Knowledge and understanding are important in the treatment and prevention of eating disorders. To better help promote knowledge of both eating disorders and factors contributing to them, this section includes a Mindfullness Recovery Kit and links to other valuable eating disorder web sites.
Individual Resource Sheets
What Is Anorexia Nervosa?
Anorexia nervosa has the highest mortality rate of any psychiatric illness.
- However, with proper treatment a full recovery CAN be made.
- Chances for recovery increase if treatment occurs during early stages
Behavioral Signs Of Anorexia Nervosa
- Self-starvation resulting in extreme weight loss Preoccupation with food, weight and body image
» A great deal of time is spent thinking about food, counting calories and planning meals.
- Desire for thinness Distorted body image
» Seeing oneself as fat or feeling fat despite being underweight
- Intense fear of food and of gaining weight or becoming “fat.”
- Denial of hunger, tiredness and emotions
- Compulsive exercise
- Consistently making excuses to avoid food or not to eat.
- Isolation from peers, avoiding social situations especially involving food.
- Pre-occupation with food related activities
» Collecting recipes, baking for others but not eating the food made.
- Food rituals
» Eating only certain foods
» Eating in a certain way (eg chewing a certain number of times) » Eating at certain times every day with little exibility
» Omitting entire food groups from ones diet
- Difficulty concentrating
- Manipulative or secretive behavior
» It is important for the individual to hold on to their eating disorder, this is their way of coping, so a lot of energy is invested in concealing the illness from others.
» Depression can contribute to an eating disorder, or an eating disorder can cause feelings of depression. ey often go hand in hand.
Many of the physical complications of anorexia are caused by nutritional de – ciencies. Although this list is thorough, it is not complete. A medical evaluation is an important component to treatment of anorexia.
- Hair loss
- Dry skin
- Sensitivity to cold
- Lanugo, a downy soft hair that grows on the body in an e ort to keep the body warm.
- Amenorrhea (loss of menstrual period in women) Dizziness, fainting spells
- Heart problems, slow or irregular heart beat
Binge Eating Disorder
What Is Binge Eating Disorder?
Binge eating disorder (BED) involves eating a large amount food in a short pe- riod of time without compensating for eating by vomiting, excessively exercising, laxative or diuretic use.
Behavioral Signs Of Binge Eating Disorder
- Feeling out of control when eating
- Feelings of shame and guilt following eating
- Eating in secret
- Eating when not hungry
- Eating little when around other people, but maintaining a high weight Binge eating
- Feeling controlled by eating or weight
- Avoiding situations or activities because of embarrassment about weight Weight or eating patterns determine how one feels about self
- Primary focus is weight. When things don’t work out, it is attributed to weight.
- “Yo- yo” dieting, observable patterns of dieting, not dieting, and then dieting again.
Physical Symptoms Of Binge Eating Disorder
- High blood pressure related to weight
- Heart disease
- Many complications often associated with clinical obesity.
What Is Bulimia Nervosa?
Bulimia nervosa is a cycle of binge eating (eating a large amount of food and feeling out of control) followed by purging. Purging may includes self induced vomiting, laxative use, diuretic use or excessive exercise. e purging behavior is aimed at ridding oneself of the food consumed during the binge. Concerns about weight and body shape are also characteristics of bulimia.
Behavioral Signs Of Bulimia Nervosa
- Secretive eating (usually binges)
- Bathroom visits after meals
- Avoiding social situations involving food Impulsive behavior
- Sadness, self-disgust, shame
- Fear of being fat regardless of weight
- Behavior suggesting food and weight are primary concerns
Physical Symptoms Of Bulimia Nervosa
- Frequent weight uctuations
- Swollen salivary glands,
- Puffy cheeks
- Broken blood vessels in eyes
- Electrolyte imbalance that can lead to irregular heartbeats and possible heart failure
- Marks on hands
- In ammation and possible rupture of esophagus Complaints of sore throats, fatigue, chest
- pain Light headedness
- Tooth decay
- Irregular menstrual period
- Low immunity against colds/flu
Negative Body Image
What Is Negative Body Image?
Negative body image or body dissatisfaction is a common experience for many people. Body image problems are not found only among individuals with eat- ing disorders. People can experience negative body image no matter what they weigh.
What Is Body Image?
Body image is your perception about how you look. It is your thoughts, feelings, and behaviors about how you think you look. Negative body image comes from a negative attitude about your appearance. It is not ABOUT APPEARANCE. It is related to generally feeling inadequate and bad about yourself.
Physical Symptoms Of Bulimia Nervosa
Negative body image causes a lot of emotional distress.
