Dual Diagnosis, Addiction and Eating Disorders: Self Destructive Behavior

It is fairly common for people to struggle with both an addiction and a mental health disorder at the same time. This is known as a “dual diagnosis,” or having at least two conditions that co-occur and interact with one another. Just how someone suffering from depression may habitually binge drink as a way to self medicate, someone suffering from anxiety, depression, OCD, self-harm or PTSD can develop an eating disorder as a means to cope with her underlying mental disorder.

Dual Diagnosis and Eating Disorders

Lately there has been a growing body of evidence to support the similarities between eating disorders and addictive conditions like drug addiction and alcoholism. The American Society of Addiction Medicine now holds a wider definition of addiction to include not just drugs and alcohol, but also “process” addictions like food. This is because all of these substances have a very similar effect on the brain.

Natural stimulants like taking care of our bodies, healthy amounts of exercise, being praised or being in love trigger special reward centers in our brain, making us feel good. These reward centers can also be activated through artificial means like drug use, alcohol, and food abuse such as binging, purging or even starving.

Chemical addiction and eating disorders arise from many of the same sources and display some of the same characteristics. Both conditions:

• Include common risk factors: family history, imbalances in brain chemistry, stress or childhood trauma
• Appear during stressful life transitions like the loss of a parent, a divorce or puberty
• Arise from low self-esteem, depression or anxiety
• Involve a pattern of compulsive behaviors
• Involve a preoccupation with a substance or activity
• Are chronic conditions that produce severe or potentially fatal side effects

  Self-Destructive Patterns of Addiction and Eating Disorders

  When the reward center of the brain is stimulated inappropriately, specifically through drugs, alcohol, or food abuse, it stops functioning the way it was intended to. These stimulants create a false sense of temporary happiness or relief with damaging consequences. An individual who struggles with an addiction or eating disorder may have a personality type that is prone to impulsivity, extremes and high anxiety and this creates a need for greater amounts of stimulation in order to feel well. Relief created by unhealthy stimulation only creates a greater risk for dependency and addiction forming habits. Despite severe medical complications, it is difficult for individuals struggling with addictions to give up their addiction, as in the case of anorexia, bulimia, binge eating disorder, alcoholism or substance abuse.
  
  

  Treatment of Eating Disorders and Alcoholism/Substance Abuse

  Since the addictive nature of eating disorders and alcoholism/addiction is similar, and the underlying issues pertaining to both conditions may overlap, it is crucial to treat eating disorders and addiction simultaneously in the recovery process. At Remuda Ranch at The Meadows, our comprehensive treatment team addresses the various needs of women and girls with co-occurring disorders through medical, nutritional and psychotherapy treatments. Our trauma-focused and brain-based approach helps us find and treat the root cause of the patient’s addictions and behavioral disorders.
  
  At Remuda Ranch at The Meadows, we understand the seriousness of dual diagnosis. In a safe and nurturing community composed of their peers, people are guided on their journey of recovery by examining the underlying causes of their eating disorder and co-occurring disorders. The goal is for these individuals to gain the courage to face difficult issues including grief and loss; heal from emotional trauma; and become accountable for their own feelings, behaviors, and recovery. Please call us at 866-390-5100 or complete the form on our website to find out if our program is right for you.
  
  

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Understanding the Difficult Eating Disorder Patient

By Vicki Berkus M.D., Ph.D., CEDS, Remuda Ranch Medical Advisor

When they first begin treatment, patients often struggle and insist on “doing treatment their way.” I tell my patients’ families that they can typically expect a phone call after two or three days, during which they are likely to hear, “Get me out of here! They don’t understand me!”

To gain some insight into what a patient’s experience was like I went undercover and entered a treatment program as a patient struggling with laxative abuse. I packed my suitcase, hid laxatives in my hair and in the handle of my suitcase and walked through the front door.

My process as a patient started with the intake interview where I had to tell a complete stranger some of the most private things about me.

