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- Herausgeber: John Wiley & Sons
- Kategorie: Fachliteratur
- Sprache: Englisch
Do you think that you or someone you love may suffer from and eating disorder? Eating Disorders For Dummies gives you the straight facts you need to make sense of what's happening inside you and offers a simple step-by-step procedure for developing a safe and health plan for recovery. This practical, reassuring, and gentle guide explains anorexia, bulimia, and binge eating disorder in plain English, as well as other disorders such as bigorexia and compulsive exercising. Informative checklists help you determine whether you are suffering form an eating disorder and, if so, what impact the disorder is having or may soon have on your health. You'll also get plenty of help in finding the right therapist, evaluating the latest treatments, and learning how to support recovery on a day-by-day basis. Discover how to: * Identify eating disorder warning signs * Set yourself on a sound and successful path to recovery * Recognize companion disorders and addictions * Handle anxiety and emotional eating * Survive setbacks * Approach someone about getting treatment * Treat eating disorders in men, children, and the elderly * Help a sibling, friend, or partner with and eating disorder * Benefit from recovery in ways you never imagined Complete with helpful lists of recovery dos and don'ts, Eating Disorders For Dummies is an immensely important resource for anyone who wants to recover -- or help a loved one recover -- from one of these disabling conditions and regain a healthy and energetic life.
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Veröffentlichungsjahr: 2011
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Eating Disorders For Dummies®
by Susan Schulherr
Eating Disorders For Dummies®
Published byWiley Publishing, Inc.111 River St.Hoboken, NJ 07030-5774www.wiley.com
Copyright © 2008 by Wiley Publishing, Inc., Indianapolis, Indiana
Published by Wiley Publishing, Inc., Indianapolis, Indiana
Published simultaneously in Canada
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Library of Congress Control Number: 2008921210
ISBN: 978-0-470-22549-3
Manufactured in the United States of America
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About the Author
Susan Schulherr, LCSW, is a licensed clinical social worker who has had a private psychotherapy practice in New York City for nearly 30 years. She has worked with people with eating disorders for over 20 of those years. Her chapter on treating binge eating disorder appears in the 2005 book, EMDR Solutions: Pathways to Healing (Shapiro, Norton). Her article, “The Binge–Diet Cycle: Shedding New Light, Finding New Exits,” was published in Eating Disorders: The Journal of Treatment and Prevention (1998). She has presented workshops at the local and national level on eating disorders and on issues of weight and eating to both professional and nonprofessional audiences.
Ms. Schulherr is a trained family and couples therapist. She has extensive experience in the trauma specialty approaches of EMDR and Somatic Experiencing, each of which she has adapted for the treatment of eating disorders.
Author’s Acknowledgments
I owe some particular thank you’s now that this project that once felt so far off is a reality. For the collaborative outpouring that became the text of this book, my thanks to the indefatigable editorial staff at Wiley Publishing: Tracy Boggier, Stephen Clark, Christy Pingleton, and to Misty Rees for her technical review. For presenting me with the opportunity to participate in the first place, my special appreciation to literary agent Margot Maley Hutchison from Waterside Productions, Inc. For concept-to-completion professional feedback and moral support without which my part in this project would have been impossible, endless gratitude to Nancy J. Napier, LMFT.
I always wish to extend heartfelt thanks to the many clients and others who have shared their eating disorder stories and struggles with me over the years. All that you have taught me has made its way into this volume and inspired me with the possibilities for healing even in the most difficult situations.
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Contents
Title
Introduction
About This Book
Conventions Used in This Book
What You’re Not to Read
Foolish Assumptions
How This Book Is Organized
Icons Used in This Book
Where to Go from Here
Part I : Eating Disorders: An All-Consuming World of Their Own
Chapter 1: Understanding Eating Disorders
Getting a Sense of the Problem
Classifying the Eating Disorders
Seeing What’s Behind the Symptoms
Seeing the Damage Eating Disorders Do
Scoping the Rise in Eating Disorders
Getting Better Is an Option
Chapter 2: Getting Insight into Anorexia Nervosa
Putting Anorexia Nervosa into Words
Looking at Anorexia’s Behavioral Traits
Seeing Anorexia’s Psychological Traits
Determining Whether You Have Anorexia
Chapter 3: Seeing Inside Bulimia Nervosa
Identifying the Many Faces 0f Bulimia
Recognizing Bulimia’s Behavioral Traits
Seeing Bulimia’s Psychological Traits
Determining Whether You Have Bulimia
Chapter 4: Understanding Binge Eating Disorder
Defining Binge Eating Disorder
Understanding the Behavioral Features of Binge Eating
Seeing BED’s Psychological Traits
Determining Whether You Have BED
Chapter 5: Eating Disorder Risk Factors
Looking at Family Traits that May Influence Eating Disorders
Looking at Your Individual Vulnerability
Zapping the Brain with Hormones
A Culture that Breeds Eating Disorders
Dieting as the Gateway to Eating Disorders
Chapter 6: Deconstructing Your Body with an Eating Disorder
Disordering Your Body from the Inside Out with Starvation
Wearing Your Body Down with Purging
Reversing the Effects with Recovery
Chapter 7: Sidekicks That Often Accompany Eating Disorders
Altering Thoughts and Perceptions
Recognizing Other Disorders That Require Treatment
Adding Addictions to Your Eating Disorder
Part II : Getting Well: Exploring Recovery and Treatment Options
Chapter 8: Seeing What Recovery Looks Like
Finding Balance in Recovery
Maintaining a Healthy Weight
Menstruating Normally
Seeing Bingeing or Purging Symptoms Subside
Getting Thinking Processes Normal
Eating Well with No Forbidden Foods
Exercising in a Healthy Way
Creating Healthy Relationships
Tolerating Your Emotions
Maintaining a Healthy Self-Image
Chapter 9: Deciding the Who, What, and Where for Treatment
Finding the Right Therapist
Assembling Your Team
Determining the Intervention You Need
Getting a Good Medical Work-Up
Making a Plan for Your Treatment
Choosing Where to Get Treatment
Exploring Experiential Therapies
Chapter 10: Finding the Treatment Approach That’s Right for You
Choosing Your Eating Disorder Treatment
Concentrating on Cognitive- Behavioral Therapy (CBT)
Delving into Dialectical Behavioral Therapy (DBT)
Setting Your Sights on Psychodynamic Therapy
Focusing on Feminist Therapy
Investigating Interpersonal Therapy (IPT)
Getting to the Bottom of “Bottom-Up” Therapies
Taking to the Trenches with Trauma Treatment
Chapter 11: Including Other People in Your Treatment
Family Therapy: Everybody Gets into the Act
Couples Therapy: Just the Two of Us
Group Therapy: Safety in Numbers
Self-Help Groups: Grass Roots Support
Chapter 12: Exploring Medication and Other Approaches
Getting Your Biology on Board with Medication
Exploring New Frontiers in Eating Disorder Treatment
Chapter 13: Making Good Use of the Approach You Choose
Letting Go of Magic for Reality
Substituting Recovery Goals for Eating Disorder Goals
Partnering with Your Therapist in a Treatment-Boosting Way
Making the Most of Groups
Chapter 14: Managing Early Stage Recovery and the Reality of Relapse
Stepping into the Unknown: A Recovery Overview
Building Recovery Habits and Skills
Dealing with Fear and Resistance
Rebounding from Relapse
Part III : Eating Disorders in Special Populations
Chapter 15: Eating Disorders in Males
Recognizing That Guys Suffer from Eating Disorders, Too!