- Preoccupation with appearance takes a lot of time and energy. Spending time worrying about how you look and hating your body takes away from time you can spend with loved ones, or enjoying favorite activities.
- Often, people attribute other things that have gone wrong or have not worked out in life to their appearance or weight “I am so ugly and fat, I will never get accepted to college.” Or “No one talks to me because I am not as skinny as they are.”
- When stressed, rather than think about what is stressful or uncomfortable thoughts, it is common to become preoccupied with their appearance. It may feel safer than looking at the “real” issues.
Talking About Your Eating Disorder
Guidelines For Talking About Your Eating Disorder
Most of the time, we read about how people can approach someone they are worried may have an eating disorder. We tend to ignore how to help people who have an eating disorder talk about it. is is a common struggle. How do you explain what is going on? How do you let people know what you need as you ght your eating disorder? is can be confusing and overwhelming, as people are afraid of being misunderstood or judged.
- Approach the topic when you are comfortable. It is important to talk about your eating disorder when you are ready, with people you are comfortable with and want to talk to.
- Be honest about your experience; let people know what types of things are helpful or potentially harmful for you.
» Requesting people not talk about their diet in front of you.
» Ask others not to ask about what you ate that day. ( is may not apply to
some family based therapies!)
- Learning to be honest and assertive about your needs is an important skill that will assist you throughout your recovery and beyond.
- You may have to educate people about eating disorders.
» Unfortunately, many myths and misconceptions about eating disorders remain.
» As di cult as it may be, even the most well meaning person may occasion ally misunderstand an aspect of your eating disorder.
» Don’t be afraid to take time to educate them, or direct them to books, web sites or articles that may help them.
» People may not ask for fear of saying the wrong thing. is does not necessarily mean they don’t care.
- Talking about your eating disorder is something that is in your control. You can talk about it when and with who you would like.
» Setting personal guidelines on this issue takes anxiety and “guess work” out of social situations, such as worrying what types of comments people may make or questions they may ask.
What do I do if someone I know has an eating disorder?
is is one of the most commonly asked questions, and probably one of the hardest to answer. Treatment and recovery are ultimately up to the individual. Getting help for an eating disorder can often be a di cult and scary rst step for the individual su ering, one often met with resistance. erefore, it is important to know that recovery can be a long process. Caring for someone with an eating disorder requires patience. It is important for individuals a ected by another’s eating disorder to nd their own support networks, and nd ways of caring for themselves too.
Ways to help
- Address your concerns in a con dential, safe environment. Be open and direct in an emphatic and non confrontational way. Let them know what you have seen and how it makes you feel.
» Example: “I am worried because I notice you go to the bathroom after meals. I am concerned you may be harming yourself.”
» Listen to their responses and what they say. Let them know their responses are important to you.
- Educate yourself. Know the signs and symptoms of eating disorders and most importantly the causes.
- Be familiar with available treatment options in the area. Suggest they make an appointment. O er to be present when they make the rst call. If the person is a minor, tell their parents or a trusted adult about your concerns.
- Remind yourself the eating disorder is not a choice. It is not something your loved one is intentionally doing to self harm, gain attention, or hurt you. Rather, they are su ering from a psychological illness.
- Be careful about the comments you make about food and weight.
» Comments such as “You look thin” will be perceived as good. “You look like you have gained weight” will be seen as bad.
» Celebrate internal qualities and talents rather than physical appearance. Avoid talking about sizes, calories, fat grams and diet plans.
- Avoid comments about others weight and body shape.
- Avoid trying to “ x” the situation. Instead, o er to listen and be supportive.
- Do not make comments such as “If you would just eat.”
- Avoid power struggles about food.
- Do not comment on your loved ones food choices or eating patterns.
- Remind your loved one that you are there to help. Ask what is helpful and what they would like you to do or how they would like certain situations handled.
» Do not avoid the topic of the eating disorder for fear of saying the wrong thing. Just ask what is most comfortable for them.
Remember, recovery is possible!
The Dangers of Dieting
- Dieting is so common among women in Western culture it is considered normative behavior.
- Dieting has been identi ed as the most common risk factor of eating pathology
- Girls as young as age 9 have reported to dieting
Why do people diet?
- Body dissatisfaction
- Increase health and prevent obesity
- Improve appearance
- Drive for thinness
- Belief that thinness equals success, control, and happiness
- Dieting can have cognitive, behavioral and physical e ects including:
- Increased thoughts of food and eating » Decreased self-esteem
» Feelings of failure
- 95% of diets do NOT work!
