Being Assertive in Relationships Can Help Your Mental Health

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Assertive communication works well when it comes to my communication styles. I have a history of vacillating between aggressiveness and passivity in relationships. Both of these styles come with their downsides and it's been an arduous journey to find an effective middle ground. Assertive communication is my middle ground.

On the one hand, for years, I remained passive in verbally and emotionally abusive relationships, internalizing the belief that I didn't deserve anything better. I had a partner tell me that every time I looked in the mirror, I should be ashamed of who I saw and should want to kill myself. I never told him how that comment made me feel.

On the other hand, when I decided I wasn't putting up with this abuse anymore, I became aggressive and scathing in my communication style. I would send nasty texts, threaten to leave partners at the drop of a hat, and inhibit all empathy and care at that moment. The downside about aggression is that it leads to hostility from your partner's end. Two people aggressively communicating doesn't get you anywhere remotely positive and surely doesn't help with mental health. That's where assertive communication comes in.

What Is Assertive Communication?

Although assertive communication is often conflated with aggressive communication, these two styles are drastically different. When people act aggressively, they are protecting their own opinions while discrediting the views and needs of their partners. Meanwhile, assertiveness entails communicating your needs while also being respectful of others. When speaking assertively, the opinions of both parties are met and considered in a caring manner. Therefore, this communication style supports open and honest discussion.

How Assertiveness Helped My Relationships and Mental Health  

So often, primarily due to my depression, I felt as if my opinion and beliefs didn't matter and lacked value. I'd remain passive in relationships until I couldn't take it anymore and aggressively exploded. Both of these styles did not improve my mental health, mainly because my needs weren't met, and I was creating interpersonal turmoil that added to my anxiety. However, I started interning as a case manager at an agency where we taught our clients how to communicate assertively and I was immediately absorbed into this skills lesson.

Since teaching this skills class to my clients, I have adopted assertive communication into all of my relationships. The good news is that this style can be learned; however, it does take practice and a certain level of emotional intelligence. When speaking assertively, you need to remain calm, agree to disagree, utilize collaborative problem-solving, and be both empathetic and self-assured. 

After implementing assertive communication into multiple facets of my life, I have found the benefits to be rewarding both for my relationships and mental health. When certain scenarios are exacerbating my mental illnesses, I speak up respectfully as opposed to remaining passive or exploding in anger. I can draw a line with people and respect their opinions and needs at the same time. Furthermore, people are more likely to truly listen and internalize what you are saying when you are calm, as opposed to raising your voice and displaying angry body language. By practicing assertiveness, I have found an increased sense of self-assurance and self-confidence, as well as an improved sense of control over my life and mental health.  

3 Ways a Quick Nap Will Change Your Life

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A quick nap during the day can change your life. Adding a nap into your life may seem impossible unless you’re in primary school, but the results are worth finding a way to make it happen. Read on for three benefits of a short nap. 

1. Avoid the Post-Lunch Slump with a Short Nap

Do you find you have a drop in productivity after lunch? Research shows that’s normal,1 but a quick nap can bring your energy back up and freshen your mind. 

It’s no coincidence that many of the top-performing tech companies now offer nap areas in their headquarters. They’ve taken advantage of the work performance benefits of napping to encourage employees to have increased productivity

2. Quick Naps Help with Sleepless Nights

Many mental illnesses (or their medications) include symptoms and side effects that keep us from sleeping. A short nap during the day helps alleviate exhaustion,2 allowing you to make it through the rest of your tasks before getting to bed at a normal time. If you go to bed early instead of napping, you may find that your sleep is further disturbed for yet another night. A nap can help reset that cycle instead.

3. A Short Nap Can Boost Your Mood

If you’re feeling down, irritable, or out of it, a nap can help change your mood.3 Just a few minutes of sleep or rest will give your brain a chance to unplug and reset. Instead of trying to process a difficult situation or argument during the day, consider lying down for a few minutes. 

While finding a spot to nap during the workday may seem tricky, consider taking a break in your car or at a park nearby. If you work in an environment with an empty office or other space, consider proposing a nap space there. Armed with current research showing the likelihood of increased productivity for everyone who naps, you might be more successful with your campaign than you’ve imagined.

