Eating Disorders - June 2012

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"Eating Disorders" is presented by Dr. Carl Christensen, MD, Ph.D.; Addictionologist; and Lori Perpich, LLP, MS Clinical Behavioral Psychology; cognitive behavioral therapist and EDEN program facilitator. This program examines the evidence that eating disorders are true biopsychosocial diseases, similar to chemical dependency. It defines various eating disorders and their consequences, explores neurobiological theories of addiction, discusses screening tools used for eating disorders, and provides information on treatment options and resources for eating disorders. This program is part of the Dawn Farm Education Series, a FREE, annual workshop series developed to provide accurate, helpful, hopeful, practical, current information about chemical dependency, recovery, family and related issues. The Education Series is organized by Dawn Farm, a non-profit community of programs providing a continuum of chemical dependency services. For information, please see http://www.dawnfarm.org/programs/education-series.

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  • EATING DISORDERS 6 23 09 We have never had an epidemic like this that we have been able to track so thoroughly and see. As I told you, this is conservative. About 60 million adults, or 30 percent of the adult population, are now obese, which represents a doubling of the rate since 1980.
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  • Eating Disorders - June 2012

    1. 1. Eating DisordersJune 26, 2012 Carl Christensen, MD PhD Pain Recovery Solutions, Ann Arbor Mi Depts of OB Gyn & Psychiatry, WSU cchriste@med.wayne.edu
    2. 2. “My War With Food Addiction” “Some people fight battles with guns and tanks, others use spoons and kitchen utensils. I remember the Battle of the Bulge. The Ponderosa Salad Bar suffered a six-plate defeat. I remember a war with a chocolate Easter bunny. In the middle of the night, I bit its head off. I admit it. I was a food addict. My life was controlled by food. Moderation was never my strong point. EATING DISORDERS 06 22 10 2
    3. 3. “My War With Food Addiction” When it came to ice cream, one scoop was never enough. I once ate a two-and-a-half gallon tub of maple walnut ice cream. It almost froze my stomach. To make matters worse, it was my roommate’s ice cream! I felt so badly afterwards that I put a 12-foot chain through the handles of the refrigerator and cupboards and told my roommate, "heres the key to your food." He wasnt impressed.”  Tom McGregor, “Eating in Freedom” EATING DISORDERS 06 22 10 3
    4. 4. Step Two: Overeater’s Anonymous “We have driven miles in the dead of night to satisfy a craving for food. We have eaten food that was frozen, burnt, stale, or even dangerously spoiled. We have eaten food off of other people’s plates, off the floor, off the ground. We have dug food out of the garbage and eaten it.” EATING DISORDERS 06 22 10 4
    5. 5. Step Two: Overeater’s Anonymous “We have frequently lied about what we have eaten-lied to others because we didn’t want to face the truth ourselves. We have stolen food from our friends, ….we have also stolen money to buy food. We have eaten beyond the point of being full, beyond the point of being sick of eating. We have continued to overeat, knowing all the while we were disfiguring and maiming our bodies.” EATING DISORDERS 06 22 10 5
    6. 6. Anorexia “I don’t see what they tell me they see in the mirror. My cheeks are too full, my hips and thighs are too wide and round, my arms carry too much fat and my stomach bulges. Looking in the mirror is a daily torture that I allow myself, because who can resist the temptation of that reflective sheet of glass? Of glimpsing who they think they are? EATING DISORDERS 06 22 10 6
    7. 7. Anorexia I am afraid. Someone please tell me there is a better way, because I just don’t know where to turn or what to do. I am fifteen, and I will join the ranks of those who call themselves anorexic.”-Anonymous EATING DISORDERS 06 22 10 7
