July 2018 LACPA Eating Disorder SIG Event

Date: Thursday, July 12th at 7:30 pm

Presenter: Ryan Sheldon, Eating Disorder Advocate

Title: Men Struggle, Too: My Journey with Binge Eating Disorder

Description: Description: I’m often asked what’s it like being a guy with Binge-Eating Disorder. It’s sad but true, many view eating disorders as female illnesses. Why is there so much shame about being a guy with an eating disorder? Why did it take so long for me to get diagnosed? Come join me to find out what it’s really like being a guy with Binge Eating Disorder. I will share my story and give you insights into working with males with eating disorders. Here’s a recent article.

Bio: Ryan Sheldon, founder of the blog Mr. Confessions formerly Confessions Of A Binge Eater, a blog he created to not only document his body image and eating disorder struggles but also to promote self love. He is proud to be a much-needed voice for men whose struggles all too often are neglected, while encouraging them to reach out for professional help. Ryan is currently working on a book and has a self-love Instagram account @BingeEaterConfessions

Location: The office of Dr. Lauren Muhlheim (4929 Wilshire Boulevard, Suite 245, Los Angeles) – free parking in the lot (enter on Highland)

RSVP to: drmuhlheim@gmail.com

SIG meetings are open to all LACPA members. Nonmembers wishing to attend may join LACPA by visiting our website www.lapsych.org

Unraveling the Enigma of Male Eating Disorders: Presentation by Stuart Murray, Ph.D.

Stuart Murray (center) with Max Feirstein, Ph.D., LACPA CE Chair, and Lauren Muhlheim

Stuart Murray (center) with Max Feirstein, Ph.D., LACPA CE Chair, and Lauren Muhlheim

On January 31, Dr. Stuart Murray, assistant professor at UCSF, presented to the Los Angeles County Psychological Association on Male Eating Disorders. I have been a fan (and follower) of Dr. Murray since he volunteered to participate in an AED tweetchat (which I helped moderate) on Muscle Dysmorphia in November, 2013. He is an active clinician, prolific researcher, and expert on male eating disorders.

Prevalence rates

While male eating disorders are often marginalized, Dr. Murray points out that eating disorders in males have been known since 1689, when Richard Morton, an English physician, described 2 cases of “nervous consumption,” one in a male patient. Males later fell off the radar of eating disorders. Less than 1% of the papers on eating disorders focus on males.

Although it is widely quoted that only 10% of eating disorder sufferers are male, Dr. Murray notes that this is not accurate. He reports that approximately 25% of individuals with anorexia nervosa and bulimia nervosa are male. He also reports that selective eating disorders of childhood, including ARFID, are actually more common in boys than in girls. The rate of males with binge eating disorder is approximately 36%. These figures are all still likely an underrepresentation due to a variety of factors including stigma and biased assessment measures. Men may be less likely to endorse symptoms of what is commonly seen as a female illness and reluctant to ask for help. Because eating disorder awareness efforts typically target only girls, boys and men also may be less aware of eating disorders and less likely to recognize their problem as one. For these various reasons, males are likely underreported in prevalence statistics.

Additionally, since all of the available measures used to assess eating disorders were designed for females, they may not capture males with eating disorders. For example, the Eating Disorders Inventory has a question, ” I think my thighs are too large. ” This item is less likely to be endorsed by males because it does not reflect their body image concerns. Dr. Murray believes that there is a need for a male-specific eating disorder assessment tool and he is currently working on validating the Eating Disorder Assessment for Males (EDAM). For example, a corresponding item on the EDAM might be something similar to, “I check my body several times a day for muscularity, ” which is more oriented toward males’ concerns.

Muscularity Concerns

One of the most striking differences between males and females with eating disorders is the difference in body image concerns. This seems to be a reflection of the difference between perceived ideal female and male bodies. While women are encouraged to be thin, males are encouraged to be muscular. There is research indicating that while the ideal body shape for females has gotten thinner over the years, corresponding research shows the ideal for men has gotten bulkier and more muscular.

