Psychiatrist - Timberline Knolls Residential Treatment Center
 
Dr. Kimberly Dennis is the Medical Director at Timberline Knolls Residential Treatment Center. She maintains a holistic perspective in the practice of psychiatry, incorporating biological, psycho-social and spiritual approaches…
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How effective are the 12 Steps for eating disorders?
Posted in Eating Disorder... by Dr. Kimberly Dennis on Dec 23, 2009
In a prior post, I talked at length about how eating disorder symptoms impact the brain circuitry in ways that produce a response similar to drug or alcohol addiction. These findings represent a major step forward in understanding the complex biology of eating disorders and the challenges associated with both treatment and recovery.

Many patients, professionals and those in recovery have asserted that the 12-step recovery model can’t reliably help with food-related addictions and eating disorders. Their reasoning? We need food to live – we can’t abstain from eating food.

But this misses an important contradiction and is at odds with my experience in treating both addictions and eating disorders. While we do need regular food intake in order to maintain our health, we also need to drink fluids in order to live. In fact, we would die quicker by abstaining from liquids than by starving ourselves. So from that standpoint, people with alcoholism need to keep drinking, but in recovery, they focus their efforts on abstaining from drinking one specific liquid: alcohol.

Similarly, people with eating disorders need to keep eating (or start eating, as the case may be!), and in recovery they focus on abstaining from eating disorder behaviors: starving, restricting, binging, using diet/laxative pills or over-exercising. Many people with eating disorders, particularly those with bulimia nervosa or binge eating disorder, can pinpoint specific trigger foods that functions for them like alcohol or drugs. Those particular foods trigger either a binging cycle or a purging cycle in the same way a sip of alcohol can trigger a substance abuser. This is the challenge for people with eating disorders: they need to continue to eat, yet while in recovery, they must develop tools to resist the urges they feel when encountering or thinking about their “alcohol foods.”

We have found that the 12-step process for recovery from addiction can be equally successful in supporting recovery from eating disorders. One common element among treatment centers utilizing the 12-step approach is holistic attention to the entire person through an integrated focus on the patient’s physical, mental, emotional, social and spiritual needs. By addressing all aspects of their being and learning to tap into a “higher power” that is meaningful for them, patients gain a broader, more objective perspective on the challenges they’ll face in their recovery. The 12-step recovery model also provides tangible tools and supportive resources an individual with an eating disorder can rely on for life – whenever they encounter triggers, or life changes create new pressures to cope.

Many people using the 12-step recovery model for both eating disorders and addiction also benefit from professional help from a comprehensive treatment team. This may include individual, group and family therapists, regular consultation with a psychiatrist and internal medicine specialist, and ongoing work with a nutritionist. Combining medical and psychological treatment with the 12-step model can greatly enhance the set of tools a patient can employ to maintain their recovery and manage the long-term risks their disease may present for their overall health. The promise of recovery for a person with an eating disorder is that her relationship with food will be healed and restored to sanity, and that she will have a fuller living experience with her disease in remission one day at a time for the rest of her life. A common myth associated with 12-step recovery models is that the patients never get better and have to struggle through life battling food (or alcohol)—which couldn’t be farther from the real life experience of the millions of people who have and continue to benefit from 12 step mutual support groups.

For some patients with advanced disorders or with co-occurring conditions that may not have been properly diagnosed, more structured treatment may be required, either in an inpatient, residential, or outpatient setting. But this does not preclude focus on the 12 steps. These may be meetings of Anorexics and Bulimics Anonymous, Eating Disorders Anonymous or Overeaters Anonymous, as well as other 12 step meetings for co-occurring addictions or compulsive behaviors, or family of origin issues. In addition, many sufferers from eating disorders are increasingly finding this type of support and fellowship online, 24 hours a day. Meetings like these are an integral part of each resident’s aftercare program, designed to provide ongoing recovery support when she leaves our treatment center.

