Monday, April 9, 2018

3 Essential Steps that Led to my Recovery from an Eating Disorder

By Kathleen MacDonald, Health Insurance Advocate
The first time I shared about my experience with an eating disorder was back on June 13, 2002. And though by then I had been suffering with bulimia and anorexia for 18 years, I had never shared with anyone about the debilitating anguish I suffered as a result.  The eating disorder had long silenced me and convinced me that no one cared, that I was too great a burden, and that I wasn’t really that sick and, therefore, I didn’t deserve to talk about what I suffered. But by the grace of God, on June 13, 2002, I found myself standing before a room full of strangers on Capitol Hill, prepared to give a speech about the 18 years I had suffered. I was given five minutes to share ‘my story’ and relate it to the topic being discussed that day on Capitol Hill: why people with eating disorders deserve to have insurance treatment.
What moved an entire room to tears left me coolly stoic. I could hear myself saying the incredibly tragic words and I knew it was ‘my story,’ but as I read the words aloud there was no wherewithal left in me to feel the pain I deserved to feel. For 18 years my emotions had been suppressed as a result of being told to ‘just get over it,’ being told I was just ‘too emotional,’ being told I didn’t ‘look anorexic,’ and years of insurance telling me that I wasn’t sick enough to need treatment. As I finished my speech, I should have been bawling my eyes out. Instead, I indifferently said, “I hope I don’t become part of the 2-5% statistic of eating disorder victims who take their own life.” What I didn’t tell the audience was that my plan was to complete suicide after the speech. Like so many sufferers, I had given up hope and the eating disorder had stolen my will to even consider another day of life.
Yet, also like so many sufferers, I truly believed I was “fine.” After the speech, person after person came up to hug me, tears in their eyes, looking for any sign of life in mine as they said, “You can beat this,” “You have to get help,” “I’m so worried for you.”  My response to everyone was, “Don’t worry. I’m fine, I promise.” How do you make sense of such a completely twisted and nonsensical state-of-being that so many eating disorders sufferers live with? How do you explain to people that a person with an eating disorder can be extremely close to death, including very close to suicide, but still utter the words, “I’m fine.” That is just one of many serious conundrums about the eating disordered brain that makes these disorders so difficult for people to understand, including the sufferer.
Well, it’s obvious that I did not complete suicide on June 13, 2002 – in fact, I did not even attempt it. The miracles of that day changed the course of my life, and resulted in me fully healing from the eating disorders and all its accoutrements (depressed mood, suicidal thinking, self-hatred, body disgust, etc.). But how? How did I go from having zero hope left, to completely healing and living the blessings of an abundantly full life? To explain all that went into my personal healing process is about as difficult as condensing 18 years down into just five minutes! Therefore, I’m going to focus on the three essential steps that allowed me to recover from the eating disorder. As I share these three essential steps, please know that I honor the fact that every person has their own unique healing journey; these steps were essential for my healing. If they help you on your journey, wonderful.  If they don’t really jive for you, that is ok, too. We are all unique, including how we heal. I believe we can always learn from one another’s journeys.
The first essential piece of my recovery process was that I had to come to grips with: suicide is never an option. The reason I did not go on to complete suicide on June 13, 2002, was because that very day I heard Kitty Westin share the story of her daughter, Anna, who completed suicide after suffering with anorexia. It was hearing and seeing Kitty’s pain that made me realize what those left behind are faced with. Even though I was convinced my family wouldn’t care if I was dead, I felt like I couldn’t fly in the face of Kitty’s pain and suffering. And so, from that day forward, “Suicide is never an option” became a recovery-mantra for me. I cannot possibly recall how many times during my recovery process I had to write down the mantra, speak it out loud, and scream it into the darkness of my eating disordered brain before it finally took root. No matter how hard healing was physically and emotionally, I made it a fact in my life that suicide is never an option.  The healing process I endured was every word in a thesaurus that means “Sisyphean.” I had gastroparesis, I had no treatment team, I felt completely alone, my spirit felt completely and utterly dead, my finances were non-existent, I had severely damaged my collegiate career, I had no friends, my family had pretty much given up – it was not easy to stop considering suicide. But I remembered Kitty and I remembered Anna. So, for them, suicide was no longer an option. I looked into my dog Gretz’ eyes and promised him that mommy’s suicide was never an option. Eventually, I looked into my own eyes and said, “Suicide is never an option.” And eventually, I no longer had to repeat the mantra. No matter what happens in life, and trust me, I have lived through some very hard life moments since I fully healed, suicide is not something I have to remind myself isn’t an option. Now I know that while I continue on living, living is my only option in this great sweep of things we call Life.