Whether an eating disorder presents as a desire for thinness or muscularity appears to be related primarily to gender role identification; that is, feminine self-identification appears to be a risk factor for the development in men of thinness-oriented eating disorder psychopathology, while masculine self-identification is linked with the drive for muscularity and may contribute toward the development in men of muscularity-oriented body image concerns.

There is a question as to whether muscle dysmorphia is a type of body dysmorphia (itself a type of obsessive-compulsive and related disorders) or an eating disorder. Dr. Murray’s research supports that it is an eating disorder, because it typically includes both compulsive exercise practices and disordered eating. Disordered eating practices are usually central to muscle dysmorphia, which is why it is not just body dysmorphia. As with female eating disorders, the compulsive exercise practices associated with muscularity-oriented eating disorders are often driven by appearance rather than health or performance.

Muscularity disordered eating may look quite different than the disordered eating more commonly seen in females. Girls and women with eating disorders usually restrict intake of high calorie food items. Males with eating disorders may increase their intake, especially of protein sources, and may also use appearance-enhancing substances such as supplements, steroids, growth hormone, and clenbuterol.

Other Differences Between Male and Female Eating Disorders:

Exercise is more central to male presentations of bulimia nervosa than is purging or laxative use. Male eating disorders most typically involve two dimensions for male body image: leanness and muscularity. These may often be mutually exclusive. This can cause a cyclical nature to male eating disorders of bulking (weight gain) followed by cutting (weight loss). Males with bulimia may also not engage in typical binge eating, but may instead have “cheat meals.”

Males with eating disorders have a later age of onset, a greater likelihood of previous overweight status, greater psychiatric comorbidity, and a greater risk for suicidality. They are also less likely to seek treatment and when they do, it is commonly after a longer period of illness, which reduces the likelihood of a full recovery. Males suffer from many of the same medical issues as females with eating disorders, but also may experience decreased testosterone and problems with sexual functioning.

Treatment Implications

Dr. Murray stated that clinicians must address with male patients the stigma of being seen for what is commonly known as a female disorder. He also suggests that clinicians explore with male clients what it means for them to be male and how their body reflects that. Treatment with males often focuses more tightly on addressing exercise, which is often the first symptom to present and the last to remit. Dr. Murray has also modified Family Based Treatment (FBT) for adolescent muscle dysmorphia. In this case, he focused on limiting exercise and reducing label checking, etc.

Learn More

Much of the presentation was based on Dr. Murray’s work. To learn more about male eating disorders, I suggest checking out Dr. Murray’s research. Many of his articles are open access. A list of publications is available here. You can also follow him on twitter.

Los Angeles Eating Disorder Events for Professionals January 2016

We are so lucky to have two amazing dynamic internationally recognized speakers regarding eating disorders in January via the Los Angeles County Psychological Association (LACPA).  One is a FREE SIG event (members only) and the other is a CE event with a charge (open to all professionals).

1)  Eating Disorder SIG meeting featuring international speaker and fat acceptance activist, Ragen Chastain

Wednesday, January 20 at 7:15 pm 

Title:   Elimination is Oppression – The Ill-Advised Fight Against Obesity

Presenter:  Ragen Chastain

Description:  You can’t have a “War on Obesity” without creating a war on fat people. There is no non-stigmatizing way to say “The world will be better when no one who looks like you exists.” The shame, stigma, bullying, and oppression that have arisen from massively failed attempts to “eradicate” obesity have far-reaching negative health effects on people of all sizes, including those struggling with Eating Disorders.  The solution is not to double down and do more of the same. The research is clear that body size and health are not the same, and that a focus on body size in healthcare does a disservice to people all sizes.  We can, and we should, create complete, thriving public health programs without the use of eliminationist language, without creating a culture of appearance-based stigma and oppression, and without waging war on anyone.

Location:  The office of Dr. Lauren Muhlheim (4929 Wilshire Boulevard, Suite 245, Los Angeles) – free parking in the lot (enter on Highland)

Bio:  Ragen Chastain is an internationally recognized thought leader in the fields of self-esteem, body image, Health at Every Size, and corporate wellness.  She is a sought after speaker on the college, corporate, and conference circuits who has set the stage on fire everywhere from Google Headquarters to Cal Tech to the Models of Pride Conference.  She is the author of the blog DanceswithFat,  the book Fat: The Owner’s Manual, a columnist for Ms. Fit Magazine, and frequently appears as a topic expert on television and in print media. Ragen is a featured interviewee in the documentaries America the Beautiful 2 – The Thin Commandments, Ragen’s More Cabaret, and A Stage for Size.  She lives in Los Angeles with her partner and their adorable dogs and in her free time she is training for her second marathon and her first IRONMAN triathlon.