    8. 8. Tonight’s talk What is an eating disorder? Are eating disorders addictions? What is addiction? What parts of the brain are involved? What is obesity? What are the consequences of eating disorders? How are eating disorders treated? What about medication? Brain scans: the lights are bright, but nobody’s home…… Where can I get help? EATING DISORDERS 06 22 10 8
    9. 9. “…..he’s very depressing” (2007) EATING DISORDERS 06 22 10 9
    10. 10. “I left tonight entirely without hope” (2011) EATING DISORDERS 06 22 10 10
    11. 11. Eating Disorders ≠ weight disorder Anorexia Nervosa Bulimia Binge eating disorder EATING DISORDERS 06 22 10 11
    12. 12. Anorexia Nervosa Refuses to maintain a “normal” weight or >15% below IBW Fear of weight gain Severe body image disturbance Absence of menstrual cycles (if post- menstrual female) 2 types: restrictive and binging/purging* EATING DISORDERS 06 22 10 12
    13. 13. Bulimia Nervosa Episodes of binge eating with a sense of loss of control followed by compensatory behavior of the purging type (self-induced vomiting, laxative abuse, diuretic abuse) or nonpurging type (excessive exercise, fasting, or strict diets). Binges and the resulting compensatory behavior must occur a minimum of two times per week for three months Dissatisfaction with body shape and weight EATING DISORDERS 06 22 10 13
    14. 14. Binge Eating Disorder Eating much more rapidly than normal Eating until uncomfortably full Eating large amounts of food when not feeling physically hungry Eating alone because of embarrassment Feeling disgusted, depressed, or very guilty after overeating EATING DISORDERS 06 22 10 14
    15. 15. Eating Disorders: are they Addictions? EATING DISORDERS 06 22 10 15
    16. 16. What is Addiction? Physiologic Dependence? Lack of willpower? An “amoral” condition? A brain disease? EATING DISORDERS 06 22 10 16
    17. 17. Physiologic Dependence: Toleranceand Withdrawal Tolerance: requiring increasing amounts of drug to get the same effect Withdrawal: the opposite effect of the drug when it is removed NEITHER of these imply chemical dependency (addiction) EATING DISORDERS 06 22 10 17
    18. 18. Lack of Willpower? EATING DISORDERS 06 22 10 18
    19. 19. An “amoral” condition? EATING DISORDERS 06 22 10 19
    20. 20. RUSH!EATING DISORDERS 06 22 10 20
    21. 21. A Brain Disease? EATING DISORDERS 06 22 10 21
    22. 22. VTA: supplies DA to the N AccThe NA: GO!!!Frontal Cortex: STOP!!!! EATING DISORDERS 06 22 10 22
    23. 23. EATING DISORDERS 06 22 10 23
    24. 24. “I feel like I don’t belong in myown skin….” anonymous alcoholic Decreased Dopamine receptors =decreased Dopamine = Decreased Hedonic Tone  Salsitz 2006 EATING DISORDERS 06 22 10 24
    25. 25. Can you find the (alleged) futurealcoholic? EATING DISORDERS 06 22 10 25
    26. 26. Chemical Dependence: DSM IVdefinition Tolerance  Great deal of time Withdrawal spent in Take more/take longer obtaining/using than intended /recovering Can’t cut down or  Important control use social/occ/recreation given up 2º to use  Use despite physical/psych problem EATING DISORDERS 06 22 10 26
    27. 27. Addiction/chemicaldependence: working definition A chronic progressive disease characterized by the following physical and psychological symptoms (the four (five) C’s): Craving Compulsion Loss of Control Continued use despite consequences, and Chronic use EATING DISORDERS 06 22 10 27
    28. 28. RELAPSE: the problem with addiction Drug triggered: “I thought I could (eat/smoke/drink) just one….” Stress triggered: “I’m going through too much right now. Gimme that!” Cue triggered: “Wet faces and wet places” EATING DISORDERS 06 22 10 28
    29. 29. Drug Triggered Relapse: Gardner2006 EATING DISORDERS 06 22 10 29
    30. 30. Stress Triggered Relapse: Gardner2006 EATING DISORDERS 06 22 10 30
    31. 31. Cue Triggered Relapse: Gardner 2006 EATING DISORDERS 06 22 10 31
    32. 32. Other parts of the Brain Dorsal Striatum (Craving) Amygdala (Memory/Danger/emergency) Hippocampus (memory) Frontal cortex (? Inhibition) Hypothalamus (Appetite/satiety) EATING DISORDERS 06 22 10 32