The second essential piece of my recovery process went hand in hand with the first step: I got serious about nourishment. I had to recognize that my emotions and my feelings about my body, my will to live, my self-disgust, etc., none of those things could ever get better if I continued to under-feed my Self. Imagine under-feeding a baby. Would the baby be happy? Of course not! I had to come to grips with the fact that I was just a big-baby, and as such, I was no exception to deserving nourishment in order to feel happy and balanced. Over the course of the 18 years I suffered, I made attempts at recovering – too many to recall. But the one thing I had always denied myself of during those attempts was really solid nourishment. I was ‘the queen’ of eating low-fat everything, exercising off what I ate, weighing myself to make sure I wasn’t gaining weight, laxative use (abuse), purging, claiming to be Vegan so I didn’t have to eat much, etc. After June 13, 2002, I got serious about nourishment. I got serious that I needed to gain fat. I got serious that I needed to ‘over-nourish’ in order to replenish all the years of undernutrition, even though my bloodwork always was “WNL” (within normal limits). I got serious that my brain had shrunk during the eating disordered years, and that if I didn’t take steps to fix it, I was likely looking at early Alzheimer’s. I got serious that my guts needed to be refed, too, and that if I didn’t take that seriously, malnutrition would persist and I would never be able to climb out of the darkest despair that led me to ever consider suicide in the first place. No matter what label of eating disorder applies to you, you must solidly re-nourish yourself, especially your guts, without compromise, if you want to heal.
The third essential piece of my recovery process was the enigmatic power of Hope. By the time June 13, 2002, rolled around, I had lost all hope and I had succumbed to truly believing that everyone would be happier if I was dead. I had lost all hope and all faith in God. But as fate would have it, I was working at a social work clinic at that time and my co-workers were very faith-filled, most practicing Judaism. My co-workers were some of the happiest and well-balanced people I had ever known, in large part because of their faith and the sustaining hope and community their faith brought to them. It was in witnessing their faith actively lived out that inspired me to start investigating my own faith. Though I had been raised in a religion, I seemingly had no faith – no surprise given that eating disorders destroy anything life-sustaining and positive. I had been raised to believe that God loved us, but the eating disorder convinced me that I was an exception to the stories from the Bible that told of God’s love and His ability to work miracles – again, no surprise given that eating disorders thrive when you’re hopeless. But slowly as nourishment began to repair my brain, I was able to ‘see the light.’ I was able to see that the parents I met on June 13th were miracles in my life. There was no other way to explain why on that June day, in a room full of strangers, I met Kitty Westin and Mr. and Mrs. George, whose daughter Leslie died from bulimia. Once I realized those miracles, I decided to blindly cling to the enigmatic power of Hope. No matter how unworthy of recovery I felt, no matter how filthy and broken I felt, no matter how many times I had been told, “You’ll never be able to fully recover,” God apparently had Hope for me still. In the beginning of my recovery, it was physiologically too hard for my brain to stay consistently focused on Hope, so instead of relying on my depleted brain, I started filling my brain with Psalms and chapters from the Bible, in an effort to fill my brain with truth and Hope. I printed out the definition of Hope and taped it up on my bathroom mirror as a constant reminder that, “Because the word Hope is in the dictionary, it exists.” The amount of speaking-truth that goes into healing the brain from an eating disorder is immense. I spent countless months simply repeating the banality that “I must believe in Hope because Webster’s says it is a word. Therefore, it exists.” It’s like I had to rebuild my brain from the ground, up. As I rebuilt my brain through nutrition and with truth, I had another miracle happen. I viscerally no longer felt filthy and worthless. I no longer believed the limitations that had been placed on me when people would say, “Once you have an eating disorder, you always have some part of the eating disorder; it’s genetic, you can’t fully heal.” But my growing faith and healing brain allowed me to be bold about my healing. I realized that NO ONE should ever tell someone what they are or are not capable of doing or what they are capable of healing from. No one should ever limit you to a lifetime of suffering from an eating disorder or body dislike and no one should ever tell you that your genetics have signed you up for a lifetime of hell. The scientific community was just on the cusp of neurogenesis when I was healing. Now we know that the human brain can be re-wired. My life is proof of that, and scientists now confirm what I found through my healing process, “The brain is a finely-tuned instrument. It is fragile, but it is heartening to know that the brain also has the amazing capacity to regenerate.” My faith made me boldly believe that I could indeed fix my brain. In reconnecting with my faith, I knew that I was the very sparrow God cares about, I was Jonah whose soul had fainted, I was Samuel who was taught that God does not see us as society sees us, but rather, God sees our hearts. Instead of seeing cellulite on the back of my thighs, instead of seeing a fat face, ugly nose, instead of seeing a number on the scale, I saw the humbling truth about my body, my very Self: that I had been drawn with loving kindness, in God’s image. As I continued to heal, the eyes of the eating disorder became dead and the eyes that I had prior to the eating disorder were restored – same eyes, restored vision. I now know that I am beautiful because I am alive. I do not see anything ugly about my body. I no longer strive to weigh xxx, I no longer strive to ‘look good’ in clothes…I only strive to make my heart something that God views as beautiful; a humbling work in progress, to say the least.
There is so much more that went into my healing process. But without the above three things I never could have fully healed.
I beg you to never give up hope. I beg you to accomplish more than what the eating disorder tells you that you can’t. I beg you to believe that YOU ARE beautiful, because you are alive.
My deepest thanks to Gürze/Salucore for providing this space to share.

