January 23, 2015
“ In a field that has very little evidence-based medicine, there is no substitute for experience.” Eating Recovery Centers: Ken Weiner, MD, FAED, CEDS Founding Partner Chief Executive Officer
Kathy Welter Nichols has over 15 years in the field of disordered eating; having seen hundreds of clients with bulimia;
I count myself as one of the ones that is pioneering understanding around what starts an eating disorder and how we can bring it to conclusion. The challenge we face in the field is not all individuals suffering with this disorder will ever seek help to recover from it. In my private practice I’ve seen many clients for other problems who shared they had an eating disorder which they themselves stopped. During the time they had it, they were as lost as any of my clients I see in my three day intensive – the Bulimia Breakthrough Method. They were heavily invested in the patterns and behaviours, keeping it secret, covering up what they were doing, and believing it was the only way to keep their weight in check – they were terrified to stop too. However, they did one day, just stop. And they didn’t gain weight either. And when I ask them how they did it, often that too is a blur, “well I just did”. In NLP we learn the strategies of looking at the behaviours that secure the outcomes people want, so the ones that could recall the steps they took, what they told themselves, and how they felt about stopping, helped me understand keys to unraveling bulimia. Based on the model of NLP, we all have a similar functioning brain process, if one person is effective with a strategy, and others follow those steps there is a good chance they can achieve similar results.
So we did that, and I recorded my results and clients recoveries, surprisingly my clients walked away from bulimia “for the last time”. I realized there are clients that are medically in need of help. I am not a medical doctor, I don’t have a hospital or clinical setting, so they have to go to MD’s and emergency wards, and rightly so. However, I am now aware, with a few more years behind me, that there are really many young people that try this and no one ever knows. They just stop, and go on about their lives with their dark secret in tack.
Does that mean anyone can start this and expect to be able to stop easily one day?
No not at all. And that’s why I wrote this book to help those out there looking for something to help them feel better about themselves, to lose weight, to feel stronger about their self esteem, and often in those middle years of the teen, where everything seems so desperate one day and on top of the world the next, bulimia is not a viable option and it is an addictive pattern. Just like drugs, you will have to figure out how you are going to stop this, and what you are going to do for the years you are enslaved to binging and vomiting up food.
That’s right, once the weight is gone, you don’t stop this behaviour. You are addicted to the patterns, and the chemical releases in the brain. No one talks about that much, but it’s there and every client I’ve had, I ask – do you appreciate the addictive high after you purge? Yes they do. It’s there, and often they are shocked that someone else knows. Many clients say to anyone that will listen “I’m fearful of what I will do without bulimia” that really means what can I use to get that high feeling when I’m not using bulimia anymore?
It’s an addiction, and more professionals are coming to understand this. So to you – the good kid that never does anything wrong, and would never try drugs, or alcohol: doing this is putting yourself in line for the same addictive patterns your friends experience using drugs. You’ve seen it. And you’ve seen what it does to their lives and their families. You are about to do this to your life and your family. I suggest you find another way and choose differently. You don’t need to lose weight because you are mad at your mom or sister, or brother, or dad, or uncle.
As we enter into our teens, we actually are trying to figure things out. Once girl shared she told her dad she’d eaten too much cake and threw it up. And because he responded with
“That’s ok, sometimes we just over do it.” and he made nothing of it. She knew she hadn’t told him the whole story. That she purposefully ate a lot of food and then stuck her fingers down her throat to make the food come up. Because he didn’t pick up on it, and ask more questions, she actually told herself, “my dad is ok with this”.
You don’t need to be deathly thin to show them how good you are at restricting food. You don’t need to rob your life of vitality, energy; and your brain of it’s ability to think, mature emotionally, and accept life is just never perfect. Life is messy, some days it will seem pretty good – others will feel like a disaster. That’s life. There is no perfect.
And you aren’t perfect either it’s a wasted goal a fantasy at best, and no matter the effort you apply, perfect is not applicable to humans.
Avoiding the horrible stereotypes of images associated with bulimia and eating disorders my production team chose this image of a young woman’s face, looking directly into the center of the lens. Her fierce determination and strength I witness in all the wonderful clients I’ve had over the years. As I look in this woman’s eyes – looking straight back at me, I know she knows who she is and she is ready to take aim. I think of my clients as rising from the ashes of bulimia and emerging triumphant in their own right, fierce, wise, like a young Artemis.
