Bulimia nervosa is an eating disorder characterized by binge eating and purging or consuming a large amount of food in a short amount of time, followed by an attempt to rid oneself of the food consumed, (purging). Typically by vomiting, taking a laxative or diuretic and/or excessive exercise and commonly accompanied with fasting over an extended period of time.^[1][2] Bulimia nervosa is considered to be less life threatening than anorexia, however the occurrence of bulimia nervosa is higher.^[3] Bulimia nervosa is nine times more likely to occur in women than men (Barker 2003). The vast majority of those with bulimia nervosa are at normal weight.^[4] Antidepressants, especially SSRIs, are widely used in the treatment of bulimia nervosa (Newell and Gournay 2000). Patients who have bulimia nervosa are often linked with having impulsive behaviors involving over spending and sexual behaviors as well as having family histories of alcohol and substance abuse, and mood and eating disorders.^[5]

The term bulimia comes from Greek βουλιμία (boulīmia; ravenous hunger), a compound of βους (bous), ox + λιμός (līmos), hunger.^[6] Bulimia nervosa was named and first described by the British psychiatrist Gerald Russell in 1979.^[7][8] Bulimia is strongly familial. Twin studies estimate the heritability of syndromic bulimia to be 54-83%.^[9][10]

Signs and symptoms[link]

These cycles often involve rapid and out-of-control eating, which may stop when the bulimic is interrupted by another person or the stomach hurts from over-extension, followed by self-induced vomiting or other forms of purging. This cycle may be repeated several times a week or, in more serious cases, several times a day,^[11] and may directly cause:

• Chronic gastric reflux after eating
• Dehydration and hypokalemia caused by frequent vomiting
• Electrolyte imbalance, which can lead to cardiac arrhythmia, cardiac arrest, and even death
• Esophagitis, or inflammation of the esophagus
• Boerhaave syndrome, a rupture in the esophageal wall due to vomiting
• Oral trauma, in which repetitive insertion of fingers or other objects causes lacerations to the lining of the mouth or throat
• Gastroparesis or delayed emptying
• Constipation
• Infertility
• Enlarged glands in the neck, under the jaw line
• Peptic ulcers
• Calluses or scars on back of hands due to repeated trauma from incisors^[12][13]
• Constant weight fluctuations are common

The erosion on the lower teeth was caused by Bulimia. For comparison, the upper teeth were restored with porcelain veneers.^[14]

The frequent contact between teeth and gastric acid, in particular, may cause:

• Severe dental erosion
• Perimolysis, or the erosion of tooth enamel^[15]
• Swollen salivary glands^[15][16]
• Constant vomiting can lead to gastroesophageal reflux^[17]

As with many psychiatric illnesses, delusions can occur with other signs and symptoms leaving the person with a false belief that is not ordinarily accepted by others.^[18]

The person may also suffer physical complications such as tetany, epileptic seizures, cardiac arrhythmias and muscle weakness.(ICD-10)^{[citation needed]}.

People with bulimia nervosa may also exercise to a point that excludes other activities.^[18]

Related disorders[link]

Bulimics are much more likely than non-bulimics to have an affective disorder, such as depression or general anxiety disorder: A 1985 Columbia University study on female bulimics at New York State Psychiatric Institute found 70% had suffered depression some time in their lives (as opposed to 25.8% for adult females in a control sample from the general population), rising to 88% for all affective disorders combined.^[19] Another study by the Royal Children's Hospital in Melbourne on a cohort of 2000 adolescents similarly found that those meeting at least two of the DSM-IV criteria for bulimia nervosa or anorexia nervosa had a sixfold increase in risk of anxiety and a doubling of risk for substance dependency.^[20] Some sufferers of anorexia nervosa exhibit episodes of bulimic tendencies through purging (either through self-induced vomiting or laxatives) as a way to quickly remove food in their system.^[21] Bulimia also has negative effects on the sufferer's dental health due to the acid passed through the mouth from frequent vomiting causing acid erosion, mainly on the posterior dental surface.

Diagnosis[link]

The onset of bulimia nervosa is often during adolescence, between 13 and 20 years of age, and many cases have previously suffered obesity, with many sufferers relapsing in adulthood into episodic binging and purging even after initially successful treatment and remission.^[22]

Adolescents with bulimia nervosa are more likely to have self-imposed perfectionism and compulsivity issues in eating compared to their peers. This means that the high expectations and unrealistic goals that these individuals set for themselves are internally motivated rather than by social views or expectations.^[23]

According to Barker, "persons with bulimia are more able to live and interact in everyday chores and tasks such as work and having relationships without the condition overly affecting their abilities".^[24]

Bulimia nervosa can be difficult to detect, compared to anorexia nervosa, because bulimics tend to be of average or slightly above or below average weight. Many bulimics may also engage in significantly disordered eating and exercising patterns without meeting the full diagnostic criteria for bulimia nervosa.^[25] The diagnostic criteria utilized by the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) published by the American Psychiatric Association includes repetitive episodes of binge eating (a discrete episode of overeating during which the individual feels out of control of consumption) compensated for by excessive or inappropriate measures taken to avoid gaining weight.^[26] The diagnosis is made only when the behavior is not a part of the symptom complex of anorexia nervosa and when the behavior reflects an overemphasis on physical mass or appearance.

There are two sub-types of bulimia nervosa:

• Purging type bulimics self-induce vomiting (usually by triggering the gag reflex or ingesting emetics such as syrup of ipecac) to rapidly remove food from the body before it can be digested, or use laxatives, diuretics, or enemas.
• Non-purging type bulimics (approximately 6%–8% of cases) exercise or fast excessively after a binge to offset the caloric intake after eating. Purging-type bulimics may also exercise or fast, but as a secondary form of weight control.^[27]

Pharmacological[link]

Some researchers have hypothesized a relationship to mood disorders and clinical trials have been conducted with tricyclic antidepressants,^[28] MAO inhibitors, mianserin, fluoxetine,^[29] lithium carbonate, nomifensine, trazodone, and bupropion.