    33. 33. Other Neurochemicals in the Brain Norepinephrine (stimulates/satiates) Serotonin (calms) Endocannabinoids (super size that, please!) Endorphins (increased feeding) Leptin (antagonist of EC) Ghrelin (stimulates appetite) EATING DISORDERS 06 22 10 33
    34. 34. FA/OA AA/NA “We ask that during  “Don’t let yourself your share you not become Hungry, mention specific food Angry, Lonely, or groups by name” Tired!” EATING DISORDERS 06 22 10 34
    35. 35. “Hi…I’m Joe. I’m cross addicted” EATING DISORDERS 06 22 10 35
    36. 36. Food Addiction???? FA: “Hi, I’m Joe. I’m a food addict”. OA: “Hi, I’m Joe. I’m a compulsive overeater.” Both are describing the same thing: an abnormal relationship with food. EATING DISORDERS 06 22 10 36
    37. 37. How many of these are addicitons? EATING DISORDERS 06 22 10 37
    38. 38. EATING DISORDERS 06 22 10 38
    39. 39. EATING DISORDERS 06 22 10 39
    40. 40. EATING DISORDERS 06 22 10 40
    41. 41. EATING DISORDERS 06 22 10 41
    42. 42. EATING DISORDERS 06 22 10 42
    43. 43. EATING DISORDERS 06 22 10 43
    44. 44. Are Eating Disorders Addictions?Mark Gold, “Eating Disorders, Overeating, and Pathological Attachment to Food”. “The 1960s were known as the decade of sex, drugs, and rock and roll. Food seems to be an afterthought and it may be that it is suppressed by drug-taking. …the heavier the patient, the less alcohol and illegal drugs they use. It is almost as if they are competing for the same reward sites in the brain. Treatment of addicts appears to result in weight gain….all supervised drug abstinence treatment causes weight gain. …loss of control over eating and obesity produces changes in the brain, which are similar to those produced by drugs of abuse.” EATING DISORDERS 06 22 10 44
    45. 45. Are Eating Disorders Addictions? Nora Volkow Many obesity researchers focus on how the bodys fuel and fat levels control appetite. But as binge eaters know, habits and desire often override metabolic need, which share some of the characteristics of drug using behavior in drug-addicted subjects. EATING DISORDERS 06 22 10 45
    46. 46. Why Healthy Fast Food May NotWork….. EATING DISORDERS 06 22 10 46
    47. 47. Obesity: use despite consequences How do you define it? How has it changed in the U.S.? What are the known causes ASSOCIATIONS not causes)? EATING DISORDERS 06 22 10 47
    48. 48. BMI Graph EATING DISORDERS 06 22 10 48
    49. 49. Obesity Trends* Among U.S. Adults BRFSS, 1990, 1995, 2005 (*BMI ≥30, or about 30 lbs overweight for 5’4” person) 1990 1995 2005No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30% EATING DISORDERS 06 22 10 49
    50. 50. Obesity Trends* Among U.S. AdultsBRFSS, 1985 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person) No Data <10% 10%–14% EATING DISORDERS 06 22 10 50
    51. 51. Obesity Trends* Among U.S. AdultsBRFSS, 1990 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person) No Data <10% 10%–14% EATING DISORDERS 06 22 10 51
    52. 52. Obesity Trends* Among U.S. AdultsBRFSS, 1995 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% EATING DISORDERS 06 22 10 52
    53. 53. Obesity Trends* Among U.S. AdultsBRFSS, 2000 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% ≥20% EATING DISORDERS 06 22 10 53
    54. 54. Obesity Trends* Among U.S. AdultsBRFSS, 2005 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30% EATING DISORDERS 06 22 10 54
    55. 55. Obesity: known Associations Prenatal: mom’s caloric intake; maternal DM Breastfeeding: protective FH: one or both parents Energy expenditure: more important than food intake? TV: every 2 hours incr obesity 23% and DM 14% EATING DISORDERS 06 22 10 55
    56. 56. Obesity: known Associations Sleep deprivation (Spiegel 2004): causes decrease in leptin and increase in ghrelin Eating!  “Fast food”: incr weight and insulin resistance (Pereira 2005)  EATING DISORDERS: nighttime eating; binge eating disorders EATING DISORDERS 06 22 10 56
    57. 57. Supersize Me EATING DISORDERS 06 22 10 57
    58. 58. Eating Disorders: Physical Problems Effects of caloric restriction Effects of purging Effects of overeating EATING DISORDERS 06 22 10 58
