Treatment of eating disorders

Treatment of eating disorders

(anorexia and bulimia through yogatherapy and eutony)

Paper to be presented at the International Conference Kaivalyadhama, Lonavla. December 2002 by Dr. Alicia Souto from Salvador University, Argentina)

Abstract

The paper discusses the basic principles of Yoga and Eutony in relation with alimentary disorders (anorexia and bulimia). This project was started on May 2001 as a cooperation between a Municipal Hospital in Buenos Aires, Argentina and the Yogatherapy and Eutony Center. The components of the multidisciplinary staff are one endocrinologist, two nutritionists, two psychologists, an intensive cares specialist and myself a yogatherapist and eutonist. Eutony means etymologically harmonious muscle tone, by this method the involuntary tonus regulation and autonomic balance can be consciously influenced.

Anorexia nervosa is an eating disorder characterized by a refusal to eat, even to the point of starvation accompanied by intense fear of becoming fat no matter how thin the individual becomes. Other symptoms are obsession with working out, extreme over activity, negative feelings about the way the body looks. 95% of the patients are female. The illness mostly appears during adolescence, between 12 and 18 years old.

Some of these patients quit eating, some take laxatives, and some make themselves vomit immediately after eating.

At the beginning of the disease most of them have normal feelings of hunger but they teach themselves to ignore them.

Another caracteristic feature of the disorder is that people with anorexia usually deny that there is anything wrong and even insists that they need to lose more weight.

Many females who are anorexic are also bulimic.

Bulimia nervosa is defined as the consumption of extremely large quantities of food in short periods of time followed by self-induced vomiting or the use of either diuretics or cathartics (purging).

Anorexia can lead to underweight, extreme weakness, cessation of menstruation (amenorrea), swelling of the neck, dizziness, ulcers and erosion of the esophagus, erosion of the back of the teeth, broken blood vessels in the face, and low pulse rate and blood pressure.

Systemic physiological changes in those suffering from anorexia include thyroid dysfunction, disturbances in the heartbeat and irregularity in the secretion of growth hormones and cortisone, vasopressin and gonadotrophin.

If anorexic behavior continues complications associated with starvation appear. Electrolyte imbalances brought on by insufficient sodium and potassium levels cause dehydration, muscle spasm and ultimately, cardiac arrest. If laxatives are used these further deplete the body of potassium hipokalemia (potassium deficiency) is a mayor problem for people with anorexia because it can cause an irregular heartbeat that can lead to heart failure.

Some years ago anorexia was considered being a psychological problem. But in the last few years medical scientists an nutritionists have identified physical components as well: For example persons with eating disorders have been found to have chemical imbalances similar to those found in individuals with clinical depression. Some cases of anorexia have been found to be caused by zinc deficiency.

As researchers have become increasingly aware of the physiological elements of anorexia, the psychological ones continue to be the most important, teasing by pears or parents can play a role in making individual obsessed with the idea that they are fat. In addition many persons who suffer from anorexia display great fear at the prospect of growing up, and girls often have difficult mother/daughter relationships. Some way try to live up to images their parents set for them, but feel inadequate. A girl with anorexia may develop an inferiority complex, seeing herself as fat and ugly and no amount of common sense can alter her distorted mental image.

About 30 percent of all people with anorexia struggle with the disorder all their lives. Another 30% have at least one life threat bond with it, while the remaining 40% outgrow it. Even if an individual recovers fully from the acute phase of the disorder, serious damage may have been done to the body.

In many cases a person with anorexia must be hospitalized and given intravenous nutrient feedings of potassium and multivitamins. This often happens in the hospital where we develop this project.

Starvation tends to increase feelings of depression irritability and anger. It may take up to a year or more for a person recovering from anorexia to improve the body image, to reestablish normal eating patterns and to reverse the effects of starvation on behavior and mood. Some recent researches consider that neurotransmitters, such as dopamine, serotonin, norepinephrine and the endogenous opioids (endorphins) play a role in anorexia.

