How Applied Behavior Analysis Can Help You Rapidly Recover from an Eating Disorder

Rachel was a young, vibrant woman who loved nothing more than hitting the open road in her car. One sunny afternoon, she was driving home from work when she was hit by a car that ran a red light. Her car was totaled, and she suffered a traumatic brain injury (TBI) that left her with severe headaches, memory loss, and difficulty concentrating. Thankfully she recovered from her physical injuries, but the most devastating consequence of the accident was the post-traumatic stress disorder (PTSD) that Rachel developed in the weeks and months that followed. Driving aside, merely sitting in a car would make her extremely stressed. She found herself reliving the accident over and over, unable to shake the fear and anxiety that had taken hold of her. Rachel’s incident is not rare. This is actually a common scenario for people who have experienced a traumatic brain injury (TBI). In this article, we'll explore the connection between TBI and PTSD, the ways in which counseling can help, and why it's so important to include counseling as part of the treatment plan for those with TBI-related PTSD. Let’s start with what TBI and PTSD are. TBI (Traumatic brain injury) is a severe injury caused by a sudden blow or jolt to the head. It can occur as a result of a wide range of accidents, including auto accidents, sports injuries, assault, and premises injuries. Auto accidents are one of the most common causes of TBI, as the force of impact can cause the brain to move within the skull, resulting in injury. Falls are also one of the most common reasons. According to CDC , almost half of the reported hospitalized traumatic brain injury cases are from falls. Sports injuries, such as concussions, can also cause TBI, especially in contact sports like football and hockey. Assault is another common cause of TBI. Examples are getting in a fight, a blow to the head, or suffering from domestic abuse. Premises injuries, such as slip and fall accidents, are also common causes of TBI. These types of injuries can occur on the job or on another business's property and can be caused by a range of hazards, such as wet floors, loose carpeting, and faulty equipment.

What’s the first thing that comes to mind when you come across the term PTSD? For many of us, the answers include going through harrowing life events like war, natural disasters, physical or sexual assault, or any other catastrophe. After all, people only develop PTSD who have experienced a severe life-threatening event, right? WRONG! Research suggests that developing post-traumatic stress disorder may not always depend on the severity of the trauma or accident. PTSD is a serious life-altering condition that shapes how we feel and show up in the world. Furthermore, individuals who have experienced trauma are at a much greater risk of developing mental illnesses, substance abuse problems, eating disorders, and other behavioral issues. As general awareness around PTSD and trauma is increasing, it is time to understand the true definition of this term and all its implications. The information we have may be incomplete or inaccurate, which may lead to those who have PTSD go misunderstood or mistreated. Trauma comes in numerous forms and affects people in different ways. Knowing what to look for can help you or your loved ones deal with the effects of trauma more effectively. Let’s first go through the word trauma in PTSD and how we categorize it. Trauma means any distressing event that affects a person’s ability to cope or function. But there is a difference between Big “T” Trauma and Small “t” Trauma. Big T Traumatic events are what we usually associate with when we think of PTSD. These more severe extraordinary events leave the person feeling hopeless and powerless and are often easily recognizable as major disturbing occurrences. A fatal car accident, sexual abuse, physical assault, combat, or war are all instances that fall under Big T. On the other hand, Small t Trauma comprises less severe events that may not be as alarming or life-threatening as Big T on the surface. These are every day or less pronounced occasions that don’t involve violence or disaster but can cause significant psychological damage. Small t Traumas are often overlooked because of their less violent nature, but research suggests repeated exposure to Small t can cause more emotional harm than a single Big T event. So, they are not to be taken lightly. Small t events are not primarily physically threatening; they can be ego-threatening or morale-threatening as they may create intense feelings of discomfort, helplessness, and having no control over one’s life. Some common causes of Small t can include: Living in a high-conflict family. Losing a job or financial worries. A challenging friendship. Prolonged stress about something. Losing a loved one or a pet. Bullying or harassment. Being disrespected. Being involved in an accident. Being involved in an athletic injury. These incidents may fly off the radar when considering the prevalence of PTSD in a person because of their less intense nature, but they are equally damaging in their effects. Take the example of an athlete. Studies have shown that athletes are more prone to PTSD than regular people. An average of 1 in 8 athletes have PTSD. How?

