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Anorexia & Autism

In our previous blog, The Science of Eating Disorders, we discussed the importance of ongoing research regarding the genetic origins of eating disorders. This focus has many implications for improving prevention, identification and treatment efforts. One example of this topic was highlighted in a recent Time Magazine article focusing on new research that uncovered possible genetic links between anorexia and autism. Autism is a brain development disorder that develops prior to age three and affects boys at a much higher rate than girls. In comparison, anorexia nervosa (AN) affects females at a higher rate than males, and the average age of onset is between 14 and 18. While on the surface these two disorders may seem like unlikely partners, recent research and clinical observations may prove differently. In fact, according to the article, research suggests that approximately 15% to 20% of patients with AN may also have Asperger’s syndrome, which is on the Autism Spectrum. The Time Magazine article addresses possible explanations for the underlying similarities between autism and AN and elaborates on further connections between the two disorders. Several of these main points are summarized and excerpted below:

Emotion regulation is a common trait among individuals with autism and in those with AN.
“There is evidence that the ‘repetitive thoughts and behaviors, rigid routines and rituals and perfectionism’ that characterize both autism and AN may be traced to the same regions in the brain.”
It’s possible that the development of autism and the development of AN actually rely on the same genetic predisposition but it may manifest differently depending on an individual’s gender.
”Starvation itself intensifies autistic characteristics like rigidity and obsession.”
Underweight individuals with AN performed poorly on a test of interpreting other people’s emotions. The test was originally developed to study impaired social interactions in people with autism-spectrum disorders.
“The theory is that hunger focuses the brain so sharply on the task of getting food that it shuts down higher cognitive functions, like reading other people’s emotions.”

To find out more about this topic, read the full length article, A Genetic Link Between Anorexia and Autism? and post your comments about this topic on our discussion board.

Published by Kate Clemmer
July 1st, 2009 in In the News, Glossary Definitions, Editor's Picks, Celebrity Topical News
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The Science of Eating Disorders

photo courtesy of http://www.makeuseof.com/

For many years it has been observed that eating disorders (EDs) sometimes run in families, but it has not been known why. Do EDs develop because family members model disordered eating behaviors/attitudes that are emulated by those who observe them? On the other hand, is there a genetic cause that has nothing to do with modeled behavior? Or, is it a combination of both factors? These questions address the classic nature vs. nurture debate. Fortunately, as technology has become more sophisticated over the last 10 years, there has been much research into the role of genetics in EDs, and the results have already begun to help guide prevention and treatment efforts.

Family studies have produced the following conclusions:

If an individual’s mother or sister has had Anorexia Nervosa (AN), they are twelve times more likely than someone without a family history of AN to develop AN.
If an individual has a family member with Bulimia Nervosa (BN), they are four times more likely to develop BN than people without a family history of BN.
If an individual has a family member with Binge Eating Disorder (BED) they are two times more likely to develop BED than people without a family history of BED.

Twin studies that compare identical twins and fraternal twins have been helpful in detecting the genetic contribution to the development of EDs. This is because twins “share” the same family environment. However, while identical twins share 100% of their genes, fraternal twins only share 50% of their genes.

Twin studies have found that:

AN and BN are more likely to occur in both twins when they are identical (100% of the same genes) than in fraternal twins (50% of the same genes), suggesting that genetics play a very important role.

In genetic linkage studies, researchers collect genetic samples from multiple generations of family members in which at least two members have EDs. They look for common variations and “linkages” in the actual genes that may be passed from parent to child. Linkages are areas on a chromosome that contain several hundred genes. In genetic association studies, specific genes of interest are compared between people who do and do not have EDs.

Genetic studies have produced the following findings:

Significant linkages have been found on chromosome 10 for BN and chromosome 1 for AN. At this point it is unknown which genes in the identified linkages are involved in EDs and what these genes control.
Genes that control the neurotransmitter serotonin have received a lot of study and results suggest these genes may play an important role in EDs, particularly AN. Serotonin is involved in the regulation of appetite and eating behavior.
Certain personality traits common in people with EDs are also considered moderately heritable. Traits seen in childhood before people develop AN or BN include obsessionality and perfectionism. These traits are neither good nor bad; for instance, perfectionism that is directed towards achieving a “perfect body” might exacerbate an ED while perfectionism that is directed towards achieving “perfect grades” can make people successful in school.

What Are the Implications?

