Prevalence & Features of Eating Disorders in Males – Part 9

To summarize, I want to describe a couple of case examples that will help to bring these two behavioral treatment strategies, Exposure-Based Treatment and Behavioral Activation Therapy, to life.

These case examples were derived from the patients that we treated right here in our eating disorders program at Rogers.

I’ve obviously changed the names and any other identifying information but, in large part, these case examples were taken from real-life practice.

Eric

This first case example we will call Eric for a pseudonym.

When Eric came into treatment, he was 28 years old and a graduate student.

He had described a really significant history of a lot of perfectionistic tendencies from early in his life he and he described that his family always focused on eating only healthy food selections.

He described cutting food items out of his diet that the family perceived to be bad or unhealthy.

In adolescence, Eric developed researching tendencies where he’d look up a lot of the ingredients of various food items that he was eating and the effects that they could have on the body.

What this led to was a really increasingly rigid pattern of avoidance surrounding “bad” foods and, throughout adolescence and into early adulthood, the extent of his restraint or cutting certain foods out of his diet became so significant that his diet became whittled down to only a very narrow range of foods that he deemed to be acceptable.

As you can imagine, this contributed to major disruptions not only in his educational endeavors but also his social life.

The course of treatment for Eric involved pinpointing some of the critical safety behaviors that Eric was encouraged to begin preventing engagement in such as doing food-related research as well as reading labels and then making food selections based only on what he deemed to be a “safe food choices.”

Eric was encouraged to gradually do away with these safety behaviors throughout the course of treatment.

Exposure-related activities that we encouraged this individual to engage in gradual inclusion of certain foods he had previously deemed to be bad into his diet such as processed foods or foods that included sugars.

We also encouraged buying any new foods that he was unfamiliar with without doing a lot of his typical researching of the ingredients, caloric content or any of the effects that the food might have on his body.

From a behavioral activation standpoint, some of the activities that this individual was encouraged to increase throughout the course of treatment included greater engagement in certain social activities that had been previously very important to him as a consistent source of positive mood as well as gradually beginning to resume his educational pursuits.

To discuss a bit more in-depth, we began at the bottom of Eric’s exposure hierarchy, doing some gradual exposure to certain food items that he deemed to be kind of unacceptable or unhealthy.

In level two, we asked him to merely dip his fingertip in a little sugar bowl and then just lick the few fine granules of sugar that had stuck to his fingertip.

We then worked up to a level four, where he was encouraged to eat several pieces of candy throughout the day.

From there, we moved all the way up to a level seven whereby the end of treatment we were able to help this guy successfully be eating multiple dessert items throughout the course of a week.

Alex

We’ll call this second case example Alex, who was a 22-year-old when he came to our program.

He was not working at the time and living at home with his parents.

Alex described that, as a child, he was labeled as overweight by his family physician and was a significant target for bullies at his school because of this.

At the age of 14, he developed a bad bout of mono, and this led to dramatic weight loss.

As such, unintentionally, he received a lot of positive feedback. People just assumed that his weight loss was intentional and he got a lot of “wow look at you!” or “what great willpower you have!”

This contributed to him becoming a lot more focused on the ideal male athletic physique that I described earlier throughout his adolescence.

Coupled with that, he began to develop some really extreme compulsive routines around exercise as a means to try to bring about this extremely athletic physique.

Alex described weighing himself excessively and as a result of whatever the number was on the scale, developing really restrictive dieting habits, following even nominal weight gain.

As an example, he might weigh himself in the morning and, even if he had gained a fraction of a pound from the previous morning’s weight, he might subsequently skip breakfast that morning.

As you can imagine, given the extensive preoccupation surrounding body image and food intake, he became very much impaired, had to drop out of college due to his inability to complete his coursework, his being consumed by those really compulsive exercise routines, and rigid dietary patterns.

As a result, Alex lost out on a lot of the friendships that he had and also became very significantly depressed.

Some of the critical safety behaviors that Alex was encouraged to gradually fade, and eventually eliminate, included those extreme compulsive exercising behaviors as well as engaging in that excessive weighing process and subsequent dietary restriction.