Research groups who have seen a relationship to seizure disorders have attempted treatment with phenytoin, carbamazepine, and valproic acid. Opiate antagonists naloxone and naltrexone, which block cravings for gambling, have also been used.^[30]

There has also been some research characterizing bulimia nervosa as an addiction disorder, and limited clinical use of topiramate, which blocks cravings for opiates, cocaine, alcohol and food.^[31]

Psychotherapy[link]

There are several empirically supported psychosocial treatments for bulimia nervosa. Cognitive behavioral therapy (CBT), which involves teaching clients to challenge automatic thoughts and engage in behavioral experiments (for example, in session eating of "forbidden foods") has demonstrated efficacy both with and without concurrent antidepressant medication. Research suggests that cognitive-behavioral therapy (CBT) is the most effective psychotherapeutic treatment for bulimia nervosa. One exception was a study that suggested that interpersonal psychotherapy (IPT) might be as effective as CBT, although slower to achieve its effects.^[32] By using CBT patients record how much food they eat and periods of vomiting with the purpose of identifying and avoiding emotional fluctuations that bring on episodes of bulimia on a regular basis (Gelder, Mayou and Geddes 2005). Barker (2003) states that research has found 40-60% of patients using cognitive behaviour therapy to become symptom free. He states in order for the therapy to work, all parties must work together to discuss, record and develop coping strategies. Barker (2003) claims by making people aware of their actions they will think of alternatives.^[33][34] Patients undergoing CBT who exhibit early behavioral changes are most likely to achieve the best treatment outcomes in the long run.^[35] Researchers have also reported some positive outcomes for interpersonal psychotherapy and dialectical behavior therapy.^[36][37]

Maudsley Family Therapy a.k.a. Family Based Treatment (FBT), developed at the Maudsley Hospital in London for the treatment of anorexia nervosa (AN) has been shown to have positive results for the treatment of bulimia nervosa. FBT has been shown through empirical research to be the most efficacious treatment of AN for patients under the age of eighteen and within three years of onset of illness. The studies to date using FBT to treat BN have been promising.^[38]

The use of Cognitive Behavioral Therapy (CBT) has been shown to be quite effective for treating bulimia nervosa (BN) in adults, but little research has been done on effective treatments of BN for adolescents.^[39] Although CBT is seen as more cost efficient and helps individuals with BN in self-guided care, Family Based Treatment (FBT) might be more helpful to younger adolescents who need more support and guidance from their families. Adolescents are at the stage where their brains are still quite malleable and developing gradually.^[40] Therefore, young adolescents with BN are less likely to realize the detrimental consequences of becoming bulimic and have less motivation to change,^[41] which is why FBT would be useful to have families intervene and support the teens.^[39] Working with BN patients and their families in FBT can empower the families by having them involved in their adolescent's food choices and behaviors, taking more control of the situation in the beginning and gradually letting the adolescent become more autonomous when they have learned healthier eating habits.^[39]

Adolescents with BN whom are either resistant to change or have not been successful with treatments such as CBT (Cognitive Behavioral Therapy) or IPT (Interpersonal Psychotherapy) could get recommended to try Cue Exposure (CE) by therapists.^[42] In this type of therapy, a patient is presented in the beginning of each session with a "forbidden food", allowing the individual to pick up the item to feel and smell it, but they are not allowed to eat it. This will usually provoke a lot of stress and anxiety in the adolescent with BN, which ultimately leads them to have a feeling of intense hunger and wish to partake in binge eating. To help control their eating behaviors, the therapist attempts with CE to expose the adolescent to the food and condition them in order to not feel as much anxiety when presented with the food. If they do not feel as much stress or anxiety when the food is right in front of them, then they will be less likely to feel the need to binge and then purge.

Some researchers have also claimed positive outcomes in hypnotherapy treatment.^{[43][44][45] [46]} The Twelve-Step model, used for chemically dependent individuals, was applied to bulimic patients with good results. Researchers at [Ohio State University], in a preliminary study, incorporated the twelve-step model in their treatment of bulimic women in an inpatient unit. They reported positive outcomes.^[47]

Biological[link]

Like with anorexia nervosa, there is evidence of genetic predispositions contributing to the onset of this eating disorder.^[48] Abnormal levels of many hormones, notably serotonin, have been shown to be responsible for some disordered eating behaviours. Brain-derived neurotrophic factor (BDNF) is under investigation as a possible mechanism.^[49][50]

There is evidence that sex hormones may influence appetite and eating in women, and the onset of bulimia nervosa. Studies have shown that women with Hyperandrogenism and Polycystic ovary syndrome have a dysregulation of appetite, along with carbohydrates and fats. This dysregulation of appetite is also seen in women with bulimia nervosa. In addition, gene knockout studies in mice have shown that mice that have the gene encoding estrogen receptors have decreased fertility due to ovarian dysfunction and dysregulation of androgen receptors. In humans, there is evidence that there is an association between polymorphisms in the ERβ (estrogen receptor β) and bulimia, suggesting there is a correlation between sex hormones and bulimia nervosa.^[51]

Social[link]

Media portrayals of an 'ideal' body shape are widely considered to be a contributing factor to bulimia^[1] (Barker 2003). In a 1991 study by Weltzin, Hsu, Pollicle, and Kaye, it was stated that 19% of bulimics undereat, 37% of bulimics eat an amount of food that is normal for an average human being, and 44% of bulimic overeat.^[52] A survey of 15–18 year-old high school girls in Nadroga, Fiji found the self-reported incidence of purging rose from 0% in 1995 (a few weeks after the introduction of television in the province) to 11.3% in 1998.^[53]

Through the cognitive and socio-cultural perspectives, indications towards the origin of bulimia nervosa can be established. Fairburn et al.’s cognitive behavioral model of bulimia nervosa provides a chief indication of the cause of bulimia through a cognitive perspective, while the “thin ideal” is particularly responsible for the etiology of bulimia nervosa through a socio-cultural context. When attempting to decipher the origin of bulimia nervosa in a cognitive context, Fairburn and et al.’s cognitive behavioral model is often considered the golden standard. Fairburn et al.’s model discusses the process in which an individual falls into the binge-purge cycle and thus develops bulimia. Fairburn et al. argue that extreme concern with weight and shape coupled with low self esteem will result in strict, rigid, and inflexible dietary rules. Accordingly, this would lead to unrealistic restricted eating, which may consequently induce an eventual “slip” where the individual commits a minor infraction of the strict and inflexible dietary rules. Moreover, the cognitive distortion due to dichotomous thinking leads the individual to binge. The binge subsequently should trigger a perceived loss of control, promoting the individual to purge in hope of counteracting the binge. However, Fairburn et al. assert the cycle repeats itself, and thus consider the binge-purge cycle to be self-perpetuating.