3 Essential Foundations of My Recovery

By Brooke Farrington, MSW, LCSW, CEDS-S
When I was asked to write an article on “three essential steps to my recovery,” it was daunting. There were so many critical steps to my healing, how could I narrow down the hardest struggle I have faced? As I began to explore the elements of my recovery, I asked myself what was most valuable in my journey. I realized that there were three foundations in my life that were monumental in my healing and have led me to be the person I am today.
Foundation #1: FAITH
“Once an eating disorder, always an eating disorder.” Those words ring clear in my mind more than a decade later. As a graduate student who had recently felt God calling me to pursue a path in the field of eating disorders, I was interviewing eating disorder specialists for an assignment about a career in the field of our choice. After a decade of battling an eating disorder and compulsive exercise, I approached the interview from the perspective of a recovered practitioner and was surprised by the feedback I received.  Would I forever be identified as the girl with an eating disorder? After all, I had been fully recovered for nearly 4 years. As a therapist in training, I felt defined by the disorder, not as a woman that defeated the beast that held me captive much of my young life. How could sufferers have faith in themselves if others did not? That is when I fully experienced the purpose of my own battle, to share my faith in all the possibilities.
While faith has always been a part of my life, it is not easy. According to Merriam-Webster, faith is defined as “firm belief in something for which there is no proof”. Being someone who asks a hundred and one questions until I feel I understand something completely, this is no easy feat. My brilliant husband often reminds me that I do not have to understand everything. Perhaps it is not mine to understand.
And here is the kicker: Faith is not about knowing anything. It is about hope, belief, and surrender. It is about stepping into the unknown and believing in something bigger than you can imagine. In my recovery, I turned to my faith in God to break the dangerous cycle of placing my worth in the eating disorder and the external world. God blessed me with a family that taught me unconditional love. He used others to show me His love, that I was lovable and enough. In the depths of my eating disorder, I borrowed faith from those who loved me. My faith in God, while different than faith in human beings, paved the way to faith in others and acceptance of their faith in me. This, in turn, helped me develop faith in myself.
In the Wizard of Oz, Dorothy found herself far away from home with no knowledge of how to return. She had to trust Glenda the Good Witch and others on the journey. Those with eating disorders have become so distant from their true selves that they may not be able to see the way home. Clients often share a lot of fear of what they might encounter there. Dorothy did not know what to expect on the journey to the Emerald City, let alone what she would encounter when she arrived. She had to take a leap of faith that there was something beyond the dark scary woods. And without the journey into the unknown, she would not have believed she had the power within herself to return to Kansas.
The same was true for me in recovery. I had originally planned to become a play therapist. I had no intention of working with eating disorders when I began pursuing a career as a therapist. God did not plant that seed until I was ready. I had to be open to seeing that there was purpose beyond the suffering and be committed to cultivating it.
I am grateful for my eating disorder. God had a plan for my life beyond what I could have seen without it. In the depths of my eating disorder and the path to recovery, He molded me for a greater purpose. My faith in God gave me the strength to have faith in others and the faith I had to develop in myself to heal. My faith has made me the person I am today.
Foundation #2: GRACE
I started college still fully engaged in compulsive exercise disguised as a committed college dancer. Perfectionism has been a judgmental companion most of my life. A “perfect” grace was something to which one aspired on the dance floor. However, giving myself true grace was a foreign concept.
