EMDR with ED:
Utilizing EMDR in the Treatment of
Eating Disorders and Disordered Eating
Presented by:
DaLene Forester Thacker, PhD, CEDS
Licensed Marriage and Family Therapist
Licensed Professional Clinical Counselor
What will we cover today?
Eating Disorders as coping Mechanisms
Common Negative Cognitions when working with Eating
Disorders
The Trauma Connection
EMDR in the Treatment of EDs
What is an Eating Disorder?
ED’s characterized by persistent pattern of dysfunctional
eating or dieting behavior
Associated with significant emotional, physical, and
interpersonal distress
Anorexia Nervosa, Bulimia Nervosa, and Binge Eating
Disorder
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It all Starts with a Diet
In 1970 the average age of a
girl who started dieting was
14.
By 1990 the average dieting
age fell to 8.
• In a study of almost five
hundred schoolgirls,
81% of the ten-yearolds reported that they
had dieted at least once
• (Mellin, Scully & Irwin, 1986).
Eating Disorders and adolescents
95% of those who have eating disorders are between the ages of 12 and 25
50% of girls between the ages of 11 and 13 see themselves as overweight
85% of 13-year-olds have attempted to lose weight
Eating Disorders and Prevalence Rates
An estimated 8 million Americans have an eating
disorder – seven million women and one million men
Nearly half of all Americans personally know someone
with an eating disorder (Note: One in five Americans
suffers from mental illnesses.)
An estimated 10 – 15% of people with anorexia or
bulimia are males
Eating disorders have the highest mortality rate of any
mental illness
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Anorexia Nervosa
Refusal to maintain minimally normal body weight
Intense fear of gaining weight
Significant disturbance in perception of shape or size of
body
Postmenarcheal females – amenorrhea
Restricting type or Binge-Eating/Purging type
Anorexia Nervosa
For females between fifteen and twenty-four years who
suffer from anorexia nervosa, the mortality rate associated
with the illness is twelve times higher than the death rate of
ALL other causes of death (Sullivan, 1995).
Anorexia nervosa has the highest premature fatality rate of
any mental illness (Sullivan, 1995).
Anorexia Nervosa – Prevalence Rates
1% of the general population suffers from anorexia
Anorexia is the 3rd most common chronic illness among
adolescents
One in 200 American women suffers from anorexia
www.NationalEatingDisorders.org
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Anorexia Nervosa – Mortality Rates
National Association of Anorexia Nervosa and Associated Disorders
(ANAD) study:
• 5 – 10% of ANs die within 10 years after developing AN
• 18-20% of ANs will be dead after 20 years
• only 30 – 40% ever fully recover
Mortality rate associated with AN is 12 times higher than the death
rate of ALL causes of death for females 15 – 24 years old.
20% of people suffering from AN will prematurely die from
complications related to their eating disorder, including suicide and
heart problems
www.NationalEatingDisorders.org
Bulimia Nervosa
Binge eating and loss of control
Compensatory purging
Self evaluation excessively influenced by body shape and
weight
On average twice a week for 3 months
Bulimia Nervosa – Prevalence Rate
Two to three in 100 American women suffer with bulimia
The incidence of bulimia in 10-39 year olds TRIPLED between 1988
and 1993.
Only 6% of people with bulimia receive mental health care.
Because of the secretiveness and shame associated with eating
disorders, many cases are probably not reported
www.NationalEatingDisorders.org
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Binge Eating Disorder (BED)
Binge eating and loss of control
Self evaluation excessively influenced by body shape and
weight
On average twice a week for 6 months
Binge Eating Disorder – Prevalence rates
Approximately 25 million are struggling with binge eating
disorder in the US (Crowther et al., 1992; Fairburn et al.,
1993; Gordon, 1990; Hoek, 1995; Shisslak et al., 1995).
Rarely talked about disorder. Seen as lacking self-control.
Onset
Anorexia – Early to mid teens, 10:1 female, 0.5 to 3.7%
females will suffer with Anorexia in their lifetime.
Bulimia- Mid teens to mid twenties, 7:1 female, 1.1 to 4.2%
females will suffer with Bulimia in their lifetime.
BED – All ages, 2:1 female, 2 to 5% of Americans will suffer
BED in their lifetime.
NIMH, 2007
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Racial and Ethnic Minorities
Rates of minorities with eating disorders are similar to those of
Caucasians
74% of American Indian girls reported dieting and purging with diet
pills
Essence magazine (1994) reported that 53.5% of their respondents,
African-American females were at risk of an eating disorder
Eating disorders are one of the most common psychological
problems facing young women in Japan.