    59. 59. Effects of Caloric Restriction (Anorexia) Osteoporosis/osteopenia Cardiac disease/sudden death Cognitive problems GI dysfunction Endocrine changes Electrolyte abnormalities Infertility EATING DISORDERS 06 22 10 59
    60. 60. Effects of Caloric Restriction Constipation (vs distorted body image) Refeeding syndrome: cardiac collapse when food intake resumes; death due to low phosphate concentration EATING DISORDERS 06 22 10 60
    61. 61. Effects of Purging (Bulimia) Dental erosion Enlarged salivary glands “finger sign” Esophageal damage EATING DISORDERS 06 22 10 61
    62. 62. EATING DISORDERS 06 22 10 62
    63. 63. Effects of Overeating: MetabolicSyndrome Elevated waist circumference: Men — Equal to or greater than 40 inches (102 cm) Women — Equal to or greater than 35 inches (88 cm) Elevated triglycerides: Equal to or greater than 150 mg/dL Reduced HDL (“good”) cholesterol: Men — Less than 40 mg/dL Women — Less than 50 mg/dL Elevated blood pressure: Equal to or greater than 130/85 mm Hg Elevated fasting glucose: Equal to or greater than 100 mg/dL EATING DISORDERS 06 22 10 63
    64. 64. Causes of Eating Disorders? Sexual abuse? (environment) Family history (genetics)  6-10X increase if 1st degree relative affected  More common in identical than fraternal twins  More common if relatives have alcoholism Associated with other psychiatric disorders Associated with other chemical dependency (B>AN) ADDICTION? EATING DISORDERS 06 22 10 64
    65. 65. Eating Disorder & ChemicalDependency A 19 year old was admitted to residential treatment for cocaine dependency. She has been treated in the past for “eating problems” but it “is over now”. EATING DISORDERS 06 22 10 65
    66. 66. ED + CD During the interview, however, she requests permission for:  “extra laxatives”  Lettuce only for meals  Permission to “jog” without supervision  Extra vitamin allowance. Records review: previous admission to ICU for severe malnutrition. EATING DISORDERS 06 22 10 66
    67. 67. Do You Have an Eating Disorder? 20 Questions EATING DISORDERS 06 22 10 67
    68. 68. Are You a Food Addict? 20 Questions from FAIR1. Have you ever wanted to stop eating and found you just couldn’t?2. Do you think about food or your weight constantly?3. Do you find yourself attempting one diet or food plan after another, with no lasting success?4. Do you binge and then “get rid of the binge”?5. Do you eat differently in private than you do in front of other people? EATING DISORDERS 06 22 10 68
    69. 69. Are You a Food Addict? 20 Questions from FAIR2. Has a doctor or family member every approached you with concerns about your eating/weight?3. Do you eat large quantities of food at one time (binge)?4. Is your weight problem due to your “nibbling” all day long?5. Do you eat to escape from your feelings?6. Do you eat when you’re not hungry? EATING DISORDERS 06 22 10 69
    70. 70. Are You a Food Addict? 20 Questions from FAIR1. Have you ever discarded food, only to retrieve and eat it later?2. Do you eat in secret?3. Do you fast or severely restrict your food intake?4. Have you ever stolen other people’s food?5. Have you ever hidden food to make sure you have “enough”? EATING DISORDERS 06 22 10 70
    71. 71. Are You a Food Addict? 20 Questions from FAIR1. Do you feel driven to exercise excessively to control your weight?2. Do you obsessively calculate the calories you’ve burned against the calories you’ve eaten?3. Do you frequently feel guilty or ashamed about what you’ve eaten?4. Are you waiting for your life to begin “when you lose the weight?”5. Do you feel hopeless about your relationship with food? EATING DISORDERS 06 22 10 71
    72. 72. Treatment for ED/Obesity Caloric Restriction Psychotherapy Spiritual Medical Surgical EATING DISORDERS 06 22 10 72
    73. 73. Treatment for ED/Obesity Caloric Restriction: if diets worked, the auditorium would be empty tonight. Psychotherapy Spiritual Medical Surgical EATING DISORDERS 06 22 10 73
    74. 74. Treatment for ED/Obesity Psychotherapy: CBT, WW, EDEN Spiritual Medical Surgical EATING DISORDERS 06 22 10 74
