Individuals with defensive or low self-esteem typically focus on trying to prove themselves or impress others. They tend to use others for their own gain. Some act with arrogance and contempt towards others. They generally lack confidence in themselves, often have doubts about their worth and acceptability, and hence are reluctant to take risks or expose themselves to failure. They frequently blame others for their shortcomings rather than take responsibility for their actions.
To gain a better understanding of your self esteem, journal your answers to the following:
1.) What do you do when you make a mistake?
2.) What do you see when you look at yourself in the mirror?
3.) Do you like what you see when you look at yourself?
4.) When you are dealing with the issue of being overweight what do you do? What do you tell yourself? What do you tell others?
5.) When you make a commitment to yourself what happens to that commitment?Read Full Post | Make a Comment ( None so far )
1. THE RISK OF CHANGE IS SEEN AS GREATER THAN THE RISK OF STANDING STILL
Making a change requires a kind of leap of faith: you decide to move in the direction of the unknown on the promise that something will be better for you. But you have no proof. Taking that leap of faith is risky, and people will only take active steps toward the unknown if they genuinely believe – and perhaps more importantly, feel – that the risks of standing still are greater than those of moving forward in a new direction. Making a change is all about managing risk. If you are making the case for change, be sure to set out in stark, truthful terms why you believe the risk situation favors change. Use numbers whenever you can, because we in the West pay attention to numbers. At the very least, they get our attention, and then when the rational mind is engaged, the emotional mind (which is typically most decisive) can begin to grapple with the prospect of change. But if you only sell your idea of change based on idealistic, unseen promises of reward, you won’t be nearly as effective in moving people to action. The power of the human fight-or-flight response can be activated to fight for change, but that begins with the perception of risk.
2. PEOPLE FEEL CONNECTED TO OTHER PEOPLE WHO ARE IDENTIFIED WITH THE OLD WAY
We are a social species. We become and like to remains connected to those we know, those who have taught us, those with whom we are familiar – even at times to our own detriment. Loyalty certainly helped our ancestors hunt antelope and defend against the aggressions of hostile tribes, and so we are hard wired, I believe, to form emotional bonds of loyalty, generally speaking. If you ask people in an organization to do things in a new way, as rational as that new way may seem to you, you will be setting yourself up against all that hard wiring, all those emotional connections to those who taught your audience the old way – and that’s not trivial. At the very least, as you craft your change message, you should make statements that honor the work and contributions of those who brought such success to the organization in the past, because on a very human but seldom articulated level, your audience will feel asked to betray their former mentors (whether those people remain in the organization or not). A little good diplomacy at the outset can stave off a lot of resistance.
3. PEOPLE HAVE NO ROLE MODELS FOR THE NEW ACTIVITY
Never underestimate the power of observational learning. If you see yourself as a change agent, you probably are something of a dreamer, someone who uses the imagination to create new possibilities that do not currently exist. Well, most people don’t operate that way. It’s great to be a visionary, but communicating a vision is not enough. Get some people on board with your idea, so that you or they can demonstrate how the new way can work. Operationally, this can mean setting up effective pilot programs that model a change and work out the kinks before taking your innovation “on the road.” For most people, seeing is believing. Less rhetoric and more demonstration can go a long way toward overcoming resistance, changing people’s objections from the “It can’t be done!” variety to the “How can we get it done?” category.
4. PEOPLE FEAR THEY LACK THE COMPETENCE TO CHANGE
This is a fear people will seldom admit. But sometimes, change in organizations necessitates changes in skills, and some people will feel that they won’t be able to make the transition very well. They don’t think they, as individuals, can do it. The hard part is that some of them may be right. But in many cases, their fears will be unfounded, and that’s why part of moving people toward change requires you to be an effective motivator. Even more, a successful change campaign includes effective new training programs, typically staged from the broad to the specific. By this I mean that initial events should be town-hall type information events, presenting the rationale and plan for change, specifying the next steps, outlining future communications channels for questions, etc., and specifying how people will learn the specifics of what will be required of them, from whom, and when. Then, training programs must be implemented and evaluated over time. In this way, you can minimize the initial fear of a lack of personal competence for change by showing how people will be brought to competence throughout the change process. Then you have to deliver.
5. PEOPLE FEEL OVERLOADED AND OVERWHELMED
Fatigue can really kill a change effort, for an individual or for an organization. If, for example, you believe you should quit smoking, but you’ve got ten projects going and four kids to keep up with, it can be easy to put off your personal health improvement project (until your first heart attack or cancer scare, when suddenly the risks of standing still seem greater than the risks of change!). When you’re introducing a change effort, be aware of fatigue as a factor in keeping people from moving forward, even if they are telling you they believe in the wisdom of your idea. If an organization has been through a lot of upheaval, people may resist change just because they are tired and overwhelmed, perhaps at precisely the time when more radical change is most needed! That’s when you need to do two things: re-emphasize the risk scenario that forms the rationale for change (as in my cancer scare example), and also be very generous and continuously attentive with praise, and with understanding for people’s complaints, throughout the change process. When you reemphasize the risk scenario, you’re activating people’s fears, the basic fight-or-flight response we all possess. But that’s not enough, and fear can produce its own fatigue. You’ve got to motivate and praise accomplishments as well, and be patient enough to let people vent (without getting too caught up in attending to unproductive negativity).
6. PEOPLE HAVE A HEALTHY SKEPTICISM AND WANT TO BE SURE NEW IDEAS ARE SOUND
It’s important to remember that few worthwhile changes are conceived in their final, best form at the outset. Healthy skeptics perform an important social function: to vet the change idea or process so that it can be improved upon along the road to becoming reality. So listen to your skeptics, and pay attention, because some percentage of what they have to say will prompt genuine improvements to your change idea (even if some of the criticism you will hear will be based more on fear and anger than substance).
7. PEOPLE FEAR HIDDEN AGENDAS AMONG WOULD-BE REFORMERS
Let’s face it, reformers can be a motley lot. Not all are to be trusted. Perhaps even more frightening, some of the worst atrocities modern history has known were begun by earnest people who really believed they knew what was best for everyone else. Reformers, as a group, share a blemished past . . . And so, you can hardly blame those you might seek to move toward change for mistrusting your motives, or for thinking you have another agenda to follow shortly. If you seek to promote change in an organization, not only can you expect to encounter resentment for upsetting the established order and for thinking you know better than everyone else, but you may also be suspected of wanted to increase your own power, or even eliminate potential opposition through later stages of change.
