Schizophrenia

Posted on by Greg E. Gifford

By Janae Stout

I. Definition

  1. Biblical Perspective
    1. A person with schizophrenia has an inability to function normally in a society due to bizarre behavior as a result of organic/inorganic forces. This includes either internal or external forces that distort judgments and reality.[1] The counselee dealing with Schizophrenia has physical implications that impairs their ability to perceive and function in a normal way, which is not necessarily sin, but the response of giving into the temptations to be self-focused, to fear, act in anger, laziness, and other manifestations are sinful. The heart theme that must be addressed in Schizophrenics is their response and deep-rooted fear, guilt/shame and selfishness.
  2. Secular Perspective
    1. Schizophrenia, literally meaning “fragmented mind”[2] is a psychiatric disorder occurring in only one percent of the population involving chronic or recurrent psychosis and is commonly associated with impairments in social and occupational functioning[3]. Schizophrenia is believed to comprise a ‘spectrum’ of related conditions with variable severity, course, and outcome.[4]

Continue reading Schizophrenia

Dementia

Posted on by Greg E. Gifford

By Theresa Egger

I. Definition

 Dementia is a syndrome wherein an individual experiences inhibited cognitive functioning to the extent that it interferes with daily life. Dementia is not synonymous with aging and it is distinguishable from the inevitable consequences of aging which include dulled senses and occasional forgetfulness.[1] Dementia is not a disease. Rather, it is a syndrome meaning that it is a group of symptoms which occur together. [2] Additionally, dementia is not synonymous with Alzheimer’s. Alzheimer’s is one specific disease that causes dementia. This means that everyone who has Alzheimer’s disease has dementia, but not everyone with dementia has Alzheimer’s. Although the term dementia is never found in Scripture, the Bible is living and active and therefore still offers relevant truths for this situation (Hebrews 4:12). First, Genesis 3 tells us that illness is the result of the fall. Like all physical disorders, this is not part of God’s original design. Because of sin, bodily decay and ultimately death are inevitable. Additionally, Scripture offers instructions for how the believer should respond to dementia. Finally, God’s Word offers hope for those who have been affected by this illness.

The secular world’s primary treatment for dementia is medication.[3] Healthy dieting is also often encouraged either to reverse or prevent dementia. [4] There are also several therapies intended to help the individual with dementia improve their memory or feel more comfortable. Examples include reminiscence therapy, music therapy, reality orientation and aromatherapy.[5]

In the past, individuals with dementia were referred to as senile however today, dementia has replaced the term senile.[6] The first edition of the DSM referred to dementia as a “chronic brain syndrome associated with senile brain disease.”[7] In the DSM-II it was considered an “organic brain syndrome.”[8] The DSM-III relabeled dementia as an “organic mental disorder.”[9] Interestingly, however, the DSM-IV categorized dementia as a cognitive disorder dropping the term “organic” because it implied that there are mental disorders which don’t have a biological base.[10] Finally, the DSM-V has dropped the term dementia all-together and renamed it a major neurocognitive disorder.[11]

II. Evidence of the Problem

Symptoms[12]

  1. Impairment in abstract thinking.
  2. Impaired judgment: inability to reason and make logical decisions.
  3. Other disturbances of higher cortical function such as language and motor skills.
  4. Personality change: Individuals with dementia may become angered more easily or irritable.

Dementia is a physical problem and therefore there is always a physiological cause. Examples of potential causes:[13]

  1. Alzheimer’s disease[14]
  2. Frontotemporal dementia (Pick’s disease).
  3. Traumatic brain injury.
  4. Lewy Body Dementia.
  5. Vascular Dementia/Binswanger’s disease.
  6. Brain tumors
  7. Parkinson’s disease.
  8. Huntington’s disease.
  9. Creutzfeldt-Jakob disease.
  10. HIV-AIDS.
  11. Normal-pressure hydrocephalus.
  12. Degenerative dementia of old age.

III. Examining the Heart

Dementia is not a spiritual problem but a physical one. Thus, the individual with dementia does not need to be encouraged toward repentance and heart change unless there have been sinful manifestations that have resulted from the dementia. For example, individuals with dementia may become angered more easily than they did prior to developing this illness. However, this does not mean that the dementia is causing the angry outbursts. A person’s body cannot cause them to sin.[15] Rather, anger is most likely a heart issue that was present before the illness, but has now been publically manifested because they are no longer able to hide it.[16] In these instances a potential heart theme to consider is control. While addressing sin in an individual with dementia will be much more complicated, the biblical instruction to lovingly confront our brother or sister in sin still applies (Matthew 18:15-17; Galatians 6:1-3).

Another issue that often arises within the discussion of dementia is the salvation of the individual with dementia. Is the person with dementia able to make the confession of faith which Romans 10:9 states is required for salvation? First, we must remember that the Gospel is profound yet simple enough for a child to understand (Matthew 18:3; Mark 10:15). Furthermore, we must trust that God is sovereign over an individual’s salvation. If God has elected that person for salvation, they will be saved (Romans 8:30). Thus, we should continue evangelizing and trust God with the results (Romans 10:14). Finally, if the individual with dementia did make a confession of faith and exhibited fruits of repentance prior to their illness, we can trust that God will keep His promise to preserve them until the end if they are truly His (Ephesians 4:30).[17]

IV. Biblical Solutions

Because dementia is a physical problem, the majority of counseling will involve coming alongside of the caregiver.[18] For this reason, the following counseling agenda has been focused towards providing hope and biblical instruction for the primary caregiver of the individual with dementia.

