Eating Disorders

DNA Puzzle

The Link Between Genetics, Depression and Eating Disorders

The origin and development of eating disorders is a complex topic. In the past, misunderstandings about these disorders led many people to create false conclusions. Thankfully, newer research on how these ailments develop in an individual are slowly dispersing these misperceptions. These newer studies have even started to explore the connection between eating disorders like anorexia, depression and a person’s genetics.

The traditional stereotype for someone with an eating disorder was a younger, wealthier, Caucasian woman. However, this stereotype is not true. In fact, people from a wide-variety of backgrounds can, and do, suffer from eating disorders. Pushing beyond societal identifiers like race and income levels, researchers are now beginning to study the human genome in order to discover additional eating disorders indicators.

For conditions like anorexia nervosa, bulimia or binge eating; healthcare professionals still are not sure as to why some people develop eating disorders. However, there are well-documented risk factors that can increase an individual’s chances for developing an eating disorders. Studies have shown a strong correlation between the existence of depression and occurrence of an eating disorder. These disorders also commonly co-occur with anxiety disorders.

Major depressive disorder or clinical depression is one of the more common mood disorders. Similar to eating disorders, the symptoms of depression can affect how a person feels and thinks. Even activities such as sleeping, eating, or working are impacted. Clinical depression is more than feeling sad for a day. It is much longer and more severe. For example, for a behavioral health professional to make a diagnosis, the symptoms for major depressive disorder usually must be present for at least two weeks.

In one study, researchers sampled 2,400 individuals who were hospitalized for an eating disorder. Out of this sample group, researchers discovered that 92% of those in this group struggled with a depressive disorder. Discovering connections between these conditions has encouraged researchers to look at more recent large-scale genomic studies. Using genetics to explore the complexity of eating disorders is starting to produce clues as to the disease’s origins and why it is so persistence.

One of the first studies that was able to document a strong correlation between eating disorders and genetics was in 2017. The research, published in the American Journal of Psychiatry, was able to identify a significant genetic marker for anorexia nervosa. The implication of this research suggests that health conditions like anorexia nervosa may both exist as a psychiatric and a metabolic disorder.

Anorexia nervosa has the highest mortality rate of any eating disorder. Commonly referred to as anorexia, the disorder is characterized by extreme caloric restriction resulting in weight loss, an intense fear of gaining weight, and a distorted body image. Individuals with this condition sometimes go undiagnosed, but researchers estimate that roughly 2 percent of women and 0.3 percent of men suffer from this disease.

Researchers have found, by studying the genetic makeup of identical twins, that anorexia is 50 to 60 percent inheritable. Earlier genetic research has linked these same genomic regions to autoimmune disorders, including type 1 diabetes and rheumatoid arthritis.

With the success of the Human Genome Project, which was completed in 2003; researchers can now study the impact of genetic code on a person’s health. The successful completion of the project gave scientist and physicians the ability, for the first time, to read the complete genetic code for building a human being. Currently, this DNA blueprint is used to research many other diseases and conditions. Hopefully, this new research will provide a better understanding as to why and how eating disorders develop, as well as offer additional treatment options.

Experienced Healthcare professionals can help individuals identify eating disorders, as well as provide safe and effective treatment options. For additional information or questions about eating disorder treatment options, please contact the staff at River Centre Clinic (RCC). Their Eating Disorders Programs provide a full range of treatment options for both adolescents and adults.

River Centre Clinic’s primary goal is to provide high quality, cost-effective, specialized care for patients with eating disorders in a state-of-the-art treatment environment. Our levels of care deemed most cost-effective for the majority of these patients is Partial Hospitalization for adults and Residential Treatment for adolescents. We also provide outpatient services for this patient population in order to facilitate transition to and from the above higher levels of care that are usually required for effective treatment of this population.

The EAT-26 (Eating Attitudes Test) assessment provides anonymous and quick feedback for a variety of eating-related health conditions.

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Eating Disorders Among Minorities

When the term eating disorder is mentioned, there is usually a specific mental image that comes to mind. Traditionally, the stereotypical person with this type of mental health issue is a young, wealthier Caucasian female. Mass media and pop culture images usually reinforce the portrayal of hyper-thin, white women who are suffering from the effects of conditions like anorexia nervosa. However, this stereotype that eating disorders only inflect younger, white women is not correct.

Eating disorders are usually placed into four overall categories: anorexia nervosa, bulimia nervosa, binge eating disorder and Other Specified Feeding or Eating Disorder (OSFED). Other mental health issues are also commonly assisted with these eating disorders such as general anxiety, Post-Traumatic Stress Disorder (PTSD), depression, bipolar disorder and Obsessive-Compulsive Disorder (OCD).

The American Psychiatric Association defines an eating disorder as an illness where people experience severe disturbances in their eating behaviors. They also have problems related to the regulation of thoughts and emotions, usually becoming obsessed with food consumption and their body weight. The prevalence of reported eating disorders, with the exception of anorexia nervosa, is similar among Non-Hispanic Whites, Hispanics, African-Americans, and Asian Americans in the United States.

