Tag Archives: anorexic

iTherapy – Integrating the iPhone into Therapy

iPhone Therapy

photo used under creative commons license

I recently read an article by Dr. Weissman of the Chicago Institute of Psychoanalysis that introduced the concept of using an iPhone in the treatment of anorexia and body dysmorphic disorder.

Times are changing faster than ever. Technological advances, such as the introduction of the iPhone, have drastically changed the way we communicate and perform everyday activities. We can easily observe our everyday lives via the video and photo component of the iPhone. Weissman believes that this component of iPhone technology could be an effective tool in the treatment of the body dysmorphia that often accompanies anorexia.

Many of my patients that are in treatment for anorexia also experience some level of body dysmorphia; they see an obese person looking back at them in the mirror even though they are drastically underweight. Today, body dysmorphia is typically treated through psychotherapy, nutritional support and medication. For some patients, these approaches have limited success rates.

When a patient talks to me about the “obese person” that they see in the mirror, I often introduce a body image exercise involving “photo-therapy”. I ask the patient to take a photograph of themselves and bring it to their next treatment session. Oftentimes, when the patient returns and we talk about the photograph, the same body that was once described as being “fat” and “obese” is now described as being “underweight” and “malnourished”.

Weissman explains that when an anorexic patient looks in the mirror, their self perception is instantly fused with a distorted body image. The brain is so overwhelmed by this distortion, that it cannot process the image of the “real” body. The brain becomes trapped in this optical illusion, this distorted view. In contrast, when an anorexic patient sees his or her self in a photograph, the brain first acknowledges that there is a person in the photograph, it then focuses on the physicality of the photographed person. The brain then sends the message to the patient that they are the person in the photograph.

Integrating iPhone Therapy into the treatment of anorexia could definitely be a powerful tool in overcoming the body dysmorphia associated with anorexia. Based upon psychotherapy techniques developed by Frieda Fromm-Reichmann in Principles of Intensive Psychotherapy I, the steps below are Weissman’s suggested approach to integrating the iPhone into treatment:

  1. Patient and therapist look at patient in the mirror. Patient describes what they see.
  2. Therapist takes a photograph of the patient with iPhone. Patient describes what s/he sees.
  3. Therapist and patient discuss the differences between the description of the patient in the mirror and the patient in the photograph.
  4. A photograph of the patient standing beside the therapist is taken. Patient describes the image of the therapist. If the patient see distortion in the therapists image, the therapist and patient develop a jointly shared description of the therapist.
  5. Patient describes image of self. If patient sees distortion, the therapist and patient develop a jointly shared description of the patient.

Weissman points out the importance of the therapist not correcting the distorted view of the patient. If the patient does experience distortion in the photograph, the therapist should remind the patient that they both agreed on the description of the image of the therapist in the same photograph. It is necessary that the therapist and patient try to come to an agreement on the description of the patient.

Weissman predicts that utilizing this iPhone exercise will lead to an eventual reduction in the amount of distortion that the patient experiences when looking in the mirror. A combination of iPhone Therapy, Cognitive Behavioral Therapy (CBT) and nutritional counseling may lead to the patient gaining the important ability to maintain a healthy weight with little outside assistance. If the therapist successfully teaches the patient to be able to independently perform this exercise on a regular basis, there could be a drastic drop in relapse rates.

Sources: “Photo-Therapy: A Promising Intervention in Anorexia Nervosa?”

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Medical Advice Disclaimer: The information included on this site is for educational purposes only. It is not intended nor implied to be a substitute for professional medical advice. The reader should always consult his or her healthcare provider to determine the appropriateness of the information for their own situation or if they have any questions regarding a medical condition or treatment plan. Reading the information on this website does not create a physician-patient relationship.

© 2012, Dr J Renae Norton. This information is intellectual property of Dr J Renae Norton. Reproduction and distribution for educational purposes is permissible.

