Category Archives: eating disorders

Physiology Phriday: Your brain and your food

We all love certain kinds of foods and when we eat them, our pleasure quotients increase dramatically. Some recent work in brain imaging suggests that women with propensity for bulimia show “greater activation of key reward regions of the brain” after tasting a chocolate milkshake. These same individuals may also experience decreased activity in parts of the brain that control self-regulation and impulse control (as reported in the April 2009 Monitor on Psychology, pp. 48-49).

This area of research is new and so the results need replication plus interpretation. Does the brain function this way after years of bulimic behavior. Or, does the brain instigate or tempt such behavior (strong reward response plus increased impulsivity) with it’s prior functioning?

Of course, the individual struggling with bulimia cares only a little about the why. They really concern themselves with the what. How do I eat with moderation? How do I not eat for emotional reasons? Unlike alcoholics who can always avoid alcohol, everyone has to eat, and eat everyday.  So, what to do when your brain responds the way it does to food? Here’s a couple of practical ideas to start you down the right path:

1. Get a “coach” or counselor who you will be completely honest with. This coach will help you construct an eating schedule and an array of responses to eating or purging temptations.

2. Construct a realistic eating schedule that avoids avoiding food. Keep a food journal. Be honest. Keep troubleshooting with your coach until you find something that works best for you. Remember to check out your schedule (times and foods allowed) with a nutritionist.

3. Construct and use an array of behavioral responses to eating temptations. These include distractions, connections with others, ways to make the moment better, crisis call opportunities.

4. Develop mindful techniques to focus on eating, on stopping eating, on other forms of pleasure God has given you–even on the difficult emotions that you feel.

5. Identify controlling automatic thoughts and lies in your “script” that drive you in particular emotional and behavioral directions. These can be about your body image, about your relationships, etc. Begin responding to them with truth from God’s point of view. Make sure your coach and others know what truthes you are trying hard to believe.

6. As you recognize triggers, temptations, etc., also identify “ways of escape” offered you by God.

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Filed under christian counseling, christian psychology, Christianity, counseling science, eating disorders, Mindfulness, Psychology

Justifying paternalism toward clients?

Got a newsletter this week that had an article about paternalism with clients who suffer with eating disorders. The author begins with this statement:

Some clients are pressured into treatement by family, friends or physicians. Other clients enter treatment willingly because they want to make changes in their lives, but those changes may not include their eating behaviors. Still other clients profess a cincere desire to change their eating behaviors, but only if they can be assured that they will not gain a pound. Virtually all clients are ambivalent about giving up their eating disordered behaviors, and some outrightly refuse to change these self-destructive patterns.

All clinicians who work with eating disordered clients are faced with an ethical dilemma: how to attend to the well-being of clients who resist recovery from a potentially life-endagering disorder, while respecting the clients’ right to autonomy and self-determination.”

How does a counselor balance individual autonomy with protection of health and life? The author tries to distinguish between weak and strong paternalism. Weak, she says, legitimizes  interfering in with the ways a person achieves a desired goal. Strong paternalism believes that some goals are confused or mistaken and thereby require intervention.

The author does a fine job talking about the challenge of allowing clients freedom and yet strongly encouraging clients in a particular direction. Really, this raises the issue of how do we “sell” something that client yet do not know that they want? Unfortunately, little in the way of helpful answers are given.

The problem with paternalism (I know what is best for you) is that it naturally leads to coercion. Coercion, even with a smile, rarely results in positive change. Instead, we need to talk to clients about choices. We need to do so early and often. They do have choices. Sometimes many, sometimes few. However, they have them none-the-less. Our job is to help them see the consequences, the benefits, etc. Some choices made will have specific and immediate consequences. If I choose to steal a car, I may be jailed and have my rights limited for a period of time. So too with some self-harmful choices. If a client wants to kill themself, then I have the right and responsibility to stop them. This is not paternalism but momentary protectionism. I do not claim that hospitalization is what is best, but I do claim that it will extend the life of a suicidal client. By extending their life, I am providing an opportunity to return to their choices and reconsider God’s gracious hand on them rather than act impulsively to deep pain.  


Filed under eating disorders, ethics

Science Monday: the state of eating disorder research

The latest American Psychologist (62:3) is a special issue all about eating disorders research. And most of it isn’t particularly encouraging. Here’s some of the concerns: Continue reading


Filed under eating disorders, Uncategorized

Science Monday: Treatment for body image problems?

One of the key hallmarks of those suffering with eating disorders is their tendency to define their self-worth primarily by body shape/weight or should I say by their perception of their body shape/weight as this group tends to overestimate their size and shape.

What treatments help a person to regain a realistic sense of body shape as well as to us a different measuring stick to measure their worth? Given the obsessive-compulsive symptoms (weight checking and compulsive restricting) do OCD treatments help here as well? Continue reading


Filed under counseling science, eating disorders