In contrast, Byrne and Mclean’s findings differed slightly from Fairburn et al.’s cognitive behavioral model of bulimia nervosa in that the drive for thinness was the major cause of purging as a way of controlling weight. In turn, Byrne and Mclean argued that this makes the individual vulnerable to binging, indicating that it is not a binge-purge cycle but rather a purge-binge cycle in that purging comes before binging. Similarly, Fairburn et al.’s cognitive behavioral model of bulimia nervosa is not necessarily applicable to every individual and is certainly reductionist. Everyone differs from another, and taking such a complex behavior like bulimia and applying the same one theory to everyone would certainly be invalid. In addition, the cognitive behavioral model of bulimia nervosa is very cultural bound in that it may not be necessarily applicable to cultures outside of the Western society. To evaluate, Fairburn et al.’s model and more generally the cognitive explanation of bulimia nervosa is more descriptive than explanatory, as it does not necessarily explain how bulimia arises. Furthermore, it is difficult to ascertain cause and effect, because it may be that distorted eating leads to distorted cognition rather than vice versa.^[54][55]

When exploring the etiology of bulimia through a socio-cultural perspective, the “thin ideal internalization” is significantly responsible. The thin ideal internalization is the extent to which individuals adapt to the societal ideals of attractiveness. Individuals first accept and “buy into” the ideals, and then attempt to transform themselves in order to reflect the societal ideals of attractiveness. J. Kevin Thompson and Eric Stice claim that family, peers, and most evidently media reinforce the thin ideal, which may lead to an individual accepting and “buying into” the thin ideal. In turn, Thompson and Stice assert that if the thin ideal is accepted, one could begin to feel uncomfortable with their body shape or size since it may not necessarily reflect the thin ideal set out by society. Thus, people feeling uncomfortable with their bodies may result in suffering from body dissatisfaction, and may develop a certain drive for thinness. Consequently, body dissatisfaction coupled with drive for thinness is thought to promote dieting and negative affects, which could eventually lead to bulimic symptoms such as purging or binging. Binges lead to self-disgust which causes purging to prevent weight gain.^[56]

A study dedicated to investigating the thin ideal internalization as a factor of bulimia nervosa is Thompson’s and Stice’s research. The aim of their study was to investigate how and to what degree does media effect the thin ideal internalization. Thompson and Stice used randomized experiments (more specifically programs) dedicated to teaching young women how to be more critical when it comes to media, in order to reduce thin ideal internalization. The results showed that by creating more awareness of the media’s control of the societal ideal of attractiveness, the thin ideal internalization significantly dropped. In other words, less thin ideal images portrayed by the media resulted in less thin ideal internalization. Therefore, Thompson and Stice concluded that media effected greatly the thin ideal internalization.^[57]

Epidemiology[link]

There is little data on the prevalence of bulimia nervosa in-the-large, on general populations. Most studies conducted thus far have been on convenience samples from hospital patients, high school or university students. These have yielded a wide range of results: between 0.1% and 1.4% of males, and between 0.3% and 9.4% of females.^[58] Studies on time trends in the prevalence of bulimia nervosa have also yielded inconsistent results.^[59] According to Gelder, Mayou and Geddes (2005) bulimia nervosa is prevalent between 1 and 2 per cent of women aged 15–40 years. Bulimia nervosa occurs more frequently in developed countries (Gelder, Mayou and Geddes 2005). There is a perception that bulimia is most prevalent amongst girls from middle class families,^[60] however in a 2009 study girls from families in the lowest income bracket studied were 153 percent more likely to be bulimic than girls from the highest income bracket.^[61]

There are higher rates of eating disorders in groups involved in activities which idealize a slim physique, such as dance,^[65] gymnastics, modeling, cheerleading, running, acting, rowing and figure skating. Bulimia is thought to be more prevalent among Caucasians.,^[72] however a more recent study showed that African-American teenage girls were 50 percent more likely than white girls to exhibit bulimic behavior, including both binging and purging.^[73]

Further reading[link]

For individuals and families being affected by bulimia nervosa, the following resources might be very helpful: http://www.nationaleatingdisorders.org/ http://www.eatingdisorders.org.au/ http://www.oa.org/ http://helpguide.org/mental/bulimia_signs_symptoms_causes_treatment.htm

See also[link]

• Anorectic Behavior Observation Scale
• Anti-fat bias
• Anorexia nervosa
• Eating Recovery

Notes[link]

Demi Lovato
Lovato in 2010
Background information
Birth name	Demetria Devonne Lovato
Born	(1992-08-20) August 20, 1992 (age 19) Albuquerque, New Mexico, U.S.
Genres	Pop, pop rock, R&B, dance
Occupations	Singer-songwriter, actress, musician, activist, The X Factor USA judge
Instruments	Vocals, guitar, piano
Years active	2002–present
Labels	Hollywood
Associated acts	Joe Jonas, Jonas Brothers, Selena Gomez, Miley Cyrus
Website	demilovato.com Demi Lovato's signature

Demetria Devonne "Demi" Lovato^[1] (born August 20, 1992)^[2] is an American singer-songwriter, musician, and actress. Her earliest roles included Angela on Barney & Friends, before she became better known for her starring roles in the Camp Rock movies, as Sonny Munroe in the Disney sitcom Sonny with a Chance, and as the star of the 2009 movie Princess Protection Program. She is also involved in philanthropic activities through charity work and various social and environmental causes.^[3]

As a solo musical artist, Lovato released her debut album Don't Forget on September 23, 2008. The album debuted at number two on the Billboard 200 selling 89,000 copies in the first week.^[4] It has since shipped over 500,000 copies, earning a gold certification in the United States.^[5] Lovato released her second album, Here We Go Again, on July 21, 2009.^[6] The album debuted at number one on the Billboard 200, selling 108,000 copies in the first week.^[7] Her third studio album, Unbroken, was released on September 20, 2011 and peaked at number four on the Billboard 200. She is working on her fourth studio album.

In Fall 2012, Lovato will be a judge on the second season of the American version of The X Factor.^[8]

Early life[link]

Lovato was born in Albuquerque, New Mexico on August 20, 1992, and raised in Dallas, Texas.^[1] She is the daughter of Dianna Hart de la Garza (born Dianna Lee Smith) and Patrick Martin Lovato.^[9] Her ancestry includes Mexican, Irish, Italian, and English.^{[9][10][11][12]} She has an older sister, Dallas Lovato, and a younger half-sister, Madison de la Garza, from her mother's re-marriage.^[1] Her mother was a Dallas Cowboys Cheerleader and country music recording artist.^[13] Lovato began playing piano at the age of seven.^[14] Lovato also began her acting career at the age of seven on the children's television series Barney & Friends as Angela, appearing in seasons seven and eight alongside long time friend Selena Gomez.^[15] In an interview with Ellen DeGeneres, Lovato revealed going through painful experiences with bullying in the seventh grade.^[16] According to Lovato, the bullying was so bad that one day, in a fit of frustration and distress, she requested her mom give her a home-schooled education.^[17] Lovato earned a high school diploma through homeschooling in April 2009.^[18] Lovato also stated in an interview with 20/20 in 2011 that she had had a "really unhealthy relationship with food" since age 8 due to bullying experienced as a child, and self-mutilated her wrists to cope with her emotions and depression since age 11.^[19] Lovato later became a spokesperson for anti-bullying organization PACER and appeared on America's Next Top Model^[20] and CNN to speak out against bullying.^[21] She has described herself as very spiritual rather than very religious and said she believes in God.^[22]