Uncovering Risk Factors for Eating Disorders in Males
Gaining Awareness of Special Issues for Treatment
Chapter 16: Athletes and Eating Disorders
Running a Greater Risk for Eating Disorders
Focusing on Female Athletes
Measuring Risk for Male Athletes
Recognizing an Eating Disorder in a Child Athlete
Scoring with the Right Coach
Tackling Special Issues for Treatment
Chapter 17: Eating Disorders on the Stage, Screen, and Runway
Discovering the Risks Behind the Scenes
Considering Eating Disorders as Part of the Job
Spotlighting Special Issues for Treating Performers
Chapter 18: Eating Disorders in Children
Becoming Informed about Childhood Onset Eating Disorders
Recognizing the “Grown Up” Disorder of Anorexia in Kids
Getting Treatment for Kids
Chapter 19: Eating Disorders Later In Life
Getting Older and Trying to be Thinner
Fighting the Loss of Youth and More
Eating Disordered Over 65
Treating Eating Disorders in the 30+ Set
Chapter 20: Eating Disorders and People Who Are Obese
Being Obese and Eating Disordered
Highlighting Special Issues for Treatment
Part IV : Advice and Help for Families and Others Who Care
Chapter 21: Forming a Plan to Help the Person with an Eating Disorder
Becoming Informed About Eating Disorders
Being Ready with Resources
Gathering Support
Chapter 22: Implementing Your Plan to Help
Knowing What You’re Out To Accomplish
Knowing Some Important Do’s
Avoiding Some Important Don’ts
Dealing with Anger and Denial
Chapter 23: Making Life Livable While Supporting Another’s Recovery
Letting Go and Ending the Food Wars
Taking “Fat Talk” Off the Table
Insisting on Accountability
Focusing Outside the Eating Disorder
Breaking through Recovery Traps
Chapter 24: Finding Support for Yourself While Supporting Another’s Recovery
Knowing When to Seek Treatment for Yourself
Turning Your Attention to Your Needs
Finding the Help That’s Right for You
Part V : The Part of Tens
Chapter 25: Ten Don’ts: Behaviors and Thoughts to Avoid
Don’t Diet
Don’t Try to Fix Your Eating Disorder by Yourself
Don’t Look for a Quick Fix
Don’t Do Anything that Feels Extreme
Don’t Believe Your Weight Determines Your Worth
Don’t Avoid Your Negative Feelings
Don’t Ignore Signs of Relapse
Don’t Nurture Your Fascination with “Thin”
Don’t Put Things Off Until You’re “Thin Enough”
Don’t Stop Treatment Too Soon
Chapter 26: Ten Do’s: Ways to Enhance Your Recovery
Do Practice Being Imperfect
Do Nurture Your Social Network as Part of Your Healing
Do Speak Up!
Do Be Truthful with Your Treatment Team
Do Experiment with Ways to Enjoy Being in Your Body
Do Use “Feeling Fat” as a Call to Awareness
Do Appreciate that Improvement Often Proceeds in Baby Steps
Do Keep Track of Your Accomplishments
Do Talk with Other Women about Social Pressures to Be Thin
Do Remember that People Can and Do Recover from their Eating Disorders
Resource Guide
Web Sites for Eating Disorder Information
Web Sites for Finding Treatment
Web Sites for Finding Local Support Groups
Web Sites for Size Acceptance and Self-Esteem
Self-Help Books
: Further Reading
Introduction
Could this be you? You don’t have much self-confidence (this applies most often to females, but males are not immune). You’d love to feel in charge of yourself, your emotions, your life. You’d do anything to be someone others love and admire. You don’t feel any of these things are true — for you.
Add to this that you live in a culture that tells you the world is yours if you’re thin. That you, or anyone, can become model-thin (or fat-free buff) if you just diet and exercise enough.
You may be a little precise or obsessive by nature. And you may have fewer of the natural brain hormones that buffer most people in life. You may even have a history of some kind of trauma that you have yet to resolve.
These characteristics are the ingredients for making an eating disorder. Because you feel vulnerable, an eating disorder is, above all else, the way you struggle against internal doubts, trying to cope. Dieting is how you try to put together a sense of control and self-esteem. Bingeing is how you comfort yourself or respond to the extremes of dieting. You have come to rely on your eating disorder symptoms so completely that the thought of surrendering them is terrifying — even when they begin to cause a lot of physical and emotional trouble.
