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“Eating Disorders Kit”
Mental Health article & self help book resource for lifetime health & fitness

SelfHelpHealthArticle Free self help books website resources and new Mental Health articles for your Lifetime Health & Fitness and wellbeing, ideal body weight, womens health issues and personal development health articles about free self help books for your improved Mental Health, nutrition & lifetime fitness. size=1>

1. Introduction

There are three main eating disorders: anorexia nervosa, bulimia and compulsive overeating. All have quite distinct and separate characteristics. However, they all involve problems with food – limiting the types of food eaten, losing control and eating too much or having to get rid of the food soon after eating.

Eating disorders are not just about eating, they are also about being unhappy with body shape size or weight and the impact this has on self-esteem, relationships and ability to cope with life in general. It is thought 10% of the population has an eating disorder.

Most people with an eating disorder are female, however more males are being diagnosed with eating disorders. Excessive exercise may also occur in order to lose weight. Males, in particular may work out in order to gain more muscle and no matter how “muscly“ they become never feel they are big enough. This can lead to abuse of steroids – an obsession with muscle development can become dangerous if it goes unchecked.

2. Causes of Eating Disorders

In spite of research and numerous publications over the past decade, there remains uncertainty about the exact causes of eating disorders. To date, evidence exists in support of a variety of risk factors that may contribute to the development of an eating disorder. The cause and influence of certain risk factors will differ from one person to another.

Psychological factors

– It is possible that feelings of anxiety, low self esteem, self criticism, feelings of inadequacy, perfectionism, the need to achieve highly and to seek other people’s approval can make you more vulnerable to developing an eating disorder.

Socio Cultural factors

– There is substantial pressure on women within western society to conform to the ideal of the “waif” look. Thinness is highly valued in our society. The beauty and fashion industries constantly persuade women to think that there is only one acceptable body image, despite the fact that the majority of women are not healthy at this size. The steroid muscle man image from cinema and magazines also influences boys to feel they need to build up their muscles to be attractive to women and to feel better about themselves.

Personal factors

– Often changes in life circumstances such as the breakdown of a relationship, changes in adolescence, or having been the victim of child abuse or rape can contribute to the development of an eating disorder.

Biological factors

– Some research suggests that hormonal or chemical imbalances in the body can play a role in developing an eating disorder.

3. Myths about Food, Weight and Body Image

Myth: People are fat because they eat too much.

Fact: In fact, most people who are large eat no more than normal weight people.

Myth: Anyone can be slim; it just takes a little self-control.

Fact: Weight is extremely resistant to change. Dieting doesn’t work; in fact, typically when dieters stop dieting they gain back all their weight plus a few pounds each time they diet. Each person’s body seems to have a “set point” weight where it naturally tends to stay. Dieting actually moves this set point upward in response to the deprivation the body experiences as a threat of starvation.

Myth: Being overweight is bad for your health.

Fact: Researchers are now finding that being underweight is just as bad for health as being overweight. The recurrent cycle of weight loss and gain (yo-yo dieting) is now thought to be more harmful than just being large and staying large.

Myth: Large=out of shape.

Fact: Not necessarily true. There are exercise and aerobics programs for large people, and some large people have excellent strength and endurance. (Conversely, some slim people have very poor levels of physical fitness.)

Myth: You can find out your ideal weight by consulting a weight table.

Fact: Weight tables disagree about ideal weights. If you have not distorted your natural healthy weight by yo-yo dieting and you build sensible, moderate eating and exercise habits and a positive body image, your body will naturally settle at its healthiest weight. This may not be the same weight as another person your height, but it will be right for you. Life insurance company weight tables have been revised upward in recent years as studies indicate that heavier people live longer. It has been realized that the weight tables of the past have been artificially and unhealthily low.


4. Types of Eating Disorders

ANOREXIA NERVOSA

People who intentionally starve themselves suffer from an eating disorder called anorexia nervosa. The disorder, which usually begins in young people around the time of puberty, involves extreme weight loss–at least 15 percent below the individual’s normal body weight. Many people with the disorder look emaciated but are convinced they are overweight. Sometimes they must be hospitalised to prevent starvation.

