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Eating Disorders are more than just anorexia and bulemia: Yoga and Binge Eating Disorder

In Uncategorized on February 26, 2009 at 2:59 pm

Recently, I was reading “Your Body Speaks Your Mind” by Deb Shapiro, a great book about what messages your body tells you through injury and illness. I’m reading this book as part of a book I’m writing on injury to body causing injury to sense of self, called “Falling.” Deb Shapiro is also the author of Yoga for Depression, a well recognized source that we’ll discuss in later posts and blogs. I’m also reading this book as part of the book reviews we at Sprout Yoga do for our newsletter, available here: http://www.sproutyoga.org.

So, the thing that struck me was this line, concerning the throat chakra “This chakra is also related to addictive behavior. When you repress your feelings or ignore deeper issues of pain, you need a way to keep them down. Addictions, such as over-eating, drug abuse, or alcholism, easily serve this purpose.” Shapiro goes on to discuss how the throat chakra forms a bridge between the head and the body, the mind and the heart. Its not hard then, to understand that those working on ending over-eating would be helped by a practice that unifies the head and the heart, the mind and the body, such as yoga.

But what struck me was not that yoga can help with compulsive over-eating, but that we can agree that compulsive over-eating is an addiction. Whereas, in contrast, we understand and agree that anorexia or bulemia is a disease. A disease that in-patient treatment is effective for when presenting in the most extreme forms.

Now, I understand that addictions are diseases, but it caused me to wonder, why do we not call compulsive overeating a disease? That question also is in my mind when I say that yoga can help those overcoming an eating disorder, people think of anorexia and bulemia, eating controlled and exercise induced anorexia, not compulsive over-eating. Nor do people think of yoga as helpful for disordered eating and body hate.

So with that in mind, I decided to share some information about compulsive overeating first.

Compulsive Overeating: An overview.

The Recovery Group, on the web at http://www.therecoverygroup.org/special/compulsive.html, states “Victims of Compulsive Eating have what is characterized as an “addiction” to food, using food and eating as a way to hide from their emotions, to fill a void they feel inside, and to cope with daily stresses and problems in their lives…. Compulsive eating has to do with how many hours you spend preoccupied with thoughts about what you are eating and what you look like.”

This strikes me because I’ve always thought that anorexia was an addiction to NOT eating. As I heard one young woman say recently “I found out I was adopted, and thought that my birth mother wanted me to disappear… I stopped eating, as a way of disappearing.” This rang so true for me in how other people coping with and overcoming eating disorders treat their bodies, they don’t eat as a way of filling that void inside them from other traumas.  Interestingly, the Recovery Group sums up the similarities this way “Words like, “just go on a diet” are as emotionally devastating to a person suffering Compulsive Overeating as “just eat” can be to a person suffering Anorexia,” and also discuss how people with  compulsive overeating use their bodies as a shield, to keep people away, often common among sexual abuse survivors. So, in essence, compulsive overeating and anorexia are similar and opposite at the same time – anorexics try to disappear, compulsive eaters try to build extra layers of protection.

Compulsive Overeating: Binge Eating

The Recovery Group also likens binge eating to bulemia, stating “Men and Women living with Binge Eating Disorder suffer a combination of symptoms similar to those of Compulsive Overeaters and Bulimia. The victim periodically goes on large binges, consuming an unusually large quantity of food in a short period of time (less than 2 hours) uncontrollably, eating until they are uncomfortably full. The weight of each victim is usually characterized as above average or overweight, and victims tend to have a more difficult time losing weight and maintaining average healthy weights. Unlike Bulimia, victims do not purge following a Binge episode….. As with Bulimia, Binging can also be used as self-punishment for doing “bad” things, or for feeling badly about themselves.”

Mirror-Mirror, http://www.mirror-mirror.org/compulsive.htm, a website about eating disorders, also discusses some of the traits of BED, noting: “Compulsive overeating usually starts in early childhood when eating patterns are formed. Most people who become compulsive eaters are people who never learned the proper way to deal with stressful situations and used food instead as a way of coping.”