Why did you write this book?
Creating this book out of the work I’ve been doing with clients over the past fifteen years seemed the logical next step. I’ve learned from my clients they like to do things themselves, and it was never what I believed was possible it was what they believed that made their choices real. I also created a card deck set, it’s just so novel to be able to say
“I healed myself from a self help book and card set” I know that will appeal to many clients with bulimia!
Who is this book for?
The sad reality is many of my clients had never been into treatment before, and often didn’t mention anything to their doctors. They self managed bulimia and they had good days and bad days. Days when bulimia was full on, days when they could back it off, and through eating enough, avoid the binging and purging until their body settled down again. They were desperate to leave it behind for good, but often they had not shared it with one other person. Their “secret” was safe. I know there are many more out there like them, and this book is for them. The strategies are there, they can follow the process and help themselves – even if just long enough to recognize how much better they feel without it. Then they can make a valued judgement based on their efforts. And it’s for those that are returning home from a treatment program where everything was monitored for them. It can be terrifying to face the idea of shopping again, cooking for yourself, or even just sitting down to a meal. How much? When to stop? How do I know what to do? This book offers a solid strategy for the the one in recovery.
What information is in the book?
All my clients shared they got into this pattern during their school years, and if they had known it was going to control their lives, they would not have started in the first place. They would have found another way. So sharing that information with the world was really imperative.
What do you think about bulimia?
I think young people get started with this disorder at a very young and at a vulnerable time in their lives. For some reason they stopped talking with mom and dad, they are more inward, and distance from everyone doesn’t seem to affect anyone. Hey don’t they miss me? Am I that invisible? It’s trending, it’s novel, it sets them apart from being the “good girl” all the time. It’s secretive and no one has to know about it. It’s not drugs, so that can’t be a bad thing – it’s just messing around with food. So what’s wrong with that? And it has a unique side benefit you seem to lose weight quickly when to you restrict food all day, then binge and purge at night. I have clients that are overweight while using bulimia. After a while it doesn’t work as a weight loss program. In fact with over production of steroids in your system someone using bulimia will often have the rounded “moon face” – and the swollen stomach. These will disappear once you leave bulimia behind.
I generally see clients that have gone under everyone’s “radar”, and have self managed this for themselves, and really no one else knows they are doing this. I recognized clients were challenged with understanding the steps to recovery and how to maintain the wellness path once they had been in therapy or in treatment – they needed a solid “what to do next” list.
How do I shop? How do I cook? How do I eat “normally”? What supplements will help? Should I follow a diet?
Without a road map in recovery, it’s hard to know if we are making progress or not. This book offers that road map, with careful considerations along the way from others that have achieved success too and offer their wisdom as encouragement.
Neuroscience and Eating Disorders
by Jeffrey DeSarbo, D.O.
Board Certified Psychiatrist
ED-180 Eating Disorder Treatment Programs
While the core treatment of eating disorders remains based in psychotherapy, behavioural modifications and close medical management, researchers are discovering more and more about the science and brain functioning of patients who suffer with eating disorders such as anorexia nervosa and bulimia nervosa. The complex and distressing thought processes associated with an eating disorder often mystify and confuse both the patient and other outsiders including family, friends, and treatment providers. Today, neuroscientists are learning more and more about how the brain is affected and, in turn, affects the course and prognosis of an eating disorder.
As the neuro-scientific and biological factors of eating disorders become demystified, many patients and loved ones have been able to lessen their confusion and self-blame and recognize the role that genetics and brain biology play with these conditions. Onset and recovery is not only defined by a change in observable behaviours. There are many functional and anatomical changes in the brain itself that help to explain these changes as they are happening.
Thoughts originate in the brain. We can tell when one is thinking or processing information when we see brain data and electrochemical signals with medical equipment such as EEGs, CAT scans, MRIs, PET Scans and SPECT. Still, we only see the signals and not the thoughts. When individuals suffer with an eating disorder, we know from what they tell us and from how they behave that their thoughts are overwhelmingly distressful, all consuming and often distorted. People with an eating disorder have a certain way in which they hear things, say things, perceive things and do things. The brain, it can be said, is speaking a foreign language that is not familiar to the individual. Yet, it still makes sense to him or her but to no one else. The thoughts are coming from their brain, but their brain is working differently than it once did.