  1. The counselor should seek to build involvement with the counselee by praying for her and showing genuine compassion. This can be done by listening well and seeking to be a friend.[19] Because of the nature of the situation it will also be helpful to offer to help with meals, home care and even house chores. Show the counselee you love them by offering to help in practical ways.
  2. During the inventory process the counselor should ask questions in three areas. First, ask questions regarding the physical well-being of the individual with dementia. This will help you gain a better understanding of the situation. Secondly, ask questions about the caregiver’s well-being. It is essential that we minister to them as whole people because the physical and spiritual components influence one another.[20] Finally, ask questions about the caregiver’s spiritual health. Ask her to share her testimony. Can she verbalize the Gospel? Ask about Scripture-reading, prayer and church attendance. This will help you know where she is at spiritually and enable you to discern whether she is a strong believer who simply needs to be encouraged, or if she is an unruly counselee who needs to be admonished (1 Thessalonians 5:14).
  3. Instilling hope in the counselee will be absolutely crucial for the counseling process. This hope should be founded on God’s promises contained in His Word. Because dementia is an illness, offer comfort from passages which assure believers that there will be a future resurrection. Revelation 21:4 assures us that in the eternal state there will be no more pain or death. Additionally, the promises of God’s presence with His people can provide invaluable hope and comfort during difficult seasons (e.g. Psalms 94:14; Matthew 28:20; Hebrews 13:5).
  4. Interpretation will involve discerning what the counselee is responsible for. Because Dementia is a physical problem, there is not sin to be repented of in this initial diagnosis.[21] There may, however, be some sins that have arisen in response to this trial. This must be addressed in counseling.
  5. Instruction should be offered in the area of sufferology. Suffering is the result of living in a fallen world. Therefore, the counselee is not responsible for the trial but how she responds. Additionally, because the individual with dementia is very forgetful and frequently repeats themselves, patience is one area that will likely need to be addressed. Point the counselee to 1 Corinthians 10:13 which reminds us that God won’t let us be tempted beyond what we are able.[22]
  6. During inducement, it will be crucial to point the counselee back to the example of Christ. It might be helpful to do a study on love and point the counselee to Christ who loved the church by sacrificing His own life. The parable of the unmerciful servant in Matthew 18 is another good passage which reminds us of the forgiveness that God has extended to us which is our motivation to forgive others.
  7. Homework should include prayer, repentance (1 John 1:9) and Bible study. Potential passages to do Bible studies on are 1 Corinthians 13, Philippians 4:4-8, and Hebrews 4:14-16.
  8. Finally, integration will be absolutely essential for the caregiver. Encourage your counselee to get involved in a small group at church. The church will be able to provide practical help as well as spiritual encouragement and accountability for the counselee during this tiring season. God has given believers the body of Christ to help one another in this way (1 Thessalonians 5:14).

Recommended books

Adams, Jay E. How to Handle Trouble God’s Way. Phillipsburg, NJ: Presbyterian and Reformed Pub, 1982.

Deane, Barbara. Caring for Your Aging Parents: When Love Is Not Enough. Colorado Springs, Colo.: NavPress, 1989.

Drew, Holly Dean, and Theological Research Exchange Network. “Counseling the Caregiver: Addressing the Biblical Responsibility and care of Aging Parents,” 2002.

Fitzpatrick, Elyse. Women Counseling Women. Eugene, Or.: Harvest House, 2010.

Welch, Edward T. Blame It on the Brain: Distinguishing Chemical Imbalances, Brain Disorders, and Disobedience. Resources for Changing Lives. Phillipsburg, N.J.: P & R Pub, 1998.

Welch, Edward T. Counselor’s Guide to the Brain and Its Disorders: Knowing the Difference between Disease and Sin. Grand Rapids, Mich.: Zondervan, 1991.

 

 

 

[1] Ed Welch. Blame it on the Brain. (Phillipsburg, N.J.: P & R Pub, 1998), 71.

[2] Consumer Dummies. Alzheimer’s and Dementia for Dummies. (Hoboken, NJ: John Wiley and Sons, 2016), 8.

[3] Kenneth Partridge. The Brain. (New York: H.W. Wilson, 2009), 114.

[4] Neal D. Barnard. Power Foods for the Brain. (New York, NY: Hachette Book Group, 2013)

[5] Consumer Dummies. Alzheimer’s and Dementia for Dummies. 150-155

[6] Welch. Blame it on the Brain. 70

[7] American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 22

[8] American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders: DSM-II. 24

[9] American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders: DSM-III. 107

[10] American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders: DSM-IV. 123

[11] American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders: DSM-V.

[12] American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders: DSM-III-R. 107

[13] Marshall Asher and Mary Asher. The Christian’s Guide to Psychological Terms. (Bemidji, Minn.: Focus Pub, 2014), 56.

[14] Ed Welch. Counselor’s Guide to the Brain and Its Disorders, (Grand Rapids, Mich: Zondervan, 1991), 108.

[15] Elyse Fitzpatrick. Women Counseling Women. (Eugene, Or.: Harvest House, 2010), 127

[16] Welch. Blame it on the Brain. 78-79

[17] Wayne Grudem. Biblical Doctrine. (Leicester, England: Inter-Varsity Press, 1004), 337.

[18] Welch. Blame it on the Brain. 63

[19] Stuart Scott and Heath Lambert. Counseling the Hard Cases. (Nashville, Tenn.: B & H Academic, 2012), 182.

[20] Ibid., 213.

[21] Welch. Blame it on the Brain. 63

[22] Fitzpatrick. Women Counseling Women.  247

Reactive Attachment Disorder (RADs)

Posted on by Greg E. Gifford

By Julie DeVore

I. Definition:

The Reactive Attachment Disorder (RADs) is characterized by a difficulty in forming healthy attachment in relationships.

II. Biblical Perspective

The Reactive Attachment Disorder is marked by a lack of attachment and trust which leads to destructive behavior. Children who struggle with RADs must learn to trust God. They must be comforted as sufferers and held accountable as sinners.

Scripture speaks to the child who has experienced great neglect and emotional pain. Scripture comforts the sufferer through the attributes of God. The pain children experience from neglect is not their own fault. However, when pain from neglect leads a child to not trust God, be self-autonomous and disobedient, they must be called to repentance.

The counselor must distinguish suffering from sin, and counsel each accordingly. One suffers because he struggles to attach due to neglect; however, one sins when he allows this detachment to cause him to disobey.

Scripture that comforts the sufferer:

  1. Psalm 139 – Promises that their birth was purposeful and planned by God.
  2. Genesis 1:27 – Created valuable in the image of God.
  3. 3 Corinthians 1:3 – God Comforts us
  4. Psalm 10:14, 17-19 – God defends the Fatherless; God is the Perfect Father.
  5. Romans 8:27-29 – God works all things for good.
  6. Romans 8:31-39 – Nothing can separate us from God’s unconditional love.
  7. Hebrews 4:14-16 – God grieves and sympathizes with our weakness.
  8. Philippians 4:6 – God is our peace.

Scripture that challenges the sinner:

  1. Romans 3:23 – Everyone has sinned in some manner.
  2. Proverbs 3:5-6 – God is to be trusted.
  3. Psalm 37: 3-7 – Confess sin of self-reliance.
    1. Trust in the Lord
    2. Delight yourself in the Lord
    3. Commit your way to the Lord
    4. Be still before the Lord and wait patiently
  4. 1 John 1:9 – Confess sin, God forgives.

