premature ejaculation: intro

Re: Premature Ejaculation
Fr: http://en.wikipedia.org/wiki/Premature_ejaculation

Premature ejaculation (PE), also known as rapid ejaculation, premature climax, early ejaculation, or by the Latin term ejaculatio praecox, is the most common sexual problem in men, affecting 25%-40% of men. It is characterized by a lack of voluntary control over ejaculation. Masters and Johnson stated that a man suffers from premature ejaculation if he ejaculates before his partner achieves orgasm in more than fifty percent of his sexual encounters. Other sex researchers have defined premature ejaculation as occurring if the man ejaculates within two minutes or less of penetration; however, a survey by Alfred Kinsey in the 1950s demonstrated that three quarters of men ejaculated within two minutes of penetration in over half of their sexual encounters. Today, most sex therapists understand premature ejaculation as occurring when a lack of ejaculatory control interferes with sexual or emotional well-being in one or both partners. Masters and Johnson recommended the use of the Lateral coital position to help alleviate premature ejaculation.

Most men experience premature ejaculation at least once in their lives. Often adolescents and young men experience "premature" ejaculation during their first sexual encounters, but eventually learn ejaculatory control. Because there is great variability in both how long it takes men to ejaculate and how long both partners want sex to last, researchers have begun to form a quantitative definition of premature ejaculation. Current evidence supports an average intravaginal ejaculation latency time (IELT) of six and a half minutes in 18-30 year olds.[1] If the disorder is defined as an IELT percentile below 2.5, then premature ejaculation could be suggested by an IELT of less than about one and a half minutes. Nevertheless, it is well accepted that men with IELTs below 1.5 minutes could be "happy" with their performance and do not report a lack of control and therefore do not suffer from PE. On the other hand, a man with 2 minutes IELT could present with perception of poor control over his ejaculation, distressed about his condition, has interpersonal difficulties and therefore be diagnosed with PE.

Scientists have long suspected a genetic link to certain forms of premature ejaculation. In one study, ninety-one percent of men who suffered from lifelong premature ejaculation also had a first-relative with lifelong premature ejaculation. Other researchers have noted that men who suffer from premature ejaculation have a faster neurological response in the pelvic muscles. Simple exercises commonly suggested by sex therapists can significantly improve ejaculatory control for men with premature ejaculation caused by neurological factors[citation needed]. Often, these men may benefit from anti-anxiety medication or selective serotonin reuptake inhibitors (SSRIs), such as sertraline or paroxetine. Some men prefer using anaesthetic creams; however, these creams may also deaden sensations in the man's partner, and are not generally recommended by sex therapists.

Psychological factors also commonly contribute to premature ejaculation. While men sometimes underestimate the relationship between sexual performance and emotional well-being, premature ejaculation can be caused by temporary depression, stress over financial matters, unrealistic expectations about performance, a history of sexual repression, or an overall lack of confidence. Interpersonal dynamics strongly contribute to sexual function, and premature ejaculation can be caused by a lack of communication between partners, hurt feelings, or unresolved conflicts that interfere with the ability to achieve emotional intimacy. Neurological premature ejaculation can also lead to other forms of sexual dysfunction, or intensify the existing problem, by creating performance anxiety. In a less pathological context, premature ejaculation could also be simply caused by extreme arousal.

Some physical illnesses, such as a prostate infection, are also known to induce premature ejaculation. In other instances, premature ejaculation is caused by a physical injury that affects the nervous system. Certain medications, such as cold medications containing pseudoephedrine, also cause premature ejaculation. Sexual dysfunction is a common symptom of psychiatric afflictions ranging from bipolar disorder to post-traumatic stress disorder. In these cases, it is best to discuss the issues openly with a physician.

Today it is believed that the neurotransmitor serotonin (5HT) has a central role in modulating ejaculation. Several animal studies have demonstrated its inhibitory effect on ejaculation modulated through the PGI system in the brain. Therefore, it is perceived that low level of serotonin in the synaptic cleft in these specific areas in the brain could cause premature ejaculation. This theory is further supported by the proven effectiveness of SSRIs, which increase serotonin level in the synapse, in treating PE.

Contents
1 Science of Mechanism of Ejaculation
2 Treatment
2.1 Alternative therapies
3 Diagnosis
3.1 Differential diagnosis
3.2 Associated conditions
4 See also
5 References

Science of Mechanism of Ejaculation

The process of ejaculation requires two sexually sequentially distinct actions, emission and expulsion.

Mechanism of Ejaculation
The emission phase is the first one to happen and it involves deposition of semenal fluid from ampullary vasa deferens, seminal vesicles & prostate gland into posterior urethra (Bohlen, et al., 2000). Second phase is the expulsion of semen which involves closure of bladder neck followed by the rhythmic contractions of urethra by pelvic-perineal and bulbospongiosus muscle and intermittent relaxation of external Sphincter urethrae (Master and Turek, 2001).