Decades ago, American societal portrayals of eating disorders were almost always shown as a white-woman problem. Shockingly, this misconception was also maintained by physicians and other healthcare professionals.

For example, behavioral health research from 2006 challenged the notion that African-American women were less likely to develop eating disorders. In this study, healthcare providers read 1 of 3 passages describing disturbed eating patterns of a fictional patient named Mary. The only differences between the passages were that the patient’s race, which was randomly changed for each provider. This meant that every fictional patient’s symptoms were identical, with only the person’s race randomly rotating between African-American, Caucasian, or Hispanic.

Healthcare professionals were then asked to diagnosis the patient’s level of depression, anxiety as well as whether an eating disorder might exist. In cases of a white racial profile, the eating behavior was considered problematic 44% of the time. For Hispanic profiles, the behavior was considered problematic in 41% of the cases. Surprisingly, when the patient was identified as African American, the eating behavior was identified as problematic in only 17% of the cases. The study’s final results suggested that healthcare clinicians appear to hold race-based stereotypes about eating disorders that could limit their detection of symptoms in African-American girls.

The results of the 2006 study reinforced earlier research from 2002 which found that the race of adolescent girls had a significant impact on the detection of disturbed eating patterns. In this study, undergraduate college students recognized the existence of an eating disorder more often when they read about a Caucasian female, rather than when they read about a minority female (Hispanic or African American) with the same behavior.

National statistics indicate that eating disorders predominantly occur in white females, but many eating disorder professionals increasingly believe that the data is skewed. Women of color have likely been alienated from personal support networks. In addition, healthcare professionals use to believe that African-American and Hispanic women were somehow more immune to eating disorders.

Until recently, people with an African American racial identify were underrepresented in treatment centers and research studies about eating disorders. Gathering quality data was more of a challenge due to societal misperceptions and prejudice. Now it is clear that perceptions of body image and disordered eating patterns are not just problems for young, white women.

Here is some additional information on eating disorders and minorities:

It is clear that eating disorders do not only occur in certain racial or socioeconomic groups. Race, ethnicity and/or socioeconomic status does not make individuals immune to these health conditions. In the past, eating disorders were primarily associated with heterosexual, young, white females. In fact, these mental health issues affect people from all demographics and ethnicities at similar rates. However, minority groups (particularly African Americans) are significantly less likely to receive help for eating disorder problems.

Regardless of one’s racial or ethnic identity, treating and recovering from an eating disorder takes time as well as professional help. An experienced mental health professional can help a person understand the origins of this behavior, whether it is an eating disorder as well as acquire coping skills.

For additional information or questions about this topic, please contact the staff at River Centre Clinic (RCC). Their Eating Disorders Programs provide a full range of treatment options for both adolescents and adults. The River Centre Clinic’s main phone number is 1.877.212.5457.

Eating Attitudes Test (EAT-26)

The EAT-26 is the most widely cited standardized self-report screening measure that may be able to help you determine if you have an eating disorder that needs professional attention. Take the EAT-26 now and get immediate and anonymous feedback.

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Eating Disorders, Minorities

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The Allure of Eating Disorders: Perfection and Shame

Some people may find this surprising, but eating disorders like anorexia nervosa and bulimia can provide individuals with a sense of purpose. They are on a mission to remake themselves and finally become happy. People suffering from an eating disorder will have an inner voice that tells them that they will be happy if they can just lose the weight. This same voice tells a person with anorexia or bulimia that their worth is primarily measured by how they physically look.

People suffering from diseases like anorexia may actually have a sense of uniqueness. As they grapple with hunger pains and thoughts that excessively focus on food, exercise and their body. They become numb to other things in their life. Eating disorders can create an anesthetic-like effect on people. When their body is perfect, they will be happy. There is simply no escape from this mission.

However, this is an illusion. For people, happiness and positive self-esteem arise from accepting and loving themselves as they are in the present. Another crucial piece for a successful recovery is for individuals to have access to love and support. In this way, people can start to understand that their eating disorder was not by choice. Yet, seeking treatment is not always an option for some people. Sadly, there is still a societal stigma towards mental health.

Due to this stigma, and feelings of shame, people may choose to struggle with their eating disorder alone. However, they should understand that there is no shame in having a diagnosed eating disorder. Perceived feelings of shame for having an eating disorder is a poor reason for not seeking professional help. But, these feelings of shame and fear create additional medical complications and high mortality rates for individuals struggling with an eating disorder.