I saw this in a recent change management project for which I consulted, when management faced a lingering and inextinguishable suspicion in some quarters that the whole affair was a prelude to far-reaching layoffs. It was not the case, but no amount of reason or reassurance sufficed to quell the fears of some people. What’s the solution? Well, you’d better be interested in change for the right reasons, and not for personal or factional advantage, if you want to minimize and overcome resistance. And you’d better be as open with information and communication as you possibly can be, without reacting unduly to accusations and provocations, in order to show your good faith, and your genuine interest in the greater good of the organization. And if your change project will imply reductions in workforce, then be open about that and create an orderly process for outplacement and in-house retraining. Avoid the drip-drip-drip of bad news coming out in stages, or through indirect communication or rumor. Get as much information out there as fast as you can and create a process to allow everyone to move on and stay focused on the change effort.
8. PEOPLE FEEL THE PROPOSED CHANGE THREATENS THEIR NOTIONS OF THEMSELVES
Sometimes change on the job gets right to a person’s sense of identity. When a factory worker begins to do less with her hands and more with the monitoring of automated instruments, she may lose her sense of herself as a craftsperson, and may genuinely feel that the very things that attracted her to the work in the first place have been lost. I saw this among many medical people and psychologists during my graduate training, as the structures of medical reimbursement in this country changed in favor of the insurance companies, HMO’s and managed care organizations. Medical professionals felt they had less say in the treatment of their patients, and felt answerable to less well trained people in the insurance companies to approve treatments the doctors felt were necessary. And so, the doctors felt they had lost control of their profession, and lost the ability to do what they thought best for patients.
My point is not to take sides in that argument, but to point out how change can get right to a person’s sense of identity, the sense of self as a professional. As a result, people may feel that the inherent rewards that brought them to a particular line of work will be lost with the change. And in some cases, they may be absolutely right. The only answer is to help people see and understand the new rewards that may come with a new work process, or to see how their own underlying sense of mission and values can still be realized under the new way of operating. When resistance springs from these identity-related roots, it is deep and powerful, and to minimize its force, change leaders must be able to understand it and then address it, acknowledging that change does have costs, but also, (hopefully) larger benefits.
9. PEOPLE ANTICIPATE A LOSS OF STATUS OR QUALITY OF LIFE
Real change reshuffles the deck a bit. Reshuffling the deck can bring winners . . . and losers. Some people, most likely, will gain in status, job security, quality of life, etc. with the proposed change, and some will likely lose a bit. Change does not have to be a zero sum game, and change can (and should) bring more advantage to more people than disadvantage. But we all live in the real world, and let’s face it – if there were no obstacles (read: people and their interests) aligned against change, then special efforts to promote change would be unnecessary.
Some people will, in part, be aligned against change because they will clearly, and in some cases correctly, view the change as being contrary to their interests. There are various strategies for minimizing this, and for dealing with steadfast obstacles to change in the form of people and their interests, but the short answer for dealing with this problem is to do what you can to present the inevitability of the change given the risk landscape, and offer to help people to adjust. Having said that, I’ve never seen a real organizational change effort that did not result in some people choosing to leave the organization, and sometimes that’s best for all concerned. When the organization changes, it won’t be to everyone’s liking, and in that case, it’s best for everyone to be adult about it and move on.
10. PEOPLE GENUINELY BELIEVE THAT THE PROPOSED CHANGE IS A BAD IDEA
I’ll never forget what a supervisor of mine said to be, during the year after I had graduated from college, secure as I was in the knowledge of my well earned, pedigreed wisdom at age twenty-two. We were in a meeting, and I made the comment, in response to some piece of information, “Oh, I didn’t know that!” Ricky, my boss, looked at me sideways, and commented dryly, “Things you don’t know . . . fill libraries.” The truth is, sometimes someone’s (even – gasp! – my) idea of change is just not a good idea. Sometimes people are not being recalcitrant, or afraid, or muddle-headed, or nasty, or foolish when they resist. They just see that we’re wrong. And even if we’re not all wrong, but only half wrong, or even if we’re right, it’s important not to ignore when people have genuine, rational reservations or objections.
Not all resistance is about emotion, in spite of this list I’ve assembled here. To win people’s commitment for change, you must engage them on both a rational level and an emotional level. I’ve emphasized the emotional side of the equation for this list because I find, in my experience, that this is the area would-be change agents understand least well. But I’m also mindful that a failure to listen to and respond to people’s rational objections and beliefs is ultimately disrespectful to them, and to assume arrogantly that we innovative, change agent types really do know best. A word to the wise: we’re just as fallible as anyone.Read Full Post | Make a Comment ( None so far )
Allegory of Change
I walk,down the street
There is a deep hole in the sidewalk.
I fall in
I am lost…….I am helpless
It isn’t my fault.
It takes forever to find a way out.
I walk down the same street.
There is a deep hole in the sidewalk.
I pretend I don’t see it.
I fall in again.
I can’t believe I am in the same place,but,
It isn’t my fault.
It still takes a long time to get out.
I walk down the same street.
There is a deep hole in the sidewalk.
I see it is there.
I still fall in……….it’s a habit.
My eyes are open.
I know where I am
It is my fault.
I get out immediately.
I walk down the same street.
There is a deep hole in the sidewalk.
I walk around it.
I walk down another street.
1) PRECONTEMPLATION STAGE
“IT ISN’T THAT WE CAN’T SEE THE SOLUTION. IT IS THAT WE CAN’T SEE THE PROBLEM” Precontemplators usually show up in therapy because of pressures from others… spouses, employers, parents, and courts… Resist change. When their problem comes up, they change the topic of conversation. They place responsibility for their problems on factors such as genetic makeup, family, society, destiny, the police, etc. They feel the situation is HOPELESS .
2) CONTEMPLATION STAGE
“I WANT TO STOP FEELING SO STUCK” Contemplators acknowledge that they have a problem and begin to think about solving it.
Contemplators struggle to understand their problems, to see its causes, and wonder about possible solutions. Many contemplators have indefinite plans to take action within the next few months. “YOU KNOW YOUR DESTINATION, AND EVEN HOW TO GET THERE, BUT YOU ARE NOT READY TO GO YET”
It is not uncommon for contemplators to tell themselves that some day they are going to change. When contemplators transition to the preparation stage of change, their thinking is clearly marked by two changes. First, they begin to think more about the future than the past. The end of contemplation stage is a time of ANTICIPATION, ACTIVITY, ANXIETY, and EXCITEMENT.
3) PREPARATION STAGE
Most people in the preparation stage are planning to take action and are making the final adjustments before they begin to change their behavior. Have not yet resolved their AMBIVALENCE . Still need a little convincing.
4) ACTION STAGE
Stage where people overtly modify their behavior and their surroundings. Make the move for which they have been preparing. Requires the greatest commitment of time and energy. CHANGE IS MORE VISIBLE TO OTHERS.