EDs are complex illnesses caused by multiple factors. While it appears that people may inherit a genetic vulnerability for EDs, this does not guarantee development of an ED. Rather, researchers think inherited genes may be “turned on” when an individual is exposed to particular environmental factors such as a culture that emphasizes thinness, dieting behavior, a traumatic event, participation in high-risk sports, or a combination of triggers. Ultimately, the hope is that a better understanding of the genetics of EDs will continue to inform prevention and treatment efforts and reduce stigma associated with the illness.

For more information, see http://www.anbn.org/.

Submitted by: Sarah Hubbard, PhD

Published by Sarah Blake
June 14th, 2009 in In the News
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Glamour Magazine’s 2009 Body-Image Survey: Insight with a Heavy Dose of Mixed Messages

Twenty-five years after their first body-image survey, Glamour Magazine revisited the task of polling 16,000 American women on how they feel about their bodies. Interested readers could participate in the poll voluntarily by filling out a survey online so it doesn’t necessarily represent a random sample of women (particularly those who would choose NOT to answer questions about their body image). While this wasn’t a scientific study , it does offer a rare glimpse at the collective state of female body image in our country and the results were recently discussed on NBC’s Today Show.

Unfortunately, in order to read about the survey results online we are confronted with some of the reasons why our body image may suffer in the first place. Be prepared. Despite an opening line in the on-line article that reads, “We at Glamour think your body is fantastic”, you will simultaneously be bombarded by diet advertisements, offers to join weight loss and work out clubs, and countless airbrushed images of models whose bodies are not representative of 98% of us. While reading, we are reminded to love our bodies as they are, yet targeted by countless internet ads and competing headlines convincing us of the best ways to change ourselves so we can look “better”. While these mixed messages are certainly frustrating, this article is worth reading and is an opportunity to practice “critical viewing of the media” which involves a self-censoring of messages and images that are false, misleading or otherwise unhealthy for our self-esteem and body image. Remember to focus on the article and the positive information it conveys such as suggestions from real women in the survey about ways to improve your body image, including:

Focus on professional achievements and look for validation in places other than in the mirror
Give compliments to other women often, and choose to believe and accept the compliments you receive from them!
Ditch the dieting scene
Surround yourself with people who make you feel good about yourself

The poll also turned up several interesting statistics regarding body image including the fact that younger women (under 30) were 20% more likely to say they are happy with their bodies than older women. Is this a result of a successful shift towards self-love for our younger generations? Or, does this stem from increasing cultural and media pressures on women in their 40s, 50s and beyond to maintain an image that was previously only expected of teenagers and twenty-something’s? What do you think? We’ve started a thread on our discussion board, and we would love your feedback. Be sure to leave your comments after reading the full article, which you can find here: Glamour’s Body Image survey.

Published by Kate Clemmer
June 13th, 2009 in Body Image
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“Exercise Bulimia”

Shoes

Is there such a thing as too much exercise? You can’t go anywhere or watch anything today without being inundated with hundreds of advertisements for diets, work-out videos and equipment, gym memberships, or reminders about how you’re supposed to look in a bathing suit. This affects all of us: men, women, college students, athletes, adolescents, moms, dads, you name it. A number of articles written in college papers, on “exercise” bulimia recently came to our attention. “Exercise Bulimia Overlooked,” written by Iliana Paul, In the Mount Holyoke News, was one such article and discussed how this disorder is becoming more prevalent in females across college campuses in the United States. As this is an important topic, we would like to highlight and clarify several important aspects of Anorexia Nervosa and Bulimia Nervosa, for our readers.

Sex. Females are not the only ones who are known to suffer from eating disorders (ED). This is a very common stereotype. Even though there is an increased likelihood for females to be seen with an ED, the known male population in eating disorder clinics around the U.S. is increasing yearly. About 10% of patients with an ED, known to mental health professionals, are male (Wolf, 1991; Fairburn & Beglin, 1990). Males may have an even greater risk of having an ED oriented around over-exercising, possibly from athletic or social gender role pressures.

Age. Individuals of all ages are affected by eating disorders. While eating disorders are highly prevalent in individuals 15-25, eating disorders effect individuals ages 10 and younger, and spans in the other direction up to 70 and beyond.

DSM - IV - TR. “Exercise” bulimia is not an official diagnosis of an eating disorder in the DSM - IV. According to the manual’s diagnostic criteria, there are two types of Bulimia Nervosa: purging type or non-purging type. Thus a person suffering from Bulimia Nervosa, non-purging type would be seen having recurring binge eating episodes followed by behavior that would indicate that they were trying to lose weight (e.g. excessive exercise). Patients with Anorexia Nervosa may also exercise excessively while not taking in the appropriate amount of calories required for the amount of activity they’re participating in.

