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Eating Disorders 101: A Basic Guide for Chemical Dependency Professionals

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Eating Disorders 101: A Basic Guide for Chemical Dependency Professionals Michelle L. Staub, LPC, CAC Diplomate Caron Treatment Centers Wernsersville, PA, USA – PowerPoint PPT presentation

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Title: Eating Disorders 101: A Basic Guide for Chemical Dependency Professionals


1
Eating Disorders 101 A Basic Guide for Chemical
Dependency Professionals
  • Michelle L. Staub,
  • LPC, CAC Diplomate
  • Caron Treatment Centers
  • Wernsersville, PA, USA

2
Goals
  • Understand diagnostic criteria of eating
    disorders
  • Understand the relationship to mood disorders
  • Understand the correlation between ED and CD
  • Theoretical Causes of Eating Disorders
  • Understand components of an evaluation

3
Goals Continued
  • Understand the components of effective treatment
  • Understand the impact of culture on eating
    disorders
  • Understand the impact of ED on males
  • Sample treatment plans

4
Definition
  • Eating disorder is defined as a persistent
    disturbance of eating or eating related behavior
    that results in the altered consumption or
    absorption of food and that significantly impairs
    physical health or psychological functioning.
  • Brownell Fairburn

5
Anorexia Nervosa
  • Refusal to maintain body weight at 85
  • Intense fear of gaining weight
  • Disturbance in the way ones body weight is
    experienced
  • Amenorrhea
  • Subtypes Restricting or Binge-eating/purging
    based on current episode

6
Anorexia Nervosa
  • Highest mortality rate of all DSM diagnosis 10
  • Starvation causes the brains ventricles to
    increase in size and the cortical mass decreases
  • Gray and white matter of the brain does not
    completely return to normal even after 12 months
    of weight restoration

7
Anorexia Nervosa
  • .5 1 of the general population
  • 10-20 times more common in females than males
  • 12 - 21 of anorexic women also abuse chemicals
  • Dr. Susan Gordon

8
Bulimia Nervosa
  • Self evaluation is unduly influenced by body
    shape and weight
  • Does not occur exclusively during episodes of
    Anorexia
  • Subtypes include purging type self induced
    vomiting, laxative, diuretics and enemas.
  • non-purging type fasting or exercise

9
Bulimia Nervosa
  • Eating more food than most people in a similar
    time frame
  • Lack of control over eating
  • Recurrent inappropriate compensatory behavior to
    prevent weight gain can include self-induced
    vomiting, diuretics, laxatives, enema,
    medication, fasting, excessive exercise
  • Occurs minimally twice a week for three months

10
Bulimia Nervosa
  • 1 3 of women in the general population
  • Twice as common in females than males
  • 9 - 55 of bulimic women also abuse chemicals
  • Dr. Susan Gordon

11
Binge Eating Disorder
  • Currently under review for separate diagnosis
  • Eating a large amount of food in a discrete
    period of time
  • A sense of lack of control over eating
  • Three or more of the following
  • Eating much more rapidly than normal
  • Eating until uncomfortably full
  • Eating large amounts of food when not physically
    hungry
  • Eating alone due to embarrassment
  • Feeling disgusted, depressed or guilty after
    overeating

12
Binge Eating Disorder (cont.)
  • Occurs minimally twice a week for six months
  • Not associated with the regular use of
    inappropriate compensatory behaviors
  • Often, but not always, overweight or obese
  • 2 of the general population
  • Slightly more common in females than males

13
Eating Disorder, NOS
  • Meets most of the criteria for Anorexia or
    Bulimia with the exception of one criteria
  • Regular use of inappropriate behaviors after
    ingesting small amounts of food
  • Repeatedly chewing food without swallowing

14
Disordered Eating
  • Currently, there is not a lot of published
    information
  • Numerous studies are currently being conducted.
  • Theory is an individual may have disordered
    eating which impacts quality of life but not
    diagnosed with an eating disorder.
  • Atkins Diet, South Beach, etc.
  • Yo-Yo dieting

15
Relationship to Mood Disorders
  • Depressive Disorders
  • Most prevalent to Bulimia
  • 50 of individuals with eating disorders are also
    diagnosed with Major Depressive Disorder
  • Typically, major depression is a consequence of
    the eating disorder
  • Depressive symptoms of ED patients are different
    from other patients with major depressive
    disorder
  • As the eating disorder improves so does the
    depressive symptoms