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Appetite Hormones 101: Peptide YY

“I’ve been treating eating disorders (ED’s) and obesity for nearly 25 years and have always had good outcomes.  My rate of success improved dramatically, however, when I discovered the critical role that processed food plays in causing as well as in preventing recovery from Anorexia, Bulimia, Bulimarexia, (a combination of the two) Binge Eating Disorder (BED,) Emotional Eating and Obesity. To this end, I find it of great importance to provide both my patients and readers with relevant nutrition information to aid in their recovery. You can view all my Nutrition, Fitness, and Health articles here.

In this third and final installment of the series, “Appetite Hormones 101”, we will discuss Peptide YY (PYY). The purpose of this series is to explain the role of hormones on both appetite and body weight goals, as it relates to both weight loss and weight restoration. If you’re a new reader, be sure to check out “Appetite Hormones 101: Leptin” and “Appetite Hormones 101: Ghrelin“.

Peptide YY (PYY)

PYY is a hormone that suppresses appetite. It was discovered to play a role in digestion in 1985. PYY regulates food intake, and is believed to improve leptin sensitivity. The amount of PYY released by our bodies is influenced by the number of calories we ingest; the more calories we ingest, the more PYY is released. The diagram below shows how our PYY levels, ghrelin and leptin levels typically fluctuate before and after meals:

PYY levels are highest in individuals battling anorexia, followed by those individuals that are lean,which explains why both groups have less hunger and also may have more difficulty eating. PYY levels are lowest among obese and morbidly obese individuals. Individuals with bulimia also experience low levels of PYY, which helps to explain why all three groups feel more hunger. Research shows that the obese individual can decrease their PYY levels by 30% by reducing their body weight by 5.4%. PYY levels are not believed to be effected by weight restoration during recovery from anorexia. It is also important to note that high levels of PYY in anorexic individuals is associated with decreased bone mineral density (BMD).

Our mood also effects our PYY levels. Recent studies show that PYY levels are higher in those suffering from major depression. This explains why many people with major depression have a decreased appetite and experience weight loss.

PYY levels can be regulated through both diet and exercise. Diets high in quality protein tend to raise PYY levels highest, followed by diets high in healthy fats. High carbohydrate diets tend to raise PYY levels the least. Aerobic exercise has also been proven to raise PYY levels, whereas strength-training has no effect on PYY levels (although strength-training does lower ghrelin levels).

In conclusion, PYY regulates our appetite. The higher our PYY levels are, the more satiated we will feel. You can ensure your PYY levels are highest by eating a high protein diet and including aerobic exercise in our workout routine.

Medical Advice Disclaimer: The information included on this site is for educational purposes only. It is not intended nor implied to be a substitute for professional medical advice. The reader should always consult his or her healthcare provider to determine the appropriateness of the information for their own situation or if they have any questions regarding a medical condition or treatment plan. Reading the information on this website does not create a physician-patient relationship.

© 2012, Dr J Renae Norton. This information is intellectual property of Dr J Renae Norton. Reproduction and distribution for educational purposes is permissible.
Please credit ‘© 2012, Dr J Renae Norton. http://edpro.wpengine.com)’.

Sources
J Clin Endocrinal Metab. 2009 Nov; 94(11): 4463-71 Epub 2009 Oct 9
http://news.sciencemag.org/sciencenow/2006/09/06-02.html
http://jcem.endojournals.org/content/91/3/1027
http://www2.massgeneral.org/harriscenter/about_bn.asp
http://www.eatingdisordersreview.com/nl/nl_edr_18_1_5.html
http://www.thebonejournal.com/article/S8756-3282(08)00162-2/abstract
http://ajpregu.physiology.org/content/296/1/R29.full
J Endocrinal Invest. 2011 Dec 15 [Epub ahead of print]

Your Health In The News – Nov 27 – Dec 4

News You Can Use

“As an Eating Disorder Professional, I know that many of my clients that are in treatment for Anorexia, Bulimia, Bulimarexia, Binge Eating Disorder or Obesity are overwhelmed by all the information in the news about our health. In hopes of relieving some of the stress this can inflict on both my patients and readers, I’ve highlighted some of the weekly health news that was of particular interest to all of us at The Norton Center for Eating Disorders and Obesity. From my eating disorder treatment center in Cincinnati, here is your news update for the week of November 27-December 4 2011”

Were there any news articles that you saw this week that really grabbed your attention? Leave a comment with a link. If the article helped you, it will likely help some of my other readers!