People with anorexia typically starve themselves, even though they suffer terribly from hunger pains. One of the most frightening aspects of the disorder is that people with anorexia continue to think they are overweight even when they are bone-thin. For reasons not yet understood, they become terrified of gaining any weight.

Food and weight become obsessions. For some, the compulsiveness shows up in strange eating rituals or the refusal to eat in front of others. It is not uncommon for people with anorexia to collect recipes and prepare gourmet feasts for family and friends, but not partake in the meals themselves. They may adhere to strict exercise routines to keep off weight. Loss of monthly menstrual periods is typical in women with the disorder. Men with anorexia often become impotent.

Specific Symptoms of this Disorder

A person who suffers from this disorder is typically characterized by their refusal to maintain a body weight, which is consistent with their build, age and height. Specifically, a person’s body weight needs to be 85% or less than that which is considered typical for someone of similar build, age and height.

The individual usually experiences an intense and overwhelming fear of gaining weight or becoming fat. This fear is regardless of the person’s actual weight, and will often continue even when the person is near death from starvation. It is related to a person’s poor self-image, which is also a symptom of this disorder. The individual suffering from this disorder believes that their body weight, shape and size is directly related to how good they feel about themselves and their worth as a human being. People with this disorder often deny the seriousness of their condition and cannot objectively evaluate their own weight.

At least three consecutive menstrual cycles must be missed, assuming the woman was menstruating previously before the onset of the disorder. Specifically, a woman is considered to have amenorrhea if her periods occur only following hormones, e.g., estrogens, and administration.

Physical Effects

 Chronic indigestion

 Loss of motivation

 Chemical imbalances

 Severe sensitivity to the cold

 Loss or thinning of hair

 Skin and nail problems

 Growth of fine body hair known as “lanugo”

 Severe weight loss

TREATMENT

The treatment of this disorder is often difficult; some individuals are notoriously difficult to help. This is because of the disorder’s insidious nature that wreaks havoc not only with the body, but just as seriously with the individual’s negative self-perception. Usually starvation is not an immediate concern of most individuals who present with this disorder, but body weight and nutrition should be thoroughly evaluated at the onset of therapy. A complete medical examination is usually warranted to evaluate the patient’s health and medical status. Underweight individuals often suffer from medical complications.

Psychotherapy

Psychotherapy needs to focus on a number of issues, after a therapeutic, trusting relationship has been established. The most powerful issue is the obsession with body image, which is also the most difficult to change. The client’s preoccupation with body image can make any clinician shake their heads in frustration. These individuals can be an extreme challenging group to work with.

Hospitalisation

Hospitalisation of anybody for a mental disorder can often be a confusing and emotion-wrought decision. Family members or significant others may need to intervene in the patient’s life to ensure they do not starve themselves to death. In these cases, hospitalisation is not only necessary, but also a prudent treatment intervention. Family members should be aware that individuals who suffer from anorexia nervosa will often resist treatment of any sort, especially hospitalisation. It is important, therefore, to come to an agreement about the need for such a step and not be swayed by the patient’s pleas for seeking alternative treatment options. Often these have already been tried to no success.

Medications

Some medications can be extremely helpful in treatment a person who suffers from anorexia nervosa. As always, the medication should be carefully monitored, especially since the patient may be vomiting, which may impact on the medication’s effectiveness. A trusting and honest relationship must be established between the physician and the individual or mediation compliance will almost certainly become an issue.

Antidepressants (such as amitriptyline) are the usual drug treatment and may speed up the recovery process. Chlorpromazine may be beneficial for those individuals suffering from severe obsessions and increased anxiety and agitation.

Electroconvulsive therapy (ECT) is never an appropriate treatment option for a person suffering from an uncomplicated eating disorder.

Self-Help

Self-help methods for the treatment of this disorder are often overlooked by the medical profession because very few professionals are involved in them. Self-help support groups are an especially powerful and effective means of ensuring long-term treatment compliance and decrease the relapse rate. Individuals find they can bounce ideas off of one another, get objective feedback about body image, and just gain increased social support. Many support groups exist within communities throughout the world that are devoted to helping individuals with this disorder share their commons experiences and feelings.

