Binging on food – Binge Eating

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

Food.
Photo courtesy of Pixabay.com

Out of control eating is officially a mental illness.

With the advent of the DSM-5, Binge Eating Disorder (307.51 F50.8), is officially a recognized mental illness. Reading through the description of this newly recognized disorder it occurs to me that this is not what most non-professionals have been thinking of when they talk about people who overeat. What follows is my oversimplified explanation of how I understand this and how it might affect clients I see. For the full official description, you would need to read the APA’s DSM-5 text.

Why does Binge Eating Disorder matter?

Given the APA’s estimates, the number of people in the U. S. who currently have or meet criteria for Binge Eating Disorder would run from 2 ½ to 5 MILLION people. A look at the criteria also indicates this is a lot more serious condition than we might first think. A lot of the criteria remind me of the features we see in alcoholism. This is more than just liking to eat. Binge Eating Disorder goes all the way to losing control.

First, some things that do not appear to be included in the definition of Binge Eating Disorder and then the things that might define the disorder.

What Binge Eating Disorder is not:

Binge Eating disorder is not being overweight or obese.

We think that excess weight is a medical problem. There are a lot of reasons someone could be overweight or even obese that have nothing to do with binge eating. Mental Health and obesity have a lot of connections but Binge Eating Disorder is not the only one. (More on how mental illness may be making you overweight in an upcoming post.)

Binge Eating Disorder is not Holiday Eating.

That Thanksgiving dinner is a good reason to gorge yourself. It is almost Un-American to eat lightly on that holiday. Lots of families have other traditional family or holiday celebrations and the food is a major part of that celebration. We do not count social eating events as Binge Eating Disorder even if after the holidays you find you have packed on some pounds.

Snacking all day is not Binge Eating Disorder.

Some people have told me that eating small amounts of food at many small meals a day is healthier than a few huge ones. I am also told that eating lots of food is healthy if you can do it all day long. (I am skeptical of that argument.) There was a time when low weight people died every winter and a fat baby was considered a healthy baby. Modern healthcare has severed that connection, but I know new parents often worry if their child is not gaining weight as rapidly as they expected.

Eating because you are chronically hungry is about poverty, famine or bad nutrition.

If someone is low in body weight and eats a lot that is probably not Binge Eating Disorder. If they are staying low body weight because they do other “compensating” behaviors that is a different kind of eating disorder most likely Bulimia Nervosa.

Eating frequently because you are growing, expending energy or just plain hungry is not Binge Eating Disorder. Binging is sneakier than that.

What factors do make it Binge Eating Disorder?

 The Binge eater feels bad when they do it.

People with Binge-eating Disorder may eat alone so others do not see how much they eat. This behavior reminds me of the alcoholic sneaking drinks. The Binge Eater does not want others to see them binging. The may eat in solitary, hide the evidence and they feel guilty or ashamed of what they do.

Eventually, that shame and or guilt become a separate problem that needs treatment and may be the thing that keeps the binging behavior going even if they want to stop.

Binge eaters lose control of their eating.

This loss of control takes many forms. The binge eater eats fast, very fast. They eat more than they want. They can’t stop eating even when they are over full. They may keep on eating to the point of feeling sick to their stomach.

One of the defining features of this disorder is the tendency to eat huge amounts of food in a short period of time. A binge eater will eat enough food for two or three people and do it in 2 hours of meal time or less.

Binge Eaters do these behaviors a lot.

This is not something that the binge eater does occasionally. To get this new diagnosis a person would need to binge at least 13 times over a three-month period.

The Binge Eating Disorder diagnosis allows for a range of severity.

The minimum is 13 times in three months. Extreme Binge Eating Disorder is binging two times a day all 7 days a week. To meet the 3-month rule and have extreme Binge Eating Disorder would require over 180 episodes of binging with no compensating efforts to lose the calories.

Emotional Eating does not automatically count as a Binge.

Most counselors have heard clients describe times they “emotionally eat.” You have a fight with your partner and there go the whole two gallons of ice cream. Those uses of food to make yourself feel better are more likely a part of depression, anxiety or that often overlooked but sometimes fatal Adjustment Disorder.

