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| Eating
Disorders Are you concerned that you may have an eating disorder?
If you answered yes to several of these questions you MAY have an Eating Disorder. If you answered yes to five or more of these questions you should seek a professional for an evaluation. Eating disorders can develop into dangerous and life-threatening diseases. They start with a diet and often take on a life of their own. What started with the person feeling in control of their body and weight escalates until the individual has no control over their life and health. Physiological and neurochemical changes take place in the brain and the individual is immobilized to make choices to save their life. Eating disorders are multifaceted disorders with a complicated origin. Some of the causes that are currently being researched are genetic factors, psychological reasons, and family dynamics, social pressure, media and cultural demands. Once believed to be a disease of adolescence, they now cut across age, gender, and ethnicity. Because of the secrecy involved in maintaining the behaviors, it is difficult to accurately cite the number of people affected. According to the organization of Anorexia and Related Eating disorders (ANRED), up to 20% of people who develop eating disorders and fail to seek treatment may die. With proper treatment death rates fall to 2-3%. Such treatment entails a team approach usually involving a psychiatrist, a medical doctor, a therapist, and a nutritionist. ANRED reports that 40 % of people will reach no or only partial recovery. Treatment takes a long time (2-7 years) depending on the age at onset, the amount of time the individual has suffered, their support system, motivation, and perseverance Are some people more at risk in developing an eating disorder? There does seem to be a profile of the child most likely to develop an eating disorder. Children likely to develop anorexia are often seen as perfect: quiet, hard-working, achievement-oriented, never causing their parents worry or concern. They are good students, people pleasers, and care takers. Under that perfect façade they feel inadequate. They want to excel in order to stand out and feel that they are special. They tend to be more rigid and have a difficult time adapting to stresses. They often fear growing up and the challenges of negotiating developmental changes. The eating disorder keeps them childlike and dependent and, therefore, safe. People who tend to first develop Bulimia tend to be impulsive and struggle with anxiety and depression. It is not unusual to find cross addictions such as alcohol and drug addiction, binge shopping, sexual promiscuity, and self-harm. They start a diet to feel better about themselves, but the restriction leads to binging, which leads to negative self descriptions. The purging relieves these anxieties. Soon the behavior becomes a way of numbing themselves to the anxieties and underlying psychological issues. Is Recovery Possible? I feel recovery is possible but only when the individual has reached the point where they no longer want to live this way. They are disillusioned with the ideal that thinness will define them and bring them happiness. Even when they reach this point it is lengthy, painful and difficult work. Many people leave treatment prematurely only to find the eating disorder reappears at another stressful time in their life. . Everyone’s recovery is different and never have I seen a linear recovery. People start, stop, slip, and relapse in the course of recovery. Often they will see multiple therapists, enter hospitals and treatment centers before they finally reach the point where they have suffered enough and can make the commitment to work through the painful issues that block a complete recovery. I looked up anorexia and bulimia on the web, and I have some but not all of the symptoms. Should I be concerned? You should be concerned if your thoughts and behaviors toward food and body shape interfere with your life, or if you interrupt your work and leisure time to think, plan, and or obsess about eating or not eating. You should be concerned if too much of your life is centered on body concerns such as excessive hours at the gym, or avoiding social engagements for fear of overeating. You should be concerned if your self-evaluation is determined by your body size. You should be concerned if you only “allow” yourself to eat certain foods. If you avoid foods that are considered high calorie and then lose control if you do eat them, you have reason to be concerned. You mentioned diets are sometimes a catalyst for eating disorders. What’s wrong with dieting? Isn’t everyone on a diet? Dieting is a trigger for eating disorders. It seems like our society has become “foodaphobic.” We are “carbophobic,” “fataphobic,” “glucoseaphobic,” and so forth. We keep looking for the magic bullet to make us look like the false images the media creates for us. The truth is only 1% of our population is genetically programmed to look this way, even though these images are computer enhanced and air brushed. The truth is diets don’t work. We know that and yet the diet industry has become a 48 billion dollar a year business. Long term weight loss has a 97% failure rate. What else would you put your money into with such odds. Which medical treatment would you seek that was predicted to have only a three percent chance of success? Yet every day people put their health at risk and lay out their money for this small margin of hope. Ancel Keyes studied the effects of dieting on healthy men back in the mid 1940’s who were on severely restricted diets. Not only did these men take on the characteristic found in eating disorders, but they continued to display their usual behavior after refeeding until their bodies reached their set points. He was the first to realize that we are genetically programmed for survival. Back in ancient times food was not always available. Our bodies were amazingly adaptable, slowing down and speeding up to stay within a certain set point range. If we severely cut back on calories (energy grams) our metabolism will slow down to save energy. If we eat extra food, our metabolism will speed up. We’ve been sold a bill of goods by the media that we can be any size if we just work hard enough. The truth is the cost of going below your set-point range is loss of health and life-threatening eating disorders. Bodies come in a variety of sizes and shapes, most within the normal range. If