Archive for the ‘dual diagnosis’ Category

Poem by Ali Valenzuela

March 4, 2008
Ali wrote this poem about her experience of recovering from an eating disorder and kindly sent it to me for publication on this site. I would like to take this opportunity to commend Ali’s courage, determination and generosity. In her struggle to gain treatment for anorexia and despite being desperately ill, she has worked tirelessly to raise the profile of eating disorders in Wales.

I was lost and alone, didn’t know who to be,
and felt like an outcast, unaccepted for me.
When I needed a friend; a voice to console,
I heard a small whisper: “You’re not on your own.
I’ve seen you around and you’re needing a friend,
and i promise to be there right until the end.”
I jumped at the offer of close company,
but little did I realise quite how close it’d be.
I felt proud to decline food-it showed me my strength
To say bno to the things I would want at great length.
I felt so in control and my confidence soared,
what with all of the exercise, I was never bored.
People said “what willpower it takes to do this!”
but little did they know it came with a twist
I was hungry and needed to eat a good meal
But the voice would get louder and started to squeal:
“what the HELL are you doing, you fat, dirty BITCH?!
We’ve got you SO far, now you shovel down THIS?!
It doesn’t make sense to delay your progress!”
But by this point, I only began to obsess
about every morsel that passed my lips
Added shame and disgust to the top of my list.
Temptation’s no match for this beast that’s insidethat slowly consumed me- I had nowhere to hide.
It was eating me up, and rotting my soul-
If it were to continue, it’d swallow me whole.
My clothes wouldn’t fit and my body was frail,
but no matter my state I couldn’t possibly fail
The anorexic voice that drowned out the lot
of my terrified family, begging me to stop.
Who crept into my room in the dead of the night
To see if their daughter was still breathing alright.
People gasped at my bones that protruded my skin,
pointing with horror at ‘the girl that’s so thin!’
I was ashamed and afraid, so much internal pain,
I thought i would never become me again
It was the worst nightmare i could possibly know
as even when I woke up, it was there in full flow.
At a rock bottom where I could have easily died
Finally, hospital help had arrived!
It took all away control of anorexia’s ways
and slowly but surely I started to change
My passion for life started to get on track
I can’t tell you how good it feels to be back!
With recovery started, I learnt to control
The anorexic voice, and listen to my own.
But I still live in terror of the voice I followed,
Dragging me back to it’s world of sorrow
So I’m sharing my story of horror and pain
to prevent this from happening to anyone again
I can never repay those who supported me through
the hardest time of my life- all i say is Thankyou.

xxx
Ali Valenzuela

 

 

 

 

 

 

 

 

 

 

 

 

 

 

addiction?

February 13, 2008

 

 

 

 

Are eating disorders an

 

 

 

 

 

 

addiction?

 

 

 

Can compulsive eating be compared to an addiction like compulsive gambling?

 

Is the chemical hit produced by periods of starvation similar to that of heroin?

 

Are eating disorders an addiction?

 

 

…This is surely one of the most controversial and emotionally laden subjects in the mental health field. In this article I will explore ways in which an eating disorder is (and isn’t) like an addiction…

 

 

 

 

I personally do not subscribe to the idea that anorexia, bulimia and binge eating are addictions. This is because eating does not create the biological dependencies which are implicit in addiction to drugs such as nicotine or crack cocaine.

For example, chemical changes occur within the body of an alcoholic so that they physically need alcohol to function in a “normal” way.

 

 

When I suffered from anorexia I was emotionally and mentally dependent on starving. There were a million reasons why I felt “unable” to eat, and physically I was unable to digest very much food because my stomach had shrunk. But I did not physically need to starve so that I could function. My need not to eat was primarily mental rather than physical.

 

 

 

 

“Addictive personality”…?

 

Up to date research suggests that only 5% of drug or alcohol users become chemically addicted and that particular personality “types” are most likely to become dependent, regardless of the chemicals used.

 

 

Certain childhood behaviours may predict adult addictive tendencies… there are “early warning” signs. You only have to sit in an AA or NA meeting to hear people in recovery describe how they knew they were an “addict” long before they ever picked up their first drink or experimented with their first drug.

 

 

Common features include childhood feelings of inadequacy, loneliness and isolation. Children who are very shy or very loud. Unhappy children who use ritualistic behaviours to soothe their internal pain. Repetitive tapping or stepping, talking to one’s self, making up secret “rules” to manage anger or anxiety.

