centile. In addition his blood pressure of 70 40, and his pulse of 60 were both abnormally low. The paediatrician felt that Joe was indeed exhibiting features of anorexia, but we both agreed that other possibilities should be excluded. This involved taking blood, to which Joe's reaction was extreme. He became very tearful and upset as soon as the mention of a blood test was made and when the needle was inserted he became almost inconsolable. He sobbed and sobbed as the blood was being extracted, saying it felt like his life was being sucked out. He was genuinely petrified and clearly thought that this simple procedure could kill him.

Support groups

In Chapter 7, I gave details of the services provided by the Eating Disorder Association. The EDA website contains a list of support groups run by volunteers. Many of these groups offer support to carers as well as to the sufferers. There may also be other carer support groups in your local area,

Selfhelp

In the preceding chapters I have described living with an anorexic boy and the effects on the family, and offered some practical tips that you might try when dealing with all the stresses and strains that anorexia has brought into your home. You and your family are probably feeling exhausted and isolated by your son's illness. However much your wider family and friends want to help, they cannot really understand what you as a family are going through if they have no direct experience of anorexia itself. Undoubtedly some of you will have been subjected to well-meaning comments such as These comments might be well-meaning but they can be very upsetting when you know deep down that there is something much more serious wrong with your son. It is at this stage that you might consider seeking outside help from people who have a great deal of experience with eating disorders. Help can come from many sources, but basically comes under two headings The Eating Disorder Association (EDA) is the...

Selfhelp for carers

The EDA and other self-help organisation also offer a wide range of services for carers of young people with eating disorders. I include more on this in Chapter 11, Caring for the carer. There are other self-help organisations that you might like to contact, such as Anorexia and Bulimia Care (ABC). It is a Christian organisation run by Christians for sufferers, their families and for carers in the UK. You can visit the Anorexia and Bulimia Care website at www.anorexiabulimiacare.co.uk

Personal accounts

There are many books written about girls who have suffered from anorexia. I found these two gave me the most insight into the complexities of the illness and what my son was feeling as he became ill and then embarked on the long road to recovery Anorexic (Anna Paterson, Westworld International Ltd.) - Anna suffered from anorexia for 14 years. She is very clear that it was triggered by her abusive grandmother. It is a harrowing story of a young girl's fight for survival and the effect on her family. This book gives hope to families who have been coping with anorexia over a long period of time. The Best Little Girl in the World (Steven Levenkron, Puffin) - this is a fictional book written by one of the foremost experts on anorexia in the USA. It describes how an outwardly happy and well-balanced child can actually be feeling very lonely and left out by the demands of other children within the family.

Other approaches

There are also many other therapies available if your son finds he is not suited to the ones mentioned above. For example, the National Institute of Clinical Excellence (NICE) published guidelines in January 2004 which advocated several psychological treatments which have been successfully adapted for anorexia nervosa including

Family therapy

Most professional experts in the field of eating disorders in young people will agree that family therapy is one of the most important ways of combating the disease. Our first family therapy session had been booked for a couple of weeks' time. Two of the families represented in this parents carers' meeting had undergone several sessions and so I was intrigued to hear their views. Both families had found the first session very awkward, they didn't know what was expected of them and naturally felt a little defensive. One of the Dads said he came out of the first session and realised he had spent the whole session apologising to his daughter for a whole range of things that were part of his everyday life. These included leaving early for work, going on business trips, watching sport on TV and occasionally playing golf at the weekend. Having thought about it afterwards he realised that his daughter was crying out for more attention from him. Both families agreed that family therapy was a...