Sympathetic motor neurons control the emission phase of ejaculation reflex and expulsion phase is executed by somatic and autonomic motor neurons. These motor neurons are located in the thoracolumbar and lumbosacral spinal cord and are activated in a coordinated manner when sufficient sensory input to reach the ejaculatory threshold has entered the central nervous system (De Groat and Booth 1980; Truitt and Coolen 2002). Several areas in the brain, and especially the nucleus paragigantocellularis, have been identified to be involved in ejaculatory control (Coolen, et al., 2004),

Treatment

Depending on severity, premature ejaculation symptoms can be significantly reduced. In mundane cases, treatments are focused on gradually training and improving mental habituation to sex and physical development of stimulation control. In clinical cases, various medications are being trialled to help slow down the speed of the arousal response.

SSRI antidepressants have been shown to delay ejaculation in men treated for different psychiatry disorders. SSRIs are considered the most effective treatment currently available for PE. These include paroxetine, fluoxetine, sertraline and more. The use of these drugs, that require chronic therapy, is limited by the neuropsychiatric side effects. New SSRI drugs specifically targeted to treat premature ejaculation (e.g. dapoxetine) can be taken on an as needed basis and have been recently shown positive results in large phase III studies. Nevertheless dapoxetine is not yet approved by any regulatory authority around the world. There is speculation that some of the associated effects are caused by lowered libido and blood pressure as well as lowered anxiety levels. Other pharmaceutical products known to delay male orgasm are; opioids, cocaine, and diphenhydramine.

The effects of the hyperforin extract of Hypericum perforatum has been evaluated on the ejaculatory reflex duration by using the intravaginal ejaculatory latency time (IELT) and sexual satisfaction (Cannon-Smith and Kaufman, 2007). In this trial sixteen men who desired longer sexual intercourse and without erectile dysfunction took with hyperforin immediately prior to sexual activity. All 16 participants completed the trial and there was a significant increase in mean ejaculation times from 246±29 to 331±34 seconds (p<0.002) in persons taking the hyperforin. The increase was seen in both the men who reported PE as bothersome and those who did not feel that PE was a problem for them. The effect of hypericum perforatum is similar to dapoxetine.

Local anesthetic creams (like lidocaine, prilocaine and combinations) have shown to be very effective in clinical trials and are being used of the treatment of PE. Their use is limited by its own anesthetic effect that reduce sensation on the penis and vagina.

Most sex therapists prescribe a series of exercises to enable the man to gain ejaculatory control. While the exercises are intended for men who suffer from premature ejaculation, other men can use the exercises to enhance their sex lives. By far the most common exercise is the so-called start-stop technique. While the technique varies, the purpose is to get the male accustomed to maintaining an erection for an extended period of time while gradually increasing sexual tolerance. In doing this exercise, the male obtains an erection through self-stimulation, or masturbation. After achieving an erection, he stops stimulating himself until he begins to lose his erection; at that point, he begins to stimulate himself again. Gradually, over a period of several weeks, he is able to stimulate himself for longer periods of time, eventually gaining ejaculatory control. In order for this technique to be successful, the male should avoid feeling discouraged if he ejaculates rapidly; instead, he should use his sexual responses to learn how to vary the technique in a way that most benefits him. Another variant, for example, is to stimulate the shaft and frenulum of the penis, exploring the glans more as control improves.

The male's partner is usually integrated into the exercises. They can stimulate the partner using the stop-start technique. When the male has achieved some level of ejaculatory control, he can insert his penis into his partner without thrusting. After his penis becomes accustomed to being inside his partner, thrusting can be gradually included, according to the male's abilities, using the stop-start technique. In less severe cases, the male might overcome his premature ejaculation early on, making exercises with his partner superfluous.

The male's partner plays an essential role in enabling him to overcome premature ejaculation. Without understanding and emotional support, the male is unlikely to obtain the level of relaxation required for sexual satisfaction. Both the male and his partner should communicate their feelings openly and with sensitivity. The male should learn to sexually satisfy his partner, orally or otherwise, while they work with him to overcome his premature ejaculation.

External latex rigid sheathes fastened to the body have been developed that cover all part of the penis during penetration so that the penis is protected from all the stimulation of the vagina. These help to gain control and to provide satisfaction to the partner.

Alternative therapies

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Many alternative therapies are available for the treatment of PE. Caution should be exercised when researching alternative sources of advice however, most treatments have not actually been shown to be effective. Some web sites even advocate the dangerous and antiquated method of pulling the testes downwards when aroused. This is actually a good way to slightly strain the interior of the testes and is associated with reports of injury and weakened/deteriorated erection. For some reason this advice is still widespread on the Internet.

Hypnosis has also proven very effective in the treatment of premature ejaculation.[citation needed] It is believed by some that ejaculation is a subconscious habit and by giving the mind hypnotic suggestions to last longer, the problem can be greatly alleviated if not completely cured.[citation needed] Most men report dramatic improvement after only a few sessions of hypnosis.

The prostate gland plays a very important part in regulating arousal. Pressure in between the engorged prostate and the erection causes most of the pleasurable sensations and it may be emptied manually before sex by prostate massage. This causes the erection to be strong but less sensitive, and increases a patient's awareness of his physiology.

