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Recovery at Risk: Eating Disorders & Addiction

2/16/2019

Liz Langreck, MS, RDN

Liz has been working to help those struggling with eating disorders since 2011. Liz is a registered dietitian who has worked at all levels of eating disorder care. She is currently pursuing certification as an Certified Eating Disorder Registered Dietitian from the International Association of Eating Disorder Professionals.

She began her career at Remuda Ranch in Wickenburg, AZ working as a registered dietician. In 2014, Liz joined Dr. Lesley Williams to collaborate at Liberation Center, an outpatient eating disorder center in downtown Phoenix.
Liz holds a Bachelor’s of Science in Dietetics, and a Master of Science in Food and Nutrition Science from the University of Wisconsin Stout. Liz completed her accredited dietetic internship through the University of Wisconsin Stout.

Liz is a Wisconsin native who enjoys sports, yoga, hiking and the outdoors, cats, and recovery. She has an interest in eastern philosophy and an obsession with the work of Brene Brown. She believes her work in this space is, unquestionably, a calling from her Higher Power.

** At this event, Liz presented on the ways that undiagnosed / untreated eating disorders impact recovery. We also discussed how prevalent eating disorders (of all types) are for people who have co-occurring substance use disorders.

COMMON SYMPTOMS OF AN EATING DISORDER
Emotional and behavioral

In general, behaviors and attitudes that indicate that weight loss, dieting, and control of food are becoming primary concerns
Preoccupation with weight, food, calories, carbohydrates, fat grams, and dieting
Refusal to eat certain foods, progressing to restrictions against whole categories of food (e.g., no carbohydrates, etc.)
Appears uncomfortable eating around others
Food rituals (e.g. eats only a particular food or food group [e.g. condiments], excessive chewing, doesn’t allow foods to touch)
Skipping meals or taking small portions of food at regular meals
Any new practices with food or fad diets, including cutting out entire food groups (no sugar, no carbs, no dairy, vegetarianism/veganism)
Withdrawal from usual friends and activities
Frequent dieting
Extreme concern with body size and shape
Frequent checking in the mirror for perceived flaws in appearance
Extreme mood swings

Physical

Noticeable fluctuations in weight, both up and down
Stomach cramps, other non-specific gastrointestinal complaints (constipation, acid reflux, etc.)
Menstrual irregularities — missing periods or only having a period while on hormonal contraceptives (this is not considered a “true” period)
Difficulties concentrating
Abnormal laboratory findings (anemia, low thyroid and hormone levels, low potassium, low white and red blood cell counts)
Dizziness, especially upon standing
Fainting/syncope
Feeling cold all the time
Sleep problems
Cuts and calluses across the top of finger joints (a result of inducing vomiting)Dental problems, such as enamel erosion, cavities, and tooth sensitivity
Dry skin and hair, and brittle nails
Swelling around area of salivary glands
Fine hair on body (lanugo)
Cavities, or discoloration of teeth, from vomiting
Muscle weakness
Yellow skin (in context of eating large amounts of carrots)
Cold, mottled hands and feet or swelling of feet
Poor wound healing
Impaired immune functioning

Common Diagnoses & Presentations
ANOREXIA NERVOSA

Dramatic weight loss (sometimes)
Dresses in layers to hide weight loss or stay warm
Preoccupation with weight, food, calories, fat grams, and dieting. Makes frequent comments about feeling “fat"
Resists or is unable to maintain a body weight appropriate for their age, height, and build
Maintains an excessive, rigid exercise regime – despite weather, fatigue, illness, or injury

BULIMIA NERVOSA

Evidence of binge eating, including disappearance of large amounts of food in short periods of time or lots of empty wrappers and containers indicating consumption of large amounts of food
Evidence of purging behaviors, including frequent trips to the bathroom after meals, signs and/or smells of vomiting, presence of wrappers or packages of laxatives or diuretics
Drinks excessive amounts of water or non-caloric beverages, and/or uses excessive amounts of mouthwash, mints, and gum
Has calluses on the back of the hands and knuckles from self- induced vomiting
Dental problems, such as enamel erosion, cavities, discoloration of teeth from vomiting, and tooth sensitivity

