In 2000, researchers identified genetic susceptibility for anorexia and bulimia, binge eating disorder and obesity as well as for substance abuse, anxiety, and major depression. Family and twin studies have shown that relatives of someone with an eating disorder are at increased risk for developing a disorder because of a genetic component present in all eating disorders. Studies have shown that 58% – 76% of the incidences of anorexia may be due to genetic factors.
An upcoming issue of the International Journal of Eating Disorders will publish ground-breaking new research by Dr. Howard Steiger that is likely to change our view of anorexia nervosa and its origins. The current project used genetic information from 1,200 anorexia patients and nearly 2,000 non-anorexic controls.
In the new report, researchers found that the longer people suffer from anorexia, the higher the likelihood of alterations in their DNA, specifically in DNA methylation, which can cause changes in an individual’s physiological and emotional make-up.
Dr. Steiger says the study demonstrates a relationship between anorexia and alterations of methylation levels in genes having to do with anxiety, social behavior, various brain functions, and the function of different organs. When gene expression is altered, the expression of traits that are controlled by those genes is also changed. Steiger states that we may come to the conclusion that eating disorders are not just about body image or bad parenting.
“These findings help clarify the point that eating disorders are not about superficial body image concerns or the result of bad parenting,” says Steiger. “They represent real biological effects of environmental impacts in affected people. Here we have physical mechanisms acting upon physiological and nervous system functions throughout the body that may underlie many of the effects of long-term anorexia. The question is, ‘Does remission of AN symptoms coincide with normalization of methylation levels?’”
Every day women are exposed to media of all kinds, movies, TV, magazines and social media that drive home the importance of being thin. But somehow all of these women don’t become anorexic or develop what’s called a “thin-ideal internalization.” Genetic factors may make certain women more susceptible to the pressure to be thin.
In each cell chemical reactions activate and deactivate parts of the genome at strategic times and in specific locations. Epigenetics is the study of these chemical reactions and the factors that influence them. Epigenetics involves genetic control by factors other than an individual’s DNA sequence. DNA methylation is used in some genes to differentiate which gene copy is inherited from the father and which gene copy is inherited from the mother, a phenomenon known as imprinting.
The epigenome dynamically responds to the environment. Stress, diet, behavior, toxins, and other factors regulate gene expression. Many brain functions are accompanied at the cellular level by changes in gene expression. Epigenetic mechanisms such as histone modification and DNA methylation stabilize gene expression, which is important for long-term storage of information.
Not surprisingly, epigenetic changes are also a part of brain diseases such as mental illness and addiction. Understanding the role of epigenetics in brain dysfunction may open the door to being able to influence it. This may lead to the development of new and more effective treatments for brain dysfunctions.
Eating disorders are complex psychiatric disorders in which genes, environment, and gene-environment interactions have a role. The combination of genes and environment can be modified by factors such as malnutrition or stress and this may result in long-term or acute epigenetic modifications.
Genetic variations can contribute to the pathophysiology of eating disorders such as anorexia nervosa or bulimia nervosa. The interplay between genetic and environmental factors is just beginning to be understood. This is the first study reporting alterations of global and gene-specific DNA methylation in a sample of patients with eating disorders.
Steiger’s discovery is important and will lead the way for further research perhaps by learning how to modify epigenetic changes in cells affecting a person’s physiology and nervous system. Will it be possible to prevent more pronounced alterations of methylation levels? When an anorexic patient goes into remission, are changes in methylation levels permanent or will they coincide with recovery? Can we develop medications that will affect methylation levels?
The possibilities for healing the human genome are endless.
Freiling, H., Gozner, A., Romer, K., Lenz, B., Bonsch, D., Wilhelm, J., Hillenmacher, T., de Zwaan, M., Kornhuber, J., and Bleich, S. (2007) Global DNA hypomethylation and DNA hypermethylation of the alpha synuclein promoter in females with anorexia nervosa. In Molecular Psychiatry, 12, 229-230.
