Stress and Eating - Cigna · 2016-09-17 · Lisa M. Groesz, Ph.D., Lic. PSY 24682 May 26, 2015...

Lisa M. Groesz, Ph.D., Lic. PSY 24682 May 26, 2015

Stress and Eating Dysregulation How stress gets under the skin Lisa M. Groesz, PhD

Objectives

● Learn eating disorder symptoms based on DSM 5 criteria

● Learn what stress is, and is not ● Understand role of stress in eating dysregulation ● Take away tools to help family members manage

stress and eating

Why am I here today?

● Eating disorders are not always physically apparent

– Address changes with the DSM-5 ● Learn role of stress in eating

dysregulation ● Provide tools ● Help you recognize indicators of

distress

Relevant concepts

●Metabolic Equation !!!!

● Body Mass Index (kg/m^2): – Underweight < 18.5 (e.g., 5’7: and 110

pounds) – Normal weight 18.5 - 24.9 – Overweight 25 - 29.9 – Obesity 30 or greater

Types of Eating Disorders● Anorexia Nervosa ● Restrictive ● Binge/Purging

● Bulimia Nervosa ●Often not physically apparent

● Binge Eating Disorder—this is new to DSM-5 ●Overall, lower threshold; severity also assessed ● Rigidity in thinking, managing uncomfortable

emotions, managing stress

Body Image

● Boys and girls, values ● Content analyses ● Body Image Likert Scale ● Role of media ● Thin ideal internalization ● Body dissatisfaction

Tools!● Compassion

– Eating disorder symptoms have been in service of something

– Would you be willing to trade in your eating disorder if it meant gaining five pounds

– What have you lost due to your disorder ● Alternative coping solutions are

needed ● Separate the eating disorder from the

self; talk back ● Work to prioritize strengths & skills

separate from physical appearance

Stress• Definition • Types of stressors • How does stress get

under the skin? • Coping

Is anyone stressed?• What does it feel like? • What other types of things cause

you stress?

What is stress?• “a state of challenge or threat that

disrupts the normal rhythm and balance of a person’s life” (Sanderson, 2004, p. 92)

!• “an external load or demand on a

biological, social, or psychological system” (Lazarus, 1993, p. 2)

Stressors• Various sources of stress

– External (work, environment) – Internal (making a difficult choice)

• Daily hassles • Stressful life events • Chronic strain

– “Risky families”: heightened sympathetic reactivity, exaggerated cortisol responses

– Poverty, bad relationship, high-stress job, multiple roles, racism

How stress gets under the skin

● Fight/Flight response, central nervous system

●Cortisol is the vehicle ● Acute stress: cortisol serves as an anti-

inflammatory agent

Why look at stress?

● Stress reactivity is important in the short term but causes impairment in long term

● People report greater frequency and severity of stress than ever before (APA, 2007)

●Chronic stress is related to psychological, immunological, and health problems such as high blood pressure

●Chronic stress is related to dysregulated eating

Role of stress● How does stress get under the skin to

influence eating patterns and weight?

Sapolsky’s work

• “Primates are super smart and organized just enough to devote their free time to being miserable to each other and stressing each other out…. But if you get chronically, psychosocially stressed, you’re going to compromise your health. So essentially, we’ve evolved to be smart enough to make ourselves sick.”

http://greatergood.berkeley.edu/article/item/how_to_relieve_stress

When stressed, do you eat:

A. !!!

When stressed, do you eat:

A. !!!

Stress and drive to eat

●Greater vulnerability to stress is associated with increased intake of high sugar high fat food

●Chronic strain and disinhibition; finding mirrored in laboratory paradigm

● High sugar foods and the limbic system

– Dopaminergic effect, nucleus accumbens

Stress, Appraisal, and Coping• Three kinds of stress

– Harm: psychological damage that had already been done

– Threat: anticipation of harm that has not yet taken place but may be imminent

– Challenge: difficult demands that we feel confident about overcoming by deploying our coping resources

• Appraisal: – Cognitive mediator of stress reactions

• Coping – Altering circumstances, or how they are

interpreted – Problem focused – Emotion focused

Coping

• Problem Focused – Address external circumstances – Factors must be controllable

• Emotion Focused – Decrease emotional and

physiological arousal

Approaches that can be less healthy

• Avoidant emotion focused – Behavioral disengagement – Thought suppression

• Aggression • Depressants (e.g., alcohol) • Stimulants (e.g., cocaine; high

sugar, high fat foods) • Narcotic analgesics (e.g., heroin)

Impact of stress on health• Immune system weakened • Ulcers • Cardiovascular disease • Diabetes • Colds and flu • Arthritis • Appendicitis • Gastrointestinal disorders • Herpes • Asthma

• Sports injuries • Migraines • Headaches • Eczema • Hives • Back pain • Hernias • Poor memory

Other ways to manage of stress• Normalization

– Other people are similarly stressed • Tools

– Social support – Mindfulness – Deep breathing – Visual imagery – Chunking projects – Esteemable acts

● Empower your family member ●Normalization

– It makes sense, when this stressed, to turn to food ●Alternative strategies

– How else have you managed uncomfortable emotions?

●Pause, look at emotional vs. physical hunger – Slow intake – Mindful eating – Esteemable acts – Re-calibrate metabolic rate and physiological cue

awareness

Helping your loved one

Take home points

●An Eating Disorder is not always physically apparent – Anorexia, Bulimia, Binge-eating

● Stress is related to dysregulated eating, weight gain and other health conditions

● There are ways to manage uncomfortable emotions, stress, and eating disorder symptoms

Other resources

● Websites ● National Eating Disorders Association: www.nationaleatingdisorders.org ● Something-fishy.org ● Academy of Eating Disorders: Aedweb.org

● Books ● Help Your Teenager Beat an Eating Disorder. James Lock & Daniel le Grange ● Skill-based Learning for Caring for a Loved One With an Eating Disorder: the New Maudsley

Method. Janet Treasure, Grainne Smith, & Anna Crane. ● Life Without Ed: How One Woman Declared Independence From Her Eating Disorder and

How You Can Too. Jenni Schaefer & Thom Rutledge

Thank you!

Questions?

Stress and Eating - Cigna · 2016-09-17 · Lisa M. Groesz, Ph.D., Lic. PSY 24682 May 26, 2015...

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