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http://www.nhs.uk/conditions/Eating-disorders/Pages/Introduction.aspx

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Read about the different types of eating disorders including anorexia nervosa, bulimia and binge eating, as well as what causes them and the treatments available.

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https://www.b-eat.co.uk/about-beat/media-centre/information-and-statistics-about-eating-disorders?gclid=EAIaIQobChMIsdSNy63-1AIVyLftCh0nFARNEAAYASAAEgJl4PD_BwE

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Information & statistics about eating disorders in the UK, such as the most common eating disorders and the number of people affected.

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https://www.eatingdisorderhope.com/information/anorexia

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https://www.eatingdisorderhope.com/information/anorexia

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https://www.eatingdisorderhope.com/information/anorexia

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What is Anorexia Nervosa (AN)?

Anorexia Nervosa is a psychological and potentially life-threatening eating disorder. Those suffering from this eating disorder are typically suffering from an extremely low body weight relative to their height and body type.

Often referred to as BMI (Body Mass Index) is a tool that treatment providers often use to assess the appropriateness of body weight for an individual struggling with an eating disorder. Additionally, observations of eating patterns, exercise, and personality traits may give indications of an anorexic diagnosis. Those struggling with anorexia frequently fear gaining weight and have a distorted body image. They often believe they appear much heavier than they are.

Additionally, women and men who suffer from this eating disorder exemplify a fixation with a thin figure and abnormal eating patterns. Anorexia nervosa is interchangeable with the term anorexia, which refers to self-starvation and lack of appetite.

Major Types of AN

There are two common types of anorexia, which are as follows:

Binge/Purge Type - The person struggling with this type of eating disorder will often purge after eating. This alleviates the fear of gaining weight and offsets some of the guilt of having ingested forbidden, or highly restricted food. The compensatory purge behavior by the individual with Binge/Purge Type anorexia may purge by exercising excessively, vomiting or abusing laxatives.

Restrictive - The individual suffering from restrictive anorexia is often perceived as highly self-disciplined. They restrict the quantity of food, calories and often high fat or high sugar foods. They consume far fewer calories than are needed to maintain a healthy weight. This is a heartbreaking form of self-starvation.

Though two classifications of this eating disorder exist, both types exhibit similar symptoms, such as an irrational fear of weight gain and abnormal eating patterns.

Causes of Anorexia

It has been said that genetics load the gun and environment pulls the trigger in eating disorders. This eating disorder is based on genetic predisposition, personality traits, and environmental factors.

Examples of environmental factors that would contribute to the occurrence of this eating disorder are:

The effects of the thinness culture in media, that constantly reinforce thin people as ideal stereotypes

Professions and careers that promote being thin and weight loss, such as ballet and modeling

Family and childhood traumas: childhood sexual abuse, severe trauma

Peer pressure among friends and co-workers to be thin or be sexy.

Examples of biological factors include:

Irregular hormone functions

Genetics (the tie between anorexia and one's genes is still being heavily researched, but we know that genetics is a part of the story).

Anorexia Signs & Symptoms

An individual suffering from anorexia nervosa may reveal one or several signs and symptoms such as:

Chronic restrictive eating or dieting, beyond the norm

Rapidly losing weight or being significantly underweight and emaciated

Obsession with calories and fat contents of food

Engaging in ritualistic eating patterns, such as cutting food into tiny pieces, eating alone, and/or hiding food

Continued fixation with food, recipes, or cooking; the individual may cook intricate meals for others but refrain from partaking

Amenorrhea: an abnormal absence of menstruation, or loss of 3 consecutive menstrual cycles

Depression or lethargic stage

Development of lanugo: soft, fine hair that grows on face and body

Reported sensation of feeling cold, particularly in extremities

Loss or thinning of hair

Avoidance of social functions, family, and friends. May become isolated and withdrawn

Dieting Vs. AN

Though the restrictive eating patterns that characterize this anorexic eating disorder are similar to dieting behaviors, there are stark differences between the two. The effects of the extreme behaviors resulting from this disease are far more devastating and consequential than any ill effects from dieting.

While someone may diet in an attempt to control weight, anorexia nervosa is often an attempt to gain control over one's life and emotions, especially in the light of traumatic events or a chaotic environment.

While someone might diet in an attempt to lose weight as the primary goal, in anorexia they may diet because they perceive losing weight as a way to achieve happiness and self-mastery.

Anorexia Treatment

Seeking anorexia recovery from a well-qualified team of eating disorder specialists, consisting of a therapist, physician and nutritionist are recommended. Effective, holistic eating disorder treatment of anorexia involves three necessary components:

Medical: The highest priority in the treatment of anorexia nervosa is addressing any serious health issues that may have resulted from the eating disordered behaviors, such as malnutrition, electrolyte imbalance, amenorrhea and an unstable heartbeat.

Nutritional: This component encompasses weight restoration, implementation and supervision of a tailored meal plan, and education about normal eating patterns.

Therapy: The goal of this part of treatment is to recognize underlying issues associated with the eating disorder, address and heal from traumatic life events, learn healthier coping skills and further develop the capacity to express and deal with emotions.

Search for accredited eating disorder treatment centers in our directory.

Articles on AN

1. How Dangerous Are the Long-Term Effects of Anorexia?
Anorexia Nervosa has the highest mortality rate of any mental health issue. The physical dangers of starvation and consequences of declining mental and physical health are numerous. Learn more about the debilitating health consequences of anorexia nervosa... Read This Article

2. Atypical Anorexia Nervosa: Signs and Symptoms
Atypical anorexia nervosa is featured in the Diagnostic & Statics Manual, Edition 5 (DSM-5) category of Other Specified Feeding or Eating Disorders (OFSED). Frighteningly, many individuals who have Atypical Anorexia do not believe they have an eating disorder and are less likely to seek the life-saving treatment they need. Learn about the dangers and concerns of Atypical Anorexia Nervosa... Read This Article

3. Anorexia Recovery and Overcoming Physical Side Effects of an Eating Disorder
A highly regarded physician specializing in treating acute eating disorders outlines the health consequences of Anorexia Nervosa and the challenges faced in recovering from this life-threatening eating disorder. Learn about electrolyte imbalances, dehydration, edema and other physical consequences of anorexia nervosa... Read This Article

Page Last Updated & Reviewed By: Jacquelyn Ekern, MS, LPC on February 14, 2018
Published on EatingDisorderHope.com, Eating Disorders Information & Resources

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Anorexia: Signs, Symptoms, Causes and Articles For Treatment

# data[].attributes.attachment_link.description
Anorexia Nervosa is a psychological and potentially life-threatening eating disorder. Those suffering from this eating disorder are typically suffering from an extremely low body weight relative to their height and body type. Often referred to as BMI (Body Mass Index) is a tool that treatment providers often use to assess the appropriateness of body weight for an individual struggling with an eating disorder.

# data[].attributes.body
https://www.eatingdisorderhope.com/information/anorexia

# data[].attributes.attachment_link.readable_text
What is Anorexia Nervosa (AN)?

Anorexia Nervosa is a psychological and potentially life-threatening eating disorder. Those suffering from this eating disorder are typically suffering from an extremely low body weight relative to their height and body type.

Often referred to as BMI (Body Mass Index) is a tool that treatment providers often use to assess the appropriateness of body weight for an individual struggling with an eating disorder. Additionally, observations of eating patterns, exercise, and personality traits may give indications of an anorexic diagnosis. Those struggling with anorexia frequently fear gaining weight and have a distorted body image. They often believe they appear much heavier than they are.

Additionally, women and men who suffer from this eating disorder exemplify a fixation with a thin figure and abnormal eating patterns. Anorexia nervosa is interchangeable with the term anorexia, which refers to self-starvation and lack of appetite.

Major Types of AN

There are two common types of anorexia, which are as follows:

Binge/Purge Type - The person struggling with this type of eating disorder will often purge after eating. This alleviates the fear of gaining weight and offsets some of the guilt of having ingested forbidden, or highly restricted food. The compensatory purge behavior by the individual with Binge/Purge Type anorexia may purge by exercising excessively, vomiting or abusing laxatives.

Restrictive - The individual suffering from restrictive anorexia is often perceived as highly self-disciplined. They restrict the quantity of food, calories and often high fat or high sugar foods. They consume far fewer calories than are needed to maintain a healthy weight. This is a heartbreaking form of self-starvation.

Though two classifications of this eating disorder exist, both types exhibit similar symptoms, such as an irrational fear of weight gain and abnormal eating patterns.

Causes of Anorexia

It has been said that genetics load the gun and environment pulls the trigger in eating disorders. This eating disorder is based on genetic predisposition, personality traits, and environmental factors.

Examples of environmental factors that would contribute to the occurrence of this eating disorder are:

The effects of the thinness culture in media, that constantly reinforce thin people as ideal stereotypes

Professions and careers that promote being thin and weight loss, such as ballet and modeling

Family and childhood traumas: childhood sexual abuse, severe trauma

Peer pressure among friends and co-workers to be thin or be sexy.

Examples of biological factors include:

Irregular hormone functions

Genetics (the tie between anorexia and one's genes is still being heavily researched, but we know that genetics is a part of the story).

Anorexia Signs & Symptoms

An individual suffering from anorexia nervosa may reveal one or several signs and symptoms such as:

Chronic restrictive eating or dieting, beyond the norm

Rapidly losing weight or being significantly underweight and emaciated

Obsession with calories and fat contents of food

Engaging in ritualistic eating patterns, such as cutting food into tiny pieces, eating alone, and/or hiding food

Continued fixation with food, recipes, or cooking; the individual may cook intricate meals for others but refrain from partaking

Amenorrhea: an abnormal absence of menstruation, or loss of 3 consecutive menstrual cycles

Depression or lethargic stage

Development of lanugo: soft, fine hair that grows on face and body

Reported sensation of feeling cold, particularly in extremities

Loss or thinning of hair

Avoidance of social functions, family, and friends. May become isolated and withdrawn

Dieting Vs. AN

Though the restrictive eating patterns that characterize this anorexic eating disorder are similar to dieting behaviors, there are stark differences between the two. The effects of the extreme behaviors resulting from this disease are far more devastating and consequential than any ill effects from dieting.

While someone may diet in an attempt to control weight, anorexia nervosa is often an attempt to gain control over one's life and emotions, especially in the light of traumatic events or a chaotic environment.