There is a trend toward the use of nutritional supplements when treating men who suffer from PE. Effective supplements must contain 5HTP which is a precursor to serotonin. A Dr. William Ganong, noted that serum serotonin levels could be increased through dietary means. Increasing the serum level of serotonin helps inhibit the ejaculatory reflex. There are a number of nutritional remedies available primarily on the Internet.[citation needed]

Diagnosis

Diagnostic criteria for Premature Ejaculation DSM-IV-TR (American Psychiatric Association)

A. Persistent or recurrent ejaculation with minimal sexual stimulation before, on, or shortly after penetration and before the person wishes it. The clinician must take into account factors that affect duration of the excitement phase, such as age, novelty of the sexual partner or situation, and recent frequency of sexual activity.

B. The disturbance causes marked distress or interpersonal difficulty.

C. The premature ejaculation is not due exclusively to the direct effects of a substance (e.g., withdrawal from opioids).

Differential diagnosis

Premature ejaculation should be distinguished from erectile dysfunction related to the development of a general medical condition. Some individuals with erectile dysfunction may omit their usual strategies for delaying orgasm. Others require prolonged noncoital stimulation to develop a degree of erection sufficient for intromission. In such individuals, sexual arousal may be so high that ejaculation occurs immediately. Occasional problems with premature ejaculation that are not persistent or recurrent or are not accompanied by marked distress or interpersonal difficulty do not qualify for the diagnosis of premature ejaculation. The clinician should also take into account the individual's age, overall sexual experience, recent sexual activity, and the novelty of the partner. When problems with premature ejaculation are due exclusively to substance use (e.g., opioid withdrawal), a substance-induced sexual dysfunction can be diagnosed.

Associated conditions
• Neurological disorders, e.g., multiple sclerosis
• Prostatitis
• Psychological disorders
• Interpersonal disorders
• ABC's Premature Ejaculation, e.g., [[2]]

See also
• Delayed ejaculation

References

• Böhlen D, Hugonnet CL, Mills RD, Weise ES, Schmid HP (2000). "Five meters of H(2)O: the pressure at the urinary bladder neck during human ejaculation". Prostate 44 (4): 339-41. PMID 10951500.
• Cannon-Smith, T. W., Kaufman, J.H.: Improved Ejacultory Control And Sexual Satisfaction In Pilot Study Of Men Taking Hypericum Perforatum Extract . The Internet Journal of Nutrition and Wellness. 2007. Volume 3 Number 2. link
• Coolen LM, Olivier B, Peters HJ, Veening JG (1997). "Demonstration of ejaculation-induced neural activity in the male rat brain using 5-HT1A agonist 8-OH-DPAT". Physiol. Behav. 62 (4): 881-91. PMID 9284512.
• deGroat WC, Booth AM (1980). "Physiology of male sexual function". Ann. Intern. Med. 92 (2 Pt 2): 329-31. PMID 7356224.
• Master VA, Turek PJ (2001). "Ejaculatory physiology and dysfunction". Urol. Clin. North Am. 28 (2): 363-75, x. PMID 11402588.
• Barry W., PhD. McCarthy; Michael E., PhD. Metz (2003). Coping With Premature Ejaculation: How to Overcome Pe, Please Your Partner & Have Great Sex. Oakland, Calif: New Harbinger Publications. ISBN 1-57224-340-6.
• Ringold MD, Warren J, "The ABC's of Premature Ejaculation"; Department Chief of Family Medicine; "Understanding and Coping with PE" link
• Truitt WA, Coolen LM (2002). "Identification of a potential ejaculation generator in the spinal cord". Science 297 (5586): 1566-9. DOI:10.1126/science.1073885. PMID 12202834.
• Waldinger MD, Quinn P, Dilleen M, Mundayat R, Schweitzer DH, Boolell M (2005). "A multinational population survey of intravaginal ejaculation latency time". The journal of sexual medicine 2 (4): 492-7. DOI:10.1111/j.1743-6109.2005.00070.x. PMID 16422843.
• Waldinger MD, Zwinderman AH, Olivier B, Schweitzer DH (2005). "Proposal for a definition of lifelong premature ejaculation based on epidemiological stopwatch data". The journal of sexual medicine 2 (4): 498-507. DOI:10.1111/j.1743-6109.2005.00069.x. PMID 16422844.

co-dependency

re: ADHD
fr: strong, j. & flanagan, m. (2005). AD/HD for dummies. indianapolis, IN: wiley, p. 224.

"be careful not to fall into the trap of being CODEPENDENT. if your partner has AD/HD, DON'T DO EVERYTHING FOR HIM, and don't allow him to treat you or anyone else poorly or to rely too much on you to do things for him. (allowing this type of behavior is called enabling.)

"... working together. be supportive without enabling. be a partner, not a servant ...."

alcoholic anonymous

when founded: 1935
where: akron, ohio
who: bill wilson, a NY stockbroker
: dr. bob smith, an Akron surgeon
method:
> the 12-step recovery program from chemical dependency
> major steps
-- admitting you are powerless over alcohol --
that your life has become unmanageable
-- believing that a power greater than yourself
could restore you to sanity
-- making a list of all persons you have harmed, &
-- becoming willing to make amends to them all.