Did you know that eating disorders have the highest mortality rate out of all the mental health conditions? Yes, you read that right. Eating disorders like anorexia are four times more likely to result in lethal consequences than the major depressive disorder. And do you know what makes them so deadly? Despite being so dangerous, people sometimes don’t consider eating disorders as urgent or high priority as they do other severe psychological conditions like borderline personality disorder or suicidal tendencies. So, eating disorders – despite having the most damaging consequences on your health – are often undiagnosed, untreated, and are dismissed as something that’s not serious enough to require immediate professional assistance. People usually think that an eating disorder is just a phase that you eventually snap out of, but in reality, it’s a deeply complex condition that rarely goes away on its own. Eating disorders are complicated, real, and life-threatening medical illnesses that have been confirmed by the National Institute of Mental Health . A lack of knowledge is often the reason why people don’t acknowledge their eating disorder and get proper treatment on time. So, let’s go over some important details so you can get a better understanding of things and approach your eating disorder with the right mindset. Eating disorders is an umbrella term that consists of a host of conditions where a person has developed an unhealthy and dangerous relationship with how they see food and their body. Anorexia, Bulimia, Avoidant Restrictive Food Intake Disorder(ARFID), Binge Eating Disorder(BED), Other Specified Feeding or Eating Disorder (OSFED), are some of the most common eating disorders that – although they belong to the same category – have differences in their symptoms, and most importantly, how they are treated. As eating disorders are not as common as other mental health disorders, most general practitioners don’t have enough information to guide people toward the right form of recovery options. Misdiagnosis is a common hurdle that keeps people from getting the proper treatment as a GP might often find it hard to pinpoint the exact eating disorder a patient is experiencing. Misdiagnosis has the potential to result in severe harm. In most cases where an eating disorder is not identified correctly, it puts the person’s health at risk, can delay recovery, and sometimes calls for treatment options that are harmful and irrelevant to the person’s scenario. To better understand why the right diagnosis matters, take the example of having flu. It could be just the normal flu, or it could be a symptom of a different virus entirely, so diagnosing the symptoms properly is crucial, and misdiagnosis can often lead to irrelevant treatment and harmful consequences later on. Avoidant Restrictive Food Intake Disorder (ARFID) and Anorexia nervosa are often confused and misdiagnosed the most among the different eating disorders. So, what makes them different, and how can you tell them apart? Anorexia nervosa, commonly known as Anorexia, is an eating disorder where you have an unrealistic perception of body weight and a strong fear of gaining weight or becoming fat. People suffering from Anorexia have an extreme obsession with their food choices and body image to the extent that it starts to become a psychological disorder, so they start relying on all kinds of unhealthy ways to stay thin or lose weight, such as calorie restriction, compulsive exercising, fasting, or self-induced vomiting. 

The historic COVID-19 is finally nearing its end. While the virus is slowly vanishing from our headlines, it is leaving an equally severe pandemic of mental health problems in its path. People have been exposed to tremendous stress levels in the past few years. Fear of death, loss of loved ones, the trauma of the widespread disease, unemployment, financial losses, are just a few of the fears left behind. The world experienced a massive 25% spike in depression and anxiety in the first year of COVID-19. It only got worse in the coming years. Even if COVID-19 is coming to a halt, we still have a long way to go to shake off the psychological problems that came with it, and instantly adjusting back to our regular lives after all this stress is just not possible. Especially for those with eating disorders and body image problems, returning to school puts them at significant risk for a perfect storm. Why? Because schools can contain many conditions that can lead to eating disorders and make them worse. Let’s look at some stresses of children going back to classes after the lockdown and how it may affect their eating disorder behaviors. Transitioning to in-person learning after years of online lectures means a new beginning, posing the biggest challenge. Children missed out on big milestones, lacked peer-to-peer interaction to develop crucial social skills, fell back in their studies, got used to staying home with the whole family all day, every day, and much more. Remote learning has taken an emotional, mental, and developmental toll on children. And reopening schools means many new starts all over again for kids because they are no longer used to such a lifestyle. They may be stressed going back to school after being isolated, might develop separation anxiety because of living for so long with their parents, may be anxious or depressed, and haven't had time to process the effects of the pandemic. And with all this, they are expected to resume like normal without having time to adjust. The added stress of wearing masks, not touching anyone, all while trying to keep a safe distance is extra hard. This transition can be challenging and stress-inducing! Adults can understand and cope with increased stress most of the time, but the same is not the case with children. Children can easily resort to unhealthy coping mechanisms. Eating food for comfort is common among children, and increased stress may lead them to develop negative eating habits like binging or restricting, which can later turn into full-blown eating disorders. For children with a history of eating disorders, this could trigger a relapse. Adjusting to a new school routine could also mean a complete overhaul of your eating habits. While children were home, they had access to the whole pantry most of the time. But with physical classes, their eating windows and the variety of foods are limited because you only have access to the food you bring to school or what school offers. For students with eating disorders, this creates anxiety about their ability to eat intuitively throughout the day. In addition, those in recovery may have negative feelings of guilt and shame around eating in public which may cause individuals to restrict food further. Social media usage skyrocketed during the pandemic. This almost 24/7 access to negative, unauthentic, perfectionistic social media feeds can foster fake, elusive, and unrealistic standards of beauty that are impossible to achieve. And children had a lot of free time and social media influence to instill such beliefs in themselves. There is a strong correlation between social media usage and negative behaviors related to eating and body image. When children return to school with a more distorted body image due to excessive social media usage, they may feel even more insecure about themselves. Social media shows us a highly filtered version of reality that people often tamper with to show what they want others to see and not how things truly are.