Neuroscientists have been making significant discoveries in finding out how and why the brain is working differently. These findings appear to be major contributing factors that can help explain what is happening with someone’s brain, mind and body that can cause and perpetuate an eating disorder. For instance, with conditions such as anorexia nervosa, neuroimaging has shown that there is a loss of brain cells in many different regions of the brain (1,2). Now researchers are trying to decipher how this brain cell loss effects the thoughts and behaviours associated with an eating disorder and how much of these brain cells can be restored with recovery (3). In one study, researchers discovered that in anorexia nervosa, there can be cell loss in the brain’s parietal lobe region which is directly associated with one’s internal thoughts that create an intense drive-for-thinness (4).
But the language of brain science is not a simple this-causes-that story. Multiple factors and brain findings have shown similar effects. Estonian researchers discovered that certain changes in brain chemistry with a specific serotonin neurotransmitter found in girls with eating disorders may also be responsible for a strong drive-for-thinness (5). Specific ways of thinking and the resulting behaviours and symptoms are more often a result of multiple biological factors that come together and lead to eating disorder pathology.
Even the physiological functioning of the brain can contribute to the symptom expression of an eating disorder. A study from the Children’s Hospital in Boston, Massachusetts, showed that there can be a change in brain blood flow patterns in women with anorexia nervosa who have body image distortions (6). These blood flow changes are similar to patients who have psychotic disorders where their perceptions are also distorted and may help explain the cause of the significant alterations in self-perception. Anorexic individuals who see themselves as “huge” are experiencing a reality that is true to them, although different than what everyone else sees.
Researchers from Hiroshima University in Japan are also discovering the different brain activity that exists with body image processing in the brains of men compared to women. When males and females are subjected to unpleasant words regarding body image, men primarily have brain activation in the cognitive areas of the brain while women have a unique activation in the fear and emotional centres of the brain (7). Studies like this can contribute to an understanding of why there are more women then men who develop eating disorders and why their time to recovery is so much greater since women have such an adverse fear reaction to negative body image ideas compared to their male counterparts.
The intense emotional dysfunction often seen with an eating disorder may also be better understood by looking at other brain changes. Another part of the brain that can be effected by an eating disorder includes the anterior cingulate cortex or ACC. This is a region that noted author and neuropsychiatrist Dr. Richard Restak describes as “where cool rationality meets heated emotions.” Researchers at the University of Heidelberg in Germany discovered that there was brain cell loss of grey matter in the ACC of patients with anorexia nervosa and that this cell loss did not appear to change with weight restoration. This finding leads to questions as to whether this finding occurred as a result of the anorexia or if it may have pre-existed, making it a risk factor to developing an eating disorder (8).
The main point of this article is to provide introductory evidence and support to the complex underpinnings of eating disorders. There is no simple explanation as to why an eating disorder occurs and no simple solution to a quick resolution. The brain is the most complex organ in the body and it is continuously affected when an eating disorder is present. Continued scientific research is needed to make major breakthroughs in treatment protocols and recovery. In the meantime, it would do patients, families, clinicians and the public well to know that there is growing evidence that helps explain how the thoughts and behaviors associated with an eating disorder are related to biological processes that are not always under the control of the individual but with treatment and recovery. And most of these biological processes do return to their healthy states.
- Swayze VW 2nd, Andersen AE, Andreasen NC, Arndt S, Sato Y, Ziebell S. “Brain tissue volume segmentation in patients with anorexia nervosa before and after weight normalization.” Int J Eat Disord. 2003 Jan;33(1):33-44.
- Joos A, Hartmann A, Glauche V, Perlov E, Unterbrink T, Saum B, Tüscher O, Tebartz van Elst L, Zeeck A. “Grey matter deficit in long-term recovered anorexia nervosa patients.” Eur Eat Disord Rev. 2011 Jan-Feb;19(1):59-63.
- Roberto CA, Mayer LE, Brickman AM, Barnes A, Muraskin J, Yeung LK, Steffener J, Sy M, Hirsch J, Stern Y, Walsh BT. “Brain tissue volume changes following weight gain in adults with anorexia nervosa.” Int J Eat Disord. 2011 Jul;44(5):406-11.