Among the youth and college students, eating disorders are particularly a problem. There is a movement to educate students, as well as the youth in general, about body positivity and the dangers of untreated eating disorders. The goal is for young people to accept that all body shapes and sizes are beautiful. For example, in Northern Ohio, Youngstown State University (YSU) spreads awareness about the dangers of eating disorders by hosting a student fashion show. The show is titled the EveryBODY Fashion Show – Awareness of Eating Disorder Fashion Show and is held to showcase and celebrate all body types. The show is held in honor of a former YSU student (Danielle Peters) from the fashion merchandising program. In 2012, this student died due to complications from an eating disorder. In addition, some students take part in the National Eating Disorders Association Walk at the Cleveland Zoo to raise money for the organization.

Beyond raising awareness, people’s relationship with dieting, body weight and their sense of themselves are complex. People who suffer from eating disorders state that they still feel uncomfortable in their own skin, even after losing a substantial amount of weight. Hopefully, these individuals realize that they are chasing the illusion of perfection and start to understand that it is not possible to “diet” oneself to happiness. There are deeper issues and insecurities at work.

It is possible to fully recover from eating disorders like anorexia and bulimia. However, when a person is alone, it may feel like there is no escape from the obsessive thoughts about food and body weight. A trained healthcare professional can guide and support people as they come to terms with their perceptions and thoughts. Research shows that without proper treatment and professional assistance, the prospects for a full recovery are greatly diminished. In this case, a do it on your own approach is not the best choice.

Recovery from eating disorders can be elusive and challenging. After recovery, individuals may continue to experience mild, moderate or even severe symptoms. What is important is that people maintain an optimistic outlook. People with chronic and debilitating eating disorders can make a full recovery. With the right professional guidance and the proper level of care, it is possible for people to learn to deal with life without the nagging inner voice of an eating disorder.

Contact the friendly staff at River Centre Clinic (RCC) for additional information or questions about eating disorder treatments. Their experienced staff and nationally recognized programs provide patients with a full range of treatment options. The River Centre Clinic is located in the beautiful Sylvania, Ohio.

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Why Are Eating Disorders More Common in the LGBTQ Community?

Eating disorders have long been a problem in the United States. These disorders have been part of the psychiatric literature for many years. In recent decades, psychiatrists and other healthcare professionals have allocated more time and resources towards the study, treatment and prevention of these disorders. Recent studies are attempting to explain a particular pattern of eating disorders in U.S. society. Researchers have found that more than half of young LGBTQ people between the ages of 13 and 24 have been diagnosed with an eating disorder.

Both the National Eating Disorder Association (NEDA),  and The Trevor Project, (LGBTQ suicide prevention organization) state that the report is based on online surveys of 1,034 young people. Among the 46 percent of LGBTQ youth who were surveyed and had never been diagnosed with an eating disorder, 54 percent reported that they at some point suspected they suffered from an undiagnosed eating disorder. Out of all the survey’s respondents, 75 percent said they had either been diagnosed with an eating disorder or suspected they had one at some point in their life. This research displays the need for additional studies in this area.

The most common disordered eating behavior from the survey was skipping meals and eating very little food in general. Not surprisingly, anorexia nervosa was the most prevalent eating disorder. The data also displayed a correlation between young LGBTQ individuals with eating disorders and suicide. Out of the individuals who had been diagnosed with bulimia, a shocking 96 percent had considered suicide. On a similar note, 66 percent of survey respondents who had stated that they had considered suicide already had been diagnosed with an eating disorder.

An earlier study in 2007 had explored at the prevalence of eating disorders in lesbian, gay and bisexual men and women. Part of the research examined associations between participation in the LGBTQ community and eating disorder prevalence in gay and bisexual men. The research was not clear as to why there was a high prevalence of eating disorders among gay and bisexual men. Researchers in this study found that gay and bisexual men had a significantly higher incidence of eating disorders when compared to heterosexual men.

Studies in 2007 were the first to assess DSM diagnostic categories, gay and bisexual men had a significantly higher prevalence of lifetime full syndrome bulimia, subclinical bulimia, and any subclinical eating disorder. At the time, gay men are thought to only represent 5 percent of the total male population in the United States. Yet, for males who have been diagnosed with an eating disorder, 42 percent of them identify as gay. For people who identified as gay, lesbian, bisexual or mostly heterosexual, they possessed binge eating, purging and laxative abuse rates that were much higher than their heterosexual peers. Data shows that for LGBTQ youth, as early as age 12, they are at a higher risk of engaging in disordered eating behavior.

So why is there a higher occurrence of eating disorders in the LGBTQ community?

Some researchers argue that because of stress from living as a minority, unhealthy eating habits are more common in the LGBTQ community. Eating behaviors such as binge eating and anorexia nervosa are symptoms of the general social stress that LGBTQ individuals experience as minorities. Thankfully, new studies and technology are making it easier to understand the physical impulses that surround unhealthy eating behaviors. Also, a broader acceptance of LGBTQ people in American culture should hopefully lower this statistic. The election of the first openly gay governor in Colorado shows that U.S. society is changing.

