Popcorn Night is a term that was coined to assist caregivers in providing a calm and comfortable night for their child following a desensitization session. Following the reprocessing of a memory, the therapist works with the caregivers to manage the possible emerging behaviors and assist with a log to track any changes in symptomology. Engaging caregivers and other outside support in eye movement desensitization and reprocessing (EMDR) therapy with kids leads to better outcomes as it provides additional support and additional information about the child's functioning. Popcorn Night is an instructional handout and log that helps guide caregivers in structuring a carefree and supportive evening after desensitization and track emerging symptoms or behaviors in the time between sessions. It is important to be transparent, flexible, and hopeful with this intervention as it can both inform treatment and encourage commitment to continued growth through EMDR.

The utilization of eye movement desensitization and reprocessing (EMDR) therapy alone, as Francine Shapiro has discussed, presents challenges when working with children, particularly with complex relational trauma. Limits for the effectiveness of EMDR include the developmental immaturity of the child and missing adaptive information, the impact of trauma on skill development, and lack of trust due to the impact of relational trauma. This chapter explores how creative arts therapy holds the potential as a special form of mentalization therapy that can support and strengthen the skills required for success in EMDR in Phase 4 processing. This approach emphasizes how the expressive arts, when used strategically, can extend the reach of EMDR by utilizing the indirect dyadic process of art making within a therapeutic relationship increasing trust, building metacognitive functioning, elevating concrete thinking through experiential learning, and taking a curious, open, and playful stance that helps grow self-reflective capacity.

This chapter serves as a call to include interventions that acknowledge, value, and celebrate the culture of children and their families. The Latinx population is growing in the United States, and it is imperative that therapists provide culturally sensitive services to this population. The chapter presents playful and creative interventions that have been helpful during the different phases of eye movement desensitization and reprocessing (EMDR) therapy with Latinx children. It highlights important cultural and clinical considerations when utilizing EMDR therapy with Latinx children and teens through the lenses of three main principles: (a) Follow the child's lead and interest; (b) be curious, ask questions, and maintain an open attitude; and (c) utilize and emphasize cultural and individual strengths. It includes playful and creative interventions that have been helpful during the different phases of EMDR therapy with this population in order to make their treatment more culturally attuned and developmentally appropriate.

This chapter provides a brief description about the intervention that was designed to support and assist children and adolescents in developing negative cognition and positive cognition in the assessment, desensitization, and installation phases using a creative intervention of “making lemonade” and turning “sour” thoughts into “sweet” thoughts. This intervention integrates eye movement desensitization and reprocessing (EMDR) and play in the processing of traumatic material. Creativity and modifications to the standard EMDR protocol have been used to great success by the leading child and adolescent therapists in the field. Lemon Squeezies is a modification of the standard EMDR protocol in the assessment, desensitization, and installation phases when working with children and adolescents. Modifications to the EMDR standard protocol should only be made to accommodate the developmental needs of each age group. If the child or adolescent does not like lemonade, the therapist may substitute another metaphor using their best clinical judgment.

A journey into learning about dissociation usually begins with a therapist being unsuccessful in the treatment of traumatized children. An eye movement and desensitization and reprocessing (EMDR) clinician starts to seek information on how to help their clients by attending training, reading books, or engaging in “What am I missing?” discussions while in supervision. Therapists have an “aha moment” when they look through the lens of dissociation at the child's symptoms and behaviors. The gift of dissociation brings relief to many children in harmful situations. This chapter provides an understanding of the internal world of self-states and what that might look like in the child's external world and in the playroom. Recognizing and knowing the guiding principles of how to access self-states provide therapists the tools for effective treatment for the child and all of their caregivers.

This chapter proposes the Pocket Smock as a Phase 2 intervention to facilitate the preparation process. The Pocket Smock is designed to be a visible and even tangible location to consolidate the child's acquired self-regulation resources. While it primarily serves to prepare the child for the trauma-resolution phases of the eye movement desensitization and reprocessing (EMDR) protocol, the Pocket Smock is suitable for use throughout the entire treatment process and beyond. The chapter introduces writing and coloring utensils; clothing items for smocks; preferred craft items; index cards; pocket smock template; office posters (step-by-step instructions in this chapter); optional: electronic drafting applications, camera, and Velcro dots.