5) MAINTENANCE STAGE
Change never ends with action. Without a strong commitment to maintenance, there will surely be relapse, usually to precontemplation or contemplation stage.
MOST SUCCESSFUL SELF-CHANGERS GO THROUGH THE STAGES THREE OR FOUR TIMES BEFORE THEY MAKE IT THROUGH THE CYCLE OF CHANGE WITHOUT AT LEAST ONE SLIP. MOST RETURN TO THE CONTEMPLATION STAGE OF CHANGE. SLIPS GIVE US THE OPPORTUNITY TO LEARNRead Full Post | Make a Comment ( None so far )
The brain makes, organizes, and controls memory. The brain, like memory operates on hormonal chemicals. These chemicals produce emotional responses in the brain and body. Just like a certain combination of flour, sugar, butter, and other ingredients can combine and produce a cake, these chemicals combine in your brain to produce certain physical reactions and emotional responses.Just like an automobile contains various fluids (brake, window washer, transmission, oil, anti-freeze, etc.), the brain operates on chemicals known as “neurotransmitters”. The levels of these hormonal chemicals or neurotransmitters in the brain create your mood. Emotional memories contain instructions for the brain to use these neurotransmitter ingredients to produce the mood. Like the oil in your automobile, neurotransmitters have a normal level in the brain and can be “low” or “high” depending upon certain situations.
Suppose your boss said to you, ‘I think you’re one of worst people I’ve ever seen … but I’m just joking, so don’t take it personally’. Even with your boss telling you that it’s not sincere, there’s nothing to keep you from blushing or from feeling tense all over. And I dare say that you’re gonna remember you boss having said that long after you’ve forgotten the other details of the rest of your discussion. I guarantee it. That’s why you remember important and emotional events in your life more than regular day-to-day experiences. First, you have a horribly or unexpected event, and then you have intense fear and helplessness. That intense fear and helplessness is gonna stimulate norepinephrine, the brain chemical associated with the fight or flight reaction. You are hard wired to secrete norepinephrine when you face stress, which makes your memories of that stressful event stronger. The detection of stress hormones triggered by an insult or a traffic accident, tells the brain that this is a memory of great importance.
It turns out your memory is sort of like Jell-O, it takes time to solidify a memory in your brain. And while its setting, you can make that memory stronger or weaker. It all depends on the stress hormone norepinephrine. Norepinephrine actually makes your brain remember better. Now you needn’t have been traumatized to understand the powerful effect that emotions can have on the formation of memory. In fact, it has been known for a while that norepinephrine, the hormone released during stress and anxiety, enhances memory. This explains why emotional arousal has such a powerful influence on how well you remember things. An event becomes a strong memory, or a traumatic memory, when emotions are high. Here are sme other hormones that alter mood:
Serotonin: Perhaps the most actively researched neurotransmitter at this time, serotonin is known to be related to depression, headaches, sleep problems, and many mental health concerns. When serotonin is low in the brain system – depression and other mental health problems are produced. A chronic low level of serotonin, as when experiencing long-term severe stress, produces strong depression. Low serotonin is also associated with bulimia, a severe eating disorder, where the body craves sweets and carbohydrates in a desperate effort to raise serotonin levels. Antidepressants, such as Prozac and Zoloft, work by increasing serotonin in the brain. As your Serotonin level changes, your mood changes.
The neurotransmitter serotonin, which acts as a chemical messenger between nerve cells, plays a critical role in regulating emotions such as aggression during social decision-making. Serotonin has long been associated with emotion, with low levels of serotonin being associated with symptoms of depression and anxiety, Though many scientists have hypothesized a link between serotonin and impulsivity, researchers have just begun to understand its precise involvement in aggression.
A recent study highlighted why some of us may become combative or aggressive when we have not eaten. They found that the essential amino acid necessary for the body to create serotonin can only be obtained through eating and our serotonin levels naturally decline when we don’t eat. This research builds on the discovery that the human brain responds to being treated fairly the same way it responds to winning money and eating chocolate; being treated fairly turns on the brain’s reward circuitry. In this study, scientists reported that people with low serotonin levels were found to be more sensitive to being treated unfairly.
Dopamine: Abnormally high levels of this neurotransmitter in the brain produce paranoia, excitement, hallucinations, and disordered thought (schizophrenia). Abnormally low levels produce motor or movement disorders such as Parkinson’s Disease.
Dopamine, a chemical with a key role in setting people’s moods, could have a much wider-ranging impact on their everyday lives, research suggests. Experiments show that altering levels of the chemical in the brain influences the decisions people make. The results show the relative importance of “gut feeling” over analytical decision making. Previous research using brain imaging techniques, have detected a signal in the brain linked to how much someone enjoyed an experience. Scientists found that signal could in turn predict the choices a person made.
With the suspicion that the signal was dopamine, the researchers set up a study to test how people make complex decisions when their dopamine system has been tampered with. The participants were given a list of 80 holiday destinations, from Greece to Thailand, and asked to rate them on a scale of one to six. They were then given a sugar pill and asked to imagine themselves in each of the destinations.
Researchers then administered L-Dopa, a drug used in Parkinson’s disease to increase dopamine concentrations in the brain, before asking them to imagine the other holidays. They rated all the destinations again, and a day later they were asked where they would prefer to go, out of paired lists of holidays. The extra dopamine gave people higher expectations when rating holiday options. And that translated into the choice of trip they made a day later.
This study reinforces the notion that dopamine plays an important part in the complex decisions humans such as what job to take and whether to start a family. The results indicate that when we consider alternative options when making real-life decisions, dopamine has a role in signalling the expected pleasure from those possible future events. We then use that signal to make our choices. This is important because we frequently overestimate the pleasure we would gain from something, because our dopamine system is influencing our assessments pof risks and rewards.
Norepinephrine: Related to worry, high levels of norepinephrine in the brain produce strong physical-anxiety manifestations such as trembling, restlessness, smothering sensations, dry mouth, palpitations, dizziness, flushes, frequent urination, and problems with concentration. A “panic attack” is actually a sudden surge of norepinephrine in the brain.
Endorphins: These substances kill pain and produce a feeling of well-being. In marathon runners, these substances are responsible for the “runner’s high”. It is also produced during anxiety as restlessness, such as a sudden need to rearrange furniture, go dancing, or clean house.Read Full Post | Make a Comment ( None so far )
Rob hated to run. But he hated to stop even more.
That’s when his disparaging inner voice, the one that had belittled him since seventh grade, would emerge. If he didn’t keep going, it said, he was going to get fat. He would never have the shredded abs that taunted him from every fitness magazine. He would be just a regular guy — not the superman he felt driven to become.
