Learning to LOVE your Body, Weight Loss, and Exercise

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1 Advanced Techniques for Dealing with Binge Eating and Bulimia CHARIS CENTER FOR EATING DISORDERS Anne Price Lewis, PhD, HSPP, LCAC Learning to LOVE your Body, Weight Loss, and Exercise ABOUT THE CHARIS CENTER Charis is an ancient Greek word meaning grace or the inner beauty of honor, courage, kindness and generosity of spirit. 1

2 WHO WE TREAT Children Adolescents Young Adults Adults Males and Females OUR SERVICES Medical Evaluation and Monitoring Outpatient Assessment and Therapy Nutritional Evaluation and Counseling Family Education and Support Intensive Outpatient Program Partial Hospitalization Program Support Groups Therapy Groups FACTS Over one-half of teenage girls and nearly one-third of teenage boys use unhealthy weight control behaviors such as skipping meals, fasting, smoking cigarettes, vomiting, and taking laxatives Girls who diet frequently are 12 times as likely to binge as girls who don t diet 2

3 DSM-5 Criteria for Bulimia Nervosa Recurrent episodes of binge eating characterized by both of the following: Eating, in a discrete period of time, an amount of food that is definitely larger than most people would eat during a similar period of time and under similar circumstances A sense of lack of control over eating during the episode Recurrent inappropriate compensatory behavior in order to prevent weight gain (self-induced vomiting; misuse of laxatives, diuretics, enemas, or other medications; fasting; or excessive exercise DSM-5 Criteria for Bulimia Nervosa (cont) Binge eating and inappropriate compensatory behaviors both occur, on average, at least twice a week for 3 mos. Self-evaluation is unduly influenced by body shape & weight Disturbance does not occur exclusively during episodes of AN Purging type (self-induced vomiting, laxatives, diuretics, enemas) Nonpurging type (fasting or excessive exercise) DSM-5 Criteria for Binge Eating Disorder Eating a large amount of food in a discrete period of time (2 hrs) Feels a loss of control Also includes 3 or more of following: Eating more quickly than typical Eating until uncomfortable or nauseated Eating when bored or depressed Eating a lot when not hungry Eating alone during normal eating periods, due to embarrassment 3

4 DSM-5 BED Criteria Cont. * Feeling disgusting, depressed or guilty after eating * Binge eating occurs on average twice weekly for 6 months * Binge eating not associated with use of compensatory behaviors * Binge eating is not compulsive in nature but an expressive disorder STATISTICS Binge Eating Disorder Affects 3.5% females Affects 2% males 30% of people in weight loss treatment Bulimia Nervosa 1-2% adolescents and young adults 20% of bulimics are male INITIAL EVALUATION 4

5 Presenting Symptoms Reasons for entering tx at this time Onset, intensity, and duration of ED sx Precipitating events Current stressors Sx of mood and anxiety disorders Evidence of trauma Current State of ED Frequency, duration, & intensity (daily vs daily x s ) Restricting Bingeing Purging Vomiting (tool?) Exercise Spitting food Use of laxatives, diuretics, diet drugs, OTCs Typical day s food intake/24-hour recall Eating Disorder History Height Weights: high, low, current, pt goal Age of 1 st diet and reason Family attitude toward pt s weight Family members attitudes toward own weights Other influences on weight (friends, sports, coaches) 5

6 Treatment Issues Common Beginning Concerns I want to lose weight! (Or, if at a lean weight artificially): I want to stay at this weight without engaging in eating disorder behaviors. Importance of debunking these myths of treatment Weight loss means eliminating foods Happiness is found in weight loss or getting to my thin self Eating Disorder treatment will be the lasting WEIGHT WATCHERS (95-98% of all diets FAIL!) You can naturally achieve the lower weight the eating disorder provides you WHY is Appearance so Important? 6

7 It s Marketing for Ya! Consumerism Dove Evolution What does appearance REALLY say about us? 7

8 What characteristics do I use to describe myself? Move from focusing OUTward to INward. How do I take care of my BODY? Sketching Awareness Exercise Someone can exercise compulsively for 15 minutes where others can work out healthy for 2 hours. WHY? What makes the difference? LOVING YOURSELF Focus on reducing behaviors (purging, binge eating) by building distress tolerance, distraction, alternative coping Focus on moving your body in a way that feels good and stronger Focus on goals that are related to internal improvement of self (what can I do for others today). Nurturing your body. Weight loss??!!! Focus on being mindful of eating disorder messages and ideas 8

9 Learning to be Happy You re on a path in the forest, and you keep taking that path expecting it will lead you to happiness and it always takes you right back to the middle of the forest. Why are you still taking the same PATH? QUESTIONS? 9

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