Frieling, H., Romer, K., Scholz, S., Mittlebach, F., Wilhelm, J., De Zwann, M., Jacoby, G., Kornhuber, J., Hillemacher, T., and Bleich, S. (2009). Epigenetic dysregulation of dopaminergic genes in eating disorders. In International Journal of Eating Disorders, 7, 577-583.
Pjetri, E., et al. (2012). Quantitative promoter DNA methylation analysis of four candidate genes in anorexia nervosa: A pilot study, Journal of Psychiatric Research, http://dx.doi.org.1016/j.jpsychires.2012.10.007.
Pjetri, E., Schmidt, U., Kas, M., and Campbell, I. (2012). Epigenetics and eating disorders. In Current Opinion in Clinical Nutrition and Metabolic Care, 15 (4), 330-335.
Adventure therapy is a key component of Mirasol’s integrative eating disorder treatment program, but plans are afoot to expand the role of wilderness therapy, especially in our adolescent program.
We’re aiming to offer bimonthly two- and three-day trips, taking advantage of Arizona’s wealth of impossibly lovely wild public lands. Each trip will include a 50-50 split of medically- and emotionally-appropriate clients and the clinical staff required to ensure their safety and support them in their journey. The results of the program will be closely monitored by administering brain maps, depression inventories and similar tools before and after each trip.
To prepare for the upcoming trips, six Mirasol therapists put their packs on their backs and spent two days trekking in a remote valley high in Tucson’s Catalina Mountains. The group was led by an experienced backpacker, and included primary therapists, exercise therapists, an aftercare therapist as well as Mirasol’s Executive Director, Diane Ryan.
“I think it’s important to see what we’re capable of — what challenges us as clinicians and as adults — and also assess what we get out of it — what we enjoy and what we struggle with,” says Mirasol Primary Therapist, Jenna Jarrold.
There were plenty of challenges to go around, from preparing (and eating!) dehydrated food to keeping your balance while dancing across roaring mountain streams on slippery boulders with pack on your back. But although nearly all of them were beginning backpackers, each one met their challenges with grace and gusto, and they were clearly inspired both by their surroundings and by their ability to overcome every obstacle.
For Primary Therapist Jamelynn Evans, the weekend was all about connection: “Nature really helps me connect within,” she reports, “but also connect with the other women in the group.”
Almost by definition, eating disorders arise from an individual’s inability to connect with the self and with others. The limitless ability of the natural world to both challenge and soothe presents opportunities to grow new relationships, and make wilderness interventions a natural fit for both adolescents and adults in treatment.
Challenge courses, hiking and other outdoor activities have always been part of Mirasol’s eating disorder treatment program. Beginning in 2006, Ryan began adding wilderness experiences including camping and even caving. The response from clients and staff was overwhelmingly positive. More importantly, EEG brain maps and standard psychological tests demonstrated significant decreases in symptoms of anxiety and depression.
“There was a significant improvement in brain functioning for most participants, especially in the beta waves that are generally associated with anxiety,” says Ryan. Most clients also reported a decrease in symptoms of depression and an increase in their ability to cope with stress, as measured by a Children’s Depression Inventory (CDI) and Coping Skills Inventory (CSI) administered before and after the camping trips.
The visible transformation that occurs during Mirasol’s adventure therapy program is a huge source of inspiration to clients and their families as well as Mirasol staff.
For more information, see Why Wilderness by Diane Ryan, Mirasol Executive Director and former Clinical Director.
“Balada Fada” featuring André Coelho, from the album ODYSSEIA by M-PeX
“When”, from the album Spin Day and the Emotional Godfather by Spin Day
“The Long Awaited Rains”, from the album The Well by saQi
The winter blues were first clinically referred to as Seasonal Affective Disorder (SAD), though the most recent revision of the Diagnostic Statistical Manual (DSM-V) refers to these seasonal blues as “Seasonal Pattern Specifier” — a descriptor applicable to major depressive disorder and bipolar disorder. Most literature continues to refer to this medical condition as SAD. It impacts nearly 11 million Americans each year.