III. Secular perspective

Definition: Reactive Attachment Disorder is defined in the DSM-V as “[1]a consistent pattern of inhibited, emotionally withdrawn behavior toward adult caregivers…” A child diagnosed with RADs “[2]minimally seeks comfort” and “Minimally responds to comfort.” The DSM explains that they have “[3]Persistent social and emotional disturbance…” The lack of relationship and attachment forms because a “[4]child has experienced a pattern of extremes of insufficient care…” This is insufficient care from neglect, and lack of basic needs such as food, comfort and stimulation. RADs may be [5]described as “persistent” if it has been present longer than 12 months. The [6]DSM describes this condition as uncommon, occurring in less than 10% of neglected children. Therefore, not every neglected child has RADs, but neglect is the definitive factor of someone who may be diagnosed with RADs.

In 1994, the DSM divided Reactive Attachment Disorder into two specific phenotypes:

  1. Inhibited – “[7]persistent failure to initiate and to respond to most social interactions in a developmentally appropriate way.”
  2. Disinhibited – “[8]Predominant disturbance in social relatedness is indiscriminate sociability or lack of selectivity in the choice of attachment figures.”

There are [9]three criteria that distinguish RADs from other disorders: Attachment, Timing & Cause.

  1. Attachment – “[10]There is a lack of attachment, exhibited by disturbed social relatedness.”
  2. Timing – The “[11]onset of symptoms of abnormal behavior begins prior to age five.” RADS is distinctive because it stems from abuse and neglect that occurred before the age of 5 years old.
  3. Cause – The cause of RADs is rooted in neglect.

Secular Therapy Methods: 

Because the problem with RADs is attachment, the therapy goal is relearned attachment. Catherin Cain, author of Attachment Disorders: Treatment strategies for traumatized children teaches that “[12]children with RAD need to go through these developmental stages [Trust and Autonomy] a second time in order to experience them in a healthy way…”

  1. Dependence and Love Therapy: The American Psychiatric Association teaches that “[13]Children with RAD need to become as dependent upon the adult as a newborn infant is, in order to rebuild the bonds of trust … ” Linda Rice explains that “[14]the child with RAD needs to return to this state of dependency and rely on the caregiver for everything. The caregiver should decide what the child will eat and what the child will wear … ask permission to eat, sleep, use bathroom, or play.”
  2. [15]Holding Method – In this method, therapists encourage forced attachment by encouraging the caregiver to hold the child until child resists. They encourage pressure which creates discomfort in the infant. They are seeking to force a response from the child.
  3. Re-Birthing Method – Reenact giving birth for an adoptive child to promote attachment with the foster mom. However, Candace a [16]10-year old girl died by suffocation in the “rebirthing” method.

IV. History

The Reactive Attachment Disorder is a newly recognized Psychological Label. It was first described in 1980 in DSM-III as “pathogenic care.” In 1994 the DSM-IV Subdivided RADs into inhibited & disinhibited phenotypes. Then in 2013 the DSM-V broke the category into two different Disorders: Reactive Attachment Disorder of Infancy and Early Childhood and Disinhibited Social Engagement Disorder.

V. Evidence of the Problem

Linda Rice, author of Parenting the Difficult child explains that RADs children are some of the hardest people to counsel. Rice synthesizes some of the common [17]characteristics of RADs:

  1. Lack of eye contact
  2. Lack of ability to give and receive affection on parents’ terms
  3. Demanding, clingy
  4. Indiscriminately affectionate
  5. Superficially engaging and charming
  6. Lying
  7. Poor friendships
  8. Abnormal eating
  9. Theft
  10. Destructive to self or others
  11. Learning delays
  12. Cruel to animals
  13. Poor impulse control
  14. Intense control battles
  15. Hypervigilance/hyperactivity

VI. Etiology

            The main spiritual problem that must be addressed is the child’s lack of trust in God. Then the counselor can begin moving the child to put off his old habits and put on new as their life is being renewed (Colossians 3). However, trust in God must be first. Otherwise, we are encouraging behavior modification instead of internal heart change (James 1:16).

While there are some physical causes that affect RADs, they do not excuse the spiritual need of trust for God. Neglect has caused it to be difficult for a RADs child to trust God and others. However, this does not excuse their lack of trust in God.  

Studies have shown that the neurons also play a quintessential role in the development of a child. Catherine Cain, author of Attachment Disorders: Treatment Strategies for Traumatized Children explains that, “[18]the more the child is exposed to during the early years of life, the more the brain structure the child will have to work with in later years. This is why early childhood experiences are so important. If not used, the neurons are eventually depleted. By the time the child is ten, half of the original one thousand trillion neurons are gone. It is as if the brain is preprogramed with more neurons than we could ever possibly use so that the brain has the ability to adapt to whatever environment it is born into and then discard what it does not need.” Cain further explains that learning is accomplished through patterns in the brain. However, “[19]a chaotic environment, or one that is not predictable, makes it difficult for the brain to figure out patterns it needs in order for these behavioral patterns to form.” Because of this, “[20]a young child left in a poor environment with minimal stimulus during the first two years of life does not stand a chance against a child raised in a rich environment with lots of experiences and sensory input.” Therefore, neglect and neurons do in fact play a major role in the physical causes of RAD.  However, while they should be considered, they should never be the sole resource. A counselor must take in both the physical and spiritual elements of an individual.

VII. Examining the Heart

Possible Heart Themes:

  1. Lack of Trust
  2. Self-Preservation
  3. Autonomy
  4. Fear
  5. Disobedience
  6. Anger
  7. Bitterness

Possible Heart Idols:

  1. Control
  2. Self – Reliance

VIII. Biblical Solutions

The core of counseling must be rooted in Scripture. As Biblical counselors we believe that Scripture is sufficient to counsel every need (1 Timothy 3:16-17). Linda Rice, in her book Parenting the Difficult Child describes five common factors in Reactive Attachment Disorder. Using these 5 labels can help inform our biblical counseling (see Appendix 1).

She recognizes that RADs stems from Neglect. When a child suffers from neglect, Biblical counselors must emphasize the comfort and love of God. The counselor teaches identity in Christ (Psalm 139 & Genesis 1:27) and God’s sovereignty. He is Comforter (1 Corinthians 1:3), Perfect Father and Defender (Psalm 10); He works all for good (Romans 8:27-29), and nothing can separate us from his love (Romans 8:31-39). God comforts the sufferer.

The next stages are Lack of Trust and Self Preservation/Autonomy. The child has “learned” from their neglect experience that people are not trustworthy. Therefore, they trust themselves. We must lead them to the perfect, trustworthy God. He will not fail them. We are commanded to trust Him (Proverbs 3:5-8). Failure to trust God is a sin that must be addressed.

