Frequently Asked Questions

What is Eating Disorders Prevention?
The primary prevention of eating disorders refers to taking proactive steps to prevent their occurrence altogether. In other words, enabling healthy, non-eating disordered people remain healthy. Secondary prevention means promoting the early detection and prompt treatment of eating disorders, thereby increasing the chance for recovery.

What are some signs that I may be on my way to an eating disorder?
Eating disorders can start out as innocent habits of weight control but can easily spin out of control. Constant concern about weight and body image can become the main thing that you think about, and before you know it these obsessions are affecting everything you do. Unfortunately our society places such importance on image and looks that it is not hard to see why some people become completely preoccupied with these kinds of thoughts. Also many athletes feel that the skinnier they are, the better they will perform. This kind of thinking is very dangerous and untrue. For all of us, eating a healthy balanced diet is the best route to take for long-term health and happiness. So ask yourself…

Do I weigh myself every day?
Do I skip at least one meal a day?
Do I count calories and fat grams every time I eat?
Do I exercise because I want to not because I have to?
If your responses to these questions are very extreme, you could be on your way to an eating disorder. If it makes you really anxious just to think about these questions, you could be on your way to an eating disorder.

Source: National Eating Disorders Association Pamphlet

What are some of the first steps involved when someone seeks to overcome an eating disorder?

Health care providers (HCP) should first try to make some kind of connection with the person who reveals their eating disorder. It often takes a lot of courage for someone to first admit their unhealthy and destructive behavior patterns regarding food, for example binging and purging or only eating very small amounts of calories per day. Sometimes it is just about listening and assuring the person that you understand or at least are trying really hard to understand. The HCP should certainly make the person feel rewarded that they have mustered up the courage to reveal their behaviors which they sometimes feel a lot of shame about. It is important for the HCP to not add to that shame by coming across as blaming or being judgmental of the person. Once the HCP has started on the road to building a sense of trust with the patient/client, then they need to provide some sense of hope and reassurance. They should be able to assure the person that they will work with others in a treatment team to try to provide a comprehensive approach to treating the eating disorder, and they should be able to refer them to the other HCP’s who have the skills and expertise required for their particular problem. The HCP should be able to express empathy about the problems that led the person to have an eating disorder and that they know it will be a challenge to overcome it. With future appointments or sessions, the HCP, will have to show patience and continued support as the patient/client strives to achieve recovery. Of course, any HCP who chooses to work with eating disorder clients needs to make sure they have the proper training and stay current with the most recent research and treatment recommendations.

Is it sometimes hard to get someone to admit they have an eating disorder?

Yes it is. People will often deny or minimize their symptoms because they don’t want to get well due to a fear of gaining weight. People are often also ashamed to admit some of their behaviors that their eating disorder makes them do such as the bingeing and purging that takes place with Bulimia. Some people deny their eating disorder for other reasons such as not really understanding their inner feelings about food and weight gain. Also a lack of nutrients can affect your thinking and make it hard to accurately answer questions related to eating disorder behaviors.

Some people do admit that they are severely restricting food or purging but deny that there is anything wrong with doing that. There are even some web sites which promote eating disorders and encourage people to keep doing these self-destructive behaviors. This is one of the worst things that has happened which makes it more difficult for the people who are trying to help others overcome eating disorders. These web sites try to make people feel good about starving themselves, when the truth is that there is really nothing good about doing this.

Source: Handbook of Eating Disorders and Obesity

What is an Eating Disorder?
Eating disorders are extreme expressions of a range of weight and food issues experienced by both men and women. They include anorexia nervosa, bulimia nervosa, and binge eating disorder. All are serious emotional and physical problems that can have life threatening consequences.

ANOREXIA NERVOSA is characterized primarily by self-starvation and excessive weight loss.

Symptoms include:

  • Refusal to maintain weight at or above the minimum normal weight for height and age
  • Intense fear of weight gain distorted body image
  • Loss of three consecutive menstrual periods.
  • Extreme concern with body weight and shape

BULIMIA NERVOSA is characterized primarily by a secretive cycle of binge eating followed by purging.

Symptoms include:

  • Repeated episodes of bingeing and purging
  • Feeling out of control during a binge
  • Purging after a binge (vomiting, use of laxatives, diet pills, diuretics, excessive exercise or fasting)
  • Frequent dieting
  • Extreme concern with body weight and shape

BINGE EATING DISORDER is characterized primarily by periods of impulsive gorging or continuous eating. While there is no purging, there may be sporadic fasts or repetitive diets. Body weight may vary from normal to mild, moderate, or severe obesity.*

Why is the team treatment approach so important when it comes to eating disorders?

Eating disorders are often disorders of great shame and secrecy. They also affect all aspects of a person’s life and therefore it is important for the person to receive medical attention for various issues. The team should include at a minimum a psychotherapist, a primary care physician (PCP), a psychiatrist or psychiatric nurse practitioner if the pharmacological (i.e. psychiatric medication) needs are beyond the scope of the PCP’s practice, and a registered dietitian. If the individual client is involved in a competitive sport, it is sometimes necessary to make the coach aware of the situation so that over-exercising can be avoided. There is often also a need for family therapy along with individual therapy. This is often provided by the individual therapist but sometimes by another therapist. One of the most important aspects of the treatment team is the communication among the members. The client should give permission for each member of the team to communicate with each other so that everyone has a similar understanding of the issues and problems that the client faces. It is really to the client’s advantage to have everyone on the team know what other team members are doing so that they can all work together and have common treatment goals.

From National Eating Disorders Association

What is Body Image?
Adrienne Ressler, CSW and National Trainer for the Renfrew Center describes body image with three questions:

How a person views their body in their “mind’s eye”.
How a person believes that other people view or see them.
How a person experiences living in their own body.