Sources

  1. Monk, T., "The Post-Lunch Dip in Performance." Clinics in Sports Medicine, 2015.
  2. National Sleep Foundation, Napping. Accessed June 9, 2019. 
  3. Milner, C. and Cote, K., "Benefits of Napping in Healthy Adults: Impact of Nap Length, Time of Day, Age, and Experience with Napping." Journal of Sleep Research, 2009.

Introduction to Rosie Cappuccino, Author of 'More than Borderline'

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My name is Rosie Cappuccino and I’m a writer, an artist, and the new More than Borderline blogger here at HealthyPlace. When I was first diagnosed with borderline personality disorder (BPD) five years ago, I felt isolated, frightened and confused about what this diagnosis meant for me. When I read up about the condition in books and online, I discovered that BPD is one of the most deeply stigmatized mental health conditions. It felt awful to be misunderstood and stereotyped as manipulative, attention-seeking and untreatable.

Rosie Cappuccino Learns to Live with Borderline Personality Disorder

Like many people with BPD, I have difficulty regulating my emotions which means that I can go from joyful to suicidal in a matter of minutes. I have strong fears of abandonment and rejection which can lead to suicidal feelings and urges to self-harm. Over the last two years, dialectical behavior therapy (DBT) has helped me to manage these difficult experiences.

Rosie Cappuccino’s Vision for ‘More that Borderline’

I’m delighted to be joining HealthyPlace as a regular writer and vlogger. I can’t wait to share more about my life with BPD, as well as my coping techniques, with the HealthyPlace community. If you have BPD, I hope my articles and videos will help you feel a little less alone. The stereotypes and myths surrounding BPD are simply not true. Everyone deserves understanding, respect and compassion.

More About Rosie Cappuccino

I live in the UK and run a blog called Talking About BPD. At the moment, I work as a service coordinator in a charity that provides psychosocial support to people with health conditions. I’m also a qualified primary school teacher with four years of experience working in schools and have worked as a volunteer counselor for young people. Recently, I completed a master’s degree in Medical Humanities during which I specialized in illness narrative and I also have a bachelor’s degree in English Literature.

Weaken Panic Attacks, Anxiety Attacks, with Self-Compassion

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Imagine weakening panic attacks and anxiety attacks simply by being nice to yourself, also known as practicing self-compassion. Both panic attacks and anxiety attacks are intense experiences of severe anxiety that effectively paralyze people, trapping them in severe physical, emotional, and cognitive discomfort. These whole-being strikes are disruptive to life and painful to experience. While often severe, meeting panic attacks and anxiety attacks with self-compassion weakens them and lessens their negative effects. 

Panic attacks and anxiety attacks are related. They both take over the physical body, thoughts, emotions, and behaviors. They share symptoms. The difference is in their cause. Panic attacks are part of panic disorder and involve the fear of having more panic attacks. Anxiety attacks, on the other hand, are a reaction to extremely anxiety-provoking situations. When it comes to weakening either panic or anxiety attacks with self-compassion, the cause isn't important; therefore, I'll use the terms interchangeably as we go. 

How Does Self-Compassion Weaken Panic Attacks and Anxiety Attacks?

Simply put, self-compassion means being nice to yourself. This doesn't come naturally or easily for a lot of us, but it can be practiced and learned. Self-compassion is loving and liking ourselves just because we exist. It's knowing that we're not perfect and embracing ourselves anyway. Self-compassion is also looking for the positive within. It becomes a balance between accepting our flaws and foibles and identifying and honing our strengths. When we're self-compassionate, we forgive ourselves for our imperfections, understanding that they're part of being human. When this happens, we free ourselves from a fear of imperfection and release ourselves from worries about being judged negatively by others. 

When it comes to weakening panic attacks, self-compassion can liberate us from the all-encompassing trap we're imprisoned in during the episode. Feeling unconditional acceptance and positive thoughts about yourself during an anxiety attack disrupts anxious thoughts and emotions, which leads to changed behavior (especially the need to avoid situations and places) and improved physical sensations. 

During panic attacks, self-compassion puts space between you and your anxiety by:

  • Countering the self-defeating belief that there's something wrong with you, you're going crazy, you're weak, or you're a failure (self-compassion tells you the truth that this panic attack isn't a sign of your worth but is just an anxiety-related experience)
  • Minimizes the sense of shame and embarrassment that others can see you and are judging you (nor only can you not tell what others are thinking, self-compassion lets you stop imposing harsh judgments on yourself)
  • Helps settle agitated physical sensations (when you're being nice to yourself rather than cruel, your body's reaction to anxiety is muted)

While anxiety attacks and their effects on you are weakened when you're self-compassionate, it's a gradual process because, for many of us, self-compassion isn't a natural way of thinking. Start strengthening it with this exercise.

