User:Scarpy/Overeaters Anonymous

Nonprofit internationa organization that provides volunteer support groups worldwide patterned after the 12-step Alcoholics Anonymous program. Addreses physical, emotional, and spiritual recovery aspects of compulsive overeating. Members encouraged to seek professional heal for individualized diet/neutrition plan and for any emotional physical problems.

Clients: Individuals who defined themselves as compulsive eaters. Staff: Nonprofessional volunteer group members who meet specific critera lead meetings sit on the board and conduct activities. Expected: Makes no claims for weight loss. Unlimited length. Cost: Self-supporting with member contributions and sales of publications (includes workbooks, tapes, newsletters, and sponsor outread programs. Its international month journal, Lifetime, costs 12.99 a year). Healthy Lifestyle Components: Recommends emotional, spiritual, and physical recovery changes. Makes no exercise or food recommendations. Comments: Inexpensive. Proves group support. No need to follow a specific diet plan to participate. Minimal organization at the group level, so groups vary in appraoch. No health-care providers on staff. Availability: 10,500 groups in 47 countries. Headqueaters: Rio Rancho, NM.



Bulimia Nervosa Using five OA skills or strategies: (1) OA meeting attendance and participation, (2) interaction with a sponsor (3)processing (i.e. wriging and journal), (4) spitituality (i.e. prayer and meditation), and (5) adherrence to a food plan. Because bulimia is reported as a hcronic disorder and the expense related to ongoing clinical treatment may be prohibitive for many individuals, there is a need to consider the role of self-help treatments in the....

Is support for self-help groups in reducing BN and can reduce the cost of treatment while providing interpersonal support to members.

Self-help involving limited professional contact or the us of self-help materials along resulted in a reduction in symptoms among a large proportion of participants.

Two recent studies using CBT dfound no difference in treatment outcomes for binge eating disorder between these treatment modalities.

"abstinence" in OA is not straying from food plan, and avoiding binge-triggering foods.

OA members experienced improvements in the emotional, spiritual, and scoail aspects of their lief as a result of group membershup. OA's emphasis on group commitment and psychological and spritual development provided a framework for developing positive, adaptive, and self-nurtuing treatment opportunities. Spritiuality and the value of abstinence were statistically significant in predicting weightloss success among overweight subjects.

Hamwi formula

Participatns regarded OA meetings attendence and a food plan to monitor deaily eating as the two most critical recovery skills. Meetings offter a consensual validation and serve to diminish feelings of guilt ans shame.

Sponsor provides guidance but gradually encourages autonomy in the sponsee. A sponsor strives to make her job obsolete.

Food plans - 1/3 rigid, 2/3 increasingly more flexible. Food plan became less rigid after one year.

Recovered women are less likely to be self-protective when discussing their eating disorders.

(100%) Regular meeting attendance was the most important part. 74%

Major name of OA is abstinence from compulsive eating (binge eating and purging)

Overeaters Anonymous (1980). Compulsive overeating and the OA recovery program. Torrance, CA: Author. Overeaters Anonymous (1993). Anonymity: The meaning and applications of traditions eleven and twelve. Torrance, CA. Author. Overeaters Anonymous, 1993

Eating Attitudes Test, Body Shape Questionnaire, Outcome Questionnaire. NEither intrinsic religiousness not religious affiliation were associated with treatment outcomes. However, improvements in spiritual well-being during treatment were significantly associated with positive gains in eating attitiudes,  less body shape conerns, and positive psychological and social functioning.



Other models aimed at eating disorder treatment include 12-Step groups such as Overeaters Anonymous. Trotzky (2002) examined the use of the 12- Step Anonymous Fellowships within the Israel Counseling and Treatment Center of the North, to examine the treatment of eating disorders through an addiction model. Bulimia nervosa and overeater/binge eaters were treated with a 12-Step approach. The results of this study showed success in the binge eating population with weight loss in 62% of the subjects. The bulimia subjects had a lower success rate, measured as abstinence from purging behaviors for sixth months, of 33%. Others have examined the success of Overeaters Anonymous, which is aimed at treating the pathologic behaviors of overeating and binge eating. Overeaters Anonymous, or OA as it is commonly known, attempts to integrate spiritual and emotional components of a person’s overeating or impulse eating (Weiner, 1998). OA’s approach to overeating is one that identifies overeating with a method that patients use to control their fluctuating moods and affects. According to Weiner (1998), OA then attempts to provide and encourage, through a self-help group model, more acceptable and less harmful ways of controlling affect and emotions than through food addiction or overeating.

Trotzky, A. S. (2002). The treatment of eating disorders as addictions among adolescent females. International Journal of Adolescent Medicine and Health, 14(4), 269–274.



A world view transformation was found in four domains: (a) experience of self; (b) Universal Order/God; (c) relationships with others; (d) perception of the problem. When eating disorders become acute they become a cental factor in the life-experience of their sufferers, sometimes even life-endangering.

OA was founded in the United States in 1960. Initially it was focuses only on overeating, but has expanded to include bulimia and anorexia. mutual aid is integrated with a spiritual program for personal development.

One way of research that impact is to track the transformation of group members' worldview.

Changes in worldview are perceived as vital for the individuals recovery process, on the assumptopn that they are accompanied by major behavioral changes. According, several research have identified world view transformation in members of various self-help groups engaged in addiction issues.

Four life domains taht which compose worldview: experience of seld; universal order/God; realtions with others; and the domain of the problem. The model was found to be broad enough to encompass a wide range of problems troubling different self-help groups such as those targeting women .... It was also found appropriate for describing processes undergone by members from different cultural backgrounds. Worldview may be reflected in the group's documents, expressed in conversations and meetings between members, or presented as part of the experiences of members and the group.

Most members attested to seeking absolute control of their own lives and those of others, with disproprotional degrees of intervention and critivism. Their experience of self was also characterized by strong feelings of personal failure, dependence, despair, stress, nervousness, low self-esteem, powerlessness, lack of contorl, self-puty, frustration and loneliness. As part of these feelings, the seld was perceived as being both a victim of circumstances and a victim of the attutude of others. Many members viewed this lack of esteem as deriving from their external appearance. Harsk self-criticism is a typical characteristic, accompanied by feelings of "I don't deserve it," and "I'm worth less than others." Such feelings were found to have a dominant influence on the structure of relationships with others.

There are two aspects unique to people with eating disorders, in comparison with NA and AA members (Humphreys & Kaskutas, 1995; Ronel & Humphreys, 1999–2000). They are the false sense of pseudo-success, and the constant attempts to control others through criticism, even in areas of life which do not directly impinge on them or their addiction. OA members are part of normative society, and since it is important for them to be accepted by it, their pretence was a supportive factor. Their selfperception was influenced by their conceiving of themselves as less valued due to their external appearance and because of the disorder they are afflicted with. Their self-conception was accompanied by attempts to com pensate for those “weak points.” Among OA members, frustration and a painful sense of failure generate a conflict between seeking control of all spheres of their lives, while still having to appear in control vis-a` -vis their experienced inability to control the disorder. Their sense of failure stems from the need to feel valued, and it creates a vicious circle that brings in its wake recurring compulsive eating, simultaneously exacerbating the vicious circle:

The members describe their sense of relaxation and liberation and the concomitant growing value of restraint and modesty in their lives. Their testimonies show that, paradoxicall, it is by cecoming aware of their powerlessness and accepting that the self's basic limitations that they start to feel the recovering self's growing power. At the same time, personal responsibility replaces self-pity and the expectation taht others will act for the good of the individual.