    75. 75. Treatment for ED/Obesity Psychotherapy Spiritual: FA, OA, FAA Medical Surgical EATING DISORDERS 06 22 10 75
    76. 76. Treatment for ED/Obesity Psychotherapy Spiritual Medical: Stimulants, AD, AED, CB1I, DAI Surgical EATING DISORDERS 06 22 10 76
    77. 77. Treatment for ED/Obesity Psychotherapy Spiritual Medical Surgical: bypass, banding EATING DISORDERS 06 22 10 77
    78. 78. Spirituality ≠ Religion Belief in a power greater than yourself “Turn your will over” Accept direction Live according to principles EATING DISORDERS 06 22 10 78
    79. 79. Spirituality EATING DISORDERS 06 22 10 79
    80. 80. Spirituality ≠ Religion EATING DISORDERS 06 22 10 80
    81. 81. Twelve Step Programs  Food Addicts in Recovery Anonymous  Overeater’s Anonymous EATING DISORDERS 06 22 10 81
    82. 82. Twelve Steps of FA/OA http://foodaddicts.org; http://oa.org1. We admitted we were powerless over food — that our lives had become 7. Humbly asked Him to remove our unmanageable. shortcomings.2. Came to believe that a Power greater 8. Made a list of all persons we had harmed and than ourselves could restore us to sanity. became willing to make amends to them all. 9. Made direct amends to such people wherever3. Made a decision to turn our will and our possible, except when to do so would injure lives over to the care of God as we them or others. understood Him. 10. Continued to take personal inventory and4. Made a searching and fearless moral when we were wrong, promptly admitted it. inventory of ourselves. 11. Sought through prayer and meditation to5. Admitted to God, to ourselves and to improve our conscious contact with God as we understood Him, praying only for knowledge another human being the exact nature of of His will for us and the power to carry that our wrongs. out.6. Were entirely ready to have God remove 12. Having had a spiritual awakening as the result all these defects of character. of these Steps, we tried to carry this message to compulsive overeaters and to practice these principles in all our affairs. EATING DISORDERS 06 22 10 82
    83. 83. Do men get eating disorders? EATING DISORDERS 06 22 10 83
    84. 84. From “Food Addiction: Stories of Men in Recovery” Being a man, I learned I was not supposed to worry about my weight. When I stopped drinking alcohol…my weight began to rise, and no matter what I tried, I could not control it. Food had become my alternative to alcohol. In FA, I was able to recognize that certain foods are addictive substances for me. I learned how to weigh and measure my food, putting boundaries around my meals. I have been able to return to the athletic activities that had become too painful…In FA, I am learning how to face life without using food as a drug.” EATING DISORDERS 06 22 10 84
    85. 85. Treatment of AN/BN Cognitive Behavioral Therapy (Lewandowski 1997) Interpersonal therapy Medications:  For AN: little data, ? Olanzapine  BN: fluoxetine, ? Ondansetron Hospitalization OA (Malenbaum 1988) EATING DISORDERS 06 22 10 85
    86. 86. Medications for Obesity: Stimulants  Phentermine (Adipex)  Diethylproprion (Tenuate)  Sibutramine (Meridia) (also serotonin)  Ephedra/ Ma Huang EATING DISORDERS 06 22 10 86
    87. 87. Medications for Obesity:Antidepressants Act on serotonin:  Sertraline (Zoloft)  Fluoxetine (Prozac) Act on norepi/dopamine:  Buproprion EATING DISORDERS 06 22 10 87
    88. 88. Medications for Obesity: Antiepileptics Topiramate (Topomax)  Commonly used for migraine prophylaxis  Produces “topomax brain” EATING DISORDERS 06 22 10 88
    89. 89. Medications for Obesity: ECantagonists (Rimonabant, Acomplia) CB1 receptor blocker Compared to placebo:  5% BW loss: 51 vs 19%  10% BW loss: 27 vs 7%  DEPRESSION: did not get FDA approval EATING DISORDERS 06 22 10 89
    90. 90. Medications for Obesity: muantagonists (naltrexone, Vivitrol) May block the “reward” of eating through the mu opioid receptor  DA release Used to block the reward of alcohol, tobacco? ? Blocks natural endorphins Blocks the ability of anyone in the ER to give you pain meds when you break your leg! EATING DISORDERS 06 22 10 90
