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Do any of these eating disorder traits fit you or someone you know? Feel free to leave a comment. If any problem with weight or eating is affecting your job, relationships, or making you unhappy, consider seeing a professional.

Staying connected with David Joel Miller

Seven David Joel Miller Books are available now!

My newest book is now available. It was my opportunity to try on a new genre. I’ve been working on this book for several years, but now seem like the right time to publish it.

Binge Eating Disorder – the other side of Anorexia and Bulimia

Story Bureau is a thrilling Dystopian Post-Apocalyptic adventure in the Surviving the Apocalypse series.

Baldwin struggles to survive life in a post-apocalyptic world where the government controls everything.

As society collapses and his family gets plunged into poverty, Baldwin takes a job in the capital city, working for a government agency called the Story Bureau. He discovers the Story Bureau is not a benign news outlet but a sinister government plot to manipulate society.

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Dark Family Secrets: Doris wants to get her life back, but small-town prejudice could shatter her dreams.

Casino Robbery Arthur Mitchell escapes the trauma of watching his girlfriend die. But the killers know he’s a witness and want him dead.

Planned Accidents The second Arthur Mitchell and Plutus mystery.

Letters from the Dead: The third in the Arthur Mitchell mystery series.

What would you do if you found a letter to a detective describing a crime and you knew the writer and detective were dead, and you could be next?

Sasquatch. Three things about us, you should know. One, we have seen the past. Two, we’re trapped there. Three, I don’t know if we’ll ever get back to our own time.

For these and my upcoming books; please visit my Author Page – David Joel Miller

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For videos, see: Counselorssoapbox YouTube Video Channel

Avoidant Restrictive Food Intake Disorder

Posted on August 17, 2012 by David Joel Miller

By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

Counseling questions.
Photo courtesy of Pixabay.com

Avoidant Restrictive Food Intake Disorder vs. Anorexia and Bulimia.

How is Avoidant Restrictive Food Intake Disorder (ARFIDO) different from all those eating disorders people have come to know? And did we really need another eating disorder diagnosis?

Proposed for the new DSM-5 and looking like a for-sure new recognized eating disorder is ARFIDO. ARFIDO has some differences from past eating disorders. Given the many possible bad relationships with food people could become involved with, my take is yes this one is different from either Anorexia Nervosa or Bulimia and it has been needed for some time.

The way we have been looking at eating disorders has had some flaws for a while now. McFarland et al in 2008 wrote an interesting article on eating disorder relapse. The topic of relapse and relapse prevention has been an important part of substance abuse treatment for a long time. Recently we have been looking at the issue of relapse related to mental health issues.

In his article, McFarland reported that they ended up including all the people with an eating disorder in the relapse study because people with an eating disorder move between disorders often enough to prevent saying someone has one and only one eating disorder.

We also are told in this article that the majority of people in treatment for an eating disorder, up to 60% of those treated in outpatient, did not meet the criteria for one of the official diagnosis and ended up in the leftover category Eating Disorder Not otherwise specified (NOS).

Creating a new disorder (ARFIDO) is supposed to reduce the number of people who were ending up in that vague NOS land.

People with ARFIDO are different from those with anorexia nervosa or bulimia in several important ways. (I have taken liberties with the new DSM-V criteria here for sake of explanation.)

1. They do not have the characteristic distorted body image.

Ask a person with anorexia what they think about their current weight and they will tell you they are fat. Show them their reflection in the mirror, bones sticking out and all and they will still say they look fat. They see themselves at fat and no facts, not even the scale and the standard weight charts, will change that perception.

People with ARFIDO do not necessarily think they are fat.

They know they are thin, abnormally thin, but they like it that way. They become proud of their ability to stay thinner than most. They will keep up the dieting even when they know they are developing a health problem or nutritional deficiency because they like being one of the thin ones.

2. They don’t especially like food, food is the enemy.

People with ARFIDO will avoid many or all foods. They may need to resort to nutritional supplements to keep their weight above the critical go-to-hospital point.

3. They avoid putting on weight as they grow or in adulthood lose excessive amounts of weight.

They will continue avoiding food even when they know they are making themselves sick by their intentional starvation. Like Pieter Pan, they do not want to grow up or get larger.