Physical exercise can be a great way to stay healthy. However, the old adage, “Do not start an exercise program without consulting with your physician,” remains. If caloric intake isn’t a part of your weekly work-out, you could cause more harm to your body then any good the exercising may be doing. Lack of nutrition plus compulsive exercise could result in significant medical and psychological issues for athletes and non-athletes alike. This can include osteoporosis, amenorrhea (loss of menstrual periods), muscle injury, depression, dehydration, stress fractures, and even cardiac arrest. So, yes, there is such a thing as too much exercise. Moderation is key, after the doctor has given his or her stamp of approval!

Submitted by: Kate Dykeman, Outreach Intern

Published by Sarah Blake
May 24th, 2009 in In the News
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Dialectical Behavior Therapy: PART II

The growing popularity of Dialectical Behavior Therapy (DBT) in the treatment of eating disorders (ED) is of great interest to professionals, patients and families who have been struggling with the effects of an eating disorder. Recently, our blog, “Dialectical Behavior Therapy: Part I” introduced the background and basic principles behind DBT in an effort to clarify its importance and relevance in the field of ED treatment. Today, Part II of the blog goes a step further to help increase understanding of the DBT process and the specific ways in which it can help move patients toward recovery. As mentioned in Part I, DBT is composed of four modules, each with its own goals and skill sets. Each of these modules are introduced and described below:

Mindfulness:

The art of “learning to be in control of your mind, instead of letting your mind be in control of you.” Accomplishing this is not a task of controlling one’s thoughts, but rather practicing the ability to control one’s attention. The goal behind this module is not change, but rather acceptance of whatever one is experiencing in any given moment. In this module, individuals learn how to:

be exposed to information from inside themselves to which they would usually be unaware
more effectively regulate these thoughts, feelings, and reactions
shift attention when attention on a certain thing is not productive

Distress Tolerance:

Distress tolerance is the ability to endure and accept emotional suffering. This is essential to good mental health since, as Linehan notes, “pain and distress are part of life; they cannot be completely removed or avoided.” Mastering these skills is vital to recovery since ED symptoms are often used to provide immediate gratification in the relief of pain/distress. If someone is not able to tolerate distressing feelings without acting on symptoms, then those impulsive actions will continually interfere with efforts at recovery. The goal of this module is to decrease impulsive behaviors (i.e. self-harm, bingeing, purging, etc.) by providing alternate healthy ways of coping with negative emotions such as self-soothing, distracting, and thinking of pros and cons.

Emotion Regulation:

As noted above, ED symptoms often serve to numb out painful emotions. As a result, many individuals in the early stages of recovery have a hard time identifying what they are feeling and why. Emotion Regulation skills focus on:

understanding one’s emotions, including learning how to identify a specific emotion and it’s function
reducing one’s vulnerability to negative emotional states and increasing positive emotions
mindfully letting go of painful emotions and/or modulating or changing a negative emotion when possible

Interpersonal Effectiveness:

Difficulties with self-esteem, perfectionism, tolerating distress, and the drive to please others, can often interfere with attempts to have healthy, fulfilling relationships. This module provides concrete strategies to help improve assertiveness and interpersonal problem-solving in order to facilitate healthy life changes and improve/maintain self-respect. Skills learned in this module include:

asking for what one needs
saying no and setting healthy boundaries
coping with interpersonal conflict effectively.

The Center for Eating Disorders is now offering DBT group therapy on an outpatient basis. Each group will meet once a week for a six month period.

Beginning June 4th, 2009, our 1st DBT group will be starting from 5:30 - 7:00 pm. A second DBT group will be starting on Tuesdays from 11:00 am - 12:30 pm. Start date TBD.

For more information about these groups or any of our DBT programming, please call (410) 938-5252.

References

Linehan, M.M. (1993). Skills Training Manual for Treating Borderline Personality Disorder. New York: Guilford Press.

Behavioral Tech, LLC. (1996-2009). What is DBT? Available at: http://behavioraltech.org/resources/whatisdbt.cfm

Written by: Kristin Grasso, Psy.D., Center for Eating Disorders at Sheppard Pratt

Published by Kate Clemmer
May 15th, 2009 in Therapies
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Dangerous Diet Pills: Hydroxycut Recalled

Recently, the FDA recalled Hydroxycut products, the popular line of weight-loss supplements that have been on the market since 2002. Consumers were warned to immediately stop using the product after it was associated with 23 reports of serious health problems, including the death of a 19-year-old male due to liver failure.