Acting career[link]

[edit] 2006–09: Camp Rock and Sonny With a Chance

Lovato with her Camp Rock co-stars, the Jonas Brothers, in London, 2008

In 2006, Lovato guest starred on Prison Break as Danielle Curtin in the episode "First Down." She also appeared in the second season of the television sitcom Just Jordan as Nicole, in the episode "Slippery When Wet." In January 2007, she landed the role of Charlotte Adams on the Disney Channel Original Short Series, As the Bell Rings, which premiered on August 26, 2007. A few of her original songs, including "Shadow", were featured on the show. In the summer of 2007, Lovato auditioned for the Disney Channel television film Camp Rock and the television series Sonny with a Chance in the same day and got both parts.^[23] For Camp Rock, she submitted an audition tape and Gary Marsh, Disney's president of entertainment, asked her to sing.^[24] She sang Christina Aguilera's "Ain't No Other Man", and Hollywood Records senior vice president Bob Cavallo said that their "jaws just dropped".^[24] Lovato received the lead role in Camp Rock,^[24] and a record deal with Hollywood Records in early 2008.^[23] In Camp Rock she played Mitchie Torres, a fourteen-year-old girl with hopes of becoming a singer. The movie premiered on June 20, 2008, in the United States on the Disney Channel with 8.9 million viewers, making Lovato a household name among young viewers.^[25] Its Disney Channel Italy premier received 1.14 million viewers on September 2008.^[26] Merchandise of the film is sold at Target, Claires, and Limited Too. They include clothing (such as pajamas, T-shirts, and underwear), bags (tote bags, backpacks, etc.), bedding collection, toys, and dolls of the characters. Play Along Toys, so far, has only released dolls of Mitchie and Shane. On May 13, 2008, Disney published Camp Rock: the Junior Novel, by Lucy Ruggles, the novelization of the film. Target retail stores sell "special editions" of the novel, hardcover books that include photos.

Starting in 2009, Lovato appeared as Sonny Munroe in the Disney channel comedy Sonny With a Chance. The show featured Lovato as the newest cast member on the show-within-a-show So Random!. The series debuted on February 8, 2009 in the United States. This is the first Disney Channel Original Series to be shot and aired in high-definition from the beginning; like most of Disney Channel's sitcoms, it is shot on tape, but uses a "filmized" appearance. The second season, some scenes are shot on location. The series is one of three Disney Channel Original Series to feature a show-within-a-show, with the others being The Famous Jett Jackson and Shake It Up. The series officially ended on January 2, 2011. Gary Marsh, president of entertainment, Disney Channel Worldwide, stated "This series is rooted in one of the core thematic attributes that we stand for, which is following your dreams, there also was the opportunity to do a hybrid show."^[27] The show began production on September 15, 2008 and the first season was taped at Stage 11 at NBC Studios in Burbank, California;^[27] for the second season, the show's production moved to Hollywood Center Studios in Hollywood, California, where The Suite Life on Deck, Wizards of Waverly Place and Jonas L.A. are also taped. In June 2009 Lovato co-starred in Princess Protection Program as Princess Rosalinda alongside Selena Gomez on the Disney Channel.^[28] The made-for-television movie is the third highest rated Disney Channel Original Movie, premiering on the Disney Channel with 9.8 million viewers. Laura Fries of Variety magazine describes the film as being "light as a summer breeze on the Louisiana bayou". Although the film does not stray far from the Disney formula, she praises writer Annie DeYoung for providing young girls a nice message about self-esteem. She says the film should be a hit with the channel's target audience.^[29]

[edit] 2010–present: Camp Rock 2: The Final Jam and hiatus

2010 World Tour in September 2010

In September 2009, production began for Camp Rock's sequel, Camp Rock 2: The Final Jam. The Disney Channel Original Movie premiered on September 3, 2010.^[30][31] The film was watched by 7.9 million viewers on its premiere night,^[32] about 1 million less viewers than its predecessor. In 2010 it also became the most watched cable television programme that week,^[33] as well as the No. 1 movie by number of viewers on 2010's cable television.^[32] In its second broadcast on September 4, the film reached 3.7 million viewers.^[33] The film also reached 21 million unique viewers over its premiere weekend from September 3 to September 6.^[34] In its UK premiere on September 17, 2010 in was watched by 637,000 viewers. The film received generally mixed reviews. The review aggregate website Rotten Tomatoes reported that 40% of critics gave the film mixed reviews, based on 5 reviews (3 'Rotten' and 2 'Fresh'), with an average score of 6.1/10.^[35] The film currently holds an 8.7 rating, earning it a "Great" film rating on TV.com.^[36] Lovato appeared as a guest star in an episode of the medical drama series Grey's Anatomy as a teenage patient named Hayley May, whose parents brought her in for schizophrenia.^[37] In a review of the episode, EW.com praised her performance, stating, "I still believe that even an unbiased observer would conclude that the Disney princess did a fine job acting it up as a suicidal 16-year-old who was admitted after trying to claw her own eyes out."^[38] On April 19, 2011, People.com reported that Demi Lovato would not be returning for the third season of Sonny With a Chance due to her health issues.^[39] As a result, the show will be renamed So Random! and focus only on the sketches rather than the behind-the-scenes antics. As a result of Lovato's departure from Sonny with a Chance, the series is the second Disney Channel original series to have its lead actor/actress leave during the series' run (after So Weird), and the fourth Disney Channel series to have a main cast member leave the series during its run (with That's So Raven and Jonas L.A. also included).^[40] The third season was then turned into its own new series based on its new format. On leaving the show, Lovato satated "...it's kind of sad for me that a chapter of my life has ended but there couldn't be a better time for me to move on...I don't think going back to Sonny would be healthy for my recovery...Being in front of a camera would make me nervous."^[41]