Exercise

Joe was a very sporty and active boy before he developed anorexia. At the beginning he felt that if he ate a little less and did a little more exercise he would become an even better sportsman. However, after a few weeks he became obsessive about exercising more and more. He insisted on going to every after school activity which involved exercise. He was particularly keen on swimming club and athletics club because he could work really hard in them. Initially, his swimming and athletics coaches were both very pleased with the results he was achieving. However, within a few weeks they both became concerned about his rapid weight loss and his obsessive determination to do better and better. A month later Joe had become so weak he couldn't carry on with these clubs, but he soon replaced his sporting activity at school with repetitive exercise at home. On a typical day he would do

Clothes

It is clear that anorexics hide their bodies beneath their clothes. Many parents of severely anorexic children have been fooled by this tactic and the child's anorexia has been allowed to develop unchallenged. Remember, the earlier the illness is diagnosed, the recovery is likely to be easier and more successful. Don't fall into the clothes trap yourselves.

Caring for the carer

There is no doubt that caring for an anorexic child is an incredibly stressful experience. Caring for any sick child is stressful, but in most cases the sick child wants to get better and will happily go along with the appropriate treatment programme. On the other hand anorexia is a mental illness and it is one where diagnosis is difficult and denial is a common feature. The child might refuse to accept there is anything wrong. Even if he does accept he is ill he may have no desire to get better. In fact the idea of putting on weight and eating normal meals probably petrifies him and faced with this prospect he can be extremely difficult and irrational. The rest of the family is all affected in some way. The stress of dealing with this scenario can be compared to It is important that the carer(s) finds ways of coping with this stress, because if the carer(s) breaks under the strain the son is almost certain to succumb to the anorexia and the anorexia is likely to take control of the...

Can anyone help us

We went straight to the chemist to pick up the prescription and whilst we were there I also purchased a booklet published in association with the British Medical Association entitled Understanding Eating Disorders. Of course nothing had been diagnosed at this stage but I was very well aware that, for some reason, my son was finding it increasingly difficult to eat. It very quickly became clear that the Fresubin wasn't going to be the answer to our problems. Joe saw it as an alternative, rather than a supplement, and so would either attempt to eat a meal or drink the Fresubin, but never both. In contrast the booklet on eating disorders was very useful and gave me some insight into what we might be dealing with if Joe was eventually diagnosed as having anorexia. It stated that whilst only one in ten or fewer of people presenting with an eating disorder is male, the balance between boys and girls is less skewed in the youngest sufferers, that is those in their early teens or even...

Authors Note

It is common knowledge that eating disorders, and in particular anorexia, are a girl thing, and we have all read articles containing startling facts such as One in 20 women will suffer from an eating disorder in their lifetime. In Britain, anorexia and bulimia have reached catastrophic levels. Of course it is also logical to assume that men and boys are not totally immune, but how many incidences of male eating disorders have you heard of Certainly up until my son was afflicted I hadn't ever heard of any examples. It turned out neither had my GPP any of the teachers at my son's school, nor any of my friends or work colleagues. So it was a huge shock when my 12-year-old son started to disappear before my eyes. He was a gifted child, in the streamed class at school, and a great sportsman representing the school at football, his main passion, as well as cross-country, athletics, rugby, cricket and swimming, and he was very popular with his peers at school. His anorexia developed...

Binge eating

Like bulimia, this eating disorder has only recently been recognised by the medical community. It is also called compulsive overeating. Like bulimics, someone suffering from binge eating will binge uncontrollably. However, they will not purge themselves afterwards despite the fact that they experience the same feelings of disgust and self-loathing at what they have just done. Some sufferers graze on high calorie foods throughout the day, but don't eat very much at normal mealtimes. As with most other eating disorders, binge eaters tend to have low self-esteem and are unhappy with some aspect of their lives. These are some of the things to look out for if you suspect your son might be suffering from binge eating disorder Being overweight has many implications for long-term health. The most obvious are heart disease and diabetes. If you suspect your son has a binge eating disorder you should contact your GP who may refer your son to a specialist for treatment or may suggest that the...