- Joos A, Klöppel S, Hartmann A, Glauche V, Tüscher O, Perlov E, Saum B, Freyer T, Zeeck A, Tebartz van Elst L. Voxel-based morphometry in eating disorders: correlation of psychopathology with grey matter volume. Psychiatry Res. 2010 May 30;182(2):146-51.
- Akkermann K, Paaver M, Nordquist N, Oreland L, Harro J. “Association of 5-HTT gene polymorphism, platelet MAO activity, and drive for thinness in a population-based sample of adolescent girls.” Int J Eat Disord. 2008 Jul;41(5):399-404.
- Gordon CM, Dougherty DD, Fischman AJ, Emans SJ, Grace E, Lamm R, Alpert NM, Majzoub JA, Rauch SL. “Neural substrates of anorexia nervosa: a behavioral challenge study with positron emission tomography.” J Pediatr. 2001 Jul;139(1):51-7.
- Shirao N, Okamoto Y, Mantani T, Okamoto Y, Yamawaki S. “Gender differences in brain activity generated by unpleasant word stimuli concerning body image: an fMRI study.” Br J Psychiatry. 2005 Jan;186:48-53.
- Friederich HC1, Walther S, Bendszus M, Biller A, Thomann P, Zeigermann S, Katus T, Brunner R, Zastrow A, Herzog W. “Grey matter abnormalities within cortico-limbic-striatal circuits in acute and weight-restored anorex
February 2015: Let’s get started:
- You cannot control other aspects of the brain/body response to counteract for the bulimic behaviour.
- Over production of steroids create the puffy round moon-face so after binging and purging the face appears “fat”.
- Obesity and diabetes are a reality; eventually bulimia stops controlling weight as systems break down
- Amenorrhea; losing your monthly cycle can lead to infertility as well as osteopenia and osteoporosis as your bone density is slowly leeched without the proper regular menses and hormones supplying it.
- The stomach is swollen and soft from binging, purging and heavy restricting. You have a continual bulge of bloating due to the stress hormone cortisol and from consuming high volumes of sugar and junk food and it will not go away.
- Skin is sallow and dark circles appear under the eyes, as a result of liver and kidney stress.
- Your heart is suffering, potassium levels fall to deathly levels, and your physical symptoms are dangerous.
- Hair can fall out, become dull and lifeless; teeth and throat are damaged from acid reflux.
- Low energy, short-term memory loss and no energy are the daily normal.
- No one trusts you; your word doesn’t mean much, most of your friends are people with the same lack of commitment to other people’s time. You find you are often dumped, forgotten or just left out. You use bulimia and isolation instead.
- Negative mood swings are common you just don’t have any resources to manage the simplest interactions and these moods often get taken out on the people who love you the most.
- Bulimia uses all your available cash and working the simplest job is hard as you have no energy and it seems you are always making excuses and apologizing for yourself to others
- You have adopted the attitude of what goes in must come out, so you don’t use supplements or take very good care of your body in other ways either.
- Brain chemistry alters further as survival mode kicks in, obsessions about food, thinking about food, planning for binges, all drive the anxiety, tension and fear, which centres on the primary focus of planning “my next fix”.
- Sugar gives you the high and also the depleted extreme lows, depression is common, feelings of low self-worth, obsessions around thinness and the fear of weight gain “did I eat too much, did I get it all out? What is normal?”
- The over use of laxatives cause major issues with the colon and bowel.
- Moral components fall away to the power of the addiction; lying, stealing and waste which you never would have considered before become a part of everyday life.
- Aspects of the personality “split off” endeavouring to survive and the behaviour itself becomes mindless and soul pillaging.
- Emotional issues are dealt with through bulimia, so you never resolve or master experience, you use bulimia instead. Anger sits uncomfortably just below the surface, vaguely masked by bland expressions.
- As bulimia depletes essential nutrients and amino acids it affects mood swings increasing isolation, fear, self-judging and robbing you of the ability to control impulses. GABA an essential amino acid drives impulses that are out of control; yeast overgrowth occurs from the sugars, carbohydrates and lack of protein which drive the system into frenzy. I must have my daily fix.