The DSM-5 criteria for adding the seasonal pattern specifier to one’s diagnosis include:
- Depressive episodes at a particular time of the year;
- Remissions or mania/hypomania at a characteristic time of year;
- These patterns must have lasted two years with no non-seasonal major depressive episodes during that same period;
- These seasonal depressive episodes outnumber other depressive episodes throughout the patient’s lifetime.
Geography, particularly latitude, appears to impact the SAD prevalence rate, which is as high as 9.9% in Alaska and just 1.4% in Florida. A deficiency in Vitamin D is common in patients with SAD. Additionally, Canadian researchers analyzed 14 studies including 31,424 participants, which indicated a link between vitamin D deficiency and depression.
Medication management and phototherapy (light therapy) are the most commonly prescribed interventions. Counseling is often advised. In severe cases, suicidal thoughts may require the support of inpatient hospitalization for stabilization.
Subclinical Seasonal Affective Changes
As many as 1 in 5 Americans share some subclinical features of SAD but do not meet full diagnostic criteria for a mood disorder or the associated seasonal pattern specifier. It is still advisable to speak to a medical professional if you experience SAD symptoms to ensure your condition doesn’t require additional medical attention.
Seasonal Mood and Eating Disorder Recovery
If you experience seasonal affective changes, this can certainly pose challenges to the rhythm of recovery. First, remember impermanence; the season is temporary. If this is naturally a more difficult time of year for you, acknowledge that recovery may feel more challenging right now.
Work with your treatment team to determine if there is a link between your food and seasonal mood. For some, depression and anxiety impair appetite. Others may overeat. The chemical changes in the brain associated with seasonal pattern depression often cause carbohydrate cravings as the brain is seeking serotonin, which lifts mood. Unfortunately, high doses of carbohydrates, without a balance of fat and protein, actually leads to blood sugar crashes and more carbohydrate cravings.
Winter can also change our movement patterns. We tend to slow down and move less, especially in colder climates. If someone enjoys exercising outside, they may experience weather related distress as a snow day or torrential downpour prevents them for carrying on with their usual workout routine.
It’s widely believed SAD impacts the circadian rhythm. Many people with eating disorders also suffer from insomnia or hypersomnia. Changes in sleep routines can challenge recovery.
Light Exposure — It is our very primal nature for mammal species to slow down, hibernate, and increase energy reserves during winter. Nature guides us into this pattern by giving us fewer hours of day light, but society asks us to work in opposition and further extend ourselves. To keep up, we need light! Sunlight actually helps trigger production of serotonin, a popular neurotransmitter that helps boosts mood, regulates metabolism, and balance hormones. Try getting morning sunlight exposure to aid circadian rhythm regulation and help the body awaken and energize. Taking a morning walk, drinking your coffee or tea on the patio, eating lunch outside as weather permits, and taking frequent sun breaks (in lieu of smoke breaks) can all increase winter exposure to sunlight. On those days when it’s too cold to be outdoors, open the blinds and allow sunlight to enter your home or office. Even introducing bright colors to indoor environments helps some people.
Sunlight is also our primary source of Vitamin D, which can have antidepressant effects in addition to its known role in maintaining strong, healthy bones. If you are unable to consume enough food sources and your winter climate does not allow enough sun exposure, it may be wise to consult your physician or dietician about supplementing Vitamin D, which can be monitored through a simple blood test. Phototherapy, often prescribed by physicians who specialize in seasonal pattern mood disorders, is therapeutic application of artificial full spectrum light. While a 10,000LUX light box is ideal for those needing phototherapy, less expensive full spectrum light bulbs can help in a pinch. Melatonin is a hormone made by the pineal gland, a small gland in the brain. Like serotonin, melatonin helps control your sleep and wake cycles, appetite, and mood. Just as light triggers serotonin release, melatonin synthesis requires an absence of light. Working together to control your circadian rhythm, you can think of serotonin as the “on” switch that awakens you and melatonin as the “off” switch that allows you to sleep.
Sleep Patterns — Developing good sleep hygiene goes a long way toward helping to regulate melatonin production. Allow for 7-9 hours of sleep each night to allow the body to rest, recover, and heal from each day. Light (especially from computer screens, ipads, and cell phones) prevents the shift to melatonin production, keeping the brain alert rather than relaxed. Therefore, aim for 2 hours of screen-free time before settling to bed. Late day caffeine consumption may also impair your ability to wind down at night.