If you recognize yourself — or someone you love — in this portrait, you’ve come to the right book! Although the culture offers plenty to keep an eating disorder going, the pages that follow supply you with lots of ingredients to counter those effects from the inside. Or to start you on that path. I describe the eating disorders from the inside out so you can make sense of what you or your loved one is experiencing. I tell you about what you need for recovery. I describe the process and personnel of treatment in detail. I advise you as a family member or other caring person how to help the person you care about and how to take care of yourself at the same time.
Eating disorders are treacherous. They destroy and even take lives, and they make sufferers doubt and hate themselves. But the happy news is that the majority of people who pitch into treatment and stay with it through recovery get better. They go on to think about and engage in other things, become successful and fulfilled, and leave their eating disorders behind. So can you.
About This Book
This book is aimed at helping you recover from your eating disorder (or helping someone you love recover). I build two big assumptions about what’s necessary for recovery into the organization of the book:
If you’re aiming at getting better, it helps to understand the nature of an eating disorder and how you get one.
The way you think about a problem determines how you try to solve it. For instance, if you think your eating disorder shows you don’t have enough willpower to control your eating, you may search for bigger and better ways to put controls on yourself. If, on the other hand, you understand that your disorder reflects low self-esteem and problems handling emotions, you can go to work on improving your life in these areas.
I spend a lot of time going over the ways of thinking and looking at yourself that make you vulnerable to an eating disorder. I spend at least as much time describing ways of thinking and behaving that can build inner reserves and make an eating disorder much less likely. This building process can be exciting and gratifying at times. But it can be frustrating and slow-going at others. Knowing what you’re doing and why can help you to keep plugging.
Studiesshow that people who stay in eating disorder treatment long enough to build up inner strengths, rather than just manage outer symptoms (like bingeing or starving), are more likely to get better and stay better.
Getting better means getting treatment.
For most people, recovering from an eating disorder isn’t a self-help operation. (You can read about the exceptions to this rule in Chapter 12.) You need to hire experts and invest a lot of yourself and your time in your treatment. I devote a lot of space to taking you through the treatment process, step-by-step, from beginning to end. This includes understanding treatment options and when to choose them, selecting a therapist and other members of your treatment team, and understanding your own role in the treatment process. I want you to have the best possible chance of being successful.
If you’re a family member, I go over in detail how to approach the person you love about treatment. I discuss your role in treatment and how to support recovery in day-to-day living.
I’vewritten Eating Disorders For Dummies so that you can jump in wherever your interest takes you — you don’t have to read this book from start to finish. Each section includes references to other parts of the book that have more information on the subject you’re reading about.
Conventions Used in This Book
Many times in this book, particularly in the treatment sections, I use fictional people to illustrate a point I’m making. These people represent composites of people I’ve met and/or worked with over the years. In no case do they represent real people.
From time to time, I introduce new terms as I explain ideas important to your understanding of the eating disorders. Mostly I do this when you’re likely to run into the term elsewhere and it may be helpful for you to know it. Each time I first use a new term, I italicize it, and usually follow it with an explanation.
Eating disorders are still primarily a female affair. So I make my life, and hopefully your reading, easier by using all female pronouns: her, hers, she. That doesn’t mean I’m not aware that men can develop eating disorders, too. If you’re a guy, your disorder is just as serious! (See Chapter 15.)
It would have made for easier language to refer to people with anorexia as anorexics, people with bulimia as bulimics, and so on. I avoid this streamlined language to make a crucial point: Saying you are a person with an eating disorder serves as a reminder that there’s more to you, much more, than your eating disorder. Also, there’s no reason to assume your disorder is a permanent part of your identity, the way you do when you say you’re a woman, or a Latina, or American-born. Saying you’re a person with an eating disorder is more like saying you have a major illness. Beating your eating disorder may be a big battle, but your eating disorder is not who you are.
What You’re Not to Read
You’re not to read anything that isn’t crucial to understanding eating disorders and their treatment if you don’t feel like it. Sometimes I add some extra information that’s a little more in-depth but not essential. I mark all such in-depth detours with a Technical Stuff icon.
In the same spirit, along the way I offer extra nuggets of information on the subject you’re reading about tucked away in gray boxes called sidebars. Read them. Don’t read them. The choice is yours. It won’t make a difference in your understanding of the subject at hand.
Foolish Assumptions
I assume if you’re reading this, you’re one of the following people:
You have or suspect you have an eating disorder: You want to know there’s hope, get a better handle on your problem, be pointed in the right direction for treatment, and get a preview of the recovery process.
You have a family member, friend, or roommate who has an eating disorder: You want to understand her problem better, know how you can help, understand treatment options if you’re the parent of a minor, and get some ideas about support for yourself.
You’re a professional who works in some way with people with eating disorders: You need a quick reference and overview to help you understand the problem and how you can help in your particular role.
If any of these descriptions sound like you, you’ve come to the right book!
How This Book Is Organized
Eating Disorder For Dummies is organized into 5 parts with 27 chapters. What follows is a description of what you can find in each part.
Part I: Eating Disorders: An All-Consuming World of Their Own
Part I intends to help you really get what eating disorders are about. Chapter 1 gives you the big picture and previews what you find in the rest of the book. Chapters 2 to 4 introduce you to the three major eating disorders: anorexia, bulimia, and binge eating disorder. These chapters each come with a questionnaire so you can judge whether you’re at risk for one of these disorders. Chapter 5 reviews the risk factors that make a person vulnerable to developing an eating disorder — genes, brain chemistry, family background, personality characteristics, trauma history, and dieting behavior. In Chapter 6 you can find out about the physical toll eating disordered behavior takes on your body. Finally, Chapter 7 describes other psychological disorders that typically accompany an eating disorder, such as anxiety, depression, addiction, and compulsive exercise.