The final stages are Emotions and Habituation. The RADs child lives off emotions and forms destructive habits. Change must take root from within the desires of one’s heart (James 1:16). Old habits must be put off, they must be renewed, and new habits must be put on. (See Colossians 3:5-17).

Picture1

This cycle of Neglect to Lack of Trust/Autonomy to Emotions to Habituation forms habits that are hard to break. Rice explains that it is [21]difficult to change because:

  1. If desire doesn’t change, we don’t change
  2. Because its hard/uncomfortable
  3. Habits are hard to break

But we believe that hope for change is possible through the power of Christ and Scripture.  (Ephesians 5:8 and Jude 1:24-27).

 

 

 

 

 

 

 

 

 

 

 

 

 

[22]Appendix 1:

 

 

 

 

 

Recommended Resources:

Asher, Marshal and Mary. The Christian’s Guide to Psychological Terms. USA, 2014.

“Biblical Answers for Attachment.” n.d. Faith Therapy. https://www.faiththerapy.org/answers-by-topic/attachment/. 19 February 2019.

Cain, Catherin Swanson. Attachment Disorders: Treatment Strategies for Traumatized Children. Lanhand : Jason Aronson Publishing, 2006.

Emlet, Michael R. “Loving Others as Saints, Sufferers and Sinners (Part 2).” The Journal of Biblical Counseling (2018): 40-65.

Hollinger, Kevin. Rative Attachment Disorder: Helping Adoptive Parents Think Biblically About Attachment. Westminster Thological Seminary, 2007. Thesis.

Rice, Linda J. Parenting the Difficult Child. USA: SeedSown Press, 2012.

Works Cited

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. Washington: American Psychiatric Association, 1994. Fourth edition.

—. DSM-V. Washington, DC: American Psychiatric Publishing, 2013.

Cain, Catherin Swanson. Attachment Disorders: Treatment Strategies for Traumatized Children. Lanhand : Jason Aronson Publishing, 2006.

Hollinger, Kevin. Rative Attachment Disorder: Helping Adoptive Parents Think Biblically About Attachment. Westminster Thological Seminary, 2007. Thesis.

Rice, Linda J. Parenting the Difficult Child. USA: SeedSown Press, 2012.

The Holy Bible – ESV. Illinois: CrossWay, 2011.

Wilson, Samantha. “Attachment Disorders: Review and Current Status.” Journal of Psychology (2001): 37-.

 

[1] (American Psychiatric Association) 265

[2] (American Psychiatric Association) 265

[3] (American Psychiatric Association) 265

[4] (American Psychiatric Association) 265

[5] (American Psychiatric Association) 266

[6] (American Psychiatric Association) 265

[7] (American Psychiatric Association) 116

[8] (American Psychiatric Association)116

[9] (Rice) 15

[10] (Rice) 15

[11] (Rice)15

[12] (Cain) 151

[13] (Cain)151

[14] (Rice) 151

[15] (Wilson) 11

[16] (Hollinger) 40

[17] (Rice) 51

[18] (Cain) 27-28

[19] (Cain) 31

[20] (Cain) 34

[21] (Rice) 51

[22] (DeVore, 2019) & (Rice) – This figure I created while reading Parenting the Difficult Child.

Anxiety (Generalized Anxiety Disorder)

Posted on by Greg E. Gifford

By Julie Golan

I. Definition

Biblical perspective

The Bible would describe anxiety as a sinful worry, often about the future (Matthew 6:25-34; Philippians 4:6). There are references in Scripture to good kinds of fear, however. The fear of the Lord, for example, is something that the Bible instructs all people to have (Deuteronomy 10:12, Psalm 33:8, Matthew 10:28). Additionally, there is biblical concern that is not sinful, which Paul uses to express genuine care, particularly in the body of Christ (1 Corinthians 12:25, 2 Corinthians 11:28-29, Philippians 2:20).

The majority of Scriptural texts mentioning anxiety or worry are in reference to sinful practices. In Matthew 6, Jesus instructs: “do not be worried about your life, as to what you will eat or what you will drink; nor for your body, as to what you will put on” (Matthew 6:25). He goes on to explain God’s provision for “the birds of the air” and “the lilies of the field”, demonstrating how much more He will provide for those who are His own (Matthew 6:26-30). Concluding, Jesus says, “So do not worry about tomorrow; for tomorrow will care for itself. Each day has enough trouble of its own” (Matthew 6:34). In Philippians, Paul commands the church to “be anxious for nothing, but in everything by prayer and supplication with thanksgiving let your requests be made known to God” (Philippians 4:6). Peter also speaks on anxiety, instructing the recipients of his letter to cast “all your anxiety on Him, because He cares for you” (1 Peter 5:7). The previous verse explains that doing so is an act of humility before the Lord (1 Peter 5:6-7). Before sending Israel into the promised land, God commanded Joshua to “Be strong and courageous! Do not tremble or be dismayed, for the Lord your God is with you wherever you go” (Joshua 1:9). Here, God reminded Joshua of His faithful character and promises, by which there was no need for fear. Again, God reminds those in Israel “with anxious heart” that they need not fear because of God’s promise for ultimate deliverance (Isaiah 35:4). Furthermore, there are many examples in the Psalms where believers have expressed deliverance from fear and that they need not fear because of God’s character and promises (Psalm 23:4, 27:1, 56:3-4, 118:6).

Secular Perspective

In a broad sense, the DMS 5 anxiety as “the anticipation of future threat”.[1] However, there are many different manifestations of anxiety within the realm of psychology. The DSM 5 separates anxiety into seven broad categories: separation anxiety disorder, selective mutism, specific phobia, social phobia, panic disorder, agoraphobia, and generalized anxiety disorder, substance/medication-induced anxiety disorder, anxiety disorder due to another medical condition, other specified anxiety disorder, unspecified anxiety disorder.[2]

Secular treatment for anxiety will primarily be done through medication and psychotherapy. The Harvard Mental Health Letter provides almost 10 different types of medication that can help anxiety and suggests three different types of psychotherapy.

II. History

Fear has existed since the fall, when Adam and Eve hid from God in the garden because they knew their nakedness (Genesis 3:8-10). In terms of anxiety, some have suggested that “Ancient Greek and Latin authors reported cases of pathological anxiety, and identified them as medical disorders” as early as the 3rd-4th century B.C.[3] In modern psychology, Sigmund Freud “coined many of the terms used for various anxiety disorders” in the early DSM books.[4] Beginning with a 1894 article [5], Freud became the first major psychologist to distinguish different types of anxiety. From his work came the popularization of panic attacks, obsessiveness, and phobias.[6] “Freud’s early work unified under the umbrella of ‘anxiety’ a variety of previously distinct syndromes or symptoms that had been associated with broader conditions.” [7] His work paved the way for the “diagnostic revolution of 1980.” [8] Up until this point, there was still a broad understanding of anxiety. However, the introduction of the DSM 3 in 1980 brought about a “large variety of distinct and categorical definitions of anxiety” unlike anything prior.[9] Since, developments and diagnoses of anxiety have only increased.

