Michigan Eating Disorders Alliance: January 2020

Tuesday, January 21, 2020

Emotion Regulation Challenges Among Teenage Girls Who Have Anorexia or Depression

Contributor: Staff at Timberline Knolls Residential Treatment Center

Given the physical, psychological, and social transformations that are characteristic of adolescence, it is not uncommon for a teen to experience temporary challenges related to healthy or appropriate emotion regulation strategies.

For teenage girls who have developed anorexia nervosa or a depressive disorder, the likelihood that they may engage in unhealthy emotion regulation strategies may be more pronounced. In turn, these dysfunctional or self-defeating strategies may exacerbate their struggles with anorexia and depression.

Healthy vs. Unhealthy Emotion Regulation

As defined by Abigail Rolston, B.A., and Elizabeth Lloyd-Richardson, Ph.D., in a document created for the Cornell Research Program on Self-Injury and Recovery, emotion regulation refers to “a person’s ability to manage and respond to an emotional experience effectively.”

Rolston and Lloyd-Richardson cited meditating, talking with friends, seeking therapy, and maintaining appropriate self-care as examples of healthy emotion regulation. Unhealthy emotion regulation strategies, they noted, include substance use, self-harm, aggression, and withdrawal.

Rolston and Lloyd-Richardson also observed that adolescence can be a “particularly precarious” time, with adolescent girls at elevated risk for interpersonal stress, which can prompt them to employ unhealthy emotion regulation strategies.

In a 2015 study that was published by the journal Frontiers in Psychology, lead author Ines Wolz of the University of Tübingen and her co-authors cite a relationship between emotion regulation, body image, and disordered eating. The authors also report that, in the absence of appropriate emotion regulation strategies, individuals may engage in unhealthy eating behaviors in an attempt to control or process their emotions, which can lead to the onset of an eating disorder.

Increased Risk Among Teenage Girls Who Have Anorexia or Depression

According to a 2019 study that was published by the Journal of Eating Disorders, both anorexia and depression can predispose adolescent girls to struggle with maladaptive emotion regulation strategies. The study was led by Anca Sfärlea and Sandra Dehning, both of whom are affiliated with the Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy at University Hospital, Ludwig Maximilian University of Munich.

Sfärlea and Dehning’s study involved 86 girls ages 12-18. Twenty-five of the study’s subjects were experiencing anorexia nervosa, 26 had been diagnosed with major depression, and 35 had neither condition. The girls who had either anorexia or depression had received either inpatient or outpatient care at University Hospital Munich. The girls in the “healthy” group had been recruited either from previous studies or via local advertisements.

Sfärlea and Dehning determined that the girls who had anorexia or major depression were much more likely than those in the “healthy” group to struggle with maladaptive emotion regulation. For purposes of this study, the researchers identified acceptance, problem-solving, and reappraisal as examples of appropriate or adaptive emotion regulation strategies. They listed rumination, avoidance, and suppression as examples of maladaptive emotion regulation strategies.

Potential Impact of Emotion Regulation on Treatment

In Sfärlea and Dehning’s study, the girls in the anorexia nervosa and major depression groups also demonstrated an increased prevalence of alexithymia, which is an impaired ability to recognize or discuss one’s emotions.

The authors of a 2017 study by researchers at the University of California San Diego and Dartmouth College reported that difficulties related to alexithymia appear to have a greater impact on emotion dysregulation among patients who were treated for anorexia nervosa.

A 2019 study from the United Kingdom suggests that alexithymia may complicate the treatment process. “It has been frequently observed that people experiencing alexithymia may find it difficult to engage with and benefit from psychological therapy,” the authors of the UK study wrote.

The Value of Comprehensive Care

As the multiple studies cited in previous sections indicate, the risks associated with anorexia nervosa and depression are not limited to the symptoms that are directly linked to these disorders. Unhealthy emotion regulation strategies and alexithymia are two of the many potential effects that can further complicate the lives of individuals who develop anorexia or a depressive disorder.

Anorexia is more common among adolescents than among adults, and more prevalent among girls than among boys. In the abstract of a 2016 study in the journal European Child & Adolescent Psychiatry, the authors report that “symptomatic anorexia nervosa showed the earliest onset with a considerable proportion of cases emerging in childhood.” The authors also observed that “eating disorder symptomatology is common, particularly in female adolescents and young women.”

For teen girls who have developed anorexia, an elevated risk for concerns such as depression, emotion regulation difficulties, and alexithymia is among the many reasons why comprehensive treatment may be most valuable. Effective care that can identify and properly address the full scope of a teen girl’s physical, mental, and behavioral health needs can best prepare her to make sustained progress toward improved well-being.