It goes on to say, importantly, “In today’s society, compulsive overeating is not yet taken seriously enough. Instead of being treated for the serious problem they have, they are instead directed to diet centers and health spas. Like anorexia and bulimia, compulsive overeating is a serious problem and can result in death. With the proper treatment, which should include therapy, medical and nutritional counseling, it can be overcome.”

The Recovery Group goes on to provide diagnostic criteria for Binge Eating Disorder,

Recurrent episodes of binge eating.

An episode of binge eating is characterized by both of the following:

A. Eating, in a discrete period of time (eg, within any 2-hour period), an amount of food that is definitely larger than most people would eat in a similar period of time under similar circumstances;B. A sense of lack of control over eating during the episode (eg, a feeling that one cannot stop eating or control what or how much one is eating).

2. The binge eating episodes are associated with at least three of the following:

A. Eating much more rapidly than normal
B. Eating until feeling uncomfortably full
C. Eating large amounts of food when not feeling physically hungry
D. Eating alone because of being embarrassed by how much one is eating
E. Feeling disgusted with oneself, depressed, or feeling very guilty after overeating
F. Marked distress regarding binge eating.
G. The binge eating occurs, on average, at least 2 days a week for 6 months.
H. The binge eating is not associated with the regular use of inappropriate compensatory behaviors (eg, purging, fasting, excessive exercise) and does not occur exclusively during the course of anorexia nervosa or bulimia nervosa.

3. Eating and/or Sleeping Problems

In addition, the University of Pennsylvania Office of Health Education, on the web here: http://www.vpul.upenn.edu/ohe/library/bodyimage/compulsive.htm, also states “Unlike anorexia and bulimia, a large percentage of compulsive overeaters are male.” It lists the signs and symptoms of BED as

Signs and Symptoms of Compulsive Overeating/Binge Eating Disorder

  1. Fear of not being able to control eating, and while eating, not being able to stop.
  2. Isolation. Fear of eating around and with others.
  3. Chronic dieting on a variety of popular diet plans.
  4. Holding the belief that life will be better if they can lose weight.
  5. Hiding food in strange places (closets, cabinets, suitcases, under the bed) to eat at a later time.
  6. Vague or secretive eating patterns.
  7. Self-defeating statements after food consumption.
  8. Blames failure in social and professional community on weight.
  9. Holding the belief that food is their only friend.
  10. Frequently out of breath after relatively light activities.
  11. Excessive sweating and shortness of breath.
  12. High blood pressure and/or cholesterol.
  13. Leg and joint pain.
  14. Weight gain.
  15. Decreased mobility due to weight gain.
  16. Loss of sexual desire or promiscuous relations.
  17. Mood swings. Depression. Fatigue.
  18. Insomnia. Poor Sleeping Habits.

For more information on BED see the Renfrew Center’s website, here: http://www.renfrewcenter.org. Renfrew lists among the various approaches to healing eating disorders as the “Addiction and Trauma Recovery Integration Model” (ATRIUM) is a comprehensive recovery model which combines psycho-educational, process, and expressive approaches to meet the challenges of trauma and addiction and how they relate to each other.

How is Compuslive Overeating Disorder Different From Obesity?

In his paper, “Obesity, Behavioral Biology, and Rational Overeating,” Trenton G. Smith of Washington State University discusses the genetic components of obesity, stating: “The normal form of the obese gene is now known to encode for leptin in humans as well as mice, and though genetically inherited defects in the obese gene are exceedingly rare in human populations, a few cases have been documented.

Historically, overeating has been viewed as a personality disorder, a symptom of “weakness of will,” and the response of the medical community to the afflicted was limited to formulaic lifestyle advice (“Exercise more!”; “Eat less!”; etc.) or referral to psychoanalysis, neither of which has proven particularly effective at producing thinner patients (Goodrick and Foreyt 1991, Brownell and Rodin 1994). As it has become clear that obesity is consistently associated with a host of health problems–including hypertension, diabetes, heart disease, and cancer–and that certain demographic groups (e.g., the poor) are at higher risk, obesity has increasingly been viewed as a public health problem. Epidemiologists studying the phenomenon have typically utilized prospective studies or large-sample surveys, mining the data for “risk factors” (usually chosen from the popular explanations for obesity: TV, sedentia, fatty foods, etc.) (e.g., Dietz and Gortmaker 1984, Ching et al. 1994). The ultimate aim of these studies is to produce an effective treatment.