III. Evidence of the Problem

Generalized anxiety disorder (GAD) is “characterized by a pattern of frequent, persistent excessive anxiety and worry that is out of proportion to the impact of the event or circumstance that is the focus of the worry”.[10] Diagnostic criteria include finding it difficult to control worry, impaired functioning, and physical symptoms such as restlessness and irritability. To be diagnosed with GAD, an individual must be experiencing these symptoms regularly for a minimum of 6 months.

IV. Etiology

According to the Harvard Mental Health Letter, GAD can occur due to other psychiatric disorders such as “substance use disorder or alcohol dependence”.[11] It also notes that “severe or constant stress can produce a hyperactive anxiety reaction”.[12] Spiritual causes for anxiety are often rooted in not trusting God, as suggested by Dr. John MacArthur in his book Anxious for Nothing.[13]

Spiritual symptoms of anxiety can include doubting God’s faithfulness to be true to His character and/or promises. Physical symptoms of GAD can include fatigue, trouble sleeping, trembling, nervousness, sweating, nausea, and irritability.[14]

V. Examining the Heart

One heart theme behind anxiety could include a desire for control. The person struggling with anxiety desires their circumstances to be different and is not meditating on and trusting in God’s sovereignty within the situation. An idol within a desire for control could include the worship of comfort. A sinful desire for comfort could tempt one toward anxiety for the future, health, safety, and more.

VI. Biblical Solutions

Jay Adams suggested the method of “eliminating fear by love”.[15] Essentially, transferring the focus off the one struggling and onto loving others, ultimately God. “Love toward God means focusing upon how one may trust, worship, and serve Him; love toward one’s neighbor likewise focuses upon a giving relationship to him”.[16]  Dr. John MacArthur suggests an agenda that has an emphasis on prayer, and in doing so practicing obedience to Philippians 4:6.[17]

Recommended Books

“Anxious for Nothing: God’s Cure for the Cares of Your Soul” by John MacArthur

“Overcoming Fear, Worry, and Anxiety: Becoming a Woman of Faith and Confidence” by Elyse Fitzpatrick

“Overcoming Anxiety: Relief for Worried People” by David Powlison

 

Recommended Homework Resources

A Homework Manual for Biblical Living by Wayne Mack

Discussion Guides in Anxious for Nothing by John MacArthur

Fear Homework Assignment Samples from The Institute for Biblical Counseling and Discipleship: https://ibcd.org/fear-homework-assignment-samples/

 

Bibliography

[1]Black, Donald W., and Jon E. Grant. DSM-5 Guidebook : The Essential Companion to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. American Psychiatric Publishing, 2014.

[2] Black, Donald W., and Jon E. Grant. DSM-5 Guidebook : The Essential Companion to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. American Psychiatric Publishing, 2014.

[3] Marc-Antoine Crocq. A History of Anxiety: from Hippocrates to DSM. The National Center for Biotechnology Information. 2015.

 [4] Marc-Antoine Crocq. A History of Anxiety: from Hippocrates to DSM. The National Center for Biotechnology Information. 2015.

[5] “The Justification for Detaching from Neurasthenia a Particular Syndrome: The Anxiety-Neurosis”.

[6] Horwitz, Allan V. Anxiety : A Short History. Johns Hopkins University Press, 2013, P 80

[7] Horwitz, Allan V. Anxiety : A Short History. Johns Hopkins University Press, 2013. P 80

[8] Horwitz, Allan V. Anxiety : A Short History. Johns Hopkins University Press, 2013. P 80

[9] Horwitz, Allan V. Anxiety : A Short History. Johns Hopkins University Press, 2013. P 6

[10] Horwitz, Allan V. Anxiety : A Short History. Johns Hopkins University Press, 2013. P 6

[11] Harvard Health Publishing. “Generalized Anxiety Disorder.” Harvard Health Blog. Accessed December 01, 2018.

[12] Harvard Health Publishing. “Generalized Anxiety Disorder.” Harvard Health Blog. Accessed December 01, 2018.

[13] MacArthur, John. Anxious for Nothing : God’s Cure for the Cares of Your Soul. Vol. 3rd ed, David C. Cook, 2012.

[14] Generalized Anxiety Disorder. Mayo Clinic.

[15] Jay Adams, The Christian Counselor’s Manual, 416.

[16]  Jay Adams, The Christian Counselor’s Manual, 416.

[17] John MacArthur, Anxious for Nothing, chapter 2.

Depression

Posted on by Greg E. Gifford

By Hannah Giesbrecht

I. Definition:

Depression is defined as a mental health disorder characterized by persistently depressed mood or loss of interest in activities, causing significant impairment in daily life.

II. Biblical perspective

Depression comes in a variety of different ways and it affects different people differently. Depression can become a debilitating state that comes as a result of spiritual or physical infirmities. The Bible views depression as a trial, a time of suffering that, if viewed with an eternal perspective and treated in a biblically way, will ultimately increase our faith. Depression results as a lack of biblical hope and trust in God. However, depression can be the result of physical imbalances, so regular doctor’s visits are crucial for someone who may be struggling with depression. Our physical body does affect our spiritual and mental health. Depression is characterized by hopelessness, joylessness, guilt, shame, sadness, and worthlessness. Whenever anything or anyone other than God is the focal point of our worship and desire, this kind of idolatry impacts our behavior, our thoughts and our emotions. Romans 5:14 says, “For whatever was written in former days was written for our instruction, that through endurance and through the encouragement of the Scriptures we might have hope.” The Scriptures are sufficient for our every need and that includes battling depression; God’s Word is overflowing with truth that brings hope and peace.

Counseling that skillfully employs and applies God’s Word is a necessary duty of Christian life and fellowship. Scripture is superior to human wisdom and the Word of God is a more effective discerner of the human heart than any earthly means. Our Heavenly Father is the only effective agent of recovery and regeneration. All the treasures of wisdom and knowledge are found in Christ Himself. It is the job of biblical counselors to point counselees to the everlasting hope found in Christ and His Word, because Scripture is sufficient.

