Yoga as a Treatment for Eating Disorders

Yoga as a Treatment for Eating Disorders

Nick Tuccinardi

Lesley University 

Author Note

This paper was prepared for Yoga: Theory, Culture, and Practice CSOCS 3452, taught by Ph.D. Laura Douglass.

Abstract

                        In this paper, “Yoga as a Treatment for Eating Disorders” I intend to provide an in-depth understanding of the use of yoga as a treatment for eating disorders. The paper will discuss where, why, and how these treatments take place with a focus on the Cambridge Center for Eating Disorders. The paper will also view how the mindfulness of yoga relates to the psychology of eating disorders. I will obtain research from scholarly journals, treatment centers, especially the Cambridge Eating Disorder Center, and online sources. This paper uses original research from interviews with friends who have attended the Cambridge Eating Disorder Clinic; I will speak with them to get some real personal reflection on whether or not treatment seems to be effective. Overall this paper serves two purposes, first to provide it’s readers with knowledge of how and why yoga can be and is used for the treatment of eating disorders. Secondly, in synthesizing information from friends, research, Ph. D. Douglass, as well as my own opinions I will examine whether or not yoga as treatment for eating disorders is effective. 

Introduction

It took a lot of research to find a suitable yet concise definition of what yoga truly is and truth be told, while The American Yoga Association has provided a solid definition it is not the “end-all” definition of yoga (Appendix A). Yoga varies tremendously depending on culture, style, location, tempo, and purpose. Although The American Yoga Association offers a very broad definition of yoga it serves as a simple background to those not familiar with the practice. One of the many uses for yoga that has become increasingly popular in the past couple of decades, in the Western world, is yoga for treatment of diseases or injuries. Specifically, this paper will examine the use of yoga as a treatment for people with eating disorders.

What is an eating disorder?

Just as it is important for the readers of this paper to understand what yoga is, it is equally important for the reader to understand eating disorders. There are some common misconceptions about eating disorders such as; it is limited to making oneself throw up or not eat. Some also believe that eating disorders are strictly a problem faced by females, not males. Others tend to neglect that there is sometimes a psychological or biological underlying condition that causes eating disorders. This leads to a misinterpretation of how eating disorders arise and how they should be handled.                                                                                                                          The National Eating Disorders Association has a copious amount of reliable information on eating disorders. It gives a simple definition of an eating disorder, “anorexia, bulimia, and binge eating disorder include extreme emotions, attitudes, and behaviors surrounding weight and food issues” (neda.org). It is crucial to understand these terms before moving forward, I have consulted the NEDA website in condensing the following definitions of specific eating disorders (these definitions have been paraphrased from definitions on the National Eating Disorder Associations website) :

Anorexia Nervosa- potentially life threatening, characterized by self-starvation and excessive weight loss                                                                                                                                Binge Eating Disorder- “Recurrent binge eating without the regular use of compensatory measures to counter the binge eating”. Essentially eating an excessively unhealthy amount on a regular basis and not properly exercising, dieting, or throwing up (bulimia nervosa)           Bulimia Nervosa- “A cycle of bingeing and compensatory behaviors such as self-induced vomiting designed to undo or compensate for the effects of binge eating.” This disorder occurs when an individual eats an excessively unhealthy amount or any amount for that matter and then makes themselves throw up to make up for the excessive eating.                                         Eating Disorders Not Otherwise Specified (EDNOS)- “A person does not have to be diagnosed with Anorexia, Bulimia or BED to have an eating disorder. An eating disorder can include a combination of signs and symptoms but not meet the full criteria.”

Yoga as a Treatment for Eating Disorders

            Yoga as a treatment for eating disorders is a fairly new train of thought, as Laura Douglass points out in her 2010 publication, “Only a few studies support the efficacy of yoga for eating disorders and at least one study has shown that yoga has no effect all” (Douglass 84). This sentiment is echoed in a number of publications such as, “When eating disorder patients become more attuned to their bodies, experts say, they are more likely to treat them with the respect they deserve…Few scientific studies have explored these claims” (Columbia News Service). In my opinion, it is ok that science is not yet behind these claims. Perhaps not ok, but understandable. Science needs time for research and case studies. Yoga may be 5,000 years old but it has only been in the public eye of the West since about the 1960’s. Furthermore the use of yoga as treatment has only been around for a few decades. A lack of scientific proof does not mean that yoga is ineffective as a treatment; at the same time it does not prove the opposite. In our culture and society today, we want scientific proof. This raises the question what is being done to get that proof out to the public?