Changes perception from someone who "eats uncontrollably" to somone who has limitations and therefor "doesn't eat what is harmful for me."

In other words, the expectation for control brings with it the experience of the self as helpless

Though the 12-step program is no linked with a specific religious group, at its core lies the aspiration for spiritual growth as a basis for recovery. Come from a secular-atheist backgrounds, with a basic attitude of relying soely on their own capacities and willpower.

In this attitude, egocentricity and exaggerated, false self-confidence perpetuate the problem that led them to join OA.

While eating disorder was active many OA members mained that their experience of self was composed of an obessive aspirtation for perfection that concealed their sense of wothlessness.

OA and its recovery program have been the object of severe feminist criticism, which maintains that the perception of powerlessness adversely affects women’s ongoing struggle for empowerment (Johnson & Sanone 1993). Critics maintain that since feelings of powerlessness constitute one of the major factors implicated in causing eating disorders, admitting to powerlessness might intensify the primary problem of compulsive eating and/or cause a further lowering of status among women suffering from eating disorders. Van Wormer (1994) claims that teaching people that they are powerless over addiction is liable to encourage passivity and prevent them from developing coping tools, and that this is especially true of women who have suffered oppression, distress, and self-hatred. In the present research, we found no reinforcement for the feminist critique. In opposition to the feminist claims, OA members in Israel do not see avoiding compulsive eating as a burden, nor as another humiliation added to those they suffered in the past. On the contrary, they view it as alleviating and improving their self-esteem. Furthermore, perceiving themselves as powerlessness did not encourage them to be passive, but to assume personal responsibility proactively. To sum up, the present study of OA reveals a phenomenological perception of various eating disorders and of pragmatic options for recovering from them. Like AA/NA, awareness of the possibility for recovery through OA is gaining recognition and is being implemented in professional practices that treat eating disorders. Changes in worldview are likely to provide a useful therapeutic component in such practices.



Part of the OA process is that members become more aware of their emotions.

Physical - the weight comes off! Emotional - not "eating down" feelings Spritual - Feeding the iner hunger appropriately.

Food plan

Breaks sense of isolation



Most of the survivors I interviewed cam from Overeaters Anonymous (OA), which was founded in 1961 by three women, to help them with their eating disorders. Today, there are about 160,000 members in the OA fellowships.



Optifast, ediets.com, Health Management Resources, Take Off Pounts Sensibly OPTIFAST, and Weight Watchers. Weight Watchers reported a loss of 3.2% of initial weight at 2 years.

These programs were associated with high cots, high attrition rates, and a high probability of regaining 50% or more of lost weight in 1 to 2 years. Commerical interventions available over the Internet and organized self-help programs produced minimal weight loss.

With the exeption of 1 trial of Weight Watchers, the evidence to support the use of the major commerical and self-help weight loss programs is suboptimal.

Overaters Anonymous believes that obesity results from compulsive eating, which, in turn, is considered the consequence of sadness, loneliness, and other untoward emotions. Participants frequenlty report that they are addicted to fodd. The program seeks to guide participants to physical, emotiona, and spiritual recovery.

Found no published evaluations of the efficacy of Overeaters Anonymous for weight loss.

Overwaters Anonymous seems most appropriate for patients who seek intensive emotional support in losting weight. Such persons should be advised to smaple different Overwaters Anonymous groups, because each apparently has its own character.

OA are imporant options for such persons, despire their lack of documented efficany for people without scratch.



People with Binge Eating Disorder (BED) failed to meet the diagnosti criteria for bulimia nervosa (BN) since they lack the compensatory wright control behaviors such as self-induced vomiting, the misuse of laxatices, diuretics or enemas, fasting execessive exercise, or the misuse of diet pills of thyroid hormons and the lack of overconcern with weight and shape. BED is part of Eating Disorders not otherwise specific (EDNOS). There is no comparable diagnostic category in the ICD-10 (WHO, 1992).

Questionnaire on Eating and Weighr Patterns. 2-5% in the United States. 65 per cent female, 35 per cent male. Approxiamately 70 percent of individuals in OA display BED. Only have of the BED subjects were obese. Only about 5% of the obese subject met BED criteria.



The same personality factors that place individuals at risk for substance abuse are often found in individuals with eating disorders. Overwaters Anonymous emphasizes the psychological and spiritual components with its main focus being the commitment to the group. Weight Watchers is also rooted in the fellowship of community, but adopts a more behavioristic model.

Food is abundant in our society, yet so are drugs. Is the abundance of drugs a reason not to take AA or NA seriously? More advanced societys has different problems to deal with as a result of their status?

Binge eatins has also been viewed as a "futile attempt to restock depleted emotional stores when attempt at doing everything perfectly have failed.

The self-destructive behavior of injecting intoxicating drugs parallels overeating in that it permits the user not only to experience comfort, but to feel deservedly punished when through.

similar personality factors: the need to discharge affective experience through action rathe than feeling or being able to talk aboutthem, an inability to regulate tension, the need for immediate gratification, poor implusive control, and a fragile sense of self.

For women, especially, thinness is equated with control, discipline, beauty, success, and popularity.

There is a large genetic component to body type.

Bulimia and depression.

Research from a family systems perspective indicates that eating disorders stem from both the adolescent's difficulty in separating from overcontrolling parents, and disturbed patterns of communication. When parents are critical and unaffectionate, the child is more prone to becoming self-destructive and self-critical, having difficulty developing the skills to engage in self-caregiging behaviors.

Developmental failtures in early relationships with others, particularly maternal empathy, impairs the development of an internal sense of self and leads to an overdependence on the enviroment. "Early separation-individuation conflicts are reactivated in adolescence when identity formation, autonomy and developing intimate relationships outside the family are the parimary developmental tasks. As adults these individuals are needy, vulnerable to addictive behaviors, and experience inner tension and emptiness as interable. In the absence of effective internal coping responses, food and drugs are often substituted as objects of gratifiaction because unlike relationships, theycan be consistently counted on.

OA's belief is that obesity is the symptom of a siease "compulsive overeating," that has physical, emotional and spiritual components. The illness can be controlled but not cured. OA ofter refers to overeating as a form of "insanity," which some critics see as a heavey-handed strategy for insuring adherence to the group's rules.

They physical explanation of compulsive overeating attribures the peron's problem to an increased tendency to secrete insulin up the sight and smell of food. Because the medical evidence supporting this is controversial, most OA groups do now dewell on biological explanations, emphasizing the psychological and spiritual components intead. From a psychological perspective, being overweight is seen as a symptom of an underlying emotional problem such as guilt, loneliness, or the suppression of anger.

The most important function of OA is the fellowship these meetings provide for people to socialize, share feelings, and ease their sense of isolation. By making contact with others who have the same problem, members alleviate guilt and heighten their commitment to the group. These helps break the cycle in which self-blame leads to depression and self-punishment, which leads to overweating, which leads to the social rejection which again leads to self-blame. OA emphasizes self-understanding and the creation of fulfilling interpersonal relationships. Instead of focusing on diets, it focuses on how to deal with life. OA has information availabe about nutrition and dieting but it does not emphasize this function; it assume its members can acquire this knowledge on their own. Abstinence is defined differently for each member; for some it isi the avoidance of white sugar, for others it is restraining from overeating or the binge/purge cycle.