RSVP to Dr. Lauren Muhlheim at drmuhlheim@gmail.com

SIG meetings are open to all LACPA members.  Nonmembers wishing to attend may join LACPA by visiting our website www.lapsych.org

2)  A CE event (tell your colleagues who are nonmembers; we provide CEUs for psychologists, nurses, drug counsellors, MFTs, LCSWs, and LPCC)

“Unraveling the Enigma of Male Eating Disorders” with Stuart Murray, Ph.D. on Saturday, January 30, 2016 

10:00 a.m. – 1:00 p.m. CE Credits 3.0 

Held at the NEW LACPA Office

6345 Balboa Blvd. Building 2, Suite 126

Encino, CA 91316

Click here to register online:

http://www.lapsych.org/events/event_details.asp?id=726923

This three hour workshop will provide a historical, theoretical, and clinical overview of eating disorder in males. Dr Murray will provide a historical overview of the development of our diagnostic framework, highlighting how this may be inaccurate in indexing male eating disorder concerns. Dr Murray will also provide an overview of the most recent empirical evidence pertaining to the transdiagnostic array of EDs in males. Finally, this workshop will include an in-depth discussion of the clinical quandaries faced in working with EDs in males.

Stuart Murray, Ph.D., is an Assistant Professor at UCSF, where he leads an international research group dedicated to advancing our understanding of male eating disorders. He also serves as the Director of the National Association for Males with Eating Disorders, and as the Co-Chair for the Academy of Eating Disorders Special Interest Group on Males & EDs. To date, Dr. Murray has published more than 70 scientific journal articles and book chapters, and has conducted workshops and seminars internationally on the topic of male eating disorders.

Winter LACPA Eating Disorder SIG meetings (2015-2016)

Thursday, November 12 at 7:15 pm.

Title: Medical-Legal Aspects of Eating Disorder Treatment with Emphasis on Denial of Care

Presenter: David Rudnick, M.D., Ph.D.

Learning Objectives:

1) Become familiar with the issues in the treatment of eating disorders that are most likely to trigger legal interventions on behalf of patients.

2)  Understand the meaning of parity and the California Mental Health Parity Act as it applies to the treatment of mental disorders generally and eating disorders specifically.

3)  Learn the current categories of level of care involved in the treatment of eating disorders, their relationship to predictors of treatment outcome and the potential impact of insurance denial of the appropriate level.

Location:  The office of Dr. Lauren Muhlheim (4929 Wilshire Boulevard, Suite 245, Los Angeles) – free parking in the lot (enter on Highland)

Bio:  Dr. Rudnick was born and raised In Los Angeles, California. He received A B.S. in Physics from Stanford University in 1962 and a Ph.D. in Physics from Harvard University in 1968. After 6 years on the UCLA Department of Physics faculty, he switched gears and attended the University Of Miami Medical School in the Ph.D. – M.D. Program. He graduated that program in 1976, and then completed an internship in Internal Medicine at the Wadsworth V.A. Medical Center and a residency in Psychiatry at the UCLA Neuropsychiatric Institute.

Following completion of his residence in 1980, he became Medical Director of the UCLA Neurobehavior Clinic and opened his private practice in Santa Monica. His interest in eating disorders began during his residency, when together with Joel Yager, M.D., he started the first adult outpatient eating disorders program at UCLA. Since completing his residency in 1980, he has supervised this program in its many inceptions. His interest in medical-legal issues began in the context of criminal offenders who were evaluated in the Neurobehavior Clinic for underlying neurological and neuropsychiatric disorders. It extended to the neuropsychiatric aspects of brain injury, leading to multiple assignments as an expert consultant and witness in brain injury cases. It was then a natural evolution to marry the interest in eating disorders to participation as a medical-legal expert in cases involving treatment issues.