Cultivating Self-Compassion: An Exercise in Being Nice to Yourself

Thinking of your own panic attacks, reflect on the following questions and statements. Use a notebook, journal, or word processing program to develop your responses.

  • List the thoughts you have during a panic attack.
  • Describe the emotions you feel.
  • What do you do during and after an anxiety attack?
  • How many of these thoughts, emotions, and actions describe who you are as a person (rather than what you're experiencing during an anxiety attack or what caused it to happen)?
  • Look at all that you've written. They're experiences you have. You are not these things. Describe who you are
  • Start a running list of self-compassionate affirmations (short statements of positive thoughts about yourself such as, "I am worthy of my own respect."). Tape them in prominent places or keep them in your notebook and your notebook nearby. Read them repeatedly every day, and add more regularly.

Self-compassion is a powerful way to weaken anxiety and panic attacks because practicing it lessens anxiety's grip on you so you can step away from it and see yourself for the wonderful person you truly are. 

Coping with Debilitating Depression at Work

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On most days, I am an individual without debilitating depression; instead, I live with high-functioning depression. But every now and then, there comes a time when depression completely takes over my body and mind. My arms ache and feel limp and my mind fixates on nothing but suicide. That is when I know I am officially too depressed to work and taking a mental health day seems like the best option. 

Now it's great whenever that's possible, but on some debilitating depression days, work just has to be done as per a preplanned schedule. So I put on my "want-to-die-but-won't-and-will-get-through-the-day" pants on and do certain things to ensure I get work done.

How to Deal with Debilitating Depression at Work

Take Frequent Breaks

Whenever I am overwhelmed with debilitating depression, I know that I will have a very hard time concentrating. I work with that by breaking up every hour of work into small chunks of 20 minutes each. After every 20 minutes of work, I make it a point to get up from my chair and take a break. The break doesn't have to be anything special, it could be something as simple as taking a walk or eating a snack. The important thing is taking a break as it helps reduce the monotony of work and makes it more manageable. 

Listen to Music

It has been scientifically proven that listening to music helps reduce depression. Therefore, I make sure that I always listen to some of my favorite music on particularly bleak days. Inspirational anthems and upbeat pop music definitely help me feel better, even if only a little. While basically, any kind of music can have a positive impact on your state of mind, I find that it's best to listen to music that you naturally reach for on your good or better days. 

Have Something to Look Forward To

Work feels like a terribly trying chore on days when I am feeling more blue than usual. I make it easier for myself to get through such days by scheduling an enjoyable activity or two post work. Although my intense bouts of debilitating depression make it impossible for me to savor anything, knowing that I have something half-decent to do after work makes getting through the day significantly more bearable.

Coping with debilitating depression at work is extremely difficult, but with the help of some patience and workarounds, it can be made significantly easier. As they say, you are not your depression. You've got this.  

The Crab Mentality: A Sign of Low Self-Esteem?

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What is the crab mentality? When you have a bunch of live crabs in a bucket, you can notice something quite interesting. As a crab tries to escape out of the bucket, the other crabs will try to drag it back down into the bucket. This unique behavior of crabs has since been used as a metaphor for how many people behave when noticing the success of others. If someone else has made some great achievement or is making progress in some area of their life, there can sometimes be a tendency to diminish that person or their success. This is known as the crab mentality. And it may actually be a sign of low self-esteem.

The Crab Mentality in Action

The crab mentality is encapsulated by the phrase, “If I can’t have it, neither can you” – a way of thinking that can manifest in all sorts of ways. It can show up in your thoughts, the things you say, and the way you behave. For example, if someone you know achieves something they’ve been hoping for, be that a promotion, a raise, a new relationship, good grades in school, or so on, you might feel some jealousy and bitterness. You might think they only achieved what they did because they were lucky, privileged, or helped by others, or you might imagine things not working out for that person as a way to feel better about yourself.

You may keep these thoughts to yourself, which is understandable, given that thinking this way about others can be a great source of shame. It’s not something most of us would like to admit to, in spite of it being a commonplace form of thinking. Other times, though, you may vocalize these thoughts to others. You might gossip about how so-and-so’s marriage is doomed to fail or complain about why it’s not fair that so-and-so is doing so well in their career.