BINGE EATING DISORDER

Secret recurring episodes of binge eating (eating in a discrete period of time an amount of food that is much larger than most individuals would eat under similar circumstances); feels lack of control over ability to stop eating
Feelings of disgust, depression, or guilt after overeating, and/or feelings of low self-esteem
Steals or hoards food in strange places
Creates lifestyle schedules or rituals to make time for binge sessions
Evidence of binge eating, including the disappearance of large amounts of food in a short time period or a lot of empty wrappers and containers indicating consumption of large amounts of food

OTHERWISE SPECIFIED FEEDING OR EATING DISORDER (OSFED)
Because OSFED encompasses a wide variety of eating disordered behaviors, any or all of the following symptoms may be present in people with OSFED.

Frequent episodes of consuming very large amount of food followed by behaviors to prevent weight gain, such as self-induced vomiting
Evidence of binge eating, including disappearance of large amounts of food in short periods of time or lots of empty wrappers and containers indicating consumption of large amounts of food
Self-esteem overly related to body image
Dieting behavior (reducing the amount or types of foods consumed)Expresses a need to “burn off” calories taken in
Evidence of purging behaviors, including frequent trips to the bathroom after meals, signs and/or smells of vomiting, presence of wrappers or packages of laxatives or diuretics

AVOIDANT RESTRICTIVE FOOD INTAKE DISORDER (ARFID)

Dramatic weight loss
Limited range of preferred foods that becomes narrower over time (i.e., picky eating that progressively worsens)
Fears of choking or vomiting
No body image disturbance or fear of weight gain

ORTHOREXIA

Cutting out an increasing number of food groups (all sugar, all carbs, all dairy, all meat, all animal products)
An increase in concern about the health of ingredients; an inability to eat anything but a narrow group of foods that are deemed ‘healthy’ or ‘pure’
Spending hours per day thinking about what food might be served at upcoming events
Body image concerns may or may not be present

COMPULSIVE EXERCISE

Exercise that significantly interferes with important activities, occurs at inappropriate times or in inappropriate settings, or occurs when the individual exercises despite injury or other medical complications
Intense anxiety, depression and/or distress if unable to exercise
Exercise takes place despite injury or fatigue

DIABULIMIA

Increasing neglect of diabetes management; infrequently fills prescriptions and/or avoids diabetes related appointments
Secrecy about diabetes management; discomfort testing/injecting in front of others
Fear that “insulin makes me fat” Restricting certain food or food groups to lower insulin dosages A1c of 9.0 or higher on a continuous basis

The above information is from the NEDA website: www.nationaleatingdisorders.org

Here is a link to their online, confidential screening tool: www.nationaleatingdisorders.org/screening-tool

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Transgender 101 Training

2/16/2019

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Now What? hosted several sober living mangers, staff and owners for this training. We discussed ways to be more inclusive, the unique barriers and obstacles our transgender peers face when seeking recovery and housing, and ways we call all work together to provide safe, informed options.

Sample Code of Conduct for Sober Living Homes

1. We will treat all persons with dignity and respect.
2. We will safeguard a resident’s privacy and confidentiality.
3. We will not threaten or commit any act of physical, verbal or emotional abuse.
4. We will maintain autonomy with current and previous residents.
5. We will not engage in harassment of any kind or nature.
6. We will receive no payments, kickbacks, rebates, bonus or remunerations for resident referrals.
7. We will not discriminate based upon a person’s race, religion, age, sexual orientation, gender identity, disability, national ancestry or economic condition.
8. We will strive for continued personal growth and self-improvement through education, training and consultation.
9. We will maintain a healthy and clean living environment.
10. We will foster an atmosphere of family living in the common areas.
11. For the safety of the home, there will be a zero tolerance for alcohol or other drug use. Alcohol and other drug screening will be used for compliance.
12. The home will have a “good neighbor policy.”
13. Each resident will attend recovery-focused meetings & have a sponsor or mentor in recovery.

Interested in bringing a training to your sober living home staff? Contact us to get that scheduled!

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Recovery at Risk: Eating Disorders & Addiction

Transgender 101 Training

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