The playroom provides a range of materials that can aid in eye movement desensitization and reprocessing (EMDR). Blending both cognitive and experiential therapies for children helps to reduce anxiety in children. Introducing a child to EMDR in a room full of toys, art, sand, and other creative avenues for EMDR processing is challenging and requires skill and an age-appropriate explanation. This chapter illustrates ways to both introduce and engage a child in EMDR even for a limited amount of time such as 5 to 10 minutes during play therapy. The interweaving of EMDR and play is also illustrated in a case study. Within the eight phases of EMDR processing, the five stages of experiential play therapy are woven together, led by the child and supported by the therapist.

In the three decades since Francine Shapiro introduced the model, adaptive information processing (AIP) and eye movement desensitization and reprocessing (EMDR) have provided mental health clinicians with a method for conceptualizing clients' responses to traumas as adaptive and protective without diminishing the pain that comes from holding stored trauma. For those working with child clients, the goal of healing emotional and relational wounds becomes substantially more attainable when caregivers also come to view children's trauma responses as adaptive and protective, all the while developing increasing capacity for being with their children's woundedness. EMDR therapists who provide family-based play therapy need ways to establish and monitor safety within family systems in order for the integration of these modalities to offer their full power. This chapter aims to offer sandtray as a modality that allows for this integration. Sandtray offers a common language for all who engage.

Play therapy allows children to develop a rich variety of resources for complex trauma. Making a safe therapeutic space for the activation and the adaptive processing of traumatic memories has been a central theme in play therapy literature. Trauma-sensitive yoga (TSY) and embodied play therapy blend well with eye movement desensitization and reprocessing (EMDR) therapy to address the preverbal and somatic challenges often associated with children who have experienced complex trauma. In order to demonstrate how to best integrate embodied play therapy and TSY techniques into the preparation phase of EMDR therapy, this chapter presents an overview of trauma and the brain–body connection, yoga, and play therapy. It also presents specific trauma-sensitive yoga and embodied play therapy exercises that can be used with children during the preparation phase of EMDR. TSY connects with the therapeutic powers of play of self-regulation, positive emotions, stress management, resiliency, and the therapeutic relationship.

Despite the potential benefits, children are often very reluctant to participate in eye movement desensitization and reprocessing (EMDR) therapy. Prescriptive play therapy for trauma involves a phase-based approach where the activities within the playroom may vary from less directive to more directive with the goal of supporting trauma exposure/trauma narrative work. Trauma-informed prescriptive play therapists guide play in the avenues that will support trauma digestion and emotional regulation. Integrating play therapy within Francine Shapiro's adaptive information processing model with a flexible approach to the EMDR protocol holds promise in using play to enter the memory network and promote healing. This chapter establishes eight essential considerations in fully integrating EMDR in a play therapy setting and examines the idea that play may be the preferred avenue to access and reprocess with EMDR the implicit memories involved so often in complex trauma in children.

This chapter addresses combining synergetic play therapy (SPT) with eye movement desensitization and reprocessing (EMDR) while maintaining fidelity to both therapies. Both SPT and EMDR are informed by the adaptive information processing (AIP) model as developed by Francine Shapiro in 1987. This combined process of therapy is synergetic and relies heavily on theories and research regarding the storage of memory, the mirror neuron system, neurobiology of the brain, interpersonal neurobiology and coregulation, and the innate states of nervous system activation. The chapter expands on these key concepts: understanding the neurobiology of coregulation as it relates to EMDR therapy and synergetic play through the lens of SPT; the importance of therapist regulation while facilitating EMDR in the playroom using SPT theory and its base in neuroscience; the stages of EMDR therapy with SPT and EMDR combined; and the use of EMDR as a directive and nondirective process in play therapy.

This chapter demonstrates how the gains acquired through Theraplay® can be leveraged for healing by infusing eye movement desensitization and reprocessing (EMDR) into Theraplay treatment. Infusion in the preparation phase will be the primary focus; however, considerations for infusing EMDR and Theraplay are offered for application within the assessment, desensitization, installation, and body scan phases of the EMDR protocol. Treatment with Theraplay yields reparative experiences that can be used for adaptive information processing during the trauma-resolution phases of treatment. Infusing EMDR into this process allows these experiences and subsequent positive feeling states to be harnessed as resources through EMDR-specific strategies. The chapter provides steps that demonstrate how these strategies can be used for resource gathering and installation, and the considerations section explains how to infuse EMDR into Theraplay for target gathering or assessment (Phase 3) and reprocessing (Phases 4–6).