The Binge Eating conclusion?

If you are overweight or obese see your doctor and work on your physical health. If you occasionally use food like a drug to treat your emotional problems work on those problems. But if you find that you or someone you know is repeatedly binging on food, feels shame and guilt about this behavior or has lost control of how much they eat, it is time for some professional help.

Staying connected with David Joel Miller

Three David Joel Miller Books are available now!

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.

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.

SasquatchWandering through a hole in time, they encounter Sasquatch. Can they survive? The guests had come to Meditation Mountain to find themselves. Trapped in the Menhirs during a sudden desert storm, two guests move through a porthole in time and encounter long extinct monsters. They want to get back to their own time, but the Sasquatch intends to kill them.

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

Books are now available on Amazon, Kobo, iBooks, Barnes & Noble, and many other online stores.

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

Want the latest on news from recoveryland, the field of counseling, my writing projects, speaking and teaching? Please sign up for my newsletter at – Newsletter. I promise not to share your email or to send you spam, and you can unsubscribe at any time.

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. If you are in the Fresno California area, information about my private practice is at counselorfresno.com.

Advertisements

Reactive Attachment Disorder is now a Trauma and Stressor-Related Disorder

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

Words about PTSD

Stress and Trauma. 
Photo courtesy of Pixabay.com

Reactive Attainment is related to Stress and Trauma but how?

We know children can be affected by reactive attachments but now we are wondering if it might underlie some problems of adults. We know what happens to you growing up can shape and affect you for the rest of your life, how much might reactive attachment disorder be contributing to adult mental health issues?

Reactive Attachment Disorder (RAD) used to be a problem relegated to a special section on childhood issues; it has been moved to the Stress and Trauma section of the new DSM-5. Two things to consider – the way in which this childhood problem may be affecting adults and how might this be another case of how much is it affecting adults rather than a simple yes or no question.

Reactive Attachment is a serious problem for very young children as any Child Protective services worker will tell you. We have a fairly good idea what causes it and some methods of treating it but the long-term consequences seem to get lost when the child reaches the school years and beyond.

Working with adults I see some of these characteristics from time to time. I do not want to minimize the problem in children nor do I think every adult problem should get blamed on childhood experiences. Just the same there are these tendencies we see in adults and I can’t help wondering how many of those adult problems had their roots in childhood experiences.

First the 7 criteria for Reactive Attachment Disorder (very roughly paraphrased from the DSM-5) and along the way some thoughts on how other adult issues may be like this one and may be different from RAD. For the full, precise set of characteristics and diagnostic criteria see the DSM-5.

1. The child is always or almost always is inhibited and withdrawn. They do not go to adults for comfort and when the adult tries they do not appear to be comforted.

2. Low or no social interaction with others, and does not look happy or like they are enjoying themselves. Lots of sadness, irritability, and fear for no good reason.

3. The child has been neglected and did not get their needs met by adults in their life. Parents could not or did not meet the child’s needs or child moved from caregiver to caregiver so much no pattern of care got off the ground. Group settings with too few adults per child can also cause this.

4. We think the lack of care caused the problem. (This can be the tricky one as we may not know what this person’s care was like way back when.)

5. This is not Autism or something like autism (The DSM lists ways to tell these apart.)

6. This started before age 5.

7. The child is developmentally at least 9 months old.

Now if you got all that you should have a picture of what this neglected (maybe also abused) child might look like. This kid could be a very difficult child to raise. The just sit there and look at you.

Most kids we expect to be cute. Give them a toy to play with and they smile. Hug them and the hug you back. Not the child with RAD. This kid cries for no reason and does not stop when you hold them. They never smile and they are always irritable. They jump at the slightest sound and then refuse your touch when you try to comfort them. Getting the picture?

Now the criteria wants us to see and know all this before 5 years and know that the neglect (or abuse) caused this.

What would this child look like in ten or twenty years as they grow up and for some reason first appear in the mental health system?

What might these symptoms look like if it was not an all or nothing situation? Say the parents worked all the time and the child had to fend for themselves. They moved around a lot and had no friends or close family members?