For exposure-related activities that we encouraged him to engage in, this boiled down to having a well-balanced meal plan without consideration of just nominal fluctuations and his weight as well as gradual engagement in less strenuous, less intense, and, most importantly, less compulsive types of exercise.

For him, this might have included going for a jog for a much shorter duration of time and with a lot less intensity than was previously typical.

From a behavioral activation standpoint, to address his depression and disconnection from important life activities, Alex was encouraged to begin to reach out and reconnect with some of his old friendships that had fallen by the wayside as well as developing some more leisurely outlets for physical activity that included his friends.

The key here was physical activity that was done in a way that was more leisure-focused as opposed to calorie burning or trying to add muscle mass.

At the bottom of Alex’s behavioral activation activity hierarchy, we included just some researching of recreational sports activities as well as simple steps to trying to reach out and rekindle some of those old friendships.

Then, higher up in the hierarchy we included more involved activities with friends where he was getting together with them several times a week and even got to a point where this individual was successful in trying to bring together a recreational sports team that he and a lot of his friends play.

It was also an opportunity for him to meet some new people as well.

In closing, let’s review some of my key points.

There’s a really high degree of stigma amongst males with eating disorders, and we have found, in our successful work at Rogers treating these males, is that engaging them in a lot of behavioral therapy exercises and activities is one way to navigate that stigma successfully.

For whatever reason, treatment approaches that involve active things such as being up and out of the chair and doing things that are consistent with values resonate more with these men as opposed to simply sitting and talking about problems that one is experiencing.

I would encourage any clinicians who routinely treat males with eating disorders in their practice to give consideration to enveloping these strategies and interventions into your practice routinely.

Please See Eating Disorders in Males

Prevalence & Features of Eating Disorders in Males – Part 1
Prevalence & Features of Eating Disorders in Males – Part 2
Prevalence & Features of Eating Disorders in Males – Part 3
Prevalence & Features of Eating Disorders in Males – Part 4
Prevalence & Features of Eating Disorders in Males – Part 5
Prevalence & Features of Eating Disorders in Males – Part 6
Prevalence & Features of Eating Disorders in Males – Part 7
Prevalence & Features of Eating Disorders in Males – Part 8

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Source:

Virtual Presentation by Dr. Nicholas Farrell in the Dec. 7, 2017 Eating Disorder Hope Inaugural Online Conference & link to the press release at https://www.prnewswire.com/news-releases/eating-disorder-hope-offers-inaugural-online-conference-300550890.html

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About the Presenter: Dr. Nicholas R. Farrell, Ph.D. is a licensed clinical psychologist who directs and supervises the treatment of patients in eating disorder programs at Rogers Memorial Hospital. Dr. Farrell specializes in the use of empirically-supported cognitive behavioral therapy (CBT) treatment strategies that are used to help patients in our eating disorders programs.

Additionally, Dr. Farrell is a regular contributor to scientific research on the effectiveness and dissemination of CBT for eating, anxiety, and mood disorders and has published over 20 peer-reviewed journal articles and book chapters. Dr. Farrell has been the gracious recipient of federal grant funding to study the role of social stigma in the context of eating disorders.

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About the Transcript Editor: Margot Rittenhouse is a therapist who is passionate about providing mental health support to all in need and has worked with clients with substance abuse issues, eating disorders, domestic violence victims, and offenders, and severely mentally ill youth.

As a freelance writer for Eating Disorder and Addiction Hope and a mentor with MentorConnect, Margot is a passionate eating disorder advocate, committed to de-stigmatizing these illnesses while showing support for those struggling through mentoring, writing, and volunteering. Margot has a Master’s of Science in Clinical Mental Health Counseling from Johns Hopkins University.

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The opinions and views of our guest contributors are shared to provide a broad perspective of eating disorders. These are not necessarily the views of Eating Disorder Hope, but an effort to offer a discussion of various issues by different concerned individuals.

We at Eating Disorder Hope understand that eating disorders result from a combination of environmental and genetic factors. If you or a loved one are suffering from an eating disorder, please know that there is hope for you, and seek immediate professional help.

Published on June 18, 2018.
Reviewed on June 18, 2018 by Jacquelyn Ekern, MS, LPC

Published on EatingDisorderHope.com