This chapter reviews how clinicians can combine play therapy skills with eye movement desensitization and reprocessing (EMDR) therapy to treat young children who have experienced trauma. It presents a descriptive approach to integrating play therapy skills with the EMDR protocol for therapists already using play to facilitate trauma. Young children's trauma often arises from early neglect and abuse, resulting in emotional dysregulation and inappropriate behaviors. Child-centered play therapy, developmental play therapy, and EMDR are interventions that address these issues and are also effective relational therapies that can be even more powerful when combined. These therapies complement each other to allow successful treatment of complex trauma in our youngest clients. Through examples and a case study, therapists will appreciate how play therapy and EMDR work well together and how clinicians' play therapy skills can be easily incorporated into all phases of the EMDR protocol.

When children are exposed to toxic environments for many years of their childhood, they may have a difficult time even imagining a calm or safe place. Fort Tent has been adapted from Francine Shapiro's Calm Place exercise. This adaptation is designed to better suit children's needs. Abused and neglected children have very few internal and external resources to enhance the original Calm Place. The initial goal of this intervention is to create a specific experience of a Calm Place. The Fort Tent Calm/Safe Place (Fort Tent) is an intervention designed to help create safety within the constructs of the therapy office. This creative intervention heightens present moment experience of safety in real time. The Fort Tent allows clients who need a more concrete, kinesthetic intervention to be involved in the development of the safe place, thus empowering them to have a level of control in their own sense of safety.

This intervention was designed to work best with children who may be sensory seeking, seem hesitant or cautious when discussing the trauma, have low tolerance for exposure to the trauma, or find bilateral eye movements challenging. It requires that children engage in bilateral stimulation and eye movements by physically tapping different color hand images for desensitization and installation. The effectiveness of this intervention relies on the level of control and independence that the child has, the bilateral stimulation and sensory experience that they gain from the tapping motions, and the increased feeling of safety for children who tend to be more guarded when exploring their trauma experience. Color Hands is a creative, play-based intervention for Phase 4, desensitization, and Phase 5, installation, of the eye movement desensitization and reprocessing (EMDR) protocol. This chapter discusses phases of EMDR; materials; rationale; description of intervention; step-by-step instructions; modifications; and considerations.

The Superhero Shuffle is a playful intervention that is designed to work best with high-energy children and children who have low tolerance for exposure to trauma or engaging in the bilateral eye movements of eye movement desensitization and reprocessing (EMDR) therapy. Superhero figurines are utilized to assist with bilateral eye movements for desensitization and installation as well as to serve as inspiration for resource development in the preparation phase and cognitive restructuring in the installation phase. The effectiveness of this intervention relies on the therapist's ability to maintain a playful, fast-paced approach to meet the child's energy levels for maintaining concentration and participation. This play-based intervention was designed specifically for the child who is unable to sit still and concentrate for long periods of time. Symptoms of trauma may include hyperarousal, sensory-seeking behaviors, inattention, and low tolerance for exposure to anything related to processing the trauma.

Resource Wand is an intervention that is designed to give added support to a child during the reprocessing of a memory that has the potential for overwhelming or flooding. It is used to manage levels of arousal and affect in Phase 4 of eye movement desensitization and reprocessing (EMDR): Desensitization. A resource wand is a play-based item such as a magic wand or stick that has a picture (real or drawn) of a support person, animal, or object on it. During eye movements, the child follows the wand with the picture while processing the target. During history taking and the preparation phase, the therapist and child should identify the supports that exist in the child's life. Resource Wand is an intervention that is playful to make and use during the reprocessing of a memory. It offers any child an opportunity to feel safe during the desensitization phase.

This chapter presents a play-based intervention that addresses the challenge of providing eye movement desensitization and reprocessing (EMDR) to early elementary school–aged boys. Their energy level, restlessness, and need to engage physically can at times get in the way of reprocessing a traumatic memory. Splatting Out the Trauma has built in resourcing, social engagement, and organic trauma response completion that can help facilitate the desensitization and installation phases of EMDR. Children with higher energy levels often need interventions that are shorter in time and are more hands-on to engage them physically. Splatting Out the Trauma is introduced during Phase 3, assessment. The child is asked to draw a picture of the worst part of the identified memory to be processed. There are some considerations and possible adjustments that may need to be made with this intervention depending on the client's needs and abilities.