So on he ran. And when even six hours a day of exercise weren’t enough to quiet the voice, he started skipping meals too.
While anorexia, bulimia and other eating disorders are potentially lethal — up to 5 percent of those suffering from them die from suicide, substance abuse or medical issues, according to a study published in the American Journal of Psychiatry — they have traditionally been viewed as women’s problems. Researchers say only 10 percent of those who are treated for the conditions are male.
But a growing body of evidence suggests that number is misleading. A study published last year estimated that males actually make up 40 percent of teens who have eating disorders. An earlier Harvard survey found that men account for 25 percent of adults with anorexia and bulimia.
Some Chicago-area therapists say more men and boys are seeking help. Niquie Dworkin, who practices on the North Side, said males have been tormented by the same kind of unattainable body images that have long plagued women and girls.
“Action figures used to look normal,” she said. “Now they’re superhuman with really cut abs and really big shoulders. Even little boys are being exposed to images of men that are not realistic.”
While eating disorders in men and women appear to have similar roots in genetics, media messages, perfectionism and low self-esteem, the symptoms are often different. Experts say one big contrast is that men usually focus on muscularity, not thinness, and they tend to manage their weight by working out to incredible extremes.
That’s what happened with Rob, 24, a young man from Elgin who asked that his last name not be used. Experts said his case was typical of men with eating disorders.
His trouble began at age 14, not long after bullying schoolmates mocked him for supposedly being fat. Vowing to gain the same kind of lean, athletic physique one of his tormentors had, he started doing 100 pushups a night. He then moved to the weight room, and when he entered high school, the cross-country team.
His parents were delighted. The other runners were laid-back, friendly and supportive, and Rob’s grades improved after he joined the team. He cut junk food from his diet and worked out with a vengeance. Not even a downpour could keep him from his training.
“All the way around, it seemed like a really good thing,” Rob’s mother recalled. “We didn’t think anything of it.”
Almost imperceptibly, though, his routines grew longer. A coach at a summer running camp preached maximum effort — When you’re not running, another guy is, and he’s going to beat you — and Rob took it to heart. By the time he was a senior, he made excuses to leave practice early so he could work out even harder alone.
“I wanted to make a name for myself, be something,” he said recently. “Working harder than anyone else in the group made me better. That’s what I thought.”
Strange thing, though: Rob didn’t care that much about winning races or setting records. He didn’t really even like running. Thinking about the hours of exercise that awaited him after school filled him with dread.
But it was far worse to skip a workout or ease up on its intensity, even when he was sprinting at a 4-minute-mile pace on a treadmill set to a 12 percent incline. If he backed down, his inner voice told him, something indefinably bad would happen.
So he absorbed the pain, and after noticing an odd relief in hunger, he began skipping meals too. Mastering his body allowed him to feel as though he could manage a life that had become lonely and socially awkward.
Daniel Le Grange, director of the eating disorders program at the University of Chicago Medical Center, said it’s common for people who suffer from the disorders to express a desire for control and self-affirmation. But any contentment that emerges from starvation and hellish exercise doesn’t last long, he said.
“We have patients who are bleeding because they’re on the carpet doing a thousand pushups and situps a day,” he said. “It never gives you that feeling that you’re yearning for, that you feel good about yourself.”
Rob’s intense exercise led to stress fractures, and he decided not to join the cross-country team when he went to college in fall 2006. But he didn’t let up on his body.
Instead he rose at 6 a.m. for a quick breakfast before heading to the gym for a four-hour workout, including 90 minutes on an elliptical machine and an hour of weights. In the afternoon, after skipping lunch, he walked for two hours before doing repeats on the library steps. He picked at his dinner before rewarding himself for his suffering with a giant piece of pie.
When Rob healed enough to run, his routines grew ever more punishing, his body ever lighter — sometimes dipping below 100 pounds on his 5-foot-7 frame. A photograph taken of him at a swimming pool in July 2009 shows deep hollows beneath his cheekbones. Striated ropes of muscle press through his skin. His arms and legs appear as thin and brittle as sticks.
Rob’s family, long in denial, knew he was in trouble. He knew it too. But even though he had begun to see a therapist, it was easier to follow his compulsions than resist.
“We would have these breakthrough moments where he would say, ‘I know I have a problem, but I’m not ready to give it up yet,’” his sister said. “I always knew when he stopped calling that he was getting worse. Because then he wasn’t ready to hear it.”
In November 2011, Rob sustained another leg fracture, the result of what doctors said was a lack of calcium in his bones. Though he was ordered to rest for a month, he became so frenzied from inactivity that he grabbed his crutches and did hobbled laps around his parents’ kitchen table.
It turned out to be his moment of clarity. He called the eating disorders recovery center at Alexian Brothers Behavioral Health Hospital in Hoffman Estates and had himself admitted.
Staffers there found that his pulse was a dangerously low 32 beats per minute, said Michelle Gebhardt, the center’s clinical coordinator. Their No. 1 job was to stabilize Rob — one of the few males to enter the program — by controlling his exercise and encouraging him to eat.
That turned meals into high drama. On one of his first days, he was presented with a modest portion of scrambled eggs he dubbed “Mount Eggerest.” He could swallow only half. Another time he refused to eat until he was given a ham sandwich; he then declined to finish it.
Finally, Rob recalled, one of his fellow patients had had enough, telling him when he arrived for dinner: “If you sit here you better eat all your food because you are really triggering us with all your crap.”
Therapy and reflection eventually convinced Rob, who was diagnosed with a condition known as eating disorder not otherwise specified, that he needed to change. He yielded to the program and spent a few weeks putting on weight before transferring to Rogers Memorial Hospital near Milwaukee, home to a rare males-only eating disorders program.
His task there was to excavate the psychological turmoil that lay beneath his behavior — the desire for control, the need to feel special, even the fear of becoming an adult — and reset his mind and body to healthy habits.
It wasn’t easy. To remind himself of happier days, he hung a photograph taken a few months earlier at his sister’s wedding rehearsal dinner. The image showed him standing behind his parents and smiling, his skin stretched tightly over the bones of his face.
His roommate asked what he thought of the picture. Rob said he thought he looked pretty good.
“When I see that, I don’t see ‘good’ at all,” his roommate said. “I see death.”
In his three months at Rogers, Rob said, he learned to take a more realistic view of himself and gain more control over his eating and exercise habits. He put on about 45 pounds in treatment and now follows a diet worked up by a nutritionist, dining at appointed times even if he isn’t hungry (his long periods of starvation scrambled the neural circuitry that governs hunger — a common side effect of an eating disorder).