There is an adolscent version of the Questionnaire of Eating and Weight Patterns (QEWP-A) -- used on those 10 to 18. Measures depression and eating attitudes. Parents completed QEWP-P. ND (no diagnosis), Nonclinical binge eating (NCB), (BED). BED had higher lebels of depression. Parents are not as likely to be aware of eating problems when they exist. BED is in the DSM-IV

Tools of OA: attendance at OA meetings, reading/writing from the Twelve Step liteature, adhering to a food plan, having a sponsor, giving service, taking time for prayer and meditation, and making phone calls to other members.

The activities of bing eating and bulimic participants were also examined to determine whether or not statistically significant differences exist between these two populations.

Results revealed the typical OA participant to be a college educated (80%), Caucasian (89%) female (84%), between the ages of 34 and 44 (30%), married or living with a partner (44%), and employed in a full-time capacity (71%). Eightfour percent of the respondents were binge eaters, 15% were bulimic, and 1% anorexic. Multiple regression analyses revealed longer lengths of involvement in OA, a decrease in the frequency of relapse or ‘slips’, performing service, greater attendance at meetings, and progress on the ninth step, to be predictors of abstinence at the .05 level of significance.

8,500 meeting froups in over 50 countries worldwide. Designed to help the compulsive eater who suffers from bing-eating disorder or Bulimia Nervosa.

Those who suffer from binge-eating disorder usually gain back all of the weight they one lost and sometimes more.

Has been good for women with bulimia.

A large history of those with bulimia nervosa have a history of anorexia nervosa.

Compulsion: "an impluse or feeling of being irresistibly drien toward the performance of some irrational action."

1:6, 1:10

Comorbid psychiatric disorders are frequently seen in patients with eating disorders, with estimates ranging from 42% to 75%. Eating disordered patients with personality disorders are at a greater risk to be dually diagnosed with mood or substance abuse disorders. Moreover, sexual abuse is reported more often in woman with eating disorders than in women from the general population (American Psychiatric Association, 2001).

OA defines compulsive eating as a serious physical, emotiona, and spiritual illness for which there is no cure.

Binge eaters consistenyly engage in excessive food consumption, usually in response to neative emotions.

Psychological characteristics associated with binge-eating disorder in women: ngreater disinhibition and poorer eating self-efficacy, greater psychological distress and depression, lower self-esteeem, less helpgul coping strategies, more hunger, and less cognitive restraint.

Compulsive overeating = binge eating disorder

Those with binge-eating disorder have a harder time remaining in a generic weight-loss treatment program than do non-compulsive eaters. Binge eaters also tend to regain any weight lot more quickly. Focusing on the binge eating and the cognitions beneath the behavior are therefore critical treatments that need to bne resolved if clients expect long-term weight control. Moreover, given the myriad of physical and psychological causes and condequences of binge-eating disorder, it is improbably that nayone treatment will be appropriate for all individuals.

Bulimia Nervosa affects between 1.1% to 4.2 of adult women, and between 4 and 10% of college females. The mean age of diagnosis is 19 years. The prototypical bulimic is described as well deducated, google-looking, high achieving and a perfectionist.

Many people with Bulimia Nervoas were raised in families or in relationships that are unpredictable. Additionally, depression affects nearly 75% of those struggling with Bulimida Nervosa and sexual abuse has been reported more frequently (betweem 20 and 50%) in bulimic patients than in the general population. Depression affects nearly 75% of those struggling with Bulimia Nervosa.

Furthermore, alexithymia, the inability to consciously experience and express emotions, has been described in many patients.

A significant number of culimics are also reported to abuse alcohol or drrugs. OFten substituted food for alchohol or vice cersa in attempts to avoid one other the other substance. The act of bingeing and purging provides the bulimic with the illusion that she can regain a sense of controill. Binge eating has also been described as a "futile attempt to restock depleted emotional stores, when attempts at doing everything perfectly have failed."

Weiner (1998) found that the personality characteristics for individuals at-risk for substance abuse are likewise present in those with Bulimia Nervosa and binge-eating disorder. These include: 1. A need to obtain affective experiences through action rather than through feeling or talking. 2. An inability to regulate tension. 3. A need for immediate gratification. 4. Poor impulse control. 5. A fragile sense of self. Weiner (1998) also hypothesized that binge eating is a response to emotional distress – tension, loneliness, anxiety, boredom, anger or interpersonal conflict. The pattern of negative thinking that leads up to and follows a binge episode can be selfreinforcing. Moreover, it mimics the patterns experienced by those with drug and alcohol dependencies.

Research has also demonstrated a relationship between the severity of the binge eating and depression and anxiety. Guilt. sahme, and self-loating tresult from binge eating. However, studies reveal mixed results as to whether depression is the cause or the effect of either disorder.

Estimates of long-term recovery (greater than five years) from compulsive eating are less than 5%, and follow-up studies ranging from one to four years are similarly discouraging. Factors encouraging long-term recovery are adherence to a food plan, attending a support group, and long-term inidivudal psychotherapt. Support provided from familt, friends, or romantic partner appears to be helpful to the recovery process. Parents were typiucally protrayed as unhelpful to the recvoeryu process.

fluvoxamine and desupramine

flexible diet plans work better than rigid ones.

No consenus among doctores regarding how to treating eating disordered patients.

Antidepressants also work on non-depressed bulimic patients.

Fluoxetine hydrochloride.

cognitive-behaviorial therapy, individual therapy.

bulimia actually precededs anorexia.

Five-level process for thosw with Bulimia Nervosa: 1) Self-help or written materials; 2)dietary education and advice, 3)antidepressant drug treatment in combination with advice or support 4) out-patient cognitive behavioral treatment 5) day or inpatient care with subsequent outpatrient treatment.

Those who are socially isolated from primary group relationships have a greater chance of acquiring a Mertonian mode of adaptation, or so called "compulsive" behavior, such as alcoholism, drug or food abuse.

Reveiging and providing support each lead to distinctive psychological benefits in self-help groups.

bi-drectionary support include cognitive reheresal of coping strategies, increased sense of meaning and purpose associated with one's life situation, social reinforcement for helping and internal feelings of self-woth and efficacy.

Maton's second explanation is a "balance therory" interpretation which suggests that the psychological costs to unidirectional receiving (e.g. inferiority, indebtedness) or

Literature clearly supports the role of social interaction and group membership and structure in the context of behavioral change

use food to regulate their emotional state and cope with stress, much like drugs. May deny their problem or keep it a secret.

Primary problem of addiction is based on reward, not withdrawl, accordingto brain biology.

“Complex progressive behavior pattern having biological, psychological and behavioral components…. What is unique about these behaviors is the individual’s pathological involvement in or attachment to it, their subjective compulsion to continue it and reduced ability to expect some influence or personal control over it. There is a need to continue with the behavior despite negative consequences for the person and usually the individual will continue the behavior despite more gratifying sources of behavior being available” (p. 545). Those with eating disorders have shared experiencing intense emotional highs and lows associated with bingeing, purging, and restricting. These feelings can result from the biochemical effect of such quantities of food or from the act of purging itself.

