Eating Disorders

What are eating disorders? Eating disorders are complex conditions

that arise from a combination of long-standing behavioral, emotional, psychological, interpersonal, and social factors.

What are they? People with eating disorders often use food and

the control of food in an attempt to compensate for feelings and emotions that may otherwise seem over-whelming.

For some, dieting, bingeing, and purging may begin as a way to cope with painful emotions and to feel in control of one’s life, but ultimately, these behaviors will damage a person’s physical and emotional health, self-esteem, and sense of competence and control.

Disorders Anorexia Nervosa Bulimia Binge Eating Disorder

Describe Most of you know someone that has

struggled with their eating -- make a group of 3 or 4 and describe the person to the rest of your group.

Did you describe the person or their behavior?

Common themes?

Anorexia nervosa Characterized by self-starvation and excessive weight loss.

Symptoms include:

Refusal to maintain body weight at or above a minimally normal weight for height, body type, age, and activity level

Intense fear of weight gain or being “fat” Feeling “fat” or overweight despite dramatic weight loss Loss of menstrual periods Extreme concern with body weight and shape

Bulimia Characterized by a secretive cycle of binge eating followed by purging.

Bulimia includes eating large amounts of food--more than most people would eat in one meal--in short periods of time, then getting rid of the food and calories through vomiting, laxative abuse, or over-exercising.

Repeated episodes of bingeing and purging Feeling out of control during a binge and eating beyond the point of

comfortable fullness Purging after a binge, (typically by self-induced vomiting, abuse of

laxatives, diet pills and/or diuretics, excessive exercise, or fasting) Frequent dieting Extreme concern with body weight and shape

Binge Eating Disorder/Compulsive Overeating Characterized primarily by periods of uncontrolled,

impulsive, or continuous eating beyond the point of feeling comfortably full.

While there is no purging, there may be sporadic fasts or repetitive diets and often feelings of shame or self-hatred after a binge.

People who overeat compulsively may struggle with anxiety, depression, and loneliness, which can contribute to their unhealthy episodes of binge eating.

Body weight may vary from normal to mild, moderate, or severe obesity.

Factors Disordered eating is NOT just about

food and diets… Can you list the other factors that play a

role in the development or continuation of disordered eating behaviors?

See how many your group can come up with.

Psychological factors

Low self-esteem Feelings of inadequacy or lack of

control in life Depression, anxiety, anger, or

loneliness

Interpersonal Factors Troubled family and personal

relationships Difficulty expressing emotions and

feelings History of being teased or ridiculed

based on size or weight History of physical or sexual abuse

Social Factors Cultural pressures that glorify "thinness" and

place value on obtaining the "perfect body" Narrow definitions of beauty that include only

women and men of specific body weights and shapes

Cultural norms that value people on the basis of physical appearance and not inner qualities and strengths

Other Factors Scientists are still researching possible

biochemical or biological causes of eating disorders. In some individuals with eating disorders, certain chemicals in the brain that control hunger, appetite, and digestion have been found to be imbalanced. The exact meaning and implications of these imbalances remains under investigation

Behavior Share some of the behaviors that you

have witnessed from people struggling with and ED regarding food and exercise.

What is the common theme for these behaviors?

Food Behavior Anorexic The person skips meals, takes only tiny portions, will

not eat in front of other people, eats in ritualistic ways, and mixes strange food combinations. May chew mouthfuls of food but spits them out before swallowing.

Grocery shops and cooks for the entire household, but will not eat the tasty meals.

Always has an excuse not to eat -- is not hungry, just ate with a friend, is feeling ill, is upset, and so forth.

Food Behavior Bulimic The person gorges, usually in secret, emptying

cupboards and refrigerator. May also buy special binge food.

If panicked about weight gain, may purge to get rid of the calories. May leave clues that suggest discovery is desired -- empty boxes, cans, and food packages; foul smelling bathrooms; running water to cover sounds of vomiting; excessive use of mouthwash and breath mints; and in some cases, containers of vomit poorly hidden that invite discovery.