"AA is no success story in the ordinary sense of the word.
it is a story of suffering transmuted, under grace, into
spiritual progress."
- bill wison, co-founder of AA

source: xpress (2007 may 17), p. 10. "sober celebration."
cf: www.aa.org

workaholism, intro

> the problem:

workaholism refers to a "tendency to spend to much time & get too great a reward at work at the expense of famly & personal life."

> proposed solutions:

- schedule your time
- force social interaction
- take time for health
- make time for short breaks
- "sharpen the saw"
---physical: exercise, nutririon, rest
---social/emotional : social & intimate connections with others
---mental: reading, learning, writing
---spiritual: connecting with nature, meditating, prayer, service
- set & review goals

"...i was letting the important things pass by me. taking the time &
spending my energy with the truly important parts of my life
(principally my wife, my family & my spiritual life) i have become
much more productive in my career & found greater joy in my
human existence."

-wayne parker
http://fatherhood.about.com/od/workingfathers/a/workaholism.htm

workaholism, antidote

Re: workaholism, antidote; 3-step process
Fr: james Adonis, work-life coach, 7Days (2007 June 26). “The pursuit of happiness,” p. 6. (underscore mine)

1. PRIORITIZE: decide what the most important thing is in your life.
Ex: family, friends, health, wealth, work
2. WORK TOWARDS YORU PRIORITY: identify barriers preventing you from achieving your goals and how you can work around them
3. FOLLOW THROUGH: follow through until you achieve

“work/life balance is a decision we make. we either decide we want to see people socially once or twice a week, or we don’t. we decide the world won’t end if we leave work on time, or we continue to work late. we choose to exercise or we choose not to.”

sexual abuse, clergy

"... the reformation itself was not so much about theology, but morals among clergy
or lack thereof. some priests were living in open relationships with women and some
church historians believe the pope himself may have fathered children.

"... one study found that 12% of the 300 protestant clergy surveyed admitted sexual
relations with parishioners (r.a. blackman, unpublished ph.d. dissertation, fuller theological seminary, 1984).

"... pastors are in a unique role in terms of trust, charisma, patriarchal privilege, and power. they are often viewed as 'god's representative,' whose
authority are also above reproach. concomitant with the position is a sense of trustworthiness and moral admiration that may be embellished by personal
charisma and charm.... if the church does not monitor itself, who will?"

- rev. les wicker (01/10/2007), senior pastor, first congregational church of naples, FL (florida). "is there a double standard for clergy?"
http://www.zwire.com/site/news.cfm? ERD=2605&dept_id=592840&newsid=17688826&PAG=461&rfi=9

a dyslexia case

july 31, 2007
today, i interviewed a 30-year old british construction manager. he admitted to me during the interview that he had dyslexia as a child, when asked about his weakness. he said that when he was 6-7 years old, his teacher suspected him to be dyslexic and referred him to a specialist who diagnosed him to be so and was given special tutorials. he was able to be independent of these specials lessons on how to read by age 10-11.
he told me that as a dyslexic, he processes reading materials differently from others and was taught techniques to cope accordingly. he had to practice reading and writing more than his classmates.
the effect on him up to now is being SLOW TO READ compared to others, like going over the long psychological tests i gave him. i also noticed that most of his writing on the information sheet were written in printed form rather than script and looked a bit crude.
when growing up, he realized math was just easier and more understandable to him than literature. thus, he became a construction manager.

reflection:
i cited this case here because i and my psychologist wife have been wondering whether our youngest son, angel, has dyslexia. he doesn't like writing, is one of the last to finish copying from the board, and even doesn't like going to school. not wanting to go to school and being left without a companion can be part of separation anxiety (childhood anxiety disorder, which is another possible diagnosis). my wife, who has 6 units of special education in the doctoral level, has been trying her best to assist him cope. she has also given him a standarized IQ test and came out average. however, i still insist on referring him to specialists for a more objective assessment. we are in the process of doing that.

eating disorders, new trend

"... eating disorders ... have long been considered diseases of the young, but experts say in recent years more women have been seeking help in their 30s, 40s, 50s, and older....
"... people who study eating disorders suggest several reasons ....
> growing public awareness,
> social pressure to be thin, and
> an aging group of baby boomers.
"... while BODY IMAGE is an issue for any age group,
women over 30 are dealing with problems that teens don't have, such as
> work,
> divorce,
> stepchildren and
> aging parents."

-- source: forleti, a. (associated press).
"doctors treating older anorexics."
http://news.yahoo.com/s/ap/20070723/ap_on_he_me/diet_eating_disorders_midlife

payer in depression

"why should i still live? but if it is not pleasing to you, o lord, to take my life,
hear me in my disgrace."
- sarah (tobit 3:15b)

PTSD (post-traumatic stress disorder), suicides

US statistics:

re: suicide rate
soliders who committed suicide:
N = 99 (2006) -- iraq & afghanistan wars
N = 88 (2005) -- iraq & afghanistan wars
N = 102 (1991) -- gulf war

suicide rate:
17.3/100,000 (2006)
9.1/100,000 (2001)

demographics:
"about 2x as many women serving in iraw & afghanistan committed suicide as did women not sent to war."

methods (most common):
firearms (for suicide)
overdose and cutting oneself (for attempted suicide)

factors:
- "failed personal relationships
- legal and financial problems &
- the stress of ther jobs."
- history of psychiatric disorders
("about a quarter of those who killed themselves had a history of at least one psychiatric disorder. of those, 20% had been diagnosed with a MOOD DISORDER such as bipolar disorder and/or depression; and 8% ... with an ANXIETY DISORDER, including post-traumatic stress disorder -- one of the signature injuries of the conflict in iraq."

research:
- "... there was a significant relationship between suicide attempt and number of days deployed in the war zones."
- there was "limited evidence to support the view that multiple ... deployments are a rich factor for suicide behavior."