While someone might diet in an attempt to lose weight as the primary goal, in anorexia they may diet because they perceive losing weight as a way to achieve happiness and self-mastery.

Anorexia Treatment

Seeking anorexia recovery from a well-qualified team of eating disorder specialists, consisting of a therapist, physician and nutritionist are recommended. Effective, holistic eating disorder treatment of anorexia involves three necessary components:

Medical: The highest priority in the treatment of anorexia nervosa is addressing any serious health issues that may have resulted from the eating disordered behaviors, such as malnutrition, electrolyte imbalance, amenorrhea and an unstable heartbeat.

Nutritional: This component encompasses weight restoration, implementation and supervision of a tailored meal plan, and education about normal eating patterns.

Therapy: The goal of this part of treatment is to recognize underlying issues associated with the eating disorder, address and heal from traumatic life events, learn healthier coping skills and further develop the capacity to express and deal with emotions.

Search for accredited eating disorder treatment centers in our directory.

Articles on AN

1. How Dangerous Are the Long-Term Effects of Anorexia?
Anorexia Nervosa has the highest mortality rate of any mental health issue. The physical dangers of starvation and consequences of declining mental and physical health are numerous. Learn more about the debilitating health consequences of anorexia nervosa... Read This Article

2. Atypical Anorexia Nervosa: Signs and Symptoms
Atypical anorexia nervosa is featured in the Diagnostic & Statics Manual, Edition 5 (DSM-5) category of Other Specified Feeding or Eating Disorders (OFSED). Frighteningly, many individuals who have Atypical Anorexia do not believe they have an eating disorder and are less likely to seek the life-saving treatment they need. Learn about the dangers and concerns of Atypical Anorexia Nervosa... Read This Article

3. Anorexia Recovery and Overcoming Physical Side Effects of an Eating Disorder
A highly regarded physician specializing in treating acute eating disorders outlines the health consequences of Anorexia Nervosa and the challenges faced in recovering from this life-threatening eating disorder. Learn about electrolyte imbalances, dehydration, edema and other physical consequences of anorexia nervosa... Read This Article

Page Last Updated & Reviewed By: Jacquelyn Ekern, MS, LPC on February 14, 2018
Published on EatingDisorderHope.com, Eating Disorders Information & Resources

# data[].attributes.attachment_link.title
Anorexia: Signs, Symptoms, Causes and Articles For Treatment

# data[].attributes.attachment_link.description
Anorexia Nervosa is a psychological and potentially life-threatening eating disorder. Those suffering from this eating disorder are typically suffering from an extremely low body weight relative to their height and body type. Often referred to as BMI (Body Mass Index) is a tool that treatment providers often use to assess the appropriateness of body weight for an individual struggling with an eating disorder.

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https://www.boundless.com/psychology/textbooks/boundless-psychology-textbook/psychological-disorders-18/feeding-and-eating-disorders-421/eating-disorders-367-12902/

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Eating Disorders - Boundless Open Textbook

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Eating disorders are mental disorders defined by abnormal eating habits, such as bingeing, purging, and/or fasting. Read more about eating disorders in the Boundless open textbook.

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https://psychcentral.com/lib/treatment-for-anorexia/

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Treatment of anorexia, as with all eating disorders, can be challenging. Effective treatment addresses the underlying emotional and mental health issues, issues that often date back to childhood and a person's self-perception and self-image. Indeed, many of the treatment approaches described below focus on helping a person with anorexia to understand how their own self-image impacts their eating behavior. Self-image can be seen as a foundation of the change that a person with anorexia needs to address, as inaccurate self-image can be devastating - to the point where an emaciated individual still see themselves as overweight.

Some people with anorexia can be in what psychologists call "denial." That is, they deny even having a problem, even if their body weight is dangerously low. They may point to supermodels or other celebrities as proof that they don't have a problem and just want to "look as thin as they do." Part of the challenge of treatment with anorexia, then, may be just helping the person with anorexia understand they do have a serious mental health concern that needs professional treatment (see Family Therapy below).

While there are many different routes to treatment, virtually all of them begin with seeing an eating disorder specialist. Usually this individual is a psychologist who has deep experience and training in helping a person with anorexia. A physical examination and workup by a medical doctor is also an initial part of the standard treatment of anorexia, to understand and begin addressing the physical problems that may have occurred as a result of the disorder.

Psychotherapy for Anorexia

Psychotherapy is the most common treatment for anorexia and has the greatest research support. Psychotherapy can involve a significant time and financial commitment, particularly if you are struggling with other issues (sexual abuse, depression, substance use, relationship problems). Psychotherapy can be very helpful in addressing not only your disordered eating, but also your overall emotional health and happiness. Indeed, the focus of psychotherapy treatment will be to address the underlying emotional and cognitive issues that result in the disordered eating.
Cognitive-Behavioral Therapy
Cognitive behavioral therapy (CBT) is considered the treatment of choice for people with anorexia. With the support of decades' worth of research, CBT is a time-limited and focused approach that helps a person understand how their thinking and negative self-talk and self-image can directly impact their eating and negative behaviors.

Cognitive behavioral therapy is the gold standard treatment for anorexia.

Cognitive-behavioral therapy will often focus on identifying and altering dysfunctional thought patterns, attitudes and beliefs, which may trigger and perpetuate the person's restrictive eating. A researcher in the early 1980s by the name of Chris Fairburn developed a specific model of cognitive-behavioral therapy to help in the treatment of anorexia, using the traditional foundations of CBT therapy - helping a person understand, identify and change their irrational thoughts (the "cognitive" part), and helping a person make the changes real through specific behavioral interventions (such as promoting health eating behaviors through goal setting, rewards, etc.).

Cognitive-behavioral therapy is time-limited, meaning that a person with anorexia will go into treatment for a specific period of time with specific goals in mind. Like all psychotherapy, it can be conducted in either an outpatient (once weekly) or inpatient setting. If done in an inpatient setting, eating disorders are often treated at residential treatment facilities, since eating is such an integral and necessary part of our lives.

According to an article published in 2008 from the U.S. National Guideline Clearinghouse, "For adults, preliminary evidence suggested that cognitive behavioral therapy may reduce the relapse risk after weight restoration. For adolescents, evidence supported specific forms of family therapy that initially focused on parental control of re-nutrition."

"Among anorexia nervosa patient populations, at least one-half no longer suffered from anorexia nervosa at follow up [after cognitive-behavioral therapy treatment], but many continued to have other eating disorders; mortality was significantly higher than would be expected in the population.

"Factors associated with recovery or good outcomes were lower levels of depression and compulsivity. Factors associated with mortality included concurrent alcohol and substance use disorders.

Another form of psychotherapy is known as family therapy. Family therapy helps a person with anorexia see and understand the often-times dysfunctional role they play within the family, and how their eating behaviors maintain that role.

Family therapy is usually conducted with the person who has anorexia and their family. However, in some instances, a few family therapy sessions may involve therapy without the person who has anorexia present. This may help the family understand the roles they are playing in supporting the disordered eating, and suggest ways the family can help the person with anorexia acknowledge the problem and seek out treatment.

The "Maudsley Method" is a specific form of family therapy where parents assume responsibility for feeding their anorexic teen to help them gain weight and improve the teen's eating habits. Research has demonstrated its effectiveness in the treatment of adolescents and children especially, before the disordered eating has become a chronic behavior.

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Treatment of anorexia, as with all eating disorders, can be challenging. Effective treatment addresses the underlying emotional and mental health issues, issues that often date back to childhood and a person's self-perception and self-image. Indeed, many of the treatment approaches described below focus on helping a person with anorexia to understand how their own self-image impacts their eating behavior.

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https://www.psychologytoday.com/blog/happiness-is-state-mind/201706/will-the-bone-trigger-eating-disorders

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Netflix did it again, first with their controversial release of 13 Reasons Why and now with their soon to be released To the Bone, a movie that could potentially glamorize eating disorders and could foster unhealthy triggers and thoughts in those who are struggling with disordered eating. To the Bone, which is released next month, tells the story of 20-year-old Ellen, who struggles with anorexia nervosa and enters a group recovery home for treatment. While the film's director says the film is intended as "a conversation starter about an issue that is too often clouded by secrecy and misconceptions," critics say the film risks glamorizing and trivializing anorexia. In this racy trailer, Collins' character is seen counting calories and is rail thin, which are known to be emotionally triggering for viewers who are struggling with eating disorders or are in recovery. Additionally, glamorizing and trivializing eating disorders can also be potentially risky for individuals who have not yet developed an eating disorder but who have engaged in unhealthy thoughts and behaviors associated with disordered eating.
Depicting between fact and fiction
The media often glamorizes weight loss and the desire to be thin resulting in many young girls, as young as eight years of age, engaging in harmful diets and calorie counting. Additionally, eating disorders are falsely portrayed in the media as disorders of thin, young, Caucasian women however eating disorders affect individuals of every size, age, shape and gender. A 35-year-old man who is overweight can be struggling with an eating disorder in the same fashion as a young, thin adolescent female. Another common misconception regarding eating disorders is the continued mix up between anorexia nervosa and bulimia nervosa, when in fact they are two very different disorders. Many individuals believe that anorexia nervosa involves restricting food while bulimia nervosa involves binging and purging however anorexia nervosa has two subtypes: the restrictive subtype and the binging and purging subtype. The main difference between these two disorders is weight. Individuals with anorexia nervosa are not able to maintain the minimal weight where as individuals with bulimia nervosa are of normal weight or are even overweight.
The truth about eating disorders
Millions of people in the United States are affected by eating disorders on a daily basis and anorexia nervosa is considered to have the highest mortality rate out of any mental health disorder making this and other related disorders a very serious issue. Anorexia nervosa, binge eating disorder, bulimia nervosa, avoidant/restrictive food intake disorder and pica are the most well known eating disorders that can be found in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM V). Eating disorders, on average, last approximately six to eight years, which is a good chunk of an individual's life. Although food and weight are the centerpieces of an eating disorder, food is rarely the cause of such disorders. Underlying triggers that have been known to cause eating disorders include past abuse or trauma, low- self esteem, bullying, poor parental relationships, borderline personality disorder, substance abuse, non- suicidal self-injury disorder (NSSI), a perfectionistic personality, difficulty communicating negative emotions, difficulty resolving conflict, and genetics.