Lovato said in an April 2012 interview with KOKO POP UK that music is currently her "top priority", but that she is "kind of getting the itch to get back into acting, so we'll see what comes next."^[42] In an interview with Fabulous Magazine UK, Lovato will not come back to acting until she is fully confident. "I need to be secure in my body before I go back in front of the camera. Anyone in recovery from an eating disorder would find that triggering, and I'm not ready," she says.^[43]

Music career[link]

[edit] 2007–09: Camp Rock soundtrack and Don't Forget

Lovato at the premiere of Hannah Montana: The Movie in April 2009

Lovato's music career began in 2007, when several of her original songs, including "Shadow", were included on the mini-series As the Bell Rings. In 2008, Lovato signed with Hollywood Records after getting the lead role in the film Camp Rock.^[23] She provided vocals on four of the songs featured on the Camp Rock soundtrack, including "We Rock", "Who Will I Be", "Our Time Is Here" and "This Is Me" featuring Joe Jonas.^[44] The song peaked at #9 on the Billboard Hot 100 and peaked at the top 20 in Australia, Canada and Norway. The soundtrack was released on June 24, 2008. The song peaked at number 3 on the US Billboard 200 and topped the US Billboard Top Soundtracks and peaked at the top 10 in Canada, Italy, Mexico, New Zealand and Spain. The soundtrack has sold over 1 million copies and was certified Platinum in the United States. Full songs of the album were made available on Camp Rock's official web site for one week, beginning June 10, 2008, and the full soundtrack premiered on Radio Disney on June 14, 2008 during Planet Premiere: Camp Rock. The soundtrack was released in the UK on July 14, 2008.The soundtrack album (both original and two-disc collector's edition) is an enhanced CD which contains a clip of an acoustic version of "This Is Me" when played on the computer with internet access. On November 16, 2008, a karaoke/instrumental version of the Camp Rock soundtrack was released. It is not available on iTunes, but can be purchased in stores such as Wal-Mart, Target, etc. In June and July 2008, Lovato performed at various House of Blues and parks for her Demi Live! Warm Up Tour in preparation for the release of her debut album and the Burnin' Up Tour with the Jonas Brothers. Lovato served as the support act on the Jonas Brothers' Burnin' Up Tour from July through September 2008.

Lovato's debut album, Don't Forget was released on September 23, 2008. The bulk of the album was co-written with the Jonas Brothers, who also produced the album with John Fields. They co-wrote ten songs in a week during the band's headlining Look Me in the Eyes Tour.^[45] The album is of the pop-rock genre and is lyrically similar to other teen-pop albums. It peaked at number two on the Billboard 200, selling 89,000 units in its first week of release. It has since sold over 500,000 records in the US.^[46] Critics noticed the distinct sound of the Jonas Brothers in the production of the album. Don't Forget spawned two singles. The first single released was "Get Back". It was written by Lovato, the Jonas Brothers, and produced by the Jonas Brothers alongside John Fields. The song features Jack Lawless on drums and John Taylor and the Jonas Brothers on guitars. The initial writing of the song took place when Lovato wanted to write a song about getting back together with an old boyfriend, as opposed to writing mean or heartbroken songs. The was released as the album's lead single on August 12, 2008, by Hollywood Records. Musically, the song is an upbeat pop rock and power pop song with a guitar-driven sound. The song was met with positive reviews from critics and performed average commercially, peaking at number forty-three on the Billboard Hot 100 and ninety-three on the Canadian Hot 100. In Australia, the song peaked at number ten on the ARIA Hitseekers chart. The accompanying music video, directed by Philip Andelman, shows Lovato and her band performing the song on top of an abandoned building with Manhattan Bridge in the background. Lovato has performed the song on several occasions, including the opening of the 2008 Disney Channel Games and the The Ellen DeGeneres Show. The second and final single, "La La Land", was released on April 10, 2009 through Hollywood Records. It was written by Lovato and the Jonas Brothers, and produced by the Jonas Brothers alongside John Fields. It is one of six songs on the album co-written by the Jonas Brothers, who also contributed backing vocals and guitars to the track. Lovato said that she wrote the song about being yourself in Hollywood and not letting other people change who you are. Musically, the song is a guitar-driven pop rock song and the lyrics speak of Lovato feeling "out of place" in Hollywood. The song was met with positive reviews from critics. Commercially, the song peaked at number fifty-two on the Billboard Hot 100, and number thirty-five on the UK Singles Chart. The song achieved its highest peak in Ireland, where it reached number thirty on the Irish Singles Chart. It was less successful in Australia and Germany, where it peaked in the lower half of the charts. The accompanying music video was directed by Brendan Malloy and Tim Wheeler, and follows the song's Hollywood theme. It was used to promote Lovato's Disney Channel sitcom Sonny with a Chance, and features guest appearances from her co-stars. Lovato joined Disney's Friends for Change, an organization which promotes "environmently-friendly behavior," and appears in its public service announcements to raise awareness for the cause on the Disney Channel.^[47] Lovato, Selena Gomez, Miley Cyrus, and the Jonas Brothers recorded "Send It On," a charity single that served as the theme song for the organization in 2009. The song debuted on the Billboard Hot 100 at #20.^[48][49] Disney's Friends for Change directed all of its proceeds from "Send It On" to environmental charities to the Disney Worldwide Conservation Fund.^[48] Lovato and Joe Jonas "Make a Wave" in 2010, the second charity single that currently serves as the theme song for Disney's Friends for Change.