            Recent studies have been conducted by a number of institutions to try and prove yoga’s efficacy. Tartakovsky recently reported that a pilot study (Appendix C) published in the Journal of Adolescent Health found that yoga was effective in treating adolescents with anorexia, bulimia and eating disorder not otherwise specified. This was in 2009 but as early as 2005 there were such studies being conducted. The 2005 study was published in an issue of Psychology of Women Quarterly. The tests and results can be seen in Appendix D. Laura Douglass explores some cases studies such as these in her 2009 article “Yoga as a intervention for eating disorders: does it help?”. It is promising to see that leading researches in the field are now studying others research to solidify whether or not the treatment is effective. Research is ongoing, in 2010 Eating Disorders Review conducted a study that concluded, “The authors concluded that individualized yoga therapy holds promise as adjunctive therapy to standard care.” All of this research seems promising, but what is truly being researched? All of the experiments list that yoga is being used but what kind and how? For these answers, let us explore the lead source. A local eating disorder clinic, The Cambridge Eating Disorder Clinic, uses yoga as a treatment.

Cambridge Eating Disorder Clinic

            The Cambridge Eating Disorder Clinic, or CEDC was founded in 2000. It’s website is very helpful and providing general information about the clinic and detailed information about eating disorders as well as many resources. Unfortunately the website does not discuss how it implements yoga as a treatment. I have some friends who have attended CEDC and one was willing to let me ask them some questions about their history and experiences at CEDC (Appendix B). Her answers provide great insight not only into yoga as a treatment for eating disorders but also the journey of how an individual develops an eating disorder and how it affects them. Her reflection on yoga in the clinic is quite thoughtful and supports that while yoga is helpful, it is not an end all cure.

Conclusion

            Yoga as a treatment for eating disorders can be viewed as a Westernly ideal or the exact opposite. On the one hand, in the West we want hard empirical proof of everything. It is hard to bend our beliefs, if we cannot see then we choose not to believe. On the other hand, as a society we like to think that we are on the cutting edge and jump at the opportunity hop on the latest bandwagon, changing fads like we change clothes. Thus I believe there is a divide between whether or not people believe yoga is an effective treatment for eating disorders.

            Personally, if I were to write this paper prior to this semester I would probably laugh at the title. I have a pretty firm grasp of what a terrible thing an eating disorder is due to the number of my female friends who suffer from them. I had little to no knowledge of what yoga really was. A semester later I feel ashamed of my prior ignorance, a small sense of enlightenment, and a realization that I have so much to learn. My journey started at the end of the summer, I was having a discussion with a friend about how in psychology we watched a video about a lady who became a millionaire selling a book/movie on how to literally “think away cancer”. She claimed that it was all about attitude. I was sick to my stomach that someone was selling such ludicrous garbage. The friend I was telling had been to India and practiced some mediation and tried to explain how although energy cannot completely cure cancer, the lady was on to something. We talked for hours about energy and what the human body and mind was truly capable of. I was not convinced of anything, but definitely intrigued. This class, Yoga, Theory, Culture and Practice further opened my mind to different possibilities. As my friend says in Appendix B, sure yoga does not cure bulimia but it provides strong tools that help to fight it.