As this person ages, they might live in various group homes. The caregiver would keep changing. They would develop trust issues. They might believe that you can’t rely on others because they will leave you.

In the teen years this child might, still angry, irritable, anxious, act out and get in trouble. These would be the children that blow foster home placements or move from group home to group home. Even if they lived with some family member, grandma or aunt, they would never really get close to that person and eventually, they would “hook up with” a member of the opposite sex and have some more little ones.

Not able to feel cared for they might not be able to care for their own children and they might abuse or neglect the next generation.

While Reactive attachment is an extreme case I think by now you might see how low caregiver contact, abuse, neglect, or frequent changes of living situation could produce some of these characteristics in greater or lesser degree as the child grows to adulthood.

Not knowing or feeling loved is at the core of these problems.

We may well have been underestimating the effects of lifespan issues in our evaluation of adult mental and emotional issues.

People can and do recover from most all forms of mental and emotional disorders, but recovery from Reactive Attachment Disorder is a difficult process.

Staying connected with David Joel Miller

Two David Joel Miller Books are available now!

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.

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

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

Want the latest on news from recoveryland, the field of counseling, my writing projects, speaking and teaching? Please sign up for my newsletter at – Newsletter. I promise not to share your email or to send you spam, and you can unsubscribe at any time.

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.

Does a low IQ score matter? Mental retardation becomes Intellectual Disability.

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

Could you be mentally ill?

What Causes Mental Illness?

Mental retardation becomes Intellectual Disability.

 

How much do I.Q. scores tell us?

There has been a lot of misunderstanding about I.Q. Scores, what they mean and just how significant a low I.Q. score may be. Some of the things we thought we knew have been challenged recently.

One definition of an I.Q. score is “The number of marks you make correctly on a piece of paper divided by your age.” We expect younger people to get lower scores and older people to get higher scores. What this does not tell us is what those scores are really measuring and what difference does it make.

The conventional belief is that people with low I.Q. scores are less mentally able.

This presumes that there are no biases in the test. Most test manufacturers or publishers work long and hard to eliminate biases. Still, we know that culture matters. Most I.Q. tests rely heavily on words, so if you speak two or more languages, but as a result know fewer words in each language you speak, you might score lower.

The presumption in the past has been that the higher you score on the I.Q. test the smarter you were and the better you should do in life. For someone with a low I.Q. we assumed that learning things would be harder.

This does not explain how someone with a low I.Q. score might be very good at a skill like music or a sport while the person with a high I.Q. might fail at those same skills.

Clearly I.Q. is not the whole story.

The mean I.Q. score is set at 100. The way I.Q. mathematics works are that the majority of people get scores from 85 to 115. That range is considered normal. So mix children with I.Q. scores of 85 and 115 together in a class and the teacher might have difficulty telling which is which, without reference to their test scores.

But if you get a score of 84, now we say you have “Borderline intellectual function.” If the 30 point differences between “normal” don’t make much difference how does that one point difference between 84 and 85 make so much difference?

The truth is small differences don’t make that much difference.

What matters most is what people do with the intelligence they have. So just like the really heavy kid may be no good at football and the skinny little kid may be able to run really fast with the ball, so to differences appear in how people use the intellectual resources they have.

The trend in the DSM-5 to move towards dimensional diagnosis rather than categories has changed our thinking from classifying mental retardation based on I.Q. scores to looking at how that low I.Q. is affecting the person.

So if the person is having difficulty with adaptive functioning because of their intellectual disability they get diagnosed with an intellectual disability disorder. If they are doing a good job of functioning despite a low I.Q. score they just may not get a diagnosis.

I realize this will take a while for the popular culture to catch up. It is no longer your I.Q. score that matters but what you do with what you got.

This shift by therapists and the APA is also likely to cause ripples in all that special education and those government programs that are still using I.Q. scores as a basis for services.

All in all, I see good and bad in this. Good if it reduces stigma against people simply because of the score they got on one piece of paper and bad if as a result of new definitions some people who need help get screened out.

Only time will tell.

So till then stop saying people have mental retardation and look to see if they are having difficulty coping with their life because of an intellectual disability or are they just sad, anxious or upset about life events like the rest of us.