The actual Netflix show will not be released until August and so far, the only images that have been released to the public are from the trailer. Eating disorder professionals worldwide are hoping that the film delivers a mindful and truthful approach to eating disorders without any major triggers however only time will tell. Thus far, the trailer has received a mixed response online. The movie's writer and director, Marti Noxon, who based the film on her own experiences, said: "My goal with the film was not to glamorize eating disorders but to serve as a conversation starter about an issue that is too often clouded by secrecy and misconceptions."

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Will "To the Bone" Trigger Eating Disorders?

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Netflix did it again, first with their controversial release of 13 Reasons Why and now with their soon to be released To the Bone, a movie that could potentially glamorize eating disorders and could foster unhealthy triggers and thoughts in those who are struggling with disordered eating.

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https://www.psychologytoday.com/blog/hunger-artist/201706/app-recovery-anorexia

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Maybe LA has been getting to me: this spring, I realised I want to create an app. I see it guiding the user along the entire arc of recovery from anorexia: from making the initial decision to act (by eating more), to resisting the urge to stop weight restoration at a predetermined BMI, to learning to leave the app's support behind. It will involve no total calorie calculations and no bodyweight targets. Instead, it will encourage the user to follow the standard cognitive-behavioural model of incorporating 500kcal extra into their usual daily intake (on top of what maintains a stable pre-recovery weight), and adjust upwards later as needed. And it will help the user learn to appreciate the importance of accepting two facts:

1) that one cannot know exactly where weight restoration will end,

and 2) that a temporary overshoot beyond one's ultimately stable bodyweight may very well need to happen.

Uncertainty and gaining more than minimal amounts of weight are what anorexia hates above all other things, but (or therefore) getting better requires both.

One of the most sobering things I've learned from the thousands of comments and questions that you, my readers, have shared over the past eight years is that a surefire way to stay ill, or semi-ill, forever is to decide on a final 'acceptable' bodyweight, eat enough to get there, and then reduce one's intake again to make sure one goes no further. Coming to realise just how often this happens has helped me understand in a new light my own late-teenage relapse, and more broadly the problematic principles underlying much clinical treatment of anorexia. It should be obvious that dieting cannot be part of recovery from anorexia, but deliberate calorie restriction is tacitly advocated, accepted as a necessary evil, or, at best, factored in as a likely occupational hazard, whenever a final bodyweight target is set.

For someone with anorexia, treating a bodyweight target as a minimum rather than a maximum is supremely difficult, and it's my impression that encouragement to do so is rarely very vehement. And even if it is, the target is often set on the basis of generic BMI ranges that mean little at an individual level, and/or is set right at the very bottom end of those ranges, on the flawed assumption that it's better to ask someone to aim low than high. Many of us are given a conservative weight target in the very early months of illness, and many people start dieting when they reach it, and then spend years wondering why nothing ever seems to really truly improve. It's terribly easy to remain haunted by that number and by what it costs to stay there, as well as by fear of what it would seem to cost to go beyond it. It may be surreally difficult to conceive of recovery without a weight target, but accepting a degree of numerical unknowability is essential to letting life back in.

The app I envisage will help the whole process feel less dauntingly vague. It will offer light-touch tracking not just of eating and exercise according to your own detailed recovery plan, but of other things that will change as your mind and body start to heal, like energy levels or mood. And it will learn from your habits and your successes and failures to provide reminders and encouragement when they're most needed. Alongside this support, there will also be more self-contained sections for tackling specific challenges. Above all, there are the two major sticking points: how to translate insight into action, i.e. decide to get better, and how to keep going beyond whatever bodyweight threshold you may long have had in mind, if that is what your body needs. But there will be other challenges too, along the way, like making your eating more varied or more sociable. And there'll be weekly planning and reflection sessions, too, to make sure you feel invested, seriously, individually, in what is changing and why.

The support system I have in mind will put food at the centre of recovery, without making it all there is. It will make recovery a personal thing (inspired by my own and others' experiences of illness and recovery, and honouring the user's own experience), while accepting that generalisations can be made and that robust new habits need establishing pragmatically, even ruthlessly at times. It will refuse the anorexic instinct to set an endpoint to recovery before it even begins. And it will respect the natural arc that recovery takes, insisting that recovery can and should be not just frightening and sometimes painful, but also exhilarating, personal, momentous, systematic, and - above all - finite.

The support will be specific to anorexia because a starting point of underweight shapes the recovery process in important ways. But it will be for you whether you were diagnosed with anorexia last week and don't yet believe there's anything really wrong, or you've been feeling for months that you must be about to hit rock bottom but never quite seem to be sure that you have, or you're looking back on a distant stalled recovery with a life so bound up with not-quite anorexia that you can barely imagine living any other way. I hope the app will complement the book I'm writing (I'm aware I first mentioned the book ages ago, but I am making progress, and I've just happily emerged from the exhausted depths of another big project, so have more time for it again). How exactly it will interact with the user's other sources of therapeutic support is something that still needs working out, and this will be tricky, because on the one hand it is by no means envisaged as substituting for professional support (where that exists), but on the other hand, significant conflicts may well arise when it comes to things like target weights. I know I'll have to tread carefully here.

I have precisely zero of the technical skills needed to make this become a reality, but I hope to find people to work with who do. The idea was recently awarded second place in a Humanities Innovation competition at the University of Oxford, and now I'm keen to try to make something happen. Writing this post feels like another little step towards that, and if you have any questions or criticisms or suggestions, I'd love to hear from you.

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Maybe LA has been getting to me: this spring, I realised I want to create an app. I see it guiding the user along the entire arc of recovery from anorexia: from making the initial decision to act (by eating more), to resisting the urge to stop weight restoration at a predetermined BMI, to learning to leave the app's support behind.

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https://www.psychologytoday.com/blog/eating-mindfully/201704/is-anorexia-the-latest-treatment-obesity

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Is it possible that a mental illness holds the secret to treating obesity? That's what some leading eating disorder experts propose. In their opinion piece "Long-term weight loss maintenance in obesity: Possible insights from anorexia nervosa" published in the International Journal of Eating Disorders, Dr. Loren Gianini and her colleagues suggest that anorexia nervosa may provide a framework for understanding long-term weight loss maintenance in people at higher weights.

Anorexia nervosa is an eating disorder that afflicts approximately 1% of women and has the highest risk of death of any psychiatric disorder. About 10% of patients diagnosed will die from the disorder. This high mortality rate results from starvation and metabolism collapse, as well as suicide.

In people across the weight spectrum, significant long-term weight loss and maintenance is a rare occurrence. In fact, it is so unusual that scientists have created a national registry to study these unicorns. The National Weight Control Registry (NWCR) is an online database of approximately 10,000 individuals who report to have lost at least 30 lbs and maintained the weight-loss for at least 1 year.

It turns out, these individuals have a lot in common with people diagnosed with anorexia nervosa. In their article, Gianini et al (2017) report that both individuals with anorexia nervosa and individuals on the NWCR:

Eat a diet low in fat and calories and restricted in diet variety

Deviation from this rigid diet is associated with weight regain, even amongst individuals who have maintained weight loss for several years

The longer that individuals maintain substantial weight loss, the less likely they are to regain weight and the more likely they are to report needing fewer strategies, less effort, and less attention to maintain weight loss. Over time, the behaviors that support weight loss maintenance become ingrained and automatic (perhaps one of the reasons that chronic anorexia is so difficult to treat).

Are physiologically primed for weight regain. Both groups have lower resting energy expenditure, lower levels of leptin (the satiety hormone) and thyroid hormone, and higher levels of ghrelin (the hunger hormone) than non-weight reduced BMI-matched controls. They have metabolic profiles that oppose further weight loss and promote weight gain, yet they override these powerful biological drives to maintain their weight loss.

In people at lower weights, these behaviors are considered an eating disorder in need of treatment. In people at higher weights, these behaviors are considered good health and encouraged by medical professionals. Why do we prescribe in one group and treat in another? Isn't what is good for the goose good for the gander?

In our fat-hating culture, we are indoctrinated to believe that health is marked by body weight and thinner is almost always better. Fat people are encouraged to lose weight by any means necessary. This paper perpetuates the myth that fat people can't be anorexic because weight loss is always healthy, even when it results from starvation. Despite the similar behavioral and neural mechanisms involved in anorexia nervosa and weight loss maintenance at higher weights, Gianini et al clarify that they "are not suggesting that the weight loss of individuals on the NWCR is pathological." In fact, what they are suggesting is that further research be conducted to inform interventions to facilitate these behaviors in the higher weight group and interrupt the behaviors in the lower weight group. Let's spend taxpayer money to help fat people learn the magic sauce that people with anorexia have mastered.

As I mentioned in my recent post " The Hidden Faces of Eating Disorders, " eating disorders are under-diagnosed in people at higher weights. There are tons of stories online about people who were told they were too fat to be anorexic and denied treatment until they finally lost enough weight to meet the BMI requirement for the diagnosis, at which point their disease was far more progressed, chronic, and entrenched-making for a worse prognosis than if the disease were treated at an earlier stage. The DSM-V (the newest edition of the psychiatry diagnostic guide) moves away from rigid weight criteria in the diagnosis of anorexia nervosa. While the DSM-IV had previously required individuals to have a body weight less than 85% of expected, the DSM-V has the more subjective criteria of "significantly low body weight." Despite these diagnostic changes, clinicians rarely consider that "significantly low" differs from individual to individual. Not everyone is meant to occupy the same body size and shape. When we endorse a one-size-fits-all model, we prescribe weight loss to everyone at higher than "normal" weights and always view this weight loss as healthy.

Anorexia nervosa is a vicious disease with dire physical and emotional consequences. Fatness does not protect against it; in fact, people at higher weights are at increased risk due to the tremendous pressure to lose weight. Rather than viewing anorexia nervosa as a tool to help fat people lose weight, the rigid restrictive dieting and preoccupation with weight and shape evidenced by people on the NWCR may signal widespread eating disordered symptoms among people at higher weights. Instead of devoting resources to trying to increase this eating disordered behavior, the real need is for more resources dedicated to the identification and treatment of eating disorders across the weight spectrum.
Alexis Conason is a clinical psychologist in private practice in New York City specializing in body image and overeating disorders. Want more mindful eating? Sign up for her newsletter at www.drconason.com, like her on Facebook, or follow her on Twitter.

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Is Anorexia the Latest Treatment for Obesity?