What does that mean, “How does a person experience living in their own body,”?
I think what Adrienne Ressler, CSW means by the third point can be explained further with some “real life” examples. For instance, many people with eating disorders describe feeling “fat, disgusting, gross, worthless, flabby, repulsive,” etc. How we feel in our bodies most often reflects or explains how we feel in our lives. For instance, when a person says, “I feel fat,” that often has much more meaning, that is, “I see my body as fat and therefore I am worthless and will be or have been rejected.” “Fat” is not a feeling but sadness, despair and rejection are feelings. The picture we have of ourselves and our bodies, contributes to how we feel about ourselves as a whole person. For a person with an eating disorder, body image becomes the person’s entire identity ie: (“I AM FAT. THAT IS WHO I AM.”)

How can I help a friend with body image issues?
Here are a few suggestions from COPE and the National Eating Disorders Association (NEDA).

  1. Educate yourself with articles, books, and brochures about body image problems.
  2. Be a good role model for self-acceptance, proper nutrition, exercise and size acceptance.
  3. Emphasize your friend’s positive personality traits and the things they do that make you want to spend time with them. Remind them of their successes.
  4. Examine your own beliefs about physical appearance.
  5. Be honest and caring.
  6. Where can I get more information about eating disorders?

See our LINKS page.
Parents:
to appear in the Summer (see http://www.tandf.co.uk/journals/titles/10640266.asp)

Eating Disorders – The Journal of Treatment and Prevention
Special issue “Addressing the Needs of Parents”
Editor: Walter Vandereycken
Introduction

Articles

  • Nicole Highet, Marie Thompson & Ross M. King, “The experience of living with a person with an eating disorder: The impact on the carers”
  • Simone de la Rie, Annemieke de Koning, Greta Noordenbos, Marianne Donker & Eric van Furth, “The quality of life of family caregivers of eating disordered patients”
  • Anne Honey & Christine Halse, “Parents dealing with anorexia nervosa: Actions and meanings”
  • Stephanie Tierney, “The treatment of adolescent anorexia: A qualitative study of the views of parents”
  • Kristian Holtkamp, Beate Herpertz-Dahlmann, Timo Vloet & Ulrich Hagenah, “Group psychoeducation for parents of adolescents with eating disorders: The Aachen program”
  • Nancy L. Zucker, Caitlin Ferriter, Stephanie Best & Amy Brantley, “Group parent training: A novel approach for the treatment of eating disorders”
  • Pierre Leichner, Dave Hall & Rose Calderon, “Meal support training for friends and families of patients with eating disorders”
  • Walter Vandereycken & Ine Louwies, “Parents for parents: a self-help project for and by parents of eating disorder patients”
  • Leigh Cohn, “Parents’ voices: what they say is important in the treatment and recovery process”
  • Stories I Tell My Patients (Arnold Andersen)

Book Reviews: Books for Families and Significant Others (Carolyn Costin)

EATING DISORDERS MUST BE RECOGNIZED AS SERIOUS MENTAL ILLNESSES
In the U.S. and abroad, the failure of insurers and other gatekeepers to treatment to consistently recognize eating disorders as serious mental illnesses has resulted in an ongoing heath care crisis for sufferers and their families. In response to growing concern about this crisis, the Academy for Eating Disorders (AED) has released a position paper in the March issue of its scientific journal explaining the scientific rationale for identifying eating disorders as serious mental illnesses.

“Recent research on eating disorders supports the proposition that these are serious mental disorders with significant morbidity and mortality,” says Dr. Tom Insel, director of the National Institute of Mental Health. “Based on genetic and neuroimaging studies, eating disorders appear to have a biological basis, analogous to what is observed in other serious mental disorders such as schizophrenia, bipolar disorder and addictive diseases. All of these illnesses, including eating disorders, need to be addressed as biomedical as well as behavioral problems if we are to help people recover.”

In summary, eating disorders are biologically-based, serious mental illnesses because:

  • There is medical and scientific evidence that anorexia nervosa and bulimia nervosa are as heritable as other psychiatric conditions (e.g. schizophrenia, bipolar disorder and depression) that are considered biologically based.
  • The behaviors of restricting food intake, bingeing and purging have been shown to alter brain structure, metabolism and neurochemistry in ways that make it difficult for individuals to discontinue the behaviors.
  • Eating disorders are associated with impairment in emotional and cognitive functioning that greatly limits life activities.
  • Eating disorders are life-threatening illnesses and are associated with numerous medical complications. Mortality rates for anorexia nervosa are the highest of any psychiatric disorder.

 

As of 2007, the laws of some U.S. states have excluded eating disorders from conditions considered to be “serious mental illnesses,” thus making it possible for patients to be denied insurance coverage for their treatment, leading to serious lifelong health consequences and an increased risk of death. “Eating disorders are associated with the highest level of mortality and medical complications of any psychiatric condition. It is imperative that eating disorders receive the same level and breadth of health care coverage that is available for treatment of medical disorders and other psychiatric conditions,” states AED President Judith Banker.

The Academy for Eating Disorders is a global professional association committed to leadership in eating disorders research, education, treatment, and prevention. The Academy issues position papers on issues of highest concern to the organization in their scientific journal, The International Journal of Eating Disorders. The position paper is available in its entirety on the AED Web site: www.aedweb.org.

Access to treatment also will be an issue raised in the upcoming International Conference on Eating Disorders to be held in Cancun, Mexico April 30 through May 2.

For more information, contact Theresa Fassihi, PhD at +1-832-794-1280 or terryfassihi@earthlink.net.

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