BULIMIA NERVOSA

People with bulimia nervosa consume large amounts of food and then rid their bodies of the excess calories by vomiting, abusing laxatives or diuretics, taking enemas, or exercising obsessively. Some use a combination of all these forms of purging. Because many individuals with bulimia “binge and purge” in secret and maintain normal or above normal body weight, they can often successfully hide their problem from others for years.

Family, friends, and physicians may have difficulty detecting bulimia in someone they know. Many individuals with the disorder remain at normal body weight or above because of their frequent binges and purges, which can range from once or twice a week to several times a day. Dieting heavily between episodes of binging and purging is also common. Eventually, half of those with anorexia will develop bulimia.

As with anorexia, bulimia typically begins during adolescence. The condition occurs most often in women but is also found in men. Many individuals with bulimia, ashamed of their strange habits, do not seek help until they reach their thirties or forties. By this time, their eating behaviour is deeply ingrained and more difficult to change.

Specific Symptoms of this Disorder

This disorder is characterized by recurrent episodes of binge eating, occurring at least twice a month for a minimum of three months, which consists of:

• Eating, in a discrete period of time (e.g., within any 2-hour period), an amount of food that is definitely larger than most people would eat during a similar period of time and under similar circumstances

• A sense of lack of control over eating during the episode (e.g., a feeling that one cannot stop eating or control what or how much one is eating)

Individuals who suffer from this disorder often try to prevent themselves from gaining any weight. This behaviour may include such things as self-induced vomiting; overusing laxatives, diuretics, enemas, or other medications; refusing to eat (fasting); or excessive exercise. A person’s self-image is usually directly correlated with their weight, with a great deal of attention focused on how their body looks.

This disorder can only be diagnosed if it is not better accounted for by anorexia nervosa.

There are two major sub-types of disorders found within bulimia nervosa:

• Purging Type: — The person regularly engages in self-induced vomiting or the misuse of laxatives, diuretics, or enemas

Non-purging Type: — The person has used other inappropriate compensatory behaviours, such as fasting or excessive exercise, but has not regularly engaged in self-induced vomiting or the misuse of laxatives, diuretics, or enemas

Physical Effects

 Chronic sore throat

 Burning or rupturing of oesophagus

 Cessation of menstruation

 Strain on the body organs

 Delay in puberty

 Decreased bone mineral density

 Swollen salivary glands

 Erasure of dental enamel due to constant purging

 Weight fluctuation

TREATMENT

As in treatment for anorexia nervosa, a supportive and trusting therapeutic relationship and good rapport must be established before any serious therapy gains can be made. Many of the same issues of a distorted self-esteem and self-perception that are relevant to anorexia treatment are similar to bulimia treatment. A complete medical examination is usually warranted to evaluate the patient’s health and medical status.

Underweight or overweight individuals often suffer from medical complications, especially if the person is using laxatives or vomiting as a method of controlling their over-eating behaviours. Therapy is most effective when it doesn’t so much focus on the actual eating behaviours, although they are important, but instead examines the causes of those behaviours, such as poor self-perception.

Medications

Some medications can be extremely helpful for a person who suffers from bulimia. As always, the medication should be carefully monitored, especially since the patient may be vomiting or taking large amounts of laxatives, which may impact on the medication’s use and effectiveness. A trusting and honest relationship must be established between the physician and the individual or mediation compliance will almost certainly become an issue.

Antidepressants (such as imipramine, desipramine, or phenelzine) are the usual drug treatment and may speed up the recovery process. Phenytoin and carbamazepine may also help reduce the frequency of the binging behaviours.

Self-Help

Self-help methods for the treatment of this disorder are often overlooked by the medical profession because very few professionals are involved in them. Self-help support groups are an especially powerful and effective means of ensuring long-term treatment compliance and decrease the relapse rate. Individuals find they can bounce ideas off of one another, get objective feedback about body image, and just gain increased social support. Many support groups exist within communities throughout the world that are devoted to helping individuals with this disorder share their commons experiences and feelings.