Staying connected with David Joel Miller

Two David Joel Miller Books are available now!

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.

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

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

Want the latest on news from recoveryland, the field of counseling, my writing projects, speaking and teaching? Please sign up for my newsletter at – Newsletter. I promise not to share your email or to send you spam, and you can unsubscribe at any time.

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.

O.C.D. or Obsessive-Compulsive Personality Disorder?

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

What is the difference between OCD and Obsessive-Compulsive Personality Disorder?

Obsession

Obsession.
Photo courtesy of Pixabay.com

There are two different mental disorders that share the OCD designation. It seems odd that we have two disorders that share the OCD part of their labels. The way I read the DSM they are rather different disorders.

The result of this dual use of the OCD label is that the two conditions may be getting confused and that people with Obsessive-Compulsive Personality Disorder may not be getting diagnosed or treated the way they should be.

People with Obsessive Compulsive Disorder have high levels of anxiety and they have rituals they feel compelled to perform that relieve the anxiety.

Think of obsession as not being able to stop thinking about something, in the case of OCD this thing they can’t stop thinking about is usually connected to some perceived danger. This is beyond just being over-anxious about a real danger. Like PTSD there are images that keep popping into the head. Having these thoughts upsets the person. The person with OCD knows these are their own thoughts and that the thoughts are excessive.

The compulsive part has to do with the inability to withstand the thought and the need to do something to relieve the tension. These obsessions are not things like avoiding the alligator, which might keep you safe. They involve things like washing of hands over and over, praying for a long period of time repeating phrases or counting.

The description of OCD reminds me of impulse control disorders like gambling or addiction and has some similarities to over eating disorders.

OCD is a more generalized condition than what you might see in someone who has difficulty controlling only one obsession or compulsion as in an alcoholic who keeps thinking about drinking until the give in and drink. In OCD the compulsions don’t have that direct a relationship.

That is a very over brief description of OCD from the DSM-4-TR.

For more on OCD and its treatment, I would refer you to another site here on WordPress called ocdtalk.

How is OCD different from Obsessive Compulsive Personality Disorder?

This description of Obsessive Compulsive Personality Disorder is taken from the proposal for the DSM-5 since it will become final very soon and Obsessive Compulsive Personality Disorder is one of the personality disorders that the DSM-5 kept.

Obsessive Compulsive Personality Disorder involves a SIGNIFICANT impairment in self-functioning. Someone with Obsessive Compulsive Personality Disorder does not just have a few symptoms about one thing but that is the way they are all the time.

Someone with Obsessive Compulsive Personality Disorder gets their self-worth, their sense of purpose in life from their work or productivity. They are compelled to do something all the time. They have overly high rigid standards and are “inflexible” about meeting these standards. This sounds like that old “black and white thinking” to me.

Someone with Obsessive Compulsive Personality Disorder is overly moralistic or conscientious. As a result of these excessive standards, they may be unable to complete projects unless they can be done “correctly” or perfectly.

People with Obsessive Compulsive Personality Disorder lack empathy for others and will put work or moral standards before relationships.

If you are not perfect the person with Obsessive Compulsive Personality Disorder will not want you for a friend. If you think you are perfect then you may well have Obsessive Compulsive Personality Disorder or another mental illness.

Other traits of a person with Obsessive Compulsive Personality Disorder include rigid-compulsive perfectionism and negative “affect.” Meaning they are negative about everything all the time.

They person with Obsessive Compulsive Personality Disorder is also likely to practice “perseveration” meaning they can’t let something go. They will keep trying to get something just right even after it no longer matters.

I get the picture here of someone who is very “puritanical.” I believe sitcoms call them “anal retentive.”

People with Obsessive Compulsive Personality Disorder do not end up in treatment very often, at least not for the personality disorder, but they do drive others around them to therapy.

Did that explain the difference? Feel free to leave a comment. I always feel compelled to reply.

Staying connected with David Joel Miller

Three David Joel Miller Books are available now!

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.

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.