Part II: Getting Well: Exploring Recovery and Treatment Options
Part II is your treatment handbook. I start you off with a map of recovery goals, so you know what you’re aiming at. If you like, you can use the charts I provide to map yourself: Where are you now and what would you like to work on next in relation to each goal?
If you’re just thinking about treatment or want to review the treatment you’re in, Chapter 9 goes over all your treatment options. This includes treatment experts and facilities. It also includes a discussion of why you might make each choice. Chapter 10 helps you pick the approach to individual therapy that’s right for you. It takes you right inside an imaginary session for each approach so you can get a feel for what it may be like. Chapters 11 and 12 explore additional options: family, couples, and group therapies; support groups; medication; and online treatments.
In Chapter 13 I help you think about your own role in using your treatment team and getting better. I follow this up with a chapter on managing early stage recovery successfully, including dealing with relapse.
Part III: Eating Disorders in Special Populations
This part focuses on special groups in the population who are at high risk for eating disorders or whose eating disorder risk has been under-recognized. I highlight special treatment considerations for each group. These groups include
Men
Athletes
Dancers, models, and actors
Children
Middle-aged and elderly people
People who are obese
Part IV: Advice and Help for Families and Others Who Care
Part IV is intended to help families and other people who care about someone with an eating disorder. I write as if you are a parent responsible for a minor child. But I stop along the way with special advice for others: siblings, partners, friends, roommates, and so on.
This is a how-to part, covering everything from getting informed to approaching someone for the first time about their eating disorder to managing life in recovery in a day-to-day way. The final chapter in Part IV focuses exclusively on your well-being and what services you may need to support it.
Part V: The Part of Tens
This is your at-a-glance part for quick ideas to inspire you or keep you on track in recovery. Ten don’ts remind you of recovery-interfering thoughts and behaviors. Ten do’s give you the other side of the coin: ten thoughts and practices to keep your recovery cooking. Finally, I offer you a guide of resources to help you throughout your recovery.
Icons Used in This Book
Throughout this book, I use figures in the margins — icons— to quickly point out the type of information you find in a particular paragraph. Here are the icons you see, along with a definition of what each one means:
This icon can mean one of two things. It can let you know I’m reviewing things I’ve gone over in more depth elsewhere. Or it can alert you that the paragraph contains some really valuable information for you to remember.
When you see the arrow in the target, you know the paragraph contains practical information for handling your eating disorder.
I place the warning icon next to any paragraph that tells you about situations or practices that may be harmful to you. I also use it when the paragraph informs you about ways you could be misled or other times you need to be on the alert.
This clever-looking guy tells you that the information in the paragraph gets a little technical, maybe providing a little more than you want or need to know. It’s okay to skip this paragraph. Reading it isn’t necessary to your understanding of the topic.
Where to Go from Here
Eating Disorders For Dummies is written so you can start wherever you want. You don’t have to read the book in order. If you’re urgent about getting treatment right now, you probably want to start with Chapters 9 to 11. If you’re a family member, you may want to start with Part IV, which is written for you. Which chapter you choose depends on whether the person you love is already in eating disorder treatment or not. If you’re still facing treatment choices, you’re likely to find Chapter 9 a useful starting place.
Part I
Eating Disorders: An All-Consuming World of Their Own
In this part . . .
I introduce you to eating disorders and explain how they differ from less-worrisome eating problems. I describe how increasing pressures on women to achieve ideal bodies have contributed to a rise in eating disorders over the last 40 years. I go over the three major eating disorders — anorexia, bulimia, and binge eating disorder (BED) — in detail. I include tools to help you decide whether you may have one of these disorders or be at risk for developing one. I discuss the major risk factors that make a person vulnerable to developing an eating disorder, including genes, family style, cultural pressures, personality, and dieting behavior.
I include chapters that tell you how eating disordered behaviors harm your body and affect your thinking processes. I also review psychological and behavioral problems that commonly accompany eating disorders, such as addiction, compulsive exercise, depression, and suicidal tendencies. For all of these companion disorders, I provide tools to help you decide whether they apply to you (indicating you should seek evaluation and treatment).
Chapter 1
Understanding Eating Disorders
In This Chapter
Understanding what an eating disorder is
Finding out why eating disorders have been on the rise
Seeing a better future through treatment and recovery
The term eating disorder sounds like something that refers to somebody who doesn’t eat right. And, in one sense, it certainly does. Some people with eating disorders severely under-eat, to the point of risking their health or their lives. Others repeatedly overeat in extreme ways and may do risky things to get rid of the calories they’ve taken in. But what’s not right about the eating is far more complicated than calories and nutrition.
In this chapter you get an overall sense of the eating disorders as physical and psychological syndromes: What do they look and feel like? Who gets them? What is an eating disorder doing in a person’s life? How is getting an eating disorder driven by the culture, and how does that help us understand people with eating disorders better?
If you have an eating disorder, I tell you what you need to do to find treatment and get better. This previews Part II of this book, which covers treatments from soup to nuts. If you are a parent or caregiver to someone with an eating disorder, I discuss some of the difficulties of your situation. Part IV of this book, expanding on what I say here, is essentially a how-to section devoted to caregivers.
Getting a Sense of the Problem
People with eating disorders experience psychological issues and are compulsive in their eating habits. These play on each other over time, causing the eating disorder to become more entrenched. Some of the techniques used to try to drop a few pounds may lead to bad eating habits. However, if the concern about weight becomes obsessive, then the problem moves from simple dieting to an eating disorder.
Eating disorders involve the body and the mind. People with eating disorders express psychological problems through their behaviors with food. For example, someone who is struggling with self-esteem may decide that losing some weight would make them feel better and be a more appealing person. This person may try dieting, like many of her friends. But because she starts depending on dieting and weight loss for a sense of self-esteem, she can’t let go of them. They become an obsessive focus, and the problem moves from simple dieting to an eating disorder. Psychological problems that existed before the eating disorder developed get worse, not better, as a result.
