Eating Disorders

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Eating Disorders
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What are eating disorders?

• Eating disorders are complex conditions that
  arise from a combination of long-standing
  behavioral, emotional, psychological,
  interpersonal, and social factors.

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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 ones life, but ultimately,
  these behaviors will damage a persons physical
  and emotional health, self-esteem, and sense of
  competence and control.

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Disorders

• Anorexia Nervosa
• Bulimia
• Binge Eating Disorder

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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?

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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

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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

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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.

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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.

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Psychological factors

• Low self-esteem
• Feelings of inadequacy or lack of control in life
  
• Depression, anxiety, anger, or loneliness

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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

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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

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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

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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?

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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Judys 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

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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.

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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").

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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.

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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.

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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.

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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.

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Inside the EDs 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.

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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.

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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.

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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."

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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."

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Helping

• If you are worried about your friends 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.

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Judys 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.

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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
  friends eating or exercise behaviors. Explain
  that you think these things may indicate that
  there could be a problem that needs professional
  attention.

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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.

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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 Im 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.

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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 Ds
• Dieting, Body Dissatisfaction, Drive for Thinness

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(No Transcript)
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Dieting

• Americans spend more than 40 billion dollars a
  year on dieting and diet-related products.
• Thats 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

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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.

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Too rich? Or just too thin?
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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 doesnt 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.

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(No Transcript)
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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."

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- 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."

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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.

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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

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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/

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Dealing with clients

• What do you need to learn to effectively and
  compassionately deal with ED patients and clients?