Bulimic binges often occur several times daily, with an individual consuming as much as 5,000 calories per binge and up to 50,000 to 60,000 calories per day. The psychological and physical associations with these ‘highs’ are the means by which these behaviors become addictive (Riley, 1991). Moreover, the release from the emotional pain and anxiety that fuels the eating disorder imposes an addictive element to the disease. Sheppard (1994) has postulated that there is an abnormality of the endorphin metabolism within the brain that triggers the addictive process. The compulsive use of a substance or behavior either alters or normalizes this system. Individuals who are prone to addiction are likely to be deficient in their levels of encephalins and endorphins, the brain’s natural pain-relieving and pleasure-causing chemicals (Institute for Natural Resources, 1995). Consequently, these individuals are susceptible to substances or behaviors that ameliorate the deficits, artificially soothe the brain, and enhance well being. This improved feeling is the physiological basis of addiction (Sheppard, 1994). Studies on eating disorders confirm that sufferers most often crave carbohydrate items during “binges” (Kayloe, 1993). When carbohydrate rich foods are ingested, serotonin is released. The cravings for foods that can elevate serotonin levels are a means by which the body instinctively attempts to compensate where neurotransmitter

deficiencies exist. From an addictions paradigm, it is not surprising that abstention from addictive food substances triggers withdrawal symptoms and a craving for the omitted substance or behavior (Sheppard, 1994). Depression and anxiety can proceed from decreased quantities of serotonin in the individual. Hence, compulsive eaters are more prone to

out of control eating, especially high-carbohydrate food, in order to experience relief from the effects of low serotonin levels (Hoffman, 1994). It is significant to note that for female recovering substance abusers, the new behavior frequently adopted relates to eating disorders. Hatcher (1989) reports that moving into Bulimia Nervosa or binge-eating disorder is not unusual; the behavior is the same, only the substance is changed. The effects of binge eating including feeling stuffed and out of touch with time or reality parallel the rewards for alcohol/drug abuse. For these reasons, Wooley and Garner (1991) have stated that compulsive eating disorders such as Bulimia Nervosa and binge-eating disorder require a behavioral and psychological management program to normalize eating habits. OA addresses this need through the abstention of trigger food items (e.g. sugar and/or alcohol), and through the application of the Twelve Steps of Alcoholics Anonymous and the OA Tools for Recovery. The 12-step approach is founded on the disease concept. This concept defines the eating disorder as “an involuntary psychobiologic state” (Riley, 1991, p. 719). The disease concept requires acceptance of the following three tenets: 1. Individuals with eating disorders are powerless over addiction, and their lives are unmanageable.

2. Although individuals with eating disorders are not responsible for their disease, they are responsible for their recovery. 3. Individuals with eating disorders can no longer blame people, places, and things for their addiction; they must face their problems and their recovery (Rogers, 1988).

Founded in 1960, Overeaters Anonymous (OA) was the first self-help program extended to those suffering from compulsive overeating and offering a new way of life. This program, also spiritual in nature, assists individuals in developing a healthier lifestyle. While OA was originally intended to provide a self-help program of change for

compulsive overeaters suffering from obesity, other eating disorders are now widely recognized and addressed in OA support groups. The modern day version of OA offers recovery for all kinds of eating concerns including Anorexia Nervosa, Bulimia Nervosa, and binge-eating disorder. Subgroups within OA have also developed. These subgroups mandate more rigid adherence to the steps and the tools of OA. For instance, being honest, open, and willing to change (H.O.W.) is one criteria for participation in the subgroup OA/ H.O.W. Clinicians at the Laureate Psychiatric Clinic and Hospital in Tulsa, Oklahoma, began to integrate the twelve-step approach with traditional psychotherapy for the treatment of eating disorders in the mid-eighties. This occurred after several patients who were unsuccessful in the original Laureate treatment program became involved in AA or OA and made “remarkable recoveries” (Johnson & Sansone, 1993, p, 122). The worldwide presence of OA today confirms the words used in 1951 in conferring the Lasker award on the sixteen-year-old Fellowship of Alcoholics Anonymous: “Historians may one day recognize Alcoholics Anonymous to have been a great venture in social pioneering which forged a new instrument for social change; a new therapy based on the kinship of common suffering; one having a vast potential for the myriad other ills of mankind’ (p. XI). Using the twelve-steps and twelve traditions of AA, OA changes the word “alcohol” and “alcoholic” to “food” and “compulsive overeater.” OA participants establish abstinence through prompt and complete cessation of foods that trigger binge eating coupled with a plan of eating. Attendance at OA meetings, literature reading and writing, regular use of the telephone to connect with other OA members, sponsorship, and giving service to OA are also emphasized as critical to obtaining and maintaining abstinence.

OA is unique in its core belief that compulsive eating is a progressive, addictive illness. Its central tenets suggest that this illness: (1) can never be eliminated but only managed as a chronic problem, (2) requires that the abuse of food must be interrupted, and (3) requires that treatment not differ fundamentally from treatment for alcohol and drug dependence. Compulsive eating is also viewed as an impulsive response to stress, which alleviates tension in the same fashion that other compulsive disorders like alcohol and drug abuse do.

plan of eating should be discussed with a doctor, nutritionist, or dietitian. Some meetings encourage no intake of sugar or alcohol, an encourage taking a multivitamin and 64 hours of water per day

OA also publishes the book Overeaters Anonymous, referred to as the Brown Book, the OA Twelve Steps and Twelve Traditions, For Today (for daily meditation), and Lifeline, their journal for recovery.

The OA program emphasizes accommodation over competition; acceptance of one’s situation instead of seeking to conquer it; seeking help, admitting powerlessness; and being humble (Norman, 1984). As in AA, the serenity prayer is their creed: “God, Grant me the serenity to accept the things I cannot change, the courage to change the things I can, and the wisdom to know the difference.”

An advantage of this accommodative perspective is the development of enhanced self-acceptance. Inherent to the twelve steps is the belief that compulsive eating is an illness, not an absence of will power. A study by Norman in 1984 revealed that a majority of OA participants agreed that joining the group had the effect of decreasing their self-blame. Participant observation, organizational literature, and interviews with OA participants were examined to confirm said hypothesis. An example of how this compulsion ideology, reinforced by an accommodative strategy, helps to neutralize self-blame is when an OA member discusses the importance of being humble rather than egotistical or selfish, and of being satisfied with oneself. “It used to be,” he said, “I wanted to change things about myself but now (since joining OA) I accept myself as I am” (Norman, 1984, p. 149).

44.5% identified as compulsive overeaters, 40.7% as bulimic, and 14.8 as anorexic.

Average weight loss for participants was 21.8 poinds.

Tho sprituality was rated as the most important part of the program, it did not correlate with the CRQ meature of weight loss.

2. The self-reported personality profile of the typical bulimic female had a less favorable opinion of herself than the normative sample. She was more pessimistic and more ambivalent in relating to others, and she strived less for recognition in areas that are socially significant or require leadership. The bulimic felt a real need to solicit sympathy, affection, and emotional support. 3. Seventy-five percent of the sample (n=37) practiced binge/purge behavior at least one or more times weekly before attending OA, and only 22% of them had the same incidence of bulimic behavior after attending OA. 4. Ninety percent of the group responded that their lives had improved either “somewhat, much, or very much” in their emotional, spiritual, job, and social lives.

In Yager, Landsverk, and Carole’s (1989) comprehensive study on help seeking and satisfaction with care in 641 women with eating disorders, the only negative feedback in terms of OA came from those struggling with Anorexia Nervosa with bulimic features. Anorexics of this subtype described themselves as “unchanged” or “somewhat

worse” with respect to this intervention. In spite of this negative feedback, bulimics (without anorexic features) and binge eaters responded on average to have gotten at least “somewhat better” by OA and other self-help interventions. A similar study conducted by Rorty, Yager, and Rossotto (1993) examined the subjective appraisal of 40 women recovering from Bulimia Nervosa for a year or more. Thirty-eight percent of their sample had utilized OA in their recovery. Of this sample, satisfaction was equally divided between somewhat or totally dissatisfied and somewhat or totally satisfied. Yeary (1987) expresses an appreciation for the differences between eating disorders and substance abuse in that the author views food as a complex mixture of chemicals that can affect the body in any number of ways. Given that the stomach and the brain communicate, compulsive eating inevitably disrupts the chemical equilibrium of the body. It is the author’s clinical opinion that “recovery from the addictive use of food is in some ways far more difficult than is recovery from psychoactive drug dependence” (p. 305).