I had to learn to stop taking life – and myself – so seriously. Laughter is restorative. Until I was able to laugh at myself, the reigns of the eating disorder still had power. Giving myself the grace to make mistakes, learn from them, and find the humor instead of burying myself in shame in the process was imperative. That is freedom.
I was 18 when my older sister got married. I had been doing behavioral recovery and was moving into a new body. I had to have my dress altered just weeks before the ceremony to make room for this new physique. I was very self-conscious and uncomfortable in my skin. As I made my way to the stage of the sanctuary of the church, surrounded by picturesque décor and hundreds of sets of eyes, I fell up the stairs. Yes, the maid of honor all but face planted at the altar just as the bride was preparing to walk down the aisle.
I oh so elegantly picked myself up along with my floor length dress to take the final step up the stairs. Yes, I neglected to pick up my dress and tripped on it. While I possessed this valuable knowledge, that day it escaped me. My cheeks turned red from embarrassment. But then an amazing thing happened. Instead of going to shame and self-criticism about my body and overall worth, I laughed. I dared to make eye contact with a few observers, smiled, shrugged, and thought, “note to self: when walking upstairs in a floor length gown, pick up said gown so you do not wipe out in front of hundreds of people.” An important life lesson learned. I was told by those who dared to speak of the incident that I fell “so gracefully.”
I am still a perfectionist and have learned to embrace the tenacity that comes with it. I have had to learn how to turn the judgement of perfectionism into perseverance and a strive for excellence. Aristotle said, “The ideal man bears the accidents of life with dignity and grace, making the best of circumstances.” I choose to continue a lifelong determination for learning and growth, striving to be the best version of myself.
Foundation #3: PASSION
When I started taking dance courses in college, my soul work began. My professor pushed me physically, technically, emotionally, and spiritually. She taught me what it truly meant to be authentic and express myself through movement and to use my passion with purpose. Dance became a metaphor for life. When life became a dance, freedom was inevitable. I found passion again, the passion that the eating disorder had hijacked for so many years. My passion for dance became my passion for learning, for connection, for life.
Being uncomfortable was a key to my healing. If you have ever had an operation, you know that healing can be painful. Without discomfort, I truly believe growth cannot occur. Pushing outside my comfort zone in movement and expression allowed me to accept discomfort in other areas of my life. During choreography class one day, my professor gave each of us a specific challenge to explore in movement. She was pushing us outside of our individual safety zones. My challenge was to not use my arms, but to focus on the energy in my core.
This was the most vulnerable I had ever felt. I felt raw. I had to move from my core, my heart, my soul. It was not graceful. I cried. I stomped. I thrashed. I convulsed. I fell. And I was real. According to Martha Graham, “movement never lies. It is a barometer telling the state of the soul’s weather to all who can read it.” All the hidden pain, sadness, fear, and anger, the heaviness I had carried since I was a child, began to be released. It was not pretty. But it was beautiful.
This experience taught me the truths I strive to instill in my clients. I learned that I could express the darkness I had been carrying and still be accepted and loved. I learned I could work through the pain instead of burying it deep inside. I learned I did not have to hide anymore. I learned how to heal.
Through faith, grace, and passion, I am growing to fulfill my purpose in this world. These foundations were not merely monumental in my recovery but have become fundamental in my life. In my rawness, insecurities, and sensitivity, I am enough. And so are you.

