Eating Disorders

North Conway, NH Eating Disorder Support Group

Eating Disorders Support Group

An intimate group designed to receive support, learn coping skills, and find strategies to overcome an eating disorder.

Brought to you by local professionals, dedicated to helping people recover from their eating disorders. The group is open to individuals, 18 years or older, who are working towards recovery from their eating disorder.

Topics include:
• Learn new skills for overcoming disordered eating behaviors
• Find out how to start changing your mindset
• Discover new self-help strategies
• Enhance your support network

Location: Reporter Court, North Conway, NH

Cost: $40 for a 4-week series

Please call 603.319.4512 or email: info@ascentcounselingnh.com for more information.

A bit about the clinicians…
• Nick Hudson-Swogger: Nick has an MA in Counseling from the University of New Hampshire and is currently pursuing a certificate in advance graduate studies from the Eating Disorder Institute at Plymouth State University. He is a trained DBT and FBT therapist and member of the Academy of Eating Disorders.
• Hope Patterson, Nutritionist & Wellness Coach: Hope is dedicated to eating disorder recovery by teaching her clients new eating strategies for their everyday life. Hope has a degree in dietetics from Simmons College and an M.Ed in Health Promotion from Plymouth State University, focusing on eating disorder recovery.
• Christine Wallace: Christine has a psychology degree from Salem State and an MS in mental health counseling from Nova South Eastern University. She also is a Ph.D-abd in metaphysical science. Christine currently practices privately in North Conway, NH, treating anxiety, depression, and addiction.

Embracing Difference

There’s a website I’d like to share today called Positive Exposure. The goal of the website is to show the unique beauty of people with various genetic conditions (albinism etc.) that are often portrayed in dehumanizing ways. It’s an amazing project, and it happened to come to my attention at the same time as I was reading two unsettling articles. The first was a report on CNN about the actress Mellissa McCarthy (of Bridesmaids among other films). Mellissa is a highly entertaining and talented actress who also happens to be plus-sized. Promotional material for her latest movie included a photograph of her that had been digitally altered to make her slimmer. While this practice is nothing new, it once again illustrates how hyper-focused our society has become on the thin ideal. While lifestyle choices are a contributing factor for obesity, there is also fact that weight and body type (ectomorph, mesomorph, endomorph) are genetically determined. What I found especially disturbing in the article was a quote from Ms. McCarthy where she stated that sometimes she wishes she would wake up and get people’s attention because she is emaciated. While disturbing, the comment does not shock or surprise me. Anyone who has worked with individuals who are obese or have an eating disorder other than anorexia has heard people refer to themselves as “failed anorexics.” Then you have Abercrombie & Fitch, a clothing company that goes out of it’s way to promote an ultra-slim body style by not making clothes in sizes that fit the average woman. Not only do their clothing sizes exclude most women, the CEO Michael Jeffries actually stated that their clothes are for “cool” kids (i.e. unnaturally thin women) and not overweight women. The venom against obese individuals even extends to college professors and Disney. I understand that the rising obesity rate in the US is concerning, and certainly a lot of it is due to lifestyle choices. But our current approach to tackling the problem is misguided. Shaming and ostracizing people because of the weight is not going to help them make lifestyle changes. Fad diets, diet pills and cosmetic surgery do not encourage people to make healthy choices. Ever-growing food portions at restaurants and the abundance of processed foods do not promote intuitive eating. Even the way exercise has become something you have to plan into your day, instead of being a natural part of one’s lifestyle (e.g. walking, hiking), is problematic. What we need is to do is rethink what it means to be healthy. The truth is that you can be healthy even if you are obese (the absurdity of the BMI is a whole subject itself). There are many people who eat healthy, exercise, and still are technically obese. Yet they are in good health. Instead of shaming them, we should be celebrating their accomplishments. Beauty is not determined by weight, and the promotion of the thin ideal in our society is backfiring. We not only have rising obesity rates, but rising rates of eating disorders, and they are occurring at younger and younger ages. Obese girls are often the subject of bullying, placing them risk for suicide and mental health problems such as depression. Being the victim of bullying and dieting are two known risk factors for developing an eating disorder. Disordered eating and body dissatisfaction are more and more common among women even if they do not have an eating disorder. It is not just women who are at risk. Males are also showing increasing rates of disordered eating and body dissatisfaction. The use of steroids, HGH and other methods of altering one’s body is becoming more common among young men in high school. When you consider all this, the reality is that we don’t have an obesity epidemic, we have a body dissatisfaction epidemic. It’s so engrained in our culture, we may not even realize we have an implicit bias against obese individuals (take the Project Implicit test for weight to see what I mean). Which brings me back to the website Positive Exposure. As a society, we like to talk about “diversity” and “acceptance”, yet often in our every-day lives we don’t live up to these aspirations. Take a moment and think about what it means to truly see beauty in every individual; to celebrate their uniqueness. Everyone is different; this is a good thing. The variety and diversity of life is what makes it so special. I challenge myself, as well as you, to be ever mindful of this truth and try and exemplify it each day.