III. Secular perspective

  1. Diagnostic criteria for depression based on DSM-IV:[1]

Based on the 9-item depression module from the MINI participants are classified in the following way:

  • Major depressive episode: 5 or more symptoms, including of the key symptoms.
  • Sub-threshold depressive symptoms: 2-4 symptoms, may or may not include a key symptom.
  • Non-depressed: 0-1 symptoms

Symptoms:

  1. Depressed mood*
  2. Loss of interest*
  3. Significant weight loss or gain or decrease or increase in appetite
  4. Insomnia or hypersomnia
  5. Psychomotor agitation or retardation
  6. Fatigue or loss of energy
  7. Feelings of worthlessness or excessive or inappropriate guilt
  8. Diminished ability to think or concentrate, or indecisiveness
  9. Recurrent thoughts of death, recurrent suicidal ideation without a specific plan, or suicide attempt or a specific plan

*key symptoms

  1. Depression is the persistent feeling of sadness or loss of interest that characterizes major depression can lead to a range of behavioral and physical symptoms.

Therapies recommended to those with depression:

  1. Cognitive Behavioral Therapy
  2. Behavior Therapy
  3. Psychotherapy

Secular treatment consists of antidepressants. Medication often prescribed to depression patients includes:

  1. Bupropion
  2. Venlafaxine
  3. Mirtazapine
  4. Duloxetine
  5. Amitriptyline

Recommended specialists:

  1. Clinical psychologist
  2. Psychiatrist
  3. Primary care provider (PCP)
  4. Emergency medicine doctor

IV. History

Many scholars think that depression was first recognized as early as the time of the Ancient Greeks. The Greeks thought the disease was due to an imbalance in the four basic bodily fluids, or humors. Later, Aretaeus of Cappadocia noted that sufferers were dejected and stern, without any real cause. The name given to depression then was known as Melancholia, which was a far broader concept than today’s depression. In the 11th century, Persian physician Avicenna described melancholia as a mood disorder. Avicenna’s work, The Canon of Medicine, alongside the work of Hippocrates and Galen, became the standard of medical thinking in Europe. In the 18th century, German physician Johann Christian Heinroth argued that melancholia was a disturbance of the soul due to moral conflict. The term depression was derived from the Latin verb deprimere, which means, “to press down.” In the 19th and 20th centuries, English psychiatrist Henry Maudsely proposed a general category of affective disorder. Depression and reactive depression came to refer to a mood and not a reaction to outside events. In the 21st century, humanistic theories of depression have represented a forceful affirmation of individualism.

Depression has also been called clinical depression, major depression and major depressive disorder. Current treatment of depression implies that depression is a biomedical disease, which is why most psychiatrists prescribe antidepressants. The expert panels for treating depression (Depression Guideline Panel 1993; Katz and Alexopoulos 1996; Ballenger et a. 1999; WHO Collaborating Centre for Mental Health Research and Training 2000) recommend a clinical approach can be summarized as follows. Providers should:

  1. Recognize the presenting symptoms of depression and its causes.
  2. Make an explicit diagnosis of depression.
  3. Educate the patient and family, and stress that depression is treatable.
  4. Engage the patient and family in choosing treatment.
  5. Assess patients’ progress regularly.

Usually, treatment of depression begins with a patient visiting a health-care provider and reporting symptoms that suggest a mood disorder. Oftentimes the emotional symptoms of depression are hidden behind physical symptoms like complaints of fatigue.

V. Evidence of the Problem

Common themes and patterns observed in the lives of those who have been diagnosed with depression are extreme sadness, anxiety, listlessness, and feeling blue. Those who struggle with depression are often fatigued, over time becoming restless and irritable. Sleep is often restless, tossing and turning all night. Nightmares occur frequently, making restful sleep even more difficult. Another common theme is utter hopelessness. Many of those who are depressed are also suicidal. Depression is a despair that consumes you.

Severe depression can be debilitating, and there are several key expressions, recognizable as symptoms of depression. some cases where the activity level is as minimal as possible. Depression can have severe long term effects on one’s daily functions, as well as relationships with friends and families. Guilt and feelings of worthlessness overcome the counselee. Everything is negative, dwelling on past sad experiences, sins, failures and disappointments. Minor problems become major problems as one imagines the worst possible scenario. Some people lose unhealthy amounts of weight, while some people struggle to eat at all. People lose interest or pleasure in what used to interest you. Many people have trouble concentrating, feeling as though thoughts and movements have been slowed down; like your brain is fuzzy and in slow motion.[2] Depression takes a big toll on one’s physical self as well as one’s spiritual self. Many believers struggle to pray when they are feeling depressed.

VI. Etiology

Depression is an issue that affects people physically and spiritually. There isn’t an over arching “rule of thumb” for theories of depression. It manifests itself differently in different people. However, hope is found in the Person of Jesus Christ, not a pill. Sometimes the source of the problem is physical, then spiritual, sometimes vice versa. There are several spiritual symptoms and physical symptoms that can be seen in most cases of depression.

  1. Spiritual symptoms
    1. Hopelessness
    2. Continual lack of peace
    3. Not trusting in God
    4. Feelings of despair
    5. Discouragement
    6. Disappointment
    7. Despondency
    8. Lack of motivation
    9. Difficult to focus
    10. Diminishing prayer life

2. Physical symptoms

  1. Restlessness, unexplainable unhappiness
  2. Drastic change in weight
  3. Headache
  4. Brain fog
  5. Blurred vision
  6. Excessive crying
  7. Sadness
  8. Lack of concentration
  9. Irritability
  10. Social isolation

 

VII. Examining the Heart

  1. Heart themes
    1. Incorrect view of the faithfulness of God
    2. Hopelessness
    3. Incorrect view of the sovereignty of God
    4. Fear of man – guilt that others will think of you differently if they knew you struggled with depression.
    5. Lack of trust in the Lord (control)

2. Idols of the heart

  1. Pride
  2. Control,
  3. Self – reliance,
  4. Comfort
  5. Selfishness

 

VII. Biblical Solutions

  1. Counseling Agenda

Depression of one of the common temptations of man. 1 Corinthians 10:13 says, “No temptation that have overtaken you but such as is common to man.” One of the first steps a counselee can make towards change is admitting that God is capable of helping overcome depression. Another practical step a counselee can take is to commune with God through His Word. Lamentations 3:17-24 says, “I still dare to hope when I remember this: The faithful love of the Lord never ends! His mercies never cease. Great is his faithfulness; his mercies begin afresh each morning. I say to myself, ‘The Lord is my inheritance; therefore, I will hope in him’” God is faithful, capable, sovereign, eternally good and we desperately need hope every day of our lives! Christians struggling with depression need to fix their eyes on the Lord, the Author and Perfecter of faith. Romans 8:28 says, “And we know that for those who love God all things work together for good, for those who are called according to his purpose.” There is a reason and a purpose for the trial of depression, but believers are called to depend on Him through it all. Hebrews 6:19 says, “We have this as a sure and steadfast anchor of the soul, a hope that enters into the inner place behind the curtain.” Christ is our sure and steadfast anchor, which offers hope through Him and His Word.