Finding ways to complete Phase 1 of the eye movement desensitization and reprocessing protocol, history and treatment planning, presents unique challenges when working with children. The therapist often has many other sources of information about the child's trauma history; still, developing a shared understanding of the trauma and the impact of trauma is just as important in child therapy as it is in the adult protocol. This chapter presents an option for using storytelling, props, and metaphor to elicit trauma history from a child in a way that is sensitive to their age and their window of tolerance for distress. Gathering trauma history from the child early on in treatment in a play-based and developmentally informed way creates an opportunity to obtain some of the painful information while keeping the child feeling emotionally grounded and safe.

TraumaPlay is a flexible, sequential, play therapy model designed for treating traumatized and attachment-disturbed children and teens. An integration of TraumaPlay and eye movement desensitization and reprocessing (EMDR) functions as a one–two power punch combination as the power of play is recognized as the child's most natural form of adaptive information processing and encourages the full-body somatic experiencing of new neurophysiological states while desensitizing and reprocessing hard things. The overarching goals of TraumaPlay include leaching the emotional toxicity out of clients' traumatic experiences, creating a more coherent narrative of these life events, and deepening relational resources. Getting through the child client's layers of protection requires developmental sensitivity, titration, and creativity. Unlocking a traumatized child's healing may take more than one key, so pairing TraumaPlay and EMDR together can maximize the effectiveness of each. TraumaPlay therapists enhance safety and security through both nondirective play therapy methods and directive play therapy interventions.

While animal cognition researchers may look strange at playing parrot vocalizations on loud speakers in the jungle or presenting gorillas with trays of colored shapes, there very much is a method to our madness. That method is the scientific method whose steps are to develop a research question, design appropriate methodologies, collect and analyze data, then share the findings with the scientific community. This chapter presents some considerations and methods for studying animal cognition with the hope that, the reader will use some of them in their future observations of animal behavior—both human and nonhuman. Animal cognition is a branch of psychology, the scientific study of behavior and mental processes. Some of the most famous and informative studies of animal cognition have been through the case study method. Most animal cognition research is conducted by scientists who are affiliated with colleges and universities.

This chapter explores the history of the field of animal cognition in order to help situate the current methods, theories, and interpretations of findings. After all, how can one truly understand the present field of animal cognition, or even speculate about its future, without being knowledgeable of how the field came to be? The chapter traces two key figures, René Descartes and Charles Darwin, and how their starkly different ways of viewing animal minds—driven by their own understanding of the natural world at the time—divided the scientific community for many generations. Out of Darwin’s presumptions of the relationship between humans and animals, it highlights how the field of animal cognition took root, complete with a few residual growing pains left over from Descartes’ perspective, and refined itself into a formal discipline, heavily influenced by scientific and societal views of its time.

Personality and emotional well-being are features of an animal’s behavior that are very real but have historically not been considered cognitive. Individual differences act as ever-present filters, influencing the cognitive processes that we have shared up to this point. Including this chapter at the end of the book should serve as to contextualize all of the findings. In the human psychology world, personality is considered someone’s enduring or stable, predictable ways of thinking, feeling, or behaving over time and across context. The chapter highlights some of the findings and methodological considerations that must be made at each of these stages. It provides multiple examples of how carefully researchers must work to ensure that the labels they assign to behaviors accurately reflect what they’re seeing, that the tasks themselves correspond to those labels, and that the labels say something about a particular core personality trait.

At a very basic level, communication involves passing an information-containing signal from a sender to a receiver. Though we tend to think of communication as a sophisticated, highly complex process, a great deal of human and nonhuman communication occurs without a hint of cognitive effort. This chapter revolves around these kinds of honest signals—ones that provide true information—being communicated between or within species. It opens with a few of favorite examples of how animals use communication to deceive one another. There are two major communication features (referential signaling and syntax) that are indicative of higher cognitive abilities rather than simply physiology, reflexes, or basic conditioning. Referential signaling is extremely important when studying complex communication systems. Once referential abilities are established, some species are able to use syntax to change the meaning of a message by manipulating the order of the vocalizations or gestures in the signal they are communicating.

For centuries, philosophers, neuroscientists, psychologists, and many others have attempted to define consciousness in humans. Depending upon who you are, what your agenda is, and how you were trained, definitions for consciousness will vary. This chapter jumps right into the hotly debated area of animal consciousness. It takes an in-depth look at how philosophers and scientists have defined consciousness, specific cognitive abilities that might signal consciousness, and which animals can be said to have them, or a version of them. The main topics covered include theory of mind, self-awareness, and emotions. Happy, the first elephant documented to behave as if she recognized herself in a mirror, as well as the important implications of this finding, is the subject of the animal spotlight. The human application section walks through how theory of mind develops in children and the ways developmental psychologists can determine whether a child has mastered it.