-- jelinek, p. (AP). "army suicide highest in 26 years." http://news.yahoo.com/s/ap/20070816/ap_on_re_st_pe/army_suicides

eating disorders, introduction

Re: Eating Disorders, Introduction
Fr: http://www.nimh.nih.gov/publicat/eatingdisorders.cfm, accessed 2007 jul 23 (italics & highlight mine)

Eating Disorders: Facts About Eating Disorders and the Search for Solutions
• Introduction
• Anorexia Nervosa
• Bulimia Nervosa
• Binge-Eating Disorder
• Treatment Strategies
• Research Findings and Directions
• For More Information
• References

Eating is controlled by many factors, including appetite, food availability, family, peer, and cultural practices, and attempts at voluntary control. Dieting to a body weight leaner than needed for health is highly promoted by current fashion trends, sales campaigns for special foods, and in some activities and professions. Eating disorders involve serious disturbances in eating behavior, such as extreme and unhealthy reduction of food intake or severe overeating, as well as feelings of distress or extreme concern about body shape or weight. Researchers are investigating how and why initially voluntary behaviors, such as eating smaller or larger amounts of food than usual, at some point move beyond control in some people and develop into an eating disorder. Studies on the basic biology of appetite control and its alteration by prolonged overeating or starvation have uncovered enormous complexity, but in the long run have the potential to lead to new pharmacologic treatments for eating disorders.

Eating disorders are not due to a failure of will or behavior; rather, they are real, treatable medical illnesses in which certain maladaptive patterns of eating take on a life of their own. The main types of eating disorders are anorexia nervosa and bulimia nervosa.1 A third type, binge-eating disorder, has been suggested but has not yet been approved as a formal psychiatric diagnosis.2 Eating disorders frequently develop during adolescence or early adulthood, but some reports indicate their onset can occur during childhood or later in adulthood.3

Eating disorders frequently co-occur with other psychiatric disorders such as depression, substance abuse, and anxiety disorders.1 In addition, people who suffer from eating disorders can experience a wide range of physical health complications, including serious heart conditions and kidney failure which may lead to death. Recognition of eating disorders as real and treatable diseases, therefore, is critically important.

Females are much more likely than males to develop an eating disorder. Only an estimated 5 to 15 percent of people with anorexia or bulimia4 and an estimated 35 percent of those with binge-eating disorder5 are male.

Anorexia Nervosa

An estimated 0.5 to 3.7 percent of females suffer from anorexia nervosa in their lifetime.1 Symptoms of anorexia nervosa include:

• Resistance to maintaining body weight at or above a minimally normal weight for age and height
• Intense fear of gaining weight or becoming fat, even though underweight
• Disturbance in the way in which one's body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or denial of the seriousness of the current low body weight
• Infrequent or absent menstrual periods (in females who have reached puberty)

People with this disorder see themselves as overweight even though they are dangerously thin. The process of eating becomes an obsession. Unusual eating habits develop, such as avoiding food and meals, picking out a few foods and eating these in small quantities, or carefully weighing and portioning food. People with anorexia may repeatedly check their body weight, and many engage in other techniques to control their weight, such as intense and compulsive exercise, or purging by means of vomiting and abuse of laxatives, enemas, and diuretics. Girls with anorexia often experience a delayed onset of their first menstrual period.

The course and outcome of anorexia nervosa vary across individuals: some fully recover after a single episode; some have a fluctuating pattern of weight gain and relapse; and others experience a chronically deteriorating course of illness over many years. The mortality rate among people with anorexia has been estimated at 0.56 percent per year, or approximately 5.6 percent per decade, which is about 12 times higher than the annual death rate due to all causes of death among females ages 15-24 in the general population.6 The most common causes of death are complications of the disorder, such as cardiac arrest or electrolyte imbalance, and suicide.

Bulimia Nervosa

An estimated 1.1 percent to 4.2 percent of females have bulimia nervosa in their lifetime.1 Symptoms of bulimia nervosa include:

• Recurrent episodes of binge eating, characterized by eating an excessive amount of food within a discrete period of time and by a sense of lack of control over eating during the episode
• Recurrent inappropriate compensatory behavior in order to prevent weight gain, such as self-induced vomiting or misuse of laxatives, diuretics, enemas, or other medications (purging); fasting; or excessive exercise
• The binge eating and inappropriate compensatory behaviors both occur, on average, at least twice a week for 3 months
• Self-evaluation is unduly influenced by body shape and weight

Because purging or other compensatory behavior follows the binge-eating episodes, people with bulimia usually weigh within the normal range for their age and height. However, like individuals with anorexia, they may fear gaining weight, desire to lose weight, and feel intensely dissatisfied with their bodies. People with bulimia often perform the behaviors in secrecy, feeling disgusted and ashamed when they binge, yet relieved once they purge.