            It is hard to accurately describe my thoughts on holistic healing. Part of me wants to scream this is pure ignorance and insanity. Then there is another part of me that wants to see how it is possible. At the very least it is important to be willing to study and understand other views. It will be a long time before the world knows such acceptance. Just the other day I was discussing my finals with my dad and brought up yoga. He had so many questions, what is yoga? How is it an academic class? What can you learn from it? He was not asking these questions maliciously he truly just did not know, I tried my best to explain, it is hard because yoga is so complex and diverse. It is my belief that yoga is a catalyst. Whether it is eating disorders, anxiety, opening the mind, sports etc. Yoga can be so helpful, so vital, in so many ways; it is time for the world to wake up and take notice of this ancient art. Yoga is not the answer to any disease or any problem but it provides a spark in a step in the right direction. Namaste.

References

“Appendix B.” (Personal Communication, December 7, 2012)

"Cambridge Eating Disorder Center CEDC specializes in treatment of eating disorders." Cambridge Eating Disorder Center CEDC specializes in treatment of eating disorders. CEDC, n.d. Web. 19 Nov. 2012. <http://www.cedc-inc.com/>.

Daubenmier, J. J. (2005), THE RELATIONSHIP OF YOGA, BODY AWARENESS, AND BODY RESPONSIVENESS TO SELF-OBJECTIFICATION AND DISORDERED EATING. Psychology of Women Quarterly, 29: 207–219. doi: 10.1111/j.1471-6402.2005.00183.x

DOUGLASS, L. (2011). Thinking Through the Body: The Conceptualization of Yoga as Therapy for Individuals With Eating Disorders. Eating Disorders, 19(1), 83-96. doi:10.1080/10640

Douglass, L. (2009). Yoga as an intervention for eating disorders: Does it help? Eating Disorders: The Journal of Treatment and Prevention. 17 (2): 126-139. Link to Abstract & Order Article:  www.ncbi.nlm.nih.gov/pubmed/19242842. 266.2011.533607

"General Yoga Information." Welcome to The American Yoga Association. N.p., n.d. Web. 19 Nov. 2012. <http://www.americanyogaassociation.org

Haynie, Devon . "Yoga: a new way to fight anorexia." Columbia News Service 1 (2007): n. pag.                      Student Work. Web. 19 Nov. 2012.

"National Eating Disorders Association." National Eating Disorders Association. N.p., n.d. Web. 25 Nov. 2012. <http://www.nationaleatingdisorders.org/>.

" Sprouting Yoga." Sprouting Yoga. Sprout Yoga, 23 Jan. 2010. Web. 19 Nov. 2012. <http://padmaease.wordpress.com/page/2/

Tartakovsky, M. (2009). Yoga, Eating Disorders & Body Image. Psych Central. Retrieved on November 19, 2012, from http://blogs.psychcentral.com/weightless/2009/11/yoga-eating-disorders-body-image/

Walters, J. (2006). Child Psychology Selection. Child & Adolescent Mental Health, 11(1), 57-59. doi:10.1111/j.1475-3588.2005.00389_3.x

Whittington, Heather. "National Eating Disorders Awareness Week: Q & A With Yoga Practitioner Heather Whittington ." The Center for Eating Disorders at Sheppard Pratt. Sheppard Pratt, 25 Feb. 2008. Web. 19 Nov. 2012. <eatingdisorder.org/blog/2008/02/national-eating-disorders-awareness-week-qa-with-yoga-practitioner-heather-whittington/>.

Yoga Sessions Show Promise as Adjunct Therapy. (2010). Eating Disorders Review, 21(1), 11.

"Yoga Takes A Bite Out Of Eating Disorders." Science Daily: News & Articles in Science, Health, Environment & Technology. Blackwell Publishing Ltd., 18 May 2005. Web. 19 Nov. 2012. <http://www.sciencedaily.com/releases/20

Appendix A

What is yoga?