Family-Based Therapy for Anorexia Nervosa

Having just returned from the 2-day training on FBT-AN, I thought now would be a good time to write a bit about this treatment. Originally developed at the Maudsley Hospital in London, Family-Based Therapy for Anorexia Nervosa (FBT-AN) is considered a first-line treatment for adolescents with AN. Some people find the treatment controversial and the topic certainly generates intense discussion among researchers and providers. However, I think that what makes it controversial is also what makes it so effective. The basic premise of FBT-AN is that inpatient hospitalization is traumatic, disruptive and has not proven to be very effective in treating AN over the long-term. It also makes the argument that most current treatment approaches disempower parents by removing them from the re-feeding process. The approach that FBT takes is that parents should be responsible for re-feeding their child, and the entire family should be involved in the treatment process. It is well documented in research literature that it is critical to achieve weight restoration as quickly as possible to reduce the risk of the illness becoming chronic. Furthermore, because cognition is severely impaired when an individual is dangerously underweight, traditional insight-oriented therapy is of no use. Cognitive difficulties and other symptoms that accompany low-weight anorexia (obsessionality, anxiety, depression) typically resolve once weight is restored. The underlying message in FBT-AN is “food is the medicine” and until the child is weight-restored and able to handle the responsibility of eating, it is up to the parents to ensure that this occurs. FBT also takes an agnostic view of AN; it does not delve into what might have caused the illness but rather on ensuring the child gets weight-restored as quickly as possible. The therapist is the expert consultant, always guiding and refocusing the family on the task at hand.

It should be noted here that FBT-AN is not a self-help approach, and parents should never attempt to implement the treatment without a qualified FBT therapist. Anorexia Nervosa is a serious illness with the highest mortality rate of any psychiatric disorder and required qualified medical and mental health providers to be effectively treated. FBT also recognizes that there are times when hospitalization is necessary due to acute medical risks and suicidality. To learn more about FBT-AN, please visit maudsleyparents.org. The developers of FBT also maintain a list of certified FBT therapists.

As with any new treatment approach that challenges current thinking, FBT has generated much discussion and debate regarding the approach and its effectiveness. Having had the opportunity to hear Daniel Le Grange discuss FBT-AN in comparison to CBT-E with Chris Fairburn at ICED 2013, and then to attend the intensive training, it is clear that no one is suggesting that FBT-AN is the only treatment option. However, with remission rates as high as 60% and long-term follow-up showing similar rates, the evidence indicates that is extremely effective for many individuals, and should be a first-line treatment for adolescents with AN.

If you or a loved one is suffering from an eating disorder and needs treatment, please contact Ascent Counseling today to schedule your initial consultation phone call.

ICED Conference

I recently returned from the International Conference on Eating Disorders, which was held this year in Montreal. It’s my first time attending the conference, and I’m very pleased to have had the opportunity. The ICED is the annual conference for the Academy of Eating Disorders, and is attended by some of the best researchers and clinicians in the eating disorder field. The conference took place over 3 ½ days, and included numerous presentations and educational opportunities. I learned more than I could possibly put into a blog post, so instead, I thought I would comment on the theme of the conference, “Crossing Disciplinary Boundaries in Eating Disorders”.