    91. 91. Bariatric Surgery Indications Contraindications Complications EATING DISORDERS 06 22 10 91
    92. 92. Bariatric Surgery Indications:  BMI > 40 or 35 with complications  Have failed medical therapy  Surgical candidates EATING DISORDERS 06 22 10 92
    93. 93. Bariatric Surgery Contraindications  Binge eating disorder  Current drug and alcohol use  Untreated MDD or psychosis EATING DISORDERS 06 22 10 93
    94. 94. Bariatric Surgery Complications  Mortality: 1 – 20? %  Malabsorption  Post-surgical complications  ? Addictive disorders EATING DISORDERS 06 22 10 94
    95. 95. Gastric Banding EATING DISORDERS 06 22 10 95
    96. 96. SOS Study: Swedish Obese Subjects Randomized to either bariatric surgery or “conventional” treatment “conventional” treatment gained 2% over 10 years Surgery group lost 16 % over 10 years EATING DISORDERS 06 22 10 96
    97. 97. BRAIN SCANS apologies to PETA EATING DISORDERS 06 22 10 97
    98. 98. DopamineEATING DISORDERS 06 22 10 98
    99. 99. EATING DISORDERS 06 22 10 99
    100. 100. Obese subjects have decreased DA EATING DISORDERS 06 22 10 100
    101. 101. Dopamine: Normal vs. Overweight EATING DISORDERS 06 22 10 101
    102. 102. Dopamine Receptors: Normal vs. Obese EATING DISORDERS 06 22 10 102
    103. 103. Effect of Cocaine Cues on Dopamine A cocaine addict is shown a picture of Bambi in the forest. The large amount of “red” indicates that dopamine hasn’t been released. EATING DISORDERS 06 22 10 103
    104. 104. EATING DISORDERS 06 22 10 104
    105. 105. Effect of Cocaine Cues on Dopamine The picture on the right shows less “red” = Dopamine has been released. THE CUE OF SEEING COCAINE CAUSED DOPAMINE RELEASE = RISK OF RELAPSE EATING DISORDERS 06 22 10 105
    106. 106. Volkow: Placebo Ritalin Food The sight of food caused a release of dopamine, just like cocaine! In this “addict”, the drug is FOOD EATING DISORDERS 06 22 10 106
    107. 107. Abnormal response to Ritalin is due toabnormal brain chemistry EATING DISORDERS 06 22 10 107
    108. 108. EATING DISORDERS 06 22 10 108
    109. 109. DAKOTA1995-2007EATING DISORDERS 06 22 10 109
    110. 110. EATING DISORDERS 06 22 10 110
    111. 111. Contact info Carl Christensen MD PhD Pain Recovery Solutions, Ypsi MI (734 434 6600) Voice/fax: 734 448 0226 Email:  ccmdphd@mac.com EATING DISORDERS 06 22 10 111
    112. 112. READY, SET… RECOVERINSPIRATIONS FOR EATING DISORDERRECOVERY
    113. 113. RESOURCES ABOUND
    114. 114. EATING DISORDERS PROFESSIONALLEAGUE OF MICHIGAN WWW.EDleague.comMission Statement We are a multi-disciplinary group of health and mental health professionals collaborating to network and to provide professional peer support, education outreach and advocacy concerning the treatment and prevention of eating disorders. At this point in time we simply function as an online resource for the public and professional community. Those specializing in the treatment of eating disorders or those in need of help can access this site for free information regarding local treatment and support
    115. 115. EDENEATING DISORDERS ANDEDUCATION NETWORK• WWW.Edenprocess.com If you personally ARE struggling with an eating disorder please contact one of our EDEN facilitators who can point you to treatment professionals in your area who specialize in eating disorders. edenadmin@charter.net  EDEN also offers community based support groups that will help you learn the HEALTHY COPING SKILLS NEEDED TO ATTAIN AND MAINTAIN RECOVERY. If there is no support group in your area EDEN also offers telephone support.  If you know someone who is struggling we are here to help GIVE THE
    116. 116. CENTER FOR EATINGDISORDERS ANN ARBOR www.center4ed.org• The first step is the hardest.• Let us help.• Founded in 1983, the Center for Eating Disorders (CED) marks 25 years of serving our community. CED offers outpatient treatment, education, support, and referral services to children, adolescents, and adults with eating, weight, and body image disorders including anorexia nervosa, bulimia nervosa, compulsive eating/binge eating disorder and related issues.