- You don’t know how to stop. You try, but you never do it. As behaviour escalates the damages increase; panic attacks, unnecessary fears, emotional outbursts as the brain craves its daily fix.
- Bulimia seemed like a good idea for weight loss; however, no matter what movies you watched, books you read or suggestions from others; CHASING HUNGER is simply no way to lose weight.
- How do we stop this addictive behaviour?
(c) Chasing Hunger
Eating Disorders and Meditation:
A Clinical Perspective on the Interplay between Neurology and Psychology
By Katie Bell, ANP, PMHNP, & Lirio Ohlson, LMFT, LPCC, RYT-500
A majority of individuals who suffer from Eating Disorders also suffer from comorbid psychiatric illnesses. The majority of these comorbidities are anxiety disorders.
Recent brain imaging research and more specifically functional magnetic resonance imaging (fMRIs) have enabled us to better understand what happens with brain function when individuals become anxious. We now know that when an individual becomes highly anxious, the brain’s focus (or oxygenation) shifts to a region of the brain called the amygdala. When this area of the brain is stimulated, “stress” neurotransmitters epinephrine and norepinephrine are released, which then signal the kidney to release the “stress” hormones adrenaline and cortisol. By design, these chemicals metabolize slowly. The brain is left to literally “bathe” in these chemicals for prolonged periods.
The amygdala functions to keep us safe from physical harm and ready our bodies to act toward self-preservation. Rational thought tends to be sacrificed to concern for physical survival. When our patients are faced with the prospect of eating and experience heightened anxiety, their brains shift to this survival mind-set. Yet to the clinician, their thought process appears highly irrational, and at times, even delusional.
In contrast, MRI studies have demonstrated that meditation practice, and more specifically, focused attention on the breath, stimulates the prefrontal cortex, leading to the release of dopamine. Dopamine is a neurotransmitter associated with feelings of calmness, peacefulness, and contentedness. When the prefrontal cortex is activated, rational thought follows: people think more clearly and recall more accurately. This state is also associated with a greater capacity for emotional regulation. When I ask patients if the idea of learning how to shift out of an anxious state into a more calm state appeals to them, I always get a resounding “Yes!”
While there is no brain imaging research to date specifically targeting neurology and Eating Disorders, we do know that the practice of meditation supports the formation of white matter in the brain (increased brain capacity), and significantly improves the brain’s ability to remain focused.
Additionally, the concept of neuroplasticity has shifted how we conceptualize our thoughts and more importantly, how this impacts the brain. We now understand that “neurons that fire together, wire together.” Individuals with Eating Disorders intuitively understand this concept. They report that the thoughts started as a “sprinkling” of negative ED self-talk, but over time, these thoughts became more repetitious or “automatic” in nature. Patients, especially those at higher levels of care, will often report that their ED thoughts are constantly in the background, unremitting. In my clinical experience, most patients, although not all, find the quieting of the ED voice an appealing proposition.
Meditation and CBT, ACT and DBT all share the essential skill of “attending to” phenomena. The act of “attending to” somehow changes the internal response to the outward phenomena. For example, in CBT, Cognitive Restructuring helps individuals identify and challenge unhealthy thoughts, and replace them with thoughts that support their health and their ED recovery. Two features of meditation that support this “attending to” phenomena include:
- Meditation is not only a means of “practicing” separating from our thoughts, but it also helps the individual develop an awarenessof one’s thoughts. In meditation circles, this awareness is usually described as a process of “waking up” to their thoughts. I worry that individuals will feel judged by these words, so I usually just use the phrase “become acutely aware.”
- Meditation introduces a revolutionary conceptregarding our brain and our thoughts: namely, that we are not our thoughts. In fact, the brain itself is an organ designed to have thousands of thoughts, but we can choose whether or not to engage in those thoughts or “stories.”
The practice of meditation supports separating, or creating space, between who the individual is, and what thoughts the individual is having. In this process of separation, the practitioner learns and develops the skills that help individuals detach their sense of self and identity from their thoughts. This ultimately supports them to become more intentional in their actions and thereby effects their moment to moment emotional experience.
In the research, Eating Disorder “negative self-talk” is argued to play a crucial role in the development, progressive and insidious nature of Eating Disorders. By separating self from thoughts, meditation practice supports what has become a common ED therapeutic intervention: helping patients distinguish their “healthy voice” from their “Eating Disorder voice”.