Eating disorders can’t be separated from the culture in which they arise. In Western society, the overwhelming cultural message is that being thin is best. As people try to define themselves and what makes them valued members of the culture, the message to get or stay thin affects behavior such as eating, dieting, exercise, even cosmetic surgery. It may also affect self-image. I discuss in this section how these effects can lead to disordered eating habits even for a great many people who don’t have formal eating disorders. For some people who are otherwise vulnerable (see “Seeing What’s Behind the Symptoms” in this chapter and a discussion of risk factors for developing an eating disorder in Chapter 5), the message that thin is best provides the central principle for fixing their lives — and an eating disorder can soon follow. (Read “Understanding the Dramatic Rise in Eating Disorders,” later in this chapter, to find out more about the development of the “culture of thin.”)
In this section and throughout the book I give you a sense of what eating disorder symptoms are about in the belief that a solid understanding is necessary in order to arrive at the right kinds of solutions. I describe more about the cultural phenomenon of disordered eating practices, of which eating disorders represent the extreme end. I also give you a sense of who gets eating disorders and how many people have them.
Psyching yourself sick
For the person with an eating disorder, weight and eating develop into a psychological problem as well as a physical one. If you have an eating disorder you’re constantly preoccupied with your weight and body shape. Your mood rises and falls with what you see on the scales. You judge your worth as a person by your weight and your success at dieting. What probably started out as ordinary dieting has developed into a rigid pattern that has gone seriously out of control. As time goes on, your eating disorder takes up more and more space while the rest of your life — friends, family, fun, future — takes up less and less.
Chances are good that you struggle with other psychological problems as well, such as depression, anxiety, obsessive-compulsive disorder, or alcohol or drug abuse problems. These problems, along with factors like personality type, family background, heredity, and biochemical make-up, may all contribute to the development of an eating disorder in a particular person.
Becoming more compulsive
The solution seems simple and obvious from the outside looking in. The person with anorexia must know she’s not close to being fat and that she’ll die if she keeps this up. The person who binges wants desperately to lose weight — so can’t she just quit eating so much? A central quality of the eating disorder is the compulsivity of the symptoms and of the inner drive to be thin. Compulsions are behaviors that have an “I have to” urgency associated with them — to the point that the person often no longer feels they are a matter of voluntary control. (Ever tried to quit smoking?)
Eating disorders versus disordered eating
If you lined up all the people in the United States who eat, you’d have a spectrum ranging from Normal Eaters on one end to People with Eating Disorders on the other.The first thing you’d notice about this spectrum is that not very many people would be at the Normal Eaters end. Why? In this day and age we have more food than any society before us. At the same time, modern conveniences have cut the need for physical activity to nubbins. And the stresses of modern living often lead to eating patterns that are bound to make us tip the scales. Yet, despite all these trends pushing us to become heavier, as a culture we prefer a slim and fit look. It shouldn’t be surprising that it all adds up to some strange relationships with food.
Who’s in the middle? Most of the eating spectrum is taken up by people who don’t have formal eating disorders but who have eating habits and beliefs that are disordered. Up to 60 percent of adult American women may be disordered eaters. Examples of disordered eating or beliefs include:
Cutting out a food group to cut calories
Eating to manage emotions
Believing the scales reveal your worth
The more disordered eating behaviors and beliefs you have, the more at risk you are for developing an actual eating disorder. (You can read more about eating disorder risk factors in Chapter 5.)
Being at risk for an eating disorder
Precise figures for the numbers of people affected by eating disorders are hard to come by. People often deny or hide their disorder, and the symptoms that identify sufferers aren’t always obvious, especially in the early stages.
Estimates indicate that between 5 and 8 million people in the United States are currently affected by some form of diagnosable eating disorder. Most of these people are young white women between the ages of 12 and 35 years. But this typical picture is beginning to shift in some ways:
Both younger girls and older women are beginning to fill the ranks.
More and more men are developing eating disorders, perhaps as many as a million currently in this country.
Minority girls and women are showing eating disorder rates that often match those of their white peers.
According to statistics, as many as 70 million people worldwide suffer from eating disorders. Eating disorders occur at strikingly lower rates in non-Western, nonindustrialized countries than in Western industrialized ones. This tips us off that eating disorders have something to do with the culture.
Classifying the Eating Disorders
In upcoming chapters of this book, I go over the many ways an eating disorder can take shape in the lives of different people. However, three major eating disorders affect the most people, so they get the lion’s share of attention. They are anorexia nervosa (usually just called anorexia), bulimia nervosa (usually called bulimia), and binge eating disorder(BED).
Anorexia nervosa
Usually when people think of eating disorders, the first image that comes to mind is the emaciated face and body of the young woman with anorexia. Though actually the least prevalent of the major disorders — anorexia afflicts about 1 in every 100 people — it was the first to gain widespread public awareness. Anorexia also grabs our attention because it’s the most dangerous eating disorder. According to the Academy for Eating Disorders, the risk of death for a person with anorexia is 12 times higher than that of someone without an eating disorder.
A person with anorexia is terrified of becoming fat — so terrified that the fear rules everything she does. She believes she’s always on the verge of fatness, regardless of her actual weight or what anyone else tells her. To guard against the dreaded outcome, she refuses to eat. The resulting weight loss can put her health and life in jeopardy. A person with anorexia may also purge like the people with bulimia I discuss in the next section, and/or she may exercise compulsively to help her control her weight.
Bulimia nervosa
You could most easily identify the person with bulimia by the behaviors of bingeing and purging — that is, if you could witness them. These behaviors are almost always done in secret. Bingeing is eating lots of food in one sitting — sometimes tens of thousands of calories — often rapidly. Purging is what the person with bulimia does to get rid of these calories. She may do this by vomiting what she’s just eaten, overusing laxatives or diuretics, exercising excessively, or other methods.
