Eating Disorders - June 2012

1. Eating Disorders June 26, 2012 Carl Christensen, MD PhD Pain Recovery Solutions, Ann Arbor Mi Depts of OB Gyn & Psychiatry, WSU cchriste@med.wayne.edu

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. “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, "here's the key to your food." He wasn't impressed.”  Tom McGregor, “Eating in Freedom” EATING DISORDERS 06 22 10 3

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. 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. 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. 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. 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. “…..he’s very depressing” (2007) EATING DISORDERS 06 22 10 9

10. “I left tonight entirely without hope” (2011) EATING DISORDERS 06 22 10 10

11. Eating Disorders ≠ weight disorder  Anorexia Nervosa  Bulimia  Binge eating disorder EATING DISORDERS 06 22 10 11

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. 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. 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. Eating Disorders: are they Addictions? EATING DISORDERS 06 22 10 15

16. What is Addiction?  Physiologic Dependence?  Lack of willpower?  An “amoral” condition?  A brain disease? EATING DISORDERS 06 22 10 16

17. Physiologic Dependence: Tolerance and 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. Lack of Willpower? EATING DISORDERS 06 22 10 18

19. An “amoral” condition? EATING DISORDERS 06 22 10 19

20. RUSH! EATING DISORDERS 06 22 10 20

21. A Brain Disease? EATING DISORDERS 06 22 10 21

22. VTA: supplies DA to the N Acc The NA: GO!!! Frontal Cortex: STOP!!!! EATING DISORDERS 06 22 10 22

23. EATING DISORDERS 06 22 10 23

24. “I feel like I don’t belong in my own skin….” anonymous alcoholic  Decreased Dopamine receptors =decreased Dopamine =  Decreased Hedonic Tone  Salsitz 2006 EATING DISORDERS 06 22 10 24

25. Can you find the (alleged) future alcoholic? EATING DISORDERS 06 22 10 25

26. Chemical Dependence: DSM IV definition  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. Addiction/chemical dependence: 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. 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. Drug Triggered Relapse: Gardner 2006 EATING DISORDERS 06 22 10 29

30. Stress Triggered Relapse: Gardner 2006 EATING DISORDERS 06 22 10 30

31. Cue Triggered Relapse: Gardner 2006 EATING DISORDERS 06 22 10 31

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. 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. 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. “Hi…I’m Joe. I’m cross addicted” EATING DISORDERS 06 22 10 35

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. How many of these are addicitons? EATING DISORDERS 06 22 10 37

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. Are Eating Disorders Addictions? Nora Volkow  Many obesity researchers focus on how the body's 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. Why Healthy Fast Food May Not Work….. EATING DISORDERS 06 22 10 46

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. BMI Graph EATING DISORDERS 06 22 10 48

49. Obesity Trends* Among U.S. Adults BRFSS, 1990, 1995, 2005 (*BMI ≥30, or about 30 lbs overweight for 5’4” person) 1990 1995 2005 No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30% EATING DISORDERS 06 22 10 49

50. Obesity Trends* Among U.S. Adults BRFSS, 1985 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person) No Data <10% 10%–14% EATING DISORDERS 06 22 10 50

51. Obesity Trends* Among U.S. Adults BRFSS, 1990 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person) No Data <10% 10%–14% EATING DISORDERS 06 22 10 51

52. Obesity Trends* Among U.S. Adults BRFSS, 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. Obesity Trends* Among U.S. Adults BRFSS, 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. Obesity Trends* Among U.S. Adults BRFSS, 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. 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. 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. Supersize Me EATING DISORDERS 06 22 10 57

58. Eating Disorders: Physical Problems  Effects of caloric restriction  Effects of purging  Effects of overeating EATING DISORDERS 06 22 10 58

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. 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. Effects of Purging (Bulimia)  Dental erosion  Enlarged salivary glands  “finger sign”  Esophageal damage EATING DISORDERS 06 22 10 61

63. Effects of Overeating: Metabolic Syndrome  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. 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. Eating Disorder & Chemical Dependency  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. 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. Do You Have an Eating Disorder? 20 Questions EATING DISORDERS 06 22 10 67

68. Are You a Food Addict? 20 Questions from FAIR 1. 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. Are You a Food Addict? 20 Questions from FAIR 2. 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. Are You a Food Addict? 20 Questions from FAIR 1. 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. Are You a Food Addict? 20 Questions from FAIR 1. 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. Treatment for ED/Obesity  Caloric Restriction  Psychotherapy  Spiritual  Medical  Surgical EATING DISORDERS 06 22 10 72