4. This is not the result of starvation or lack of resources. People with ARFIDO do this on purpose. The will harm their health to look thin while living in a home with a full refrigerator.

5. Because they are so good at avoiding eating, people with ARFIDO do not have the need for the extreme measures we see in Anorexia Nervosa or Bulimia.

That is my understanding of this new diagnostic category at the current point in time. The new DSM will be out early next year and we can all get the full details then.

The update I read at the APA site was May 14-2012. They also note that when this is all done they expect there to be three subtypes of ARFIDO, A People who do not eat and are not interested in eating B People who will only eat food with certain sensory characteristics, C People who won’t eat because of an aversive experience.

Other posts about eating disorders and the new DSM-V proposals will be found at:

Middle class and starving to death in America – An Eating Disorder called Anorexia

Love Hate relationship with food – Bulimia Nervosa

Binge Eating Disorder – the other side of Anorexia and Bulimia

So do you think that this creation of ARFIDO will improve recognition of poorly recognized eating disorders? Do you believe you or someone you know has had an episode of Avoidant Restrictive Food Intake Disorder? If you recovering from or have you had a relapse to Avoidant Restrictive Food Intake Disorder would you care to leave a comment?

Staying connected with David Joel Miller

Two David Joel Miller Books are available now!

Casino Robbery is a novel about a man with PTSD who must cope with his symptoms to solve a mystery and create a new life.

For these and my upcoming books; please visit my Amazon Author Page – David Joel Miller

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For more about David Joel Miller and my work in the areas of mental health, substance abuse, and Co-occurring disorders see my Facebook author’s page, davidjoelmillerwriter. A list of books I have read and can recommend is over at Recommended Books. If you are in the Fresno California area, information about my private practice is at counselorfresno.com.

Binge Eating Disorder – the other side of Anorexia and Bulimia

Posted on May 26, 2012 by David Joel Miller

By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

Binge Eating Disorder – the other side of Anorexia and Bulimia
Photo courtesy of Pixabay.

Eating yourself to death – Binge Eating Disorder.

We used to ignore Binge Eating and only pay attention to eating disorders that involved inappropriate ways to control weight. Anorexia and Bulimia are well-recognized eating problems that were covered in previous posts.

Other posts about eating disorders and the new DSM-V proposals will be found at:

Middle class and starving to death in America – An Eating Disorder called Anorexia

Love-Hate Relationship with food – Bulimia Nervosa

Recently we have started to see how the overeating part can be a major issue even without the effort to control weight. In Binge Eating Disorder the emotional eating component takes place but it is as if the person with Binge Eating Disorder gives up and stops even trying to control their weight.

As in Bulimia, the food is consumed in a relatively short period of time, two hours or less. One episode of this behavior does not make for the diagnosis; Binge Eaters do these behaviors on a regular basis. The strict diagnostic criterion calls for at least one episode a week for at least three months.

Loss of control is a hallmark of this as well as other impulse control problems. It is not simply that the person likes to eat but that they are driven to eat. Even when they try to avoid the excess calories they are unable to control themselves.

Binge eaters eat faster than everyone else, they wolf the food down. And the Binge eater does not stop when full. They are unable to realize they are full until it becomes impossible to eat more. Even when not hungry the Binge eater will continue to eat for the emotional values of the experience rather than for the nutritional ones.

This eating disorder like other eating disorders is characterized by secrecy and avoiding others seeing what the Binge Eater is doing, they will eat surreptitiously to avoid notice. After a binge episode, the Binger may become sad, anxious, and have feelings of guilt. They can begin to hate themselves.

Binge eaters are not comfortable with what they are doing, they wish they could stop but efforts to control their food intake are unsuccessful.

Binge eating is not a simple case of overeating, laziness, or unwillingness to exercise. It is a specific psychiatric problem that includes the uncontrollable urge to eat even when full and the lack of any energy to attempt to lose weight.