This is not the first instance of a weight-loss supplement being removed from the market as a result of its serious health consequences. (Remember the recalls on Fen-Phen and Ephedra?) However, many consumers were still surprised to hear the news; the popularity and wide availability of Hydroxycut products for the past seven years have provided a false representation of the products’ safety.

It’s important to realize that unlike pharmaceutical drugs, manufacturers of dietary supplements do not need FDA approval before putting their products on the market. Instead, the FDA will step in to identify harmful products after they are already on sale. The problem with this system is that it can be difficult to identify isolated incidents, especially since the FDA depends on voluntary reports which can often come late or not at all. Case in point: the death of the 19-year-old male from his use of Hydroxycut occurred in 2007, but was not reported until March of 2009.

We here at The Center for Eating Disorders at Sheppard Pratt, would like to take this opportunity to remind you about the dangers of using any type of dietary supplements, which have the potential to become addictive and affect your health. Seizures, cardiovascular disorders, and rhabdomyolysis were just a few of the reported health problems associated with Hydroxycut. Additionally, there were reports of liver damage from those who took the doses recommended on the bottle, which goes to show that you do not have to abuse these popular supplements to be a victim of their harmful side effects.

In the often constant focus by society and individuals on the pursuit of thinness, the thought to the cost associated with this pursuit is often lost. This recall sheds light on just some of the tremendous dangers associated with this desire to change ones body through this type of “quick fix” via a pill. The list of consequences and of unhealthy schemes are too numerous to list here, but before embarking on another weight loss plan, give some thought - are the risks REALLY worth it?

Published by Sarah Blake
May 12th, 2009 in Celebrity Topical News
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A Legacy for Your Children

Mother's day

A recent article in Real Simple magazine’s May issue, asked readers “What’s the Greatest Gift your mother ever gave you?” One of the responses that stood out was from a woman who wrote,

“My mother told me, every day, that I was beautiful inside and out. When the mirror reflected my braces, clunky navy blue glasses, the body of a 12-year-old boy, and that horrific perm, I wanted to doubt her, but she was so steadfast and convincing that I didn’t.”

-excerpted from Real Simple, May 2009

This Mother’s Day, remember and celebrate the enormous impact you can have on the body image and self-esteem of the young girls in your life. Whether you are a Mom, Aunt, or Grandmother, you are a powerful force in helping these girls develop a healthy sense of self, confidence, and love of their own bodies.

Often times, when we are in the community educating young people about positive body image, we ask them “when do you think we start to develop our body image?” Most people guess that this occurs some time during early adolescence - or those “awkward” middle school years. In reality, body image begins to form at a much younger age. Think about all of the things a toddler sees you do and tries to emulate - funny faces you make, the way you eat your food or perhaps that four letter word you let slip. If she sees you criticizing body parts in the mirror or cursing your waistline, she will learn that being critical of her body is something she is supposed to do, as well. On the other hand, if she can watch you displaying body confidence on a daily basis, she can begin to do the same.

Telling your daughter she is beautiful, both inside and out, is just one piece of helping her to develop a positive body image. Here are a few more tips and important ways you can help your daughter love herself and her body:

Love yourself. As a mom, you are the most important role model for your daughter. It’s up to you whether you model body appreciation or body dissatisfaction in your own life.
Celebrate the diversity of beauty with your daughter. Avoid falling into the media’s narrow definition of what is beautiful. Remove magazines and other media from your home that pay unnecessary attention to body size, appearance or criticism of the way people look.
Place value on talents, interests, and intellect instead of solely on physical appearance.
Teach those around you about the hazards of making negative body comments and ban them from your home. Tell your family and friends that you wish to teach your children about loving their bodies which cannot be done if the people around them are commenting on their bodies or your children’s bodies!
Teach your children that healthy people come in all shapes and sizes. Work on stamping out fat discrimination one person at a time - start with yourself and your children.

To all of the mother’s out there, and all of the individuals celebrating Mother’s Day, The Center for Eating Disorders wishes you a happy Mother’s Day. May it be a day filled with joy and wonderful positive thoughts and actions.

Published by Kate Clemmer
May 9th, 2009 in Body Image
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Dialectical Behavior Therapy: PART I

What is a life worth living? That is the essential question behind Dialectical Behavior Therapy (DBT), the goal of which is to help individuals build a life that has meaning and worth, with a freedom from suffering.