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. Treatment for ED/Obesity  Psychotherapy: CBT, WW, EDEN  Spiritual  Medical  Surgical EATING DISORDERS 06 22 10 74

75. Treatment for ED/Obesity  Psychotherapy  Spiritual: FA, OA, FAA  Medical  Surgical EATING DISORDERS 06 22 10 75

76. Treatment for ED/Obesity  Psychotherapy  Spiritual  Medical: Stimulants, AD, AED, CB1I, DAI  Surgical EATING DISORDERS 06 22 10 76

77. Treatment for ED/Obesity  Psychotherapy  Spiritual  Medical  Surgical: bypass, banding EATING DISORDERS 06 22 10 77

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. Spirituality EATING DISORDERS 06 22 10 79

80. Spirituality ≠ Religion EATING DISORDERS 06 22 10 80

81. Twelve Step Programs  Food Addicts in Recovery Anonymous  Overeater’s Anonymous EATING DISORDERS 06 22 10 81

82. Twelve Steps of FA/OA http://foodaddicts.org; http://oa.org 1. 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 wherever 3. 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 and 4. Made a searching and fearless moral when we were wrong, promptly admitted it. inventory of ourselves. 11. Sought through prayer and meditation to 5. 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. Do men get eating disorders? EATING DISORDERS 06 22 10 83

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. 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. Medications for Obesity: Stimulants  Phentermine (Adipex)  Diethylproprion (Tenuate)  Sibutramine (Meridia) (also serotonin)  Ephedra/ Ma Huang EATING DISORDERS 06 22 10 86

87. Medications for Obesity: Antidepressants  Act on serotonin:  Sertraline (Zoloft)  Fluoxetine (Prozac)  Act on norepi/dopamine:  Buproprion EATING DISORDERS 06 22 10 87

88. Medications for Obesity: Antiepileptics  Topiramate (Topomax)  Commonly used for migraine prophylaxis  Produces “topomax brain” EATING DISORDERS 06 22 10 88

89. Medications for Obesity: EC antagonists (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. Medications for Obesity: mu antagonists (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. Bariatric Surgery  Indications  Contraindications  Complications EATING DISORDERS 06 22 10 91

92. Bariatric Surgery  Indications:  BMI > 40 or 35 with complications  Have failed medical therapy  Surgical candidates EATING DISORDERS 06 22 10 92

93. Bariatric Surgery  Contraindications  Binge eating disorder  Current drug and alcohol use  Untreated MDD or psychosis EATING DISORDERS 06 22 10 93

94. Bariatric Surgery  Complications  Mortality: 1 – 20? %  Malabsorption  Post-surgical complications  ? Addictive disorders EATING DISORDERS 06 22 10 94

95. Gastric Banding EATING DISORDERS 06 22 10 95

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. BRAIN SCANS apologies to PETA EATING DISORDERS 06 22 10 97

98. Dopamine EATING DISORDERS 06 22 10 98

100. Obese subjects have decreased DA EATING DISORDERS 06 22 10 100

101. Dopamine: Normal vs. Overweight EATING DISORDERS 06 22 10 101

102. Dopamine Receptors: Normal vs. Obese EATING DISORDERS 06 22 10 102

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

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. 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. Abnormal response to Ritalin is due to abnormal brain chemistry EATING DISORDERS 06 22 10 107

109. DAKOTA 1995-2007 EATING DISORDERS 06 22 10 109

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. READY, SET… RECOVER INSPIRATIONS FOR EATING DISORDER RECOVERY

113. RESOURCES ABOUND

114. EATING DISORDERS PROFESSIONAL LEAGUE OF MICHIGAN WWW.EDleague.com Mission 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. EDEN EATING DISORDERS AND EDUCATION 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. CENTER FOR EATING DISORDERS 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. UNIVERSITY OF MICHIGAN UNIVERSITY HEALTH SERVICES Recovery is possible! Eating disorder treatment is available and recovery is possible! It is possible to access eating disorder treatment while taking classes at UM. In some cases, students choose to take fewer credits or temporarily withdraw to allow more time and energy for treatment. In any case, we can offer support and assistance! Regardless of how long you've struggled with eating issues or the severity of your eating disorder, the sooner you begin treatment, the better. The longer disordered eating patterns continue and the more deeply ingrained they become, the more difficult recovery may be. Seek help soon if you think you or a friend might be struggling with eating problems. If you'd like information about eating disorder treatment or if you are concerned about a friend or family member, check out Resources for Eating Disorders and Body Image. http://www.uhs.umich.edu/eatingdisorders