Essentially, binge eating disorder can make you obese, but not everyone who is obese has binge eating disorder. See http://kidshealth.org/parent/growth/feeding/binge_eating.html, discussing the prevalence of BED in nonobese kids.

Yoga for Addictions

Its widely known in the yoga community that Yoga can be helpful to those in recovery from drug and alcohol addiction. As reported in the Yoga Journal, http://www.yogajournal.com/practice/679?print=1, Mary Margaret Frederick, Ph.D states “addicts are profoundly out of control internally. They have knee-jerk panic reactions and tempers. The will and determination yoga requires helps people regain control over their body and their mind.”

But that seems a bit simplistic, doesn’t it?

The Yoga Journal article goes on to state that “Journal of Alternative Therapies that found yoga to be useful in addiction treatment. Based on a randomized clinical trial using yoga at a methadone clinic in Boston, the study revealed that in a group setting yoga was just as effective as traditional psycho-dynamic group therapy.”

I still feel like that’s not getting at the heart of why yoga works for dealing with addictions.

“Aruni Nan Futuronsky, the director of retreat and renewal at the Kripalu Center for Yoga & Health, teaches a program called “Yoga of Recovery‹12-Step Spirituality” because she believes yoga and the 12 steps complement each other. She points out that the second step acknowledges a power greater than ourselves and the 11th step dictates meditation and prayer: “I see addiction as the ultimate disconnection from the body. Yoga philosophy teaches us about addiction when it teaches us about running from sensations in the body.“” As reported in the Yoga Journal.

Yoga for BED.

The relevance then, for yoga for BED is that it assists in learning not only to FEEL the body’s sensations, but what to do when those sensations aren’t comfortable. How to moderate the breath when a situation becomes complex, scary or uncomfortable. It teaches us, while holding positions that have activated the muscles, or while balancing, that we are strong, we are loved and we are loving. All while feeling slightly off center, or vulnerable, or even well, “like a geek” as one student put it.


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Talking ‘Bout a Revolution: The FREED ACT and why its important

In Uncategorized on February 21, 2009 at 3:11 pm

On February 25, 2009, a coalition of groups working to prevent, educate and eliminate eating disorders will convene in Washington, DC in support of the Federal Response to Eliminate Eating Disorders (FREED ACT). This bill was sponsored in 2008 by Representative Patrick Kennedy and supported by the Eating Disorders Coalition (EDC).  The aim of the bill is to make eating disorders a national health priority. Representative Kennedy will be introducing the bill again, with the support of the EDC this year. Previous bills have been introduced in the House, especially by eating disorder awareness champion Representative Judy Biggert (R-IL). That bill, the Eating Disorders Awareness, Prevention, and Education Act of 2005, would have allowed funding to:

(1) improve identification of students with eating disorders;

(2) increase awareness of such disorders among parents and students; and

(3) train educators with respect to effective eating disorder prevention and assistance methods.

The Press Conference and Briefing on February 25, 2009 is free to the public. Check out the EDC website for more information, including the location. By the way, the EDC was a strong proponent of mental health parity and we here at Sprout Yoga LOVE THAT! They also have sponsored congressional briefings on the intersection of America’s obsession with beauty and eating disorders, relying on epidemiologists and other community health experts.  Go to: http://www.eatingdisorderscoalition.org/briefingSeptember2008.htm for more information. Or you can check out the Alliance for Eating Disorder Awareness at http://www.eatingdisorderinfo.org/Home/tabid/944/Default.aspx#Coalition.

Other great information is available here: http://www.freedfoundation.org/

For information on state based FREED Acts, check out this link: http://www.nationaleatingdisorders.org/p.asp?WebPage_ID=840

So why is the FREED Act so important?

As the EDC describes it, the FREED Act is “A comprehensive eating disorders bill conceptualized and drafted with input from dozens of eating disorder organizations around the country.  Among the many initiatives this bill will address include: creating Centers of Excellence to fill the current gap in eating disorders research, improving training of health and school professionals to appropriately identify and respond to eating disorders, and requiring insurance companies to reimburse for eating disorders treatment on par with physical illnesses.”