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Is it possible that a mental illness holds the secret to treating obesity? That's what some leading eating disorder experts propose. In their opinion piece "Long-term weight loss maintenance in obesity: Possible insights from anorexia nervosa" published in the International Journal of Eating Disorders, Dr. Loren Gianini and her colleagues suggest that anorexia nervosa may provide a framework for understanding long-term weight loss maintenance in people at higher weights.

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https://www.psychologytoday.com/blog/inside-out-outside-in/201703/what-is-bulimia-nervosa

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As we recognize National Eating Disorder Awareness Week, I hope the information I share below will be both informative and useful. For even more information about eating disorders, and ways you can help make a difference in the life of a loved one or for yourself, please visit the National Eating Disorder Association website. Remember, "It's time to talk about it." #NEDAwareness
In the United States, there has been a culturally driven obsession with weight loss and body image.

Just look at the models and actresses we see on television, in movies, in women's magazines and online. Many studies have documented the impact of media on a drive to attain thinness. The pressures even begin in school age kids.

And in our own personal conversations, what do you hear, male or female, when you've lost 5-10 pounds? "You look GREAT!"

Fortunately, the impact of the media studies has made most of us aware of the ill effects on women in particular, and television has done an excellent job over the last decade in exposing us to a wide range of stars with different body sizes and shapes.

In this blog I focus on Bulimia Nervosa. It had been called "the secretive syndrome" because most of the folks who suffer from this disorder are normal or slightly above weight and hide their behavior. Their shame, often personal torture, makes it very different from women with Anorexia Nervosa.

Those with anorexia nervosa, though compulsively driven to thinness, are usually extremely gratified by refraining from eating and losing weight. Their eating disorder is not viewed as foreign from their personal experience. It is not an intrusion.
"Karen"
This is quite the opposite for bulimia nervosa. It feels like something foreign has taken over and is in the driver's seat.
Karen was a sophomore in college. She was deeply involved in her sorority, loved to drink and party, and was a top student. She played on the school softball team. After meals, Karen would frequently leave abruptly to go to the bathroom. One time a friend happened to find her vomiting in the bathroom stall. Her friend had no clue whether to confront her or to keep it to herself. Karen would often hoard food, mostly carbohydrates, like loaves of bread, boxes of cookies or doughnuts, and frantically eat them late at night, then purge. She became clinically depressed, binged more and more frequently, increased her alcohol consumption, and had to take a medical leave of absence. No one knew exactly why she was out, other than knowing she was depressed and out of control at parties.
Let's begin with a vignette, drawn from a number of young women I have seen over the years:

In my clinical practice I have worked with many women who have had anorexia and bulimia nervosa. I have found these young women to be among the brightest, most sensitive and caring individuals I have known. And most families are dutiful, loyal and dedicated to the wellbeing of their kids.
What is Bulimia Nervosa?
But something goes terribly wrong.

Bulimia Nervosa is a disorder that is characterized by episodes of eating a large amount of food in very short periods of time, with a feeling that there is no control of this behavior. It is an irresistible compulsion. Following binges, there is the impulse to compensate for the behavior by purging - and this might include vomiting, induced by one's finger or taking some medication such as Ipecac, laxatives or diuretics, or going on a long run.

Binges typically occur on average once a week though sometimes multiple times a week. The purging behavior is tied to attempts to control body shape and weight.
Associated Features
From a psychological perspective, bulimia feels like an addiction. It feels like something the person cannot control, and often results in very low self-esteem, poor self-image, and is not a pleasant experience. It feels "disgusting" and "out of control." - bulimia is a living torture. The intense shame often obstructs seeking help.

Bulimia tends to be three times more common in women than in men, and it typically begins in the late teens or early 20s.

People with bulimia nervosa often have personal characteristics that may not be severe enough to create dysfunction. These are the features we are born with. The traits often seen in folks with bulimia include perfectionism; compulsive behavior (need for control, exactness, and order); impulsivity (often associated with abrupt and, at times poor decision making); and narcissism (extreme needs for validation and admiration, self-centered behavior, excessive focus on image).

There are also a number of psychiatric disorders that are very common in people who have bulimia.

Depression is the most common associated disorder, and occurs in about 50% of cases. Other common associated problems include:

There are a number of risk factors for bulimia including childhood trauma, such as sexual abuse, and discontinuation of psychotherapy.

Of considerable importance is that, like many other mental health disorders, multiple factors have an added impact. For bulimia nervosa, a history of childhood maltreatment is often associated with depressive conditions, anxiety disorders, and borderline personality disorder. And in these cases the prognosis is worse.

Bulimia nervosa has been associated with personality disorder.

Many patients and family members ask about personality disorders and just what they mean. Personality disorders should not be confused with disorders of the "person." Rather, they are labels that indicate a constellation of behavioral, emotional and cognitive characteristics that cause problems in one's social, occupational or academic, and recreation life. While I am not fond of the label "personality disorders" I understand that it is shorthand for looking at a cluster of qualities that more often than not are present together.

The most common personality disorder associated with bulimia is Borderline personality disorder. Borderline traits include:
Medical Complications and Outcome

difficult, often stormy interpersonal relationships;

intolerance or uncontrolled anger;

feelings of aloneness or emptiness;

seeing the world in black and white terms - as all good or all bad;

difficulty regulating emotions; low self-worth;

self-destructive behaviors such as suicide attempts, shoplifting, substance abuse, and impulsivity.

People who have bulimia nervosa often have complications that result from excessive purging, including:

dehydration;

loss of salts in the blood (electrolytes);

gastrointestinal problems, such as inflammation of the stomach or esophagus;

enlarged salivary glands (from eating excessive carbohydrates that stimulate saliva production);

erosion of dental enamel with increased risk of cavities, due to the acid in vomit.

The good news about bulimia is that with treatment 30-80% have a remission. However, the recurrence rate is very high. This means that even if the symptoms abate, ongoing care and attention to the underlying problems needs attention.
Treatment
The bad news is that the death rate for bulimia is quite high. Now when considering mortality, most studies have looked at a composite death rate - death due to all causes - the combined effects of bulimia with other behaviors and disorders. The all-cause death rate for bulimia nervosa is 2-8 times greater than the rate for the general population. This is largely due to the increased rates of suicide.

Treatment for bulimia nervosa can be highly effective.

It generally involves a team effort, including a primary care physician, nutritionist, and mental health clinicians.

The most important treatments include monitoring of medical and nutritional status, including possible medical complications and psychiatric care.
Prevention
From the mental health standpoint, effective treatments include psychotherapy, most importantly, cognitive behavior therapy. Additional psychotherapy methods for many patients include mindful meditation, techniques to regulate emotions, and family therapy. Medications, and in particular the antidepressant medications are extremely valuable in diminishing binging and purging episodes. They also treat associated depression, anxiety and obsessive compulsive disorders if present, and diminish impulsivity. The selective serotonin reuptake inhibitors (SSRIs) are among the most effective antidepressant for bulimia nervosa.

I cannot emphasize the value of prevention for eating disorders. Among the most important preventative measures are: increasing knowledge of the illness, and using techniques to reduce the importance of body image and thinness for our kids - starting this as early as possible, both at home and in school. Studies have also found that programs that can diminish the need for dieting and increase the emphasis on good nutrition and healthy eating patterns, without need for dieting, and improving emotional regulation all help.

Prevention is most effective for bulimia nervosa (and virtually all other mental health problems) if programs are conducted in all areas in which the child lives - at home, in school, in after school and community programs.
I began seeing Karen on her medical leave from college. For the initial phase of our work, she was very reluctant to talk with me about the details of her binging and purging, and avoided talking about her body image. In time she earned my trust and we began discussing details of her impulses to binge and purge. My goal was to increase the interval from the impulse to binge to the action. The longer I could help her increase this interval the less powerful the impulse led to binging and purging. What helped? Medication. Meditation. Use of humor. Appreciation of what we liked in pop culture, including music, films, and other media. Looking at photos of women together and candidly talking about how she compared herself to them. And discussing the exaggerated or distorted thoughts (cognitions) she had about her body, self, and relationship with others. This progressed to discussing her use of alcohol, and her sexual, often promiscuous behavior in order to achieve positive self-esteem. We then considered other means of feeling good about herself. We also talked about ways of controlling her emotions. I brought in her family to help them understand her disorder and help out when she needed it. We also talked about her remote history of sexual abuse from another kid in the neighborhood, and its shameful and devastating impact on her. This was new news to her parents. In about 3-4 months her binging stopped. There were recurrences, but we did not let them derail us from our work. I stayed in touch with her and have been working with her for over 10 years following her return to school.
Now let's go back to Karen:

Young people like Karen need an anchor in their lives, one who, despite the ups and downs of these long term problems, will not give up on them, and one who becomes a trusted friend.

As I say to all my eating disorder patients - this is a marathon, not a sprint.

And then, we work hard together, and hope for the best.
A version of this blog was originally posted on The Clay Center for Young Healthy Minds at the Massachusetts General Hospital.
That is about the best we can do, but it is worth doing every single time.

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As we recognize National Eating Disorder Awareness Week, I hope the information I share below will be both informative and useful. For even more information about eating disorders, and ways you can help make a difference in the life of a loved one or for yourself, please visit the National Eating Disorder Association website.

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https://www.psychologytoday.com/blog/eating-mindfully/201702/the-hidden-faces-eating-disorders

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What is the face of an eating disorder? Often, we envision a young thin white woman. However, research indicates that people at higher weights-fat people-are at increased risk for eating disorders. And their symptoms typically go unnoticed.

A recent study ( Lipson & Sonneville, 2017) examined 9713 students from 12 different colleges and found that body weight was the most consistent predictor of eating disorder symptoms. Students with a BMI in the "overweight" or "obese" range were at the highest risk and students with a BMI in the "underweight" range were surprisingly at the lowest risk. A history of elevated body weight is common in patients seeking eating disorder treatment. A 2015 study by Lebow et al. examined patients seeking treatment for restrictive eating disorders, such as anorexia nervosa, and found that over 36 percent of patients had a history of BMI above the 85th percentile. And disturbingly, symptoms in these patients are often not diagnosed until later and more severe stages of the illness. A 2013 article by Sim et al. that I wrote about in an earlier post found that eating disorder symptoms in adolescents with a weight history in the "overweight" or "obese" range not only were under-diagnosed, but symptoms were actually encouraged by medical professionals who congratulated these patients for losing weight.