COMPULSIVE OVEREATING DISORDER

It seems that in our society, people with compulsive overeating are not taken seriously in spite of the fact that they have a serious eating disorder. While many women suffer from this illness, there are a high number of men that also suffer. Everyone seems to glorify thinness while we can’t tolerate those who are obese.

Compulsive overeating is a serious eating disorder that should not be taken lightly by those who suffer or by the people who love and care about them. Overeating is characterized by episodes of gorging, continuous eating and of weight gain. Please note, that there is a difference between compulsive bingeing and the occasional overindulgence we can all be guilty of once in awhile. The weight of an individual suffering from compulsive overeating may vary from normal to sever obesity.

A sufferer may be over exercising or “compulsive exercising” in an attempt just to burn calories and lose weight. Often they will sneak away behind closed doors to exercise in privacy. Where the average person can enjoy exercising for health benefits, the sufferer often does not and seems to forget that exercising can be fun and enjoyable. By over exercising, the sufferer seems to feel they are in control and they gain a sense of self-respect.

Like Anorexia and Bulimia, the sufferer is driven and fuelled by their fear of gaining more weight. It is easy to see how many over eaters can later develop Bulimia Nervosa or Anorexia Nervosa. Eating disorders are the preoccupation with body shape, food, thinness and control and it’s no surprise when it today’s world we all seem to want the perfect body and shape in which we can feel good and accepted.

BINGE EATING DISORDER

Binge eating disorder probably affects millions and is the newest recognizable eating disorder and perhaps even the most common. While people with Bulimia are perfect examples of binge eating however it is rare for people with binge eating disorders to purge (self-induced vomiting) or use laxatives or diuretics. Now just because someone overeats, this does not mean they suffer from binge eating disorder. Some victims of binge eating disorder may show behaviours or have feelings such as:

 They eat faster than usual.

 Eat in privacy (usually over guilt and embarrassment about how much food is being consumed)

 They often feel they cannot control how much they eat.

 They will frequently eat when they are not hungry.

 Episodes of eating large quantities of food.

 Frequent feelings of disgust, self-hate or guilt after eating.

Most sufferers of binge eating are obese. This is slightly more common in females than males. It is even more common in those who suffer from severe obesity.

This disorder can be very difficult for those who have it and many who attempt to try and control it usually fail. There are times where victims may not attend social functions, school or even work so they stay in privacy to binge eat.

Many feel embarrassed and ashamed and conceal their problem from others thus making them feel isolated and even depressed. Since so many binge eaters are preoccupied about their body weight and size, they may avoid or be absent from family gatherings or social functions. Close friends and family members of the sufferer are often unaware of the disorder.

NOCTURNAL SLEEP-RELATED EATING DISORDER (NS-RED)

Research is currently being conducted into a new type of sleep disorder called “Nocturnal Sleep-Related Eating Disorder. While 10-15% of sufferers have an eating disorder of some sort, NS-RED is not considered to be an eating disorder, but a sleep disorder.

Sufferers who have this disorder eat in a state of sleep and often have no or little memories of any nighttime eating that took place. Individuals who suffer are typically on a restricted diet during the day, which leaves their bodies hungry at night.

At night during sleep, their control and alertness is weakened therefore making them vulnerable to eating during the night. Sufferers will often eat foods that they have restricted or not allowed themselves to eat during the day and often these foods are high in sugar and high in fat content.

NS-RED can occur once or twice or it can be a chronic problem for a sufferer. While some who have it have eating disorders, there are also others who have a prior history of drug and alcohol abuse and other sleep related disorders such as Sleep Apnea. Sleep disorders can be genetic and run in families and it’s always wise for suspected sufferers to investigate their family history.

5. Telling Someone About your Eating Disorder

Don’t fear the worst!

Things aren’t always as bad as we anticipate them to be. You have to first take the risk to discover what the true outcome will be.

Tell someone you trust.

First, you can start by telling a close friend or family member that you trust. It is important that you feel comfortable with that person and feel comfortable talking to them.

Bring someone with you.

If you are telling your family and will have great difficulty, consider having a friend with you for support and encouragement. Having a therapist present while you talk to your family can also provide you with more security. The therapist can offer information, help discuss feelings and be there to answer questions.