However, there are still unique stressors that people in the LGBTQ community are forced to face every day. These stressors create higher levels of anxiety and depression. This, in turn, can encourage unhealthy coping mechanisms that creates eating disorders and/or substance abuse. Some of the stressors that may encourage the development of eating disorders include:

  • Internalizing negative messages.
  • Living in fear from being harassed which can develop into PTSD.
  • Stress from discrimination.
  • Living as a runaway and/or experiencing homelessness.

Healthcare professionals who have direct experience with diagnosing and treating eating disorders can help people successfully recover from an eating disorder infliction. For additional information or questions about bulimia and anorexia, please contact the staff at River Centre Clinic (RCC). Their Eating Disorders Programs provide a full range of treatment options for both adolescents and adults. Their facility is located Northwest Ohio in the town of Sylvania, OH.

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DBT For Eating Disorders

When people are struggling with binge eating behavior or weight management issues, they are sometimes told to simply eat less and exercise more. This advice, perhaps well intended, will potentially make the situation worse and create an unhealthy diet cycle that focuses on a negative body image and deprivation. People need a sound treatment plan that addresses the complexity of the behaviors, thinking patterns, and relationship with food. This is where a type of treatment known as Dialectical Behavior Therapy (DBT) is helpful. DBT is a type of therapy that combines elements of cognitive behavioral therapy with principles of from Zen Buddhism. DBT has been proven an effective theoretical framework that helps promotes changes that are necessary to treat binge eating as well as other eating disorders.

What is DBT?

Dialectical behavior therapy is a specific type of cognitive-behavioral psychotherapy developed in the late 1980s by psychologist Dr. Marsha M. Linehan. The original goal of DBT was to find better treatment options for people suffering from borderline personality disorder. Dr. Linehan, who is currently a professor at the University of Washington actually developed DBT as a response to her own borderline personality disorder, which had previously not been properly treated. However, since the development of this therapy, it has been used to treat other kinds of mental health disorders.

Dialectical behavior therapy is a type of psychotherapy (talk therapy) that utilizes a cognitive-behavioral approach that emphasizes the psychosocial aspects of treatment. The main concept behind DBT is the view that some people are prone to react in a more intense and out-of-the-ordinary manner toward certain emotional situations. These emotional situations are primarily triggered by romantic, family and friend relationships. DBT theory advocates that some people’s arousal levels in such situations can increase far more quickly than the average person’s, attain a higher level of emotional stimulation and thereby take significantly more time to return to baseline arousal levels.

Dialectical behavior therapy understands that there are times when people act on emotions that do not match a social situation. This is when a skill from dialectical behavior therapy (DBT) called “opposite action” is invaluable. It’s a skill that helps us to manage our emotions, enhance our relationships and enhance our lives. It’s a skill that helps us make more healthful decisions. DBT would advocate that an opposite action is required in these situations, because it allows people to recognize that their thoughts are not facts. Individuals learn how to experience emotional urges, but take the opposite action and not act on these urges. This provides a level of self-regulation and allows people to have more control over their thoughts, feelings and actions. Not surprisingly, dialectical behavior therapy is an effective treatment approach for people struggling with eating disorders.

A summary of how DBT works:

The term dialectical is based on the principle of blending two key ideas together, acceptance and change. In therapy, both of these ideas produce better results when they are combined together. DBT has patients focus on accepting their experiences, but simultaneously working on changing unhealthy behaviors. A major goal is to provide patients with the necessary skills that allow them to cope with, and change, these unhealthy behaviors. This form of therapy was initially designed to treat people with suicidal behavior and borderline personality disorder. But, DBT has been successfully adapted to treat other mental health problems that threaten a person’s safety, relationships, work, and emotional well-being.

Traditional dialectical behavior therapy focuses on behavioral skills for four domains:

  1. Emotion regulation: Recognizing, labeling, and adjusting emotions.
  2. Interpersonal effectiveness: Navigating conflict and interacting assertively.
  3. Distress tolerance: Feeling intense emotions like anger without reacting impulsively or using self-injury or substance abuse to dampen distress.
  4. Mindfulness: Becoming more aware of self and others and attentive to the present moment.

DBT takes these four domains and applies them in a linear, multistep approach. The first step is to treat the most self-destructive behavior (suicide or self-injury). The next step is to control behavioral response such as emotional regulation, distress tolerance, and interpersonal effectiveness. The third and fourth steps promote better personal relationships and self-esteem while encouraging a sense of happiness and connection.

For additional information or questions about dialectical behavior therapy for eating disorders, contact the staff at River Centre Clinic (RCC). Their programs provide a full range of treatment options for both adolescents and adults. River Centre Clinic is located in Sylvania, Ohio.

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Childhood Eating Problems & Adolescents Eating Disorders

Many parents are familiar with children who are picky eaters. In fact, for babies, this is often a normal eating behavior. As children age, they start to develop their own personal food preferences. However, as children grow older an overly selective eating behavior could be a sign of deeper health concerns. Many people are not aware that eating disorders are the third most common chronic illness in adolescents according to the American Academy of Pediatrics (AAP). Since the 1950s, there has been a steady increase in the incidence and prevalence of anorexia nervosa, bulimia nervosa as well as other eating disorders in both children and adolescents.

