By LAUREN METZGER
Published: October 17, 2014
A couple of weeks ago, I attended a small conference on eating disorder treatment and recovery hosted by St. Joseph Mercy Hospital in Ann Arbor, MI. Even though Ann Arbor is my hometown, I was eager to attend the event for other reasons. I thought it would offer a nice platform to spread the word about ANGI to clinicians and researchers outside of North Carolina, and it looked as though I could not pass up a chance to learn from an excellent line-up of presenters. In this post, I am going to recap the main points from three of the seven presentations at the conference and add some personal comments and observations along the way.
The first presentation of the day was by professor Kelly Klump, Ph.D., FAED of Michigan State University. Her lively and entertaining presentation was on the neurobiological risk factors for binge eating in women, in which she specifically focused on her research examining the role of estrogen and progesterone. Dr. Klump did a wonderful job at connecting the findings from her large breadth of research on this topic, including research with animal and twin models. These are what I consider to be the take-home messages from her presentation:
- Based on research with animals, we know that increases in estrogen cause decreases in food intake, but that increases in progesterone cause increases in food intake that counteract the effect of estrogen.
- During a woman’s menstrual cycle, the mid-luteal phase (post-ovulation) appears to be a risk time for binge eating because levels of both estrogen and progesterone are high.
- Pre-ovulation appears to be a time with less frequent binge-eating because estrogen is high and progesterone is low.
- Hormones may “turn genes off and on,” thereby activating genetic risk.
- Birth control pills may contribute to risk for binge eating disorder in women who are also at a genetic risk due to the effect some pills have at increasing levels of estrogen and progesterone.
- We still need more research examining the influence of hormones on menopausal and post-menopausal women, as well as men.
For the next presentation, I had a choice between learning how to navigate the legal and ethical issues in treating eating disorders and learning about the essential considerations for treating binge-eating disorder (BED). Since I recently starting co-leading a BED therapy group at UNC CEED, I thought the latter option would be best. Therefore, I attended Amy Pershing’s presentation. Pershing is a clinical social worker at St. Joe’s Center for Eating Disorders and has paired up with Chevese Turner (founder of BEDA and also one of the conference presenters) to found the Pershing Turner Centers for eating disorders in Annapolis, MD. I found Pershing’s presentation insightful and very helpful in fully understanding how both complex trauma and toxic shame contribute to the development and maintenance of BED. Here are the highlights from her presentation:
- People with BED tend to be blamed for their eating disorder, and the disorder is trivialized and viewed as just a lack of will-power.
- Clinicians need to understand the adaptive function of binge eating.
- Weight stigma can be a forms of complex trauma and a source of toxic shame.
- When eating is the only coping skill to deal with trauma, “resistance” to therapy should be understood as “resistance to change” and to protecting the self from further harm from the world.
- The “authentic self” and “authentic body” need to be validated because often reality and sense of self have not been validated due to complex trauma.
- The body is a home rather than a billboard and we should all embody our bodies.
- We should tend toward following the Health at Every Size (HAES) principals.
Any finally, the last presentation I will recap was by Ron Thompson, Ph.D., FAED, CEDS. He is the consulting psychologist to the Athletic Department of the University of Indiana and also co-founder of the Victory Program at MacCallum Place in St. Louis, MO. I was especially excited to meet Dr. Thompson because I have a special interest in athletes with eating disorders, which was the focus of his presentation. I will again take note of some of the key points to his presentation and then also add my own personal comments.
- Athletes have the same general risk factors for eating disorders, but they also have distinct risks due to the athletic environment.
- Athletics typically plays an indirect role in the development of the eating disorder rather than a direct role – many of the athletes who develop eating disorders would have regardless of their sport participation.
- It is fundamental to understand the athlete persona and identity during the treatment process, and leveraging these characteristic in the treatment process – athletes are “coachable”.
- The Victory Program is a specialized treatment facility for elite athletes.
- Research has shown exercise and training can be performed by elite athletes during treatment without negative consequences (*Victory Program uses exercise in treatment when they feel it will have no adverse medical or psychological implications).
- Sundgot-Borgen et al. (2002) found that exercise produced greater treatment effects than CBT in a sample of normal-weight women with bulimia nervosa; at follow-up 62% of exercise group had recovered from BN as compared to 36% in the CBT group
- Pressure from teammates may be a greater factor driving disordered eating than influence from coaches.
- Revealing uniforms can cause distress around body image and contribute to disordered eating and eating disorders.
As someone who identifies as an athlete, I think the standout point listed above is that treatment providers need to understand the athlete persona and that being an athlete is an identity. In addition, sport participation and exercise, similar to binge eating, can be a protective and adaptive coping skill. Being told to stop exercising could be heard the same way as “stop binge eating”, and this will likely produce resistance. As mentioned above, there is resistance because this may be the only skill the client has to regulate emotions, and without it, the world looks like a scary place that could be harmful (emotionally, physically, psychologically, etc.). For me, running has always been a source of comfort and protection – an emotional and physical escape when I was younger. While I feel I have a balanced relationship with running, if I were told to stopping running, I would surely be resistant. I feel there is sometimes a hard line set against exercise in the field of eating disorders, but I think the purpose of exercise needs to be better understood in the treatment process. Like the Victory Program – how can we use exercise as a source of healthy motivation with clients? And how can we understand exercise as adaptive and while also helping to expand their coping skills? Kudos to those clinicians and researchers who are working hard to answer these questions. There is no doubt that there will never be a one-size-fits-all when it comes to exercise and recovery, but it’s great to have such dedicated professionals exploring all of the possibilities.