If you have ever Googled “How to lose weight fast,” you have surely come across intermittent fasting as an easy and quick solution to shedding some extra pounds. But is it really safe? Is intermittent fasting healthy, or can it lead to the exact opposite? As the name suggests, intermittent fasting is a fixed period every day where a person does not eat. It means no meals, no snacking, and only consuming calorie-free liquids like water, coffee, green tea, all within a predetermined fasting window. This fasting window can be anywhere from 12 hours to 16 and even 20 hours a day. Depending on your preference, you can even branch out and fast only certain days a week. Unlike conventional weight loss techniques like dieting that tell you what and how much to eat, intermittent fasting primarily focuses on how long and regular your fasts are and not that much on what you eat during the eating window. The proponents of intermittent fasting claim that restricting your food intake during the fasting window can promote weight loss, improve blood sugar levels, and reduce the risk of heart disease. Because of the simplicity and no restrictions on what you can eat, intermittent fasting has become the talk of the town in recent years for wellness and weight loss purposes. It is easy to become mesmerized by a seeming shortcut and easy-way-out to lose weight and achieve health at the same time, but it can cause us to focus on short-term gain and forget to look at the other side of the picture and how it can negatively affect us over time. Intermittent fasting can be hard to stick to and may even lead to dangerous health problems such as eating disorders. One of the biggest reasons why intermittent fasting puts you at risk is because it makes you vulnerable to forming an unhealthy relationship with food that usually goes under the radar but leads you to develop severe complications in the long run. Naturally, when you remain hungry for extended periods, your body uses some of its fats to generate energy, but at the same time, the hunger center of the brain and appetite hormones go into overdrive. You get a strong biological urge to overeat. When you reach your eating window after a long day of fasting, you are more likely to indulge in unhealthy eating practices such as consuming too much food in a short amount of time. Over time, binging turn into an eating disorder such as Bulimia Nervosa or Binge Eating Disorder (BED) . Similarly, you can become malnourished if you do not get the right amount of nutrients in your eating window, leading to all sorts of deficiencies in your body. This can also put you on the road towards developing Anorexia or Avoidant/Restrictive Food Intake Disorder. Malnutrition can also affect the regulation of chemicals in your brain that handle mental performance, such as serotonin or dopamine, thus leading to psychological issues over time such as heightened anxiety and depression. Other than that, what can be some signs of impending eating disorder disguised as intermittent fasting ? The following questions will help. 

Is it Anorexia or Avoidant Restrictive Food Intake Disorder (ARFID)? As parents, it is not uncommon to see your children push away their plates or needing to convince them to finish their veggies during mealtimes. But sometimes this avoidance and restriction of food can become more persistent and concerning! What if your child is experiencing distressing thoughts and emotions around food more commonly than others? What if it reaches a point that it starts to affect their physical, psychological, and social functioning negatively? If you observe such tendencies in your child, it could signal the presence of a severe underlying mental health condition: an eating disorder. A quick Google search about your child avoiding their foods, having a loss of appetite, or experiencing food anxiety might lead you to conclude that they have anorexia nervosa. But in some cases, you may see that your child does show some symptoms of anorexia nervosa but does not correctly fit the profile to be considered anorexic. For example, they may be a fussy eater, have unhealthy weight loss, and have other issues with food, but they do not show any concerns about their body weight, self-esteem, or how they look. This presence of some symptoms and lack of others can lead to confusion and misdiagnosis. If your child is a picky eater and avoidance and restriction of food seems to be a more prevalent problem than body image issues, then it could indicate Avoidant Restrictive Food Intake Disorder (ARFID) and not anorexia nervosa. Especially during COVID, the availability of foods and increasing stress might affect your child’s eating habits. It can lead to the development of eating disorders or worsen existing issues. The causes and symptoms of ARFID may differ, but the consequences may be equally damaging as other eating disorders! So, how can you know what your child is going through is Avoidant Restrictive Food Intake Disorder (ARFID)? Overall, ARFID is identified by severely restricting or limiting foods based on the foods themselves and not how they might affect a person's body image.