After binge episodes, a person with bulimia feels extremely shamed and worthless. She’s as preoccupied with avoiding fat as the person with anorexia. Also like the person with anorexia, she believes her weight determines her worth. Unlike the person with anorexia, however, chances are good that the person with bulimia is also dealing with alcohol or drug abuse and with depression.As many as 3 or 4 in 100 young women in the United States have bulimia nervosa.
Binge eating disorder (BED)
People with binge eating disorder (BED) binge pretty much like people with bulimia. And they feel just as bad afterward. But they aren’t driven toward purging behaviors. More likely, they become engaged in cycling between periods of bingeing and periods of rigid dieting. For some, this keeps their weight in a normal range. Other people with BED gain weight and may even become obese.
Estimates are that anywhere from 3 to 8 in 100 people in the United States have BED. According to a 1998 survey in the Annals of Behavioral Medicine, as many as 40 percent of the people with BED are men.
Seeing What’s Behind the Symptoms
Eating disorder symptoms are very dramatic. But the real drama lies beneath the surface, in the hearts and minds of sufferers. While most people enjoy good food, those with eating disorders become obsessed over food-related issues. Eating isn’t fun. Weight is the enemy. Strictly controlling eating and not eating is seen as a magical way to bring order to areas of life that feel out of control.
Food and weight as the visible focus
Think of the person with an eating disorder as a magician. The magician does his magic by getting us to look over here, while the real action is over there. The difference with the eating disorder is that the person who has it is as fixated on her food and weight symptoms as everyone else. And because her symptoms can cause anything from severe misery to outright physical danger, those who care have to keep at least one eye on them. But staying focused on food and weight means never getting to the heart of what an eating disorder is really about.
Eating disorders as “solutions”
Nobody has an eating disorder for the fun of it. If you’ve developed an eating disorder, it’s because something hasn’t been working in your life. You’ve turned to your eating disorder because it seems to help; never mind the terrible price you’re paying for it.
Sadly, your eating disorder is a vote of no-confidence in your personal ability to solve problems, manage feelings, or create a life to be proud of. Depending on your disorder, you’ve discovered that weight loss brings admiration, dieting gives you a sense of control, bingeing provides temporary comfort, or purging offers a sense of release and relief. Each makes the eating disorder seem like a powerful and readily available ally.
The tricky thing about eating disorder symptoms is that the more they appear to solve for you, the more you ask them to solve — and the more you believe in them as problem-solvers. When a symptom seems to fix so much, it can achieve a very “dug-in” place in your life.
Seeing the Damage Eating Disorders Do
Eating disorders can take a terrible physical toll. They can also bog sufferers down in the self-defeating patterns of thinking and behavior that got them into their disorders in the first place. Having someone with an eating disorder in your life can leave you feeling helpless, angry, frightened, and exhausted.
Damage to the eating disorder sufferer
Eating disorders are physically dangerous. Anorexia and atypical disorders that include starving are the most dangerous. Starving can result in damage to the heart and other major organ systems. Death can follow. Anorexia has the highest mortality rate of any psychiatric disorder. Starving also impairs clear thinking and judgment.
Purging as part of bulimia or an atypical disorder can also damage the heart or other parts of the body. Though mortality rates are low compared to anorexia, the effects of purging can still be quite serious. (You can read in detail about the physical effects of the eating disorders in Chapter 6.)
Damage to those around the sufferer
From the time you realize someone you love has an eating disorder to the time she becomes ready to seek treatment can be a long journey. Those who care are often left to watch helplessly as the eating disorder sufferer gets drawn more deeply into her symptoms and potential danger. This is probably the worst part of caring about someone with an eating disorder. However, an eating disorder can affect the lives of those around the sufferer in a number of other ways as well, including:
Family functioning: Eating disorder symptoms sometimes start to rule family life. Fear and worry can make it hard to find time for rest or fun.
Intimacy: It often feels as if the person’s relationship with her eating disorder takes priority over other relationships. Secrecy and deceit about symptoms interfere with feelings of closeness.
Personal rights and boundaries: Stealing food or money for food and leaving a messy bathroom or kitchen are just a few of the ways eating disorder symptoms can infringe on others’ rights.
You can read more about living with someone with an eating disorder in Chapter 23. Chapter 24 is all about getting help for yourself while you do.
Scoping the Rise in Eating Disorders
Before 1960, few people had heard of anorexia nervosa. By the end of the decade, it was taking the lives of a shocking number of young women. By the end of the next decade, bulimia and binge eating disorder were also taking a toll. At the same time, weight and eating preoccupations began increasing in the general population, mostly among women.
You might call the eating disorders the scary cousins of the more general cultural trends. Between the early ‘70s and the dawning of the new millennium, the number of women reporting dissatisfaction with their bodies went from just under 50 percent — bad enough — to nearly 90 percent.
How cultural forces have taken a toll
In many ways, it takes a village to create an eating disorder. By this I mean that cultural ideals about the best way to look can deeply affect a person’s self-image and behavior. Achieving the ideal look is promoted in advertising and every form of entertainment as the way to purchase your ticket to many of the rewards society has to offer: admiration, a good mate, perhaps a better job.
In the last 40 years, the ideal look has come to mean, above all else, being thin and free of body fat. In fact, for women, it has meant becoming thinner and thinner. According to one study 45 years ago, models — who tell us what we should look like through media images — were just 8 percent slimmer than the average woman. Today, they’re 23 percent slimmer than the rest of us.
How have women (and an increasing number of men) responded to these unreachable images? They’ve dieted. They’ve dieted alone, in groups, in secret, in public, with or without exercise, with supplements, with fasting . . . the list goes on. By now, for women, dieting is almost a cultural right of passage. For some women who don’t feel okay about themselves or their worth, dieting seems like a solution. When you can’t diet too much and the outcome of your dieting determines your sense of worth, you have the recipe for an eating disorder.