An anecdotal saying often conveyed in OA meetings is that “when you are addicted to alcohol you put the tiger in the cage to recover; when you are addicted to food you put the tiger in the cage, but take it out three times a day for a walk” (personal communication, Anonymous, May 8, 2001).

Lester’s (1999) expressed concern with OA stems from a feminist-cultural perspective on eating disorders. The author contends that the acceptance of “twelvestep truths” (e.g. accepting powerlessness, relying not on self – but on a Higher Power greater than the self, the surrender of one’s life over to this Higher Power, etc…) is often incorporated into an individual’s belief system over and above overcoming the addictive

behavior. Such a consequence could affect a woman’s interpretations of new life experiences. The author cites gender and power as two areas that can negatively impact women who participate in OA. Van Wormer (1994) challenges how appropriate the 12-step program is to the treatment of women. The author cites Johnson’s condemnation of AA and other 12-step programs as male institutions that inevitably accompany “the self-abasing, powerlessness, external focus, and ultimate rejection of responsibility inherent in male religion and politics” (p. 289). Consequently, the author contends that it retains a male perspective that women are forced to accept (1994). The author further notes that the concepts of powerlessness, surrender and humility are detrimental to women discovering their own power. Moreover, the concept of surrendering one’s life to God “invokes images of women passively submitting their lives to male doctors, teachers, and ministers” (Kasl, 1992). Further, Van Wormer (1994) asserts that women would do better to focus on pride than on humility.

Finally, the issue of abstinence has been criticized for its inherent ambiguity. In AA, abstinence was adopted because the alcoholic must abstain entirely from alcohol. The compulsive eater, on the other hand, can construe abstinence as “overly simplistic” (Fallon, Katzman, and Wooley, 1994), demanding rigid adherence from overeating, bingeing, or eating between meals to complete abstention from sugar and white flour. Garner (as cited in Fallon et al., 1994) argues against a black and white definition for abstinence. Instead, the author proposes defining abstinence with the normalizing of food consumption. Otherwise, the value of abstinence may supersede one’s ability for moderation, flexibility, and independent thinking.

Suler and Bartholomew (1986) document additional ideological substitutions that were particular to OA. They include: 1. The belief that it is bad to eat, exchanged for the belief that one must eat to live and should not always feel guilty about it 2. The belief that one is simply overweight and needs to lose pounds, exchanged for the belief that one has underlying psychological and interpersonal problems 3. The belief that one must deprecate oneself, deprive oneself, please other people, exchanged for the belief that it is okay to express positive feelings about oneself and take care of one’s needs 4. The belief that food is the answer to all problems, the source of solace, exchanged for the belief that psychological and emotional needs should be fulfilled in relationships with people (1986, p. 52). These more adaptive beliefs substantiate what Suler (1986) recognizes as OA’ ideological emphasis on self-awareness and greater interpersonal relationships.

Eating disorders continue to primarily be a concern for Caucasians over and above other ethnic groups.

84% binge etaters, 15% as bulimic, and 1% as anorexic.

Abstinence and Relapse Data Of the 231 survey participants, 70% (n=162) were abstinent for more than 30 days at the time this survey was distributed. Just over half of those OA participants who were abstinent for more than 30 days had between one month and one year of abstinence. The remaining participants had between one and greater than ten years of abstinence. Figure 3 depicts the frequency distribution for subjects’ length of abstinence. The final dependent variable examined was that of relapse frequency. It appears that of the 70% of the participants who have attained abstinence in excess of 30 days, forty-six percent report never or rarely relapsing. Whereas 54% of those who are abstinent relapse or ‘slip’ between weekly and every few months. Figure 4 describes the frequency distribution for relapse across survey participants.

Sugar, 12%, Alcohol 12%, Wheat 25%.

The length of abstinence ratio did correlate significantly with the use of several of the OA ‘tools’ and demographic variables among subjects.

The respective variables and their correlation to the abstinence ratio can be seen in Table 2. Specifically, frequency of relapse, adherence to a food plan, weighing and measuring food, making phone calls to other participants, prayer and meditation, and performing service work all correlate positively with the length of abstinence ratio at the .01 level. Completing a fourth and ninth step similarly correlated to the abstinence ratio at the .01 level. Writing about thoughts and feelings, attending 12-step meetings, frequency of communication with a sponsor, education level, eating disorder diagnosis, and using the Internet as a recovery tool also correlated positively with abstinence at the .05 level. The only variables that

Multiple regression equations were run to determine, which, if any, variables make a significant addition to the prediction of increasing an individual’s length of abstinence (relative to their time of involvement in the OA program). Decreased frequency of relapse, longer lengths of OA attendance, holding a service position, increased frequency of attending meetings and making progress on the 9th step were all significant predictors of longer lengths of abstinence relative to time in OA at the .05 level (see Table 3).

Several of the OA variables assessed (calling a sponsor, adhering to a food plan, weighing and measuring food, reading, writing, phone calls, and completion of the fourth and ninth steps) inversely correlated to relapse/‘slip” frequency at the .01 level. Albeit not a formal tool, the use of the Internet similarly inversely correlated to relapse/’slip’ frequency at the .05 level, as did prayer and meditation. Only the length of OA attendance, number of meetings attended weekly, and the eating disorder diagnosis did not correlate with the frequency of relapse. The individual correlations for the aforementioned relationships can be seen in detail in Table 2. The correlational coefficient between the frequency of relapse and/or ‘slips’ and the independent variables was r2 =.40, which translates to 40% of variance shared by the variables. The square root of the R2 was .63 representing a large effect according to Cohen (1988). Multiple regression equations were run to determine, which, if any, variables make a significant addition to the prediction of decreasing the frequency of relapse or “slips.” Length of abstinence and OA attendance, adherence to a food plan, frequency of phone calls, and more frequent writing about thoughts and feelings were all significant predictors of a decrease in the frequency of relapse at the .05 level (see Table 4). It is of interest to note that the frequency of relapse and the length of abstinence correlate most with each other. While it is intuitively comprehensible that this is so, their strong collinearity statistically demonstrates this assertion.

Calculation of an Independent Samples t-test revealed that the average length of abstinence for bulimic respondents (M= 3.63, SD= 2.77) was significantly higher than the average length of abstinence for binge eaters (M = 2.60, SD = 2.46), t (227) = 2.24, p= .03. The difference in abstinence ratios (length of abstinence/ time in OA) for the two populations was also significant t (227) = 2.2, p = .03. The average ratio for bulimic respondents was .69 (SD = .64) whereas the binge eater’s average ratio was .48 (SD = .50). This indicates that the average bulimic’s length of abstinence is greater than that of the average binge eater when their length of time in OA is accounted for. The strength of the relationship between the eating disorder diagnosis and the length of abstinence in OA was determined by assessing the size of the effect. This was calculated by finding the difference between the means (1.02) divided by the pooled standard deviation (3.12). Thus, for length of abstinence, d was .33, which is a medium effect size. Complete data comparing bulimics with binge eaters is outlined in Table 5. The effect size for the abstinence ratio (length of abstinence over time in OA) was d = .35, demonstrating that the strength of the relationship between eating disorder diagnosis and the abstinence ratio is also moderately strong. With respect to the frequency of relapse, the Independent Sample t-test revealed that the mean frequency for bulimic respondents (M= 3.49, SD = 1.34) closely approximates that for binge eaters (M = 3.06, SD = 1.33). The difference in the frequency of relapse or ‘slips’ between the populations was not significant t (227) = 1.73, p = .08.