He works out cautiously, lifting weights with his father lest he get carried away. On a recent Sunday morning he went for a slow walk around the block, the only form of cardiovascular exercise he allows himself.
“Sometimes there’s the urge to hurry up,” he said, strolling past well-watered lawns and vibrant flower beds. “It’s a little battle. I usually win.”
Le Grange, the University of Chicago expert, said males are so scarce in eating disorder studies that there is no good data about their chances for long-term recovery. Indeed, while Rob today looks fit and healthy, he says he’ll have to be wary of backsliding for the rest of his life.
For now, though, he has managed to quiet the voice inside him with the mantra he took away from treatment: He is more than his body.
“There are so many other things that set me aside,” he said. “I have my goals and aspirations, like wanting to be a counselor. What I do physically will not be the defining characteristic for me.”Read Full Post | Make a Comment ( None so far )
Eating disorders aren’t just a problem for teens and young women.
Many women over 50 grapple with issues related to body image and food, a new study finds.
Two-thirds of 1,849 women surveyed by researchers from the University of North Carolina School of Medicine said they were unhappy with their overall appearance. More than 70 percent said they were trying to lose weight. Nearly 8 percent reported purging within the last year, and about 4 percent reporting binge eating at least once a week.
About 28 percent of the women reported past experience with eating disorders. But the survey found that many older women with eating disorders had no previous history with them. The findings were just published in the International Journal of Eating Disorders.
For more, we talked with psychologist Cynthia Bulik, the lead researcher on the survey and director of the UNC Eating Disorders Program. She’s also the author of The Woman in the Mirror: How To Stop Confusing What You Look Like With Who You Are.
Here are highlights from our conversation, edited for length and clarity.
Q: What factors do you think are influencing the growing prevalence of eating disorders in women over 50?
A: “I think part of this is that our society has made it not OK to age. Many industries have put enormous pressure on women to continue to look young even as they age. So I think part of this is a nasty side effect of what I call the ’70 is the new 50′ movement. Women are feeling like they need to go to extreme measures to continue to look thin and attractive and young.”
Q: How big of a change are you seeing versus previous research?
A: “One study was done in Austria a while back, but we can’t compare them because they are different countries at different times. One thing that this country [the United States] lacks is good epidemiological data to really look at trends. So we have no idea if this was any different 10 years ago. One possibility is that we really are seeing an increase in eating disorders in older women. Another possibility is that no one’s ever bothered to ask, and so it has been this way all along.”
Q: How does the obesity epidemic factor into this?
A: “Basically as the world is getting bigger and more obese, our societal ideals haven’t changed. So the distance between what you are seeing in the mirror, and the societal ideal is becoming greater. That contributes to even more dissatisfaction, because the ideal seems so unattainable. And that’s driving some of these extreme weight-control behaviors.”
Q: What options are available for older women who may have an eating disorder?
A: “Part of the problem is that a lot of our treatments were actually developed for adolescent and young adult women. One of the things we know, for example, is for youth, family involvement is important. So one thing we’ve been doing is bringing partners in, if they have a committed partner, and getting them involved in the treatment and the recovery process. And that seems to be a very innovative and positive way to treat eating disorders in women over 50.”
Q: Is there anything else you think our readers should know?
A: “A message to the women is, if they can look in a mirror every day and say something positive about themselves that has nothing to do with their physical appearance, that’s going to really help break through how stuck we are in this negative body image. Those wonderful characteristics will persist long after traditional adolescent female beauty fades with age. And for the health care professionals, the message is: Keep eating disorders on your radar screen, no matter what the age of the patient. Just because someone is over 50 doesn’t mean they’re not at risk.”Read Full Post | Make a Comment ( None so far )
Talk about a disparity between theory and practice. The American Academy of Pediatrics tells parents that children’s total entertainment media time should not exceed two hours daily. According to the Kaiser Family Foundation, average kids watch at least twice that much television. They also spend more than an hour per day online and another hour on video games. These activities, collectively called “screen time,” are widely blamed for the tripling of obesity rates in children since the 1980s.
Zoning out in front of a television or video game monitor for hours doesn’t seem healthy, but no one yet has found any causal link between time spent lolling on a couch and childhood obesity. In February, for example, researchers in Texas reported their findings on whether it would help kids lose weight to have their regular video games replaced with a more active alternative such as the Nintendo Wii console. In their study, 84 children received Wii consoles and one half of those got a collection of exercise-oriented games like Wii Sports and EA Active, which ask players to move their arms and legs or jump around to control the action. The other half of the kids got “inactive” games like Madden NFL, which can be played from a seated position with minimal full-body movements. The results of the comparison were disappointing. After three months, “there was no evidence that children receiving the active video games were more active in general or at any time,” the authors wrote. (The year before, a similar study in New Zealand had shown only minor improvement with active games; kids weighed just a pound less after six months of “exergaming”.)
Such studies are complicated by the fact that even regular video games—the ones so often blamed for the present rates of childhood obesity—may not be as passive as you think. A decade ago, a physiologist named Arlette Perry at the University of Miami worried that her 10-year-old son Thomas was spending a lot of time with a controller in his hand. To measure the effects of chronic gaming, she studied her son and 20 other children as they played Tekken 3 on a Sony PlayStation in her lab. She found that the fighting game increased the kids’ heart rates and blood pressure to the same extent as walking at 3 miles per hour. Children burned roughly twice as many calories playing Tekken 3 as they did sitting in one place, which translates to an extra 40 to 80 calories burned every hour. In other words, this traditional, “passive” video game was itself providing children with a form of exercise.
If video games aren’t the problem, then what about television? We’ve know for a long time that attempts to reduce television-watching among children have a limited effect on their body weight. For a 1999 paper in the Journal of the American Medical Association, researchers gave a group of third- and fourth-graders in California regular lessons on the dangers of excessive television. Their parents were asked to enforce time budgets (using a device to limit total screen time) and participate in television turnoffs lasting 10 days, among other projects. This very involved, two-month intervention halved television watching among participants. Eight months later, researchers measured the children’s heights and weights, and compared them to those taken from children at a school without a similar program. The drastic reduction in television-watching made for only a very modest difference: Weight gains in the experimental group were reduced by an average of only one pound.
Reducing time spent watching television or playing video games may have some benefits—more time for creative play or academic work, for example—but slimmer bodies don’t seem to be among them. It’s also not necessarily the case that increasing screen time will lead a child to gain weight: Between 1999 and 2010, screen time among kids jumped by more than two hours per day, according to the Kaiser Family Foundation. Yet childhood obesity rates remained relatively stable over the same period.