Data from the National Institute of Mental Health (NIMH) estimates that out of 800 public high school students, approximately 20-22 students will be impacted by eating disorders and even more will experience subclinical (not detectable) symptoms of the disease. Adolescents who have suffered from eating disorders are more likely to experience medical co-morbidities such as depression, anxiety, substance abuse and suicide.

During a person’s adolescence is when many of these diseases first occur. Adolescence is a time in people’s life when a great deal of change is occurring. Body changes, confusion, social anxiety only accelerate feelings of self-consciousness and low self-esteem. The onset of eating disorders often appears during this period, but these diseases can develop at a later time in a person’s life.

Not all of these eating disorders directly develop due to body image issues. Among children, they may struggle to eat certain foods because they feel physically nauseous. This can create a lack of appetite for food, which will make it more difficult to eat. A fear of vomiting or choking makes a child avoid certain foods, which can gradually become more restrictive over time. According to the National Eating Disorder Association, this restrictive eating behavior is a possible sign of what was previously identified as selective eating disorder, but is now referred to as ARFID or Avoidant Restrictive Food Intake Disorder.

ARFID is similar to anorexia in that both disorders involve limitations in the amount and/or types of food consumed, but unlike anorexia, ARFID does not involve any distress about body shape or size, or fears of fatness. Although many children go through phases of picky or selective eating, a person with ARFID does not consume enough calories to grow and develop properly. In children, this results in stalled weight gain and vertical growth. ARFID can also result in problems at school, due to difficulties eating with others and extended times needed to eat. As with all eating disorders, the risk factors for ARFID involve a range of biological, psychological, and sociocultural issues. These factors may interact differently with different people, which means two individuals with the same eating disorder can have very diverse perspectives, experiences, and symptoms.  

Eating disturbances are considered problematic when it causes the child to become upset or worry and when he or she is not eating enough to sustain proper nutrition and facilitate proper growth. Complications around eating can take many forms including but not limited to:

  • Trouble with food textures/sensory issues
  • Temper tantrums during meals
  • Refusing to eat
  • Limiting food groups
  • Choking, gagging, or vomiting after eating
  • Body image concerns
  • Anxiety/OCD

Due to the concern over the growth of eating disorders among children and adolescents, the Centers for Disease Control and Prevention (CDC) has researched this modern health concern. The CDC made the following recommendations during their 2008 national initiative. Their screening of high school students for eating disorders found that almost 15% of girls and 4% of boys scored at or above the threshold of 20 on the EAT-26, which indicated the possible existence of an eating disorder. The CDC recommended regular health screenings for high school students in order to identify at-risk students who could benefit from early intervention. Early identification and treatment of disordered eating and weight control behaviors can prevent progression of the disease and reduce the overall chronic health risk. To complicate matters, pedestrians have pointed out that some obesity prevention efforts may actually encourage the development of an eating disorder. The majority of adolescents who develop these disorders were not previously obese, but some teenagers, in a mistaken attempt to lose weight, can develop an eating disorder.

For additional information about childhood and adolescent eating disorders, please contact River Centre Clinic. Their Childhood Eating Problems Program director is Anna Lippisch, MSW, LSW. She can be reached at 419-885-8800 or by email. The EAT-26 (Eating Attitudes Test) assessment provides anonymous and instant feedback for a variety of eating-related health conditions.

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Childhood eating problems, Adolescents eating disorders, ARFID

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Can Yoga Help Treat Eating Disorders?

Yoga, Eating Disorders,

Are there links between body image, physical activity and eating disorders? Stories and research from decades ago have shown that competitive sports can encourage the development of eating disorders. In the 1990s, Sports Illustrated articles openly discussed the deadly impact of anorexia on women athletes. Yet, roughly twenty years later, this problem still exists in U.S. culture. As of 2011, according to the Huffington Post and the National Eating Disorder Association, approximately 33 percent of male athletes are affected by eating disorders who participate in aesthetic sports and weight-class sports. But what if some physical activities actually decreased the occurrence or actually provided effective treatment for eating disorders?

Newer research is studying whether certain physical activities such as yoga, provide effective treatment for eating disorder related illnesses. Yoga, originally a Hindu spiritual and ascetic discipline from India, as an activity is increasingly popular around the world. Yoga is popular in the United States as a hobby that promotes health and relaxation. The activity incorporates movement, body postures, breath control as well as meditation. The popularity of yoga has raised questions as to whether different styles of yoga can provide complementary therapy for patients who are receiving treatment for eating disorders.