In other situations, when listening to someone telling you about their success, achievements, and happiness, the crab mentality may cause you to react – often unconsciously – by making comments that undervalue a person. You might try to sow the seeds of self-doubt in the other person’s mind or you might try to point out something wrong or flawed about his or her achievement.

How the Crab Mentality Can Be a Sign of Low Self-Esteem

If you notice yourself engaging in the crab mentality, then this could be a sign of low self-esteem. When you suffer from low self-esteem, you will try to find ways to boost it. But a lot of the time, these methods for raising self-esteem can be unhealthy in the long-term. You might think that putting others down is an effective way to protect your self-esteem, yet it doesn’t usually work out like that.

There will always be others who are more successful than you or more skilled, virtuous, happy, and so on. When your self-esteem is based on comparisons with others, it will always be unstable and, in turn, unable to provide you with the self-confidence you need to move forward in the world. The crab mentality doesn’t allow you to feel secure in yourself. All it does is maintain a sense of unworthiness while also preventing you from being genuinely pleased about the success of others, including those closest to you.

It’s important to keep the crab mentality in check. This means being aware of it when it raises its head, recognizing whether it’s a sign of low self-esteem, and making efforts to build healthy self-esteem so that you can interact in a more positive way with others.

How My Cat Helps Me Through Tough Times

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My cat helps me through tough times. I’ve talked about my cat, Lemmy, on and off on this blog since it began. I’ve even devoted an earlier post to him. But he’s never really been featured front and center on video before, and I wanted to change that.

Lemmy, My Cat Helps Me Through Tough Times

This video features Lemmy as a guest – I show him off and discuss the ways in which my cat helps me through tough times.

5 Types of Self-Care for Mental Health

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Did you know there are many different types of self-care? I believe there are five primary types of self-care, and all of them are equally important. It can be easy to practice some and neglect others. If your only types of self-care are going to the gym, taking bubble baths, or getting massages, you are likely missing some key components to maintaining overall wellbeing.

The Different Types of Self-Care

Self-Care for Mental, Physical and Emotional Health

Mental self-care activities include exercises that challenge and stimulate your mind. These include learning new things, taking on an interesting project, or engaging in favorite hobbies. My personal favorites include reading, watching documentaries, and playing games. It can also be fun to get out and take a class or go to a museum. 

Physical self-care includes movement and taking care of our physical health. This involves nourishing our bodies with healthy food, staying hydrated, and practicing good sleep hygiene. It can also include stretching, dancing, yoga, or walking.

Emotional self-care encourages inner peace and positive mood. These are the activities we might engage in to ground us when we are upset or to self-soothe at the end of a stressful day. I like to meditate, color in an adult coloring book, or sing to brighten my mood. Of course, sometimes just permitting ourselves to feel our painful emotions is a form of self-care.

Self-Care for Spiritual and Relational Health

Spiritual self-care is the practice of nurturing your soul and being connected to something bigger than yourself. I feel the most spiritually connected when in nature, so I like to hike, camp, or lie outside and look at the stars. Self-Compassion and breathing exercises are some of my favorite soul-nourishing activities. Many people feel spiritually connected when they are volunteering or working with others on an important cause.

Finally, relational self-care helps us nurture healthy relationships and connect to others. I practice relational self-care by setting appropriate boundaries with others and asking for help when I need it. Simple activities like inviting a friend to coffee or lunch, offering someone a compliment, or doing a good deed are all forms of relational self-care. Cuddling with a pet counts and is a personal favorite.

I'd love to hear how you nurture yourself by engaging in different types of self-care. Leave me a comment and let me know what works best for you.

Distress Tolerance: Learn a DBT Skill that Curbs Self-Harm

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Distress tolerance skills are coping skills taught in dialectical behavior therapy (DBT). Dialectical behavior therapy is a type of treatment that teaches patients how to regulate their emotions and respond to distress through skills training. Distress tolerance skills have proved to be especially effective in people struggling with self-harm and other self-destructive, maladaptive behavior. 

What Are DBT Skills?

Though DBT can seem complicated at first glance, DBT skills training is essentially composed of four modules: mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness. 

Together, these skills teach patients how to recognize and honor their emotions, regulate their intensity, and respond to them without the use of maladaptive coping mechanisms.

Today, we will be taking a look at distress tolerance in DBT. 

What Is Distress Tolerance?