you find this difficult to believe, look at other countries, where people are less likely to be on diets. You will see that most people are in the normal range. The more we’ve tried to alter our size, the higher the incidence of obesity and eating disorders. While obesity and eating disorders have risen in the last forty years our genetic structure has not changed. I believe my child is developing an eating disorder. What can I do? First of all, always be aware that eating disorders are not about food. Do not make mealtimes a battleground. Check your own behaviors and attitudes about weight and body size. Anger and demands are not helpful, but a listening ear and acceptance go a long way towards showing support. Don’t try to cure them and give advice. Educate yourself on eating disorders and find local resources to offer them. Encourage them to accept help. When you first show your awareness and concern, they may react with anger or denial. Let them know you are just worried and will be there to talk, listen, and help see them through this. Don’t be afraid to revisit the subject. If your child is severely underweight and/or you have evidence they are binging and purging multiple times a day, you may have to take a more forceful role. A good first step is taking them in for a physical. Make sure your physician is familiar with eating disorders and takes the proper tests. Following is a list of the standard tests that you can take with you: Laboratory Testing For Eating Disorder Patients Standard Complete Blood Count (CBC) with differential Urinalysis Complete Metabolic Profile: Sodium, Chloride, Potassium, Glucose, Blood Urea Nitrogen, Creatinine, Total Protean, Albumin, Globulin, Calcium, Carbon Dioxide (CO2), AST, Alkaline Phosphate, Total Bilirubin Serum Magnesium Thyroid Screen (T3, T4, TSH) Electrocardiogram (ECG/EKG) Special Circumstances 15% or more below IBW or any neurological sign Brain Scan 20% or more below IBW or sign or mitral valve prolapse Echocardiogram 30% or more below IBW Skin testing for immune functioning 15% or below IBW lasting 6 months or longer at any time during course of eating disorder Dual Energy x-ray absorptiometry (DEXA) to assess bone mineral density Estradiol level (or testosterone in males) Even when taking tests you may not find any complications yet. This does not necessarily mean that your child is not in any danger. Changes in the psychological and cognitive functioning often occur before changes in the lab findings. Discuss your fears with your doctor ahead of time, so he can help you. Until your child is in imminent danger, you cannot force them to change, so a collaborative and supportive approach is the most helpful. Forced hospitalizations, although necessary in extreme cases, are not beneficial to the individual who is forced to regain the weight without the benefit of addressing the underlying fears and issues concurrently. Some of the problems that may necessitate hospitalizations are extremely low weight, electrolyte disturbance, severe depression, suicide ideation, cardiac dysfunctions, dehydration, and an inability to function in one’s everyday life. It is scary and confusing to deal with a frightening and potentially life-threatening disease in someone you love. You will be dealing with various emotions of your own. Often parents in trying to “fix” their child will say and do things that cause the child to retreat. Even giving a compliment like telling your child he or she looks great now with a few regained pounds may cause them to react, “I’m fat; I need to lose more weight.” Remember your child is confused already, and if you withdraw from them because of fear or project blame in any way, that may lead to their confusion. Seek your own counseling to help you regain comfort in dealing with your child’s eating disorder. Are there other types of eating disorders other than anorexia, bulimia, and binge eating? The DSM IV-R (Diagnostic and Statistical Manual) only lists these three currently, but professionals and the media discuss other types of problems related to eating and/or body image, which could interfere with one’s life and lead to emotional issues, or interfere with one’s happiness and ability to find satisfaction in their life. These include: Compulsive exercising This person overdoes exercise, going far beyond the standards set by ACE ( American Council on Exercise). They exercise to compensate for eating and a focus on weight control. They are competitive and forget that exercise can be fun. They cut into important areas of their life in order to devote the excessive time they spend exercising. They are rarely satisfied and are always pushing themselves harder. While this can be part of the behavior of the normal spectrum of eating disorders, it can also exist as the only behavior. Body Dismorphic (BDD) This disorder is considered to be a form of an obsessive-compulsive disorder and not an eating disorder. These people are abnormally over concerned with their appearance. They focus on one or two features and become obsessed with these self perceived flaws. They often try to change their appearance through surgery and exercise. They suffer from depression and anxiety. Bigeria This is a subtype of BDD. This an over concern with one’s muscle development. It’s usually found in males and is considered to be the opposite of anorexia. Body builders often suffer from this disorder. Orthorexia Nervosa This is not an official diagnosis but was coined by Stephen Brattman, M.D. A person suffering from this disorder is abnormally focused on only eating healthy and superior foods. They focus on all aspects of what to eat, how much to eat, and finding these special foods. This becomes there mission in life and overshadows everything. People’s value, relationships, and goals become overshadowed by their adherence to their difficult mission of eating “perfect”. Pica This is a nutritional deficiency, most commonly found in children. They develop a craving for non-food related items. Sufferers often eat paint chips, dirt, clay, or chalk. Chewing and Spitting This is often used as a method of weight control. It is part of the spectrum of eating disorders and not a separate disorder. The person puts the food in their mouth, chews it but spits it out rather than swallowing. The person is not consuming essential nutrients and their health is threatened just as in other types of eating disorder behaviors. Night
Eating Syndrome
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