Binge-Eating Disorder

Community surveys have estimated that between 2 percent and 5 percent of Americans experience binge-eating disorder in a 6-month period.5,7 Symptoms of binge-eating disorder include:

• Recurrent episodes of binge eating, characterized by eating an excessive amount of food within a discrete period of time and by a sense of lack of control over eating during the episode
• The binge-eating episodes are associated with at least 3 of the following: eating much more rapidly than normal; eating until feeling uncomfortably full; eating large amounts of food when not feeling physically hungry; eating alone because of being embarrassed by how much one is eating; feeling disgusted with oneself, depressed, or very guilty after overeating
• Marked distress about the binge-eating behavior
• The binge eating occurs, on average, at least 2 days a week for 6 months
• The binge eating is not associated with the regular use of inappropriate compensatory behaviors (e.g., purging, fasting, excessive exercise)

People with binge-eating disorder experience frequent episodes of out-of-control eating, with the same binge-eating symptoms as those with bulimia. The main difference is that individuals with binge-eating disorder do not purge their bodies of excess calories. Therefore, many with the disorder are overweight for their age and height. Feelings of self-disgust and shame associated with this illness can lead to bingeing again, creating a cycle of binge eating.

Treatment Strategies1

Eating disorders can be treated and a healthy weight restored. The sooner these disorders are diagnosed and treated, the better the outcomes are likely to be. Because of their complexity, eating disorders require a comprehensive treatment plan involving medical care and monitoring, psychosocial interventions, nutritional counseling and, when appropriate, medication management. At the time of diagnosis, the clinician must determine whether the person is in immediate danger and requires hospitalization.

Treatment of anorexia calls for a specific program that involves three main phases: (1) restoring weight lost to severe dieting and purging; (2) treating psychological disturbances such as distortion of body image, low self-esteem, and interpersonal conflicts; and (3) achieving long-term remission and rehabilitation, or full recovery. Early diagnosis and treatment increases the treatment success rate. Use of psychotropic medication in people with anorexia should be considered only after weight gain has been established. Certain selective serotonin reuptake inhibitors (SSRIs) have been shown to be helpful for weight maintenance and for resolving mood and anxiety symptoms associated with anorexia.

The acute management of severe weight loss is usually provided in an inpatient hospital setting, where feeding plans address the person's medical and nutritional needs. In some cases, intravenous feeding is recommended. Once malnutrition has been corrected and weight gain has begun, psychotherapy (often cognitive-behavioral or interpersonal psychotherapy) can help people with anorexia overcome low self-esteem and address distorted thought and behavior patterns. Families are sometimes included in the therapeutic process.

The primary goal of treatment for bulimia is to reduce or eliminate binge eating and purging behavior. To this end, nutritional rehabilitation, psychosocial intervention, and medication management strategies are often employed. Establishment of a pattern of regular, non-binge meals, improvement of attitudes related to the eating disorder, encouragement of healthy but not excessive exercise, and resolution of co-occurring conditions such as mood or anxiety disorders are among the specific aims of these strategies. Individual psychotherapy (especially cognitive-behavioral or interpersonal psychotherapy), group psychotherapy that uses a cognitive-behavioral approach, and family or marital therapy have been reported to be effective. Psychotropic medications, primarily antidepressants such as the selective serotonin reuptake inhibitors (SSRIs), have been found helpful for people with bulimia, particularly those with significant symptoms of depression or anxiety, or those who have not responded adequately to psychosocial treatment alone. These medications also may help prevent relapse. The treatment goals and strategies for binge-eating disorder are similar to those for bulimia, and studies are currently evaluating the effectiveness of various interventions.

People with eating disorders often do not recognize or admit that they are ill. As a result, they may strongly resist getting and staying in treatment. Family members or other trusted individuals can be helpful in ensuring that the person with an eating disorder receives needed care and rehabilitation. For some people, treatment may be long term.

Research Findings and Directions

Research is contributing to advances in the understanding and treatment of eating disorders.

• NIMH-funded scientists and others continue to investigate the effectiveness of psychosocial interventions, medications, and the combination of these treatments with the goal of improving outcomes for people with eating disorders.8,9
• Research on interrupting the binge-eating cycle has shown that once a structured pattern of eating is established, the person experiences less hunger, less deprivation, and a reduction in negative feelings about food and eating. The two factors that increase the likelihood of bingeing—hunger and negative feelings—are reduced, which decreases the frequency of binges.10
• Several family and twin studies are suggestive of a high heritability of anorexia and bulimia,11,12 and researchers are searching for genes that confer susceptibility to these disorders.13 Scientists suspect that multiple genes may interact with environmental and other factors to increase the risk of developing these illnesses. Identification of susceptibility genes will permit the development of improved treatments for eating disorders.
• Other studies are investigating the neurobiology of emotional and social behavior relevant to eating disorders and the neuroscience of feeding behavior.
• Scientists have learned that both appetite and energy expenditure are regulated by a highly complex network of nerve cells and molecular messengers called neuropeptides.14,15 These and future discoveries will provide potential targets for the development of new pharmacologic treatments for eating disorders.
• Further insight is likely to come from studying the role of gonadal steroids.16,17 Their relevance to eating disorders is suggested by the clear gender effect in the risk for these disorders, their emergence at puberty or soon after, and the increased risk for eating disorders among girls with early onset of menstruation.