118. ANOREXIA BULIMIA ANONYMOUS HTTP://WWW.ANOREXICSANDBULIMICSANONYMO USABA.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. OVEREATERS ANONYMOUS WWW.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. NATIONAL EATING DISORDERS ASSOCIATION http://www.nationaleatingdisorders.org Welcome to the National Eating Disorders Association. We're 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. ANAD NATIONAL ASSOCIATION OF ANOREXIA NERVOSA AND OTHER ASSOCIATED EATING DISORDERS www.ANAD.org National Association of Anorexia Nervosa and Associated Disorders is the oldest non-profit in the country 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 professional partner. Visit our Get Information section to get accurate information and resources to help yourself of someone else suffering from an eating disorder. Of course, our helpline (630) 577-1330 is available for questions, direction or further resources.

122. WWW.GURZE.COM

123. TREATMENTS  Research has not provided us empirically proven treatments for the long term relief from eating disorders. WHAT DOES THIS MEAN?

124. CELEBRATE

125. STRONGLY SUPPORTED TREATMENTS

126. COGNITIVE BEHAVIORAL THERAPY FOR EATING DISORDERS Cognitive-behavioral therapy is an active type of counseling. Sessions usually 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 will most likely recur. To keep a diary of eating episodes, binge eating, purging, and the events that may have triggered these episodes. To eat more regularly, with meals or snacks spaced no more than 3 or 4 hours apart. How to change the way you think about your symptoms. This reduces the power the symptoms have over you. How to change self-defeating thought patterns into patterns that are more helpful. This improves mood and your sense of mastery over your life. This helps you avoid future episodes. Ways to handle daily problems differently. What To Expect After Treatment You can use your cognitive-behavioral skills throughout your life. You may find that additional "tune-up" sessions help you stay on track with your new skills. http://www.webmd.com/mental-health/cognitive-behavioral-therapy-for-eating-disorders

127. INTERPERSONAL PSYCHOTHERAPY  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. EMERGING TREATMENTS  12-STEP PROGRAMS  DBT DIALECTICAL BEHAVIOR THERAPY  ACCEPTANCE & COMMITMENT THERAPY  ONLINE SUPPORT GROUPS  SUPPORT GROUPS

129. DIALECTICAL BEHAVIOR THERAPY DBT DBT Therapy Treatment Treatment in DBT therapy has four parts, which are all important to effective treatment: Individual Therapy Telephone Contact Therapist Consultation - good communication between group therapist and individual therapist is essential to the successful outcome of DBT therapy. Skills Training - Conducted by a behavioral technician or another therapist usually in a group context. - Conducted in weekly sessions of 2.5 hours with a break half way through each session. - The focus is on learning and practicing adaptive skills, not personal or specific complaints of the clients and thus, any specific or personal issues are redirected to be discussed in individual therapy. http://bipolar.about.com/cs/menu_treat/a/aa031016.htm

130. STAGES OF CHANGE

131. STAGES OF CHANGE  Pre-Contemplation  Contemplation  Preparation  Action  Maintaining

132. TREATMENT FROM AN ADDICTION PERSPECTIVE You Do Not Will Yourself Out Of An Eating Disorder…. You Get Well By Working A Program, And Through The Help Of Others

133. BUILD YOUR PROGRAM  Physician  Therapist  Support Network/Groups  Nutritional Counseling  Residential Treatment

134. TAKE A WHOLE PERSON APPROACH SEEK DEVELOPMENT & BALANCE  Emotional  Social  Physical  Spiritual

135. THE TREATMENT CHALLANGES  COMPASSION & ACCOUNTABILTY  EMOTIONAL AWARENESS & HABIT BREAKING  FAILURE & INSPIRATION  WILLINGNESS & ACCEPTANCE

136. FOR THOSE SUPPORTING You are not alone. Seek support for yourself. Learn healthy boundary setting.

137. FOR THOSE TRYING TO RECOVER YOU DO NOT HAVE TO DO THIS ALONE YOU CAN DO THIS YOU CAN LIKE YOURSELF TODAY

138. THANK YOU

Eating Disorders - June 2012

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