Prepared for Cigna by

Milestones Eating Disorders

Program

Marty Lerner, Ph.D.

2015

The case for looking at an eating disorder as an addictive disease – a checklist to consider

Does this apply to Anorexia, Bulimia, Binge Eating?

How can Food be Addictive? Nature of the Person + Nature of the

Behavior or Substance? Brain Chemistry, Addiction, and Eating

Disorders – “The Common Ground”

Tolerance Withdrawal [Physical / Psychological] More For Longer Periods Than Intended Unsuccessful Effort To Cut Back Or Control Significant Time To Obtain Or Recover From

Effects Decreased Activities Due To Dependency

[Isolation] Continuation Despite Consequences

Question: How Many Of The Above Criteria Need To Be Met To

Qualify As Dependency –Aka Addiction? Answer: 3, 4, 5, 6, Or All ?

Nature of Substance / Behavior + Nature of Person= “The Perfect Storm”

-Amounts and for How Long? Brain Chemistry with Eating Disorders -

Reward Circuits in the Eating Disordered brain – anorexia, bulimia, binge eating

Junk Foods [sugar, flour, processed foods] and the overeating disorders [bulimia, binge eating]

Restricting – Can that be addictive too?

Physical Addiction with Eating Disorders-

What the research is showing us with

recent advances in “brain mapping”

What are the “offending” substances with

Bulimia and Binge Eating – the role of

sugar, refined flours, and volume

What about starvation, chronic dieting,

compulsive exercising, or self induced

vomiting with anorexia?

Cocaine

Meth

Alcohol

Heroin

Eating Disordered Brain

Anorexia will show elevated levels of dopamine after a meal

Restricting anorexics will experience elevated levels of dopamine as unpleasant – anxiety provoking

Anorexics have a tendency to dislike effects of stimulants or dopamine enhancing drugs

Binge Eating / Purging will show elevated levels of dopamine but few D2 receptors

Binge eaters will experience elevated levels of dopamine as rewarding / pleasant

Higher incidence of cross addiction / abuse to both alcohol and drugs as effects are “pleasant”

U. Bailer– UCSD 2012 – Int’l Journal Eating Disorders

Addiction Or Psychiatric Model? What intensity of Treatment [Setting]? The Great Food Debate: “Intuitive Eating” Or Structured Food Plan – Anything Goes Or Eliminating The Offending Substances / Foods? Multiple Issues – Eating Disorder + Mood

Disorder + Drug or Alcohol Abuse…. “What Are We Dealing With Here”? * How much focus on Body Weight change as a

measure of the success of treatment [loss or gain]?

MOST FREQUENT HOW COMMON

MOOD DISORDERS [Depression, Anxiety, Bi-Polar]

SUBSTANCE ABUSE [alcohol, drugs] PAST TRAUMA – PTSD* [Post Traumatic Stress] ATTENTION DEFICIT PERSONALITY DISORDERS [borderline, compulsive] PROCESS ADDICTIONS [behavioral – e.g. spending, gambling, sex addiction]

Estimates 70-90%

Estimates 40-60%

Estimates 20-40%

Estimates 20-30%

Estimates 20-40%

Estimates 20-40%

“One Size Does Not Fit All”

Inpatient (Hospital Based)

Residential (Non-Hospital Based)

Partial Hospital (Day Treatment)

Intensive Outpatient (Half-Day Treatment)

Outpatient (Therapist, Dietitian, etc.)

TREATMENT SETTING: LEVELS OF

CARE

Assumes ED is an addictive process with physical,

emotional, and spiritual [identity] components

Assumes “disease” [pre-disposition] often life-long

with periods of prolonged remission and often

punctuated by relapses followed by continued

recovery – Treatment is a “process” not event

May incorporate traditional therapies, nutritional

therapies, psychiatric medications, and relevant 12-

step and other community based support groups

when indicated

PART IV: A BLENDED TREATMENT MODEL

Structured Food Plan – eliminates “trigger” foods

Cognitive Behavioral Therapies + Harm Reduction

Constructive Living Model – Responsibility for

Recovery responsibility is with patient with less

emphasis on “fixing feelings” more on “right actions”

Treatment of [multiple issues / disorders] with ED

“Real World Setting”– [Inpatient / Residential]

Use of Community based support groups

Role of Medication for Mood Disorders when needed

Evidence Based Treatments

Daily Living Skills [meal preparation, shopping, etc.]

Individualized Family Therapy*

TREATMENT COMPONENTS WITH BLENDED MODEL

APPROACH

Prescribed by a registered dietitian

familiar with eating disorders and

addiction model

Often involves weighing, measuring and

monitoring amounts / volume of food

Schedule of eating 3 to 5 times daily

Limits or eliminates junk food

Focus on a food plan not a “diet”

Discourages patients focusing on weight

but rather on restoration of health

STRUCTURED FOOD PLANS

S.E.R.F. – Components

S = Spirituality

E = Exercise

R = Rest

F = Food Plan

ESSENTIAL ELEMENTS OF RECOVERY

LIFESTYLE

Note: Above is individually prescribed, depending on the

patient’s needs at the time…

Milestones In Recovery – 800-347-2364

ED Support Groups PA, NY, FLA [954-272-0806]

OA (Overeaters Anonymous) OA.ORG

ABA (Anorexics and Bulimics Anonymous)

ANAD Support Groups

EDREFERRAL.COM

A Guide to ED Recovery – download at i-Books *

*Access through an i-Pad Device Or request a free cop by email

[mlerner@MilestonesProgram.Org]

RESOURCES

800 347-2364

TREATING EATING

DISORDERS since 1999