Once I was admitted, I was given an exam gown and my luggage was removed to be searched. I had to change into the exam gown in the shower so that the nurse could see whether I was hiding anything. Then, I was again questioned and went through a physical exam. I had blood drawn, an EKG, and weight taken without hearing or seeing the results. I then was allowed to eat and read the orientation packet.

I was exhausted after three hours of being somewhere I didn’t want to be, talking to people I didn’t trust and having no support (or perceiving that I had no support.) Throughout my stay, I was told when to eat and when to sleep, and had most of my personal items taken from me and locked away.

Finding Empathy for Struggling Patients

I knew as a doctor and eating disorder treatment professional that the purpose of all of this wasn’t to make me feel like an infant, but to make sure I was medically stable and safe in that environment.

Many of our patients don’t quite understand that. They are angry, tired, lonely, and scared. It takes courage to go through treatment.

My insight increased over the next few weeks as I ate with peers, attended Family Week, and sat in process groups observing the patients’ progress. Overall, it wasn’t an entirely pleasant experience for me; I can’t imagine having an eating disorder in my head and trying to go through this process. I’m glad I had a chance to experience it first-hand so that I would not longer have to base my assumptions on my limited perception.

Today, I tell my patients that I don’t expect them to like treatment or even want treatment; but, if they know deep down that their way isn’t working to just do it anyway. I think the key when trying to help eating disorder patients is to set boundaries and be firm while including incentives in their treatment that they can earn.

Starvation, biochemical changes in the brain and body while re-feeding, and co-occurring mood disorders all exacerbate the disease and the lack of control over emotions and behaviors. I think back to my residency days when I was on call every other night (at age 43) and remember that without proper sleep and nutrition, I was not fun to be around.

Think about the last time you were trying to function without the right amount of sleep or food, and try to remember how you felt when dealing with your patient or loved one as they enter into eating disorder treatment.

Remuda Ranch Can Help

The experienced staff at Remuda Ranch at The Meadows understands the pain that eating disorders can bring. There is hope. We can help you or your loved one get on the road recovery.

Our beautiful campus in the heart of the Sonoran Desert offers patients large rooms, indoor and outdoor horse arenas, a swimming pool, and a challenge course. Among the lush landscapes, patients are surrounding by peace and tranquility while they work with our team to overcome their eating disorders and dual diagnoses, and find peace within. Call us today 866-390-5100 or reach out online.

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Rewards Matter for Eating Disorder Patients

By Vicki Berkus M.D., Ph.D., CEDS, Remuda Ranch Medical Advisor

People who are struggling with their eating disorders (ED) and refusing to cooperate in treatment often need rewards they can work toward. Being in treatment would be hard for anyone; but, it’s especially hard for adolescents and for those who don’t yet have coping skills or a mind that’s fed well enough to fully function.

Privileges as Rewards

To encourage patients to follow their treatment plans, most programs use levels of activity as rewards. Anything that patients tend to look forward to–going on outings, going to a movie, more exercise time, eating somewhere other than the treatment group table for a meal—can serve as motivation for patients to adhere to their treatment regimens.

I used to be stopped in the hall by my patients with requests. “Can I _________?” they would say. They couldn’t help themselves. The idea that their entire treatment team would have to make the decision, not just me, was not in their thoughts at the moment of the request.

I decided to come up with a system that would help them know exactly what they needed to do to earn one of the privileges they wanted.

Actions Replace Words

I would have patients fill out a “request sheet” every Monday. On the sheet they were asked to write down what they wanted to do most at the end of the week – exercise more, go on an outing, etc. They also would have to write down what would be required for them to be allowed to do what they asked. (e.g., eating 100 percent for the three days prior to the activity, or not needing to be reminded to limit their movement when sitting.)

Depending on each patient’s need, the clinical team would either set the criteria for them or the patient would sit with the therapist to develop the criteria. Either way, the patient knew and agreed upon exactly what they needed to do on their part to get the added perks.