Bring information with you.

The person you choose to tell may not know a lot about eating disorders and maybe even nothing at all. It would be a good idea to bring a book or sheets of information you have about eating disorders.

Write a letter.

When it is too difficult to say things verbally to someone writing a letter can be a great way to communicate. You can tell someone about your eating disorder in a letter and express your thoughts, feelings and fears. You can take time to write your letter and give more thought as to how to say things. This also gives the recipient of your letter time to react and think about your letter and they can even reread your letter if they wish and need to. A letter is a good idea if you are too afraid to tell but want someone to know.

6. How You Can Help Someone with an Eating Disorder

COMMUNICATE

Try to talk to your friend or loved one in a gentle and loving manner. There isn’t anything wrong with going to them and telling them you are worried and concerned about them. You can also let them know that you are there to listen if they want to talk about anything.

RESEARCH

Another thing you can do is educate yourself on the topic of Eating Disorders. There are many books available at your local library or bookstore. They will offer information on a variety of issues pertaining to Eating Disorders. The more educated you are, the more of a help you will become to your friend or loved one.

There are also many web sites on the Internet about Eating Disorders. Not only can you find support for the sufferer but you may have the opportunity to seek support from others that have endured the same experience as you. Chat rooms are one of the great ways to meet others and a great way to communicate.

LISTEN

Learn to be a great listener. Eating Disorders are not just about food. They are about a way to feel in control, a way to hide, a way of coping and dealing with emotional pain, low self-esteem, stress and depression. It may be difficult but try to pay more attention to what comes out of their mouth rather than what’s going in.

7. EATING DISORDER TEST

This test is to help you determine if you have an Eating Disorder. Be as honest as possible and remember the only person who can decide if you have an Eating Disorder is you.

Answer YES or NO to the following questions below.

 Do you feel out of control when you eat?

 Do you starve yourself?

 Do you feel in control when you don’t eat?

 Do you feel you don’t deserve to eat?

 Do you have an intense fear of gaining weight?

 Do you believe you are fat even though others disagree?

 Do you use diet pills or laxatives to control your weight?

 Do you feel guilt after eating?

 After eating, do you binge and self induce vomiting?

 Do you binge if you are feeling sad?

 Do you feel food and weight are the only things that you have control over?

 Do you tell yourself you’re ugly, fat, worthless etc.?

 Do you avoid social gatherings or meals because of food?

 Are you ashamed of your eating habits?

 Do you think about food constantly?

 Do you exercise excessively to lose weight?

 Do you believe you will be happier if you lose weight?

 Do you get angry with people if they ask you about your eating habits?

 Are you secretive about what you eat or don’t eat?

 Do you have a need to be perfect?

 Do you lie about your weight loss and make efforts to hide it from others?

 Do you constantly think about food, calories and recipes?

 Do you think that you may have an Eating Disorder?

If you have answered YES to four or more of the questions then you may have an Eating Disorder or have one starting. It is suggested that you to discuss matters with your health care provider, therapist or someone who specializes in eating disorders. Also consider talking to a close friend or family member who may help lead you in the right direction to get help.



8. Where to Get Help?

 Your local GP

 Community Health Centre (under ‘Community Health Centres’ in the White Pages)

 School counsellor or teacher

 Eating Disorders Association of NSW on 02 9889 5344

 Eating Disorders Support Network on 02 9412 4499 (also has support groups)

 Look under counselling services in the White and Yellow Pages

 Telephone Counselling Services eg. Lifeline 131 114, Salvo Careline 02 9331 6000, Kids HelpLine 1800 551 800.

 Many hospitals have Eating Disorder Units, contact them directly for details.

 Australian Psychological Society (APS) 1800 333 497 for a referral to a psychologist in your area.

 Mental Health Information Service 02 9816 5688 or 1800 674 200 (for services in your area)

9. Further Research (& Sources)

www.eating-disorder.org – Support Concern and Resources for Eating Disorders

www.edsn.asn.au – Eating Disorders Support Network

www.edeo.org – Eating Disorder Education Organization

www.edansw.org.au – Eating Disorder Association of NSW

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