Eating Disorders 101: Raising Counselor Awareness Diagnosis, Intervention & Treatment Options

1. Eating Disorders 101: Raising Counselor AwarenessDiagnosis, Intervention & Treatment Options LPCA 15th Annual Convention May 15-18, 2003 Wyndham Peachtree Conference Center Peachtree City, Georgia by Vicky Ng, EdS Susan Boes, PhD Lisa Sheehan-Hicks, MA

2. Section I: Introduction • Criteria/Pathology of : • Anorexia Nervosa, • Bulimia Nervosa, & • Compulsive Eating

3. Anorexia Nervosa • Refusal to maintain body weight at or above a minimally normal weight for age & height • In postmenarcheal female, amenorrhea occurs • Intense fear of gaining weight or becoming fat, even though underweight • Disturbance in way one’s body weight or shape is experienced

4. Bulimia Nervosa • Recurrent episodes of binge eating. • Recurrent inappropriate compensatory behavior in order to prevent weight gain • Binge eating & inappropriate compensatory behavior both occur, on average, at least 2x/week for 3 months

5. Eating Disorder NOS - All criteria for Anorexia Nervosa are met, but a few exceptions - All criteria for Bulimia Nervosa are met except it occurs at a frequency of less than 2x/week or duration of < 3 months - Regular use of inappropriate compensatory behavior by individual of normal body weight after eating small amounts of food - Repeatedly chewing & spitting out, but not swallowing, large amounts of food - Binge-eating disorder: recurrent episodes of overeating

6. Causes of Eating Disorders

7. Psychological Low self-esteem Tendencies to: be perfectionistic set rigid standards for oneself Depression, anxiety, anger, emptiness or loneliness. Feelings of lack of control or inadequacy.

8. Sociocultural • Narrow definitions of beauty & ideal body • Persistent & pervasive media messages encouraging dieting & thinness • Cultural pressures that place extreme value on "thinness" • Cultural norms that place more emphasis on physical appearance rather than inner strengths & qualities

9. Interpersonal • Difficulty expressing feelings & emotions • Family disharmony • Troubled interpersonal relationships • History of being ridiculed based on size or weight • History of physical and/or sexual abuse • Family factors may include: • Obesity • Parental preoccupation with eating & weight • Unrealistic expectations for achievement

10. Biological & Biochemical There are potential biochemical or biological causes Some sufferers have imbalances in certain chemicals in brain that control hunger, appetite, and digestion. Investigation into implications of these imbalances is still underway

11. Dangers

12. Anorexia • Delayed pubertal development • Shrinkage of internal organs • Loss of menstruation (Amenorrhea) • Osteoporosis • Severe constipation • Weakness, fatigue, and/or fainting spells • Infertility • Digestive problems • Bowel & urinary problems • Hair loss and/or growth (Lanugo) • Headache • Severe Dehydration • Heart failure • Death

13. Bulimia • Weakness & fatigue • Irregular or loss of menstruation • Irregular heartbeat • Heart failure • Digestive problems • Stomach ulcers • Death • Broken blood vessels & swollen glands • Kidney & Liver damage • Swollen or infected saliva glands • Sore throat & pain • Diabetes • Teeth & gum problems • Bleeding of Esophagus

14. Medicinal Compensatory Aids disruption in menstrual cycle, change in sex drive, hair loss, blurred vision, fever and urinary tract problems. vomiting and diarrhea or constipation, intestinal disturbances, tingling in extremities, nervousness, restlessness, insomnia, high blood pressure, fatigue and hyperactivity, heart arrhythmias and palpitations, congestive heart failure or heart attack, stroke, headaches, dry mouth, excessive perspiration, dizziness, Diet pills, both over-the-counter & prescription, can cause: Overdoses can cause tremors, confusion, hallucinations, shallow breathing, renal failure, heart attack &convulsions

15. Symptoms & Salient Warning Signs of Anorexia & Bulimia Nervosa

16. Physical Symptoms - Dramatic weight loss - Wearing big or baggy clothes or dressing in layers to hide body shape and/or weight loss - Frequent trips to bathroom immediately following meals - Visible food restriction & self-starvation - Depression - Fatigue - Loss of menstrual cycle - Visible binging and/or purging - Isolation - Unusual food rituals