DBT was originally developed by Marsha Linehan, Ph.D., to treat individuals who engage in self-harm behavior, many of whom meet the diagnostic criteria for borderline personality disorder. DBT represents a merging of therapeutic approaches, including cognitive behavioral therapy (CBT) and Eastern therapuetic modalities. CBT which emphasizes one’s ability to change thoughts and behaviors, has been criticized for not addressing emotional dysregulation (a difficulty with responding to emotions in the culturally accepted manner), often a significant problem for people with Eating Disorders (EDs). Thus, in developing DBT, Linehan also integrated Eastern psychological and spiritual philosophies, including the practice of mindfulness, which provide for a heightened focus on acceptance (rather than change) and on the healthy regulation of difficult emotions.

Research has shown DBT to be effective in the treatment of borderline personality disorder, substance dependence, chronic life threatening behavior, and dissociative behaviors. These are issues that often co-occur with EDs. The research directly linking the utility of DBT for EDs is preliminary, but investigations have shown promising results for patients with Bulimia Nervosa and Binge Eating Disorder.

The Center for Eating Disorders utilizes DBT at all levels of care. The first three modules are introduced in our inpatient and partial hospitalization programs, while full coverage of all four modules is applied in our intensive outpatient program, as well as in individual therapy at all levels of care. If you’d like to read more about the four modules of DBT, check back to our blog again soon for Dialectical Behavior Therapy: Part II.

The Center for Eating Disorders is now offering DBT group therapy on an outpatient basis. For more information about these groups or any of our DBT programming, please call (410) 938-5252.

References

Linehan, M.M. (1993). Skills Training Manual for Treating Borderline Personality Disorder. New York: Guilford Press.

Behavioral Tech, LLC. (1996-2009). What is DBT? Available at: http://behavioraltech.org/resources/whatisdbt.cfm

Written by Kristen Grasso, Psy.D, Center for Eating Disorders at Sheppard Pratt

Published by Kate Clemmer
May 8th, 2009 in Editor's Picks
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Annual Symposium Review

As we mentioned in our last few Q&A posts, we hosted our Annual Symposium on Saturday, April 18. The beautiful weather and gathering of accomplished eating disorder professionals made for an extremely enjoyable day. Our symposium was designed to bring cutting edge, innovative treatment knowledge and options to the professionals caring for people with eating disorders. And, we are happy to report that more than 135 people were in attendance!

Below is a list of speakers, topics and a few pictures from our exciting event:

Steven Wonderlich, Ph.D., spoke about trauma as it relates to eating disorders and the impact this trauma may have on diagnosis and treatment.

Stewart Agras, M.D., discussed empirically-based treatments for Bulimia Nervosa, including Guided Self Help, Cognitive Behavioral Therapy and the use of antidepressants in the treatment of bulimia.

Judith Banker, MA, LCP, FAED, talked about the gap between research and practice and the concern that research findings and clinical observations become lost in this gap. She went over the proposed guidelines for Research-Practice Integration and the benefits to patients, researchers and clinicians in this exchange.

Dr. Kathryn Zerbe created a beautiful artwork backdrop to help illustrate her description of interventions with eating disorders based on their specific life stage. Throughout her discussion of transferance and countertransferance, she continued to provide fantastic works of art to help solidify her concepts.

Michael Levine, Ph.D., who returned to the symposium after postive feedback from his presentation last year, revisited the ideas around prevention efforts and the ways in which media and culture can shape individual’s views on beauty and cultural norms. He exhorted the audience to use courage to fight against the pervasive messages within our culture, not just in reference to beauty but in reference to gender, class, race and the ideas of power, as well.

Keep checking back as we will post select video footage from the symposium soon!

Published by CED Editor
May 3rd, 2009 in CED Events
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Anorexia Nervosa and Autism Spectrum Disorder Link?

We saw this recent article in New Scientist about some links between Anorexia Nervosa and Autism Spectrum Disorder, particularly in some of the thinking styles.

Janet Treasure, PhD FRCP FRCPsych, a researcher and clinician in London, who spoke at the Center for Eating Disorders Symposium in 2008, has been researching this concept and has found that more than 1 in 5 individuals with Anorexia meet criteria for Autism Spectrum Disorder. The Autism Society of America states that Autism is reported to be found in 1 to 1.5 million Americans. As you can see, this represents a significantly higher rate in those with Anorexia then in the general public. With this information, additional research has been done to look at these thinking patterns, and potential therapies that may assist in working with these patterns.

The Center for Eating Disorders thinks that while more research is necessary, this study holds promise and we plan to keep our eyes and ears open for additional findings. Stay tuned to our blog for more information as it becomes available!

Published by Sarah Blake
April 25th, 2009 in In the News, Editor's Picks
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