The rise of social media and popular press articles on the Internet has done wonders to make the field of animal cognition more visible and accessible to those outside of academia. In addition to animal cognition findings being used to change how we legally treat and view animals, the field of animal cognition has ushered in an exciting shift in the value of the work. Not everyone in animal cognition’s history has subscribed to practice of a diverse interdisciplinary perspective, and especially not psychologists who were trained and working during the behaviorist movement. Humans have changed the planet in the last few hundred years into something that is almost unrecognizable. For a long time, feelings of human superiority prevented us from learning about other species for the sake of learning about them. This concluding chapter discusses technological advancements; interdisciplinary collaborations; and human induced rapid environmental change.

Within the animal kingdom, sociality is on a giant continuum, with a large degree of diversity in how social, with whom, and how complex those interactions are among conspecifics. This chapter explores in greater depth some of the advanced ways that animals engage with one another. As reader sees, there appears to be a correlation between sociality and cognition. Knowing something about the depth (or lack thereof) of a species’ social behavior allows researchers to contextualize and better understand cognitive abilities such as theory of mind, problem solving, and referential signaling in communication. By learning from others, one can effectively and efficiently interact with the environment. One very special way humans and animals also use social cues are called social referencing, which involves learning from others’ emotional responses. These responses, like a grimace after the first bite of a disgusting meal, act as signals that communicate information to social partners.

This chapter addresses the overall flexibility of the animal mind. It discusses about instincts; planning and forethought. The cognitive processes necessary to project into the future epitomize a highly flexible mind. Nonetheless, evolutionarily speaking, mental time travel may not be useful for all animals. Following this, the chapter discusses problem solving; play behavior; and innovation. For centuries, there have been those who believe animals are mindless behaving machines. One probably does not think that, or one would not be reading, but where is the line between instinct and cognitive behavior? Do animals plan out their actions in advance, play, and create? One creative crow, and her remarkable ability to problem solve and use tools, are featured in the animal spotlight. In human application, it discusses the difficult question of how to measure creativity in humans and tips for how can find and increase creativity and innovation in one’s own life.

Consciousness is something that every child understands, yet scientists and philosophers struggle to explain it. Consciousness provides an essential human quality to life experience, as one depends on it to organize and prioritize their memories, emotions, and actions. Unraveling the enigma of consciousness, and its impairment, has been a thorny road to travel, often littered with confusion and denial. This has been particularly true regarding understanding of the effects of psychological neglect and trauma on ones biopsychosocial systems. Consciousness is alterable by several influences: alcohol, drugs, anesthesia, childhood neglect and abuse, traumatic experiences, neural injury, and disease. This chapter begins by briefly exploring global alterations of consciousness, such as anesthesia, coma, and vegetative states. This allows us to examine the impact of these pervasive states of impaired consciousness on the neural systems, noted earlier. It then examines in detail disorders of consciousness induced by psychic neglect and trauma.

The chapters of the book examine neuroplasticity as it manifests in maturation, development, information processing, and the disorders associated with each. Growth, development, and integration of neural networks, as manifestations of neuroplasticity, are the mechanisms underlying consciousness, parenting, interpersonal relationships, and the healing process of psychotherapy. Today, neuroplasticity is increasingly understood to be an underlying mechanism of neurofunction at any age. The adult brain appears to possess a tendency toward neural stabilization, while at the same time maintaining a potential for plastic reorganization. More and more, we see evidence that the brain is capable of reorganization in response to changes in stimulation. Some examples of these changes are dramatic and result, in great part, from the application of sensory stimulation. The robust effect of eye movement desensitization and reprocessing in type I posttraumatic stress disorder is one such example.

To understand consciousness and information processing, we must solve two interrelated problems. The first is the problem of how the brain, within the self, begets the mental patterns and neural maps that generate the images, or representations, of an object. The second problem is how, in parallel with generating the mental patterns/maps of the object, the brain also “engenders a sense of self in the act of knowing”. This chapter discusses consciousness in neurobiology. It briefs about evolution of the nervous system. The nervous system appears to be necessary only for creatures that express active movement, a biological property known as motricity. The chapter then discusses neural automation and fixed action patterns. Following this, it describes parallel distributed processing, sensation, and perception. The chapter then provides a brief description on memorial consolidation and long-term potentiation. It also discusses the evolution of biological action systems.