For More Information
Eating Disorders Information and Organizations from NLM's MedlinePlus (en Español)

References

1American Psychiatric Association Work Group on Eating Disorders. Practice guideline for the treatment of patients with eating disorders (revision). American Journal of Psychiatry, 2000; 157(1 Suppl): 1-39.

2American Psychiatric Association. Diagnostic and Statistical Manual for Mental Disorders, fourth edition (DSM-IV). Washington, DC: American Psychiatric Press, 1994.

3Becker AE, Grinspoon SK, Klibanski A, Herzog DB. Eating disorders. New England Journal of Medicine, 1999; 340(14): 1092-8.

4Andersen AE. Eating disorders in males. In: Brownell KD, Fairburn CG, eds. Eating disorders and obesity: a comprehensive handbook. New York: Guilford Press, 1995; 177-87.

5Spitzer RL, Yanovski S, Wadden T, Wing R, Marcus MD, Stunkard A, Devlin M, Mitchell J, Hasin D, Horne RL. Binge eating disorder: its further validation in a multisite study. International Journal of Eating Disorders, 1993; 13(2): 137-53.

6Sullivan PF. Mortality in anorexia nervosa. American Journal of Psychiatry, 1995; 152(7): 1073-4.

7Bruce B, Agras WS. Binge eating in females: a population-based investigation. International Journal of Eating Disorders, 1992; 12: 365-73.

8Agras WS. Pharmacotherapy of bulimia nervosa and binge eating disorder: longer-term outcomes. Psychopharmacology Bulletin, 1997; 33(3): 433-6.

9Wilfley DE, Cohen LR. Psychological treatment of bulimia nervosa and binge eating disorder. Psychopharmacology Bulletin, 1997; 33(3): 437-54.

10Apple RF, Agras WS. Overcoming eating disorders. A cognitive-behavioral treatment for bulimia and binge-eating disorder. San Antonio: Harcourt Brace & Company, 1997.

11Strober M, Freeman R, Lampert C, Diamond J, Kaye W. Controlled family study of anorexia nervosa and bulimia nervosa: evidence of shared liability and transmission of partial syndromes. American Journal of Psychiatry, 2000; 157(3): 393-401.

12Walters EE, Kendler KS. Anorexia nervosa and anorexic-like syndromes in a population-based female twin sample. American Journal of Psychiatry, 1995; 152(1): 64-71.

13Kaye WH, Lilenfeld LR, Berrettini WH, Strober M, Devlin B, Klump KL, Goldman D, Bulik CM, Halmi KA, Fichter MM, Kaplan A, Woodside DB, Treasure J, Plotnicov KH, Pollice C, Rao R, McConaha CW. A search for susceptibility loci for anorexia nervosa: methods and sample description. Biological Psychiatry, 2000; 47(9): 794-803.

14Frank GK, Kaye WH, Altemus M, Greeno CG. CSF oxytocin and vasopressin levels after recovery from bulimia nervosa and anorexia nervosa, bulimic subtype. Biological Psychiatry, 2000; 48(4): 315-8.

15Elias CF, Kelly JF, Lee CE, Ahima RS, Drucker DJ, Saper CB, Elmquist JK. Chemical characterization of leptin-activated neurons in the rat brain. Journal of Comparative Neurology, 2000; 423(2): 261-81.

16Devlin MJ, Walsh BT, Katz JL, Roose SP, Linkei DM, Wright L, Vande Wiele R, Glassman AH. Hypothalamic-pituitary-gonadal function in anorexia nervosa and bulimia. Psychiatry Research, 1989; 28(1): 11-24.

17Flanagan-Cato LM, King JF, Blechman JG, O'Brien MP. Estrogen reduces cholecystokinin-induced c-Fos expression in the rat brain. Neuroendocrinology, 1998; 67(6): 384-91.
________________________________________
This publication was written by Melissa Spearing, Public Information and Communications Branch, National Institute of Mental Health (NIMH). Expert assistance was provided by NIMH Director Steven E. Hyman, M.D., and NIMH staff members Bruce N. Cuthbert, Ph.D., Regina Dolan-Sewell, Ph.D., Benedetto Vitiello, Ph.D., Clarissa K. Wittenberg, and Constance Burr. Editorial assistance was provided by Margaret Strock and Lisa D. Alberts, also NIMH staff members.

NIH Publication No. 01-4901
Printed 2001

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filipino coping mechanism, humor

"according to manila businessman, tonyboy ongsiako, there is so much wit in the philippines because we are a country where a good sense of humor is needed to survive."
- fwd email by aceoralde@yahoo.com, 2007 aug 23

relaxation exercises

Re: Stress Management, Relaxation Techniques
Fr: Meyer, R. G. & Deitsch, S. E. (1996). The clinician’s handbook: Integrated diagnostics, assessment, and intervention in adult and adolescent psychopathology (4rth ed.). Needham Heights, MA: Allyn & Bacon, pp. 499-504.