Signs and Symptoms
Sudden weight loss or gain
Preoccupation with weight, shape, size
Body checking
Intense fear of gaining weight
Significant disturbance in perception of shape or size
of body
Secret eating, skipping meals, denial of hunger
Preoccupation with calories, carbs, or fat grams
Withdrawal from previously enjoyed activity
Risk Factors
Being female
Mother with an ED
Dieting
Depression, anxiety, OCD, substance abuse
Sexual abuse
Media
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Media Influence
Tiggemann and Slater (2004)
84 female students between 18 and 30 yrs
Six music videos 2 mins ea – total 12 mins
Music Video featuring thin, attractive females vs. music
video featuring scenery
Measures of mood, body dissatisfaction, and appearance
comparison
Tiggemann and Slater Results
Felt fatter
Less confident
Less physically attractive
Less satisfied with their bodies
All in less than 15 minutes
Course and Outcomes
The earlier the treatment the better the outcome
40-50% of patients with AN recover, 33% improve
somewhat, and 17% remain chronically ill
50% of patients with BN recover, 40% improve somewhat,
and 10% remain BN at ten year follow-up
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Consequences
Psychosocial – quality of life, self-image, interpersonal
relationships, financial status, job performance
Psychological – mood disorders, anxiety disorders,
substance abuse disorders
Medical – ED’s effect all organ systems
ACCESS TO TREATMENT
1 in 10 people with eating disorders receive treatment
Approx. 80% of individuals who have accessed care do not get
the treatment needed to stay in recovery – they are often sent
home weeks earlier than recommended
Treatment of an eating disorder in the US ranges from $500
per day to $2,000 per day. The average cost for a month of
inpatient treatment is $30,000 (3 – 6 mos. is typically
recommended).
Health insurance companies for a variety of reasons do not
typically cover the cost of treating eating disorders
Outpatient treatment, including therapy and medical
monitoring, can extend to $100,000 or more
Treatment
Cognitive Behavioral Therapy
EMDR
Dialectical Behavior Therapy
Family Based Treatment (Maudsley Method)
Psychopharmacology
Interpersonal Therapy
Nutritional rehabilitation
Equine Therapy
Art Therapy
Music Therapy (Drumming)
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Developing a Treatment Plan
Affect Tolerance – Breathing exercises, yoga, EMDR,
TFT, Hypnosis, Talk therapy
Self-Soothing – Breathing exercises, positive selftalk, imagining treating self as a friend, child, loved
one
Coping Behaviors – Distractions, delay tactics,
coping phrases, management of anxiety symptoms,
understanding behavioral choices – these are
choices not seizure disorders
Identify High-Risk Situations and practice healthy
options
Overview of EMDR as a Treatment for
Bulimia Nervosa
The study examined the possibility of treating the
underlying complex trauma symptoms associated
with Bulimia Nervosa using Eye Movement
Desensitization and Reprocessing (EMDR) in a
clinical private practice setting.
Theoretical Framework:
Most relevant literature
Traumatic experiences have been linked to the development of
Bulimia (Smyth, Heron, Wonderlich, Crosby, & Thompson, 2008; Faravelli, Giugni, Salvatori, & Ricca,
2004; Jacobi, Hayward, deZwaan, Kraemer, & Agras, 2004; Steiger, Gauvin, Israel, Kin, Young, & Roussin,
2004).
EMDR has been reported to successfully reduce trauma
symptoms (Lee, Gavriel, Drummond, Richards, & Greenwald, 2002; Maxfield, 1999; Scheck;
Schaeffer, & Gillette, 1998; Wilson, Becker, & Tinker, 1997, 1995).
Given the strong connection between a trauma history and
Bulimia it appears reasonable to assume the treatment of
Bulimia would benefit from a trauma treatment such as EMDR.
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Research Design
In this Wait List design study participants were randomly
assigned to the EMDR group or the Wait List group.
Dependent Variables – EDI-3 and TSI
Independent Variables – EMDR and Wait List groups
Research Design
Time-1
Time-2
Time-3
Time-4
Time-5
Test-1
EMDR
Test-1
Wait List
Test-2
No Tx
Test-3
Test-2
EMDR
Test-3
Participants
11 Females Volunteered
4 of the volunteers withdrew or were dropped prior to the study
1 failed to complete the test measures, invalidating the data.
The final sample resulted in a total of six participants, a 54.6%
inclusion rate.
Participants included in the study
100% female
21 to 53 years of age, mean age 37 years
Five (83.3%) Caucasian; One (16.7%) Hispanic
Five (83.3%) Single; One (16.7%) Married
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Anecdotal data
•Of the six participants, three (50%) no longer met
diagnostic criteria for Bulimia at the end of the study.
In response to the question “How are you doing now
compared to when you entered the study?” all six
participants (100%) reported improvement.
All participants reported a reduction of bulimic episodes
following EMDR treatment.
Comparison of pre and post bulimic episodes
following EMDR treatment
Initial Bulimic Episodes
per day
Number of participants
Number of participants
prior to EMDR Treatment after EMDR Treatment
0
0
4
1-2
2
1
2-4
3
1
5-10
1
0
DaLene’s favorite sites for ED info
www.somethingfishy.com
www.pbs.org/wgbh/nova/thin/
www.NationalEatingDisorders.org
www.anad.org
www.winsnews.org
www.daleneforester.com
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What we just covered
Eating Disorders as coping Mechanisms
Common Negative Cognitions when working with Eating
Disorders
The Trauma Connection
EMDR in the Treatment of EDs
Thank you
DaLene Forester Thacker, PhD, CEDS
LMFT, LPCC
Phone 530-245-9221 Fax 530-245-9222
Email: [email protected]
Website: www.aei4you.com
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