Dr. Rudnick has evaluated and testified about many aspects of eating disorder treatment that have come under legal scrutiny, and will talk to us about those experiences with emphasis on the, currently, hotly contested issue of denial of care.

RSVP to Dr. Lauren Muhlheim at drmuhlheim@gmail.com

SIG meetings are open to all LACPA members.  Nonmembers wishing to attend may join LACPA by visiting our website www.lapsych.org

Wednesday, December 2 at 7:15 pm – joint with Sport & Performance SIG

Title:   When Fit Becomes Foe: Excessive Workout Supplement Use as an Emerging Eating Disorder in Men

Achiro

Presenter:  Richard Achiro, Ph.D.

Description:  Dr. Achiro will discuss his recent study which provides preliminary evidence that excessive over-the-counter workout supplement use is a variant of disordered eating in gym-active men. This work—which has received international recognition from sources such as Reuters, WebMD, The Huffington Post, NPR, CBS News, and the BBC—is timely due to the drastic increase in workout supplement use in recent years. Although consuming protein powders, creatine, and caffeinated “boosts” have become standard lifestyle practice for a significant subset of the male population, misuse of these products has remained largely overlooked as a potential risky body change behavior. Dr. Achiro will highlight psychological factors found to be associated with misuse of workout supplements, with an emphasis on gender issues and implications for assessment and treatment.

Location:  The office of Dr. Lauren Muhlheim (4929 Wilshire Boulevard, Suite 245, Los Angeles) – free parking in the lot (enter on Highland)

Bio: Richard Achiro, Ph.D. is a psychotherapist and published researcher who received his doctorate in clinical psychology with an emphasis in health psychology from the California School of Professional Psychology, Los Angeles. He has maintained several leadership positions, including past service on the Los Angeles County Psychological Association (LACPA) Board of Directors. Dr. Achiro provides treatment to individuals and couples as a Registered Psychological Assistant supervised by Stephen Phillips, J.D., Psy.D. in Beverly Hills.

RSVP to Dr. Lauren Muhlheim at drmuhlheim@gmail.com

SIG meetings are open to all LACPA members.  Nonmembers wishing to attend may join LACPA by visiting our website www.lapsych.org

Wednesday, January 20 at 7:15 pm

Title:   Elimination is Oppression – The Ill-Advised Fight Against Obesity

Presenter:  Ragen Chastain

Description: You can’t have a “War on Obesity” without creating a war on fat people. There is no non-stigmatizing way to say “The world will be better when no one who looks like you exists.” The shame, stigma, bullying, and oppression that have arisen from massively failed attempts to “eradicate” obesity have far-reaching negative health effects on people of all sizes, including those struggling with Eating Disorders.  The solution is not to double down and do more of the same. The research is clear that body size and health are not the same, and that a focus on body size in healthcare does a disservice to people all sizes.  We can, and we should, create complete, thriving public health programs without the use of eliminationist language, without creating a culture of appearance-based stigma and oppression, and without waging war on anyone.

Location:  The office of Dr. Lauren Muhlheim (4929 Wilshire Boulevard, Suite 245, Los Angeles) – free parking in the lot (enter on Highland)

Bio: Ragen Chastain is an internationally recognized thought leader in the fields of self-esteem, body image, Health at Every Size, and corporate wellness.  She is a sought after speaker on the college, corporate, and conference circuits who has set the stage on fire everywhere from Google Headquarters to Cal Tech to the Models of Pride Conference.  She is the author of the blog DanceswithFat,  the book Fat: The Owner’s Manual, a columnist for Ms. Fit Magazine, and frequently appears as a topic expert on television and in print media. Ragen is a featured interviewee in the documentaries America the Beautiful 2 – The Thin Commandments, Ragen’s More Cabaret, and A Stage for Size.  She lives in Los Angeles with her partner and their adorable dogs and in her free time she is training for her second marathon and her first IRONMAN triathlon.

RSVP to Dr. Lauren Muhlheim at drmuhlheim@gmail.com

SIG meetings are open to all LACPA members.  Nonmembers wishing to attend may join LACPA by visiting our website www.lapsych.org