Interestingly, in practice—regardless of how sick a patient may be—ED patients report being knowledgeable as to which thoughts DO NOT support health (ED thoughts) versus which thoughts DO support their health. This is poignant, because as a clinician, it provides me the opportunity to honor the individual’s inner wisdom. These patients know what supports their health and they know what hurts their health, regardless of how much they want to be in their Eating Disorder.
This clarity coupled with their desire to be in a present experience that is more calm, content and at peace provides ‘the grist to the mill,’ as they say, when I am in conversation or discussions with ED patients regarding their motivation in recovery.
Thus far, current research on Meditation and Eating Disorders is limited to one study (Kristellar and Hallett, 1999) specific to Binge Eating Disorder. This study demonstrated a reduction in Binge Eating Disorder (BED) behaviors following a 6-week meditation-based group.
In 2005, Baer, Fischer, and Huss, published a study that utilized a Mindfulness Based Cognitive Therapy (MBCT) from an ACT perspective, which was revised specifically for BED. Rather than acting as a stand-alone intervention, meditation practice was one tool of several in this revised curriculum. The findings from this study demonstrated that eating-related meditation rather than general meditation, was the strongest indicator of improvement in eating control. Baer, Fischer, and Huss went on to publish a case study in 2006, which demonstrated a reduction in binge eating behaviors and increased levels of mindfulness.
There is no research to date regarding ED focused MBCT or meditation and its efficacy at reducing other ED behaviors and cognitions such as food restriction, compensatory behaviors, or body image disturbance. Additionally, there is no research specific to Eating Disorders and neurological changes to the brain. Given what we know about the neurological and psychological benefits of meditation, more research in both disciplines seems like a logical “next step.”
A Case from Clinical Practice
One profound example that demonstrates how educating and practicing meditation in clinical practice can be helpful involved a 16 y/o female that engaged in food restriction and excessive exercise behaviors. Her walking and running regimen was so fierce that her feet were bruised and blistered to an extent unlike anything I had ever seen. For approximately three months (IOP level of care), our multidisciplinary team worked with her around her excessive activity behaviors. She was able to stop running but after three months, we were still struggling to help her stop her two to three hours of daily walking.
Over this same three-month period, I was also leading a weekly “Meditation” group that incorporated both experiential and didactic components. In the fourth month of this patient’s treatment, I asked her about her “Activity” from the previous week. This activity assessment is a standard question I ask patients during their medical appointments with me. When I asked about her most recent activity, she responded “none.” “Even walking I asked?” She nodded her head. “What happened..?” I asked. “I just didn’t walk” she responded. “What actually happened in the moment when you had the urge to walk?” I asked. “I just sat and breathed like we do in Meditation” she responded. “And..?” I asked. “It was really hard…but I was able to do it…” she said. I almost fell off my exam stool in shock. I gave her a hug, and then a high-five. She graduated from our IOP program a couple of months later “not really caring” about whether she exercised or not.
In Summary and Review
Meditation practice supports a neurological and psychological interplay that promotes the development and maintenance of a recovery-oriented mind-state. Research in the fields of neurology and psychology have increased our understanding as to how meditation can be an effective tool and skill for an Eating Disorder patient to utilize their path of recovery. Rather than having an “along for the ride” experience, meditation can empower patients to be more proactive in their process by teaching them how to “shift” from being hi-jacked by their amygdala and redirect their focus and attention to the prefrontal cortex. These skills also have the capacity to extend and prolong treatment intervention because they allow the patient to engage in a meaningful response to their own ED thoughts as they arise outside of the therapy room.
I routinely review with patients the concept: neurons that fire together, wire together. The practice of meditation supports the patients’ separation from their Eating Disorder while their “team” is equipping them with the skills and tools to replace these eating disordered thoughts with more recovery-oriented thoughts.
I also try to empower patients by helping them understand the concept of neuroplasticity: they have the ability to “prune” their brains by challenging their Eating Disorder voice. Initially, these more recovery-oriented thoughts are like the “sprinkles” of thoughts they had when their Eating Disorder started. Over time, however, these more recovery-oriented thoughts will become their “automatic” thoughts, in the same way their Eating Disorder thoughts became automatic over time. Eventually, their experience will be one that supports a more calm, content and peaceful existence. Now who doesn’t want that?