» Altered metabolism due to ignoring bodily hunger cues
- This may lead to weight uctuation.
- Particularly common in “yo-yo” dieters
» Decreased sex drive
» Physical side e ects related to lack of nutrients
» Use of diet pills, laxatives and diuretics can adversely a ect physical health
Treatment For An Eating Disorder
Treatment For An Eating Disorder
There are various treatment options available for eating disorders. It is important to have an initial assessment done by a therapist specializing in eating disorders to help determine an appropriate treatment plan. As the causes of eating disor- ders are complicated, and unique for each individual, it is important for treatment plan to address an individuals specific needs.
Eating disorders can be treated on an inpatient, outpatient and intensive outpa- tient (day program) basis. e initial evaluation can determine the appropriate level of care.
Whether a treatment is conducted on an inpatient or outpatient basis, almost all forms of treatment include a team approach of di erent eating disorder profes- sionals.
These professionals include:
- Psychologist/psychotherapist: Psychotherapy can help people become aware of the factors underlying and contributing to their eating disorder. New ways to address and cope with emotions that do not involve food can be learned. oughts, feelings and behaviors related to food should also be addressed in therapy. erapy can include individual, group therapy, and/or family therapy.
- Nutritionist: e nutritionist helps the individual “re-learn” the process of eating by assisting with the development of balanced dietary plans. Nutrition- ists can also address potential nutritional de ciencies and help provide accu rate information about a balanced diet. is treatment is not about learning how to diet, but rather approach food in a balanced, healthy manner.
- Psychiatrist: At times, medication may be appropriate. Depression and other psychiatric disorders may occur along with the eating disorder. Medication is most e ective when used with psychotherapy.
- Medical doctor: It is important to have regular check ups to monitor possible physical side e ects of the eating disorder. Symptoms of starvation and nutritional de ciency can occur and should be monitored.
- Dentist: Tooth decay is a possible side e ect of regular vomiting, (tooth enamel is eroded by stomach acid). Regular check-ups and possible dental treatment is important. It is important to be honest with your dentist about purging behavior so he/she can adequately treat possible decay and also pro vide education about dental care and eating disorders.
- Gynecologist: Irregular menstrual periods are common physical e ects of an eating disorder related to weight loss or uctuation in weight. A gynecologist may monitor this. Use of contraceptives and pregnancy are common issues that may be complicated by an eating disorder, and may be important topics to address.
People with eating disorders often nd it di cult to get help, as their coping mechanism is being challenged. It is important to encourage a loved one to seek help if they are su ering from an eating disorder. With the appropri- ate treatment, an individual su ering from an eating disorder can again live healthfully with food and themselves.
What Causes An Eating Disorder?
- Eating disorders are not about food and weight.
- Eating disorders are attempts to use food and weight as a way of dealing or avoiding emotional di culties that can not be seen by the outside observer.
»The observable signs, such as binge eating and/or restricting are symptoms of the illness.
- The causes of eating disorders are unique for each person.
- The causes are usually complex, with several factors occurring. An eating dis order is not something one person can “cause” or “give” to someone else.
- Think of the eating disorder as a stool- there are several “legs” or supporting factors that contribute to the eating disorder.
Contributing Factors To e Development Of An Eating Disorder
» Temperament: e tendency to respond or cope in a certain way (being obsessive, anxious, sensitive, avoidant) may make people more vulnerable. ese things may be partially determined by genetics.
» Eating disorders often run in families suggesting a genetic component.
» In some people with eating disorders, chemicals in the brain that regulate
hunger, satiety and appetite have been found to be unbalanced.
- Psychological factors
» Perfectionistic tendencies: Seeing things only in black and weight. Having
high expectations for self, (eg “Being the thinnest is the best.” Or “I have to be good.”)
» Developmental concerns: An eating disorder may be a way of delaying one’s maturation or avoiding concerns about what growing up means. It may also be a way of developing an identity, rather than focus on internal aspects of self “thinness” can become a way of de ning who one is.
» Avoiding feelings: Preoccupation with food and weight, planning meals or binges takes a lot of energy and leaves little time to look at feelings. An eating disorder can be a way of preventing oneself from feeling painful emotions, avoiding the fear of being overwhelmed by emotions, or indi- rectly expressing feelings.
- Relationship problems
» Controlling relationships
» History of being teased or criticized for appearance
- Societal factors
» Consistent exposure to unrealistic standards of beauty. Culturally
promoted belief that thinness equals happiness and success.
» Socially accepted myths about food, weight, and dieting.
» Undue emphasis on appearance and narrow de nitions of beauty.