What makes eating disorders more likely
What happened to make us think that being thin is naturally superior? What happened to our tolerance for diversity and round edges? Two big things happened that the culture is still digesting: falling in love with youth and experiencing the women’s movement.
The quest for youth
The baby boomers began to come of age in the 1960s. They were bound to have a big effect, if only because there were so darn many of them. Many believe the fashion trends of this era flowed from the boomers’ new values, including street fashion over haute couture and a new waif-like look, embodied by the infamous model, Twiggy. The fashion industry took over the waif look and made it mainstream.
American society not only fell for the boomers’ taste but it also fell for their youthful energy. If you couldn’t be young, you could at least be youthful-looking. Twiggy-style slimness came to stand for youthfulness. Dieting was the key to getting there. Fashion magazines began to report not just on clothing but on how women could perfect their bodies to fit the new trend and look good in more revealing styles.
Meanwhile, the belief that excess fat is also unhealthy exploded to a new level during the same period. Increasing weight was linked with increasing risk of heart disease. The ideal of fitness and its evil twin, fat phobia, became cemented into the mindset of the youth culture.
The belief developed that anyone who wanted it badly enough could achieve the new slimness. It sounds so democratic. You can’t easily see the trap in it when no one is admitting that for many people — apparently the majority — the ideal is out of reach.
The women’s movement
Up until recently, eating disorders have been mostly a women’s affair. What’s been different for women during the rise of weight obsessions and eating disorders? The biggest single development has been the women’s movement and the social changes that followed.
Those who believe a connection exists between eating disorders and the women’s movement point out that just as women began to break out of narrow roles and take up more space in society, the culture of thin told them they had to take up less space, not more. When women wanted to participate in the larger world, they were encouraged to become preoccupied with counting calories and the inches on their thighs.
Some see these developments as backlash by that other gender that had the most to lose as women gained power. They point out, for example, that the waif look made grown women appear childlike. No threat there. Others believe women also felt threatened. What if, for all they gained, they just ended up being rejected as unfeminine and unattractive?
Society still hasn’t figured these issues out. Where are the guidelines for young women to follow? At a crossroads where neither the young nor the old have their footing, the path to success promised by the culture of thin remains seductively simple and clear.
How perceptions are beginning to shift
Are there any glimmers of hope in the 40-year march toward slimmer ideals, more dieting, and more disordered eating? A few. For example, the modeling world itself is beginning to look at the negative effect of too-thin standards on its models. Several manufacturers have started to present their products with average-sized women. (Read more about these trends in Chapter 17.) Prevention programs starting with the very young are popping up in classrooms and on TV. These programs counter messages that only thinness is acceptable with positive messages about a variety of body shapes and sizes.
Getting Better Is an Option
Eating disorders don’t usually just go away on their own. But treatment is available and people get better. The process is neither quick nor easy. In fact, recovery usually takes a lot longer than people bargain for (though not forever!) For most this means a matter of years rather than weeks or months. The good news to keep in mind is that it’s doable. And, contrary to what you may have heard, you don’t need to think of your eating disorder as something you’re stuck with for life once you have it. Full recovery from an eating disorder means leaving your symptoms behind and moving onto other things you’d rather focus on in life. For many, if not most, this is an achievable goal.
Getting help
The process of getting better is composed of two important parts. Engaging in both parts strongly improves your outlook for long-term recovery. The first part involves learning how to manage your eating disorder symptoms — starving, bingeing, purging, and/or dieting. The second part involves working on internal skills that can make you more effective in life and can help buffer you from eating disorder relapse in the future.
Your eating disorder affects your body, mind, and spirit. Getting better often includes some kind of healing work for all three. Creating a treatment team that includes medical, psychological, nutritional, and other experts to help you in your journey is typical. If your symptoms are severe or life-threatening, part of your treatment may need to take place in a protected environment, such as a hospital or residential treatment center.
Part II of this book is devoted to helping you through the maze of treatment choices. You can read about which steps you need to take first, who to contact, and how to choose among a variety of treatment approaches. I also include chapters on how to participate in treatment effectively and how to deal with relapse.
Emerging developments in treatment
In the early days of discovering anorexia, treatment focused on unraveling the hidden psychological dynamics holding the symptoms in place. Being able to see behind the curtain and make sense of things continues to be an important treatment option. But the last several decades have introduced treatments that allow you to work directly on reducing symptoms without having to reflect on their meaning. Cognitive Behavioral Therapy (CBT) was the first of these. Interpersonal therapy (IPT) and Thought Field Therapy (TFT) are two of the more recent additions. (I describe these and other therapies for eating disorders in detail in Chapter 10.)
Chapter 2
Getting Insight into Anorexia Nervosa
In This Chapter
Defining anorexia nervosa
Identifying key behavioral markers of anorexia
Seeing the psychological aspects of anorexia
Finding out whether your own thoughts, feelings, and behaviors fit an anorexic profile
Like the phantom in The Phantom of the Opera, anorexia nervosa has two domains: what’s outside for everyone to see and what’s inside, hidden not only from others but often even from the sufferer herself.
The visible behaviors and outcomes of anorexia are often shocking, except to people with the disorder. You can easily get lost in the focus on what’s visible on the outside. But as you discover in this chapter, these behaviors are driven by an invisible engine of internal distress — and an astonishing level of determination to overcome that distress through thinness.
If you have anorexia, you may not agree with the part about distress or anything else in this chapter that describes your emotional reactions. You may feel that you’re solving what’s distressing in your life with your thinness and ability to control what you eat. Consider that, in fact, the genius of your anorexia is that it takes all that internal distress and turns it into one simple external issue: the daily challenge of avoiding fat and staying thin. Anorexia gives you a feeling of control when you otherwise feel helpless in life, and it makes you feel worthwhile when you so often doubt your worth.