Dr. Dennis
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21
Beware of False Prophets, they are everywhere. Some may not realize that they themselves epitomize one, due to lack of knowledge of the suffering we go through. There are no short cuts. Don't you feel stupid for not knowing you could change with one step all along? What's it about, gathering followers to sell something? I don't think the One Step here as shown would be the case, it just does not capture the populace who is truly suffering. If I can't find forgiveness from ANYONE, to let me know I'm okay afterall..they who will do that with me? It's about Love...not food.
By vortex2  Dec 03, 2011
20
I would like to include where I'm coming from. I was near death with anorexia, severely bulimic/anorexic after that for 30 years..to escape that I ended up alcoholic as well...and I was diagnosed from the beginning as clinically depressed which changed to BiPolar. As i sit here today..I can do nothing but throw my arms up in the air as tears stream down in gratitude for god being with me all along...so where was he all that time? Waiting for me to open my heart to Him. He was in my head, but not my heart. Read Chaper 4 in the AA Big Book . It is online if you are atheist.
By vortex2  Dec 03, 2011
19
In regard to being stuck in the meetings for life. Consider people who have lost everything! They not only have no material possessions, but have also lost their spirit. Being in a group of people they can relate to, and who can relate to them brings a sense of belonging. The group then provides a purpose for living through action, once recognition (recovery) of the true self begins. Action is through appreciation to the God that loves us all along when we thought there was no hope. Whoever wrote a one step either never bottomed out in whatever disease or is simply a diet guru. Dont believe it for one second unless you didn't need to come to this group in the first place.
By vortex2  Dec 03, 2011
18
12 Steps are for ANYWAY..even non-addicts...Self Help is all about ME ME ME..as long as we are stuck in ME we never get the bigger picture of what a REAL, FULL, life filled with love for other people is like..the full life experience. Some people are still down and glum in meetings, but that is because they are still healing..or trying to find a way. Not all of them are though. Is that what you want to see? Look at yourself in your mind...and be honest..are we above everyone else..and if so..why are you looking for help? It's hard to be honest with oneself with the same mind set that has the problem.
By vortex2  Dec 03, 2011
17
Thank you for sharing this, I learned some good things from this blog. I was thinking the 12 steps program was hard because of the abstinence. I could do abstinence for alcohol and cigarettes, this food issue is difficult. Also you shed some light on this subject for me. Also I know it is all about control of portions. I have tried to eliminate all the junk food in my life, but I will still binge on healthy foods. Sometime I suffer from the binge on the healthy foods, but my mind has not changed to stop the suffering. For instance too much gas because of a lot of high fiber foods eating.
By PrincessWithin  Sep 27, 2011
16
There are many bulimics and anorexics in 12 step Programs, along with compulsive, emotional, behavioral and medical eaters. It is a spectrum of the disease of food addiction. Food, like other addiction can be chemical, behavioral or both. All addictions intersect at some point on another psychological spectrum. There is no "pure" obesity. Treated with medicine, behavioral or emotional modalities alone, there is not complete success. A combination of medical treatments, emotional/ psychological support and 12 steps work is the best bet at long term success.
By Baritweet  Mar 06, 2010
15
Anyways Im 5'6 and was over 300 pounds just over two years ago. I figured since AA worked for me that I should try OA, I did their 12step workbook along with the BigBook around my food addiction and I'm abstinent from my trigger foods and I've lost around 150 pounds. At the beginning the meetings inspired me and gave me the hope and strength to not give up. I've battledy weight my whole life and it's no longer a struggle. I've been blessed with a new body that I'm incredibly grateful for, and even though it's far from perfect, I accept it and love it. Not only that but thru abstinence of my trigger foods and doing those steps, I became closer to the God of my understanding which like I sed is the greatest gift of all. Now I'm starting to try and apply the steps to my mental illness, thru dual recovery anonymous. The 12 steps changed my life in other areas so why not? 
By Return2grace  Feb 24, 2010
14
Well I can say that I got introduced to 12 steps thru AA, practice the 12 step program and have no desire or interest in using, by the grace of the god of my understanding. Tapping into that power is the greatest gift I've ever recieved. Not only that but I've been restored to sanity around drugs and alcohol. I was powerless over substances, nothing could stop me from picking up. If I take a drink or a hoot 2day it would start all over again thus I'm still powerless over substances. In AA were told if were the type of alcoholic that's described in the book then we don't have the power to choose whether we'll pick up or not so we need to get hooked in with a power greater than ourselves (and stay hooked in with it) that can help us via the 12 steps. Anyone who's gotten to that point in their lives where they realize no human power can keep 'em clean & sober won't have a problem with 12 step programs.
By Return2grace  Feb 24, 2010
13
Jasgall:

I agree, not everyone fits my statement. Unfortunately you might be one among thousands, probably millions. The overwhelming majority are on the other side.
By hippo1010  Jan 03, 2010
12
hippo1010-i am in OA, and i don't believe that it's the only way to recover...so not everyone fits your statement.
By jasgall  Dec 28, 2009
11
I've never seen one Eating Disorders Anonymous meeting in my area. 24 years of this and I'm told 12 step brainwashing is the key to my problems. I don't think so. I went to OA. Imagine a woman who doesn't need to lose weight sit in on a meeting that's about weight loss. I've researched this topic and I think it's garbage but if it works for someone else then that's great.
By AnneL  Dec 28, 2009
10
Thanks you for the post.
Hi guys, Im a newbie. Nice to join this forum.
__________________
http://watchmoviesfree.biz
By sharonk868  Dec 28, 2009
9
I go to Overeaters Anonymous and have not eaten dessert for 6.5 years and lost 85 pounds. I can say that OA does not have a lot of long term success, and I do believe there are other ways of dealing with an eating disorder. I also don't agree with a lot of things in the 12 steps and literature. I pretty much go and get what I need each week. The stuff I don't agree with, I just ignore. It is not the answer for everybody. I don't totally agree with the concept of a higher power that many people have. I had to form a concept of a higher power that worked for me.
By autumn123  Dec 27, 2009
8
hippo1010 says: "Aside from common allergies and food poisoning, there are no food that chemically causes dependency the way alcohol does"

This is simply incorrect- there are many foods which cause dependency- the most well known being an additive in many foods called MSG- It's the one we've all heard of but by far not the only one. Apparently emotional or psychological dependency also goes over your head.
By hlks  Dec 27, 2009
7
Part 4

You state: "A common myth associated with 12-step recovery models is that the patients never get better and have to struggle through life battling food (or alcohol)—which couldn’t be farther from the real life experience of the millions of people who have and continue to benefit from 12 step mutual support groups."

That's not a myth. People never get better there. I've seen it and experienced it. Furthermore, people in 12-steps believe that they are the one and only thing there is for recovery. That mentality is like the one in cults.

There are healthy alternatives to the 12-step model.

http://www.seekwellness.com/wellnes...
By hippo1010  Dec 27, 2009
6
Part 3

When I see the "old timers", people who have been in programs for a long time, they are certainly not an example of who I want to become. I have NEVER, EVER heard one single person express happiness, fulfillment or even joy, even when things turn right in their lives. They keep going on and on and on about how bad things are in their lives, even when they have made major accomplishments they find something bad to say about it. The keep making an analysis of every simple thing in their lives, fostering a sense of inadequacy in what should be just simple human spontaneity. God forbid you act spontaneously in those programs!
By hippo1010  Dec 27, 2009
5
Part 2

You state: "The promise of recovery for a person with an eating disorder is that her relationship with food will be healed and restored to sanity, and that she will have a fuller living experience with her disease in remission one day at a time for the rest of her life."

After over a decade of being in touch with people in 12-step programs, I'm still waiting to see anyone who has anything good or positive to say about restoring sanity or healing.

12-step recovery programs foster dependence upon the programs, tend to keep people in an eternal "powerlessness" state, and constantly try to convince participants of their woeful inadequacy without the support of the group, the 12 steps, and/or a vague higher power.
By hippo1010  Dec 27, 2009
4
Talk about faulty logic! I have been on and off in 12-step programs, and based on my experience this is what I have to say:

You state: "While we do need regular food intake in order to maintain our health, we also need to drink fluids in order to live. In fact, we would die quicker by abstaining from liquids than by starving ourselves. So from that standpoint, people with alcoholism need to keep drinking, but in recovery, they focus their efforts on abstaining from drinking one specific liquid: alcohol."

Aside from common allergies and food poisoning, there are no food that chemically causes dependency the way alcohol does. Therefore, your analogy is just faulty. Comparing the CHEMICAL effects of alcohol in the body to the NATURAL effect of food is preposterous. The human body needs food. The human body doesn't need ALCOHOL. It needs fluids but not that type of fluids.
By hippo1010  Dec 27, 2009
3
zero percent if you refuse to go because you're an atheist and the steps idiotically tell you that you have no control over your issue and you have to "give it up to a higher power"
By hlks  Dec 24, 2009
2
thank you so much for your informative and well-written posts! thank god there is finally an eating disorder expert here! i have struggled with bingeing since i was 11, and have not been able to understand why it is so hard to stop. i had no idea that behavior could actually change my brain. i am now in oa and although i have not been formally diagnosed, i am pretty sure i have binge eating disorder.
By jasgall  Dec 24, 2009

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