Three Essential Steps to My Recovery

By Ilene Fishman, LCSW
As I contemplate writing this article, I notice how challenging it is to separate my own personal recovery odyssey from my professional experience. I have been helping people navigate their own path to getting well from eating disorders for the past 34 years. My understanding of what it takes to achieve recovery certainly started with me and has no doubt morphed over time. I am as passionate now as I have ever been about how good treatment can lead to full recovery and clearer than ever about how to get there.
I developed Anorexia Nervosa at 12 years old in the early 1970s. No one knew what to do with me, let alone how to diagnose or treat me. It was harrowing for me as well as for my parents. I spent a lot of time in hospitals to address my medical condition and about a year in and out of psychiatric hospitals enduring incorrect diagnoses, even schizophrenia! I was completely misunderstood. After solely restricting and being severely underweight, I began purging which then progressed into binge-purge cycling while simultaneously restricting. It was awful.
My eating disorder continued for 11 years until I was 23 years old. What was notable about me is that I was extremely unhealthy and I knew it. I was also extremely driven to get well. I did not deny my pathology. Instead, I desperately wanted help. Most of the professional help we could find was misguided and disappointing, but there were a few outstanding positive, healing, and helpful experiences along the way.
Here are the top three things that helped me achieve recovery:
  1. Honoring and respecting my need for my eating disorder
  2. Understanding and addressing my unique self-hatred and self-criticism
  3. A feminist perspective regarding society, myself, and eating disorders

  1. I responded very well when my need for my eating disorder behaviors was understood and not threatened. Of course, I wanted it to stop and so did any professional who was treating me. But first and foremost was the reality that I needed my anorexia and my bulimia and could not live without those behaviors. Trying to merely change my behavior or thinking was not helpful. Understanding myself led me naturally to wanting and then being able to change my self-destructive behavior.
  2. I coined the term “internal tyrant” many years ago referring to a uniquely critical relationship with self. I believe without hesitation that identifying the way an internal tyrant lives in someone with an eating disorder as a self-protective defense mechanism is absolutely critical for recovery.  No one gets fully better, not just with the eating disorder symptoms, but also with the problematic personality traits that underlie all eating disorders until this is successfully identified and healed in treatment.
  3. I stumbled upon an article in 1983 about something called “Bulimarexia”. I was shocked to find a description of my eating disorder and my struggle for the first time. I reached out to the professional named in the article and traveled to attend one of her very first week-long therapy groups. It changed my life. This experience not only addressed my eating disorder, it also introduced me to the concept of feminism and personal empowerment. I came to understand eating disorders and crushingly low self-esteem as a heartbreaking misuse of personal power. It became increasingly unacceptable to me to minimize myself in response to societal pressures. This understanding helped me to use the energy that fueled my eating disorder to heal my unhealthy and painful relationship with myself.
My best advice is to find good therapy – the right therapy and therapist for you. Do not settle for less than full recovery and don’t stop until you get there because nothing is more important.

Is Orthorexic Behavior Common In The General Public?

ED Referral.com

A large representative study in Germany. Orthorexia is described as a strict, health-oriented eating pattern with clinically significant impairment in everyday life. Its prevalence varied widely in previous studies due to heterogenous assessment procedures. Determinants for the eating pattern and its prevalence have not been investigated in larger representative studies. METHODS: A population-based telephone survey in Germany was conducted in n = 1007 participants. The Dusseldorf Orthorexia Scale with a cut-off of 30 was used to assess orthorexic behavior. Determinants of orthorexia, including personal BMI, depressive symptoms Patient Health Questionnaire and socio-demographic variables were analyzed in multivariate regression. RESULTS: The prevalence of orthorexic behavior was 6.9%. A higher rate of orthorexic behavior was observed in heavier, less educated, vegetarian and more depressed participants; in multivariate analysis only associations to lower educational attainment, a vegetarian diet and depressive symptoms remained. No gender or age differences were observed. CONCLUSIONS: The study results show that orthorexic behavior may indeed by associated with significant strain and psychological distress. Current debates on the criteria of clinical significance of orthorexic behavior call for new instruments and further investigations, to elicit the prevalence of people with orthorexic behavior that classifies as a pathological eating disorder. Eat Weight Disord. 2018 Mar 21. doi: 10.1007/s40519-018-0502-5. [Epub ahead of print]