    117. 117. UNIVERSITY OF MICHIGAN UNIVERSITY HEALTH SERVICESRecovery is possible! Eating disorder treatment is available and recovery ispossible!It is possible to access eating disorder treatment while taking classes at UM. Insome cases, students choose to take fewer credits or temporarily withdraw toallow more time and energy for treatment. In any case, we can offer supportand assistance!Regardless of how long youve struggled with eating issues or the severity ofyour eating disorder, the sooner you begin treatment, the better. The longerdisordered eating patterns continue and the more deeply ingrained theybecome, the more difficult recovery may be. Seek help soon if you think you ora friend might be struggling with eating problems.If youd like information about eating disorder treatment or if you are concernedabout a friend or family member, check outResources for Eating Disorders and Body Image. http://www.uhs.umich.edu/eatingdisorders
    118. 118. ANOREXIA BULIMIA ANONYMOUSHTTP://WWW.ANOREXICSANDBULIMICSANONYMOUSABA.COM• WHO ARE WE? Anorexics and Bulimics Anonymous (ABA) is a Fellowship of individuals whose primary purpose is to find and maintain “sobriety” in our eating practices, and to help others gain sobriety. The only requirement for membership is a desire to stop unhealthy eating practices. There are no dues or fees for ABA membership; we are self-supporting through our own contributions. ABA is not affiliated with any other organization or institution, nor are we allied with any religion.
    119. 119. OVEREATERS ANONYMOUSWWW.OA.ORG• OA Program of Recovery• Overeaters Anonymous offers a program of recovery from compulsive eating using the Twelve Steps and Twelve Traditions of OA. Worldwide meetings and other tools provide a fellowship of experience, strength and hope where members respect one another’s anonymity. OA charges no dues or fees; it is self-supporting through member contributions.• OA is not just about weight loss, gain or maintenance; or obesity or diets. It addresses physical, emotional and spiritual well-being. It is not a religious organization and does not promote any particular diet. If you want to stop your compulsive overeating, welcome to Overeaters Anonymous.
    120. 120. NATIONAL EATING DISORDERSASSOCIATION http://www.nationaleatingdisorders.org Welcome to the National Eating Disorders Association. Were glad you found us. NEDA is dedicated to providing education, resources and support to those affected by eating disorders. Whether you are an individual living with an eating disorder, a family member or friend looking to offer support to a loved one, or a treatment professional looking to help others — we are here for you. If you are looking for treatment options or a support group, click here: GET HELP TODAY.
    121. 121. ANAD NATIONAL ASSOCIATION OF ANOREXIA NERVOSA AND OTHER ASSOCIATED EATING DISORDERS www.ANAD.orgNational Association of Anorexia Nervosa and Associated Disorders is the oldest non-profit in thecountry dedicated to alleviating and preventing eating disorders.                                                       Visit our Get Help section if you are looking for a therapist, support group or treatment program.           our  Get  Involved  section  if  you   Visit                                         would like to become a member, volunteer or professionalpartner.                                                                              Visit our Get Information section to get accurate information and resources to help yourself ofsomeone else suffering from an eating disorder.                                                                                      Of course, our helpline (630) 577-1330 is available for questions, direction or further resources.    