Nutrition — Due to changes in seasonal availability of foods, it is common to change our diet this time of year. Crisp salads and summer smoothies are commonly replaced with warm comfort foods like soup, pot pies, and casseroles.
Carbohydrate cravings are common for those with SAD because of a need for serotonin and their quick rush of energy into the bloodstream. Unfortunately, excessive carbohydrate consumption leads to blood sugar crashes and additional carbohydrate cravings. Rather than avoid comfort foods, focus on balancing all three macronutrients: proteins, carbohydrates, and fats.
Exercise — Individuals with eating disorders are advised to seek medical approval and clearance from their treatment team before beginning an exercise routine because they are at higher risk for compulsive exercise and overtraining. Additionally, their bodies may be physically compromised and unable to manage any additional energetic or caloric expenditure.
Once these risks are considered and assessed, you can decide with your team if adding moderate exercise would aid your recovery. Time and time again, exercise has proven to have amazing antidepressant results almost as powerful as medication. Endorphins are released into the bloodstream, helping to energize our body and mood. Exercise can also generate body heat and improve circulation. Winter also offers a time-limited opportunity to embrace cold weather activities such as skiing, snowboarding, tubing and sledding. Enjoying these activities may help you appreciate the season a bit more, and that shift in perspective can impact your mood.
Aromatherapy — Smells can be a source of comfort by evoking positive memories and triggering emotions. A National Institute of Health (NIH) study found aromatherapy as an effective supplementary treatment for people with mild depressive symptoms. Aromatherapy experts recommend serotonin-enhancing pure therapeutic grade essential oils like Frankincense, Marjoram, Geranium, Lemongrass, Bergamot, Jasmine, Lavender, Clary Sage, Chamomile and the Citrus-derived oils. Try adding a couple of drops of these essential oils to your bath water to warm yourself up from the inside out. In general, citrus oils are invigorating and best used in the morning while calming oils, such as lavender and chamomile, would be best used at night. Essential oils can also be used in a diffuser or applied topically throughout the day. Whether you inhale the therapeutic properties through the lungs or they absorb into your bloodstream through the skin, you will enjoy the benefits.
Socialize — Reflecting rhythmic seasonal flow, the urge to hibernate is completely natural, making winter a great time to conserve energy – especially for someone who has a tinge of social anxiety. The desire to cozy up to a fireplace (or space heater in my case), with a book is understandable. However, that doesn’t mean isolate and avoid social opportunities. If you tend to dread the anticipation of social engagements but feel slightly revitalized after, first focus on just showing up. Use accountability measures. Reach out to someone else who may also be experiencing cabin fever and go do something together that embraces the season, whether it be sipping peppermint mocha or taking a day ski trip following a nice powdery snow fall. Flowing with the season will help you embrace it.
Hygge — Most of these ideas are quite basic yet profound: sunlight, sleep, nutrition, exercise, aromatherapy, and socializing. When discussing this blog with a friend, she shared the Danish concept of hygge with me, which was derived from a Scandinavian word meaning “well-being” and best translates to coziness. Think atmosphere, environment, comfort, and engaging the senses and you have hygge!
Adding that splash of color to your drab office, enjoying eggnog or pumpkin flavored anything while it’s in season, adding candlelight to your aromatherapy bath, and even becoming a human burrito wrapped up under plush covers watching your favorite movies with friends all counts as hygge.
Anything that improves your quality of life would get two thumbs up from the great Danes!
By Tara Shultis, MA, LMT, TRE Practitioner
TRE® is an innovative series of exercises that assists the body in releasing deep muscular patterns of stress, tension, and trauma. The exercises are simple, easy to learn and safely elicit a natural reflex mechanism of shaking and/or vibrating that calms the nervous system. TRE was developed over 20 years ago from Dr. David Bercelli’s work with large traumatized communities in the Middle East and Africa. His observations led him to understand that this shaking or vibrating is the body’s built-in healing mechanism to quiet the mind and release chronic tension.