Why are people at higher weights at increased risk of eating disorder symptoms? For one, we live in a culture that villainizes fat. Inhabiting a fat body is seen as a moral failing, evidence of being a sub-par human being. Fat people face the scorn of society and are open targets for discrimination and bigotry. It's no wonder that so many will try anything possible to lose weight, even if that means engaging in eating disorder behaviors that compromise their health. This is not to say that eating disorder symptoms are the first line of action for people trying to lose weight. More commonly, weight loss efforts start with dieting or "healthy eating," which gives way to disordered eating.

Eating disorder prevention and intervention efforts are often targeted at people in the "underweight" range while people categorized as "overweight" or "obese" are targeted for weight loss interventions. Fat people are told to diet, even though dieting is one of the strongest predictors for both development of eating disorders and weight gain. Isn't it time we stopped prescribing behaviors to people at higher weights that are diagnosed as eating disorder symptoms in people at lower weights? Food restriction, purging food (either through laxative use, self-induced vomiting, or exercising to compensate for calories consumed), viewing foods as "good" or "bad," and defining our self-worth based on the numbers on the scale are unhealthy at any weight. We need to recognize these symptoms as what they are-signs of an eating disorder-even when the person who is engaging in them lives in a fat body.
Alexis Conason is a clinical psychologist in private practice in New York City specializing in body image and overeating disorders. To learn more about her practice and mindful eating, visit drconason.com, like her on Facebook, or follow her on Twitter.

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What is the face of an eating disorder? Often, we envision a young thin white woman. However, research indicates that people at higher weights-fat people-are at increased risk for eating disorders. And their symptoms typically go unnoticed.

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https://www.psychologytoday.com/blog/rhythms-recovery/201706/yoga-and-nutrition-bulimia-and-disordered-eating

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Eating disorders reflect complex psychobiological stressors. They also occur with complex nutritional imbalances and may be understood as efforts to regulate affect through food and food-related behaviors. There is a high rate of eating disorders among women and men who were victimized in childhood (Korn, 2013). Eating disorders often have a dissociative and obsessive-compulsive component. The eating disorders in general are linked to dissociation and alternate states of consciousness achieved through food types and binging/fasting/purging activities. For example, purging activates vagal response. If you have ever thrown up, you know that afterward you are often exhausted and fall asleep. Historically, across cultures, humans (and other animals) are known to engage in ritualized behaviors of purging and regurgitation as methods of altering states of consciousness. At a larger social level are the influences of pressure and advertisements on children and adults of what constitutes a perfect body and the ways that food, or lack thereof, may achieve that.

Bulimia, and binge eating disorder (BED) affect all ethnicities in the United States. Bariatric surgery patients have a 27 percent lifetime prevalence of BED (Herrin & Larkin, 2013). There are elevated levels of anxiety and depression among bariatric surgery candidates and higher rates of mental disorders among the obese and then even higher rates of mental disorders in obese people who seek bariatric surgery (Mitchell & Zwaan,2011). Bisexual and gay men have a higher risk for eating disorders with as many as 15 percent (Herrin & Larkin, 2013). Eating disorders are highly comorbid with obsessive-compulsive disorder, and the functional nutritional treatment for both is very similar.

People generally use carbohydrates as their food of choice in bulimia, though they may choose fatty foods as well. These are mood altering by way of the serotonergic system, and they also lead to a sense of fullness by filling the stomach and putting pressure on the diapgragm. Balancing serotonin levels with nutrition is central to managing the range of symptoms that occur along the eating disorders continuum. The use of specific animo acids, like tryptophan or 5HTP support serotonin and can contribute to satiety and relaxation. Endocannabinoid deficit may be involved in Bulimia and eating disorders (Gérard, Pieters, Goffin, Bormans &Van Laere, 2011) and may be why some people with bulimia and night eating syndrome appear to lose their appetite when using CBD-rich strains of cannabis.

Foods have psychoactive components, which are enhanced when there are allergies or sensitivities, for example, to the opiate-like chemistry of gluten and casein that affects many people with eating disorders. This is why overeaters anonymous encourages sobriety from wheat and gluten. People who engage purging (and fasting) frequently engage in intensive aerobic exercise. All of these behaviors alter consciousness by inducing endorphin and endocannabinoid response, which reduces anxiety, but intensive aerobic exercise can also exacerbate dissociative symptoms.
Purging Behaviors
Bulimia nervosa behaviors may include purging and extreme use of laxatives, which upset the digestive process and also the health balance of intestinal flora. The anxiolytic NT GABA is made in the gut in interaction with gut flora suggesting the importance of fermented foods to decrease anxiety. Chronic purging can be dangerous and lead to nutritional deficits, GERD, and even death. In my clinical practice I provide intensive nutritional support to address the neurobiological substrates of bulimia behaviors while we address the psychological aspects. I provide detailed evidence for these protocols in my book Nutrition Essentials for Mental Health.
Yoga for Bulimia
I also teach yoga for bulimia (and also specific bodywork methods that release tension in the diaphragm). Below, I outline one of these yoga methods from my clinical textbook Rhythms of Recovery: Trauma Nature and the Body called Uddiyana Bandha. This exercise stimulates vagal response by simulating the movement of the diaphragm similar in purging and may be done therapeutically to provide relief from anxiety and dissociation in contrast to the dangerous of chronic purging with food. This exercise is reframed from the original yogic meaning to approximate similar movement that occurs during purging. However, the exercise is done on an empty stomach and is a reframe done in the context of therapy
Uddiyana Bandha
Bandhas regulate the flow of prana. This bandha is designed to move the energy up toward the head. Stand with the feet a foot apart and bend over slightly, knee slightly bent, placing hands on the thighs. Lower the head between the collarbone and the breastbone, and let it rest there in that notch. Inhale deeply and exhale quickly, forcing all the air to exit the lungs. Immediately after the exhale, hold the breath, pull the abdominal region back toward the spine, contract and lift the diaphragm toward the breastbone, putting your weight on the hands on the thighs. Hold and then release. When you have mastered this motion, then repeat and instead of holding, exert a pumping action, pushing out and pulling in, all the while maintaining this pose and holding your breath.

This exercise (which can be demonstrated in person or seen on video) can be taught to clients for home use when the urge to purge arises, to desensitize somatic sensations in the "solar plexus" and to quiet affective fires by reducing tension. Yogic practice prescribes this exercise to improve digestive function and cleanse the spirit. Because chronic dissociation among individuals interferes with experiencing bodily-based perceptions, this exercise can foster new sensory awareness and provides people who are working on decreasing purging and bulimia behaviors with therapeutic alternatives to achieve relaxation and balance. It also helps the client to understand that their urge derives from a complex psychobiological response that can be addressed through movement and nutrition.

Combining psychotherapy with nutritional therapies and yoga provides an integrative approach to efficacy and empowers our clients in their recovery process. This approach also gives hope and emphasizes the essential benefits in integrating the mind and body in treatment

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Yoga and Nutrition for Bulimia and Disordered Eating

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Eating disorders reflect complex psychobiological stressors. They also occur with complex nutritional imbalances and may be understood as efforts to regulate affect through food and food-related behaviors. There is a high rate of eating disorders among women and men who were victimized in childhood (Korn, 2013).

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https://www.psychologytoday.com/blog/brain-waves/201610/which-treatments-might-help-reduce-bulimia-symptoms

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During the past two years in my clinical work, it seemed more clients were entering counseling for eating related concerns. In my several decades of counseling the incidence rate has always gone up and down, but these two years seemed noticeable.

I decided to research the incidence rate and discovered that according to Smink and colleagues, the incidence of bulimia in 10-39-year-old women had tripled between 1988 and 1993. New cases of eating disorders in general had increased since the early 1950's with greatest increase in 15-19-year-old females. Lifetime prevalence for anorexia for females is .9 percent and males is .3 percent, and eating disorders will affect one in eight young women. Anorexia has the highest mortality rate of any psychiatric disorder at .51 percent per year and 12 times higher than any other cause. Of those who died, one in five committed suicide and others died of medical complications. Eating disorders commonly occurred with alcohol, substance abuse, depression and obsessive compulsive disorders ( OCD).

Those statistics are always alarming, so I have been searching for the most effective treatment for eating disordered clients. In this blog I will share one success story from a 50-year-old female who has been suffering with bulimia for three decades.

I will call her Susan. She is a competent and successful mother of six children and came into counseling for anxiety concerns. After six sessions Susan confided that she had been bingeing and purging since college. She was thin and had never shared her eating disorder concerns with anyone. We did a year of cognitive behavioral counseling, and she did learn coping skills for decision making with foods and techniques such as skin temperature control, diaphragmatic breathing and heart rate variability.

Susan was functioning better but was still vomiting and needed more help, so I integrated neurofeedback (NFB) into Susan's treatment plan. There is much in the literature about the efficacy of NFB for eating disorders, so I visited with Susan about attacking her symptoms at the source of the problems, the brain.

I did a complete NFB assessment including a 5-channel EEG, self-report inventories focusing on anxiety, depression, insomnia, trauma, symptom checklist and attention. Susan also took one computerized continuous performance test for Attention Deficit Hyperactivity Disorder (ADHD). She also completed the Millon Clinical Multiphasic Inventory (MCMI) III for presenting symptoms and personality disorders.

From the results of those assessments we developed a NFB treatment plan for Susan. We ended up completing 40 NFB sessions with incredible success. The NFB focus was decreasing high beta waves for anxiety reduction and synchrony of alpha and theta waves over the entire head. After 40 sessions, Susan was no longer purging for the first time in three decades! She was thrilled.

Susan completed all the same post-tests with very similar symptom reduction results. Below is just one example from the MCMI. Readers can see the dramatic drop in scores for clinical syndromes.

This is only a sample size of one client, but the quantitative data supports her qualitative data. Susan is now healthier than she has even been in her life and sees the NFB treatment as the major key to her elimination of bulimia in her life.

As a Board Certified Neurofeedback practitioner, I am thrilled for Susan too. From her success, I will continue to integrate NFB into my counseling treatment for eating disorders in the future.

For information about Bradley University's online Master in Counseling go to: http://onlinedegrees.bradley.edu/counseling.

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Which Treatments Might Help Reduce Bulimia Symptoms?

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During the past two years in my clinical work, it seemed more clients were entering counseling for eating related concerns. In my several decades of counseling the incidence rate has always gone up and down, but these two years seemed noticeable.