The conference was kicked-off with a keynote address by renowned psychologist David Barlow. Dr. Barlow is well known for his research of cognitive-behavioral treatments for anxiety disorders, and focused his discussion on the idea that it may be more effective to investigate psychiatric disorders from the perspective of what they have in common, versus what separates them. He termed this “lumping” versus “splitting” and noted that the latest version of the DSM, DSM-5 has continued the trend of “splitting”. Interestingly, DSM-5 is slated to be released this month, and the director of the NIMH has gone on record as saying NIMH is moving away from researching psychiatric disorders using the DMS-5 nosology. His comments provoked a response by the American Psychiatric Association, who basically said, “This is the best we can do until you researchers give us better evidence.” Meanwhile, the shortcomings of DSM-5 have led some to question the biomedical framework for psychiatric disorders, while others argue that it encourages mental health practitioners to pathologize normal human behavior. I think this controversy is unfortunate and only serve as fodder for the anti-psychiatry movement. The mental health field has worked extremely hard at reducing the stigma around seeking treatment for mental illnesses. It would be devastating if the current DSM-5 controversy negatively impacted this effort.

Eating disorders, in my opinion, are an excellent example of the “lumping” versus “splitting” issue. Research has shown that for many individuals with eating disorders, their diagnostic presentation changes with time. It is not unusual to have someone develop Anorexia Nervosa during adolescents, but then continue to struggle with a variety of eating disordered behaviors over the course of the lifetime, including binging and purging. In fact, most individuals with an eating disorder end up in the Not Otherwise Specified category because, while clinically impaired, they do not meet the specific criteria for either Anorexia Nervosa or Bulimia Nervosa. This would suggest that there are strong commonalities between disorders that are conceptualized as being separate. On the other hand, Binge Eating Disorder, which is being added to DSM-5, may be more distinct from AN & BN. For example, prevalence rates for men are much higher for BED than for AN or BN and there does not seem to be the diagnostic “crossover” that occurs with AN & BN. However, the inclusion of BED in DSM-5 does continue the trend of “splitting” diagnostic categories, which may or may not be helpful to our understanding of eating disorders.

One of the fascinating things about eating disorders is the interplay between biology and psychology. A classic study informally referred to as the Keys Study showed how starvation can induce behaviors that mimic Anorexia Nervosa (the ethics of the study are a different story). It was one of the first studies to clearly demonstrate the biological underpinnings of eating disorders and how starvation can negatively affect psychological functioning. Another such example is the research that suggests there are different personality traits associated with Anorexia Nervosa and Bulimia Nervosa and how they may impact the development of these illnesses. We desperately need better research into the biological basis for personality traits and how these relate to psychiatric disorders. I think a major shortfall of the DSM-IV was the artificial separation of personality disorders and mental illness. The reality is that the two are intertwined and likely share common pathophysiology in the brain. So I am firmly in the “lumping” camp at this point, and hope that the NIMH RDoC effort helps us develop better dimensional models of psychiatric disorders that delineate the underlying biological mechanisms and associated environmental factors.

Eating Disorder News

Just a few eating disorder-related news items to pass along in this post. The first is that a parental education law was just passed in Virginia. If you haven’t heard about the controversy regarding the new Victoria Secret “Bright Young Things” product line that targets young teens, I recommend you read this and this. While eating disorders are certainly biologically based brain disorders, there is no doubt that cultural influences that perpetuate the thin ideal contribute to these illnesses. I hope that pressure can be put on Victoria Secret to end this product line. On a more positive note, there was a nice article on CNN recently about a woman who recovered from her eating disorder. While we still have a long way to go in developing effective treatments for eating disorders, one fact that research has shown is that if you intervene when an eating disorder first presents, and are able to treat it effectively, the risk of relapse decreases significantly. That is why programs such as the one being developed in Virginia are so important. The earlier we identify and treat these illnesses, the better chance they will not become chronic conditions. I hope that we see similar legislation in New Hampshire in the near future.