Recommended Resources:

Adams, Jay E. A. The Theology of Christian Counseling. Grand Rapids, MI: Zondervan,

1979.

Adams, Jay E. The Christian Counselor’s Manual. Grand Rapids, MI: Zondervan, 1973.

Bridges, Jerry. Trusting God: Even When Life Hurts. Colorado Springs, CO: NavPress.

Busenitz, Nathan. Living A Life of Hope. Uhrichsville, OH: Barbour Publishing, 2003.

Lane, Timothy S., and Paul David Tripp. How People Change. Greensboro NC: New

Growth Press, 2008.

Somerville, Robert B. If I’m A Christian, Why Am I Depressed? United States of

America: Xulon Press, 2014.

Welch, Edward T. Depression: Looking Up from the Stubborn Darkness. Greensboro,

NC: New Growth Press, 2011.

Welch, Edward T. Depression: The Way Up When You Are Down (Resources for

Changing Lives). Greensboro, NC: New Growth Press, 2011.

Tada, Joni Eareckson. A Place of Healing: Wrestling with the Mysteries of Suffering,

Pain, and God’s Sovereignty. Colorado Springs, CO: Wolgemuth & Associates,

Inc. 2010.

Mack, Wayne A. Out of the Blues: Dealing with the Blues of Depression and Loneliness.

Minnesota: Focus Publishing, 2006.

Mack, Wayne A and Deborah Howard. It’s Not Fair! Finding Hope When Times Are

Tough. P & R Publishing: 2008.

Adams, Jay. What Do You Do When You Become Depressed? Phillipsburg, NJ:

Presbyterian and Reformed, 1975 (pamphlet).

Bridges, Jerry. Trusting God. Colorado Springs, CO: NavPress, 1989.

 

 

 

Recommended homework resources

Sample 1(taken from Robert Somerville’s book: If I’m a Christian, Why Am I Depressed?[3])

Somerville recommends journaling what you’re going through, as you’re learning and growing.

  • Journal a paragraph or two describing the anguish you feel.
  • Write out 1 Corinthians 10:13 in your journal and on a 3×5 card.
    • Memorize it.
    • On the back of the card write out a prayer, paraphrasing the verse as a prayer back to God. It might look like this: “Father, I thank You that You are faithful and that all our problems are common to man. I thank You that You never give us a temptation, test, or trial that is greater than we can handle. I thank You that You always provide a way through the problem so that we can handle it. Lord, as I face my depression today help me to look for the way out that You have provided so that I might be able to endure.”
    • Review the card and pray it back to God several times each day.
  • Read 1 Corinthians 10:13, Hebrews 4:14-16, and 1 John 1:9 and answer the following questions on each verse:
    • What has God promised you?
    • What hope and encouragement do you get from these three passages?
    • How will you respond to God’s promises in your situation?

 

 

[1] Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, by the American Psychiatric Association.

[2] Somerville, Robert B. If I’m A Christian, Why Am I Depressed? United States of America: Xulon Press, 2014.

[3] Somerville, Robert B. If I’m A Christian, Why Am I Depressed? United States of America: Xulon Press, 2014.

Gluttony

Posted on by Greg E. Gifford

By Luke Brannon

Problem/Condition: Gluttony

  1. Definition
    1. Biblical Perspective: Gluttony
      1. The biblical term for overeating is gluttony (Prov. 23:2, 21; Prov. 18:7, Titus 1:12-13). Gluttony is the uncontrolled eating of food that is excessive and unnecessary. Gluttony or overeating occurs when a person eats to a level that is wasteful, unhealthy, and lacking self-control. Gluttony, in the Bible, is often related to laziness and excessive drinking of alcohol. Food is a gift from God, and God wants us to enjoy eating food with a spirit of thankfulness to Him (1 Cor. 10:31). However, it is important to understand that gluttony is condemned in the Bible. Believers must exercise self-control over their bodies to avoid falling into the sin of gluttony. Eating becomes gluttony when a person eats in an excessive manner which is unhealthy to his body and is lacking of self-control.
  2. Secular Perspective: Overeating
    1. The most general secular term for gluttony is overeating. Overeating includes any time that person eats more food than is needed for his/her body. Usually isolated instances of overeating are not recognized as a significant issue, but regular overeating is recognized as a major issue. There are several patterns of overeating that are classified as disorders.
    2. Bulimia Nervosa and Binge-Eating Disorder
      1. Both of these disorders describe compulsive and recurring binge eating sessions.[1] Bulimia Nervosa is the name for the disorder in which a person compulsively binge eats then uses methods such as induced vomiting or laxatives to expel the food. Binge-Eating Disorder is the title for the disorder in which a person compulsively binge eats, but does not take any measures to expel the food.[2] The secular world views these actions as disorders in which the person’s body and past is responsible for the person’s binge eating sessions.
    3. History of Overeating
      1. Overeating, or gluttony, has existed from very near the beginning of time. A biblical example of this can be found in Judges 3 and the story of Ehud and Eglon. Eglon, the king whom Ehud assassinates, is a described as being a very fat man (v. 17). This example, with countless other examples of overeating and overweight people in the past, clearly show us that gluttony is not a new issue. However, it is true that over the past several decades obesity has become a larger issue.[3]
    4. Evidence of the Problem
      1. The prevalence of gluttony in our world today is evidenced by the high rates of obesity. According to an article published by CDC Stacks, over the last 50 years the percentage of overweight people in the United States has remained quite steady, but the percentage of obese people has been greatly increasing.[4] This shows that excessive eating has been on the rise in America.
      2. Gluttony and obesity are connected with numerous medical and interpersonal issues. Gluttony causes numerous health issues such as diabetes, heart problems, and many others.[5] It also can encourage interpersonal issues such as depression, embarrassment, and hate of self.[6]
  • Etiology
    1. Physical Causes
      1. While physical causes are not solely responsible for gluttony, or what the secular world calls binge eating, they do play a role in enticing a person to overeat. Factors such as genetics, the way one’s body reacts to certain stimuli, or even metabolic damage from extreme dieting can make a person more prone to binge eating.[7]
    2. Spiritual Causes
      1. While a person’s body may encourage him to sin by gluttony, each person is still responsible for his own actions. For a person who struggles with gluttony, the most likely spiritual issue is a lack of self-control. A person who is gluttonous gives in to his bodily cravings. However, the Bible commands each person to exercise self-control over his/her body. In 1 Corinthians 9:27 Paul writes on self-control, “But I discipline my body and keep it under control, lest after preaching to others I myself should be disqualified.” Paul also writes in Galatians 5:16-17, “But I say, walk by the Spirit, and you will not gratify the desires of the flesh. For the desires of the flesh are against the Spirit, and the desires of the Spirit are against the flesh, for these are opposed to each other, to keep you from doing the things you want to do.” These verses show that fleshly desires must be defeated with Spirit-filled self-control.
    3. Physical Symptoms
      1. As mentioned above, gluttony can result in obesity which can lead to serious health issues such as heart problems, diabetes, and many others.
    4. Spiritual Symptoms
      1. Overeating can lead to depression and insecurity. A person who struggles with gluttony will often feel like a failure. They may begin to develop a fatalistic mentality in which they believe they are unable to overcome temptation in their lives. Discouragement and even apathy are often spiritual symptoms of gluttony.
    5. Examining the Heart
      1. The main heart issue behind gluttony is the worship of the comfort and pleasure that food brings. Often times a person who overeats will do so because of stress, anxiety, depression, or some other discomfort. The person who turns to food instead of the Lord for relief to their problems is placing his worship in the wrong place. A person who struggles with gluttony needs to learn to find his refuge in the Lord rather than in the comfort that food brings. In Psalms 121:1-2 David writes, “I lift up my eyes to the hills. From where does my help come? My help comes from the Lord, who made heaven and earth.” He also writes in Psalm 86:7, “In the day of trouble I call upon you, for you answer me.” David’s hope in hard times was found in the Lord. A person who places his trust in the Lord will not be let down, but a person who places his hope for security and satisfaction in food will only make his problems worse. Gluttony stems from a worship of the comfort and pleasure that food brings, but only worship of God will bring true satisfaction and peace.
    6. Biblical Solutions
      1. Counseling Agendas
        1. Kelly Jo Lynch in “Approaches to the treatment of Overeating in Christian Literature” writes that there are 5 key elements that must be present in a counseling plan for gluttony. The five components of biblical response to sin are “acknowledgement and confession of sin; repentance; receiving grace, mercy and power from God; confession of sin to others; and changed behavior.”[8] Any counseling plan for a person who struggles with gluttony must bring the counselee to a point where he recognizes gluttony as a sin and repents of it. He then must come to an understanding of God’s grace and rely on God’s power to overcome his sin. He should confess his struggle to others so that they can keep him accountable as he takes measures to change his behavior.