 

 

When I was a child I said individual prayers on behalf of everybody, everybody I knew, every night. I even said a prayer from the people I didn’t know. I said one from the people I would meet one day and another from those I would never meet. I said extra prayers in case I forgot anybody… it took hours. I wasn’t a religious child, but I would wake up guilty and terrified if I forgot anybody.

 

I never stepped on cracks, I only sat on the floor at home, I touched things the same number of times with my right hand and then my left. I walked the long way to school to avoid passing the Golden Labrador pup. All the children loved to pet him ~ but I couldn’t bare to leave him. I couldn’t go until I saw another kid in the distance and knew he wouldn’t be alone.

 

I failed miserably to communicate with children my own age and preferred to play by myself. I wasn’t bullied, but I had no friends. I could go on and on… mostly small, quiet things which nobody ever noticed; but my childhood was a series of carefully balanced rituals planned to avoid or justify feelings of guilt. Such disassociative actions could be perceived as the early emergence of addictive behaviour.

 

 

 

 

 

 

Addictions and Eating Disorders

 

 

 

Shared Characteristics

 

 

Eating disorders certainly share many characteristics, symptoms and behaviour trends with addictions. It is common to hear people describe themselves as being “addicted” to chocolate or salty foods. They also feel deprived when they can not eat these foods and crave them.

 

 

People with eating disorders (for example anorexia) may achieve both an emotional and physiological “high” when starving. A bulimic might experience stress release of tension relief when purging. Compulsive eating can provide both a rush of energy with sugar, than drowsiness when satiated. At the beginning, there is always a “reward”.

 

 

 

Some shared

 

 

 

characteristics:

 

 

Secrecy

 

 

Deception and lies (e.g. pretending to have eaten)

 

 

Ritual (Rules and specific patterns of eating, a particular routine for vomiting, etc)

 

 

Pre-occupation (constantly thinking about food)

 

Use of a behaviour or drug to “cope”

 

 

Prioritising compulsive behaviour or addiction above all else

 

 

(e.g. above relationships, finance, physical and emotional health) etc

 

 

Illegal behaviour to support behabiour (such as shoplifting)

 

 

Social withdrawal and depression

 

 

Gradual reduction in the “positive” effects of their disorder or addiction and an increase in drug or behaviour use to compensate.

 

 

Ultimately, eating disorders can become the centre of a person’s life in the same way as any chemical addiction and sufferers are likely to feel emotionally unable to cease damaging behaviours.

 

 

The relationship between eating

 

 

 

 

 

 

disorders and chemical addiction

 

 

 

 

 

Statistically, there is no hard evidence to suggest that people with eating disorders are more likely to have alcoholics or chemical addicts as close family members. I personally find this surprising to the point of disbelief.

 

 

The majority of sufferers I know have some family experience of addiction.

There is evidence to suggest that somebody with a close family member who has an eating disorder is four or five times more likely to develop one themselves. But this could be learned behaviour. We already know that amongst young girls who are not genetically related, a single sufferer can significantly increase the risk of eating disorders in her peers.

 

 

Finally, there is much written about the prevalence of cross addiction or co-morbidity. It is indisputable that a huge amount of people with eating disorders also suffer from a chemical addication or self-injury (self-harm). There is so much to say on this subject… I guess that’s another blog.

 

 

Addiction or not – an addiction model can be a helpful form of treatment. OA (which adopts the AA 12-step recovery model) provides free self-help groups world wide. And whilst the abstinence model may be negated (a person with an eating disorder must learn to manage eating healthily if they wish to recover) the emphasis on peer identification, openness, acceptance and personal responsibility can be empowering and supportive.

 

 

Interested in this subject? You may find the short film below helpful………

 

 

 

suicide, eating disorders and self-injury links

February 5, 2008

Suicidal Young Girls Need More Help

Monday, February 26th, 2007business-card-imagejpg.jpg

BBC on-line

Young girls are crying out for help – last year one in six calls to a 24 hour mental health helpline came from young girls considering suicide. Depression, eating disorders sexual abuse and bullying seemed to be some of the main problems affecting young girls – according to the article on the BBC website, rates of depression and anxiety have increased among young people in the UK by 70% in the last 25 years. That’s a huge percentage, and an extremely worrying one.

Joelle Leader, assistant director of ChildLine said “At the moment, there are simply not enough therapeutic services for children with these problems, and we are urging the government to give this issue urgent attention.”

More doctors

Eating problems also featured high on the list of mental health concerns, with 1,854 girls and 158 boys ringing for help and advice.