In DBT, distress tolerance skills teach patients who experience negative emotions in an especially overwhelming, disempowering way to accept and better tolerate distress. This helps minimize instances of patients responding to stress with negative behavior.

The goals of distress tolerance are to help patients learn how to get through a crisis without making them worse, to accept reality as is and thus enable them to move forward, and to become free of the demands of their own urges and emotions.1

While there are several skills within the distress tolerance module, we will focus on four crisis survival skills designed to help people through distress: distracting, self-soothing, improving the moment, and pros and cons.2

4 Crisis-Survival Distress Tolerance Skills

Distracting Skill

Distress tolerance uses distraction to help patients shift their acutely negative thoughts and emotions to more neutral or positive ones. One way to remember these skills is with the phrase “Wise Mind ACCEPTS”:

  • Activities -- Enjoyable and/or distracting activities
  • Contributing -- Contributing and doing things for others
  • Comparisons -- Comparisons with other's suffering or own past suffering for perspective
  • Emotions -- Activities that induce different emotions from the current one(s)
  • Pushing away -- Pushing away by mentally leaving the current situation and blocking related thoughts
  • Thoughts -- Occupying and diverting attention with other thoughts, such as by doing a puzzle
  • Senses -- Stimulating physical sensations using multiple senses, such as taking a hot/cold shower

Self-Soothing Skill

Self-soothing uses the five senses to calm and nurture. Below are just some examples of common activities, but feel free to tailor it to what works for you.

  • Vision -- Look at beautiful/interesting things.
  • Hearing -- Listen to music or nature sounds.
  • Smell -- Use favorite soap or lotion, use essential oils, smell plants and flowers.
  • Taste -- Eat favorite foods, try new foods.
  • Touch -- Pet an animal, get a massage, put on comfortable clothes.

Improving the Moment Skill

Improving the moment uses positive mental imagery to improve the situation. One way to remember these skills is with the word “IMPROVE”:

  • Imagery -- Relaxing, positive mental imagery, such as imagining everything turning out well
  • Meaning -- Find or create meaning from pain situation
  • Prayer -- Prayer to your higher power for strength 
  • Relaxation -- Relaxing, such as by breathing deeply or stretching
  • One thing -- Remain present by focusing on just one thing in the moment
  • Vacation -- Take a mental break, or vacation, such as by going to the park or turning off your phone
  • Encouragement -- Encourage and rethink the situation by talking to self in a positive manner

Pros and Cons Skill

Use the pros and cons skill when deciding between two courses of action. 

First, make a list of the pros and cons of acting on your urges. This includes behaviors such as self-harm. Then, make another list of the pros and con of resisting your urges. 

Carry this list with you and review the pros and cons often. When a crisis/urge hits, take out the list and go over it again and imagine the positive consequences of resisting the urge, the negative consequences of acting on the urge, and remember past consequences of when you have acted on the urge.

These skills will help you cope with and lessen painful emotions -- help you to tolerate distress -- and give you the tools to resist engaging in harmful behavior.

Sources

  1. Bray, S., “Distress Tolerance in Dialectical Behavior Therapy.” GoodTherapy.org. January 17, 2013. 
  2. Linehan, M., “Distress Tolerance Handouts.” DBT Skills Training Handouts and Worksheets, Second Edition. 2015.

Is Bulimia Like a Drug Addiction?

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Bulimia is characterized by recurrent binge-eating followed by compensatory behaviors like fasting, purging or over-exercising. Research studies have found many parallels between bulimia and addiction, in particular, people struggling with these illnesses report a sense of losing control and withdrawal when they try to abstain from certain disordered eating behaviors.

It’s common to hear bulimics talk about consuming entire cakes or multiple packets of sweets until they feel physically sick, and not being able to stop once they start as though some unknown power has taken over them. Shame and guilt are toxic accompaniments, and this vicious cycle of compulsion can go on for years despite the tremendous pain it causes. Bulimia certainly sounds like an addiction.

Similarities Between Bulimia and Drug Addiction

Although the neurological similarities between bulimia and drug addiction haven’t yet been established, studies have shown that certain behavioral and eating patterns, such as binge eating, purging, and dietary restriction, are highly addictive.1 A prominent study led by Tufts Medical School demonstrated that cravings for food or drugs can be associated with specific locations or situations, and the brain may be wired to pair cravings with certain emotions.2 A similar neurological pattern of withdrawal was also suggested, as bulimics experience similar symptoms as drug addicts when they try to stop binge eating, including anxiety, inability to sleep, and intense cravings.