This chapter discusses cellular communication in the neural environment. The brain is composed of gray matter and white matter. The gray matter accounts for approximately 40% of the brain’s mass and comprises the neurons. The white matter accounts for 60% of the brain and is composed of various forms of glial cells. Neurons are embedded in a scaffolding of glia cells. Structurally, every neuron has four components: a cell body, a number of dendrites, an axon, and a group of axon terminations called presynaptic terminals. A neuron is like a battery and generates voltage. This voltage is known as the membrane potential. Neurons communicate with one another at highly specialized contact points called synapses. Most of the remarkable information-processing activities of the brain emerge from the signaling properties of synapses. This is mediated by the actions of chemical synapses, electrical synapses, and by the interactions of action and synaptic potentials.

This chapter discusses the mystery of consciousness. A way to explore these mysteries is to ask how the brain mediates information processing, which brings us to the study of individual neurons and their relationship to neural systems. Systems neuroscience is the study of neural systems, which include those involved in vision, memory, language, emotion, somatosensory integration, and motor function. Consequently, the study of systems neuroscience emphasizes the identification of neural structures and events associated with the hierarchical steps in information processing. The prodigious growth of modern systems neuroscience is owed to the convergence of three key subdisciplines, each of which contributed major technical or conceptual advances to the understanding of information processing: neuropsychology, neuroanatomy, and neurophysiology. The chapter explores consciousness and evolution. It then describes the characteristics of consciousness. In the past 20 years, consciousness has been described and investigated with respect to three characteristics: unity, subjectivity, and prediction.

Investigating the human mind as an abstract concept is very difficult. Exploring its biological foundations—especially consciousness—is an even more daunting task. If developing a map of the mind is the final frontier of the life sciences, the cartography of consciousness will be its last and most important accomplishment. The study of the conscious mind alone could not lead to a complete understanding of the brain. Consciousness and Eye Movement Desensitization and Reprocessing (EMDR) have long been intimately related, albeit under a different name. Whereas the field of neurobiology has utilized the term consciousness to denote the processes of sensation, perception, learning, cognition, emotion, somatosensory integration, and memory, the discipline of psychology has chosen to use the term information processing. EMDR has evolved into a comprehensive therapeutic approach guided by the adaptive information processing model. This introductory chapter discusses consciousness and EMDR and provides a brief description about the book.

This chapter explores the implications of consciousness and human development on the adaptive information processing (AIP) model and the treatment principles that emerge from it. The AIP model is a neurobiological heuristic based on the concept of neural networks. It is a robust model that reflects the major aspects of neural mapping and information processing. It is configured to target memory, predictive cognition, and the affective nature of feelings and emotions. AIP denotes a paradigm shift away from psychological theory and toward neuroscientific theory. It thus serves as the theoretical foundation that explains and predicts the treatment effects of eye movement desensitization and reprocessing (EMDR) therapy. The AIP model asserts that EMDR mediates the accessing of dysfunctionally stored information, stimulating the inherent neural processing mechanisms through the standardized protocols and procedures (including the bilateral sensory stimulation), and facilitates the linking of the adaptive information held in the other memory networks.

Medically unexplained symptoms (MUS) was a term generally used in mainstream medical literature to describe numerous and varied somatic complaints for which thorough examination could not provide a conventional biomedical explanation. Historically, these symptoms have been described and categorized into a number of syndromes. The list of well-researched syndromes that are or have been classified as manifestations of MUS include fibromyalgia, rheumatoid arthritis, reflex sympathetic dystrophy, Hashimoto’s thyroiditis, Graves’ disease, systemic lupus erythematosus, Sjögren’s syndrome, Crohn’s disease, type 1 diabetes, multiple sclerosis, and chronic fatigue syndrome. The central character in nearly all of these mysteries appears to be the steroid cortisol, whose relationship to trauma and these diseases has been puzzling and bewildering. To understand these previously enigmatic medical conditions, one need’s to appreciate the relationships between the autonomic, endocrine, and immune systems, specifically focusing on cortisol’s role in their interrelated functioning.

There are two neurobiological models of information processing that currently dominate the consciousness landscape: the parallel distributed processing (PDP)/connectionism model and the thalamocortical–temporal binding model. Both have been thoroughly researched and generally reflect agreement with one another, at least with regard to their core components. PDP provides a framework for understanding the nature and organization of sensation, perception, thought, learning, memory, language, emotion, and motricity (motor function). The process of neural mapping must be illustrated in order to appreciate the linkage function of PDP and the synchronization role of thalamocortical–temporal binding. The process of PDP creates neural spatial maps, whereas temporal binding creates neural temporal maps. Put another way, spatial maps are maps of linked systems (oscillating at their own signature frequencies) that must be synchronized with respect to frequency, temporally (in real time), thereby creating temporal maps.