I was amazed at how quickly their behavior changed. Instead of finding me and putting a lot of energy into “making their case,” they would get excited for the change and for the challenge of meeting their goals. They would then hear from the clinical team by Thursday what the weekend would look like in terms of activities and changes.

It sounds simple but ED patients are adept at holding onto the yardstick that compares their peers’ eating disorder behaviors to their own. The ability to put on “emotional blinders” and focus on their treatment is just not in their skill set in the beginning of treatment. Having structured reward systems help them to achieve that focus.

A Team Approach

It is important for treatment teams to be consistent with patients and for each team member to be fully up to date on the latest information about their behavior and their risks. Patients need to know that the team members have access to their daily behaviors including, meal consumption, fluid consumption or daily weights. They also need our united front on the decisions we make that have such a significant impact on them during their treatment.

At Remuda Ranch at The Meadows, we use a consistent team approach every day and work with each person individually based on their strengths. With the support of our teams, our patients achieve much greater success toward their recovery.
If you would like to find out more about Remuda Ranch, please call 866-390-5100 or contact us.

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When Food Speaks

By Jessica Setnick, MS, RD, CEDRD, Remuda Ranch at The Meadows Senior Fellow
Even before he or she could speak, your child was able to communicate with you through eating behavior. This can continue into childhood and adolescence when someone has difficulty expressing him or herself through words.

Undereating, overeating, or limiting variety of foods are sometimes clues kids and teens are struggling with particularly negative or stressful feelings. Particularly significant are changes to established eating behaviors, such as eliminating snacks or certain food groups that the child previously enjoyed; secretive eating, sneaking or hiding foods, or lying about eating by a child who is typically open and honest; or avoiding family meals or social events by a teen who was formerly extroverted and friendly.

What Your Child’s Eating Behaviors Can Tell You

Some possible messages that might be conveyed through changes in eating behaviors are:

• I’m sad about something or someone I’ve lost.
• I’m depressed.
• I feel so alone.
• I’m angry.
• I don’t fit in.
• Stop telling me what to do!
• I’m having trouble concentrating.
• I’m struggling to adjust to changes in my life.
• I’m never good enough.
• No one likes me.
• I’m having trouble making decisions.
• I’m scared to make a mistake.
• I don’t feel well.
• I’m exhausted.

In the face of feelings that they don’t know how to manage, children and teens may turn toward or away from food for a sense of comfort or control. Yet they may not realize that their eating changes are connected to their innermost thoughts and feelings. It is the role of caregivers and other trusted adults help with recognizing the connections. It is a mistake to only address the eating behaviors without investigating the emotions and thoughts that are behind the scenes.
If you suspect that a child or teen in your life has changed her eating due to emotional distress, Remuda Ranch intake counselors are available 24 hours a day at 866-390-5100. Or, you can fill out the contact form at our website, www.RemudaRanch.com.

Horses Can Help Uncover Personal Truths

By Colleen DeRango, MA, LISAC, SEP, Co-Facilitator of Equine Workshops

In my most quiet moments of reflection, I often recall what one client said in one of her somatic equine sessions:

"Nothing reduces my anxiety from a 9 to a 3 faster than being with a horse."

I don't know why this is, but I do know that it is my daily experience around these sacred beings who have blessed my life. In this world of addiction, trauma, and mood disorder treatment, we often spend time looking through the lens of pathology; whereas, in the presence of a horse, we seem to quite often be looking through the lens of authenticity. Horses somehow help us return to the truth of who we really are.

Horses can also often help us find a subtle, gentle, whole, connected sense of being. Being with another being. Being seen, being understood, being accepted it is deeper than the sensation of love. It is perhaps presence in communion.

REGISTER FOR SPIRIT: A SOMATIC EQUINE WORKSHOP

You can experience the gentle light of acceptance too, by attending one of our Spirit Equine Workshops. The Spirit workshop has a 5-day and a 3-day option. The next 5-day workshops will be offered on Sept. 7-11 and November 2-6. The next 3-day workshops are October 2-4 and Dec. 4-6. Register today as spaces are limited. Call 800-244-4949 for more information.

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