The bill also provides funding for comprehensive research, including the collection of data on the prevalence of eating disorders, the death rates, and the economic cost to our communities from these disorders. This data is crucial not only for public health officers to understand how to prepare a response, but also for those involved in treating ED.

But here’s what is so vitally important about this bill: It would require that any insurer that provides health care coverage be required to provide coverage for eating disorders. A Chance to Heal (www.achancetoheal.org) reports the story of one of its founders, and notes that “Health insurance over the last twenty years has drastically reduced the average stay for inpatient eating disorder treatment from the optimum of 7-10 weeks to as few as one week of inpatient care. Once inpatient care is terminated, outpatient care must take over. Recovery on an outpatient basis, however, requires frequent, consistent sessions with a psychotherapist and, ideally, with an entire therapeutic team including a Nutritionist, Psychiatrist, and Physician. Slowing treatment down due to lack of funds is likely to compromise the recovery progress and promote the disease process.”

The FREED Act would also provide that insurers would be required to follow standards of care written by the American Psychiatric Association. These standards of care would take the issue of where the treatment is provided to the ED sufferer from the insurer to the insured, allowing for individual variables such as age, sex, ability to manage severity or comorbidity, family experience and staff expertise.

The FREED Act would also provide grants for educating and training all health professionals to identify, prevent and appropriately treat ED, and for educating and training educators by relying on evidence based education programs about eating disorders. This training for educators involves more than teachers, it also includes cooks, school nurses, counselors and coaches.

Finally, the FREED Act would provide funding for much needed public service announcements (PSAs). The presence of PSAs running on radio and tvs in the same mix as commercials for diet products and commercials involving dangerously thin women hawking products cannot be underestimated in terms of the positive impact these PSAs could have.

Eating Disorders affect so many women and men in this country, some estimates are as high as 24 million people in the US alone. Its time to get serious, its time to get angry, and its time to do something. Let’s start a revolution of loving our bodies, and loving each other enough to help others to love their bodies. A revolution of ease with the physical house YOU reside in.

UPDATE:

 

The FREED Act was introduced on February 25, 2009 as H.R.1193. There is no currently similar bill in the Senate. The bill as of May 4, 2009, has been assigned to committees and no further action has been taken. The more cosponsors a bill has, the more likely it is to get a hearing and ultimately move out of committee for a floor vote. You can help by calling your representatives and letting them know you are interested and care about this bill. For a list of cosponsors, click here: http://thomas.loc.gov/cgi-bin/bdquery/D?d111:1:./temp/~bdDT0O:@@@P|/bss/111search.html|

Yoga is being taught in more schools across the country, and research has shown that yoga helps infuse its students with a healthier body image. Yoga can help prevent eating disorders, when done in conjunction with other educational programs. Get the house to MOVE on this bill and get the revolution started.

What therapies ARE available for PTSD?

In PTSD and Yoga on February 17, 2009 at 3:34 pm

Post Traumatic Stress Disorder (“PTSD”) was first diagnosed in the 1970s among returning vietnam veterans. In essence, it was a revamped updated and more complete version of what was formerly called Shell Shock.

Post-traumatic stress disorder is a pattern of behavior that develops after a traumatic event. A traumatic event in this context is defined as one that may bring serious injury or death to oneself or to another person. Traumatic events capable of causing post- traumatic stress disorder include kidnapping, natural disasters (hurricanes, earthquakes, tornadoes, floods, etc), physical and sexual abuse, combat, drug abuse, and near-death experiences.” (http://www.medicinenet.com/script/main/art.asp?articlekey=12516)

I’ve also described that yoga can be of assistance in combination with other therapies. So what are the current therapies available and in use?

