anorexia

Mindfulness and Eating Disorders: Latest Research on Binge Eating Disorder and Bulimia Nervosa

Mindfulness, a practice rooted in paying non-judgmental attention to the present moment, has emerged as a promising approach to treating various mental health conditions, including eating disorders such as Binge Eating Disorder (BED) and Bulimia Nervosa (BN).  New research is shedding light on how mindfulness-based interventions can help individuals improve their relationship with food as well as their emotional well-being. Let’s explore the latest findings on how mindfulness is being utilized to treat BED and BN.  What is Mindfulness? At its core, mindfulness involves the intentional, non-judgmental awareness of one’s thoughts, emotions, bodily sensations, and the surrounding environment. In the context of eating disorders, mindfulness helps individuals tune into their hunger cues, become more aware of emotional triggers, and ultimately cultivate a more compassionate relationship with food. Mindfulness-based interventions, such as Mindfulness-Based Cognitive Therapy (MBCT) and Mindfulness-Based Stress Reduction (MBSR), have been increasingly used as part of integrated therapeutic approaches to treat disordered eating behaviors. Binge Eating Disorder and Mindfulness Binge Eating Disorder (BED) is characterized by recurrent episodes of consuming large quantities of food, typically accompanied by emotional distress and guilt. Unlike other eating disorders, such as anorexia or bulimia, BED is not associated with compensatory behaviors like purging or excessive exercise. As the most common eating disorder in the United States, BED has attracted significant attention from researchers studying its psychological origins and treatment options. Recent research suggests that mindfulness can be particularly effective in reducing binge episodes and improving emotional regulation for individuals with BED. Mindfulness-Based Interventions (MBIs) A 2021 meta-analysis of randomized controlled trials found that mindfulness-based interventions significantly reduced the severity of binge eating episodes in individuals with BED. The study indicated that MBIs, particularly Mindfulness-Based Cognitive Therapy (MBCT), resulted in a reduction of binge eating episodes by approximately 50%, with long-term benefits observed in follow-up assessments1. This finding highlights the potential of mindfulness not only for immediate symptom reduction but also for sustained recovery.   Improving Emotional Regulation Emotional regulation is a key challenge for individuals with BED, as many binge eating episodes are triggered by negative emotions such as anxiety, sadness, or stress. Mindfulness practices can help individuals become more aware of their emotional states and reduce emotional reactivity. One study showed that practicing mindfulness meditation decreased binge eating and emotional eating due to improved emotional regulation.2   Use of Dialectical Behavior Therapy (DBT) DBT is also being explored as a tool for reducing emotional dysregulation in individuals with BED.  Originally developed as a modality for improving emotional regulation in personality disorders, more research is showing mindfulness-based strategies of DBT are effective in treating BED.  In a meta-analysis of eleven studies, DBT demonstrated greater efficacy compared with the control group in improving emotion dysregulation.3 Bulimia Nervosa and Mindfulness Bulimia Nervosa (BN) is an eating disorder characterized by episodes of binge eating followed by compensatory behaviors such as purging (vomiting or using laxatives), excessive exercise, or fasting. The disorder is often accompanied by severe body image distortion and extreme anxiety about weight and shape. Treatment for BN requires a multifaceted approach, but mindfulness is gaining recognition as a promising tool to address the psychological and behavioral components of the disorder.  