[edit] 2009–10: Here We Go Again and Camp Rock 2: The Final Jam soundtrack

Lovato and her band performing on her 2009 Summer Tour

Lovato embarked on the Summer Tour 2009 to promote her second album, Here We Go Again, released in the summer of 2009.^[50] The album debuted at #1 on the Billboard 200 with 108,000 records sold in its first week.^[51] The album was more inspired by acoustic music, such as John Mayer's songs, than her debut's pop rock-influenced sound.^[52] The album received favorable reviews from critics,^[53] Billboard called Lovato "a natural talent who could really take flight after outgrowing Disney."^[54] Allmusic ranked Here We Go Again as one of the best pop albums of 2009.^[55] The album was preceded by the lead single, "Here We Go Again," which was released on June 23, 2009.^[56] It was written by Isaac Hasson, Lindy Robbins and Mher Filian and produced by SuperSpy, for Lovato's second studio album of the same name (2009). It was released as the album's lead single on June 23, 2009, through Hollywood Records. Musically, the song is a power pop song with guitar lines and pop hooks, and the lyrics speak of the protagonist's on-off relationship with a hesitant boyfriend. The song received positive reviews from critics, who praised its pop hook and made comparisons with works by Kelly Clarkson. The song peaked at number 15 on the Billboard Hot 100 and became Lovato's first top 40 hit on the chart as a solo artist.^[57] The song also peaked at number 38 in New Zealand and in the lower region of the Canadian Hot 100. The accompanying music video was directed by Brendan Malloy and Tim Wheeler. The album's second and final single, "Remember December," was released on November 17, 2009. It was written by John Fields, Lovato and Anne Preven, and produced by Fields. The song was released as the album's second and final single outside North America on January 18, 2010, through Hollywood Records. The song adapts power pop and synthpop genres and diverges from Lovato's usual pop rock sound. The lyrics describe the protagonist's attempt to remind her boyfriend of the good times of their relationship. Lovato described the song's sound as an example of what she wanted her future music to sound like. The song received generally positive reviews from music critics; the majority of them praised its hook and chorus. Several critics also named it one of the album's standouts. The song underperformed commercially; it only managed to reach #6 on Billboard's Bubbling Under Hot 100 (number 106 on the Hot 100) and it peaked at number 80 on the UK Singles Chart. Tim Wheeler directed the accompanying music video, which features appearances from Lovato's female co-stars in Camp Rock 2: The Final Jam. Instead of including a love interest in the clip, Lovato chose to give it a theme of female empowerment. Lovato has performed the song numerous times, including on her tour Summer Tour 2009 and The Alan Titchmarsh Show. Lovato's South American Tour^[58] was her first international headlining tour. The tour commenced on May 23, 2010, in Santiago, Chile, and concluded on May 28, 2010, in São Paulo, Brazil. She later joined the Jonas Brothers Live in Concert tour as a special guest.^[59]

The soundtrack, Camp Rock 2: The Final Jam, was released on August 10, 2010. She provided vocals on nine of the songs featured on the soundtrack, including "Brand New Day", "Can't Back Down", "It's On", "You're My Favorite Song", "What We Came Here For", "This Is Our Song", "Different Summers", "It's Not Too Late" and "Wouldn't Change a Thing".^[60] The song was released on July 31, 2010. The song was released as the soundtrack's fourth single. The song failed to chart in the US Billboard Hot 100 but peaked at number 10on the US Billboard Bubbling Under Hot 100 Singles chart.^[61] The soundtrack peaked at number 3 on the US Billboard 200 and topped the US Billboard Top Soundtracks, and peaked at the top 10 in Brazil, Canada, Italy and Spain. The soundtrack has sold over 500,000 copies and was certified Gold in the United States. The tour is actually Jonas Brothers' 2010 World Tour, which special guests are Demi Lovato and the cast of Camp Rock 2: The Final Jam. The Camp Rock 2 Tour is officially called Jonas Brothers 2010 World Tour/Camp Rock 2 Tour.^[62] Meaghan Martin was not be on tour due to filming a movie. The tour started on August 7, 2010, two weeks later than planned.

[edit] 2010–present: Sonny with a Chance soundtrack, Unbroken and fourth studio album

Demi Lovato at the Festival Verano Iquique in Chile, February 2012

The soundtrack, Sonny with a Chance, was released on It was released on October 5, 2010 from Walt Disney Records. She provided vocals on four of the songs featured on the soundtrack, including "So Far, So Great", "Me, Myself and Time", "What to Do" and "Work of Art". It debuted at no. 163 on the Billboard 200, making it Lovato's lowest debut and peaking soundtrack there.^[63] It also debuted at number 3 on the US Kid Albums and at number 8 on the US Top Soundtracks.^[63] Two singles were released from the soundtrack. The first single to be released was "So Far, So Great". It was released on June 9, 2009 and is the theme song for the series. It first appeared on the album Disney Channel Playlist, and was later released on Demi Lovato's album Here We Go Again as a bonus track.^[64][65] The song is about chasing your dreams. It has also received rotation on Radio Disney. Lovato performed the song in her "Summer Tour 2009". It is the ninth and final track of the soundtrack, written by Jeannie Lurie, Aris Archontis and Chen Neeman and the length of the song is two minutes and fourteen seconds. The second single to be released was "Me, Myself and Time". It was published for the title track of the CD. It was released digitally on August 3, 2010, but was shown worldwide on April 11, 2010, the episode was issued Sonny With a Song in the United States chapter of the series in which Sonny shows her singing career performing the song appears to promote the fashion line of her character. The song managed to peak at number 6 on the US Billboard Bubbling Under Hot 100 Singles chart.

Demi Lovato live in Credicard Hall in São Paulo, Brazil 2012.

Lovato's third studio album, Unbroken, was released on September 20, 2011.^[66][67] Lovato began working on the album in July 2010, prior to receiving treatment. She had described it as having a more soulful and R&B inspired sound, citing Keri Hilson and Rihanna as inspirations for the sound.^[68] After Lovato's stint in the treatment facility, producer Timbaland expressed interest in working with her.^[69] Lovato confirmed in July 2011 that she was working on a duet with the producer. The album was described as more "radio friendly" than her previous albums, as she planned to incorporate dance, hip-hop and R&B styles in it. The song received mixed to positive reviews from music critics, praising Lovato's vocals and growth in musicianship compared to her previous two albums, as well as some of the album's ballad tracks. The first single off the album, "Skyscraper", premiered on July 12, 2011, as a promotional single, before the album released. It was written by Toby Gad, Lindy Robbins and Kerli Kõiv and produced by Gad. The song was inspired by a picture of the apocalypse, in which the world was in ruins, and among collapsed buildings, one skyscraper was still standing. Kerli originally recorded "Skyscraper" and Gad offered it to Lovato, who wanted to record it as she felt that both she and her fans could relate to it. When recording it in 2010, Lovato was very emotional which triggered outbursts and caused her to start crying. Later the same year, she entered a treatment facility to deal with her personal struggles. After finishing it in early 2011, she re-recorded the song, but kept the original recording as she felt that it was "symbolic" to her. "Skyscraper" was released on July 12, 2011 via Hollywood Records as the first single from Unbroken. According to Lovato, the song represents the journey she had been on the previous year. Musically, "Skyscraper" is a ballad and the lyrics speak of staying strong and believing in yourself. The track opens with a lonely piano that is soon accompanied by heavy percussion. Lovato showcases breathy and quivering vocals throughout the song. The song was very well received by music critics and also by the media, with the majority of them praising Lovato's vocals and the inspirational lyrics. Upon its release, it was also met with praise from celebrities on the microblogging site Twitter. The song debuted at number ten on the Billboard Hot 100, spending a total of 17 weeks on the chart. The song became Lovato's highest-peaking single on the chart since "This Is Me" peaked at number nine in August 2008. "Skyscraper" sold 176,000 paid digital downloads in its first week of release in the United States, setting a sales record for Lovato. Internationally, the song reached the top twenty in Canada, New Zealand, and the U.S. In August 2011, the song was awarded with Summer Song at the Teen Choice Awards. The song was also officially certified Gold in Australia on April 3, 2012.^[70] The song has sold over 1,000,000 digital copies and was officially certified Platinum in the United States on April 24, 2012.^[71] The song's accompanying music video was directed by Mark Pellington and shot in the Bonneville Salt Flats for twelve hours. Lovato performed the song for the first time at the Do Something Awards on August 18, 2011. The album officially released on September 20, 2011, with sales exceeding 96,000 copies in its first week of release.^[72] On October 24, 2011, Lovato performed the National Anthem at Game 5 of the 2011 World Series.^[73] The album's second single, "Give Your Heart a Break", was officially released on January 23, 2012.^[74][75] The track was written and produced by American songwriters Josh Alexander and Billy Steinberg. Musically, it is a dance-pop ballad that comprises instruments like the drums, violin and strings; the latter two, according to music critics, are reminiscent of those used in Coldplay's "Viva la Vida" (Viva la Vida or Death and All His Friends, 2008). Hollywood Records serviced the song to mainstream radios on January 23, 2012 in the United States. Lyrically, the song chronicles the protagonist's attempt to win over her lover who has been hurt in a relationship. The song received critical acclaim from contemporary music critics, praising the production as well as Lovato's vocals. The single reached number seventy on the US Billboard Hot 100, and has so far peaked at number 43. It also reached number thirty-nine in Brazil. In Belgium, it peaked at number 32. The music video for the song features Lovato attempting to persuade her lover into falling in love with her again, creating a collage of photographs taken during the video that when put together create a photo of the two in each other's embrace. Lovato has promoted the song through several stage performances, including her performance at the Z100 Jingle Ball concert. Lovato revealed her Summer Tour 2012 and will begin on June 12, 2012 and end on September 1, 2012.