The cumulative findings of this study include the demographic and descriptive characteristics of the participating OA participants in the Washington metropolitan area and the results pertaining to the three research questions. Most of the OA participants (N=231) surveyed were female (84%), between the ages of 34 and 44 (30%), married or living with a partner (44%), and employed full-time (71%). Most (89%) were also Caucasian, likely to consider herself to be either Protestant (26%) or ‘spiritual’ (20%), and has a college degree (80%). Other descriptive characteristics of the sample indicated that 84% were binge eaters. Attendance at OA meetings was skewed towards those with less than two years in attendance (32%) and those who have been attending more than ten years in total (36%). Seventy percent of the sample claimed to be abstinent for more than 30 days at the time this survey was distributed, while 30% have between 0 to 30 days of abstinence from their eating disordered symptoms. Calculation of Pearson product-moment correlation’s, Independent Samples ttests, and multiple regression equations analyzed the three research questions. The results were as follows: The length of abstinence ratio did correlate significantly with the implementation of several of the OA ‘tools’ among participating participants. Specifically, greater adherence to a food plan, increased frequency in weighing and measuring of food, making phone calls to other participants, more time spent engaging in prayer and meditation, and performing service work all correlated with the length of abstinence ratio at the .01 level. Progress on the fourth and ninth steps also correlated to the abstinence ratio at the .01 level of significance. Variables corresponding to the abstinence ratio at the .05 level of significance are also displayed in Table 2. The shared variance between the length of abstinence ratio and the use of the ‘tools’ was 39%, representing a substantial degree of overlap or confounding between the variables. Moreover, multiple regression analysis revealed increased lengths of OA involvement, a decrease in the frequency of relapse or ‘slips’, holding a service position, greater attendance at meetings, and progress on the ninth steps to be significant predictors of abstinence at the .05 level. A decrease in the frequency of relapse or ‘slips’ also correlated significantly with the implementation of several of the OA ‘tools’ among participating participants. Specifically, calling a sponsor, adhering to a food plan, weighing and measuring of food, making phone calls to other participants, reading, writing, performing service work, and progressing on the fourth and ninth steps all inversely correlated with increasing frequency of relapse at the .01 level. The shared variance between the length of frequency of relapse or ‘slips’ and the use of the ‘tools’ was 40%, representing a large degree of overlap. Lastly, multiple regression analysis revealed that longer lengths of abstinence and involvement in OA, greater adherence to a food plan, increased frequency of phone calls to other members, and more time spent writing about one’s thoughts and feelings were all significant predictors of decreasing relapse frequency at the .05 level. With respect to the third research question, Independent Sample T-tests revealed significant differences between bulimics and binge eaters in terms of their mean lengths of abstinence and abstinence ratios. In short, bulimic respondents have significantly longer periods of abstinence in OA, whether or not their length of time in the program was accounted for. Moreover, the effect size for both the length of abstinence (d = .33) and the abstinence ratio (d = .35) was moderately strong. Conversely, bulimic participants attended less meetings (M = 2.11, SD = .72) than did the population of binge eaters (M = 2.38, SD = .90) t = -1.94 (55.42), p = .057. Moreover, the frequency of relapse or ‘slips’ between the two populations was not significant, suggesting that both bulimics and binge eaters have a comparable likelihood to relapse or slip into eating disordered symptoms. The first research question was to delineate a profile of the typical OA member in the Washington metropolitan area. The results of the survey demographics were remarkably consistent with the National Membership Survey that was conducted in 1992 by the Gallup Organization. The majority of OA participants continue to be women (84%), supporting the American Psychiatric Association’s assessment that the male to female ratio of those with eating disorders ranges anywhere from 1:6 to 1:10 (2001). It also appears to be consistent with the message from the media, primarily aimed at females, conveying the message that thinness is a prerequisite to be attractive, popular and healthy (Flood, 1989). The percentage of males in the organization has increased from 9% in 1981 to 16% in 2001. Flood (1989) draws attention to the fact that the media has also begun to target men with advertisements suggesting that without “lean, well-muscled bodies, their achievements was be meaningless.” Consequently, they, too, have responded with an increased obsession with food and fitness (p. 46). Respondents were largely Caucasian, highly educated, and married or single. They ranged in age from 18 years of age to greater than 55 years. The absence of much racial diversity in this sample was comparable to previous OA membership surveys. This was referenced in the literature as possibly the result of different cultural perceptions on obesity. The media has historically tended to portray the thin, attractive female as Caucasian. Nevertheless, it is noted that as racial diversity is increasingly embraced and promoted by the media, so, too, have eating disorders begin to increase in their rate of occurrence among minorities. A variety of religious practices were embraced, although Protestantism, Catholicism, and those who claim a more generic “spirituality” were practiced by approximately 70% of the participants. The concept of ‘Spiritual’ as a category evolved through the large number of respondents placing it in the “Other” category for religious practice. Albeit not a formal religion, it was described as believing in the presence of a Higher Power. Given the ‘spiritual’ nature of the program, it is consistent with the steps practiced by those in all 12-step programs. The original 12-step literature made frequent reference to God. As the concept of God made some participants uncomfortable, the term “Higher Power” began to be embraced. This allows participants the freedom to choose their own higher power, which could apply to the individual’s 12-step group, therapist, or “God-like deity” (Johnson & Sansone, 1993). The group sanctions accommodation rather than orthodoxy. Nonetheless, in spite of the absence of a specific definition of God, the focus in the first three steps does remain on spirituality. The fact that a large percentage of 12-step participants embrace ‘Spirituality’ rather than a formalized religion is therefore not surprising. Suler and Bartholomew acknowledge that yielding to a higher power may often satisfy religious needs in the member’s life that have otherwise been neglected (1986). It is their belief that while the surrender of control can be explained in purely psychological terms, the spiritual benefits cannot be denied. Many of the participants they surveyed in their examination of OA further attest that they experienced “a rejuvenation of their religious convictions and activities” (p. 53). This may also serve to explain the large number of participants practicing a more formalized religion. The majority of the participants surveyed were binge eaters (84%); however a fairly sizeable percentage of bulimics (15%) and a few anorexics (1%) also frequented the meetings. This in sharp contrast to the OA that originated in 1960, that was designed strictly for the compulsive overeater. It is clear that as the American creed, “one can never be too rich or too thin” has continued, coupled with the media’s promotion of an ultra-slim image, eating disorders have and was continue to proliferate. In turn, those with other variations of eating disorders are increasingly utilizing self-help groups like OA. In reflecting upon the variety of eating disorders represented, Malenbaum et al. (1988) documented the experience of women with eating disorders in OA. Their results revealed that in addition to the binge eaters, those with normal weight bulimia also tended to find the experience helpful. In contrast, the only negative experiences were reported by the anorexic population, who described themselves as “unchanged” or even “somewhat worse” as the result of the program (Yager, Landsverk, and Edelstein, 1989). The dearth of anorexic participants participating in OA may be indicative of this difficulty. A major concern with the 12-step approach for anorexics is that it is not sufficiently equipped to deal with the substantial medical and psychiatric problems associated with Anorexia Nervosa. Moreover, it would be inappropriate for an anorexic to be encouraged to refrain from particular foods (e.g. white flour or sugar) given the active deprivation already characteristic of this disease. The typical OA member surveyed works in a full-time capacity. Homemakers only comprise 6% of the population, in contrast to 30% of those surveyed in 1981. This vividly reflects the trend in our society for increasing numbers of females to be employed outside of the home. Further, 80% of today’s participants have attained a college degree, far surpassing the 59% of those attaining the degree in 1981. Another noteworthy change is reflected in the percentage of those divorced or separated. This number has risen from 10% in 1981 to 21% in 2001. It is apparent that greater gender equality over the last twenty years has significantly contributed to myriad demographic changes, yielding both positive and negative consequences. The second research question addressed whether the steps and ‘tools’ of OA correlate with individual’s lengths of abstinence. As previously mentioned, an abstinence ratio was created that adjusted the individual’s length of abstinence to their time spent in OA. Correlations were then assessed between this ratio and the dependent variables. The majority of the tools and steps of the program demonstrated a strong correlation with an individual’s abstinence. Specifically, increased adherence to a food plan, the weighing and measuring of food, the frequency of telephone calls, the attainment of service positions, time spent in prayer and meditation, and progressing through the fourth and ninth steps all correlate with abstinence across OA respondents at the .01 level of significance. Moreover, greater educational status, more communication with a sponsor, writing about thoughts and feelings, and meeting attendance all correlate with the attainment of abstinence at the .05 level.