Drug Therapy

There has been some evidence that administering propranolol within 20 hours of the traumatic event can reduce anxiety and stress symptoms by up to half of those not given the drug. (http://www.psychologytoday.com/articles/pto-20031027-000002.html).  Propranolol is also called Inderol and it acts by  blocking the sympathetic nervous system. (http://www.medicinenet.com/script/main/art.asp?articlekey=12516)

Other studies have shown that the use of  Zoloft for those with PTSD (a drug commonly administered to those suffering from depression) has shown some relief.  Initially, researchers targed the neurotransmitters responsible for the occurrence of flashbacks. ” For example, antidepressants including imipramine and phenelzine (Nardil) that alter neurotransmitters such as serotonin, norepinephrine, dopamine, and acetylcholine have been found do more to reduce flashbacks and the feelings of helplessness more than placebo (a dummy pill). Unfortunately, however, side effects interfered with the long-term use of these drugs. ” (http://www.medicinenet.com/script/main/art.asp?articlekey=12516)

However, it should be noted that the studies showing positive effects with treatment of Zoloft, as noted above, involved women who developed PTSD after an episode of sexual violence. The result was a 50% reduction in stress symptoms as opposed to a 30% for those treated witha  placebo (or sugar pill). When replicated, the results were not shown again. Additionally, there was no effect when the same study was tried on veterans. (http://www.medicinenet.com/script/main/art.asp?articlekey=12516)

Other drugs are being studied, including:  Nefazodone (Serzone), mirtazapine (Remeron) fluoxetine (Prozac), paroxetine (Paxil), and citalopram (Celexa).

Counseling/Talk Therapy

Talk therapy has also been shown to be effective in treating PTSD. Specifically, the earlier treatment is given to someone with PTSD, the more effective it can be.  For help finding a therapist specifically trained to work with trauma and its effects,  contact the Sidran Traumatic Stress Institute by email at help@sidran.org or by phone at (410) 825-8888 ext. 203.

What kind of therapy?

  • Trauma-focused cognitive-behavioral therapy. Cognitive-behavioral therapy for PTSD and trauma involves carefully and gradually “exposing” yourself to thoughts, feelings, and situations that remind you of the trauma. Therapy also involves identifying upsetting thoughts about the traumatic event–particularly thoughts that are distorted and irrational—and replacing them with more balanced picture.
  • EMDR (Eye Movement Desensitization and Reprocessing) – EMDR incorporates elements of cognitive-behavioral therapy with eye movements or other forms of rhythmic, left-right stimulation, such as hand taps or sounds. Eye movements and other bilateral forms of stimulation are thought to work by “unfreezing” the brain’s information processing system, which is interrupted in times of extreme stress, leaving only frozen emotional fragments which retain their original intensity. Once EMDR frees these fragments of the trauma, they can be integrated into a cohesive memory and processed.
  • Family therapy. Since PTSD affects both you and those close to you, family therapy can be especially productive. Family therapy can help your loved ones understand what you’re going through. It can also help everyone in the family communicate better and work through relationship problems.

How does yoga fit into therapy?

Some therapists, such as Babette Rothschild, use movement and body feedback focusing in their talk therapy. By focusing on the body, sensations and movement, a client can begin engaging parts of the brain needed to tag the traumatic memories with a date and time, a space and place. By doing so, that allows that memory to stop repeating in the form of flashbacks.

Yoga can be used as a kind of cognitive behavioral therapy, in that it allows the practioner to learn to recognize feedback from their body, and due to positional memory (where holding a certain position can recall thoughts and feelings raised when the body was last in that position), can help gently begin the process of allowing traumatic memories to rise, and be recognized, then worked through in other talk therapy.

Secrets & Lives: PTSD cuts across cultures

In PTSD and Yoga, Uncategorized on February 13, 2009 at 4:16 am

What do an Iraq veteran and a Hasidic Jew have in common? Not much you’d think, at first. But two news stories released over the last few weeks show that they have the possibility to both suffer from PTSD.

First, what is Post Traumatic Stress Disorder? Clinically, PTSD is an anxiety disorder that is caused by exposure to one or more traumatic events that threatened  or caused  serious physical harm. Commonly, people associate PTSD with veterans, and rightly so. Many Vietnam veterans suffered from PTSD without getting adequate access to mental health therapies.  However, research in the mid 1980s showed that rape and sexual abuse survivors also held the possibility of developing this disorder. I’ve read some estimates as high as 80% of all rape survivors have developed PTSD. PTSD can also be triggered by diagnosis of a life threatening illness, such as cancer or other diseases. Some individuals who survived childhood cancer experience PTSD as they grow into their teen and adult years, due to the repeatedly traumatic experiences of surgery, testing, and radiation.