A systemic review published in the journal Nutrients last year showed that particular foods affect our brains in similar ways as alcohol, nicotine, and hard drugs.3 Often these foods release neurotransmitters associated with pleasure and reward, like endorphins, temporarily relieving emotional pain, anxiety, and depression. Processed foods with added sweeteners and fats were found to be most addictive: they give our blood sugar levels a huge spike and overrule the body mechanisms that let us know when we’ve eaten enough. Just like with cocaine or nicotine, people can become physically and emotionally addicted to frequent consumption of these foods.

The authors of a paper exploring the validity of “food addiction” in the journal Neuropsychopharmacology, concede that:

“some individuals clearly demonstrate a failure to exert control over their food choices, despite a desire to do so, and as a result, experience significant negative consequences”.1

Still, “food addiction” remains controversial, with many within the scientific community arguing that the concept is unsupported.

Recovery Through an Abstinence-Based Program

I struggled with bulimia for many years without receiving help, as I failed to recognize that I had a problem and that effective, evidence-based interventions, like cognitive behavioral therapy (CBT) and family-based therapy (FBT), were available to me via my healthcare system. I privately sought out alternative treatments, like hypnotherapy, which were helpful for a limited period of time, but I couldn’t afford to continue them in the long-term.

In the early phase of my illness, restricting my food intake felt like a conscious expression of discipline and strength, but at the height of it, I felt completely out of control, especially in the moments before and during a binge. Intense cravings and thoughts about restricting and eating often felt obsessive and all-consuming. It took me years to realize that willpower alone wasn’t enough to overcome a serious disorder like bulimia.

In my late 20s, I was able to establish a healthy relationship with food through the use of a supportive community and a combination of powerful psychological tools, like CBT and hypnotherapy. A 12-step program – commonly used for addiction – was a big part of my early recovery, which involved refraining from certain “trigger” foods and addictive behaviors, attending support group meetings, and being guided and supported by a sponsor. The program receives a fair amount of criticism due to the dearth of scientific evidence regarding its efficacy, but I’ve heard as many anecdotal “success stories” as I’ve heard negative ones, especially from people with eating disorders that share behavioral patterns with addictions, such as bulimia and binge eating disorder.

Treatment Options for Bulimia and Bulimia as an Addiction

Bulimia Treatment

Bulimia is a complex, difficult-to-treat illness. As a research assistant within an eating disorders service in London, I observed effective treatment of bulimia in adolescents using the evidence-based Maudsley approach, namely family-based therapy, which was originally developed to treat adolescent anorexia nervosa.4 Parents are seen as powerful resources in recovery, as they can work collaboratively with their child to stop harmful behaviors, help them acquire positive coping mechanisms, and maintain a consistent eating pattern. For adults, CBT remains the first-line approach, with other treatments including pharmacological (e.g., selective serotonin reuptake inhibitors) and combination interventions.5

Treatment for Bulimia as an Addiction

Conceptualizing bulimia as an addiction, or simply understanding the similarities between these mental health problems may help open up new possibilities for bulimia treatment. An abstinence-based approach isn’t for everyone and wasn’t the right choice for me in the long term, but it helped me get back some control and disrupted my disordered eating behaviors when they were at their worst. I believe that 12-steps programs, such as Overeaters Anonymous (OA) and Food Addicts Anonymous (FAA), should be available to individuals struggling with food-related mental illness, and that further research should be conducted on the effectiveness of these programs to ensure that a broader spectrum of people can get the help that they need.

Do you see bulimia as an addiction? Why or why not?

Sources:

  1. Fletcher, P., and Kenny, P. “Food Addiction: A Valid Concept?Neuropsychopharmacology. 2018.
  2. Umberg, E., et al. "From Disordered Eating to Addiction: The “Food Drug” in Bulimia Nervosa." Journal of clinical psychopharmacology. June 2012.
  3. Gordon, E., et al. "What Is the Evidence for “Food Addiction? A Systematic Review." Nutrients. March 2018
  4. Le Grange, D. "Family-Based Treatment for Adolescents with Bulimia Nervosa." Australian and New Zealand Journal of Family Therapy. June 2010.
  5. National Institute for Health and Care Excellence (NICE). Eating Disorders: Recognition and Treatment. Accessed May 30, 2017.