About the authors:
Katie Bell, ANP, PMHNP, is a board certified Nurse Practitioner in Adolescent/Adult Medicine and Psychiatric Mental Health with over ten years of experience working with eating disorder at all levels of care. In 2009, she completed a yearlong Meditation course at San Francisco’s Zen Center called Establishing a Path of Practice. She continues to study and practice meditation routinely, and is actively providing education to her patients about meditations’ health benefits. In 2013, Katie co-founded The Healthy Teen Project, a PHP/IOP Adolescent Eating Disorder program located in Los Altos, California. Alongside Healthy Teen, she maintains a private outpatient practice with a multidisciplinary team of eating disorder providers called The Community Health Collaborative. Katie also has a keen interest in eating disorder prevention and early identification with the aim of reducing overall rates of eating disorders in the local Bay Area community. In this role, Katie has been serving as a Wellness Advisor to a local Ballet School (Ballet San Jose) since 2013. She is also forming a Bay Area Task Force comprised of local, seasoned Eating Disorders specialist with the goal of providing education to Bay Area schools and organizations.
Lirio Ohlson LMFT, LPCC, ERYT-500 is a psychotherapist and yoga instructor. She maintains a private psychotherapy practice in Los Altos and coordinates wellness services for the Santa Clara Unified School District in California. She addresses a variety of concerns with diverse therapeutic modalities such as Object Relations and Emotion Focused Therapy as well as Mindfulness informed therapeutic approaches. She believes in the innate ability of her clients to heal and achieve fundamental change if they are provided the right opportunity with the right tools. Lirio Ohlson has taught yoga for over twenty years and maintains an active yoga teaching schedule in the South Bay Area. She enjoys teaching a practice that cultivates physical health and stress reduction in a safe and enjoyable manner to students of all levels.
March 6 2015
“Kathy Welter-Nichols is a significantly contributing member of the Research and Recognition Project where we are utilizingHypnosis and NLPNeuro LinguistProgramming, bringing this model of recovery into the rigorous testing needed to add it into evidence based medicine with needed research to make it available in all models of recovery. Entering a research protocol for bulimia in conjunction with other programs and supporting the research of other clinical developments (like RTM)Reconciliation of Traumatic Memories. The vision is to bring individual clinical developments researched from which a new field will open up with recognized experts in specific clinical areas. These individual careers are enhanced by their support and participation in the process of “evidence based medicine.”
Recognizable changes in the field
Changes to the medical and psychiatric models of care are today evident in the considerable lack of the “us versus them” mentality. At the recent conference in Vancouver, B.C., in a break out session on the very dangerous Re-Feeding Syndrome, I was in the company of many clinicians, therapists, and medical professionals. The Australian team were present as well, and are currently leading the world in Eating Disorder protocols for medical emergency wards. There was a neuro surgeon present, Chief of medicine from Toronto, and conducting this process an internal medicine specialist from Calgary’s highly respected Foot Hills Hospital. Two other specialists from our university here, and also Women’s Hospital were conducting this break out session. This group represented some of the best in the world, with the latest work in the field of eating disorders.
The three doctors facilitating the break out session had a flip chart ready with paper and markers and when we all gathered, expecting to hear from them on their work, they said, “We’re looking for collaboration and to learn from what you are doing in your facilities… so lets have it tell us who you are, where you are from and what you are doing.”
It took everyone a few moments and then the group erupted sharing experience and coaching each other. It was wonderful hearing from across the globe information and recommendations that they were finding worked.
The Australians offered they begin re-feeding with nasal gastric tubes, and 4000 cal per day, until the weight stabilizes and they do not use dextrose or potassium drips. There were many ah’s around the room, and questions too. They have agreement in the ER’s for admissions that they must call an ED specialist in on every ER consultation, no matter the hour, and they have not lost a patient due to re-feeding syndrome issues in a very long time. They are contributing around the world with their strategies.
We heard from everyone, and the input was non-judgmental in nature, it was collaborative and respectful. It’s exciting to think times are changing to inclusive thinking broadening our horizons to what is possible working together.
It’s lovely to think we are breaching the need for sensationalism and know that anyone working in the “trenches” with eating disorders is working very hard indeed to find the way to help those in need.