We learn through social cues to turn off this natural shaking mechanism, but in extreme cases i’ts nearly impossible (for good reasons) to control the body’s natural response to trauma or stress. Perhaps you’ve experienced the aftershock from a car accident so intensely that you “shook like a leaf”. Or, after your body rushed to escape danger, you quivered with fear. This shaking mechanism is wired into our nervous systems to release what is no longer necessary once the body is out of harm’s way. We refer to TRE as a self-healing technique because we induce the therapeutic tremor in a safe environment on our own schedule. Once we learn how to safely and effectively elicit the therapeutic tremor on a regular basis, we are more accepting of our body’s natural response to stress.
Whether someone has experienced a traumatic life event or accumulated stress over the course of a lifetime, releasing unnecessary tension helps the body and mind return to a more calm and peaceful state. Since its development, TRE has helped thousands of people worldwide in more than 35 countries reduce the effects of stress, tension and trauma. The reported benefits of a regular TRE practice include, but are not limited to:
- less worry and anxiety
- better sleep
- fewer PTSD symptoms
- reduced muscle + back pain
- more energy and endurance
Most relaxation techniques rely on conscious control. TRE relies on unconscious control, allowing an individual to listen to music or watch TV while the involuntary muscular shaking process does all the work. As part of Mirasol’s integrative approach to eating disorder treatment, TRE expands the client’s ability to control emotions, sensations, thoughts, and feelings independently of external supervision or regulation. Once learned, TRE is a self-healing technique and prevents the accumulation of chronic stress, tension and trauma.
During a typical TRE session, whether it’s an individual or group session, each client is guided through the series of seven exercises by one of our certified practitioners to safely and effectively elicit the therapeutic tremor. Clients receive individual support to help regulate and modulate the tremor to their levels of comfort and resilience. Clients are asked to rate their emotional and physical well-being before and after each session to determine the overall effectiveness of TRE.
For more information about TRE please visit www.traumaprevention.com
By Dr. Dawn Bantel, Staff Physician
Yes, we eat six times each day. This is one of the very first conversations that I have with a new client when she enters treatment. This concept is so difficult for someone with an eating disorder. In fact, it’s pretty mind-blowing for her. She always thinks that there has to be some control or compensation involved to maintain a healthy body weight. This is generally true for all the eating disorders.
Our dieticians create a meal plan that is composed of three meals and three snacks per day. It is adjusted for the calories needed for weight gain, weight loss or weight maintenance depending on what the client needs. If one is on a weight loss meal plan it is possible to loose weight by eating six times per day! The client never believes this until it actually happens. She doesn’t have to restrict/purge/exercise to loose weight and she doesn’t get hungry.
Hunger and low blood sugar can contribute to a binge. If a client is satiated from eating just a few hours before, she may make better choices. Also, low blood sugar will create a strong desire to acquire a quick fuel source such as ice cream, energy drinks, candy, etc. People with eating disorders are usually stuck in a cycle that they are unable to interrupt.
For the client that has a history of restriction it is easier to eat the required number of calories in six portions through out the day. Usually, she will experience improved mood and improved cognition with regular eating. In fact, the majority of clients will admit to how impaired they were before eating regularly.
Most staff will become accustomed to eating six times per day. We pull out our snacks right on schedule as our appetites are used to eating this way. It helps to maintain our energy too.
Eating Disorder Hope Award
- Ground-Breaking New Research on the Genetic Origins of Anorexia Nervosa March 4, 2015
- Gone Wild: Backpacking with Mirasol March 2, 2015
- Curing the “Winter Blues” March 2, 2015
- TRE (Tension + Trauma Releasing Exercises) February 23, 2015
- Six Times a Day? February 16, 2015
- Turning Points February 11, 2015
- RESHARE: Insurance Companies Coming Up Short January 15, 2015
- RESHARE: Ten Things I Wish Physicians Would Know About Eating Disorders December 22, 2014
- Live Your Life: Finding Connection When Lost December 18, 2014
- Compulsive Overeating Disorder November 18, 2014