10 signs of ARFID – the eating disorder you’ve never heard of Is your son often turning up his nose during mealtimes? Is picky eating a more common problem with your daughter than other children of her age? It is not unusual for children to be selective about their foods. But normally, it doesn't take long before they grow out of this behavior and develop healthy eating patterns. However, for some children, food anxiety can be a more severe problem and is often ignored because parents think it’s “just a phase”. If your child shows a general lack of interest in eating and has issues with food to the extent that it starts to affect their growth and development, it could mean that they're not just a fussy eater. Rather, they're going through something more serious—which, if left untreated—can have harmful effects on their lives. Avoidant Restrictive Food Intake Disorder (ARFID) , or in simpler terms, "extreme picky eating," is a food disorder where a child faces issues with food, but their fears around eating are very different from more common eating disorders like anorexia nervosa or bulimia. Because of these differences in symptoms, ARFID can be confusing, so doctors may not recognize the problem, which may leave your child undiagnosed, untreated, and at great risk for their lives – and the problem might follow them well into adulthood. It follows that having a good understanding of ARFID symptoms and being able to recognize them is vital to save your child from unhealthy weight loss, malnutrition, social issues, or other problems that may come with Avoidant Restrictive Food Intake Disorder. To help you gauge your child's condition better, here are some telltale signs and symptoms of ARFID. 1. A lack of interest in food A child suffering from ARFID knows that they must eat, but they have no interest in eating. This lack of interest in eating is not due to fears related to body shape, size, or concerns about fatness as it is in other eating disorders like anorexia nervosa or bulimia. Your child may complain of having no appetite, but they may have no solid reason other than the food itself to explain why they don't want to eat. They likely do not have issues with how they look, low self-esteem, or medical or physical problems that prevent them from eating fully. Additionally, they say they are “full” sooner, have typically low appetite, and show increasing indifference to food. 2. They avoid eating certain foods for their sensory characteristics. Their concerns are more focused on the food itself and not that much on its impact on their body image. For example, their primary reason not to eat food is certain textures, colors, and smells that bother them. If the food does not have the particular characteristics they desire, they refuse to eat it. This rigidity often also extends to how food is served, such as different foods on a plate cannot touch or should be cut into fine pieces; otherwise, they can't eat it. 3. They avoid and restrict themselves to only certain types of food. They have a very restricted list of acceptable foods that becomes more limited over time. Almost all of these foods have certain traits, such as a similar texture, taste, temperature, odor, and color. Other than their desired foods with specific characteristics, they may ignore whole food groups such as fruits, vegetables, and meats because these foods distress or disgust them. 4. They are afraid that foods without specific characteristics might make them choke or vomit. Their extreme picky eating can occur because they experience distress about certain foods. It is not just a disciplinary issue. They have an adverse emotional or physical reaction associated with the foods, such as fearing that they might choke or vomit if they try to eat those foods. Again, this fear is not associated with body shape, size, or weight. It's more focused on how they feel about the food itself while eating it. 5. They are very reluctant to try different or new types of food They are precise with their food selection and refuse to try anything else. Similarly, they may even have rigid standards regarding how a particular food should be cooked, and they may not eat even a desired food if it's cooked in some other way than they want it to be. For example, refusing to eat a fried egg if its texture gets too hard or turns brown during frying.

Are COVID and back-to-school stress leading to increased eating disorders in our boys and girls? The summer break is over, and children are trying to get back to school. Back-to-school is usually a time of heightened emotions. Some kids feel low that their holidays are over, and they must get back to responsibilities. While others are excited or anxious because they now must change their routines, meet new friends, and start new classes. Either way, it's a time of sudden change in children's lives. But because of COVID, this year's back-to-school is more stressful than ever, for both parents and kids. The long pandemic and quarantined way of living have made us accustomed to a lot of new life changes. The stay-at-home restrictions have changed our relationship with how and why we use the internet. Children were online more than ever. While social media helped some pass their time, it had negative consequences on others. Social media often represents a distorted image of reality where you only see 'perfect' and happy moments in people's lives. For someone struggling with body image or self-esteem issues, watching others posting pictures of their almost perfect lives can lead to developing insecurities and making unhealthy and unrealistic self-comparisons. On top of that, the sedentary lifestyle due to quarantine has also led to weight fluctuations in a lot of people. This can give rise to increased dissatisfaction with physical appearance and body weight. And as back to school approaches and children now have to be face-to-face with one another after almost an entire year, this might lead them to resort to unhealthy behaviors to change body weight to “fit in” with unrealistic body image expectations. Other than physical appearance, there are many more factors about back-to-school that can lead children to heightened stress. Academic pressure is also increased this year as children now must go back to physical learning after a year of more of online learning, so adjusting back to physical mode and earning good grades can cause tremendous amounts of stress. Peer pressure and comparison of one's body, weight, grades, popularity, friends, etc., can also be stressful. Sports and athletic activities are also going to resume, which means you have to get back in shape. All these stressors and fixation on achieving an ideal physical appearance can lead children to turn to unhealthy behaviors to help them cope.