An early starter

In the special care unit Joe had seemed quite big compared to some of the other prem. babies, but when we got him home he suddenly seemed so tiny and helpless. I was very nervous to begin with, but the nurses at the hospital had trained me very well in the art of looking after a prem. baby. In no time at all Joe was as strong, healthy and active as any baby that had been born full term. Little did I know that the effects of being born prematurely could manifest themselves much later in life. There is evidence that prem. babies are significantly more likely than full term babies, to suffer from behavioural problems, including eating disorders, in their later years.

About men

There are very few books about eating disorders in men, although this is changing and I was delighted when Fit to Die was published in 2004. These are the books I would recommend Fit to Die (Anna Paterson, Lucky Duck) - in this book the author draws the reader's attention to the characteristics of and special difficulties for men with eating disorders. If this book had been around when my son was ill I would have felt a lot less lonely and less guilty about my son having developed an eating disorder. I would also have been more prepared as a carer for a male sufferer to cope with the ups and downs of my son's illness. Making Weight (Anderson, Cohn & Holbrook, Gurze Books) - this book is written by three of the leading experts on eating disorders in males in the US. It describes the explosion in the numbers of men with eating disorders, body image conflicts, compulsive exercise and obesity. This book examines why men have become affected by such issues and what to do about it. Eating...

A lean Christmas

About two weeks into the trip Joe's father called me and said that they were worried about Joe's eating habits. He seemed to be pushing his food around the plate and was more interested in going for a run than eating a proper meal. It was difficult for me to respond to this because I couldn't actually see how Joe was behaving, so I gave what I thought was the best advice I could in the circumstances. Obviously keep an eye on things, but don't make too much of a fuss about it, as it could blow up into an even bigger issue. I suppose I thought at the time that Joe was being a typically difficult prepubescent boy, who perhaps didn't particularly like the food being served to him. He had said in the past that when he visited his father the food portions were always enormous, with cooked breakfasts and rich puddings being the norm rather than the exception. Little did I realise that Joe was virtually starving himself, whilst also running himself into the ground, and that his father and...

Scott Crow

I'm a 45-year-old woman who presented for treatment of BED at a multi-disciplinary eating disorder treatment program. I began engaging in episodes of binge eating in the seventh grade. About three times a week I eat a large amount of food with loss of control, usually in secret. I don't have a history of purging, except for brief experimentation when I started college. I have begun psychotherapy sessions and have been working with a dietician about two months prior to this latest medication evaluation. I feel my relationship with food has improved substantially, and the amount of time I spend thinking about eating, weight, and shape-related issues has diminished somewhat. The frequency of eating binges has gone from four or five times a week down to three a week, but I believe this has plateaued. Medications provide one potential treatment approach for BED. As with other eating disorders, medications play a less prominent role than psychotherapy and or changes in nutritional patterns....

What other factors are used to determine if a person is a good candidate for bariatric surgery

With regard to emotional health, people with a history of anorexia nervosa are generally not considered good candidates for this surgery. Likewise, uncontrolled bulimia (self-induced vomiting, typically following binge eating) is generally a contraindication for bariatric surgery. If you have had an eating disorder in the past but have been well controlled for a long time, your doctor may consider you a good candidate.

Indications Horseradish

Abrasion (f HOO) Allergy (f1 LIB PED) Alzheimer's (1 COX X15231456) Anorexia (f APA DEM) Arthrosis (f1 APA BGB CAN COX X15231456) Asthma (f1 BGB DEM FNF) Atony (f FEL) Bacillus (1 X10548758) Bacteria (12 HHB HH2 KOM X17260672 X10548758) Bronchosis (f12 APA PHR PH2 SKY X16618018) Bruise (f HOO) Cancer (1 FNF JLH) Cancer, abdomen (f1 FNF JLH) Cancer, breast (f1 FNF) Cancer, colon (f1 FNF JLH X15231456) Cancer, liver (f1 FNF JLH) Cancer, nose (f1 FNF JLH) Cancer, spleen (f1 FNF JLH) Cancer, stomach (f1 FNF JLH) Cancer, skin (f1 FNF JLH WO2) Catarrh (1 KOM PHR X17260672) Chilblain (f GMH) Cholecystosis (f PHR PH2) Cold (f1 DEM SKY) Colic (f APA PH2) Congestion (f1 APA) Cough (f12 GMH PHR PH2) Cramp (f1 HHB WIN) Cystosis (1 LIB PHR) Debility (f BOW) Dental Plaque (f FAD) Diabetes (f DEM LIB) Dropsy (f FEL GMH HHB) Dysmenorrhea (f DEM) Dyspepsia (f PHR PH2 SKY) Dysuria (CAN PED fi PHR) Edema (f BGB CAN) Enterosis (1 PH2 WO2) Epistaxis (f HOO) Escherichia (1 HH2 X17260672 X10548758) Fever (f...