On April 4, 2012, Lovato announced on Twitter that writing for her fourth studio album had began, saying that she was "so excited to start writing for my fourth album", and that "this time, there's NO holding back.."^[76][77]

Other work[link]

Philanthropy[link]

Lovato has partnered with mall proprietor GGP as the face of Shop Til You Rock, a music-inspired series of public events, which kick off at malls around the US in Summer 2010. The combines the season’s hottest fashions & today’s most popular musical guests in a series of interactive events.^[78] Lovato is also the spokesperson for anti-bullying organization PACER. Lovato explained to NY Post about becoming a spokesperson against bullying “Bullying is a very serious thing to me, I’ve witnessed it first hand – I was bullied myself when I was 12, I want to be able to help other girls around [my sister’s] age come into their own with a strong confidence in their skin, their size, who they are and everything about themselves.” Lovato is also the spokesperson for the Join the Surge Campaign!, DoSomething.Org and the Clean & Clear Brand launched Joining the Surge, which is a national campaign that empowers teenagers to take action in their communities.^[79]

Lovato is involved in Disney's Friends for Change, an organization which promotes "environmently-friendly behavior", and appears in its public service announcements to raise awareness for the cause on the Disney Channel.^[47] Lovato, Selena Gomez, Miley Cyrus, and the Jonas Brothers recorded "Send It On", a charity single which serves as the theme song for Disney's Friends for Change in 2009. The song debuted on the Hot 100 at number twenty.^[48][49] Disney's Friends For Change will direct all of its proceeds from "Send it On" to environmental charities to the Disney Worldwide Conservation Fund.^[48] Lovato and Joe Jonas recorded a new song called "Make a Wave", the second charity single which serves as the theme song for Disney's Friends for Change in 2010. In January 2010,^[80] Lovato was one of the many stars featured in a public service announcement for Voto Latino in order to promote the organization's "Be Counted" campaign for the 2010 United States Census.^[81] Lovato is also part of the "A Day Made Better" School Advocacy Campaign.^[82] "The campaign is giving a deserving teacher with $1,000 in school supplies on behalf of OfficeMax’s “A Day Made Better” school advocacy campaign."^[83]

Lovato has also supported charities such as DonateMyDress.org, Kids Wish Network, Love Our Children USA, ST. Jude Children's Research Hospital, and City of Hope.^[84] To raise awareness about personal issues similar to her own, Lovato became a Contributing Editor to Seventeen magazine. She will discuss her personal issues as a part of a larger campaign called "Love is Louder than the Pressure to Be Perfect", directed towards teen girls.^[85]

[edit] Judge on The X Factor

In 2012, rumors that Lovato and Miley Cyrus were in talks to be replacement judges on the season two of the American version of The X-Factor, in hopes of luring a younger audience, began circulating.^[86] Lovato reportedly signed a deal to judge the show on May 13, 2012.^[87] On May 14, 2012, it was officially confirmed that Spears and Lovato would join The X Factor as the two newest judges.^[88] When asked about the new judges, Cowell said: "I'm absolutely delighted Britney and Demi are joining us. Britney remains one of the biggest stars in the world, she's talented, fascinating – and I believe she knows exactly how to spot The X factor. Demi's had an amazing career in music, TV and film for someone her age. She's young, confident, and enthusiastic. I think it’s really important that she speaks to our younger audience. The new panel will be dynamic and will work really well with the changes we are making to the show."^[89]

Personal life[link]