Taken together, the data above suggest that public health efforts to cut or reallocate screen time won’t have a huge impact on childhood obesity. There is indeed a well-known correlation between obesity and hours spent in front of a video screen, but the fact of that linkage doesn’t tell us anything about causality. Does watching television make kids fat, or do fat kids just happen to watch a lot of television? The accumulating work in this area suggests the latter.
In short, whatever calories a kid might burn off playing Dance Dance Revolution or turning off the TV to go for a walk are small potatoes. Even an adult will only burn off a few hundred calories by working out intensely for half an hour—a benefit that’s wiped out by a single bag of chips or a scoop of ice cream. That might be why taking up dozens of classroom hours in an effort to reduce screen time, or paying to outfit homes with active video games, yield such a small return on investment. That doesn’t mean someone can’t exercise his or her way from obesity to thinness, but the bar is very high. A more efficient way to reduce pediatric obesity would fixate less on the number of calories going out, and more on the number going in.
In the end, schoolchildren don’t get obese from mostly watching television. They pack on weight because they eat too much. Consider the results of another major clinical study, in which the families of obese 8- and 12-year-old kids received nutritional counseling, either with or without additional information about exercise. Teaching the parents and children about food habits made almost all the difference: Kids in the study lost around 15 pounds in 6 months, on average, with the extra lessons on the importance of exercise having only a minor impact—a pound or two of extra weight loss. After two years, the effects of dietary changes persisted, at least to some extent; the effects of the exercise teaching remained small by comparison. That’s also why there are no major differences in weight loss among the major dieting programs, like Weight Watchers, the Zone diet, the Atkins diet, and Ornish diet. They all work to about the same degree, because they all reduce the total of what goes in.
It’s likely that the kinds of households in which kids watch hours of television per day happen to be the same ones where healthy food options are hard to come by, or ones in which the parents are not well educated in how to make good dietary choices. Though it seems like a convenient cure, just disconnecting the cable service isn’t going to fix those problems.
Think about something it took you a really long time to learn, like how to parallel park. At first, parallel parking was difficult and you had to devote a lot of mental energy to it. But after you grew comfortable with parallel parking, it became much easier — almost habitual, you could say.
Parallel parking, gambling, exercising, brushing your teeth and every other habit-forming activity all follow the same behavioral and neurological patterns, says New York Times business writer Charles Duhigg. His new book The Power of Habit explores the science behind why we do what we do — and how companies are now working to use our habit formations to sell and market products to us.
It turns out that every habit starts with a psychological pattern called a “habit loop,” which is a three-part process. First, there’s a cue, or trigger, that tells your brain to go into automatic mode and let a behavior unfold.
“Then there’s the routine, which is the behavior itself,” Duhigg tells Fresh Air‘s Terry Gross. “That’s what we think about when we think about habits.”
The third step, he says, is the reward: something that your brain likes that helps it remember the “habit loop” in the future.
Neuroscientists have traced our habit-making behaviors to a part of the brain called the basal ganglia, which also plays a key role in the development of emotions, memories and pattern recognition. Decisions, meanwhile, are made in a different part of the brain called the prefrontal cortex. But as soon as a behavior becomes automatic, the decision-making part of your brain goes into a sleep mode of sorts.
“In fact, the brain starts working less and less,” says Duhigg. “The brain can almost completely shut down. … And this is a real advantage, because it means you have all of this mental activity you can devote to something else.”
That’s why it’s easy — while driving or parallel parking, let’s say — to completely focus on something else: like the radio, or a conversation you’re having.
“You can do these complex behaviors without being mentally aware of it at all,” he says. “And that’s because of the capacity of our basal ganglia: to take a behavior and turn it into an automatic routine.”
Studies have shown that people will perform automated behaviors — like pulling out of a driveway or brushing teeth — the same way every single time, if they’re in the same environment. But if they take a vacation, it’s likely that the behavior will change.
“You’ll put your shoes on in a different order without paying any attention to it,” he says, “because once the cues change, patterns are broken up.”
That’s one of the reasons why taking a vacation is so relaxing: It helps break certain habits.
“It’s also a great reason why changing a habit on a vacation is one of the proven most-successful ways to do it,” he says. “If you want to quit smoking, you should stop smoking while you’re on a vacation — because all your old cues and all your old rewards aren’t there anymore. So you have this ability to form a new pattern and hopefully be able to carry it over into your life.”
It’s not just individual habits that become automated. Duhigg says there are studies that show organizational habits form among workers working for the same company. And companies themselves exploit habit cues and rewards to try to sway customers, particularly if customers themselves can’t articulate what pleasurable experience they derive from a habit.
“Companies are very, very good — better than consumers themselves — at knowing what consumers are actually craving,” says Duhigg.
As an example, he points to Febreeze, a Proctor & Gamble fabric odor eliminator that initially failed when it got to the market.
“They thought that consumers would use it because they were craving getting rid of bad scents,” he says. “And it was a total flop. People who had 12 cats and their homes smelled terrible? They wouldn’t use Febreeze.”
That’s when Proctor & Gamble reformulated Febreeze to include different scents.
“As soon as they did that, people started using it at the end of their cleaning habits to make things smell as nice as they looked,” he says. “And what they figured out is that people crave a nice smell when everything looks pretty. Now, no consumer would have said that. … But companies can figure this out, and that’s how they can make products work.”
Companies can also figure out how to get consumers to change their own habits and form new ones associated with their products or stores. The megastore Target, for example, tries to target pregnant women, says Duhigg, in order to capture their buying habits for the next few years.
“The biggest moment of flexibility in our shopping habits is when we have a child,” he says, “because all of your old routines go out the window, and suddenly a marketer can come in and sell you new things.”
Analysts at Target collect “terabytes of information” on its shoppers. They have figured out that women who buy certain products — vitamins, unscented lotions, washcloths — might be pregnant and then can use that information to jump-start their marketing campaign.
This can get tricky: One father was upset after receiving coupons for baby products in the mail from Target addressed to his teenage daughter.
“He went in and said, ‘My daughter is 16 years old. Are you trying to encourage her to get pregnant?’ and the manager apologizes,” Duhigg says. “The manager calls a couple of days later … and the father says, ‘I need to apologize. … I had a conversation with my daughter, and it turns out there’s some things going on in my house that I wasn’t aware of. She’s due in August.’ So Target figured it out before her dad did.”
“What we know from lab studies is that it’s never too late to break a habit. Habits are malleable throughout your entire life. But we also know that the best way to change a habit is to understand its structure — that once you tell people about the cue and the reward and you force them to recognize what those factors are in a behavior, it becomes much, much easier to change.”