Medical Advice Disclaimer: The information included on this site is for educational purposes only. It is not intended nor implied to be a substitute for professional medical advice. The reader should always consult his or her healthcare provider to determine the appropriateness of the information for their own situation or if they have any questions regarding a medical condition or treatment plan. Reading the information on this website does not create a physician-patient relationship.

© 2011, Dr J Renae Norton. This information is intellectual property of Dr J Renae Norton. Reproduction and distribution for educational purposes is permissible.

Please credit ‘© 2011, Dr J Renae Norton. http://edpro.wpengine.com’

The Norton Center Video – Eating Disorder Therapy in Cincinnati

What You Need to Know In Order to Help Your Obese or ED Patient

Eating Disorder Research

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Research has clearly established a relationship between neurotoxins such as MSG, high fructose corn syrup (HFCS) and sweeteners Splenda and NutraSweet and the current epidemic of obesity. I believe that there is also a relationship between these neurotoxins and the proliferation of eating disorders in the US. For example, research has shown that patients suffering from Anorexia as well as those who are obese, suffer from a condition called leptin resistance.
1 ,2 Further, this condition appears to be a function of the type and amount of neurotoxin ingested. In my practice, when I have helped those suffering from Anorexia, Bulimia, and Bulimarexia and obesity eliminate such neurotoxins from their re-feeding regimens, recovery time has shortened and the likelihood of relapse has decreased significantly. (I am in the process of publishing these anecdotal results and have also applied for several grants to research this relationship experimentally in greater depth.)

Treatment of obesity and eating disorders is negatively impacted for the uninformed treating professional i.e. re-feeding is a nightmare for those suffering from Anorexia, Bulimia, Bulimarexia, Binge Eating Disorder and Obesity when the role of these neurotoxins is not taken into consideration. Thus, to the degree that their impact on the eating habits of individuals suffering from ED’s and obesity is not understood, or worse, ignored, treatment is less likely to succeed, and in many cases, more likely to make the problem worse. For help on refeeding contact me directly. Also check out all of the blog articles on this site. 3

For the past 40 years food additives, known to have neurotoxic effects, especially in children, have been added to the American food supply because they were profitable. These additives include MSG, sweeteners Aspartame and Aceulfame, (Splenda and NutraSweet) growth-enhancing hormones, and pesticides that are incorporated into the DNA of crops like soybeans. The amount of these neurotoxins added to our food has increased enormously since their introduction. For example, since 1948 the amount of MSG doubled every decade. By 1972 over 262,000 metric tons were being added. (Whetsell, 1993)[1] Today it is impossible to determine the actual amounts of the various neurotoxins that are added to the U.S. food supply, as the additives are effectively unregulated by the FDA or any other regulatory agency. As a result, they can be added in ways which make them difficult, if not impossible, to quantify.

Besides being difficult to quantify, the additives are very difficult for the average consumer to identify, as they can be called such innocuous names as “citric acid” “malted barley” and “natural flavoring”! Even for individuals who are well-informed, and therefore know what to look for, it is still a daunting task to try and avoid them. Presently, they are in 90 to 95% of all packaged, bottled, and/or processed foods, including organic and/or foods that are marketed as “healthier” choices.

Perhaps the most alarming issue is that food manufacturers target children’s foods for inclusion of these additives. In the U.S. to day, 1 in 3 children are obese. Many will remain that way for life. We are one of the only countries in the world to have children who suffer from Type II Diabetes, which heretofore has been a disorder of middle adulthood. The connection between childhood obesity and an eating disorder such as Anorexia, for example, is that a history of premorbid obesity increases the risk of the development and decreases the likelihood of recovery from the disorder.

1 J Lab Clin Med. 2002 Feb;139(2):72-9.Leptin in anorexia nervosa and bulimia nervosa: importance of assay technique and method of interpretation.

2 Metabolism: Clinical and Experimental [1997, 46(12):1384-9]Neuropeptide Y, galanin, and leptin release in obese women and in women with anorexia nervosa.