Carpenter Karen 195083

In 1983, at the age of thirty-three, she died of heart failure. This was both alarming and eye-opening for the public who thought that since she had gained weight, she was healthy again. Her dieting, highly visible weight loss, and dramatic death in 1983 drew anorexia nervosa into popular discourse and shaped the ways in which eating disorders continue to be represented and understood. Carpenter's death was a major catalyst for the constitution of eating disorders as a public health issue (Brumberg 1988 Young 2006). Rapidly following her death, media coverage boomed and other celebrities came out about their eating disorders. This moment marked the dawn of support groups and specialized clinics for eating disorders (Young 2006). With public knowledge and acceptance of the disease anorexia nervosa came funding for treatment and research into the causes of the disease. Carpenter's death came at a time when the after-school special on television could be used...

Alexander P Nagle Indications

Appendectomy is indicated in patients for acute appendicitis. The patient's history and physical examination remain the most important aspects of diagnosing acute appendicitis. However, the common signs and symptoms such as fever, anorexia, and right lower quadrant pain are often absent up to 33 of patients have an atypical presentation. Diagnostic accuracy varies by sex and age. The diagnosis of acute appendicitis may be difficult in women of childbearing age because symptoms of acute gynecologic conditions may manifest similarly. In selected clinical settings, a CT scan can improve the diagnostic accuracy up to 95 .

Other Clinical Characteristics

Anorexia nervosa is more frequent among daughters of white, affluent, achievement-oriented families in developed societies it is extremely uncommon in areas of the world with poor nutrition. It tends to occur during the last years of high school or at the time of departure to a university or college. The onset of anorexia nervosa is usually subacute, over a period of weeks, not uncommonly after an episode of weight gain or after somebody has made a comment about the patient being overweight. Initially, it appears as an innocent attempt to lose weight, but soon thereafter it starts showing its rebellious and progressive nature. Anorexia nervosa appears in small epidemics in cities and countries, probably owing to social pressures and to imitation behaviors. In primary or classical anorexia nervosa, patients lose weight by dieting (restrictive) and exercising. These patients tend to be younger, more naive, introverted, and obsessive, and they do not resort to subterfuges to lose weight....

Nutritional Treatment

Initially, oral intake should be monitored carefully with a nurse sitting through the eating period and for 30 min thereafter to prevent postprandial vomiting. The tray should be checked for any food not consumed. In this way, a careful energy count is obtained daily. If the energy intake is inadequate or if the patient is not gaining weight, the diet should be supplemented with low-residue, high-energy canned formulae dispensed by the nurse during medication rounds. These diet supplements should be consumed in front of the nurse. Many patients with anorexia nervosa have subclinical vitamin deficiencies and they should receive a multivitamin tablet every day.

Selection of Treatment for Specific Patients

Eating disorder and obesity history A history of early onset of binge eating, binge eating in the absence of obesity, or obesity in combination with numerous bouts of weight loss and regain over time ('yo-yo' dieting) suggests a course of psychosocial treatment. Such patients can be reassured that significant improvements in the aberrant eating and eating disorders psychopathology associated with BED can be obtained without weight loss. On the other hand, clinical experience suggests that patients who report adult onset of binge eating and obesity, and do not have a history of marked weight fluctuations, may be more likely to benefit from a behavioral weight control approach. Behavioral weight control may also be indicated for patients who remain overweight after a trial of eating disorders treatment. Although behavioral weight control appears to be beneficial on average, it is important for each individual to evaluate the likelihood that he or she will be able to sustain lifelong...