Sources

Brown, T.A.; Avery, J.C.; Jones, M.D.; Anderson, L.K.; Wierenga, C.E.; and Kaye, W.H. The Impact of Alexithymia on Emotion Dysregulation in Anorexia Nervosa and Bulimia Nervosa over Time. Eur Eat Disord Rev. 2018 Mar;26(2):150-155. doi: 10.1002/erv.2574. Epub 2017 Dec 21. PubMed PMID: 29266572. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/29266572

Hemming, L.; Haddock, G.; Shaw, J.; and Pratt, D. (2019) Alexithymia and Its Associations with Depression, Suicidality, and Aggression: An Overview of the Literature. Front. Psychiatry 10:203. doi: 10.3389/fpsyt.2019.00203

Nagl, M.; Jacobi, C.; Paul, M.; Beesdo-Baum, K.; Höfler, M.; Lieb, R.; Wittchen, H.U. Prevalence, incidence, and natural course of anorexia and bulimia nervosa among adolescents and young adults. Eur Child Adolesc Psychiatry. 2016 Aug;25(8):903-18. doi: 10.1007/s00787-015-0808-z. Epub 2016 Jan 11. PubMed PMID: 26754944. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/26754944

Rolston, A. and Lloyd-Richardson, E. What is emotion regulation, and how do we do it? Cornell Research Program on Self-Injury and Recovery. Retrieved from http://selfinjury.bctr.cornell.edu/perch/resources/what-is-emotion-regulationsinfo-brief.pdf

Sfärlea, A.; Dehning, S.; Keller, L.K.; et al. Alexithymia predicts maladaptive but not adaptive emotion regulation strategies in adolescent girls with anorexia nervosa or depression. J Eat Disord 7, 41 (2019) doi:10.1186/s40337-019-0271-1

Wolz, I.; Agüera, Z.; Granero, R.; Jiménez-Murcia, S.; Gratz, K.L.; Menchón, J.M.; and Fernández-Aranda, F. (2015) Emotion regulation in disordered eating: Psychometric properties of the Difficulties in Emotion Regulation Scale among Spanish adults and its interrelations with personality and clinical severity. Front. Psychol. 6:907. doi: 10.3389/fpsyg.2015.00907

Masculinity, Males, and Muscles: Teaching our Young Men to Honor Their Bodies

I do a lot of writing for Eating Disorder Hope, something that I enjoy and take seriously. Often I write in the third-person and approach a topic with the attitude of a journalist objectively reporting on a topic. At times, I put more of my own experience as a therapist into an issue, hoping that this will benefit readers.

And sometimes, I’m presented with a topic that feels like it could land me in deep waters. Writing on the subject of masculinity is one of those moments.

In light of the recent #Metoo movement, I am particularly sensitive to how masculinity has harmed and degraded women. It is lamentable that we participate in a culture which objectifies and uses women as commodities.

I’m also aware that some would like to label all traditional ideas of masculinity as toxic.

So, it is with great humility that I offer my thoughts on helping raise boys to honor their bodies in the hope they do not develop self-contempt, body hatred, or body dysmorphic disorder.

Actually, rather than offering many thoughts on the topic, I bring one, what I hope is substantial, concept to the table; we need to honor people as people and celebrate the dignity of each individual.

Some men are physically and athletically gifted; others are rocket scientists. Some like the University of Nebraska’s assistant football coach Jovan Dewitt posses are both (before coaching, he was a rocket scientist for NASA). There are female athletes, politicians, mathematicians, and surgeons. Some are black, some white, some brown. Some African, some Asian, some Brazilian.

There are individuals, like my friend Daniel who has severe autism and can’t communicate in full sentences but lights up a room with songs and movie quotes. And there is a 16-year-old Asperger’s sufferer who is challenging world-leaders to treat climate change with urgency.

Among the nearly 7 billion people on planet earth, you can find both a black, female gymnast amazing the world with a triple-double tumbling pass and a young man with Down’s Syndrome starring in a movie about a Peanut Butter Falcon.

Personally, my worldview is one that honors the dignity of all people. And the body is a necessary, beautiful aspect of being human. Bodies do limit and shape us, such as in our career choices.

Because of my size and lack of speed, I won’t ever be a player in the National Football League. Meanwhile, the physical limitations of Stephen Hawking did not stand in the way of his reshaping how we understand space and time.

In other words, I see the body as an essential aspect of human identity. Yet, alone, it cannot sustain the burden of defining someone’s value or identity.

Being athletic may provide advantages and opportunities in our culture not afforded to those who can’t jump as high or throw as far. Yet these abilities do not measure the true impact one can make in the world around them.

In light of this, let’s teach young men to see their own bodies as worthy of care, but not as definitive statements on their masculinity or dignity. And let’s encourage them to do the same with each individual they meet, regardless of race, gender, ability, or appearance.

REFERENCES:

Heady, C. (2018, March 19). Huskers assistant Jovan Dewitt has teaching outside linebackers down to a science. Retrieved December 18, 2019, from https://www.omaha.com/sports/college/huskers/teams/football/huskers-assistant-jovan-dewitt-has-teaching-outside-linebackers-down-to/article_81d7a6df-714e-59d0-b5c5-090c1a9d6011.html.