The foregoing examination of the neural substrates of information processing serves as a platform from which one examines the expression of different types of disruption of consciousness. However, given that a number of disorders of consciousness are developmental in origin—that is, they occur during human neural maturation and growth—certain precepts of human development must first be illustrated in order to fully realize the diverse spectrum of ways in which consciousness can fall into disrepair. The right brain is centrally involved not only in processing social–emotional information, promoting attachment functions, and regulating bodily and affective states, but also in the organization of vital functions supporting survival and enabling the organism to cope dynamically with stress. The maturation of these adaptive right-brain regulatory capacities is experience dependent, embedded in the attachment connection between the infant and its primary caregivers. Thus attachment theory is an affect-regulatory theory.

There are a multitude of biological and medical factors associated with eating disorders. Some of these factors help to explain why an eating disorder might develop to begin with, whereas many others are serious consequences of being chronically malnourished or using dangerous weight control methods. This chapter discusses the various factors that are associated in some way with eating disorders: brain function; genetics; medical factors; vital signs and laboratory values; cardiovascular factors; oral and gastrointestinal health; neurological problems; endocrine system and diabetes; skeletal health; dermatologic; and nutritional factors. It examines biological factors that may put an individual at risk for developing an eating disorder. Generally speaking, the biological factors are likely risk factors, meaning that they predate the onset of the disorder though that is not always clear. The medical factors by and large represent consequences or costs associated with having a particular eating disorder diagnosis.

This concluding chapter of the book presents several scenarios that are designed to illustrate for the reader what an eating disorder might "look like" in the real world and what initial treatment efforts might entail. The first scenario is about a 10-year-old elementary school student who throws food away at lunch. The second scenario is about a 14-year-old freshman in high school whose weight puts him in the body mass index (BMI) category of obese. The third scenario is about a 19-year-old college student who had a long-standing history of eating disorders. The fourth scenario is about a 55-year-old married mother who dieted extensively in her teens and early adulthood. The fifth scenario is about a 20-year-old competitive collegiate student-athlete. The final scenario is about an 18-year-old high school wrestler.

There is still a lot to learn in terms of how to implement the most effective forms of eating disorders prevention to the greatest number of people. The three types of prevention target different stages of the development of any disease or disorder. Primary prevention refers to any effort designed to prevent a disease or disorder from developing in an otherwise healthy individual. Secondary prevention involves efforts to identify the disease or disorder as early as possible before the problem gets worse. Tertiary prevention includes efforts to ameliorate the effects of a disease or disorder once it has already been established. This chapter describes prevention efforts in general and prevention programs designed specifically for eating disorders. It addresses eating disorder prevention in middle school as most programs have been studied with high school students and young adults, and prevention efforts implemented via technology.

Eating disorders are complex and difficult to treat. One of the most significant reasons for difficulty with respect to treatment is not only the degree to which these disorders can be life threatening, but perhaps more significantly, the degree to which the eating disorder fights tooth and nail to ensure its survival. Strong emotional reactions, often referred to as countertransference reactions, to patients with an eating disorder are common and can range from care and concern to frustration and rage. Acknowledging and identifying one's own countertransference reactions can help both the person feeling them and the patient as well. This is particularly true for treatment providers who can risk harm to themselves and/or the patient if countertransference reactions remain unidentified. By contrast, when countertransference reactions are identified and appropriately understood the treatment provider may learn more about himself or herself as well as the patient, which ultimately can benefit treatment.

This chapter provides an overview of eating disorders along with a brief look at related syndromes and disorders. Eating disorders are now classified in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) along with feeding disorders usually diagnosed first in childhood, whereas previously, in the DSM-IV, eating disorders comprised a category of their own. The chapter focuses on the disorders that made up the eating disorders category in earlier editions of the DSM (i.e., anorexia nervosa, bulimia nervosa, binge eating disorder). There are a multitude of myths surrounding eating disorders, including who does and who does not get eating disorders, who or what is to blame for the development of eating disorders, and how long someone will have an eating disorder. The chapter explores common myths associated with eating disorders.