Immune Deficiency Including Human Immunodeficiency Virus

The immune system plays a pivotal role in ensuring homeostasis is maintained within the system. The immune-deficient child is susceptible to common gastrointestinal infections that can occur in the immune-competent host however, chronic enteropathy in immunodeficiency is characterized by recurrent, persistent, severe unusual and opportunistic infections with subsequent secondary malabsorption and maldigestion states. The immune-deficient child with persistent diarrhea often rapidly spirals into a cycle of anorexia, inadequate dietary intake, catabolic losses to combat infection, and catabolic losses from the gastrointestinal tract (fig. 1). Micronutrient and general malnutrition are key risk factors for as well as consequences of many chronic enteropathies resulting in well-defined impairments of immunity. The combination of immunodeficiency, malnutrition, and chronic enteropathy and their mutually reinforcing properties is a major global cause of childhood morbidity and...

The Cycle of Malnutrition and Infection

Conversely, infection can affect energy requirements and appetite, and can lead to weight loss in adults and growth faltering in children. This occurs through a simultaneous increase in energy requirements during the acute phase response of an infection, anorexia (primarily mediated by inter-leukin (IL)-1 released by infected macrophages), physical loss of nutrients from the intestine, and malabsorption. The resulting deterioration in nutritional status is associated with additional mucosal damage, which can in turn further prolong and increase the severity of the infection as well as leaving the individual susceptible to further pathogenic invasion, thus bridging the vicious cyclical relationship between malnutrition, impaired immunity, and infection.

The Effect of Infection on Nutritional Status

The acute phase reaction is mainly driven by cyto-kines produced by infected leucocytes. Interleukin-1 (IL-1) is the primary mediator of the acute phase response and stimulates endocrine changes that lead to amino acid mobilization as well as the initiation of anorexia (loss of appetite). This can be compounded by physical discomfort associated with eating or swallowing that can occur in certain infections. For example, dehydration due to diarrhea can lead to mouth dryness, and opportunistic oral infections may occur following acute infections. Nutritional intake can be further reduced as a result of the cultural practice of withdrawal of food from individuals with signs of infection (such as fever or diarrhea).

Gavril W Pasternak

NALTREXONE IN TREATMENT OF DRUG DEPENDENCE Naltrexone (brand names TrexanR, ReviaR U.S. , NalorexR France, U.K. ) is a synthetic antagonist of opiate (morphine-like) drugs, which blocks their actions without itself having any opiate effects. Naltrexone differs from most other pure opiate antagonists in having a relatively long duration of action (at least 24 hours) and being effective when taken by mouth. These characteristics have led to its clinical use as a long-term or maintenance treatment for OPIATE and Opioid dependence after detoxification. Naltrexone is also being studied experimentally as a possible treatment for cigarette smoking and eating disorders, and was approved in 1995 for treatment of alcoholism.

Bone Mass Acquisition

Nutrition Increasing dietary calcium intake during childhood and adolescence is associated with a greater bone mass gain and a higher peak of bone mass. The skeleton seems to be more responsive to an increase in calcium intake before the onset of pubertal maturation (18). Benefits are more marked in the appendicular than the axial skeleton. Among other nutrients, protein intake is especially important (19). During the period of growth, inadequate energy and protein intake can affect bone development. Low protein intake also reduces the production of IGF-1. During adolescence, a relative deficiency in IGF-1 may result not only in a reduction of bone longitudinal growth but also of cross-sectional growth. Young people affected by anorexia nervosa or other forms of eating disorders are at high risk of osteoporosis, also because they may have severe calcium, protein or energy (caloric) deficits.

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