Exercise The person exercises excessively and

compulsively. May tire easily, keeping up a harsh regimen only through sheer will power. As time passes, athletic performance suffers. Even so, s/he refuses to change the routine.

May develop strange eating patterns, supposedly to enhance athletic performance. May consume sports drinks and supplements, but total calories are less than what an active lifestyle requires.

Exercise Up to five percent of high school girls and seven

percent of middle-school girls have tried steroids in attempts to get bigger and stronger in sports and also to reduce body fat and control weight.

Some say they don't mind gaining weight as long as it's muscle weight, not fat.

Male abuse of steroids is also well documented.

Thoughts and Beliefs In spite of average or above-average intelligence, the person thinks in

magical and simplistic ways, for example, "If I am thinner, I will feel better about myself." S/he loses the ability to think logically, evaluate reality objectively, and admit and correct undesirable consequences of choices and actions.

Becomes irrational and denies that anything is wrong. Argues with people who try to help, and then withdraws, sulks, or throws a tantrum. Wanting to be special, s/he becomes competitive. Strives to be the best, the smallest, the thinnest, and so forth.

Has trouble concentrating. Obsesses about food and weight and holds to rigid, perfectionistic standards for self and others.

Is envious of thin people in general and thinner people in particular. Seeks to emulate them.

Feelings Has trouble talking about feelings, especially anger. Denies anger,

saying something like, "Everything is OK. I am just tired and stressed." Escapes stress by turning to binge food, exercise, or anorexic rituals.

Becomes moody, irritable, cross, snappish, and touchy. Responds to confrontation and even low-intensity interactions with tears, tantrums, or withdrawal. Feels s/he does not fit in and therefore avoids friends and activities. Withdraws into self and feelings, becoming socially isolated.

Feels inadequate, fearful of not measuring up. Frequently experiences depression, anxiety, guilt, loneliness, and at times overwhelming emptiness, meaninglessness, hopelessness, and despair.

Social Behavior Tries to please everyone and withdraws when this is not possible. Tries to

take care of others when s/he is the person who needs care. May present self as needy and dependent or conversely as fiercely independent and rejecting of all attempts to help. Anorexics tend to avoid sexual activity. Bulimics may engage in casual or even promiscuous sex.

Person tries to control what and where the family eats. To the dismay of others, s/he consistently selects low-fat, low-sugar non-threatening -- and unappealing -- foods and restaurants that provide these "safe" items.

Relationships tend to be either superficial or dependent. Person craves true intimacy but at the same time is terrified of it. As in all other areas of life, anorexics tend to be rigidly controlling while bulimics have problems with lack of impulse control that can lead to rash and regrettable decisions about sex, money, stealing, commitments, careers, and all forms of social risk taking.

Judy’s Story My name is Judy Sargent. I

am 37 years-old and a recovered anorexic. I suffered from severe anorexia nervosa for 10 years, was hospitalized 26 times, and landed myself in intensive care units on multiple occasions. You would never guess any of these things looking at me today.

http://www.angelfire.com/ms/anorexianervosa/images/then.gif

Story Did you get good grades in school? Yes, I was a straight "A" student. My father is

a professor, so there was always pressure to perform. If I got an "A," my father said that I didn't challenge myself enough. If I got an "A-," my father said that I didn't apply myself hard enough. I couldn't ever seem to "win" the approval I so desired from my parents.

Did you feel as if you were not perfect

compared to your peers? I guess you could say I'd always been a

perfectionist (striving for perfection in everything that I did), but the pressure was internal (competing with myself and nobody else). In terms of my peers, I felt inferior. I had HORRIBLY low self-esteem. I never felt "better than" my peers, nor did I do things to make myself feel that way. In my minds eye, I knew that I was inferior. Socially, I felt like a misfit (even though I was on the cheerleading squad and outwardly looked like "I had it all").

Why did you decide to stop eating rather than something like become bulimic?

It all started as a simple "diet" (as part of my self-devised, self-improvement plan), but it snowballed out of control. Eventually, I became afraid to eat (and even, at times, to drink water). It was like a phobia (fear) of weight gain and food.