SasquatchWandering through a hole in time, they encounter Sasquatch. Can they survive? The guests had come to Meditation Mountain to find themselves. Trapped in the Menhirs during a sudden desert storm, two guests move through a porthole in time and encounter long extinct monsters. They want to get back to their own time, but the Sasquatch intends to kill them.

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

Books are now available on Amazon, Kobo, iBooks, Barnes & Noble, and many other online stores.

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

Want the latest on news from recoveryland, the field of counseling, my writing projects, speaking and teaching? Please sign up for my newsletter at – Newsletter. I promise not to share your email or to send you spam, and you can unsubscribe at any time.

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. If you are in the Fresno California area, information about my private practice is at counselorfresno.com.

What are Minor Depressive Disorder and Depressive Disorder NEC?

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

Depressed person

Depression.
Photo courtesy of Pixabay.com

UPDATE – changes in the DSM.

You can erase most of this post from your memory. During the process of updating the Diagnostic and Statistical Manual of Mental Disorders (DSM) from the DSM-IV to the DSM-5 a lot of things were proposed. Some of those suggested changes were instituted and others were left out. This post includes mostly ideas that did not make it to the final DSM-5. Because these ideas were included in a lot of research articles and other blog posts I have left the post up, but need to tell you that this information is now out of date.

Minor Depressive Disorder is out.

It did not even make the maybe section of disorders needing more study that is in the back of the DSM.

NEC or Not Elsewhere Classified is one of those left out ideas.

It was discussed as an improvement over the old Not Otherwise Specified (NOS.) A lot of people were receiving NOS diagnosis rather than a more precise or accurate diagnosis. In retrospect, I can see how NEC like NOS could have turned into another Fuzzy catchall diagnosis.

The final decision was for the DSM-5 to have two miscellaneous designations for things that do not fit nicely into a particular category. These two new designations are; Other Specified and Other Unspecified.  When those two specifiers get used will need a whole other post but for now, just know that:

NOS is out

NEC is not in and does not replace NOS

 Here is the old post:

The new sort-of depressive disorders

Minor Depressive Disorder is another one of those disorders that were proposed as somehow different from other depressive disorders. It was proposed in the DSM-4-TR as a condition needing further study.

The reason some researchers suggested this one is that the diagnoses in the DSM are yes or no things. You either meet criteria or you don’t, give or take some judgment calls we could describe as “clinical judgment.”

People do not come with discrete specific mental illnesses very often. They have problems and suffering and want help. To get that help we need to give them a “diagnosis.” The labels do not always fit well.

Minor Depressive Disorder was hard to tell from the other Depressive Disorders and does not seem to have made the cut for the DSM-5. (I am reading the on-line version; the paper version will not be out until next year.)

What we will have is a new group of Depressive Disorders Not Elsewhere Classified (NEC.) Here is my quickie version of the new categories. For the full version check the APA website for the DSM-5 or wait for the Book or the Movie version.

Recurrent Brief Depression

Every month for a year they have 2-13 days of depressive symptoms. This comes with a list of reasons to not give this one or other diagnosis that it might be.

Mixed Subsyndromal Anxiety and Depression

Lots of people who are anxious get depressed and people who get depressed can become anxious. This happens so often that a new Mixed Anxiety and Depression diagnosis was proposed. That one did not make the cut. So for full-on Depression and full Anxiety looks like we will continue to use both diagnoses. It will be interesting to read the full text on this one when the DSM-5 comes out. Somehow this Subsyndromal mix got its own label.

Short duration (4-13 days) Depressive Episode

So if your brief depression does not recur every month you can still get a depressive diagnosis. This one concerns me and I will need to learn more. It seems to open the door for anyone who has ever had a “blue week” to now get a diagnosis of a mental illness. Wonder if this will get used a lot or very little?

Subthreshold Depressive Episode with insufficient symptoms

With only a few exclusions everyone now gets to be depressed.

Uncertain Depressive Disorder

This works for anyone else that would like a depression diagnosis but has not yet gotten one.