Binge Eating may lead to depression or may accompany a mood disorder. Gradually the pounds are packed on; the Binge eater becomes isolated from family and friends and may begin to hate themselves but still can’t stop without help. This condition requires professional treatment. Treatment for Binge eating may be less widely available than therapy for other eating disorders because the health damage occurs more slowly, but untreated the ill effects on health will certainly occur.

There is a fourth category of Eating disorders, Eating Disorders Not Otherwise Specified (NOS) which includes both unusual problems in food and weight loss and those cases that are not quite severe enough to get a diagnosis of one of the three principal types.

Three brief posts to cover four potential problems in the area of food and eating. There is treatment available for all of these issues. If you have experienced an eating disorder and care to share your experience, strength, and hope please leave a comment about anything related to Anorexia, Bulimia Binge Eating Disorder, or any other topic related to recovery.

Staying connected with David Joel Miller

Seven David Joel Miller Books are available now!

My newest book is now available. It was my opportunity to try on a new genre. I’ve been working on this book for several years, but now seem like the right time to publish it.

Binge Eating Disorder – the other side of Anorexia and Bulimia

Story Bureau is a thrilling Dystopian Post-Apocalyptic adventure in the Surviving the Apocalypse series.

Baldwin struggles to survive life in a post-apocalyptic world where the government controls everything.

Dark Family Secrets: Doris wants to get her life back, but small-town prejudice could shatter her dreams.

Casino Robbery Arthur Mitchell escapes the trauma of watching his girlfriend die. But the killers know he’s a witness and want him dead.

Planned Accidents The second Arthur Mitchell and Plutus mystery.

Letters from the Dead: The third in the Arthur Mitchell mystery series.

What would you do if you found a letter to a detective describing a crime and you knew the writer and detective were dead, and you could be next?

Sasquatch. Three things about us, you should know. One, we have seen the past. Two, we’re trapped there. Three, I don’t know if we’ll ever get back to our own time.

For these and my upcoming books; please visit my Author Page – David Joel Miller

Want the latest blog posts as they publish? Subscribe to this blog.

For videos, see: Counselorssoapbox YouTube Video Channel

Middle class and starving to death in America – An Eating Disorder called Anorexia

Posted on May 25, 2012 by David Joel Miller

By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

Unhealthy relationship with food.
Photo courtesy of Pixabay

Anorexia is a killer.

We know Anorexia Nervosa, Anorexia for short, is out there. This eating disorder can be a fatal disease. Most of us can name a famous celebrity or two who suffered and died as a result of Anorexia. But when someone we know, someone in our family develops Anorexia we are likely to look the other way until it is too late.

Anorexia Nervosa, along with Bulimia and Eating Disorder Not Otherwise Specified, mostly binge eating without an effort to lose the weight, these are the three currently recognized eating disorders. There are many misconceptions about Anorexia.

Anorexia is not dieting gone too far. Anorexia’s most recognizable feature is a refusal to maintain normal body weight. It is a distortion in the way the person sees themselves. The person with Anorexia sits in front of me. It is hard for me to look at them. The bones are visible and they look like a skeleton walking. They hid this from people for a long time with baggy clothes, strange secretive eating habits, or other devices.

Anorexia is not a loss of appetite. Even in the presence of extreme hunger, someone with Anorexia will refuse to eat.

I ask the person with Anorexia what she thinks of her weight. She says she needs to lose some weight, she is getting fat. I ask how much weight, she tells me five maybe ten pounds. If I were to show her the mirror, let her see the bones sticking out, would that change her mind? Not likely. People with Anorexia even when confronted with a look at the bones that stick out will still insist they are too fat; they need to lose more weight. The problem is not in the diet but in the mind. The image in the mirror looks fat to them.

It is not about a lack of interest in food. Many with Anorexia watch cooking shows, own recipe books, and even hoard food. In the early stages, they may develop odd picky eating preferences and habits. Some appear to have Obsessive Compulsive Disorder when it involves food, weight, and dieting. They may refuse to eat in public and insist on taking their food to their rooms. They may have a strong perfectionist inclination.

They know the ingredients in the foods and can tell you more about the nutritional values than most dietitians, only they refuse to eat until they damage some organs. Sometimes the dieting and the other behaviors continue until death.