In an interview with Ellen DeGeneres, Lovato admitted to going through painful experiences with bullying in the seventh grade.^[90] According to Lovato, the bullying was so bad that one day, in a fit of frustration and distress, she requested her mom give her a home-schooled education.^[91] In an interview with Fabulous Magazine UK, she said that: "They called me a whore and told me I was fat and ugly. I shouldn't have listened, but I took it to heart and it hurt. I thought maybe I didn't have friends because I was too fat," she remembers. So she starved herself, and anything she did eat, she threw up again. Within six months she had lost over 2st and weighed 6st 4lb - unhealthy for her 5ft 2in height. "I'd make myself sick up to six times a day," she says. "My mum was worried, but because I was going through puberty I was having growth spurts so she assumed that was why I was thinner."^[43] She wrote the song "For the Love of a Daughter" about her estranged father. According to Fabulous Magazine UK, the song is about the rift between Lovato and her father after he - seemingly keen to cash in on his daughter's notoriety - did a series of interviews about her. The betrayal is still raw, and she says she has no interest in rebuilding a relationship with him.^[43] In an MTV interview, Lovato stated that she likes metal music, particularly black metal and metalcore. She called symphonic black metal band Dimmu Borgir "one of her favorite live acts".^[92] On the July 24, 2009 episode of Late Night with Jimmy Fallon, Lovato stated that three of her favorite bands were metalcore/symphonic black metal band Abigail Williams, deathcore band Job for a Cowboy and southern metal band Maylene and the Sons of Disaster. On another episode of Late Night with Jimmy Fallon, after her release of Unbroken, she stated that she is now more into hip-hop and R & B styles of music, and has moved on from death metal. In the March 2009 issue of Teen Vogue, Lovato stated, "My first passion is music, because it comes naturally to me. Acting has been like a hobby."^[93] Lovato is a Christian and prays with her band before they perform.^[1] She was best friends with Selena Gomez, whom she has known since Lovato "asked her to sit on my jacket and draw with crayons with me" at the Barney & Friends auditions. On March 12, 2010, Lovato confirmed that she had begun dating Joe Jonas, whom she first met while filming Camp Rock in 2007.^[94] On May 24, 2010, Lovato confirmed via her official Twitter that she and Jonas were no longer together. In an interview with UsMagazine, Jonas stated, "Demi and I knew that going into our romantic relationship it may not be an easy one. I realize that over the time we have spent together that I feel I care more about our friendship right now. It was my choice to break up, but I love her as a friend. She's been there for me when I needed her. I will continue to be her friend and be there for her." Lovato is a vegetarian.^[95] Lovato has been honored The Honorary Ambassador of Education award from the American Partnership For Eosinophilic Disorders.^[96] In 2010, on her 18th birthday, Lovato bought her family a Mediterranean Style house in Los Angeles. She said, "For me to give that to my family on my birthday, that was the best present." then added, "It's got pretty much everything you could possibly imagine in it. It's the most beautiful, homey-feeling house. I love it."^[97] Lovato also purchased their current $1.88 million home in Toluca Lake, LA. She bought the house when she was 16 years old.^[98]

Public image[link]

Lovato has been described as an "inspirational person" and has inspired many people after her going through her treatment facility, her release of her song "Skyscraper", and her release of her documentary, Demi Lovato: Stay Strong.^[99] She has inspired many celebrities including Lucy Hale, Katy Perry, Pete Wentz, Selena Gomez, Ashley Tisdale, Kelly Clarkson, Jordin Sparks, Kim Kardashian, Victoria Justice, Cheryl Cole and Britney Spears. ^{[100][101][102]}

Personal struggles[link]

On October 30, 2010, Lovato dropped out of the Jonas Brothers Live in Concert World Tour 2010 in order to enter a treatment facility to treat physical and emotional issues.^[103] The tour was not scheduled to be complete until November 13, 2010. Lovato's publicist stated that "she regrets not being able to finish her tour, but is looking forward to getting back to work in the near future."^[104][105] In particular, many media sources immediately reported that Lovato had decided to enter treatment right after punching a Jonas Brothers back-up dancer, Alex Welch, on a flight out of Bogotá, Colombia, allegedly because Lovato believed that Welch had informed tour managers of inappropriate behaviour on Lovato's part the previous night, causing Lovato to be confronted by her managers and her stepfather, Eddie de la Garza.^[106] Days after Lovato entered rehab, photos circulated on the internet showing Welch sporting a black eye. Welch subsequently confirmed that the story was true, noting that she had been blindsided by the assault. Although Lovato had pulled aside the tour's back-up dancers prior to the flight and threatened, "If I find out who told on me...", Welch was not concerned because she had not witnessed what had happened the previous night and was not the dancer who had informed on Lovato. Welch claimed that she "didn't get a call or text from Demi or a 'hey, you got a problem with me,' nothing." She said Lovato simply approached her during the flight, punched her, and then "literally walked away and got in her seat." Lovato's representatives responded by saying, "We are in the process of engaging with Alex's lawyer and hope to resolve this as quickly as possible."^[107] Lovato's camp reached a financial settlement with Welch in late December 2010, with Welch stating that the agreement stipulated for a portion of the settlement to be donated to charity.^[108] On January 28, 2011, it was reported that Lovato had completed her inpatient treatment.^[109] She took six months off from the limelight after leaving rehab.^[43] The day after the announcement, a Disney spokesperson told People that Disney "support[s] Demi's decision to put her health first and [they] send her [their] best wishes".^[110]

On January 28, 2011, it was reported that Lovato had completed her inpatient treatment at the rehab facility and returned home to Los Angeles, where she "will continue to see doctors" to "help her work on the issues she confronted in treatment."^[111] On March 8, 2011 an exclusive video was released on Cambio.com in which Lovato thanked her fans for their support during what she described as "the darkest time of my life" and also stated that she was excited to get back to work.^[112] Lovato granted her first post-rehab interview to ABC newscaster Robin Roberts, which aired on Good Morning America and 20/20 on April 22, 2011. During the interview, Lovato confirmed reports that her treatment was for bulimia and self-injury, and had taken place at the Timberline Knolls facility in Illinois after the aforementioned confrontation between her and Welch led to an intervention by her family and management team. Her condition came to a head during the tour because Lovato "was performing concerts on an empty stomach...I was losing my voice from purging. I was self-medicating. I was not taking medication for depression, and I literally was so emotionally whacked out that I took it out on someone that meant a lot to me." Later elaborating on this "self-medicating", Lovato said, "I'm not gonna lie. I was self-medicating. I was doing things like drinking and using [drugs], like a lot of teens do to numb their pain."^[113] Lovato expressed regret at her actions towards Welch, stating "I take 100 percent, full responsibility..."^[114] In another interview, Lovato added that she had "basically had a nervous breakdown",^[19] and was also diagnosed with bipolar disorder during her treatment.^[115] As part of her efforts to raise awareness about issues similar to her own, Lovato was announced in April 2011 as a Contributing Editor to Seventeen magazine. She will discuss her personal issues as a part of a larger campaign called "Love is Louder than the Pressure to Be Perfect", directed towards teen girls.^[116]

On December 23, 2011, Lovato posted a message on Twitter criticizing her former network for airing episodes of Shake It Up and So Random! which featured characters making jokes about eating disorders.^{[117][118][119]} Disney Channel publicity officials quickly took action and apologized to Lovato, then removed those episodes from the network's airing cycle and video on demand sources, after further criticism in the wake of Lovato's message to the network's public relations account.^{[120][121][122][123]} On March 2012, Lovato released her MTV documentary special called "Stay Strong" about her time in rehab.^[124] In the documentary, she opened about her fans, battling her eating disorders and getting back to touring.^[125]

Filmography[link]