The conclusion

In my estimation, there will be a lot more people who can qualify for a depressive disorder diagnosis under the new system. I will need to study this one some more before we implement the new DSM-5. This may mean that a lot of people who need help but used to get turned away because they did not meet criteria for a diagnosis will get help. Or it could mean that everyone will get one of the depressive diagnoses and that a Depressive Disorder Diagnosis will stop meaning anything. Only time will tell.

Staying connected with David Joel Miller

Two David Joel Miller Books are available now!

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.

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

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

Want the latest on news from recoveryland, the field of counseling, my writing projects, speaking and teaching? Please sign up for my newsletter at – Newsletter. I promise not to share your email or to send you spam, and you can unsubscribe at any time.

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.

Mid-life and later life eating disorders?

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

Unhealthy food

Unhealthy relationship with food.
Photo courtesy of Pixabay

Why are mid-lifers and seniors developing eating disorders?

Eating disorders have traditionally been thought of as diseases of adolescence and young adulthood. Recently we think we are seeing an increase in eating disorders in middle age and older adults. Are people first developing an eating disorder as adults and if so why?

The first eating disorder to be recognized and studied was anorexia. When someone weighs less than 85% of the “average” weight for their height and age they stand out. Consider also that those average weight charts cited in some of the research may date from 1959 when most people here in the U. S. were smaller than we are now.

Bulimia was not recognized as a separate disorder until very recently and the closer we look the more eating disorders we find. Currently, a very large number of eating disorders are lumped together under the heading Eating Disorders Not Otherwise Specified (EDNOS). When the DSM-5 comes out next year (2013) there will be a whole new way of categorizing eating disorders and our understanding is likely to change.

Anorexia has long been thought of as a disease that first starts in adolescence or early adulthood. We thought it was brought on by a distorted body image or the influences of media emphasis on thinness. Anorexia is often a life long illness with relapses and can be fatal. We thought if you got out of your teen years without this illness you were home free.

We also thought that eating disorders were mostly a problem for women because of the emphasis of society on valuing women for their bodies. So when men began to be diagnosed with eating disorders this made us question what we knew about eating disorders. That change in thinking came slowly.

One study from a large European service reported in what they called a “definitive” study, that there were no cases of eating disorders that developed after age 26. I have left the name of the author of this report out from a sense of kindness. The trouble with the study was that they ended up, after looking at ten years of cases, with only eleven patients they were able to interview. Among those eleven were only one man, one person with Bulimia Nervosa and one person with EDNOS. They conclude that no one gets an eating disorder as an adult.

A study by a U. S. nonprofit of clients who were in treatment for an eating disorder in their midlife reported on a sample of 100 clients (Kally, Cumella, 2008.) They found significant incidences of late onset of an eating disorder and differences in why they may occur.

Kally & Cumella considered the question “Could these later life presentations just be people who always had the disorder but never got diagnosed and were just now reaching treatment?”

They conclude that eating disorders can and do first develop in midlife and beyond but for different reasons than those reported in samples of younger people.

They looked at three factors, background factors that predisposed the person to an eating disorder, the immediate precipitator or trigger for the episode and factors that maintain the disorder once it is established. What they found strikes me as having implications for eating disorder sufferers of all ages as well as pointing us in the direction of why more men are receiving the diagnosis these days.

The largest contributing factors they found (in my words not necessarily theirs) were a history of abuse or neglect, not just as children but at any age, and critical non-affirming people in their support system. Respondents reported that factors in the home they lived in were more important than some general societal message.

This agrees with the things many children have told me. They developed eating problems because a parent or sibling called them fat not because of some celebrities appearance. Family pressure to look a certain way, parents who controlled food or abuse substances, along with a history of abuse or neglect were some of the background reasons or risk factors for developing an eating disorder.

It takes more than a background risk factor to cause an eating disorder.

Most of the sample talked about a specific triggering event and the triggers were different for older onset cases. Children developed symptoms as a result of their family of origin problems. Those who develop eating disorders later were often triggered by events in their family of choice. So if you were abused or neglected as a child or your parents divorced you might get through the event without developing a psychiatric diagnosis. But if that sort of event happened to you as an adult, you get a divorce, then you might develop an eating disorder. People with the risk factor might show increased sensitivity to the same sort of event happening at a later point in their life.