What made you look at yourself as not

a thin enough person? Contrary to popular belief, I

saw myself as thin, although I told people that I was "fat." For me, the word "fat" took on a whole new meaning.

When I looked at myself in the mirror, I saw the protruding bones and the greyish blue skin. In my mind, I was still "fat" because I was still less than perfect and still unhappy.

How did your friends cope with the

problem? My friends quickly dissipated and then

disappeared completely. The anorexia became all consuming. I spent hours exercising, and I avoided any social gatherings that had anything to do with food.

I never imagined…. I started losing weight, never

dreaming that I'd become anorexic, that I'd lose control over my life and almost wind up dead. I began my diet as a simple self-improvement campaign, as an attempt to "feel better" about myself. Initially, I felt better...so I lost more weight...quickly it became a trap and spiraled

out of control.

Inside the ED’s mind Anorexia nervosa is not really about

losing weight, eating or not eating, exercising like a maniac or not. It is about self-esteem. It is about how you feel about yourself. True happiness comes from within, it cannot be gleaned from reading the numbers off of a bathroom scale.

Behaviors Restaurant Rules: Before ordering, ask for a full glass of ice water (with lemon,

optional) and consume it. Get a refill when the waiter comes to take your order.

Get nutrition information ahead of time if you can. Surf the 'net or call the restaurant (just tell them you have "health issues") and ask about the calorie, fat and carb content of their dishes. Then you will know what to order -- or whether to even bother going there.

Avoid all breaded or battered items, fried items, sauteed items, breads, pasta, rices, sweetended drinks, and of course, desserts.

More “Rules” Get the simplest foods in their

most natural form available, such as grilled fish and a tossed salad. Lean proteins like shrimp are best. (You don't NEED the cocktail sauce, ignore it!)

When given a choice, always lunch portion, never dinner portion.

Request all sauces and dressings on the side. That way you retain control over how much you consume. Nearly all the excess calories, fats and carbs are in restaurant sauces and dressings.

Have your water glass refilled when the food arrives.

One or two sips of water between bites.

Set down fork after each bite. Chew slowly and thoroughly. Be discreet; don't make a

spectacle of yourself. You are there to survive the experience, savour your sense of control, and enjoy your time out -- not to draw attention to how weird you can be with food.

Excuses? "Oh, thank you, but I already

ate at work (school, friend's house, on your way home, etc. wherever you just came from)."

"Well, I haven't really been feeling well today. My stomach is kind of queasy; maybe I'll just have some hot tea and see if it settles for now."

"Man, I've got a massive headache -- I'll just take a big glass of water and an aspirin (tylenol, ibuprofen, whatever) if you don't mind ..."

"Well, I had a really HUGE breakfast (lunch, snack, whatever) and I'm still full from that ... maybe later."

Reality? "My favorite safe food is egg

whites. 15 calories each and pure protein, no fat. 4 are just 60 cal. total and you will think you just had an omlette at perkins. My second fav is canned chicken broth. 20 cals in the whole can (fat free kind of course) warms you up and no guilt."

Helping If you are worried about your friend’s

eating behaviors or attitudes, it is important to express your concerns in a loving and supportive way. It is also necessary to discuss your worries early on, rather than waiting until your friend has endured many of the damaging physical and emotional effects of eating disorders.

Judy’s advice I usually encourage people to voice their

concern to their friend by saying something like, " ___ (name), I'm concerned about you. I've noticed that you've lost a lot of weight lately. I really care about you and I'm afraid of losing you. Would you consider going to get help?" Denial and resistance is common in the early stages of an eating disorder, so this approach may not work.

Communicating Set a time to talk. Set aside a time for a

private, respectful meeting with your friend to discuss your concerns openly and honestly in a caring, supportive way. Make sure you will be some place away from other distractions.

Communicate your concerns. Share your memories of specific times when you felt concerned about your friend’s eating or exercise behaviors. Explain that you think these things may indicate that there could be a problem that needs professional attention.

Communicating Ask your friend to explore these concerns with a

counselor, doctor, nutritionist, or other health professional who is knowledgeable about eating issues. If you feel comfortable doing so, offer to help your friend make an appointment or accompany your friend on their first visit.