“I felt like I had a lot of habits that I was powerless over. … I have a 3-year-old and a 10-month-old. And I remember when my 3-year-old was 1 1/2 or 2. I was writing the book. We would feed him chicken nuggets or other stuff for dinner, which was the only stuff he would eat. And it was impossible for me to stop from reaching over and grabbing his chicken nuggets. It was a struggle every night not to eat his dinner because a 2-year-old dinner is designed to taste delicious and to disintegrate into your mouth into carbs and sugar. And so, I was really interested in this, and I wanted to exercise more and I wanted to be more productive at work.”
“The weird thing about rewards is that we don’t actually know what we’re actually craving.” “When [Alcoholics Anonymous] started, there was no scientific basis to it whatsoever. In fact, there’s no scientific basis to AA. The 12 steps that are kind of famous? The reason why there’s 12 of them is because the guy who came up with them — who wrote them one night while he was sitting on his bed — he chose them because there’s 12 apostles. There’s no real logic to how AA was designed. But the reason why AA works is because it essentially is this big machine for changing the habits around alcohol consumption and giving people a new routine, rather than going to a bar or drink. … It doesn’t seem to work if people do it on their own. … At some point, if you’re changing a really deep-seated behavior, you’re going to have a moment of weakness. And at that moment, if you can look across a room and think, ‘Jim’s kind of a moron. I think I’m smarter than Jim. But Jim has been sober for three years. And if Jim can do it, I can definitely do it,’ that’s enormously powerful.”Read Full Post | Make a Comment ( 1 so far )
In the United States, 90% of adults consume caffeine on a regular basis — most often by drinking coffee. A study suggests that coffee not only wakes people up, but also may offer some protection against depression. What’s less clear is why this might be.
Researchers at the Harvard School of Public Health and Brigham and Women’s Hospital analyzed data collected from nearly 51,000 women participating in the Nurses’ Health Study, all free of depression in 1996. The researchers then determined how many of the women had developed depression a decade later and compared their caffeine intake to determine whether it affected risk. (They also controlled for other health and lifestyle factors such as weight, cigarette smoking, and exercise.)
By 2006, 2,607 women were diagnosed with depression or had started taking antidepressants. The researchers found an inverse dose-response relationship between caffeine intake and mood: the more caffeine a woman ingested per day, the lower the likelihood that she developed depression during the study period. Women who drank the most caffeinated coffee per day were 20% less likely to develop depression than women who drank the least. Other sources of caffeine — such as tea, soda, and chocolate — did not have an impact on risk of depression. The researchers speculate that this was because these other sources provide such minimal amounts of caffeine in comparison to coffee.
In this study, women in the highest quartile of caffeine consumption — who were least likely to develop depression — were ingesting 550 mg of the stimulant per day. The caffeine content of coffee varies greatly, depending on the beans, how they’re roasted, and other factors. The average for an 8-ounce cup is about 100 mg. That means in this study, women at the highest level of caffeine consumption were drinking about five and a half cups of coffee per day.
This study was not designed to prove that drinking coffee prevents depression — but it does raise interesting questions about how one variable might influence the other.
Caffeine gets absorbed in the stomach and small intestine and is then distributed throughout the body, including the brain. The amount circulating in the blood peaks 30 to 90 minutes after it’s ingested, and just trace amounts are around eight to 10 hours later. In between, the amount circulating declines as caffeine gets metabolized and broken down by the liver.
Once it reaches the brain, caffeine probably has multiple targets, but the main one seems to be adenosine receptors. Adenosine is a brain chemical that dampens brain activity. By hogging its receptors, caffeine sets off a chain of events that affects the activity of dopamine, an important neurotransmitter involved in mood. Caffeine also indirectly affects two other neurotransmitters, serotonin and acetylcholine. In addition, caffeine acts on areas of the brain involved in sleep, arousal, pleasure, and thinking.
Although the exact way that caffeine acts in the brain remains a matter of conjecture, the behavioral effects are well known. Caffeine perks people up because it increases vigilance and arousal, boosts energy, and counters sleepiness.
One study, no matter how well conducted, is not enough for clinicians to make a recommendation about caffeine intake. And it’s important to keep in mind the limitations of this particular study.
First and most important, the Nurses’ Health Study is a prospective epidemiological study — meaning that the researchers followed participants over time. This kind of study cannot prove cause and effect. It can only suggest an association between caffeine and mood. It’s possible, as the authors point out, that women with mild symptoms of depression or those prone to depression may avoid drinking caffeinated beverages — and not that coffee prevents depression.
Second, while caffeine might boost mood as well as energy, it is also a potent stimulant. In excess, caffeine may cause jitteriness and worsen anxiety, especially in people who are already stressed or sensitive to caffeine’s effects.
In an epidemiological study of men in Finland, where rates of suicide and coffee consumption are both relatively high, the risk of suicide was lower than average for men consuming as many as seven cups of coffee per day. But risk increased for those who drank eight or more cups of coffee per day. Men who drank 10 or more cups of coffee per day were nearly twice as likely to kill themselves as men who drank no coffee.
There are other health issues to keep in mind. Especially in the short term, caffeine also has negative effects, which include raising blood pressure, making arteries stiffer, and increasing levels of insulin and possibly cholesterol. (Habitual use may cause some of these effects to wear off.)
So it’s too soon to advise people to have a cup of morning Joe (or several) to help reduce their risk of depression (or to drink seven cups to reduce suicide risk). But people who do drink coffee regularly should take heart that this is one habit that isn’t a vice — and may even be healthy.Read Full Post | Make a Comment ( None so far )
For some, aging may bring on — or rekindle — an eating disorder.
Most people who develop eating disorders — an estimated 90% — are female. Typically associated with adolescents and young women, eating disorders also affect middle-aged or elderly women — although, until fairly recently, not much was known about prevalence in this older age group.
Secrecy and shame are part of the disorder, and women may not seek help. This is particularly true if they fear being forced to gain unwanted weight or stigmatized as an older woman with a “teenager’s disease.”
Despite underdiagnosis of eating disorders in older people, clinicians at treatment centers specializing in such issues report that they’ve seen an upswing in requests for help from older women. Some of these women have struggled with disordered eating for decades, while for others the problem is new. The limited amount of research on this topic suggests that such anecdotal reports may reflect a trend.
In community surveys conducted in 1995 and again in 2005, for example, Australian researchers found that while younger women reported eating disorder behaviors more often than older women did, the rate of these disorders in older women increased dramatically between the two surveys, while it remained stable for young women. In women ages 65 and over, strict dieting, fasting, and binge eating all tripled, while purging quadrupled. In the same surveys, rates of strict dieting or fasting and purging also increased dramatically in women ages 45 to 64. A study of Canadian women surveyed in the general population likewise found that women ages 45 to 64 were more likely to binge on food, feel guilty about eating, and be preoccupied with food compared with younger women.