Blood Test May Distinguish Anorexia From 'Constitutional Thinness

EDreferral.com

' NICE, France – A simple, inexpensive blood test can help clinicians to distinguish between anorexia nervosa (AN) and constitutional thinness (CT) in severely underweight young women, new research suggests. Since the introduction of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), the diagnostic criteria for AN have relied on psychological factors, making it harder to distinguish AN from CT. However, a new study of more than 150 young women showed that blood levels of a thyroid hormone can be used to distinguish the two conditions with high sensitivity and specificity. In cases in which the exclusive use of psychological criteria is not sufficient, the diagnosis of AN "should be completed by at least free T3 determination, which is a cheap and accessible" test, note Natacha Germain, MD, PhD, Endocrinology and Eating Disorders Reference Center, Centre Hospitalier Universitaire de Saint-Étienne, France, and colleagues. The findings were presented here at the European Psychiatric Association (EPA) 2018 Congress. Germain told meeting attendees that using criteria from the DSM-IV to differentiate between AN and CT in a young woman whose body mass index was less than 18.5 kg/m2 was "quite easy." That's because the criteria for AN included the presence of an eating disorder, resistance to food intake, and amenorrhea. In contrast, CT was "a state with no eating disorder, no resistance to body weight gain, no undernutrition, and no amenorrhea." However, the amenorrhea criteria were removed with the introduction of the DSM-5, making it easier to confuse AN and CT. This confusion "is highly detrimental, especially for CT, because of the social stigmatization, health insurance penalty, and the inefficient, aggressive therapy applied in this population," said Germain. To identify distinguishing markers that could be used to easily tell the difference between the two conditions, the investigators studied 40 patients with AN, 56 patients with CT, and 54 women with normal weight, who served as controls. DSM-IV criteria were used to define AN and CT. They evaluated hormonal and nutritional parameters, and administered a series of psychiatric questionnaires to find robust, distinguishing markers that would fit with criteria from the DSM-5. Performing receiver operating characteristic curve analysis, they found that only the restrained eating subscale of the Dutch Eating Behavior Questionnaire could be used to distinguish between AN and CT. It had a specificity of 94% and a sensitivity of 95% at a cutoff of 0.74. "Unfortunately, it's only one dimension in a complex questionnaire, and it's sometimes biased by denial," said Germain. She added that in clinical practice, the availability of the questionnaire is very low. Estradiol was, as expected, the best marker for distinguishing between the two populations. It had a sensitivity and specificity of 87% and 80%, respectively, at a cutoff of 24. However, using estradiol as a biomarker in this context is incompatible with the DSM-5, Germain noted. Leptin was also very good at distinguishing between the conditions, with a specificity of 80% and a sensitivity of 84% at a cutoff of 2.58. "Unfortunately, leptin testing has a low availability and high cost, so it's not very easy to use it as a marker," she said. The researchers found that free triiodothyronine (T3) levels could be used to distinguish between the patient groups It had a sensitivity of 80% and a specificity of 91% at a cut-off of 3.3 pmol/L (P < .0001). Moreover, the test for free T3 levels is cheap, and the results are simple to interpret. It is also widely available. Germain concluded that for a young, thin woman, a free T3 level of less than 3.3 pmol/L indicates AN with undernutrition. Psychiatric Association (EPA) 2018 Congress. Abstract OR0174, presented March 6, 2018. Read more details from this article: Blood Test May Distinguish Anorexia From 'Constitutional Thinness' - Medscape - Mar 07, 2018. https://www.medscape.com/viewarticle/893578#vp_1