16
Relationship to Mood Disorders (cont.)
  • Anxiety Disorders
  • Social phobia is common among eating disorder
    patients
  • Obsessive Compulsive Disorder also has a high
    prevalence among eating disorder patients --
    Theory OCD symptoms are a consequence of the
    dieting and resulting starvation.
  • Brownell Fairburn

17
Diagnostic Complications between ED and CD
  • Which is primary?
  • Is chemical use part of the eating disorder or a
    separate diagnosis? Or vice versa?
  • Typical drugs of choice heroin, cocaine,
    alcohol, tobacco, caffeine and stimulants

18
Common Characteristics between ED and CD
  • Patients are in denial
  • Hide behaviors
  • Chronic and fatal
  • High rates of relapse
  • Effects physical, psychological, social , family
    and overall interactions
  • Eating Disorders are not about food, CD is not
    about the alcohol

19
Common Characteristics between ED and CD (cont)
  • Easier to think about calories/drinking or using
    than to deal with painful feelings and emotions
  • Treatment needs to be multi-disciplinary and
    multi-focused

20
Common Risk factors between ED and CD
  • Tend to emerge in adolescence
  • Symptoms tend to increase in times of stress
  • Many have a history of physical and/or sexual
    abuse
  • Co-occur with other psychological diagnosis
    (depression, anxiety)
  • Bulimia is the most common ED diagnosed in CD
    population

21
Influences During Active Addiction
  • Eating Disorders promote the use of substances
    that enhance eating disorder behaviors
  • Some substances (alcohol and marijuana) produce
    weight gain and trigger ED behaviors in an
    attempt to reduce weight
  • Substances decrease self-control and trigger ED
    behaviors in an attempt to regain control
  • Dr. Susan Gordon

22
Influences During Treatment
  • Other non-treated co-occurring psychological
    conditions can trigger both CD and ED
  • Weight gained in CD treatment can trigger relapse
    to ED behaviors
  • The loss of ED and/or CD as a coping skill can
    trigger relapse to another untreated disorder
  • Dr. Susan Gordon

23
Other Misused/Abused Substances
  • Diet Pills
  • Fat Burners
  • Diuretics
  • Ipecac
  • Laxatives

24
Diet Pills
  • Phenylpropylalanine (PPA) no longer available
    due to high incidence of heart attacks and death
  • Ephedrine (Ma Huang) 10
  • Caffeine 36
  • Combination 54
  • Remuda Ranch July 30, 2004

25
Ephedrine Abuse Complications
  • Heart Attack
  • Stroke
  • Liver failure
  • Kidney problems
  • Dizziness
  • Increased Heart Rate
  • Headache
  • Nervousness
  • Tremors
  • Insomnia
  • Remuda Ranch July 30, 2004

26
Fat Burners
  • Most are a combination of ephedra, caffeine and
    aspirin
  • Some also contain diuretics and amino acids
  • These also include the most recent and popular
    carb blockers

27
Diuretic Abuse
  • Most common over the counter diuretics contain
  • Diuretic/herbal product plus
  • Caffeine
  • Potassium salts (K)
  • Analgesics
  • Salicylates
  • Acetaminophen
  • Remuda Ranch Treatment Centers

28
Diuretic Abuse
  • Decreased Potassium (K)
  • Decreased Chloride (CI-)
  • Dehydration
  • Magnesium Deficiency (Mg)
  • Hyponatremia (Na)
  • Hypercalcemia (Ca)
  • Remuda Ranch Treatment Centers

29
IPECAC
  • 28 of bulimic patients had tried at one time
  • 3-4 used regularly
  • Direct action on the gastric lining
  • Some will use to help start vomiting
  • Others use as their gag reflex is reduced
  • Toxic
  • Cardiomyopathy
  • EKG changes
  • Present as palpitations, skipped heart beats,
    dizziness, chest pains, shortness of breath can
    resemble panic attack.
  • Remuda Ranch Treatment Centers

30
Theoretical Causes of Eating Disorders
  • Family Dynamics and Genetics
  • Perfect family places importance on externals
    (appearance) achievements concerned about how
    they are perceived by others.
  • Over protective family parents are overly
    involved, children confused about own identity
    and have difficulty with individuation and
    independence
  • Chaotic family children are victims of abuse,
    rules are inconsistent, distrusting of themselves
    and others