In a similar fashion, the results of the third research question, assessing the relationships of the frequency of relapse across the OA population to these same variables, also produced several significant correlations. Adherence to a food plan, weighing and measuring of food, reading OA/AA literature, writing, making phone calls, holding a service position, and progressing through the fourth and ninth steps all relate to a decrease in the frequency of relapse at the .01 level. Multiple regression analyses conducted on the OA population enabled specific predictions between the type of involvement in these interventions and their outcomes to be made. Attending meetings, progressing on the ninth step, doing service, minimizing relapses or ‘slips,’ and remaining involved in the OA program all predict an increase in abstinence at the .05 level of significance or better. Furthermore, the length of attendance in OA, writing about thoughts and feelings, making telephone calls to other participants, adhering to a food plan, and sustained abstinence all predict a decrease in the frequency of relapses or ‘slips’ at the .05 level of significance or better. It was concluded then, that the application of the steps and the tools of OA might directly promote abstinence and reduce the frequency of relapse in those with bingeeating disorder and Bulimia Nervosa. Previous research supports this contention. Convergent findings include Ferster, Nurnberger, and Levitt’s (1962) earliest behavioral approach to the treatment of eating disorders. They demonstrated positive effects from self-monitoring of food intake and stimulus control techniques pertaining to the environmental cues associated with compulsive eating. Such techniques parallel the tools that enforce the weighing and measuring of food, communicating with a sponsor approach to the treatment of eating disorders. They demonstrated positive effects from self-monitoring of food intake and stimulus control techniques pertaining to the environmental cues associated with compulsive eating. Such techniques parallel the tools that enforce the weighing and measuring of food, communicating with a sponsor (where food is frequently ‘turned over’), the daily writing of thoughts and feelings, and the support of making phone calls to other participants. Ferster, Nurnberger, & Levitt’s (1962) approach did, however, differ from that promulgated in OA in that they de-emphasized any strict adherence to one food plan. Smith, Wasiam, Bray, & Ryan (1999) confirmed this idea through research that demonstrated how flexible dieting strategies were associated with an absence of overeating, lower body mass and lower levels of depression and anxiety. This may help to explain that while adherence to a food plan correlates with abstinence, it does not predict it with any degree of certainty. It is possible that too rigid adherence to any one food plan could, in fact, have the reverse of the desired effect of increasing one’s abstinence. It might also explain the disproportionately small number of anorexics in program. As previously mentioned, with an anorexic patient who already wrestles with requiring control, the too rigid adherence to any one of the program’s tools (e.g. adherence to a food plan) would only serve to underscore the maladaptive thought patterns already intact. The strong correlations and regression between length of abstinence and frequency of relapse with the variables assessed demonstrate the efficacy of the first three steps in OA. In summary, through acknowledgement of one’s powerlessness (Step One), acceptance that something greater than the self can promote change (Step Two), and the surrender to that power that results in the wasingness to engage in new behaviors (Step Three), a new way of life (e.g. abstinence) is established. This occurs not because the taking of the first three steps “cures” the problem; rather it inhibits the relapse process by urging participants to adopt more adaptive attitudes (Antze, 1976). For example, Antze described how alcoholism is perpetuated by the alcoholics’ belief that they could stop drinking if they wanted to. Unfortunately, the failure to stop at that “last drink” results in guilt, self-blame, and further binges to escape those feelings. The 12-step ideology impedes this insidious cycle by encouraging its participants to relinquish their “omnipotent attitude by accepting the addiction as a disease beyond their control, by confessing their inadequacies and guilt (Steps Four and Nine), and by relying on their higher power and the strength of the group to change (Steps Two and Three) (as cited in Suler and Bartholomew, 1986) The resulting behavioral changes further mimics those seen through cognitivebehavioral approaches. The difference between the Twelve-step approach and cognitive-behavioral therapy lies in its acceptance of a Higher Power and reinforced interpersonal reliance (through sponsoring, etc…). One large study, known as Project MATCH, compared a Twelve Step facilitated therapy approach with cognitive-behavioral therapy and motivational enhancement therapy in alcohol abusers (Humphreys, 1999). Besides increasing the participant’s involvement in A.A./N.A. related activities, the Twelve Step intervention was more effective in promoting abstinence. For example, after one year of treatment, 45% of those involved in Twelve Step programs reported abstinence from alcohol and other drugs compared to 36% of those treated in the cognitive behavioral program. With this research in mind, it can be surmised that the benefits of utilizing the OA tools and steps could minimally serve as an adjunct to more traditional forms of therapy for eating disorders. after one year of treatment, 45% of those involved in Twelve Step programs reported abstinence from alcohol and other drugs compared to 36% of those treated in the cognitive behavioral program. With this research in mind, it can be surmised that the benefits of utilizing the OA tools and steps could minimally serve as an adjunct to more traditional forms of therapy for eating disorders. Given Wilson and Fairburn’s (1998) assumption that cognitive-behavioral therapy is the most effective treatment for Bulimia Nervosa, the behavioral components of this program coupled with the cognitive adaptations that result from working the Twelve Steps could provide bulimics in particular with a viable alternative to more costly forms of treatments. Wilson’s (1999) opposition to this approach stems from those groups that press for rigid dietary restrictions (e.g. white flour or sugar) in their definition of abstinence. It should be noted, however, that OA does not promote abstention of any food groups per se; rather, participants are encouraged to avoid their ‘binge foods.’ It is at the disgression of individual groups whether or not to endorse a blanket recommendation that all participants should abstain from sugar or white flour. For this reason, the newcomer to OA is encouraged to ‘shop-around’ to find groups that are compatible with their individual needs. The predictive relationship between the number of meetings attended and abstinence support Allon’s (1975) allegation that the structured activities for selfdisclosing and sharing parallel those of psychotherapy groups. However, OA is unlike group therapy in that it does not allow its participants to express their feelings about and directly to each other. OA meetings provide a forum for the expression of experience, strength and hope. Participants can stay in touch with the disease and simultaneously seek and receive support from those who have recovery. While opponents to 12-step meetings point to participants that become enmeshed in extreme subcults within the program that can be a destructive influence, the majority of 12-step organizations emphasize a balance between “isolation and integration” outside of the group (Suler and Bartholomew, 1986). The slogan “principles before personalities” belies the need to place the group’s ideology before personal desires. Ardent support for anonymity outside of the fellowship is a universally established principle. Furthermore, participants are always encouraged to reach out to other participants in trouble. All of these forces exemplify “The social force that channels energy into group solidarity and identity” (1986). Nevertheless, “these forces that shape the group as a substitute or supplemental family are counterbalanced by the group’s acknowledging and supporting individual’s participation in familial, recreational, and occupational groups outside of OA” (p. 50, 1986). As