A randomized controlled clinical trial study in 2009 attempted to discover what effects individualized yoga practice had on adolescent patients. These individuals were receiving outpatient treatment for diagnosed eating disorders (anorexia nervosa, bulimia nervosa, or eating disorder not otherwise specified). In this randomized study, out of 50 girls and 4 boys, the group that was participating in yoga experienced a greater decrease in eating disorders. The participates who were receiving non-yoga activities showed some initial decline, but then returned to baseline levels after 12 weeks. In this study, the yoga treatment did not have a negative effect on BMI, but the overall therapeutic approach was seen as holding promise as an adjunctive therapy to standard care.

Research in 2016 also asked the question as to whether the practice of yoga provided positive results in an outpatient setting. Specifically, in treating anxiety, depression and body image disturbances among adolescents with eating disorders. In this study, researchers concluded that outpatients eating disorder therapies combined with yoga practice showed decrease levels of anxiety, depression, and body image disturbances. Like the earlier 2009 study, the practice of yoga was seen as a beneficial treatment strategy when blended with multidisciplinary care. However, researchers did add that further study was needed on treatments approaches that presented yoga as a standard element of outpatient eating disorder therapy.

More recent studies from 2018 are continuing to research the application of yoga as a treatment strategy.  A small randomized control trial investigated the impact of an 11- week yoga program for women who were diagnosed with bulimia nervosa or other not specified eating disorders. Interestingly, this small study found that the women experienced benefits from yoga for months after the original research. A more detailed and larger study is planned in collaboration with the University of Buffalo. Like earlier research, this study will document the impact of regular yoga practice as a viable eating disorder treatment. Researchers in this study did note that examining eating disorders is challenging due to the fact that most yoga-eating disorder studies have few participants, short duration window as well as other design challenges. This two-year study will provide eating disorder researchers with an opportunity to collect data on an established, manualized yoga program that serves hundreds of individuals in community, educational and medical settings.

For additional questions about the use of yoga practice to supplement the treatment of eating disorders, please contact the staff at River Centre Clinic. The clinic’s mission is to provide specialized and cost-effective treatment for individuals suffering from eating disorders (anorexia nervosa, bulimia nervosa, binge-eating disorder, and other eating disorders). An innovative approach to treatment is designed to reduce costs without compromising a high quality of care. They follow a well-established therapy model for treating eating disorders that integrates individual, group, and family therapy. For real-time feedback, their EAT-26 (Eating Attitudes Test) assessment provides anonymous and instant feedback about a variety of eating-related health conditions.

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Eating Disorders Among Active Duty Military Personnel

The United States has one of the best militaries in the world, with just over 1.34 million active-duty troops in 2015. They are prepared to meet any threat or challenge facing the country. However, many Americans are unaware of the personal and mental health challenges facing members of the nation’s armed forces. One of these challenges is the prevention and treatment of eating disorders among the ranks of U.S. military service personnel. Recent studies by the U.S. military indicate that eating disorder diagnoses for members of the armed forces have increased by 26 percent over a period of five years. The same study hints that the actual incidence of these illnesses is likely even greater.

According to research, it is estimated that roughly 30 million Americans will experience some type of eating disorder. Similar studies have shown that there are elevated rates of this disease among the nation’s active duty military members. In particular, the disease appears at higher proportions for women who are enlisted for active duty in the military. This data is not a new phenomenon. Back in 1999, researchers at the Mayo Clinic studied the eating behaviors of 423 women on active duty at Madigan Army Medical Center in Fort Lewis, Washington. This study reported that 8 percent of the women were diagnosed with an eating disorder. For comparison, the incidence of this disease for non-military women is estimated at only 1 to 3 percent of the total population. Active duty service members, including West Point graduates, reported that they feeling pressure from family, school and peers to “make the uniform look good.” This pressure can create a cycle of binging and purging with soldiers feeling like they can never be thin or in shape enough. The same disease also occurs among male active duty service members.

In all of the armed forces, more women than men are diagnosed with diseases like anorexia, bulimia and binge eating. More than two-thirds of cases involved female troops and the overall incidence rate among women, at 11.9 cases per 10,000, was more than 11 times that of males. Interestingly, the overall incidence rate of eating disorders among female Marine Corps members was nearly twice the amount when compared to women Army members. For male active duty service members, the rates were highest in the Army and Marines. Potential reasons for the increased risk for developing an eating disorder while in the military is likely due to exposure to trauma, as well as the need to routinely meet physical fitness and body weight requirements. These factors likely elevate the risk of eating disorders developing among both women and men. Children of military families also reported similar conditions at a significantly higher rate than the civilian population.

Research published in the U.S. Military’s Defense Health Agency’s Medical Surveillance Monthly Report found that incidence rates had risen steadily from 2013 to 2016 before decreasing slightly in 2017. Diagnoses for eating disorders increased from 2.3 per 10,000 to 3 per 10,000 in 2016, before dropping to 2.9 per 10,000 in 2017. “Results of the current study suggest that service members likely experience eating disorders at rates that are comparable to rates in the general population, and that rates of these disorders are potentially rising among service members,” the report states. “These findings underscore the need for appropriate prevention and treatment efforts in this population.”