31
Theoretical Causes of Eating Disorders (Cont.)
  • Social Dynamics
  • Major life transitions puberty, illness, death
    of a loved one
  • Societal expectations
  • Mother/daughter connection as it relates to
    body image and dieting
  • Prejudices against obese people
  • Failure at work, school, competitive events
  • Traumatic events

32
Theoretical Causes of Eating Disorders (Cont.)
  • 31 of 8 year olds feel fat
  • When girls go through puberty, body fat increases
    165
  • 11-14 year old girls normal to gain 40 lbs in
    four years
  • Bulimic philosophy shopping, relationships,
    sex, exercise and work

33
What can be done in chemical dependency programs
in regards to eating disorders?
  • Assess/Evaluate
  • Motivate
  • Refer

34
A Thorough Evaluation Should Include
  • Weight history
  • Supplement use
  • Exercise organized and unorganized
  • Dieting history
  • Family eating patterns

35
Evaluation (Cont.)
  • Need to be able to identify
  • Symptoms mood
  • Severity frequency
  • Cognitive impairments
  • Biological impairments

36
Evaluation (Cont.)
  • Assess as part of the medical assessment
    biopsychosocial
  • Assessment methods
  • Clinical interviews
  • Standardized screening tools
  • EDI Eating Disorder Inventory
  • EAT Eating Attitudes Test
  • Advantages economical, brief, easily
    administered
  • Disadvantages less accurate than an interview

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Goals of Basic Treatment (Motivation)
  • Increase Awareness
  • Educate by identifying symptoms and consequences
  • Increase motivation
  • Identify individual triggers

40
Objectives for Treatment (in general)
  • Establish/increase motivation for recovery
  • Develop a reason to recover
  • Develop an identity without the eating disorder
  • Legalize food look at food as a source of
    nutrition, not a source of fear

41
Objectives for Treatment (Cont.)
  • Separate food from feelings by dispelling myths
    about food and weight
  • Develop healthy ways to manage feelings assist
    in overcoming thoughts and emotions and focus
    efforts on recovery

42
Treatment
  • In PHP and inpatient, treatment typically
    addresses the effects and stabilize symptoms, but
    does not typically address the actual eating
    disorder pathology.
  • The actual eating disorder pathology is typically
    only addressed in long-term individual
    psychotherapy.

43
Treatment Components
  • Co-morbidities
  • Weight
  • Body image
  • Readiness for change
  • Coping style
  • Eating Disorder Center of Denver

44
Issues To Address In Therapy
  • ED is important to sense of self
  • Many refer to the ED as a monster inside the
    individual sees this as a positive influence
  • Without the ED, the individual loses identity
    thereby eliminating a perceived effective coping
    strategy

45
Treatment Statistics
  • 80 who stay in treatment make progress
  • 20 drop out and relapse
  • Treatment can take 7-10 years or even longer

46
Dieting
  • Has been normalized within society and is a
    cultural norm
  • 35 of normal dieters progress to pathological
  • 20-25 develop eating disorders (NEDA, 2005)

47
What is the current culture? How does it impact
eating disorders?
48
A Childs Culture
  • Scraped knee chocolate chip cookie everything
    is ok
  • Barbie dolls 57, 100 pounds, size 2 reality
    54, 140 pounds, size 14

49
A Teenagers Culture
  • A recent study showed a teenager currently has a
    greater fear of being fat, than he/she does over
    cancer, or losing a parent
  • 50 of 9 year olds and 80 of 10 year olds are on
    diets

50
The Worlds Culture
  • McDonalds burger, fries and coke 1950 590
    calories
  • 2002 1550 calories
  • Jean Kilbourne

51
The Worlds Culture (Cont.)
  • Portions have dramatically increased
  • Since 1990, China has tripled in obesity
  • New modern lifestyle everything is already
    chopped and prepared

52
University of Minnesota Study
  • The effects of mothers dieting had a greater
    influence over sons than daughters
  • 2-3 times more likely to worry about weight/body
    image
  • 2-3 times more likely to diet
  • 7 times more likely to binge

53
Media and Eating Disorders
  • Ads normalize eating disorders
  • Ads depicting a woman are usually 4-5 women to
    create one
  • Ads with hands over mouth express themselves in
    other ways not what you say others believe it
    is a symbol not to eat

54
Media and Eating Disorders (Cont.)
  • Food is replacement for sex good girls say no
    dont eat
  • Television reality shows
  • Swan
  • Extreme Makeover
  • Biggest Loser