So if we assembled a group of people to “look” like PTSD, it would be composed of veterans, rape and torture survivors, and possibly survivors of childhood illnesses. Which explains why I’m talking about an Iraq war veteran. But what’s up with the Hasidic Jew?

NPR featured a story last week concerning serious sexual abuse of hasidic children in NYC, and some allegations of cover ups by the synagogues. The story, which can be found here:   http://www.npr.org/templates/story/story.php?storyId=99913807

mirrors what many of the children abused at the hands of the Catholic Church suffered – a blame shifting, a denigration of whether the abuse was “that bad” or “not serious.” Essentially, adults telling kids that their fear and guilt, their response to a traumatic, overwhelming experience was overblown. That in turn, causes the child to submerge their feelings even deeper, causing more and more serious levels of emotional disturbances.

I care about these issues, because right now, right here, in this country, nothing is more important than making sure everyone has the capacity to be productive, useful members of society. But letting PTSD go untreated leads to parts of our community leading splintered or fractured lives, holding back from expressing their skills and talents into a world that needs creative solutions to energy, poverty, growth, homelessness, food security, violence and many other problems. Unleashing the power of so many individuals to possess their own sense of ease, of confidence and the ability to live, maybe not without fear, but with less fear, more ease, could create a very different society in the next few decades. Yoga can help people with PTSD, when combined with other treatment modalities.

So the soldier and the hasidic jew, they both may suffer from PTSD, but not know how they can get treatment that can make them feel strong, capable and ready to handle taking those traumatic memories that are not properly given a time and place and continue to bump into their daily lives in the form of flashbacks or dissociation.

And why is this so necessary now? Well, recently more studies have shown that our returning vets are succombing to suicide at a rate double and triple that of the rest of the population. Information available here:

http://www.npr.org/templates/story/story.php?storyId=100341242

and here: http://www.npr.org/templates/story/story.php?storyId=100352110

To be blunt, they are dying because we can’t get treatment to them, in a way that will work for them. Why not try everything available? Why not try new ways of doing talk therapy, new drugs, new movement based therapy? What do we have to lose? If it saves half of those who might have committed suicide then it is a raging success.

Keeping secrets, of being abused, of being threatened and terrified and not willing to try therapy because of not being considered capable or strong, these secrets cost lives.

So, what is Sprout Yoga Doing?

In Sprout Yoga Activities, Uncategorized on February 13, 2009 at 3:49 am

I’m SO glad you asked what we’ve been up to in the last couple of days at Sprout Yoga. Its the reason why I’ve been not posting on this blog.

First, I am now teaching every Wednesday morning at 7 am at Providence Meeting House, in Media, PA. Info available here: http://www.phillyfunguide.com/event.php?id=27234.

AND

I am now also teaching (as of February 28, 2009) at Tango 411 in Media, every saturday at 5 pm. Info to be posted here: http://www.tango411.com/Home.html.

All of that based on donations – all of the donations go to Sprout Yoga. And we need those donations too! I just did the barebones budget for Sprout Yoga, and we’ll need to raise $2500 by the summer to get our projects completed.

That’s a LOT of Yoga!

So what are we up to?

Here’s a glimpse:

Teacher Training – teaching yoga teachers how to work with people overcoming eating disorders and post traumatic stress disorder, to be held in New York City.

Yoga Retreat for Young Women with Body Hate Issues – we are planning a yoga retreat, for approximately 15 women, working on self esteem issues, and building body confidence in young women, with mild disordered eating.

Teacher Curriculum – organizing and summarizing medical literature that currently exists on treatment of ED and PTSD with yoga and other similar modalities.

And of course, providing free yoga to people who are overcoming PTSD and ED, who are currently in a counseling relationship (e.g., have an existing therapist, or have had a therapy relationship that they can return to), and would benefit from yoga.

We are also monitoring the FREED Act – A soon to be proposed bill in the House of Representatives that would provide federal funding to teach eating disorder prevention in schools. We love this bill, and we hope that we can see some real action on it in the future.