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.

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.

Avoidant Restrictive Food Intake Disorder

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

Counseling questions

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:

Binge Eating Disorder – the other side of Anorexia and Bulimia 

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

Love Hate relationship with food – Bulimia Nervosa

Eating Disorders and Substance abuse  

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!

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.

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

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

Unhealthy food

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 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. The 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 the 85 % of normal weight measure. 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:

Binge Eating Disorder – the other side of Anorexia and Bulimia 

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

Love Hate relationship with food – Bulimia Nervosa

Eating Disorders and Substance abuse  

Avoidant Restrictive Food Intake Disorder

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.

DSM-5 Diagnoses begin to disappear

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

Medical record

Diagnosis.
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 some this information is now out of date.

Mental illnesses appear and disappear like magic – More DSM-5.

The effort to improve and refine the Diagnostic and Statistical Manual of Mental Disorders continues. This round of revisions has created a lot of concern about the way in which things we thought we knew about the nature and treatment of mental illness can change dramatically in a short time span.

There has been a lot of opposition to some of the proposed changes from both inside the American Psychiatric Association (APA) and those outside the association who have to work with the manual. The effects for consumers and clients may not be obvious for some time.

Recently the APA posted a notice on their website about changes they are making to the proposals for the new edition of the DSM. Not surprisingly, those revisions in proposals have coincided with the APA’s convention. The pressure to get this worked out is on now as the new edition is due out next year at the May 18-22, 2013 APA convention. That means the decisions need to be made and the book sent to the publishers by the end of 2012. The APA is accepting comments on their website from May 2nd to June 15th, 2012.

Most of these ideas are tested in carefully controlled trials with strict adherence to criteria. Unfortunately in daily practice clients don’t come in with only one problem and clinicians don’t have the time or resources to do extensive testing and diagnosing. The question remains, will this new understanding of mental disorders help or hinder the efforts to get clients the best possible care and still stay inside agencies budgets?

Here are some of the most recent changes

1. Mixed Anxiety and Depression

This is getting moved to the back of the book under diagnosis for further study. We know that clients often have both of these together but then they also may have diabetes and sore throats but so far we are not creating lots of combo diagnosis. Bottom line if you have two mental illnesses you get two diagnoses, not one “combo,” for now.

2. Attenuated Psychosis

This moves to the back of the book also. We have plenty of psychosis class diagnosis, not sure one more will make any difference.

3. Depression gets a footnote about being careful not to make normal things into mental illnesses.

But that always has needed some judgment. If it is causing you too many problems it gets diagnosed if it is within normal it does not. So we still try to keep categories of illnesses while we also allow for variations in degree.

4. The Non-Suicidal Self-Injury Diagnosis (often called cutting)

So far has not worked the way they thought it would. Some have proposed adding Suicidal Behavior Disorder also. Currently, neither of these is considered a mental illness. They are symptoms of something but we are not all agreed on what they are symptoms of. These two are likely to end up in the back of the book along with that complex grief thing.

So the announced changes in the draft move us back closer to where we were before – except that to this point the APA is staying with their proposed changes in Autism and Substance Use Disorders. 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.