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https://www.psychologytoday.com/blog/happiness-is-state-mind/201703/eating-disorders-it-s-not-all-about-food

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Our strive to be thin, fit, pretty, and forever young is not only portrayed in our personal lives through our strict "no carb diets", excessive workouts, or our cosmetic products and procedures in which we choose to actively adopt, but this strive for perfectionism is also strongly expressed in society through social media, magazines, the fashion world, television, movies and modeling agencies. We often think if we lose those ten pounds, gain muscle or adopt that healthy skin glow then we will feel better about ourselves to only soon realize that our deeply rooted self-esteem issues are still present; we still feel we are not good enough or don't look a certain way and therefore we continue to lose more weight or gain more muscle to look better. So then what?

Often times we will adopt even stricter diets, weighing every ounce of food we consume; exercising even more excessively or seeking cosmetic procedures until we are knee deep in a vicious cycle of chasing our self-esteem and reaching for the impossible, until the impossible leads us down a road of self-harm behaviors such as laxative abuse, self-induced vomiting, body shaming, obsessions with the scale, and fascinations with our body image. Our friends may tell us our behaviors are unhealthy and our parents may try to sit us down to have an intervention, but let's be honest; we must come to realize we have a problem before we can actively seek help. Approximately 20 million women and 10 million men suffer from an eating disorder in the United States and anorexia nervosa is the number one killer of all mental health disorders so if food doesn't necessarily cause our eating disorder then what does?
So what causes eating disorders?
The most well-known eating disorders in The Diagnostic & Statistical Manual (DSM-V) are anorexia nervosa, binge eating disorder, and bulimia nervosa. The two other disorders in the DSM are known as avoidant-restrictive food intake disorder (ARFID) and Other Specified Feeding and Eating Disorder (OSFED). Although each of these disorders may differ by their signs, symptoms, and presentations, they all have one thing is common: similar underlying triggers.

The American Psychological Association (APA) has shown that past abuse or trauma, low-self esteem, bullying, poor parental relationships, borderline personality disorder, substance abuse, non- suicidal self-injury disorder (NSSI), a perfectionistic personality, difficulty communicating negative emotions, difficulty resolving conflict, and genetics are known underlying triggers that contribute to the development of an eating disorder.

In fact, approximately 30% of individuals who engage in self-harm behaviors such as cutting will engage in binging and purging behaviors. Maternal psychopathology such as negative expressed emotion, the thrive for perfectionism, and maternal encouragement of weight loss can lead to the development of eating disorders in children and teenagers.
The relationship between trauma and the development of eating disorders
Trauma, known as a deeply distressing or disturbing experience, comes in all forms such as emotional trauma, physical trauma, and sexual trauma. Whether an individual was physically assaulted, verbally abused, sexually assaulted, endured a very unhealthy romantic relationship, was bounced around foster homes as a child, or grew up in an unstable home; these past traumas result in underlying triggers that are carried out into mental health disorders, including eating disorders.

The individual tries to gain a sense of self-control through food and exercise since this is the one and only aspect of their life they are actually able to control. Choosing to engage in binging, extreme dieting, purging and other obsessive behaviors relating to body image and weight loss are attempts to "self-treat" their lack of control in other aspects of their life where they have no control.

The obsessions of binging and purging are brought on by low-self esteem, fear and anxiety and therefore an individual will binge, purge or exercise excessively to only be relieved of these unhealthy emotions and feelings temporarily until feelings of self-blame and guilt follow. This vicious cycle of fear and anxiety followed by temporary feelings of relief and calmness are soon replaced by feelings of self-guilt and this cycle of emotions repeats itself over and over again until the eating disorder becomes so self-destructive that either the individual realizes they need help or a serious medical complication occurs. Unfortunately, suicide is the answer for some individuals who cannot escape this unhealthy cycle. Studies have shown that up to 35% of individuals with an eating disorder, particularly bulimia nervosa; engage in a non-successful suicide attempt.
How to successfully overcome an eating disorder
The treatment for an eating disorder lies at recognizing and overcoming the underlying triggers associated with the eating disorder. Depending on the type of eating disorder and it's associated underlying triggers; medications can be used to ease symptoms of co-occurring disorders such as depression and anxiety. Fluoxetine, an antidepressant, more specifically a selective serotonin reuptake inhibitor (SSRI), is known to help reduce binging and purging and is specifically used in some cases of bulimia nervosa. The main or first-line treatment for all eating disorders is psychotherapy which encompasses a broad range of therapy approaches such as cognitive behavioral therapy (CBT) and dialectal behavioral therapy ( DBT) which aim to recognize and reduce the harmful thoughts and emotions associated with the eating disorder and works to develop productive coping mechanisms and tools to help the individual engage in positive thoughts, emotions and behaviors in order to overcome their past traumas and low-self esteem. Other skills and tools learned in therapy include mindfulness, relapse prevention skills, meditation, nutrition counseling, art therapy and relationship building.

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Eating Disorders: It's Not All About Food

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Our strive to be thin, fit, pretty, and forever young is not only portrayed in our personal lives through our strict "no carb diets", excessive workouts, or our cosmetic products and procedures in which we choose to actively adopt, but this strive for perfectionism is also strongly expressed in society through social media, magazines, the fashion world, television, movies and modeling agencies.

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https://www.helpguide.org/articles/eating-disorders/binge-eating-disorder.htm

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Binge Eating Disorder: Symptoms, Treatment, and Help for Compulsive Overeating

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Do you struggle with binge eating? Learn about compulsive overeating, binge eating disorder, and what you can do to stop it.

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http://eating-disorders.org.uk/information/compulsive-overeating-binge-eating-disorder/

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Binge and compulsive overeating is where someone feels compelled to eat when they are not hungry and who cannot stop when they have had enough. It affects more people than both anorexia and bulimia. We know that 1 in 2 people who seek help for their weight problem eats compulsively. Put another way, about 12 million people in the UK suffer from compulsive overeating to some extent.

Statistics

Two eating disorder experts, Fairburn and Beglin, have identified rates of binge eating in community studies as follows:

About 1 in 2 individuals trying to control their weight say that they have binged in the last month (not stating what is in the binge). 1 in 4 adults of both sexes trying to control their weight have Binge Eating Disorder as defined below. 6% individuals in the adult community as a whole describe themselves as "Compulsive Eaters" with 2% meeting the criteria for full blown Binge Eating Disorder.

Another community sample cited by Fairburn 1992, in Oxford hire identified 15% of young women aged 16-24 reporting at least one binge in the previous 3 months.

Definitions

Experts and the general public differ in their understanding of compulsive overeating and binge eating disorder.

Binge Eating Disorder is the name of an eating disorder in which a person is unable to prevent himself or herself from eating large amounts of food, often in a mindless state and in a short space of time; and the eating feels out of control. One difficulty in knowing whether you have Binge Eating Disorder is that no-one knows exactly what kind of eating constitutes a "binge". One man's binge may be just another man's hearty meal.

Compulsive Overeating is not the name of an eating disorder, it is a term that sufferers use to describe eating patterns that feel out of control and which can feel like an addiction to food that could make them gain weight. People who describe themselves as compulsive eaters feel that they cannot control their eating and thus they end up eating more than they need. As a result, compulsive overeaters usually struggle to control their weight. Compulsive overeaters have cravings that they cannot master, and may overeat small or large amounts of food, or just pick and nibble some of the time.

So Binge Eating Disorder and compulsive overeating are much the same thing and the differences between them do not really matter. Because compulsive overeaters feel that they cannot control their intake of food, they are likely to describe themselves as lacking in "willpower" and they would usually say that they are eating for comfort rather than for genuine physical need.

"Expert" Definitions of Binge or Compulsive Overeating include some or all of the following features which occur with regularity at least 3 times per week:

Eating faster than usual

Eating past the point of fullness

Eating when not physically hungry

Eating alone or in secret

Feeling upset or guilty after overeating

Feeling that you are abnormal

Feeling "taken over" or "driven" as if by an other presence in respect of eating

Trying to compensate for overeating by dieting or restraining food or purging ( in the latter case you are suffering from bulimia)

Sufferer descriptions might include comments like the following:

I cannot control myself. I'll open the fridge and eat. No matter what time of day, even if I've just finished breakfast or dinner. I'll still search for food. I'm not necessarily hungry, I'm just addicted - its like a drug. The more I have the more I want. I eat it so quick, like there's no tomorrow. And it's always in secret. I even bring food to bed, and in the morning I put the wrappers in an outside dustbin so no-one knows what I've eaten.

If I know that my family and husband are going out, I'll make up an excuse to stay home, that way I can eat and eat and eat.

I'm so disgusted and ashamed of myself. I hate myself for doing it. I know it's wrong while I am doing it but I will carry on. That is what I can't understand, while I'm bingeing. I know what I'm doing but I don't stop. Food is ruling my life. I just wish I could take it or leave it. But it's never enough.

I eat properly in front of other people and eat masses when I get home and on-one can see me.

I go backwards and forwards to the fridge looking for something to satisfy me and nothing seems to.

I start a diet on Mondays and by 11 o clock I am in the biscuit tin, saying here I go again.

I am fine for a while then I say just one bit of chocolate won't hurt then it's like I've blown it so who cares and I will start again tomorrow.

I eat in the car before I get home stuffing my face and if people knew what I was doing I couldn't bear it.

I get this craving in my head and my mouth for chocolate and I can[t relax until I have had it.

Who are compulsive overeaters?

This affects men and women of all ages, unlike the other eating disorders which are heavily biased toward females. However, women are more likely to ask for help and this is probably because women are more concerned about the effects of overeating on their appearance.

Some common factors are interesting:

Most but not all begin to eat compulsively after a period of dieting

Most, but not all would describe themselves as kind

Most put others first and attend to the needs of other people and not themselves

Most, but not all have some difficulty knowing or expressing their needs

Many, but not all lack clarity about how they feel and cannot manage their feelings properly

Most, but not all have low self worth

Most , but not all need to be liked

Psychologically they are otherwise not different to people who eat normally except among those who are particularly overweight

Some of these observations are useful in helping the expert to treat the condition and help someone to regain an enjoyable relationship with food.

Making sense of compulsive overeating

Is compulsive overeating:

A dieting disorder?

A food addiction?

A bad habit?

A lack of willpower?

Comfort eating - to manage difficult and troublesome feelings?

A stress disorder?