These two relaxation techniques help clients relax “both physiologically and psychologically” (p. 499).

1. BRIEF RELAXATION TRAINING (pp. 499-500)

-- brief and straightforward, useful in crisis and short-term applications

“Lie relaxed with your legs uncrossed and your arms comfortably beside you. First, focus mentally on your toes, imagining them to be limp, warm, and relaxed (you can vary this procedure by first flexing each muscle group before you proceed into a relaxation phase; some find that this increases the subsequent relaxation effect). Now, visualize your foot and then your ankles, and suggest that they relax and feel loose. Follow this pattern up your body, silently focusing on and identifying each part as you relax it (calves, knees, upper legs, hips). Then proceed through your lower torso, including the genital and anal areas. Suggest relaxation, calmness, and warmth. Proceed slowly but surely into the stomach area, again identifying each area, particularly if there is noticeable tension there. Suggest to yourself that your breathing is normal and calm (neither slowed abnormally nor fast). Go up through your chest, shoulders, and, part by part, down your arms to your fingertips. Then focus on the neck area, particularly noting the jaw muscles and even such small areas as the tongue and the tip of the nose. Focus next on the forehead, but suggest coolness there, for this is one body part where coolness is clearly associated with relaxation. Then suggest looseness in the scalp, and possibly finish off with a mental image of your whole body as relaxing calmly and serenely.

[“You might choose instead to work downward from the head to the toes or to develop other variations that feel more comfortable to you. Don’t expect remarkable results in the first few days or so. But continued practice of a relaxation approach of some sort is one effective antidote and preventive measure in controlling many psychological disorders.”]

2. AUTOGENIC TRAINING (AT) (pp. 500-504)

-- focused on prolonged physiological relaxation, designed to be practiced over a substantial duration and integrated into one’s lifestyle like yoga and tai-chi
-- invented by a German academic Westernizing yoga techniques I the early 1900s
-- indications and benefits: “to (a) enhance IMMUNE responses, (b) reduce situational TENSION, and (c) lessen chronic ANXIETY” (p. 504).

a. Positions

(1) Prone Position (lying on a couch or bed)
- remove shoes
- legs slightly apart
- feet inclined outward at a V-shaped angle
- support (ex: folded blanket) under knees
- trunk, shoulders, and head symmetrical
- arms slightly bent beside trunk
- fingers slightly spread and flexed

(2) Reclining Chair Position
- high enough back for trunk and head
- support length of arms and legs
- (same as most of prone position above)

(3) Straight Chair Position
- feet rest solidly on ground
- straighten up completely in sitting position
- arms hang down at sides, touch legs in loose position
- collapse trunk, shoulders, and neck while back straight
- body feels “hanging loose”
- head drop forward
ps: test: lift hand and let it drop of its own accord

b. Training Elements (pp. 501-502)

(1) Passive Concentration
- attitude toward result = casual and passive, i.e., no need to see results occurring
during exercise
- self-talk: “During this particular session, I really don’t care whether my particular goal happens. I know it will happen sometime, so I’m calm about it now.”
- vs. active concentration = concern, attention, and even active efforts to try to make results come about during the exercise
-
(2) Steady Flow of Images
- by speaking the words aloud, using inner voice, or visual image

(3) Mental Contact
= putting the mind’s attention on the body part in focus

(4) Reduction of Stimuli
- quite with low light
- loosen to a point of comfort or remove restrictive clothing (glasses, belt, girdle, or necktie)
- cut off external distractions like telephone
- no time pressure

(5) Time in Practice
- 1-2x a day
- 1 formula = ~60 sec

b. The Exercises

(1) The Overall Formula
- mental contact:: whole body, “central core” of the body, or up above body looking down
- inserted between specific formulae, ex: “I am at peace.” “I am calmness throughout.”

(2) Standard Exercise 1: Heaviness
- Induce a feeling of heaviness (correlated with relaxation)
- mental contact: limbs
- formula: “My right arm is heavy. My left arm is heavy. Both arms are heavy.” (then change “arm” to “leg”.)
- after some months: “My arms and legs are heavy.”

(3) Standard Exercise 2: Warmth
- induce a feeling of warmth (correlated with relaxation)
- mental contact: most body parts, limbs included
- formula: same as above, just change “heavy” with “warm”

(4) Standard Exercise 3: Respiration
- natural breathing rate
- formula: “My breathing just naturally happens.”
- use passive concentration: goal – to let it just happen
- mental contact: chest area or overall body

(5) Standard Exercise 4: Abdominal Warmth
- mental contact: solar plexus = area ~2-3 inches below navel
- formula: “My solar plexus is warm.” (warmth here counteracts anxiety)

(6) Standard Exercise 5: The Cooling of the Forehead
- mental contact: ~1 inch above eyes into scalp
- formula: “My forehead is cool and smooth.”
(coolness in the forehead is associated with relaxation)

stress management, tips

re: blogging!!!
fr: 3tails (a National University of Singapore english language professor) http://etails.blogspot.com

"... and this time now, blogging my tension away, is a 'time-out' moment before i resume the arduous task ...."