You don’t see a lot of Anorexia in poor families. It is more likely among the middle class and the rich. All the resources in the richest country on earth and still they starve – on purpose.

The thing that matters most to the anorexic is not the food – it is the control. They may have no control in any other area of their life but you can’t make them eat. Force feed them and they will vomit. The ways a person with Anorexia may reduce their weight are varied and imaginative. They may restrict, purge, use laxatives, or exercise to the extreme.

Anorexia doesn’t just cost weight. It affects a person’s overall psychical health, their psychology, and their social life.

Anorexia is most often not a stand-alone disorder. It like the other eating disorders, Bulimia and Binge Eating, frequently co-occur with anxiety and depression.

Besides the low weight, how can you tell if it is Anorexia and not just a dedicated dieter?

Someone with Anorexia will weigh less than 85% of what is considered normal for their height and age. They become extremely fearful of gaining any weight even when they know that they are thinner than their peers.

In women, they will have missed three or more menstrual cycles.

Someone with Anorexia sees their extremely low weight as a great achievement rather than a life-threatening illness.

Anorexia is not a phase teenagers go through even though many first develop the symptoms in their teen years. It is a life-threatening illness. Without treatment, it is highly unlikely to go away and is very likely to get worse until eventually it impairs health and may result in death.

Dieting is not the only way someone with Anorexia might control their weight. Some people binge eat and then purge, they may develop a ritual around their efforts to vomit and undo the binge eating. Those with Anorexia who binge and purge are more likely to develop other impulse control problems; they may abuse drugs and alcohol and engage in excessive, risky sex. Those who binge and purge are more likely to attempt suicide.

Anorexia Nervosa affects about one in two hundred people. Lots more cases come close but don’t get diagnosed because they don’t get below 85 % of normal weight measures. Most clients with Anorexia are female and this disorder most often starts in the early to middle teenage years, but not always.

Most any clinician can recognize and diagnose Anorexia but very few are willing to treat this condition. Even psychiatric hospitals are likely to refuse clients with Anorexia because of the high risk of permanent medical problems or death. There are effective techniques for treating Anorexia but they are specialized and often treatment occurs at treatment facilities that specialize in eating disorders.

Anorexia is a dangerous sometimes fatal condition. If you or someone you know has signs of this disorder please seek professional help before it is too late.

Other posts about eating disorders and the new DSM-V proposals will be found at:

Middle class and starving to death in America – An Eating Disorder called Anorexia

Love-Hate Relationship with food – Bulimia Nervosa

Staying connected with David Joel Miller

Seven David Joel Miller Books are available now!

My newest book is now available. It was my opportunity to try on a new genre. I’ve been working on this book for several years, but now seem like the right time to publish it.

Binge Eating Disorder – the other side of Anorexia and Bulimia

Story Bureau is a thrilling Dystopian Post-Apocalyptic adventure in the Surviving the Apocalypse series.

Baldwin struggles to survive life in a post-apocalyptic world where the government controls everything.

Dark Family Secrets: Doris wants to get her life back, but small-town prejudice could shatter her dreams.

Casino Robbery Arthur Mitchell escapes the trauma of watching his girlfriend die. But the killers know he’s a witness and want him dead.

Planned Accidents The second Arthur Mitchell and Plutus mystery.

Letters from the Dead: The third in the Arthur Mitchell mystery series.

What would you do if you found a letter to a detective describing a crime and you knew the writer and detective were dead, and you could be next?

Sasquatch. Three things about us, you should know. One, we have seen the past. Two, we’re trapped there. Three, I don’t know if we’ll ever get back to our own time.

For these and my upcoming books; please visit my Author Page – David Joel Miller

Want the latest blog posts as they publish? Subscribe to this blog.

For videos, see: Counselorssoapbox YouTube Video Channel

Love Hate relationship with food – Bulimia Nervosa.

Posted on May 25, 2012 by David Joel Miller

By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

Unhealthy relationship with food.
Photo courtesy of pixabay

Bulimia Nervosa a relapsing eating disease.