A body image problem?

A sign of a deeper emotional problem?

A Dieting Disorder

Many writers have blamed dieting for provoking compulsive eating problems. They claim that dieting makes people deprived and depressed - and thus increases the desire for food which they are not supposed to eat. The solution would therefore be to forgo dieting, stop worrying about one's weight, eat to excess all the foods on the forbidden list and eating would then settle down.

Formal studies of dieting have shown that dieting provokes cravings, impulsive eating (you must eat something just because it is there), low mood, and the inability to stop eating when satiated. These symptoms persist well after someone has stopped dieting and even if they are eating normally. But not all people who diet become compulsive overeaters so obviously something else must be true those who develop a very unhappy relationship with food.

Not all people who ditch their diets regain control of their eating. Also, while the importance of prior and ongoing dieting cannot be ignored, other personal influences will bear on whether one dieter will develop a problem and the other will not.

Food Addiction

Food can feel like an addiction, a desire to eat something that is forbidden; that will make you feel better in the short term even though it may harm your health and your weight in the long term. Both addicts and overeaters refer to preoccupation with the "substance", the sense of craving for particular foods, giving in, and not being able to stop when you have had a reasonable amount. Both addicts and overeaters talk of repeated attempts to give up "tomorrow". Like the traditional addictions to alcohol and drugs, compulsive eating can interfere with your life and cost a great deal of money and remorse.

Food like ice cream, chocolate, biscuits and French fries which are rich in fats or sugars affect the same regions of the brain which are stimulated by drugs, cigarettes and alcohol. Trying to stop eating these foods can lead to withdrawal symptoms.

There is a popular theory that certain people are "addicted" to refined foods and sugar and must abstain from them. But when such persons are given white flour and sugar in blind trials, they do not show increases in cravings or loss of control. This suggests that the addictive effects of these substances are largely psychological.

So, addictions and compulsive overeating share some features but at the NCFED we firmly believe that it isn't helpful to think of compulsive eating as the same as, for example, alcoholism because we can live without alcohol but we cannot live without food. We do not like to think of people as addicts and we can treat compulsive eating effectively.

A Bad Habit

Much of what we do is habit and some habits can be very stuck. Where food is concerned some of our habits track right back to our childhood. Food habits are predictable, we all tend to eat what we like and we eat more at the weekend than we do at the start of a week. Even our indulgences are a habit. None of us change our habits very easily.

Treating compulsive overeating must involve treating that part of the disorder which is a habit. But this is one aspect of the problem, even if it is a very important part.

Lack Of Willpower

People who try to control their weight but fail to do so often say that they lack willpower. They may try many different kinds of diets, or resort to slimming pills or other more dangerous practices to control their weight but nothing works in the end. Some people say that they have just given up trying to lose weight but this does not change their damaging relationship with food.

Compulsive overeaters do not have less willpower than people who eat normally and healthfully. They do however have more cravings for food and stronger cravings. It follows that to treat compulsive eating means getting rid of the cravings and then it will be far easier to stay in control of food and weight.

Eating For Comfort

We all eat to change our emotional state to some extent and we all learn to do this early in life. We might reward ourselves with food at times, eat to share a social occasion, nibble in response to anxiety, eat to fill up the time when we are bored, or have a special meal to calm ourselves down when we have had a bad day. However research clearly shows that people who eat compulsively are often triggered by mood changes, whether the moods are good or bad. Feelings such as anger, guilt, sadness and anxiety can often trigger episodes of overeating.

What does this tell us about the inner world of someone who eats compulsively? Psychologists believe that comfort eating is not so much a way to feel better as it is a way to avoid or manage emotions that might lead to shame or emotional discomfort. The events which have given rise to this situation are varied.

Treatment of the overeating involves helping people to manage these emotions without needing to turn to food instead. It may also involve providing a person with a new range of skills dealing more effectively and assertively with other people.

A Stress Disorder

People with binge or compulsive overeating problems are very stressed. Stress can come from the disorder itself; after all, overeating and blaming yourself for your behavior is very stressful. People are very ashamed of their behaviour and try to hide it from others. And this may lead to more overeating.

Sometimes life is very stressful and the sufferer has learned that overeating provides a short term remedy for feeling overwhelmed, also offering a way of coping with the ups and downs of life.

Sometimes the stress comes from within. If you suffer from perfectionism, and are always trying to perform to your own high standards, if you never feel quite good enough, overeating can be both a way of consoling yourself for the pressure or even beating yourself up for not being as effective as you would like.

Learning how to manage stress is an important part of treatment but the therapist must first discover where the stress comes from and how to address its roots.

A Body Image Disorder

People who binge eat generally hate the way they look and have poor body image. They always feel that they should be eating less even if they can't always do something about it. Horrible feelings of fatness means that even when they do eat they can't enjoy it properly. Poor body image has many effects, from avoiding social situations, not taking care of yourself and not being able to enjoy a holiday. Compulsive eaters believe themselves to be fat even when they are not and they feel instantly fat after eating foods which are considered forbidden.

The consequence of feeling fat and feeling terrified of weight gain leads to constant attempts to compensate for taking in unwanted calories by dieting, starving, taking slimming pills and so on. Sadly these strategies usually make the eating problem even worse. There are some overeaters who feel so hopeless about their weight that they give up trying to control it. I'm fat anyway, so why bother, they might say as they reach for another piece of cake.

Helping a person think more kindly of their body is an important part of treatment and will have knock on effects on self esteem. Treating body image helps a person be kind to themselves with food and predicts recovery from the eating disorder.

A Deeper Emotional Problem

Many people believe that compulsive or binge eating is a sign of deeper psychological difficulties. There is little evidence that this is the case, although severely overweight binge eaters have a greater lifetime risk of depression, alcohol abuse and anxiety disorders.

Compulsive overeaters who develop harmful weight control practices such as vomiting or laxatives have a greater likelihood of traumatic events in their early childhood such as physical or sexual abuse, or even neglect. It is only necessary in treatment to go back and resolve these issues if it is felt that the person is still being affected by these events.

Treating Binge and Compulsive Overeating

The first part of treatment is a very good assessment with a professional who understands eating disorders and who will identify what kind of compulsive eating is going on from the checklist above. A full eating history will allow the therapist to identify the events and challenges that predisposed you to the problem. The assessment will also pinpoint what is keeping you stuck right now.

Treatment will then be directed to both the physical and emotional factors which are maintaining the unhelpful relationship with food, depending on what has emerged at the assessment.

Treatment of compulsive overeating is more than giving you a positive relationship with food. We would attend to the "whole person" and our outcomes would include all or some of the following;

Dealing effectively with your feelings

Eating comfortably in a wide variety of situations

Managing problem situations like parties and Christmas effectively

Sleeping well and feeling healthy

Managing stress and being happier

Handling personal relationships well

Building self worth

Being able to say "no" to food and people when you need to

And much more...

Drug Treatment

Antidepressant drugs do not work well for binge or compulsive overeating and what happens when you stop taking the tablets. This is why we do not recommend drug treatment for binge eating. If someone has other problems such as phobia or a severe depression, then drugs may be useful to help the eating therapy to work more effectively. We suggest careful consideration before doctors reach for the prescription pad and in our experience drugs are needed for very few people.

Appetite suppressants also do not work in the long run for compulsive overeaters and can often make the problems worse in the long run. Good therapy will give control back where it is most needed - from within.

© Deanne Jade 2010

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National Centre for Eating Disorders - Compulsive Eating & Binge Eating Disorder

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Binge and compulsive overeating is where someone feels compelled to eat when they are not hungry and who cannot stop when they have had enough. It affects more people than both anorexia and bulimia. We know that 1 in 2 people who seek help for their weight problem eats compulsively.

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https://www.b-eat.co.uk/about-eating-disorders/types-of-eating-disorder/ednos?gclid=CIWchvmx_tQCFRXgGwod54UI2g

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A diagnosis of OSFED or EDNOS is typically given to someone whose symptoms don't match the criteria for anorexia or bulimia.

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http://www.something-fishy.org/whatarethey/ednos.php

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Eating Disorder Not Otherwise Specified - The Something Fishy Website on Eating Disorders

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Eating Disorders -- Anorexia, Bulimia, Binge Eating Disorder, Compulsive Overeating. Eating Disorders definitions, signs and symptoms, physical dangers, online support and much more.

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https://www.recoveryranch.com/articles/eating-disorders/ednos-the-silent-killer/

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Everyone has heard of anorexia, bulimia, and probably compulsive eating as well. These are the eating disorders that can wreck lives and leave the sufferers devastatingly thin, morbidly obese, and with a host of physical and psychological damages. They kill, too; but the eating disorder that kills most often is little known. It is quiet, more common than the other disorders, and more deadly. It is called eating disorder not otherwise specified, or EDNOS.

Although anorexia and bulimia tend to get the attention, EDNOS actually makes up 70 percent of all 24 million eating disorder diagnoses in the United States. A person with EDNOS may be diagnosed as such because she does not fully meet the criteria for anorexia or bulimia. She may have some symptoms of both disorders, but not severely enough to warrant a diagnosis.

[highlight] If you or a loved one are suffering from an eating disorder, learn more about our Eating Disorders Treatment programs to get help today >> [/highlight]The Diagnostic and Statistical Manual, which is the bible for diagnosing psychiatric disorders, recognizes only anorexia and bulimia nervosa as eating disorders. Anyone who meets some, but not all of the criteria for either of these may be labeled as EDNOS. Someone with EDNOS may also meet some of the bulimia or anorexia criteria partly, but not completely. For instance, one criterion for bulimia is binging and purging more than twice a week for at least three months. If someone binges and compensates less than twice a week, she may not meet the requirements for a bulimia diagnosis and could be described as EDNOS.

One of the dangers of EDNOS is that it may seem less serious than anorexia or bulimia. The label, especially the "not otherwise specified" portion, can make the affected person feel as if her disorder is not as serious or as common, or even as important as the more well-known disorders. The truth, however, is that more people suffer with EDNOS than with anorexia and bulimia combined. And these people struggle with the same feelings of fear, self-loathing, shame, and obsession, and engage in the same risky behaviors. Because EDNOS is so much more common, it is the leading killer of disordered eaters.