This chapter reveals the key behaviors, psychological characteristics, and physical features that define anorexia. You can begin, if you like, by taking the questionnaire in the section “Determining Whether You Have Anorexia” at the end of this chapter, which taps anorexic characteristics.
Putting Anorexia Nervosa into Words
Anorexia is a severe emotional disorder that impacts your mind and damages your body through starvation. The hallmarks of anorexia are a fear of fatness and a refusal to eat. If you have anorexia, you’ve developed a fear of becoming fat that organizes your entire existence. You believe you’re always on the verge of becoming fat, regardless of your actual weight or what anybody tells you about how thin you are. You take steps to manage your fear of fatness by refusing to eat. Food refusal also allows you to feel in control, which is of central importance to your sense of well-being. You may also binge and purge and may exercise compulsively to help control your weight.
Anorexia takes its toll on both your brain and your body. (For more information on the ways it affects your body, see Chapter 6.) The physical symptoms of anorexia are due to starvation. These symptoms include:
Heart muscle damage
Heartbeat irregularities
Low blood pressure
Kidney damage or failure
Convulsions, seizures
Liver damage or failure
Loss of menstrual periods
Loss of bone density
Fertility problems
Anorexia nervosa is a progressive disorder, meaning that, without treatment, the disorder just gets worse and worse over time. The longer you have anorexia, the greater your risk of death. This progression is very likely due to the unique interaction between the mind and the body. The psychological and physical factors work together to create a tighter and tighter knot to untie, a prison of distorted thoughts and behaviors:
Distorted Behaviors: You have psychological features that take on an increasingly addictive quality — probably feeling more and more vital for survival — as you become more deeply involved in your eating disorder and the rituals that accompany it. (See the section “Becoming ritualistic,” later in this chapter, for more information on ritualistic behavior.)
Dangerous Thinking: At some point, starvation begins to affect your brain and impair your thought processes. These effects actually change your emotions and the way you think. For instance, you may feel depressed or your need to be a perfectionist may increase. (I discuss these effects in more detail in Chapter 7.)
Anorexia defined by sufferers
If you have anorexia, it’s desperately important to you to maintain control of your weight and eating — and, for that matter, anything else you can control about your life. You like to get everything just right. Being thin, being restrictive about eating, and being perfect are how you try to make your world feel safe. It feels less safe when you think of facing an unknown or hard-to-control future. Here is how those issues look among different people with anorexia:
Jenny is 8 years old. Her parents are getting a divorce. Everything in her world is turning upside down. When she thinks about dieting, she’s not so upset. She’s found something she’s in charge of — what she puts in her mouth!
Nicole is 13. Her friends talk about nothing but boys, which she finds stupid and boring. Even though her friends say they’re worried because she’s so thin, she thinks they’re actually jealous. After all, they’ve all been dieting, too.
Michelle is 18. She’s just getting out of the hospital where she went when her weight fell dangerously low. She’s a straight-A student with an athletic scholarship in track and field, but her parents have told her she can’t go away to college in the fall if she doesn’t maintain her hospital discharge weight. She’s had to limit practice to keep her weight up and is afraid she’ll lose her scholarship.
Polly is 54. Her husband left her last year for his secretary (age 22). Compulsive dieting and exercise are taking the place of the life she lost and the future she can’t imagine. Besides, she likes picturing that she’s thinner than her ex’s new wife.
Marie is 79. Her kids and doctor have just made her leave her home of 45 years and move to this assisted living place. Okay, they won that one, but they can’t force her to eat the food!
Anorexia defined by professionals
Mental health professionals attempt to establish a basic working agreement with each other about what constitutes various psychological disorders, including eating disorders. Controversy abounds, but these agreements, to the extent that they exist, come together in the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV), published by the American Psychiatric Association.
Be sure to notice that, right off the bat, DSM-IV distinguishes anorexia from any involuntary form of weight loss — such as weight loss resulting from an illness like tuberculosis or cancer — with the language “refusal to maintain body weight.”
The following list paraphrases the DSM-IV’s definition of the characteristics of anorexia:
Refusal to maintain minimum body weight: Weight loss (or failure to gain weight during a growth period) leading to a body weight that is less than 85 percent of the normal minimum weight expected in accordance with age and height.
Fat phobia: Intense fear of gaining weight or becoming fat, even though you’re underweight.
. Body image disturbance: Disturbance in the way in which you experience your body weight or shape, or basing your self-image on weight.
Body weight denial: Denial of the seriousness of your current low body weight.
Loss of menstrual periods in women: Amenorrhea (the absence of at least three consecutive menstrual cycles). Note: This criterion doesn’t apply to girls who haven’t started menstruating, but may still have anorexia.
The DSM-IV also breaks anorexia out into two basic types:
Restricting type: During the current episode of anorexia nervosa, you have not regularly engaged in binge eating or purging behavior. In the restricting type of anorexia, you rely only on cutting calories, and probably exercising, to control weight.
Bingeing/purging type: During the current episode of anorexia nervosa, you have regularly engaged in binge eating or purging behavior.
In both the restricting and bingeing/purging types of anorexia, starvation is a key component. But according to Anorexia Nervosa and Related Eating Disorders (ANRED), Inc. (www.anred.com), as many as half of those who attempt to starve themselves can’t stick to the starvation regime (it does totally defy nature!) and become bulimic rather than anorexic. (See Chapter 3 for more on bulimia.)
Others remain anorexic, but add purging — that is, they remain underweight and continue to starve, but they also resort to the purging techniques more typically associated with bulimia in order to control their weight. Purging techniques include vomiting, laxative and diuretic abuse, and/or the use of enemas. This second group constitutes the binge/purge subtype of anorexia. Some may actually have binge episodes, but many purge any time they eat more than their bare-bones regimens allow.