In the most severe cases, patients develop life-threatening complications, such as cardiac arrhythmias, kidney failure, and liver failure. This is one reason that anorexia nervosa is one of the most deadly psychiatric disorders, killing 5.6% of patients for every decade that they remain ill. Treatment is challenging because starvation not only severely damages the body, but also harms the brain — causing changes in thinking, emotions, and behaviors that may be difficult to reverse.
The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) describes two subtypes of anorexia nervosa. In the restricting subtype, patients drastically reduce food consumption. They may also exercise excessively in an effort to lose weight. In the binge-eating/purging subtype, patients lose weight by forcing themselves to vomit or by using laxatives, diuretics, or enemas.
Once weight decreases to the threshold required for a diagnosis of anorexia nervosa, patients may experience changes in thinking processes, such as difficulty concentrating. They may develop odd food rituals, such as cutting food into tiny pieces, eating only at certain times, and weighing food. Weight gain may eventually improve these psychological problems, but it seldom eliminates them completely — which is why maintenance treatment is so important.
Bulimia nervosa. Bulimia nervosa is characterized by a cycle of binge eating followed by some type of compensatory action to avoid weight gain. Researchers estimate that one to three women out of 100 will develop bulimia nervosa at some point in their lives. In men, the rate of diagnosis is only about one-tenth the rate in women.
Although many Americans overeat by consuming too many calories per day (which helps explain why more than one in three are obese), binge eating involves consuming extreme amounts of food within a restricted time frame — usually within two hours. While on a binge, a patient may eat an entire cake rather than one or two slices, or a full gallon of ice cream rather than a bowl.
The DSM-IV describes two subtypes of bulimia nervosa, based on the strategy a patient uses to rid herself of excess calories. Patients diagnosed with the purging subtype, the most common form, may make themselves vomit or use laxatives or diuretics. This diagnosis overlaps with the binge/purge subtype of anorexia, but people with bulimia do not have the same preoccupation with maintaining a low body weight. In the nonpurging subtype, patients may exercise excessively or stop eating for a day or longer.
If a vicious cycle of overeating and deprivation takes over, patients may eat to the point of physical pain, then compensate so dramatically that they feel ravenously hungry. When the binge-and-compensation cycle occurs at least twice a week for three months, patients meet DSM-IV diagnostic criteria for bulimia nervosa.
Binge-eating disorder. Binge eaters regularly binge, usually in secret and accompanied by feelings of guilt or shame. Unlike bulimics, they don’t follow a binge with a purge, so they may be overweight or obese, and their eating disorder may remain unrecognized. In the DSM-IV, binge-eating disorder is categorized as an “eating disorder not otherwise specified,” but it is proposed for inclusion as a freestanding diagnosis in the next edition of the diagnostic manual. Many older women do not fit the strict definitions for eating disorders, yet they deserve treatment.
Grief. With age, people are increasingly likely to lose people they care about. Mourning can take away your appetite, and restricting food or purging can be a way to deal with distressing feelings. For example, the comedian Joan Rivers has written about the sudden onset of bulimia in her 50s after her husband’s death by suicide.
Divorce. In addition to grief and loss, the breakup of a marriage can spur a woman to view her body unfavorably in comparison with other singles or an ex-spouse’s new girlfriend.
Heightened awareness of aging. This can be particularly acute when women return to school or work or need to keep working past the traditional retirement age, especially in appearance-related fields.
Medical illness. If a short-term illness results in weight loss, a woman may receive compliments on her slender appearance and continue to restrict food after she has recovered to avoid regaining weight.
On the other hand, some older women decide to get professional help after years of disordered eating. This decision may emerge for any of several reasons.
For example, eating disorders take a physical toll on the body, and the impact is more apparent with age. Dental problems, arrhythmias (irregular heartbeats), or osteoporosis (a common complication of eating disorders) may prompt a woman to seek treatment. In an older body, forceful vomiting may result in a medical emergency, such as a stomach rupture or tear in the esophagus, which can bring a woman to professional attention.
A woman’s priorities may also shift over time. Disordered eating and attempts to hide it take a great deal of time and effort. Sometimes an unrelated health scare, death of a loved one, or other event sparks a realization of the sheer amount of psychic and physical energy required to maintain these behaviors, and a woman may finally decide that enough is enough — and seek treatment.
The goal of treating an eating disorder is to help a patient achieve a healthy weight, exercise level, and eating pattern; to eliminate binge eating and purging; and to address any contributing emotional problems or distorted thinking. This usually requires the help of a mental health professional, a nutritionist, and other clinicians.
Psychotherapy. This is the cornerstone of treatment for eating disorders. Various kinds of psychotherapy can help. Cognitive behavioral therapy (CBT) challenges unrealistic thoughts about food and appearance and helps people develop more productive thought patterns.
Other types of psychotherapy may also be useful in particular circumstances. For example, interpersonal and psychodynamic therapy can help people gain insight into issues such as role transitions, loss, and unresolved relationships that may underlie disordered eating and an excessive focus on body image.
Nutritional rehabilitation. A dietitian or nutritional counselor can help a woman recovering from an eating disorder learn (or relearn) the components of a healthy diet and can help motivate her to make the needed changes. At different stages in recovery, a nutrition professional will help plan how and when the patient should eat in a way that keeps the digestive system working well and avoids dangerous changes in electrolyte and fluid balances that can occur when a person begins eating again after a period of semi-starvation.
Medication. Fluoxetine (Prozac) is the only medication approved for the treatment of an eating disorder. At high doses (about 60 mg per day), it reduces binge eating and vomiting up to 70% in the first eight weeks, though results are much poorer if patients aren’t also receiving psychotherapy. Other antidepressants and the seizure medication topiramate (Topamax) may be prescribed for bulimia or binge-eating disorder, but fewer controlled trials have studied their effectiveness.
No medications are approved specifically for treating anorexia. Although antidepressants, seizure medications, and certain antipsychotic medications are sometimes used in treating the condition, food is considered the primary medication. No drug works well until some weight is restored. However, if depression or anxiety is also involved, medications may be prescribed to address these problems.
Hospitalization. Eating disorders are usually treated on an outpatient basis. But hospitalization may be recommended if a woman is dangerously underweight, unable to eat or stop vomiting, seriously depressed or suicidal, medically unstable (for example, because of heart arrhythmias, low pulse or blood pressure, or electrolyte imbalances), or has other medical complications that require hospital treatment.
Academy for Eating Disorders
International Association of Eating Disorder Professionals
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