Monday, February 26, 2018

Q&A: Sleepless Nights and Purging

Q: I have a 21-year-old female patient who continually complains about lack of sleep. She was diagnosed with anorexia nervosa, binge-purge type (ANbp), about 3 years ago. She thinks that her lack of sleep might be making the binge-purging worse. Does disturbed sleep worsen purging? (LB, Palo Alto, CA)
A: This is certainly possible. Disrupted sleep is common among people with ED. Evidence for disrupted sleep in ED is clear, although most work has focused on night eating syndrome (Allison et al, Curr Psychiatry Rep. 2016; 18: 92). Disturbed sleep does appear to be common among patients with eating disorders. In one study of 549 college women, 30% of those with AN, BN, or BED, had significant trouble with insomnia, compared to 5% of the students overall.
According to a report from Kohnodai Hospital in Chiba, Japan, patients with binge-purge subtype AN have worse global sleep quality and more disturbed sleep than do anorexic patients with the restrictive form of the illness (ANr). This is the first study to focus on the role purging behaviors with eating disorders play in sleep quality. Dr. Tokusei Tanahashi, a psychosomatic medicine specialist, and his colleagues examined how purging relates to subjective sleep quality and sleep patterns, and the effect of disordered eating behavior on global sleep quality among women with both subtypes of AN (Biopsychosocial Medicine. 2017; 11:22). Dr. Tanahashi and his group also reported that in their earlier study of female outpatients with ANr and ANbp (Sleep Med. 2015; 16:S347), they found that patients with ANr or ANbp had a relatively high prevalence of sleep disturbances (15.8% and 70.8%, respectively).
In their current study, when the authors compared the two groups of patients, using the Japanese version of the Global Pittsburgh Sleep Quality Index (PQI-), the mean score of the ANbp type anorexic patients was significantly higher than that among the restrictive group. Sleep latency, habitual sleep efficiency, and daytime dysfunction of ANbp patients all were significantly greater in the ANbp group than in the ANr patients. Circadian rhythm was also more disrupted among the binge-purge group.
How might purging affect sleep? The authors speculate that any patients with habitual vomiting tend to binge-eat at night, due to the high rate of night-eating syndrome among persons with eating disorders. This factor might in turn delay the onset of sleep. This can take the form of a long delay before falling asleep, sometimes into the afternoon hours. Binge-eating/vomiting before bedtime might cause sudden electrolyte abnormalities and blood glucose variations, resulting in poorer quality of sleep. Patients may then stay up late eating but still wake early to accomplish their daily routine Another possible outcome would be sleeping too long because of illness related interference with their social life, leading to worse daytime function.
Importantly, sleep may normalize with weight restoration. El Ghoch and colleagues (Eur ED Review. 2016; 24:425) examined sleep patterns in 50 people with AN and 25 controls using wearable sleep monitors. People with AN had less sleep time and shorter sleep onset latency, and these both normalized with weight restoration. -SC

Television and Dysfunctional Eating in Teens

One gender-related difference emerged in a study in southern Italy.
Adolescence can be a wondrous time of physical growth and exposure to new ideas and experiences, but it may also bring social aspects of everyday life that negatively affect body image. Environmental factors such as teasing by peers and family members and exposure to unattainable ideals of thinness are good examples.
Dr. Barbara Barcaccia and researchers at the University of Sapienza, Rome, and Boston College explored the possible influence of models portrayed on TV on adolescents. The authors sought to examine body image, uneasiness with one’s body, eating-disordered behavior, depression, and anxiety among a group of teens and young adults (Revista Brasileira de Psiquiatria. 2017; doi:10.1590/1516-4446-2016-2200, published online before print). The Italian researchers studied 301 teens 14-19 years of age who were recruited from 13 high schools in southern Italy. The teens filled out a series of questionnaires, including The Body Uneasiness Test (BUT) and the Eating Disorders Inventory-2. The BUT contains 71 questions about weight phobia, body image concerns, and worries about specific bodily parts and functions (Eat Weight Disord. 2006; 11:1). Sample statements include “I avoid mirrors” and “I compare my appearance with others.”
Responses differed by gender
One trend that emerged from the study was gender-based responses to media exposure, highlighting differences in susceptibility to body misperceptions among males and females. Just as reported in previous studies, drive for thinness was impacted more by media exposure in females than males. Perhaps sensitivity to media images helps explain differences in ED prevalence by gender. The authors noted that women do watch more entertainment and image-focused television programs than do men (Eat Behav. 2013. 14:441). They also pointed out that objectification theory states that in Western culture women are specifically objectified and their bodies used to measure self-worth. This then leads to a subconscious tendency for women to compare their body image to others to a greater extent than do men (Psychol Women Q. 1997. 21:173).
Another interesting finding in this study was that the extent to which males’ friends wished to physically resemble TV characters; this was the only statistically significant finding for the males in the study. The authors pondered various possible causes for this trend. While males and females are sensitive to the influence of their friends, in the Italian culture, according to the authors, boys and men interact socially to a greater extent than in other parts of the world.
The results also showed that women were more susceptible to ED behaviors, distorted perceptions of their bodies, and development of depression after exposure to mass media. In contrast, males were more susceptible to distorted perception of their bodies, state and trait anxiety, and depression through indirect comparisons to the mass media through their friends.