About the Author:

Travis Stewart, LPC has been mentoring others since 1992 and became a Licensed Professional Counselor in 2005. His counseling approach is relational and creative, helping people understand their story while also building hope for the future. Travis has experience with a wide variety of issues which might lead people to seek out professional counseling help.

This includes a special interest in helping those with compulsive and addictive behaviors such as internet and screen addiction, eating disorders, anxiety, and perfectionism. Specifically, he has worked with eating disorders since 2003 and has learned from many of the field’s leading experts. He has worked with hundreds of individuals facing life-threatening eating disorders in all levels of treatment. His website is wtravisstewart.com

The opinions and views of our guest contributors are shared to provide a broad perspective on eating disorders. These are not necessarily the views of Eating Disorder Hope, but an effort to offer a discussion of various issues by different concerned individuals.

We at Eating Disorder Hope understand that eating disorders result from a combination of environmental and genetic factors. If you or a loved one are suffering from an eating disorder, please know that there is hope for you, and seek immediate professional help.

Published January 3, 2020, on EatingDisorderHope.comReviewed & Approved on January 3, 2020, by Jacquelyn Ekern MS, LPC

Setting Reasonable Expectations for Eating Disorder Recovery in 2020

Our culture is constantly chasing the concept of instant gratification. In fact, this is one of the factors that make an individual vulnerable to developing disordered eating patterns as a “quick fix” to achieve a certain appearance or resolve personal or mental health challenges. But, eating disorder recovery is not a “quick fix”.

It is this same desire for instant gratification that can lead to disappointment in recovery. Once the brave decision to recover is made, we want it just to happen. The sad truth is that deciding to recover is only the first step of many.

Be Honest About Where You Are in Eating Disorder Recovery

The first step to setting any realistic goal is first to establish the truth about where you are at this very moment. If we aren’t being transparent about our current disordered thoughts and behaviors, we can’t even begin to consider what a realistic expectation is.

Precisely where you are in recovery is where you need to be to begin the process of moving forward.

Narrow Your Focus

The clear goal of eating disorder treatment and recovery is to become recovered. Before you click the “back” button because I just stated something incredibly obvious, consider that goal.

Doesn’t it bring about more questions than guidance and answers? What does eating disorder recovery look like? What does it look like for me? Who decides? Do I have to be recovered mind, body, and soul to achieve it?

When we set our sights on the umbrella goal of “being recovered,” it’s hard to know what that looks like. This not only makes it confusing on where to begin but can be disconcerting when we don’t allow ourselves to feel successful until we’ve risen to this giant and overwhelming challenge.

Narrow your focus to more attainable, smaller goals that lead up to ultimate eating disorder recovery.

Are you beginning with weight restoration, finding a treatment facility, engaging in therapy, looking for a dietitian, communicating with your loved ones, processing past trauma, changing your self-talk?

All of these may be necessary at some point in your journey, but based on where you are right now (see above), what needs to come first? Once you’ve determined that, break it down even smaller.

If you decided your goal is to recover from an eating disorder and get into eating disorder treatment in 2020, you will first need to find a treatment center and consult with your doctor. You should also ask your insurance company what will be covered, work through how you will get there, and consider how to arrange your job or school while you are in treatment.

All of this sounds incredibly overwhelming, and often, we set a goal, consider the steps it will take to achieve, feel overwhelmed, and throw in the towel. Instead, write out each step and place them in the order they need to be accomplished.

Start with the first one. That is your goal.

Give Yourself a Deadline

Alright, we have a smaller goal. Now, we need to consider a realistic timeline for achieving it.

Using the example above, your first goal might be to consult with your doctor. What is a reasonable time in which you can schedule and attend an appointment with your doctor?

This turns your goal into something less intangible and overwhelming and makes it manageable based on your capabilities. “I will schedule and attend an appointment with my doctor within the next month to ask about eating disorder recovery and referrals.”

In this way, you exactly know what your goal is, what it will look like once it is achieved, and exactly how much time you believe is reasonable to have completed it.

Going “small” in this way not only helps you to feel in control over your recovery process but gives you more opportunities to feel successful and pat yourself on the back.

If we only say “I will be recovered,” we don’t know what that looks like and won’t give ourselves credit for progress until we are fully and completely recovered, which takes time. This can break-down our momentum and feelings of self-worth in the meantime.

Making your goals specific, attainable, and timely helps you to make them more realistic, thus leading to eating disorder recovery!

About the Author:

Margot Rittenhouse, MS, PLPC, NCC is a therapist who is passionate about providing mental health support to all in need and has worked with clients with substance abuse issues, eating disorders, domestic violence victims, and offenders, and severely mentally ill youth.

As a freelance writer for Eating Disorder Hope and Addiction Hope and a mentor with MentorConnect, Margot is a passionate eating disorder advocate, committed to de-stigmatizing these illnesses while showing support for those struggling through mentoring, writing, and volunteering. Margot has a Master’s of Science in Clinical Mental Health Counseling from Johns Hopkins University.

Published January 8, 2020, on EatingDisorderHope.comReviewed & Approved on January 8, 2020, by Jacquelyn Ekern MS, LPC