3 Other resources: http://dorway.com/ http://www.drkaslow.com/html/leptin_and_amylose.html www.msgtruth.org/obesity.htm

 

Medical Advice Disclaimer: The information included on this site is for educational purposes only. It is not intended nor implied to be a substitute for professional medical advice. The reader should always consult his or her healthcare provider to determine the appropriateness of the information for their own situation or if they have any questions regarding a medical condition or treatment plan. Reading the information on this website does not create a physician-patient relationship.

© 2011, Dr J Renae Norton. This information is intellectual property of Dr J Renae Norton. Reproduction and distribution for educational purposes is permissible.

Please credit ‘© 2011, Dr J Renae Norton. http://edpro.wpengine.com’

The Connection Between Leptin Levels and Eating Disorders

Leptin

image used under a creative commons license

Recently the Division of Endocrinology at the University of Kentucky College of Medicine performed a study on the connection between Leptin levels and eating disorders. Leptin is a peptide hormone neurotransmitter produced by fat cells and involved in the regulation of appetite. It signals your brain when you’ve eaten enough and stimulates you to burn more calories. In order to span a full range of human body weights for their investigation, the analysts, examined serum leptin levels in anorexic, bulimic, obese, and control individuals.

Compared to the analysis generated from non-anorexic patients, patients with anorexia nervosa were found to have much higher serum leptin levels values. In effect, having leptin levels so high is contributory to a blunted physiologic response to being underweight and consequently builds resistance to dietary treatment. Simply put, they have too many of these leptin hormones being sent to the brain that are saying, “You are full.” Therefore, anorexic patients repel the need to consume enough of the nutrients their body realistically needs to function properly.

On the other hand, what this study found in bulimic patients when compared to non-bulimic patients is the opposite effect. Bulimic patients were found to have much lower leptin levels. This deficiency of leptin hormones is usually caused by a form of Leptin resistance and this contributes to the patients food-craving behavior. The Leptin resistance found in most bulimic patients comes from a chemical surge located in the pleasure center of our brain. This chemical surge overrules leptin’s messages that are trying to tell the bulimic patient “your tank is full.” So in other words, there is a chemical battle going on inside a bulimic patients brain. The leptin hormones are trying to tell the defense to kick in and protect them against overeating but at the same time, in a much louder voice, the pleasure center of the brain is saying, “No! Pass those cookies this-a-way.”

When examining leptin levels in most obese people, it was found that they actually have high leptin levels. However, their bodies usually cannot respond to these leptin hormones because they have another form of leptin resistance. Instead of leptin messages being rejected and overruled by the pleasure center of the brain (like the type of resistance indicated in most bulimic patients), obese patients cells’ have completely stopped accepting leptin messages all together. Therefore, they do not receive any message from their leptin hormones that would be telling them to stop eating.

Essentially, regulating your leptin levels and defeating leptin resistance plays a large role in overcoming an eating disorder. Foods that are high in sugar or additives such as high fructose corn syrup and MSG should be avoided because these ingredients excited the pleasure center of your brain making it much more difficult to respond to your leptin hormones. So basically, the more foods you consume with these ingredients, the louder the voice saying, “Pass those cookies this-a-way,” will become and the softer the voice saying, “You are full!” will become. Also, your cells become more sensitive and responsive to leptin when you exercise and build muscle!

Medical Advice Disclaimer: The information included on this site is for educational purposes only. It is not intended nor implied to be a substitute for professional medical advice. The reader should always consult his or her healthcare provider to determine the appropriateness of the information for their own situation or if they have any questions regarding a medical condition or treatment plan. Reading the information on this website does not create a physician-patient relationship.

© 2011, Dr J Renae Norton. This information is intellectual property of Dr J Renae Norton. Reproduction and distribution for educational purposes is permissible.

Please credit ‘© 2011, Dr J Renae Norton. http://edpro.wpengine.com’

Sources:

The National Center for Biotechnology Information – Leptin in anorexia nervosa and bulimia nervosa: importance of assay technique and method of interpretation (http://www.ncbi.nlm.nih.gov/pubmed/11919545)