Recommended books

  1. Fitzpatrick, Elyse. Idols of the Heart : Learning to Long for God Alone. Second ed. Phillipsburg, New Jersey: P & R Publishing, 2016.
  2. Lynch, Kelly Jo, and Theological Research Exchange Network. “Approaches to the Treatment of Overeating in Christian Literature,” 2001.
  3. Mack, Wayne A, and Wayne Erick Johnston. A Christian Growth and Discipleship Manual. Homework Manual for Biblical Living, 3. Bemidji, MN: Focus Publishing, 1995.
  1. Pritchard, Ray. Man of Honor : Living the Life of Godly Character. Wheaton, IL: Crossway Books, 1996.

Recommended Homework Resources

  1. Adams, Jay E. The Christian Counselor’s Manual : The Practice of Nouthetic Counseling. The Jay Adams Library. Grand Rapids, Mich.: Zondervan, 2010.
  2. Mack, Wayne A. A Homework Manual for Biblical Counseling. Phillipsburg, N.J.: Presbyterian and Reformed Pub, 1979.

 

 

 

 

 

 

 

Bibliography

“Binge-Eating Disorder.” Mayo Clinic, Mayo Foundation for Medical Education and Research, 5 May 2018, www.mayoclinic.org/diseases-conditions/binge-eating-disorder/symptoms-causes/syc-20353627.

Chambers, Natalie. Binge Eating: Psychological Factors, Symptoms and Treatment. New York: Nova Biomedical, 2009. https://ezproxy.masters.edu:4443/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=nlebk&AN=333503&site=ehost-live&scope=site.

Fryar, Cheryl D., Margaret D. Carroll, and Cynthia L. Ogden. “Prevalence of overweight, obesity, and severe obesity among adults aged 20 and over: United States, 1960–1962 through 2015–2016,” 2018.

Lynch, Kelly Jo, and Theological Research Exchange Network. “Approaches to the Treatment of Overeating in Christian Literature,” 2001.

Ogunbode, A M et al. “Health risks of obesity” Annals of Ibadan postgraduate medicine vol. 7, 2009.

Parrillo, Vincent N. Encyclopedia of Social Problems. Thousand Oaks, Calif: SAGE Publications, Inc, 2008. https://ezproxy.masters.edu:4443/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=nlebk&AN=474380&site=ehost-live&scope=site. P. 632

Tracy, Natasha. “Types of Eating Disorders: List of Eating Disorders.” HealthyPlace, Healthy Place, 10 Jan. 2012, http://www.healthyplace.com/eating-disorders/eating-disorders-overview/types-of-eating-disorders-list-of-eating-disorders.

[1] Chambers, Natalie. Binge Eating: Psychological Factors, Symptoms and Treatment. (New York: Nova Biomedical, 2009). 24.

[2] Tracy, Natasha. “Types of Eating Disorders: List of Eating Disorders.” (HealthyPlace, Healthy Place, 2012).

[3] Parrillo, Vincent N. Encyclopedia of Social Problems. (Thousand Oaks, Calif: SAGE Publications, Inc., 2008). 632.

[4] Fryar, Cheryl D., Margaret D. Carroll, and Cynthia L. Ogden. “Prevalence of overweight, obesity, and severe obesity among adults aged 20 and over: United States, 1960–1962 through 2015–2016.” (2018). Table 3

[5] Ogunbode, A M et al. “Health risks of obesity” Annals of Ibadan postgraduate medicine vol. 7 (2009). 22-5.

[6] Ibid.

[7] “Binge-Eating Disorder.” Mayo Clinic, Mayo Foundation for Medical Education and Research, 5 May 2018.

[8] Lynch, Kelly Jo, and Theological Research Exchange Network. “Approaches to the Treatment of Overeating in Christian Literature,” (2001) 59.