Recent studies suggest that mindfulness can help break the cycle of binge-purge behavior and improve body image, leading to better treatment outcomes. Reducing Binge-Purge Behaviors A 2021 study investigated the effectiveness of mindfulness-based cognitive therapy on reducing the cognitive load of words related to eating disorders could result in a decrease in purging behaviors. Mindfulness skills improved significantly which were accompanied by a decrease in depressive mood. The researchers concluded that mindfulness-based cognitive therapy could be an effective tool in reducing binge-purge behaviors.4   Improving Body Image and Self-Compassion Body dissatisfaction and low self-esteem are common in BN and are often central to the disorder’s maintenance. Mindfulness interventions focusing on body awareness and self-compassion have shown promise in reducing these issues.  This shift in perspective is crucial, as body image issues often drive the cycle of binge eating and purging in BN.5   Addressing Cognitive Rigidity Cognitive flexibility, the ability to hold multiple perspectives and tolerate ambiguity, is often impaired in individuals with BN, leading to rigid thinking patterns about food, body image, and self-worth. Mindfulness has been shown to enhance cognitive flexibility by promoting an open, non-judgmental awareness of thoughts and experiences.6 Mindfulness-based interventions are emerging as a promising tool in the treatment of both Binge Eating Disorder and Bulimia Nervosa. The latest research suggests that mindfulness can significantly reduce binge eating and purging behaviors, improve emotional regulation, and promote healthier body image and self-compassion. As the field of mindfulness research continues to grow, it is crucial that these interventions be further refined and integrated with other therapeutic approaches to provide comprehensive, effective treatment for individuals struggling with eating disorders.  At LCWNS, we help you integrate mindfulness as part of a holistic treatment plan.   References Grohmann D, Laws KR. Two decades of mindfulness-based interventions for binge eating: A systematic review and meta-analysis. J Psychosom Res. 2021 Oct;149:110592. doi: 10.1016/j.jpsychores.2021.110592. Epub 2021 Aug 1. PMID: 34399197. Katterman SN, Kleinman BM, Hood MM, Nackers LM, Corsica JA. Mindfulness meditation as an intervention for binge eating, emotional eating, and weight loss: a systematic review. Eat Behav. 2014 Apr;15(2):197-204. doi: 10.1016/j.eatbeh.2014.01.005. Epub 2014 Feb 1. PMID: 24854804.  Rozakou-Soumalia N, Dârvariu Ş, Sjögren JM. Dialectical Behaviour Therapy Improves Emotion Dysregulation Mainly in Binge Eating Disorder and Bulimia Nervosa: A Systematic Review and Meta-Analysis. J Pers Med. 2021 Sep 18;11(9):931. doi: 10.3390/jpm11090931. PMID: 34575707; PMCID: PMC8470932. Sala L, Gorwood P, Vindreau C, Duriez P. Mindfulness-based cognitive therapy added to usual care improves eating behaviors in patients with bulimia nervosa and binge eating disorder by decreasing the cognitive load of words related to body shape, weight, and food. Eur Psychiatry. 2021 Oct 28;64(1):e67. doi: 10.1192/j.eurpsy.2021.2242. PMID: 34706785; PMCID: PMC8668447. Jansen P, Zayed K, Kittsteiner J. Body image and the relation to mindfulness and self-compassion in physical education students: a cross-cultural study. Health Psychol Res. 2021 Jan 14;8(3):9172. doi:

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Is it ARFID, Anorexia, or Both?

Eating disorders can be complex and multifaceted, making accurate diagnosis and treatment crucial. Two disorders that often cause confusion are Avoidant/Restrictive Food Intake Disorder (ARFID) and Anorexia Nervosa. Both involve restrictive eating, but they manifest differently and require distinct approaches for effective management.  At the same time, both disorders are rooted in disturbance in sensory processing.  In this post, we delve into the overlap between ARFID and anorexia through the lens of a sensory processing disorder.  Understanding ARFID and Anorexia Nervosa ARFID is a relatively newer diagnosis that involves a significant reduction in food intake due to various factors, including sensory sensitivities, a lack of interest in food, or a fear of negative consequences of eating, such as choking or vomiting. Individuals with ARFID may experience extreme picky eating, aversions to specific textures or colors of food, or a general lack of appetite. Unlike anorexia, ARFID does not necessarily involve a desire to lose weight or a distorted body image.1  Because ARFID is still a newer diagnosis, it often leads to misdiagnosis or delays in diagnosis.  Anorexia nervosa, on the other hand, is characterized by an intense fear of gaining weight and a distorted body image, which leads to severe food restriction. Individuals with anorexia often see themselves as overweight despite being underweight, and their eating behaviors are driven by a desire for weight loss and an obsession with body shape and size.2  Key Differences Between ARFID and Anorexia Nervosa Motivation Behind Food Restriction: ARFID: The restriction is often due to sensory sensitivities, a lack of interest in food, or past negative experiences related to eating. There is typically no desire for weight loss or a preoccupation with body image. Anorexia Nervosa: The restriction is driven by an intense fear of weight gain and a distorted perception of body image. The primary motivation is often to lose weight and maintain a low body weight. Body Image and Self-Perception: ARFID: Individuals with ARFID generally do not have a distorted body image. Their concerns are more about the sensory aspects of food or past experiences rather than their body weight or shape. Anorexia Nervosa: Body image distortion is a core feature. Individuals may see themselves as overweight even when they are dangerously underweight and may have an obsession with being thin. Eating Behaviors: ARFID: Eating behaviors in ARFID can include extreme selectivity in food choices, aversion to certain textures or colors, or avoidance of food due to fear of adverse consequences, such as choking or gastrointestinal discomfort. Anorexia Nervosa: Behaviors often include strict calorie counting, excessive exercise, and rituals around eating. Food intake is meticulously controlled with the goal of losing weight. Physical Health: ARFID: Physical consequences can include malnutrition and weight loss, but the primary issue is not necessarily driven by a desire for thinness. Growth delays and nutrient deficiencies are common, especially in children and adolescents. Anorexia Nervosa: Severe malnutrition is a result of extreme caloric restriction and can lead to a host of medical complications including cardiac issues, osteoporosis, and organ failure due to the drive for thinness. Co-occurrence of ARFID and Anorexia Overlap between ARFID and anorexia is frequently seen when individuals with ARFID also develop symptoms and features of anorexia. In addition to food sensitivities and aversions, they may also have concerns about body weight and shape, preference for less calorically dense foods, negative body image or body dysmorphia, and fear of weight gain.  There is increasing research that anorexia is also a disorder that involves sensory processing disturbances. These individuals may display a lack of interoceptive awareness and inability to feel hunger and fullness cues, which have an influence on how they process taste and sensations.3  ARFID is common in neurodivergent individuals.  Because anorexia is based in sensory disturbances as well, it is imperative to understand how this overlap may manifest for people with ADHD or autism.  For example, while fear of weight gain is a common characteristic of anorexia, it is not an experience shared by all with the disorder.  For a neurodivergent individual, their eating disorder symptoms may arise from a need for safety and control where they may feel challenged with change and lack of a routine.   Additionally, those with co-occurring ARFID and anorexia may experience nutritional deficiencies, gastrointestinal discomfort, challenging eating in social settings, fear of judgement from others, and mistrust and disassociation from their bodies.4  Treatment of Co-occurring ARFID and Anorexia Treatment of these overlapping eating disorders requires medical oversight, nutritional rehabilitation, as well as work toward establishing trust and safety in the body.  In collaboration with an eating disorder therapist and registered dietitian, clients may work through food exposures, increasing their food variety, and re-establishing interoceptive awareness.   Understanding whether one is dealing with ARFID, anorexia nervosa, or a combination of both is crucial for effective intervention and recovery. Treating clients from a sensory processing disorder perspective can be helpful in identifying when overlapping ARFID and anorexia are present.  Both disorders require compassionate, creative, and individualized care and support from a team of professionals including an eating disorder registered dietitian, therapist, doctor, and psychiatrist.  At Laura Cipullo Whole Nutrition Services, our team of dietitians is here to support.  References Zimmerman J, Fisher M. Avoidant/Restrictive Food Intake Disorder (ARFID). Curr Probl Pediatr Adolesc Health Care. 2017 Apr;47(4):95-103. doi: 10.1016/j.cppeds.2017.02.005. PMID: 28532967. Zipfel S, Giel KE, Bulik CM, Hay P, Schmidt U. Anorexia nervosa: aetiology, assessment, and treatment. Lancet Psychiatry. 2015 Dec;2(12):1099-111. doi: 10.1016/S2215-0366(15)00356-9. Epub 2015 Oct 27. PMID: 26514083. Cobbaert L, Hay P, Mitchell PB, Roza SJ, Perkes I. Sensory processing across eating disorders: A systematic review and meta-analysis of self-report inventories. Int J Eat Disord. 2024 Jul;57(7):1465-1488. doi: 10.1002/eat.24184. Epub 2024 Mar 21. PMID: 38511825. Becker KR, Breithaupt L, Lawson EA, Eddy KT, Thomas JJ. Co-occurrence of Avoidant/Restrictive Food Intake Disorder and Traditional Eating Psychopathology. J Am Acad Child Adolesc Psychiatry. 2020 Feb;59(2):209-212. doi: 10.1016/j.jaac.2019.09.037. Epub 2019 Nov 26. PMID: 31783098; PMCID: PMC7380203. https://neurodivergentinsights.com/misdiagnosis-monday/anorexia-and-arfid?format=amp  

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