Avoid conflicts or a battle of the wills with your friend. If your friend refuses to acknowledge that there is a problem, or any reason for you to be concerned, restate your feelings and the reasons for them and leave yourself open and available as a supportive listener.

Communicating Avoid placing shame, blame, or guilt on your friend regarding

their actions or attitudes. Do not use accusatory “you” statements like, “You just need to eat.” Or, “You are acting irresponsibly.” Instead, use “I” statements. For example: “I’m concerned about you because you refuse to eat breakfast or lunch.” Or, “It makes me afraid to hear you vomiting.”

Avoid giving simple solutions. For example, "If you'd just stop, then everything would be fine!"

Express your continued support. Remind your friend that you care and want your friend to be healthy and happy.

Body Image Body image is . . . How you see yourself when you look in the mirror or when you

picture yourself in your mind. What you believe about your own appearance (including your

memories, assumptions, and generalizations). How you feel about your body, including your height, shape, and

weight. How you sense and control your body as you move. How you

feel in your body, not just about your body.

3 D’s Dieting, Body Dissatisfaction, Drive for Thinness

Dieting Americans spend more than $40 billion dollars a year on dieting and

diet-related products. That’s roughly equivalent to the amount the U.S. Federal Government

spends on education each year. It is estimated that 40-50% of American women are trying to lose

weight at any point in time. One recent study revealed that 91% of women on a college campus

had dieted; 22% dieted "often" or "always." Researchers estimate that 40-60% of high school girls are on diets Another study found that 46% of 9-11 year olds are sometimes or very

often on diets And, another researcher discovered that 42% of 1st-3rd grade girls

surveyed reported wanting to be thinner

Media All media images and messages are constructions.

They are NOT reflections of reality. Advertisements and other media messages have been carefully crafted with an intent to send a very specific message.

Advertisements are created to do one thing: convince you to buy or support a specific product or service.

To convince you to buy a specific product or service, advertisers will often construct an emotional experience that looks like reality. Remember, you are only seeing what the advertisers want you to see.

Too rich? Or just too thin?

Media Advertisers create their message based on what they think you

will want to see and what they think will affect you and compel you to buy their product. Just because they think their approach will work with people like you doesn’t mean it has to work with you as an individual.

As individuals, we decide how to experience the media messages we encounter. We can choose to use a filter that helps us understand what the advertiser wants us to think or believe and then choose whether we want to think or believe that message. We can choose a filter that protects our self-esteem and body image.

Actress Jennifer Aniston for Vanity Fair, May 2001

"The media create this wonderful illusion-but the amount of airbrushing that goes into those beauty magazines, the hours of hair and makeup! It's impossible to live up to, because it's not real."

- Elizabeth Hurley for Details magazine

"On my last Cosmo cover," she explains, "they added about five inches to my breasts. It's very funny. I have, like, massive knockers. Huge. Absolutely massive."

Christy Turlington Christy Turlington explains to

Elle magazine... "Advertising is so manipulative," she says. "There's not one picture in magazines today that's not airbrushed." ... "It's funny," Turlington continues. "When women see pictures of models in fashion magazines and say, 'I can never look like that,' what they don't realize is that no one can look that good without the help of a computer.

Reverse triggers From the website… “These images represent what we

never want to become. If you want to know why ... just look around you at how these people too often end up being treated. Perhaps you yourself have been guilty of this at times. For the record, this site does not condone bashing fat people. We just choose not to be among their number, is all. “

http://www.plagueangel.net/grotto/id11.html

Pro-Anorexia? "Pro-ana" thus becomes short for proactive, volitional anorexia.

It refers to actively embracing the concept of anorexia as a lifestyle choice rather than an illness.

Philosophy: There are No Victims Here Volitional, proactive anorexia is not a disease

or a disorder. It is not to be confused with ED-anorexia; it is not something invasive which one "suffers from." There are no VICTIMS here. It is a lifestyle choice that begins and ends with a particular faculty human beings seem in drastically short supply of today: the will.

http://www.plagueangel.net/

Dealing with clients What do you need to learn to effectively

and compassionately deal with ED patients and clients?