Bulimia Nervosa is included in the eating disorder category along with Anorexia Nervosa but it is very different from the other eating disorders. Anorexia progresses like a vice, starving the sufferer until their weight reaches a critical potentially fatal low. Bulimia runs its course in episodes of extreme eating and efforts to undo the overeating and lose the weight until it finally does its damage.

If you didn’t hear the person with Bulimia talking about food, should you only hear the emotional component, it would be hard to distinguish Bulimia from the binge drinking form of alcoholism.

Episodes of binging and the resulting guilt can be triggered by many of the same things that trigger addictive binges. Poor relationships and conflicts with others, the feeling of deprivation from excessively strict diets, or feeling out of control all can trigger the binges.

Binge eaters describe these overwhelming obsessive-compulsive urges as emotional eating. Emotional eaters who do not purge develop Binge Eating Disorder. Those who start compensating develop Bulimia.

Most people who develop Bulimia start off at normal or even a little overweight. They are likely to be a little older than the beginning person with Anorexia, perhaps late teens or even early twenties. There may be a period of moderate to strict dieting before the Bulimia strikes.

When they diet they have increasingly intense urges to eat. The tension continues to grow until the individual can’t stand it any longer, then like the alcoholic, the binge is on. At this point, the “just don’t think about it” approach does not work and may make things worse. In a previous post “Don’t think about Elephants.” I described why the “just not thinking about things” approach does not work and what else can be done in this circumstance.

Binge drinking is defined as 4-5 drinks on a single drinking occasion, enough to get intoxicated. Binge eating is described as eating far more than a normal person during a single food intake episode lasting two hours or less. Bulimics crave food and then when they give in and eat it is not a little, but a lot of food consumed in a short amount of time. This overconsumption results in guilt and regret.

These episodes increase in frequency. Typically the person with Bulimia will have two or more episodes of loss of control, binge eating, and then efforts to purge the food every week for at least three months. The guilt over the episode increases the risk they will binge again.

Often the food of choice is ice cream or cake though no one food type is the choice of all people with Bulimia. They will eat until they reach the over-full point, become uncomfortable, or even painfully full.

The Bulimic then tries to undo the excess calories by deliberate vomiting or other compensatory behaviors. This is not a disease of gradual overeating and excess weight gain. Bulimia may result in sudden swings in weight, both increases, and decreases. The damage comes not from the weight gain or loss but from the radical behaviors used to undo the binge episode.

The emphasis is on the person’s use of “inappropriate” methods to undo the overeating. Someone with Bulimia may vomit so often that the enamel in the teeth is destroyed. They may develop calluses on the knuckles from repeated efforts to force the vomiting.

There can be damage to the throat and esophagus. A great many medical problems develop over time but may go unnoticed as the person’s weight swings up and down rather than moving to an extreme.

Bulimia is more common than Anorexia with up to three percent of women developing Bulimia during their lifetime.

These episodes of binge eating and the resulting efforts to undo the overeating are generally done in secret. The sufferer tries to be inconspicuous and may withdraw from family and friends damaging their relationships.

Self-esteem for the person with Bulimia is dependent on body shape and weight. They often develop intense depression after a period of bingeing and purging. Some have undiagnosed depression before the Bulimia, but Bulimia can also cause depression and anxiety.

Bulimia Nervosa like Anorexia Nervosa is treatable but both require specialized treatment by someone knowledgeable and experienced in treating eating disorders.

Bulimia is not associated with a high risk of suicide or death from medical complications, though some who have suffered from Bulimia can become severely depressed and have thoughts of self-harm.

Bulimia Nervosa is an illness not a case of vain or selfish behavior. If you want to be helpful to someone with this disorder listen to what they have to say in an open and non-judgmental way.

If you have Bulimia, get help now. If you know someone who has this problem encourage them to seek professional help.

Other posts about eating disorders and the new DSM-V proposals will be found at:

Middle class and starving to death in America – An Eating Disorder called Anorexia

Love Hate relationship with food – Bulimia Nervosa

Staying connected with David Joel Miller

Seven David Joel Miller Books are available now!

My newest book is now available. It was my opportunity to try on a new genre. I’ve been working on this book for several years, but now seem like the right time to publish it.