There are more differences between early onset and late-onset eating disorders.

Adolescents are more likely to be triggered by their body image. This is the result of a natural process of growth and development. The body changes and it can be uncomfortable. This is more likely if those in your house are unsupporting or critical.

Adults develop eating disorders because of changes in the family they have created. Divorce, separation, and relationship conflicts are all triggers. As the rate of divorce increased so did the rate of adults with an eating disorder. Adults also can be triggered by health and medical issues. There was a time when there was no such thing as being too heavy. A baby who was chubby was referred to as healthy. As people live longer and become heavier we see more and more negative effects of excess weight.

Men also are feeling the effects of a shift in societal views. Overweight men are now expected to lose weight. People of both sexes have the increasing problem of weight gain caused by medications. More than ever before people are facing medication caused weight gain.

Children who were forced to diet early in life are more likely to develop a binge eating or overeating disorder in adulthood (Rubenstein, et al., 2010.) In adulthood, the number of men who develop eating disorders begins to catch up with the number of women (Keel et al., 2010.)

The eating disorder conclusion.

Young people develop eating disorders because of a faulty or poor body image. Adults, as they get older, develop eating disorders because they do not like the changes in their bodies and in their life that aging cause.

What are your thoughts about why mid-lifers and seniors are developing eating disorders?

Staying connected with David Joel Miller

Two David Joel Miller Books are available now!

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.

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

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

Want the latest on news from recoveryland, the field of counseling, my writing projects, speaking and teaching? Please sign up for my newsletter at – Newsletter. I promise not to share your email or to send you spam, and you can unsubscribe at any time.

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.

Hoarding – Could the brains of hoarders really be different?

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

Brain

Memory.
Photo courtesy of Pixabay.com

Hoarding is about to become a recognized mental illness.

Hoarders just can’t make decisions when it comes to their own stuff. They don’t have trouble evaluating other people’s things, just their own, according to a study funded by the National Institute of Health.

There has been a lot more publicity about this than in times past but I have to believe that there have always been hoarders. People who lived through the “Great Depression” (1929 not 2008) tended to keep lots of stuff because if you ran out of wire or nails there might not be money to buy more. That is not the sort of saving that gets diagnosed as hoarding.

There seems to be something uniquely different about the way the mind of a hoarder works. Even when outsiders come in and reorganize the place, dispose of the garbage, the problem is not solved. The hoarder faced with new stuff, today’s mail or leftover napkins and condiment packets from fast food, can’t make a decision about what to keep and what to save. The result is they keep everything.

Proposed for inclusion in the new DSM-5 the new “Hoarding Disorder” is a fairly straightforward diagnose with only a few characteristics needed to make the diagnosis.

The characteristics needed, in my oversimplified explanation of this one are:

1. Can’t bear to throw things away whether they are worth saving or not.

2. They feel like they must keep it and get upset if forced to part with the item.

3. As a result of the hoarding, they run out of room and can’t use parts of their home for what it should be used for.

4. Hoarding is causing them problems with job, friends, making them unhappy or creating an unsafe situation.

5. No other reason, medical etc., for this behavior is found

6. This is not caused by another mental illness like depression or anxiety etc.

Points one to three are what makes this disorder different and points four to six are standard conditions for almost all diagnosis to look for other possibilities and make sure this really is a problem before making the diagnosis.

There appear to be two types of hoarders.

Those who are indiscriminate collectors and go out of their way to get new stuff, buying, stealing and scavenging things even when they have no use for the item.

Those hoarders who do not go out of their way to get things but can’t figure out what to keep and what to toss after they get things.

Whichever type of hoarder you or a person close to you are, the hoarder needs help. Cleaning out a hoarder’s collection is a short-term temporary fix. Hoarders need help from a profession to change their thinking or the whole process of accumulating just keeps repeating its self.

Staying connected with David Joel Miller

Two David Joel Miller Books are available now!

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.

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

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

Want the latest on news from recoveryland, the field of counseling, my writing projects, speaking and teaching? Please sign up for my newsletter at – Newsletter. I promise not to share your email or to send you spam, and you can unsubscribe at any time.

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.