Marjorie Wallace, chief executive of SANE, said the charity had recorded an increase in the number the number of calls to its helpline from young people who self-harmed – sometimes in a brutal fashion.

“Those young people calling about self-harm report an almost doubled rate of suicidal thoughts than non self-harmers, and a significantly higher incidence of past suicide attempts.

“What is alarming is the numbers of those taken to A&E departments who are sent home without any follow-up help.

“We need doctors and teachers to be more alert to the potential risks, and many more therapists available, to prevent the vicious cycle of relief by painful self-harm.”

 

 

Dual diagnosis (evidence and statistics)

January 23, 2008

the_alcoholic.jpg

It is commonly accepted that eating disorders often co-exist or co-present alongside mental illness or addiction. Associated problems include depression, anxiety disorder and suicidal behaviour.(1) In addition, sufferers are highly vulnerable to developing substance misuse problems or alcohol dependency(2). The national Eating Disorder Association actually identify self harming behaviour, drug addiction, alcohol abuse and tranquilliser addiction as being consequences of an eating disorder.
So how do we “take due account of ordinarily confounding issues including contemporary patterns of co-morbidity and co-occurrence of problems and disorders…” (3)

The Graham Menzies Foundation and Cyswllt Contact Ceredigion have compiled a proposal for a dual diagnosis pilot service in Ceredigion, with both local and national reach. If you are developing similar plans or placing funding bids in this area then the following evidence and reading may be of use. Please contact me if you need more information or support.

Rowenna

Some Statistics

The prevalence of non-lethal self-injury among ED patients is approximately 25%, regardless of the type of eating disorder or the treatment setting(4)

About 25% of self-harming individuals with ED (eating disorders) appear to meet the criteria for borderline personality disorder (BPD). (4)

Co-morbid major depression or dysthymia has been reported in 50%–75% of patients with anorexia nervosa and bulimia nervosa.(3)

Estimates of the prevalence of bipolar disorder among patients with anorexia nervosa or bulimia nervosa are usually around 4%–6% but have been reported to be as high as 13%).(3)

The lifetime prevalence of obsessive-compulsive (OCD) among anorexia nervosa cases has been as high as 25%, and obsessive-compulsive symptoms have been found in a large majority of weight-restored patients with anorexia nervosa treated in tertiary care centres.(3)

OCD is also common among patients with bulimia nervosa.(3)

Co-morbid anxiety disorders, particularly social phobia, are common among patients with anorexia nervosa and patients with bulimia nervosa.(3)

Substance abuse has been found in as many as 30%–37% of patients with bulimia nervosa; among patients with anorexia nervosa, estimates of those with substance abuse have ranged from 12% to 18%, with this problem occurring primarily among those with the binge/purge subtype).(3)

Co-morbid personality disorders are frequently found among patients with eating disorders, with estimates ranging from 42% to 75%.(3)

Eating disordered patients with personality disorders are more likely than those without personality disorders to also have concurrent mood or substance abuse disorders.(3)
(1) KCL Anorexia Nervosa, The physical Consequences
(2) Eating disorders and psychiatry, Kings College London. By professor Janet Treasure and Dt Anna Crane, 2008.

(3) All Wales Eating Disorder Special Interest Group, report comissioned for Health Commission Wales.

(4) The Prevalence of SHB (self harming behaviour) Among Eating Disorders Patients

Eating Disorders and Self-Harm: A Chaotic Intersection Eating Disorders Review

Randy A. Sansone, MD is a Professor at Wright State University School of Medicine, Dayton, OH.
John L. Levitt, PhD is Clinical Director of the Eating Disorders Program at Alexian Brothers Behavioral Health Hospital, Rolling Meadows, IL.
Lori A. Sansone, MD is in private practice with Alliance Physicians, Dayton, OH

Interested in this subject? Suggested further reading:

‘Self Harm and Eating Disorders’ (edited by John L. Levitt, Randy A. Sansone and Leigh Cohn).
This book explores the prevalent but largely uncharted relationship between self-injury behaviours and eating disorders symptoms. (available from Amazon).

And check out… a related construct; “multi-impulsive bulimia”, which also involves impulsive self harm behaviour (e.g. suicide attempts), in addition to other forms of impulsivity such as substance abuse and sexual promiscuity. Compared with BPD, considerably less is known about multi-impulsive bulimia in terms of etiology. It may be that this syndrome is actually made up of a subset of individuals with BPD. (4)