Why summer is the best time to get help for your child’s eating disorder. Every year, summer brings an opportunity for children to take a step back from the pressures of school and take a well-deserved break. The restrictions are off, and finally, your child can relax and unwind, but what does this sudden freedom and shift in lifestyle mean for those who are struggling with eating disorders? Does summer break make eating disorder symptoms worse, or is it an opportunity for improvement? The answer is: it can be both. Your child is out of school, academic pressures have decreased, pressures seem to be cooling down, and for some kids it may seem as if their eating disorder is getting better by itself. Parents often assume that spending time with their family and having plans for summer will make it easier for the eating disorder to just go away. Unfortunately, putting off treatment during summer could be a huge mistake. Eating disorders are much more complex and deep-rooted than that. Even if the symptoms subside for some time, they can quickly get back up and worsen if the person is not getting proper support and treatment. Eating disorders have a high relapse rate, and out of all mental health issues, illnesses like anorexia nervosa can have the most damaging impact on a person. A young person’s eating disorder must not be taken lightly, and it is crucial that they get timely and adequate support. Summer is the time where parents of children with eating disorders should double their efforts instead of toning down. Even if this break does not cause a flare up your child’s symptoms, it can be an excellent opportunity to focus entirely on improving and reinforcing positive behaviors . These three months can be an immensely powerful block of time to help children learn to manage their symptoms effectively, before the pressures of school start up again. Let us examine why summer should not be taken lightly for kids with eating disorders and why delaying treatment is not a good idea. Summer is associated with having fun outside, going to beaches, and “The swimsuit season.” This means naturally less clothing and more body exposure. Fitting into a swimsuit or wearing more revealing attire can be exceptionally hard for someone who suffers from body image problems. For children and teens struggling with body dysmorphia, this change of clothing can trigger shame and an increase in dissatisfaction with their bodies. And to cope with it, several symptoms of eating disorders can resurface and therefore increase the chances of your child resorting to unhealthy eating patterns to get their weight under control or even relapsing to previous eating disorder symptoms that had been in remission, such as abuse of laxatives or purging. They might become victims of anorexia, where they refuse to eat food, even to dangerously unhealthy levels, so that they can lose fat and maintain their ideal body shape, even if it is seriously harming their health. They might also develop bulimia nervosa, where they first engage in binge eating, regret their decisions to overeat, and then purge to get rid of extra food. Moreover, summer break reduces structured routines during the day, which could mean skipping meals, unhealthy sleep patterns, and more accessible access to emotionally comforting snacks. This loss of routine can cause kids to move away from the positive coping strategies that were helping them stay healthy and cope with their eating disorder. Kids often have more free time, which leads to more alone time during the summer. Isolation, boredom, and secrecy provide excellent conditions for your child’s insecurities and eating disorder to thrive. Initiating new habits or leaving previous ones can also be a stressful transition. They might start binge eating to cope with boredom, stress, or sadness. Food is comforting and readily available - it can help fight stress temporarily. Abuse of food as a coping mechanism can exacerbate body image issues. Not to mention the fuel social media can add to the fire. A bombardment of seemingly perfect and beautiful photos of men and women can increase the desire for an unrealistic body figure, thus increasing the dissatisfaction with our body. This frustration can result in forming obsessions with healthy eating and exercising. While it is good to focus on an improved diet and physical activity, individuals with eating disorders often take it to the extreme. This overindulgence in clean food and exercise can also lead to the development of orthorexia which is an eating disorder where a person puts too much emphasis on making sure that they are exercising and eating right, so much so that it could damage social interactions and a person’s ability to function in society properly. All these factors can make eating disorders particularly challenging during summer. When the social pressure resumes during fall, it can make it difficult for children to maintain mental resilience and get back on track.