The need for prevention and treatment of military members and their families suffering eating disorders has not been unnoticed. The U.S. Department of Defense’s (DOD) Peer Reviewed Medical Research Program (PRMRP) has allocated funding for eating disorders research, intervention and treatment programs. Congress first made the topic of eating disorders eligible for funding in 2017. In 2018 Congress is expected to allocate $5 million towards the prevention and treatment of eating disorders. However, federal funding for research on eating disorders is limited, with only $0.93 per person affected by eating disorders compared to other diseases such as autism receiving $44 per person affected.

To complicate matters, there is still a stigma surrounding the reporting of diseases such as eating disorders. Members of the Armed Forces are less likely to seek treatment, making prevention programs and access to treatment an imperative need across all branches. The occurrence of these diseases may, in fact, be much greater among active duty military members.

For additional questions about this topic, contact the staff at River Centre Clinic. Their programs provide a full range of treatment options for women and men with a primary diagnosis of an eating disorder. For immediate and confidential feedback, take River Centre Clinic’s EAT-26 (Eating Attitudes Test) assessment.

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Body Weight and the Diet Cycle

According to research from Harvard Medical School, eating disorders such as anorexia, bulimia and binge eating, afflict more than 30 million Americans, while millions more experience disordered eating and weight control behaviors. This statistic is even more sobering when one considers the fact that eating disorders have the highest mortality rate of any psychiatric disorder in the United States. Numbers like these have real consequences on people’s health and overall quality of life. Often people are trapped in a vicious cycle of weight gain and severe dieting. In many instances, dieting does not produce permanent weight loss. Instead, it creates an unhealthy diet cycle where a person’s body weight quickly cycles up and down. What is needed is a holistic understanding of health that does not stigmatize body weight. People should focus on healthy behaviors and physical well-being instead of body weight.

The central idea behind the act of dieting tends to create problems. Extreme diets can actually damage people’s metabolism as well as their mental perception of food and eating. This means that individuals can end up in a worse place versus when they started the diet. The diet cycle can start here, with people’s weight gain and loss having a yo-yo appearance. The rise and fall of body weight creates the appearance that people are actually at war with their food (and weight). What is more beneficial for people is an active and healthy lifestyle, as well as an acceptance of their physical appearance and body weight.

When people are informed that they are overweight, there are unintended consequences. This information can reduce people’s satisfaction with their body and create other negative emotions and behavior. This is due to the fact that modern society tends to reinforce the message that “thin” is beautiful and good. People who struggle with their weight tend to also have lower self-esteem. The stigma of being overweight can help to set up a cycle for additional weight gain or the development of eating disorders like bulimia or anorexia. Individuals at all body weights often respond to stress and anxiety by eating. This emotional-induced eating will likely only encourage more weight gain. An increase in body weight can create a feeling of lower self-esteem and anxiety in a person. People quickly become trapped in an unhealthy feed back loop of weight gain and dieting.

More has to be done in order to make it safe to be a larger-bodied person. Most eating disorders are often accompanied by trauma, but body shaming and fat loathing only make these diseases worse. Actions from the fashion and food industry, as well as pop culture, almost seem to encourage eating disorders. However, attempts have been made to address the issues surrounding perceptions of physical imperfections, body weight and fat shaming. A few examples from fashion and marketing are from lingerie retailer Aerie and the increasing popularity of plus-size models. Since 2014, the ad campaigns of lingerie retailer Aerie (American Eagle) reportedly uses non-airbrushed photos of women of various body shapes and colors. Successful Fashion designer Chris Siriano has stated that there have “always been customers of different sizes since day one.” Currently, one half of Siriano’s fashion collection is made in extended sizes. These are positive steps in the right direction, but body weight fears and stigma surrounding fat is still a common occurrence.

For additional questions about the connection between body image, body weight and the diet cycle, contact the staff at River Centre Clinic. Their programs provide a full range of treatment options for children and adults with a primary diagnosis of an eating disorder. For immediate and confidential feedback, take River Centre Clinic’s EAT-26 (Eating Attitudes Test) assessment.

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Body Weight, Diet Cycle

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Pride Flag image - LGBTQ-River Centre Clinic

LGBTQ+ and Advice to Eating Disorder Treatment Providers

Guest contributor:  Lee R.

When asked to write this blog post, I turned immediately to my good friend Google to look up some statistics and check out the latest research. What I found, or what I did not find, was revealing, albeit not entirely surprising to me. Google Scholar turned up 1,360 results for the search “LGBT eating disorder” in the last 10 years, whereas simply “eating disorder” racked up over 59,000 hits for the same time period.