one member described recovery, “the goal is to utilize the program to actively live life, rather than make the program one’s life.” The fact that involvement in service positions within the organization portends abstinence from the disease (t = 2.67 (231), p = .01) supports the utility of the 12th step. Specifically, “Having had a spiritual awakening as the result of these steps, we tried to carry this message to other compulsive eaters and to practice these principles in all of our affairs” (Overeaters Anonymous, 1992). Suler and Bartholomew’s statement that “people can be therapeutically transformed by helping others” (p. 50) similarly upholds this principle. In a 31-week post-treatment study, Miller and Verinis (1995) found that although attendance at AA meetings was not predictive of abstinence, involvement in AA meetings (e.g. service) and related activities did predict more favorable results with respect to abstinence. A comparable study completed by Humphreys in 1997 followed 628 alcoholics post-treatment over eight years. The number of meetings attended predicted abstinence, lower depression, and better relationships at the 8-year follow-up. Involvement in the program also predicted better relationships after only one year. In summary, several studies have demonstrated that attendance at meetings and performing service for the group presage auspicious outcomes in decreasing addictive behaviors. Lastly, the predictive relationship between progression on the 4th and 9th steps and length of abstinence and frequency of relapse presage the value of confession and penitence in the process of change. Foucault’s early writings on Christianity attempt to explain how confession and penitence “produces intrinsic modifications in the person who articulated it; it exonerates, redeems, purifies him; it unburdens him of his wrongs, liberates him and promises him salvation” (p. 151, as cited in Lester, 1999). The 4th and 9th steps mimic the actions of confession and penitence and are therefore the concrete action steps that 12-step participants take to change their interior lives. The fact that the steps are integrally related to long-term abstinence from both binge-eating disorder and Bulimia Nervosa demonstrate the multifaceted nature of these disorders. The goal is not to merely abstain from compulsive eating; rather it is to transform one’s life on the inside so that the ‘sick’ self is abdicated in favor of a healthier self, both mentally, physically, and spiritually. The remaining research question addresses what differences, if any, exist between those with binge-eating disorder and Bulimia Nervosa. T-test analyses reveal significant differences between the two populations on variables assessing the member’s length of abstinence and number of meetings attended. Bulimic participants prove able to maintain longer periods of abstinence in OA, even when their time in OA is accounted for (via the abstinence ratio) (M = 3.63, SD = 2.77 vs. M = 2.6, SD = 2.46) t (227) = 2.24, p = .03. Conversely, they attend less meetings than do binge eaters (M = 2.11, SD = .72 vs. M = 2.4, SD = .90) t (55.42) = -1.94, p = .057. Their commitment to write on their thoughts and feelings on a daily basis is also somewhat less than those with binge-eating disorder (means: 2.11 vs. 2.38; p = .09). These differences may be explained by the nature of the bulimic cycle. Flood (1989) describes it as a predictable experience, one that is in sharp contrast to many of the families’ relationships that bulimics were raised in. The chaotic environment prevents the bulimic from relaxing, as the rules are continually changing. The routine of the binge-purge cycle becomes important for through it she is able to control (e.g. anesthetize) her feelings and predict her experience. Attending meetings and the disciplined nature inherent in the OA program provide the bulimic with a structured and concrete action plan. The bulimic member can begin at Step One and progress forward. Furthermore, meetings are replete with rituals from opening and closing readings to ceremonies to mark a member’s transitions into recovery. It may be the ability to work well within such structure that leads bulimics who participate in the OA program to attain longer periods of abstinence. Conversely, the bulimic’s predisposition towards control may also lead to an “allor- nothing” comprehension of recovery and subsequent relapse if any changes occur (Riley, 1991, p. 722). For this reason, many clinicians do not approve of the term relapse because it implies a failure. Those struggling with eating disorders need to expect some variability in their diet without the harsh self-deprecation that comes from viewing an occasional slip as a failure. This type of perfectionistic thinking only serves to perpetuate the bulimic cycle once a slip has occurred. This may also serve to explain why in Rorty, Yager, and Rossotto’s (1993) appraisal of women recovering from Bulimia Nervosa, the thirty-eight percent of their sample that utilized OA were nearly equally split between somewhat or totally satisfied and somewhat or totally dissatisfied with the program. Such research may indicate that the bulimics who remain in the OA rooms (e.g. those surveyed) are limited to those who are satisfied with the 12-step approach. Those who do not find OA beneficial may be absent due to voluntary attrition. The fact that bulimics procure longer periods of abstinence in OA is surprising from the vantage point that Fairburn et al. (2000) concluded that the prognosis for those with binge-eating disorder was better than for those with Bulimia Nervosa. In a 5-year community-based study, only 18% of those with binge-eating disorder had an eating disorder of clinical severity in contrast to 51% of the bulimics. A high degree of flux was noted in the bulimic sample. Each year approximately a third remitted and another third relapsed. Instability was also noted in Keller et al’s (1992) prospective study of the course of Bulimia Nervosa. There was significantly less instability in the binge-eating disorder group. Rather, they tended to gradually improve, with about 50% remitting annually. Such research paradoxically supports the notion that bulimia, rather than binge-eating disorder, is the more recalcitrant disorder. As the present study is limited to a one-time sample design, it is possible that repeat assessments could convey different treatment outcomes. In summarizing the results of the extraneous interventions that are utilized by OA participants, it is clear that the majority of the participants that were surveyed exercise regularly, attend religious services, and use the Internet as part of their recovery program. Moreover, one-third of those participants engage in individual psychotherapy and are being prescribed antidepressants. This is encouraging in light of concerns that a potential disadvantage of 12-step programs may be that participants are precluded from other therapeutic interventions outside of the 12-step approach (Johnson and Sansone, 1993). When asked what other practices they found paramount to their recovery a sizeable number of participants responded with ‘honesty.’ Indeed, Chappel and Dupont (1999) comment on how most people are amazed by the level of honesty at 12-step meetings. Working the steps reinforces this quality in participants’ daily lives. A 12-step meeting is a unique forum in which people genuinely reveal not only their strengths, but also their weaknesses and character defects.

Based on the findings from this study, it can be concluded that the abstinence from binge-eating disorder and Bulimia Nervosa can be significantly increased by performing service within the group, attending meetings, progressing through the 12 Steps, and by increasing one’s time of participation in OA. It can also be concluded that the longer one is abstinent from either disorder, the less likely relapse is to occur. Relapse or ‘slip’ frequency can be significantly decreased by way of adherence to a food plan, frequent telephone calls to other participants, regular writing down of one’s thoughts and feelings, and by increasing one’s time of involvement in OA. It can also be concluded that the less an individual relapses or ‘slips,’ the more likely he or she was attain longer periods of abstinence.

Finally, significant differences between the two populations were apparent in their respective lengths of abstinence and number of meetings attended. As a group, bulimic respondents were likely to attend fewer meetings yet attain longer periods of abstinence than binge eaters.