EDNOS is more common in women, especially young women, than in men, but like anorexia and bulimia, it can occur in anyone of any age or sex. Most typically, it begins in adolescence or young adulthood. The behavior of binge eating is actually evenly split between men and women. The signs and symptoms of EDNOS are very similar to those for bulimia and anorexia:

A constant awareness, bordering on obsession with food, calorie counting, exercise, and weight.

Behaviors that are meant to compensate for eating, which can include vomiting, using laxatives, or exercising. Binging or compensating may not be initially obvious. Signs include the disappearance of food in large quantities, spending a lot of time alone, or spending a long period of time eating.

Restricting food intake and calorie consumption.

Cycles of restricting food, binging, feelings of shame and guilt, and then purging.

Rules about food, such as foods that can never be eaten, times of day to avoid eating, and others.

The medical risks and complications associated with EDNOS are serious and just as much cause for concern as those that go along with bulimia and anorexia. Purging can cause dehydration and electrolyte imbalances, and even heart problems and death. In extreme cases, binging can cause stomach rupture. Restricting calories can result in hearth failure, low blood pressure, a reduced heart rate, a hormonal imbalance, bone weakening, and mental and emotional issues.

Because the behaviors associated with EDNOS are varied, specific treatment plans for the disorder are hard to find. Treatments similar to those used for bulimia and anorexia are typically used and include cognitive-behavioral therapy, individual counseling, and group therapy. These treatments focus on helping to change distorted thinking patterns and to self-monitor and change unhealthy behaviors. Therapy is also often combined with nutritional counseling and sometimes with prescription medications.

Because EDNOS is so prevalent in the realm of eating disorders, prevention is also important. Not enough people know about the disorder and there are likely millions who are currently undiagnosed. When more people understand that they do not have to have anorexia or bulimia to have a dangerous mental illness and to be risking their lives with their food habits, more lives can be saved.

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Everyone has heard of anorexia, bulimia, and probably compulsive eating as well. These are the eating disorders that can wreck lives and leave the sufferers devastatingly thin, morbidly obese, and with a host of physical and psychological damages. They kill, too; but the eating disorder that kills most often is little known.

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https://www.youtube.com/watch?v=1OQbUZeYAik

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EDNOS: Most Dangerous, Unheard of Eating Disorder | Nightline | ABC News

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Inside the secret lives of millions of American women quietly battling every bite. SUBSCRIBE for the latest news and updates from ABC News ► http://www.youtube.com/subscription_center?add_user=abcnews To read the full story and others, visit http://www.abcnews.com Watch more news stories from ABC News!

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http://www.priorygroup.com/eating-disorders/binge-eating

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Binge Eating Disorder | Help, Treatment & Recovery | Priory Group

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Binge eating disorder (BED) is an eating disorder identified by overeating in binges, often when you are not hungry. Get compulsive eating help with Priory.

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https://www.waldeneatingdisorders.com/cognitive-behavioral-therapy-binge-eating-disorder-8-key-treatment-benchmarks/

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Cognitive Behavioral Therapy (CBT) is an evidence-based treatment model focused on the premise that an individual's thoughts, feelings and behaviors are intertwined and can ultimately be re-structured to support more productive actions. Historically routed in the treatment of depression and anxiety, CBT is becoming more prevalent in eating disorder treatment settings, particularly more recently, with Binge Eating Disorder (BED).

CBT focuses on three phases of treatment - the behavioral phase, cognitive phase and maintenance and relapse phase. Below is an overview of each stage, with critical treatment components specific to the Binge Eating Disorder population:

Behavioral Phase: In this phase, the patient and the clinician/therapist build rapport. The patient identifies negative emotions and behaviors, and with the support of the clinician/therapist, a plan for normalizing eating behaviors is developed.

This requires:

1. Addressing & minimizing negative behaviors associated with BED such as episodic binge eating and subsequent behaviors derived from guilt and shame.
2. Providing education and awareness about balanced eating, meal planning and nutrition.
3. Developing coping strategies for managing negative emotions that provoke episodic binge behaviors. Distraction, prolonging urges and thought stopping are some of the skills taught to cope with overwhelming urges.

Cognitive Phase: In this phase, "cognitive restructuring" techniques are introduced. Patients are encouraged to challenge their thought process and learn to identify unhealthy, treatment-interfering thoughts. They are supported in reshaping their thoughts by developing new perspectives.

This requires:

4. Conquering concrete & distorted thoughts about negative body image or self-worth as it applies to an unrealistic level of perfectionism.
5. Improving interpersonal relationships begins here. Patients identify unhealthy thought patterns, looking introspectively into the impact of their thoughts on relationships and patterns of communication with others.
6. Providing increased hopefulness, as patients gain insight into how their thoughts affect their behavior and begin to embrace positive change.

Maintenance & Relapse Prevention Phase: This final phase focuses on maintaining the skills learned in the previous stages of treatment. A comprehensive relapse and recovery plan is developed by the patient, with the clinician/therapist's support, to assist the patient in managing the negative thoughts and behaviors associated with BED.

This requires:

7. Improving self-confidence as patients become more comfortable using the acquired skills and can identify triggers before they manifest into negative thoughts and behaviors. Patients should be positively reinforced by the noticeable progress that is visible to themselves and others.
8. Achieving holistic healing as the BED symptoms are improved and stabilized. Patients should be able to focus on the root cause and subsequent areas of mental and physical health that will assist in transitioning them into a life of recovery.

CBT isn't easy - and certainly requires patience. But using these steps, clinicians can truly make a difference in re-shaping the mindset and providing invaluable skills for binge eating disorder patients in their journey forward.

Do you use CBT and know of any other critical components? Comment below, or @WaldenBehCare on Twitter.

Click here to learn more about innovative Binge Eating Disorder treatment.

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Cognitive Behavioral Therapy & Binge Eating Disorder: 8 Key Treatment Benchmarks

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Cognitive Behavioral Therapy (CBT) is an evidence-based treatment model focused on the premise that an individual's thoughts, feelings and behaviors are intertwined and can ultimately be re-structured to support more productive actions. Historically routed in the treatment of depression and anxiety, CBT

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https://www.eatingdisorderhope.com/information/bulimia

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What is Bulimia?

Bulimia Nervosa is a psychological and severe life-threatening eating disorder described by the ingestion of an abnormally large amount of food in short time period, followed by an attempt to avoid gaining weight by purging what was consumed.

Methods of purging include forced vomiting, excessive use of laxatives or diuretics, and extreme or prolonged periods of exercising. Often, in these binge/purge episodes, a woman or man suffering from this disorder will experience a loss of control and engage in frantic efforts to undo these feelings.
Jane Fonda discusses her recovery from bulimia. As posted by Amanda de Cadenet
Since he or she may have bingeing and purging episodes in secret, they are often able to conceal their disorder from others for extended periods of time. Those suffering from bulimia nervosa often utilize these behaviors in an attempt to prevent weight gain, to establish a sense of control, and/or as a means of coping with difficult circumstances or situations.

Described and classified by the British psychiatrist Gerald Russell in 1979, Bulimia Nervosa comes from a Greek word meaning ravenous hunger. If you or a loved one are suffering from this eating disorder, seek professional treatment for eating disorders.

Major Types of Bulimia

There are two common types of bulimia nervosa, which are as follows:

Purging type - This type of bulimia nervosa accounts for the majority of cases of those suffering from this eating disorder. In this form, individuals will regularly engage in self-induced vomiting or abuse of laxatives, diuretics, or enemas after a period of bingeing.

Non-Purging type - In this form of bulimia nervosa, the individual will use other inappropriate methods of compensation for binge episodes, such as excessive exercising or fasting. In these cases, the typical forms of purging, such as self-induced vomiting, are not regularly utilized.

Causes of Bulimia

The exact cause of bulimia nervosa is currently unknown; though it is thought that multiple factors contribute to the development of this eating disorder, including genetic, environmental, psychological, and cultural influences. Some of the main causes for bulimia include:

Stressful transitions or life changes

History of abuse or trauma

Negative body image

Poor self-esteem

Professions or activities that focus on appearance/performance

Bulimia Signs & Symptoms

An individual suffering from bulimia nervosa may reveal several signs and symptoms, many which are the direct result of self-induced vomiting or other forms of purging, especially if the binge/purge cycle is repeated several times a week and/or day.

Physical signs and symptoms of this eating disorder are:

Constant weight fluctuations

Electrolyte imbalances, which can result in cardiac arrhythmia, cardiac arrest, or ultimately death

Broken blood vessels within the eyes

Enlarged glands in the neck and under the jaw line

Oral trauma, such as lacerations in the lining of the mouth or throat from repetitive vomiting

Chronic dehydration

Inflammation of the esophagus

Chronic gastric reflux after eating or peptic ulcers

Infertility

Signs and symptoms of binge eating and purging are:

Disappearance of large amounts of food

Eating in secrecy

Lack of control when eating

Switching between periods of overeating and fasting

Frequent use of the bathroom after meals

Having the smell of vomit

Bulimia nervosa can also create problematic strains between the sufferer and family and friends, particularly as the individual has abnormal eating behaviors and/or the avoidance of social activities to engage in binge/purge episodes.

Bulimia Treatment

Since negative body image and poor self-esteem are often the underlying factors at the root of bulimia, it is important that therapy is integrated into the recovery process. Treatment for bulimia nervosa usually includes:

Discontinuing the binge-purge cycle: The initial phase of treatment for bulimia nervosa involves breaking this harmful cycle and restoring normal eating behaviors.

Improving negative thoughts: The next phase of bulimia treatment concentrates on recognizing and changing irrational beliefs about weight, body shape, and dieting.

Resolving emotional issues: The final phase of bulimia treatment focuses on healing from emotional issues that may have caused the eating disorder. Treatment may address interpersonal relationships and can include cognitive behavior therapy, dialectic behavior therapy, and other related therapies.

Don't delay and risk serious medical complications. Seek out an eating disorder treatment facility in your area.

Articles on Bulimia Nervosa

Page Last Updated & Reviewed By: Jacquelyn Ekern, MS, LPC on February 11, 2018
Published on EatingDisorderHope.com, Eating Disorders Information & Resources

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About Bulimia: Symptoms, Signs, Causes & Articles For Treatment Help

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Bulimia Nervosa is a psychological and severe life-threatening eating disorder described by the ingestion of an abnormally large amount of food in short time period, followed by an attempt to avoid gaining weight by purging what was consumed. Methods of purging include forced vomiting, excessive use of laxatives or diuretics, and extreme or prolonged periods of exercising.