17. Psychological Symptoms - Obsession with food, weight & exercise - Fear of eating around & with others - Self-defeating statements after food consumption Low self-esteem & feelings of worthlessness Need for acceptance & approval from others Perfectionistic personality

18. Symptoms of Binge Eating Disorder (Eating Disorder NOS)

19. Physical Symptoms Chronic dieting on a variety of popular diet plans Hiding food in strange places (closets, cabinets, suitcases, under bed) to eat at a later time Vague or secretive eating patterns Weight gain Mood swings, Depression - Fatigue

20. Psychological Symptoms Fear of not being able to control eating while eating, not being able to stop. - Isolation. - Fear of eating around and with others - Holding belief that life will be better if they can lose weight - Blames failure in social & professional community on weight - Holding belief that food is their only friend

21. Section II:Intervention

22. Family Dynamics • Children seek acceptance & validation from parents. If a lack of praise child may feel disapproved of, thus contributing to low self-esteem. • Obsession with weight & body image by one or both parents will lead to same in their children. • Controlling & demanding parents can lead children to believe they have to be perfect to gain acceptance. • Either parent may have a negative means of coping with life (Eating Disorder, Alcoholism, Drug Addiction) or existing psychological condition • Parents who are workaholics & have a problem meeting obligations to their children • Disruption in home environment • Abuse in family

23. What Parents Need to Know Dieting at any given time: 1-3 women & 1-4 men35% of occasional dieters progress into pathological dieting 4 of 5 US Women are dissatisfied with their appearance 1 in every 4 television commercials send out some sort of message about attractiveness

24. How & When to Intervene Approach person privately & discreetly when there is enough time to seriously discuss issue - Offer observations in a caring but direct manner. Try to be as specific as you can regarding your observations & concerns. -Tell person you are worried & would like them to seek help - Encourage person to express feelings openly & listen intently. Do not be judgmental, instead ask questions about what was expressed - Try to get family or main support system involved.- If a concern that ED has reached life-threatening stage, enlist help of mental health professional immediately

25. Family Involvement Always try to get person’s family or main support system involvedFamily will need to talk about a variety of issues - not just focus on problems or person with eating disorder

26. Prevention 1. Consider your thoughts, attitudes, & behaviors toward your own body. Make an effort to maintain positive, healthy attitudes & behaviors. Children learn from things you say & do! 2. Examine closely your dreams & goals for your children & other loved ones. 3. Encourage your children to be active & to enjoy what their bodies can do & feel like. Do not limit their caloric intake unless a physician requests that you do this because of a medical problem. 4. Make a commitment to help others appreciate & resist ways in which television, magazines, & other media distort body & imply that a slender body means power, excitement, & sexuality.

27. Section III:Treatment Options & Goals

28. Therapy • Individual counseling - • Cognitive behavior therapy, • Jungian therapy, • Marriage and/or Family counseling • Group counseling - • 12 Step groups • Support groups for families

29. Other Treatment Options Inpatient and Outpatient care Residential Facilities Psychotropic drugs Medical treatments

30. Treatment Goals • Help client with distorted body image & negative self-image/low self esteem • Address any family issues which may be a contributing factor • Expose fallacy & inaccuracies of messages media presents & how they can effect ones thinking • Work with client regarding their eating habits to help them regain an appropriate weight • Refer client to an eating disorders specialist if you do not have adequate experience in this area

31. Web resources • “Something Fishy” - http://www.something-fishy.org • “Support Concerning and Resources for Eating Disorders” (S.C.a.R.E.D.), http://www.eating-disorder.org/scared.html • Organizations • National Eating Disorders Association; Seattle, WA; (206) 382-3587 • Eating Disorders Awareness and Prevention, Inc.; Seattle, WA; (206) 382-3587 • National Center for Overcoming Overeating; New York, NY; (212) 875-0442 • Overeaters Anonymous; Rio Rancho, NM; (505) 891-2664 • WINS (We Insist on Natural Shapes); Sacramento, CA; 1-800-600-WINS Resources