Treatment Notes by Sari Fine Shepphird

Binge Eating and the Brain

I would like to thank my friends at the Eating Disorders Network of Central Maryland and Eating Disorders Hope for calling my attention to a new research which suggests that overconsumption of fatty, sugary foods leads to changes in brain receptors, increasing opioids in the area that controls food intake.

Purging Disorder

As many of you may know, research findings indicate that at least half of all people diagnosed with an eating disorder do not meet the full criteria for either of the two primary eating disorders diagnoses (anorexia nervosa and bulimia nervosa). 

 

According to the DSM-IV-TR, “eating disorder not otherwise specified” (EDNOS) is the diagnostic term used to describe clinically significant eating disturbances that fall outside of the complete diagnostic criteria for either anorexia nervosa or bulimia nervosa. 

 

It is important to understand that a diagnosis of EDNOS is no less clinically significant than that of anorexia or bulimia, nor is it necessarily of less concern. EDNOS can be quite serious and requires the same attention and level of treatment as another eating disorder diagnosis.

 

One example of disordered eating that currently falls under the EDNOS diagnostic classification is a syndrome unofficially known as purging disorder.

Calorie Restriction, Longevity, and Eating Disorders

Perhaps you have heard the buzz this week. The results are in from a 20-year longitudinal study which show that decreasing calorie intake by 30% results in life-extending metabolic changes that appear to slow the aging process. Hooray! For the monkeys that is...

The highly regarded experiment looked at 75 rheses monkeys, the latest in a long string of studies into Calorie Restriction (CR) and its effect on longevity. Studies like this aren't new. Researchers since the 1930's having been looking into how CR might be capable of extending the maximum lifespan of a species. Some results showed an increase in longevity of up to forty-percent. Results have boasted that CR delays the onset of almost all disease and even creates a new maximum lifespan. At the same time, CR was found to reduce the incidence and severity of most age-associated diseases, including cancer and cardiovascular disease.

Here's the problem (well, there is more than one...), while various studies have shown that CR extends the life span of rats, worms, dogs, and now monkeys, there is no evidence which suggests that CR leads to a longer lifespan in humans.

True, some studies suggest that reduced calorie consumption in humans is associated with benefits such as lower blood pressure and lower cholesterol, however, these same benefits can also be obtained through a more balanced approach to food and exercise (click here for a related article form the Journal of Nutrition).

Something else: what the recent primate research does not allude to is that studies have shown that humans who adhere to a CR diet display many of the same symptoms associated with anorexia nervosa, including food obsession, increased hunger, and decreased sexual drive.

In addition, studies also show that CR increases the risk of the following in humans:

• Developing an eating disorder
• Decrease in bone density
• High risk of bone fracture
• Anemia
• Fatigue
• Muscle weakness
• Gallstones
• Depression
• Cognitive Deficiencies
• Irritability
• Infertility
• Sensitivity to cold
• Constipation
• Lethargy

and, a very low Body Mass Index is associated with a higher risk of death.

So, if a client or patient says to you that he or she is thinking about adopting a CR lifestyle, I suggest you help them take another look. Given the evidence demonstrating the many potential health risks involved with a CR approach to diet in humans, it's best to think again.

You can learn more about CR and related effects of calorie restriction on human health in my book "100 Questions and Answers about Anorexia Nervosa". 

If you have a question or topic you would like to see addressed in this Blog, go to http://www.drshepp.com, or e-mail mail@drshepp.com, or send your question via Twitter to www.twitter.com/drshepp

 

Price of Food Affects Obesity Epidemic in Youth

A new report from the University of Ilinois at Chicago suggests that cutting rices on fruits & vegetables could bring down obesity rates across the United States...

Self-injury and Eating Disorders

I had been seeing Mark for just a couple of weeks. He always wore long sleeve shirts, even in the middle of summer. That should have been my first clue. But Mark had a lot of tattoos on his body, so I wrongly assumed that he had "sleeves" of tattoos that he was simply covering during our sessions.

Little did I know that what was actually concealed underneath the sleeves of his shirts were a vast series of scars, scabs and fresh wounds.

Mark denied engaging in self-injury when we first met. During the intake, he mentioned thinking about self harm on several occasions, but never acting on it. As our trust and relationship was growing, he decided it would be safe to share his "legacy", for that is what he called the scars that marked his body.

Mark would never injure himself where the scars would be visible to a passerby, or acquaintance. So no scars on his wrists or face, just his shoulders, chest and stomach. Mark said that whenever he felt "dead inside" he would cut, scratch, or burn himself, until it bled or he could not stand the pain.

Dangerous Distortions: eating disordered beliefs

I have been traveling a bit the last several weeks...

I was struck by how many times I noticed an emaciated frame on the tourist walking past me. Is that because there are more very underweight folks walking around, or because I am primed to notice them more?

In one city overseas, my husband and I were enjoying an evening meal when we overheard a young women at the next table telling her older companion (whom we assumed was her mother) "No, I am not going to eat."

"Please", her companion prodded.

"No. I believe that it is better to feel hungry than to give in to food."

This young woman is not alone in her belief. Even though the statement itself is false, millions of eating disordered individuals would agree with her resoundingly.

This type of sentiment may sound familiar to some of you. It resembles aspects of something called "Ana's Creed", a set of beliefs that are often adopted, to one degree or another, by countless women and men in the throngs of an eating disorder. Distorted as these beliefs are, they often account for, or are a symptom of, disordered eating of a severe magnitude.

This is Ana's Creed, along with its companion, the "Thin Commandments". I thought it important that treatment professionals be informed as to the content of these belief sets. However please note, that my including them here in no way endorses their content. My efforts and energies to the contrary, and I thank you sincerely for yours as well. 

 

Ana s Creed  

I believe in Control, the only force mighty enough to bring order to the chaos that is my world.

I believe that I am the most vile, worthless and useless person ever to have existed on the planet, and that I am totally unworthy of anyone's time and attention.

I believe that other people who tell me differently are idiots. If they could see how I really am, then they would hate me almost as much as I do.

I believe in perfection and strive to attain it.

I believe in salvation through trying just a bit harder than I did yesterday.

I believe in bathroom scales as an indicator of my daily successes and failures.

I believe in hell, because I sometimes think that I am living in it.

I believe in a wholly black and white world, the losing of weight, recrimination for sins, abnegation of the body and a life ever fasting

 

The Thin Commandments

• If you are not thin, you aren't attractive.

• Being thin is more important than being healthy.

• You must buy clothes, cut your hair, take laxatives, starve yourself, and do anything to make yourself look thinner.

• Thou shall not eat without feeling guilty.

• Thou shall not eat fattening food without punishing oneself afterwards [sic].

• Thou shall count calories and restrict intake accordingly.

• What the scale says is the most important thing.

• Losing weight is good/ Gaining weight is bad.

• You can never be too thin.

• Being thin and not eating are signs of true will power and success.