55
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59
Differences Between Males and Females
  • Onset for males is a a later age 20.5
  • Males focus on waist up
  • Males prefer to purge through fasting and
    exercise rather than vomit

60
Differences Between Males and Females (Cont.)
  • Male messages focus on body shape/image rather
    than weight
  • 41 of men are dissatisfied with weight, whereas
    70 are dissatisfied with body image

61
Males and Eating Disorders
  • Primary drug of choice steroids
  • Physical effects of steroid abuse in conjunction
    with compulsive exercise
  • Blurred vision, hallucinations, rage, skin
    problems (acne), high blood pressure, joint pain,
    loss of sex drive

62
Males and Eating Disorders (cont.)
  • Anorexia recent studies show for every four
    females one male is diagnosed
  • Bulimia for every eight females one male is
    diagnosed
  • Many more men are considered compulsive
    overeaters/binge eating disorder appear equally
    among both genders

63
Males and Eating Disorders (cont.)
  • These statistics may not be accurate as men do
    not seek treatment
  • Only 10 of individuals seeking treatment are
    male
  • This is comparable to womens chemical dependency
    treatment 15 years ago

64
Male Risk Factors
  • Overweight as a child
  • Family encouraged dieting as a teenager
  • Participates in sports that demands thinness
  • Job or profession that demands thinness
  • Homosexuality

65
Male Characteristics
  • Low self-esteem perfectionist
  • Avoids conflicts hates everything
  • Puts others ahead of themselves

66
Sample Treatment Planning
67
Goals of Body Image Group
  • Provide psychosocial educational information on
    the recovery barriers created by body image
  • Provide an opportunity to share with peers
    specific issues related to body image
  • Develop a relapse prevention plan that addresses
    both chemical dependency and body image
    concurrently

68
Possible Interventions
  • I will meet with the staff dietician on a weekly
    basis to discuss my progress on my food plan
  • I will cooperate with the medical staff regarding
    lab work
  • I will complete an EAT-26 and discuss the results
    with my counselor
  • I will initiate conversation at the dining table
    that does not involve food or treatment
  • I will participate in weekly blind weights
  • I will keep a journal regarding my feeling before
    each meal, my food intake and my feelings
    afterwards

69
Possible Interventions (Cont.)
  • I will discuss the secondary gains from my
    purging during the weekly group
  • I will keep a journal including my thoughts,
    feelings, behaviors, and desires to purge and
    discuss in the weekly group
  • I will discuss with my counselor what my purging
    has cost me
  • I will identify my triggers and a relapse
    prevention plan and share in the weekly group and
    with my family

70
Our Role
  • Start where the client is currently
  • Create a safe enviornment for change, the place
    of truth
  • Provide hope with a vision of recovery
  • Do the work together strategize and educate
  • Address any resistance

71
Conclusion
  • Therapists need to be aware of his/her own bias
  • Own body image
  • Own concerns over weight
  • Immediate reaction is to respond to the outside
    rather than focus on the inside
  • Food is fuel no more, no less

72
References
  1. Andersen, A. Anorexia Nervosa 11 Areas of
    Advancement. Eating Disorders Review March/April
    2003.
  2. ANRED. (2002) Treatment and Recovery
    www.anred.com
  3. Boston College Eating Awareness Team (2002).
    Eating Disorders and Men www.bc.edu
  4. Brownell, K.D. Fairburn, C.G. (1995). Eating
    Disorders and Obesity A Comprehensive Handbook.
    Guildford Press New York, NY.

73
References Cont.
  • Diagnostic and Statistical Manual of Mental
    Disorder Fourth Edition. Published by the
    American Psychiatric Association. Washington, DC.
    (1994).
  • Gordon, S. (1999). Research Update Eating
    Disorders and Substance Abuse Caron Foundation,
    Wernersville, PA.
  • Gordon, S. (2004). Co-Occurring Disorders
    Understanding Addiction with Relationship to
    Eating Disorders Caron Foundation, Wernersville,
    PA.
  • Karin Kratina, Nancy King, Dayles Moving Away
    from Diets - 2nd edition, Helm Publishing, Lake
    Dallas, TX (2003).

74
References Cont.
  • Kilbourne, J. (1999). Cant Buy My Love
    Touchstone New York, NY.
  • Remuda Ranch Substance Misused and Abused
    (2004). IAEDP Conference July, 2004.
  • Weiner, K.L. and Bishop, E.R. (2004). Levels of
    Care for Eating Disorders IAEDP Conference
    July, 2004.
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