Prepared for Cigna by Milestones Eating Disorders Program...drugs Binge Eating / Purging will show...
Transcript of Prepared for Cigna by Milestones Eating Disorders Program...drugs Binge Eating / Purging will show...
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
RESOURCES
800 347-2364
TREATING EATING
DISORDERS since 1999