“The classical techniques of Yoga date back more than 5,000 years. In ancient times, the desire for greater personal freedom, health and long life, and heightened self-understanding gave birth to this system of physical and mental exercise, which has since spread throughout the world. The word Yoga means “to join or yoke together,” and it brings the body and mind together into one harmonious experience. The whole system of Yoga is built on three main structures: exercise, breathing, and meditation. The exercises of Yoga are designed to put pressure on the glandular systems of the body, thereby increasing its efficiency and total health. The body is looked upon as the primary instrument that enables us to work and evolve in the world, and so a Yoga student treats it with great care and respect. Breathing techniques are based on the concept that breath is the source of life in the body. The Yoga student gently increases breath control to improve the health and function of both body and mind. These two systems of exercise and breathing then prepare the body and mind for meditation, and the student finds an easy approach to a quiet mind that allows silence and healing from everyday stress. Regular daily practice of all three parts of this structure of Yoga produce a clear, bright mind and a strong, capable body.”       -The American Yoga Association

Appendix B

An Interview with a Cambridge Eating Disorder Clinic Patient 12/7/12

Do you feel comfortable answering some questions about your condition and your treatment in regards to yoga practices? If at any time you don’t feel comfortable answering a question or continuing please let me know.

Yes sure, I’m ready as I’ll ever be.

What is it that your condition?

You mean what am I suffering from? I was diagnosed with bulimia with anorexic tendencies. The unofficial term is bullimarexia. I’ve shown tendencies since the age of 14 but was only diagnosed when I was 18. I’m now 20. I was also diagnosed with generalized anxiety disorder and depression in October of 2012.

When were you first committed to the Cambridge Eating Disorder Clinic?

At the beginning of my senior year in high school (2010) I went to a Primary Care Physician weekly for weight and vital checks. I was also seeing an outside therapist but it was not a good experience so I stopped going. My PCP referred me to CEDC where I went for the first time in the summer of 2011. I was in the Intensive Out Patient program, I went three nights a week for three hours and, but I didn’t participate in any yoga.

Do you have any experience with yoga?

When I was 15 I went to a “stretching yoga” class with my mom at a Methodist Church in my hometown.  The demographics were mainly women in their 40’s, the teacher was very hippy-like, there were many mirrors in the room and I felt very self conscious. I hated it. I then did not practice yoga in any capacity until the fall of 2011. I was attending Syracuse University. I was not doing well with my eating when I left for school; my therapist said I was “functioning in a downward spiral.” At school my anorexic tendencies increased and I felt a lot of stress to achieve a 4.0 GPA. My friend encouraged me to attend a Saturday evening yoga class from 10 to 11pm. Although I vowed to never do yoga again after the uncomfortable experience in my mom’s class, my friend really pushed how relaxing it was, so I gave it a try. It was a Hatha yoga class and I fell in love. It was a nice way for me to escape the stress and pressures of the week. I did it from October until May, but did not continue over the summer when I got home. In the fall, 2012, I transferred to the University of Virginia. My PCP was hesitant to send me to school; I had a breakdown towards the end of the summer and fainted. My weight was low and I was depressed. Despite these warnings I went to school as planned.

Do you think your breakdown would have been avoided if you continued your yoga practices?

I think that it would have helped to lower my anxiety but by no means would it have been a cure. Yoga helped lower my anxiety levels and anxiety tends to lead to greater eating disorder tendencies.

Did you pick up yoga again at UVA?

No. Unfortunately a month and a half into the semester I had another breakdown. I was sent home. It was a new low pint for me, I had it rock bottom. The first day I got home I went to the hospital got my vitals checked and got an EKG. The next day I went for an intake at the CEDC. My parents encouraged me to go immediately. The intake was a series of questions about my history, behavior, background, mental stability, physical evaluation, and vitals. I was then placed into Partial Hospital Therapy. I would be attending the clinic 5 days a week for 6 and half hours a day. The options for treatment at CEDC are Residential, where you live at the clinic 24/7, IOP, which I previously mentioned/was enrolled in, or Outpatient, where you meet with a CEDC therapist.

What did a normal day look like for you?

We would check in and talk about or struggles from the previous night. We then had snack followed by two group sessions. We then had lunch and two more group sessions. A short group and then a session where we would plan out our evenings followed a pm snack.

What are the groups?

Recovery narratives, bibliotherapy, target behavior, psychotherapy, coping, nutrition, healthy anger, relationships, roadblocks to recovery, CBT-cognitive behavioral therapy, emotional regulation, and yoga.

Can you talk about the yoga you practiced?