It is not clear whether or not the LGBTQ+ (Lesbian, Gay, Bisexual, Transgender, Queer/Questioning, etc.) community is underrepresented in eating disorder research, but it certainly is not prominent, appearing in only 2.3% of the research references. But that should not be interpreted as meaning that the disease does not impact the LGBTQ+ community. In fact, it’s quite the opposite.

The Trevor Project and NEDA (National Eating Disorder Association) came together in 2018 to research the prevalence of eating disorders in LGBTQ+ youth1 and the results were staggering. About 54% of the sample had been diagnosed with an eating disorder, and an additional 21% suspected they had an eating disorder due to disordered eating habits. In another study2, it was found that nearly 16% of transgender college students had been diagnosed with an eating disorder in the past year, as opposed to approximately 2.5% of their straight, cisgender counterparts.

Though the research on LGBTQ+ eating disorders is scarce, what does exist speaks volumes. Eating disorders run rampant through this community, yet it is rarely spoken about in the LGBTQ+ community itself, and even less frequently in the mainstream eating disorder treatment community. Where there is currently silence, there needs to grow a discussion on how LGBTQ+ eating disorders develop and progress, how they present, and the best treatment modalities to help sufferers receive the best care possible.

That is not to say that mainstream providers cannot appropriately serve the LGBTQ+ community. However, if providers were educated specifically on how eating disorders impact the LGBTQ+ community, there may be an even greater success rate for recovery. As a start, here are 5 things I, and a few others in the community, wish treatment providers were more aware of:

  1. Gender dysphoria exists and can make it difficult for a person to live in their own body. Gender dysphoria is the feeling of distress that occurs when someone’s gender does not match the one they were assigned at birth. It can often focus on specific parts of the body that society reads as one sex or another. It can result in restriction of food, compensatory behaviors, or binge eating. Providers need to be aware of gender dysphoria, because of the added complications to recovery. Poor body image or body dysmorphia is not the only physical hurdles in those who experience gender dysphoria. Additionally, gender dysphoria is not necessarily due to poor body image, though one may trigger the other.
  2. Internalized homophobia is also a thing that exists. Internalized homophobia refers to the prejudices that members of the LGBTQ+ community turn inward after seeing and hearing the prejudices in society. This can lead to negative views and even shame of their own sexuality. This shame and negativity can then lead to further flawed thinking and disordered eating habits.
  3. Language is important. Using my pronouns is not just a suggestion. While I’ll probably present it as a timid request and tell you “it’s fine” when you mess them up, my pronouns are actually very important to me. They help me feel more at peace with who I am, especially in such a tumultuous time as the beginning stages of eating disorder recovery. By using the correct pronouns for me, you not only convey that you respect who I am, you also help me build trust and rapport. Additionally, using gender-neutral language is imperative. People of all genders can have eating disorders, using female-centric language is outdated. Help everyone feel at home by neutralizing your language.
  4. Do not assume we are just confused. I identify as a queer non-binary person. I am not confused about who I love or what gender I am; I am completely confident in both aspects. And it is quite possible your clients will be too. When they do come out to you, know that this means they trust you. Do not insist that it’s “a phase” or that it’s due to their eating disorder. In fact, it’s likely the other way around: eating disorders often develop and progress due to minority stress, internalized homophobia, and gender dysphoria. If your client is in the beginning stages of exploring their gender and/or sexuality, do not diminish their journey by crediting the eating disorder.
  5. Having culturally sensitive resources available to us is so important. Whether it’s an LGBTQ+ process group, a therapist who is a member of the LGBTQ+ community, or even something as simple as gender-inclusive bathrooms, having resources readily available to us helps us feel included and heard. Knowing that a treatment team is culturally competent can be a great relief for LGBTQ+ people who may otherwise have felt like they needed to keep their identity a secret.

This list is by no means extensive; it really is just a beginning. Every client is unique, and the best way to get to know what they want you to know is to open an honest conversation with them.

I have found in my experience that the staff at the River Centre Clinic is willing to have those honest conversations with their patients. When I first arrived at RCC in 2014, I was unsure if I wanted to come out as genderqueer. I began by talking about it with several of the other patients who then encouraged me to tell the staff. Once I did come out to everyone, the support I received from the staff and my peers did not waver. The staff was willing to learn more about my identity and use the pronouns I chose. Even when I returned in 2016, they remembered my identity and treated me with the same respect and compassion with which they treated everyone else. I believe that the acceptance I received was a vital component in making my recovery as strong as it is today.

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1 – National Eating Disorder Association. (2018). Eating Disorders Among LGBTQ Youth [Press release]. Retrieved from https://www.nationaleatingdisorders.org/sites/default/files/nedaw18/NEDA -Trevor Project 2018 Survey – Full Results.pdf

2 – Diemer, E. W., Grant, J. D., Munn-Chernoff, M. A., Patterson, D., & Duncan, A. E. (2015). Gender identity, sexual orientation, and eating-related pathology in a national sample of college students. Journal of Adolescent Health, 57(2), 144-149.

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