During my observations, anorexia patients showed their difficulty to make contact with their families and with other patients from the group like as if they feel mistrust towards the world instead of taking pleasure from been in contact.

I used in this project a great deal of intuition. The principle of contact from eutony was fundamental as it gives results because of the tone regulation achieved.

Eutony means etymologically harmonious muscle tone, by this method the involuntary tonus regulation and autonomic balance can be consciously influenced.

The tone regulation stimulates breathing, circulation and metabolism. The contact with the environment also removes the feeling of isolation and is particularly valuable in these cases.

There is a great difference between the medical approach and the eutonic and yogic approach. The medical model has made the patients into passive subjects while in these not traditional methods of therapy the patients are required to take full responsibility and active participation to overcome their difficulties.

The special yoguic practices that I indicate are: âsanas that increases agni like Mayurâsana, Pashcimatanâsana, vakrâsana, practices like yogamudrâ, ashvin- mudrâ, uddiyanabandha, prânâyâmas like bhastrikâ, suryabhedana and nadishodhana, kriyâs as agnisara, kapalabhati, meditation and relaxation.

During yoga practice the accent is in samprayoga aspect, the awareness of every change: patients should guide their attention on perceiving the feedback information from their experiences. This sensory orientation is termed as samprayoga and with its help the patients are able to follow a higher amount of information. Both the propioceptive and interceptive perceptions can be gradually improved to a great extent.

Sometimes they work on the sensations of touch on the spine with bamboo sticks to release tensions and to increase the awareness of the volume and weight of the body. From their testimony, yogic and eutonic practices developed them physically and mentally giving them peace of mind and the capacity to accept their physical imbalances. They observed that their concentration had increased and their body awareness had improved.

We try to help our patients to develop their own concrete security during the practices through the conscious support of their bone structure helping them to achieve self-awareness and self-help.

Generally after the class the pupil feels freer, full of energy with a big opening in the whole person and they are able to feel themselves more clearly, this is experienced as very helpful.

At the end of the classes the participants were asked to write down and draw what they had experienced immediately after the practices. Sometimes they were asked to model their experience in clay with eyes closed. They manifested in this way differences in body awareness and the relationship with space and people around, and slowly with treatment they became more conscious of their own body image

In anorexic girls we realized that the awareness of the shape and proportion of the body do not always coincide with the visible reality.

Even the best treatment can have no lasting success if a false body image is not corrected simultaneously whit patients with eating disorders. It is important to realize that the whole personality is shown in their clay models.

More often than not, these modeling and drawing tests show that this kind of patients rarely have an image of their body corresponding to its actual form. This is indicative of their general alienation from the body, the lack of real contact and the isolation to be found in our society.

The first step is to normalize their body image.

During the class before and during the practice of âsanas or breathing techniques they were asked to take contact with the ground, another important aspect to develop the unity of the body is the awareness of inner space as a whole.

There are general approaches from allopathic medicine and Ayurveda.

In relation with our work at a National Hospital in Argentina: We work as a multidisciplinary team, the numbers are: one endocrinologist, one childrens doctor, one intensive care specialist, two nutritionists, one psychiatrist, two psychologists and myself as a yogatherapist and eutonist.

As staff members meet once a week to discuss about our difficulties and findings in treating the patients.

The patients are regularly subject to laboratory tests, as blood, urine and hormonal tests. They should attend psychological sessions and once a week a family session with the psychiatrist. They have weekly meetings with the nutritionist to control and guide their diet.

Till now we continue working in this difficult disorder and it's surprising to see the effect of the practices in relation with their behavioral and alimentary patterns.

I know this pathology is new in India, is only present in big cities and especially in wealthy families, which are influenced by western fashion, but is interesting to find that also Ayurveda considers anorexia under the name of arochaka and as a psycho physiological condition usually seen in girls.

We are hoping, with this multidisciplinary approach and with the addition of disciplines as yoga and eutony to go a step forward in the difficult treatment of eating disorders.

Alicia Souto Ph.D.
Argentina
Salvador University