Dr. Sunny Steinmeyer presentation entitled “Eating Disorders from the Inside Out”

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Dr. Sunny Steinmeyer presentation entitled “Eating Disorders from the Inside Out”

Dr. Steinmeyer obtained a Masters degree in Clinical Psychology from Edinborough State College in 1978 and a Ph.D. in Psychology from United States International University in 1986. Since then, she has served as an eating disorder consultant at various medical centers. She is currently the Director of the Eating Disorder Program for Sovereign Health and also maintains a private practice in Laguna Hills.

What an eating disorder is not:

  • Not a disease – no pathogenic behavior – not medical.
  • Not a choice.
  • Not a moral lapse, nor a matter of will power.
  • Not a life/death sentence. People do get well.

What an eating disorder is: A functional abnormality, involving a complex interval of various mental and physical factors, with no predictable course.

Eating Disorder vs. Normal Behavior

  • Unlike substance dependence behaviors, all eating disorders are a distortion of normal behaviors.
  • Moreover, we also share many of the same attitudes when it comes to negative self-perception, although not to the same degree.
  • For example, most of us act out to food in response to stress. Does this mean that we all have eating disorders? No!

The Mirror: “Every morning, I hate what I see in the mirror.” This is true for most people. For those with no eating disorder, the only person that is disappointed by the mirror is him/herself. People with ED usually think that they disgust everyone.

Characteristics of ED in general

  • Abnormal, harmful, food-related behaviors, such as restricting, bingeing, purging, etc.
  • Unhealthy obsessions, perceptions and expectations about food, weight and body shape.
  • Dangerous to careers and relationships. The eating disorder is always #1. Everything else is second. Relationship with food becomes more important than relationship with people.
  • Potential long-term health problems, life-threatening illnesses and even death.

Strengths of people with eating disorders

  • Often intelligent, tenacious, accomplished, attractive, sometimes self-absorbed, sometimes perfectionist to a fault.
  • Generally very rational/honest, except when it comes to food, body image and self-esteem. Then their distortions of the truth are astonishing and their perceptions assume psychotic properties.

Body Dysmorphia

  • Preoccupation by a perceived defect in physical features. For example, the belief that ‘fat’ appears immediately after eating.
  • Any perceived flaw is a major cause for public shame; any abdominal swelling (even if because of water).

The Many Roles of Food

  • A means of self punishment.
  • A standard for self-assessment.
  • A form of stress release and/or a way to mask unacceptable feelings.
  • In an environment of self neglect or denial, a form of reward.
  • A response to the illusion of being controlled.

Case Histories

  • Mother no longer the pivotal element.
  • Associated with trauma.
  • ‘Best little girl’ – always having to be better.
  • Genetic component.

Demographics

  • Around 8 million Americans with eating disorders. 7 million female and 1 million men.
  • Around 10% to 15% of people with eating disorders are men.
  • 95% who have eating disorders are between 12 and 25 years old.
  • Only 1 in 10 people with eating disorders get proper treatment. They need anywhere from 3 to 6 months of inpatient care. Cost can be $100,000 or more. Insurance does not cover this.

Eating Disorder Diagnoses

Anorexia (Anorexia Nervosa)

  • Obvious loss in body weight (15% or more below average weight for height/age). Preoccupation with being thin, while at the same time insisting that he/she is ‘fat’. Denial of hunger and avoiding eating meals in the presence of others. Obsession with nutritional values so that fats and carbohydrates can be avoided. Unusual food rituals – cutting tiny bites, eating foods in a particular order, e.g.
  • Anorexia can result in:
    • Osteoporosis.
    • Infertility.
    • Organ Failure (especially of the heart, kidneys).
    • At its extreme can be fatal.
    • Brain functions – Often when re-nourished, people regain memory and mental acuity.

Bulimia (Bulimia Nervosa)

  • No weight qualifications – may be average or overweight.
  • Frequent episodes of binge eating which may last 2 hours or more and in which more than 10,000 calories can be consumed (costing as much as $100/day).
  • Binge episodes are followed by some form of compensating behavior: vomiting, over-exercising, or laxative abuse, in particular.
  • Binge-purge cycles occur in response to negative feelings, particularly guilt or anger (no taste or pleasure).
  • Bulimia can result in:
    • Severe dental erosion.
    • Gastrointestinal disorders.
    • Esophageal ulcers.
    • Blood pressure.
    • Heart irregularities.

Compulsive Overeating (Binge Eating) Disorder

  • Often overweight.
  • Large amounts of food are consumed in a short period of time – usually in secret.
  • Compensating efforts are not present.
  • Often associated with unfulfilled needs for affection and validation (food = comfort).
  • Binges produce intense feelings of guilt or shame.
  • Binge eating can result in:
    • Diabetes.
    • High cholesterol.
    • Other health problems associated with obesity.

Orthorexia

  • Originally described by Steven Bratman, M.D., in 1997.
  • May go hungry rather than eat what does not meet ‘healthy’ criteria.
  • Motivated by a desire to feel healthy or ‘pure’ rather than to lose weight.
  • Research and food preparation are time consuming, often socially limiting.
  • Food is selected for its ‘purity’ rather than taste preference.
  • Orthorexia may result in:
    • Medical complications associated with malnutrition and starvation.
    • Often complicated by co-occurring disorders such as depression, substance abuse or OCD.

Diabulimia

  • While not an officially recognized term, the concept was developed by Anne Goehbel-Fabbri, Ph.D. Refers to women with Type 1 Diabetes who deliberately skip or reduce insulin in order to lose weight. Women with Type 1 Diabetes are 2.5 times more likely than other women to develop an eating disorder.
  • Diabulimia can result in:
    • Long-term damage to kidneys, nerves and the circulatory system.
    • Blindness or the need for amputations.
    • High risk of coma.

How do ED and substance abuse differ?

  • Different goals. Goal of alcohol/drug treatment is abstinence. Not true for eating disorders.
  • Eating is a natural need, unlike substances.
  • Different attitude towards relapse. Impossible not to expect it for eating disorders.
  • Treatment is not 12-step oriented. More focused on cognitive strategies.

Treatment Philosophy at Sovereign Health

  • Individualized treatment, incorporating elements from mental health or substance abuse components as indicated.
  • Cognitive-behavioral approach in which old ideas are challenged and behavioral risks are taken with reference to food, in presence of support.
  • The individual – not the program or therapist – is in control is emphasized throughout treatment.

Additional Therapy Options

  • Equine therapy.
  • Holistic practices: yoga, meditation, and biofeedback.
  • Neurobehavioral therapy: engaging state of the art computer programming to facilitate new and healthy thought patterns.
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