We practiced for 40 to 50 minutes on Tuesday afternoons. We had the option of yoga or meditation. It was a very gentle stretching type of yoga. The clinic restricts exercise so we mostly held the poses.

Do you know which poses you did?

Childs pose, downward dog, tree pose, sitting back stretch, warrior two, cat/dog, and some others that I cannot remember.

Did you do any meditations or chanting?

We didn’t mediate but we occasionally ended with an om. There was a great emphasis on breathing techniques, which I found to be the most helpful.

Why did you choose yoga over meditation?

 Mediation seems helpful if you have the right mindset going in, the breathing tactics of yoga force me to get into the right mindset.

What sort of mindset does yoga get you in?

Well, it’s interesting. Yoga focuses on the body, which is something that an individual with an eating disorder may not want to do. But it’s a different kind of self-awareness of the body. It’s hard to explain. Focusing on breathing helps me to detach. It’s the kind of thing that like, if I thought of binging, I could focus on my breathing and try to push the bad thoughts out of my mind. Yoga is all about breathing and being mindful. As someone with an eating disorder, I will always be in some state of recovery; having the mindfulness that yoga preaches helps with different coping mechanisms to not engage in harmful behaviors.

Could you please evaluate the following statement: Yoga is helpful in curing eating disorders.

First off cure isn’t really the right term, as I said if you have had an eating disorder you are always in recovery. That being said, I think that on its own, in most cases, yoga will never be the cure. I do think that it’s helpful to focus on mindfulness of the body and breathing. It’s a safe way to indulge in thinking about the body in a positive way. I focus on my body in a negative way, but yoga focuses on the positives.

Is it hard to practice yoga when our Western culture pushes crazy ideals? Like women in sports bras and booty shorts?

I cant say for sure because I haven’t engaged in that sort of class, but at CEDC all the girls where sweats and sweatshirts, or whatever they wore that day. CEDC is a welcoming environment for body image, there are no mirrors, no competitive or sexual Western ideals, and it’s helpful that all the girls are in a similar place. There is a sense of community. I know yoga is all about the internal focus, but on a subconscious level, it’s helpful to know the girls around me are going through the same struggles.

So yoga at the clinic is helpful?

Yes but I wish it were done more. We only do it once a week and it is on Tuesdays. I wish we could do it on a Friday afternoon to release the stress of the week.

Thank you very much, any final comments?

Thank you and yes. Eating disorders are often overlooked. I was in the clinic for about 3 or 4 weeks and am now being forced to leave because I am no longer physically at risk. My insurance no longer covers the treatment. I don’t blame CEDC in the slightest but it is terrible that just as I am starting to progress I have to leave. I fear that I will fall into old habits, which could be avoided if I were to just continue at the clinic. I guess in short I just want to see awareness raised; it is a serious issue and does not get the attention it deserves.

Appendix C

“Specifically, the study looked at two groups: one group received standard care, which involved an appointment with a physician or dietician every other week; the second received standard care plus yoga.

Immediately after the yoga sessions, teens reported being less preoccupied with food. At 12 weeks, these teens also had lower scores on the self-report questionnaire, Eating Disorder Examination. While the teens who didn’t practice yoga experienced an initial decline in scores, they returned to their baseline at week 12. Also, importantly, the teens didn’t lose any weight. The researchers concluded that, “Results suggest that individualized yoga therapy holds promise as adjunctive therapy to standard care.”- Margarita Tartakovsky, Yoga, Eating Disorders, and Body Image

Appendix D

“Study 1 consisted of three types of women: those currently taking yoga classes, those partaking in aerobic classes, and those who had not participated in either for the past two years. Participants were asked to complete a survey on "women and exercise" that they completed at home and mailed back. Study one consisted of women who, on average, were thirty-seven years old. Study two consisted of undergraduates, a population known to be at greater risk for self-objectification and eating disorders. The results were consistent in both studies. "Through yoga, this study suggests that women may have intuitively discovered a way to buffer themselves against messages that tell them that only a thin and 'beautiful' body will lead to happiness and success," the author explains.” –Science Daily