Many individuals with eating disorders will not self-refer for treatment or seek an evaluation; therefore, the ability of friends, family, and others to recognize signs and symptoms of an eating disorder is crucial. This chapter discusses the role various individuals can play in the identification and referral of someone suspected of having an eating disorder, what happens after a referral is made, and what can be done to increase the chances that an individual will follow-through on a referral. Educators and other school personnel are also in a position to be among the first to know about or to be informed about a problem that may indicate the presence of an eating disorder. In many cases, athletes may be more at risk for developing an eating disorder than the general population. Although work itself is not necessarily a cause of an eating disorder, job-related stress may exacerbate eating disorder symptoms.

Multiple interpersonal and sociocultural factors can have a negative influence on eating disorder behaviors and related concerns. Some factors associated with family, peers, and the media, when examined together, have been found to result in a higher degree of body dissatisfaction and a greater likelihood of how much control over food intake someone is exerting. This chapter examines some of the influences found among interpersonal factors, including peers and family, and sociocultural influences including mass media, social media, and video games. Interpersonal relationships in the form of friendships and relationships with family members can influence how someone views his or her body and the degree to which he or she desires to pursue the thin ideal. By contrast, when these relationships are more supportive, they can be a buffer against other factors that may contribute to the development of an eating disorder.

Psychological factors involve internal experiences that an individual has. In this context, these internal experiences will revolve around one's perception about body weight, shape, and size; other mental health issues in addition to an eating disorder; personality characteristics; and the degree to which an individual has control over his or her emotions and behaviors. There are a multitude of psychological factors that can affect the development of, maintenance of, or recovery from an eating disorder. Personality disorders have often been associated with eating disorders and are believed to be the most commonly occurring comorbid diagnosis. Although many people think eating disorders are purely about food, the myriad psychological factors associated with eating disorders indicate that there is much going on within a person with such a diagnosis to state that eating disorders reflect an issue with one particular thing.

Athletes are believed to be at greater risk for eating disorders than the general population. When examining the rates of autism spectrum disorder (ASD) among those with or without an eating disorder, an ASD diagnosis was found to be more common among those with an eating disorder. Accurately identifying older adults who may have an eating disorder has its challenges. Eating disorders understood in the context of physical disabilities reveal not so much an issue with respect to effectively and accurately diagnosing an eating disorder but in regard to the degree that body image issues can be pronounced among those who have a physical disability. Refusing to eat or engaging in fasting for spiritual reasons was a common practice during medieval times. The difference between those who benefit from having a religious faith and those who do not may lie in the difference between religion and spirituality.

This chapter presents general signs that an eating disorder may be present. It discusses in detail the signs and symptoms of specific eating disorders such as anorexia nervosa; bulimia nervosa; and binge eating disorder. The chapter presents each specific eating disorder in terms of the signs that may signal that particular disorder followed by a description of diagnostic symptoms that are indicative of that disorder. It looks at what may be an indicator that an eating disorder of some kind may be developing or has already developed. Emotional signs of an eating disorder can involve specific changes in emotions, the expression of particular emotions, or the experience of things that can negatively impact someone's emotions. In addition to emotional and behavioral signs, there are many physical signs indicative of an eating disorder that can affect potentially every system in one's body.

Increasing rates of eating disorders are found among males, individuals of all ages, and from an increasing diversity in terms of culture and ethnicity. This chapter discusses the prevalence rates of eating disorders among males and females. There are identifiable differences between those of a different age, sex, race/ethnicity, and socioeconomic status when it comes to eating disorder diagnoses and issues related to eating disorders such as body image dissatisfaction. Understanding these differences can help us understand why some people struggle with eating disorders and related issues and others do not, though it remains important to be wary of stereotyping for any group as making an assumption about the presence or absence of an eating disorder based on what is currently known can mean someone with an eating disorder will be overlooked and not get the treatment he or she needs.

This chapter focuses on who is involved in the treatment of eating disorders, the various levels of care, modes of treatment, and treatment approaches available to individuals dealing with an eating disorder and their families. It provides an introduction to what forms and approaches of treatment are commonly used. The American Psychiatric Association recommends that a team of professionals be actively involved in the treatment of someone with an eating disorder. This reflects the highly complex nature of eating disorders and the need to be sure that not only the individual's psychological health is being attended to but also his or her nutritional needs and medical well-being. This team is referred to as a multidisciplinary treatment team and at minimum should include a licensed mental health professional, a licensed medical professional, and a registered dietitian.