    122. 122. WWW.GURZE.COM             
    123. 123. TREATMENTS Research has not provided us empirically proven treatments for the long term relief from eating disorders. WHAT DOES THIS MEAN?
    124. 124. CELEBRATE
    125. 125. STRONGLY SUPPORTEDTREATMENTS
    126. 126. COGNITIVE BEHAVIORAL THERAPY FOR EATINGDISORDERSCognitive-behavioral therapy is an active type of counseling. Sessionsusually are held once a week for as long as you need to master new skills.Individual sessions last 1 hour, and group sessions may be longer.During cognitive-behavioral therapy for anorexia or bulimia you learn:About your illness, its symptoms, and how to predict when symptoms willmost likely recur.To keep a diary of eating episodes, binge eating, purging, and the eventsthat may have triggered these episodes.To eat more regularly, with meals or snacks spaced no more than 3 or 4hours apart.How to change the way you think about your symptoms. This reduces thepower the symptoms have over you.How to change self-defeating thought patterns into patterns that are morehelpful. This improves mood and your sense of mastery over your life. Thishelps you avoid future episodes.Ways to handle daily problems differently.What To Expect After TreatmentYou can use your cognitive-behavioral skills throughout your life. You mayfind that additional "tune-up" sessions help you stay on track with your newskills. http://www.webmd.com/mental-health/cognitive-behavioral-therapy-for-eating-disorders
    127. 127. INTERPERSONALPSYCHOTHERAPY Interpersonal Psychotherapy (IPT) is a time-limited psychotherapy that focuses on the interpersonal context and on building interpersonal skills. IPT is based on the belief that interpersonal factors may contribute heavily to psychological problems. ... A brief and highly structured manual-based psychotherapy that addresses interpersonal issues, to the exclusion of all other areas of clinical attention. Short-term therapy for depression that looks for solutions and strategies to deal with interpersonal problems rather than spending time on interpretation and analysis. highered.mcgraw-hill.com/sites/007242298x/student_view0/glossary.html
    128. 128. EMERGING TREATMENTS 12-STEP PROGRAMS DBT DIALECTICAL BEHAVIOR THERAPY ACCEPTANCE & COMMITMENT THERAPY ONLINE SUPPORT GROUPS SUPPORT GROUPS
    129. 129. DIALECTICAL BEHAVIOR THERAPY DBTDBT Therapy TreatmentTreatment in DBT therapy has four parts, which are all important to effectivetreatment:Individual TherapyTelephone ContactTherapist Consultation- good communication between group therapist and individual therapist isessential to the successful outcome of DBT therapy.Skills Training- Conducted by a behavioral technician or another therapist usually in a groupcontext.- Conducted in weekly sessions of 2.5 hours with a break half way through eachsession.- The focus is on learning and practicing adaptive skills, not personal or specificcomplaints of the clients and thus, any specific or personal issues are redirectedto be discussed in individual therapy. http://bipolar.about.com/cs/menu_treat/a/aa031016.htm
    130. 130. STAGES OF CHANGE
    131. 131. STAGES OF CHANGE Pre-Contemplation Contemplation Preparation Action Maintaining
    132. 132. TREATMENT FROM AN ADDICTIONPERSPECTIVEYou Do Not Will Yourself Out Of An Eating Disorder….You Get Well By Working A Program,And Through The Help Of Others
    133. 133. BUILD YOUR PROGRAM Physician Therapist Support Network/Groups Nutritional Counseling Residential Treatment
    134. 134. TAKE A WHOLE PERSON APPROACHSEEK DEVELOPMENT & BALANCE Emotional Social Physical Spiritual
    135. 135. THE TREATMENT CHALLANGES COMPASSION & ACCOUNTABILTY EMOTIONAL AWARENESS & HABIT BREAKING FAILURE & INSPIRATION WILLINGNESS & ACCEPTANCE
    136. 136. FOR THOSE SUPPORTINGYou are not alone.Seek support for yourself.Learn healthy boundary setting.
    137. 137. FOR THOSE TRYING TO RECOVERYOU DO NOT HAVE TO DO THIS ALONEYOU CAN DO THISYOU CAN LIKE YOURSELF TODAY
    138. 138. THANK YOU

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