Eating Disorders

1. Eating Disorders Brittany Jackson

2. Overview Types of Eating Disorders Warning Signs Developmental Issues Counseling and Prevention Strategies

3. Types of Eating Disorders

4. Anorexia Nervosa Eating disorder characterized by the refusal to maintain a minimally normal body weight, an intense fear of gaining weight, and a significant disturbance in the individual’s perception and experiences of his or her own size. (Mash, et al, 2010) 2 types: restrictive type (individuals seek to lose weight primarily through diet, fasting, or excessive exercise) and binge-eating/purging type (individual regularly engages in episodes of binge eating or purging, or both). (Mash, et al, 2010) Adolescents with anorexia are described clinically as being obsessive and rigid, preferring the familiar, having a high need for approval, and showing poor adaptability to change. (Mash, et al, 2010) In adolescents, a lack of menstruation can be a sign of anorexia. (Berger, 2008)

5. Treatments for Anorexia • Hospitalization and Refeeding– hospitalize the patient and force him or her to ingest food to prevent death from starvation. • Behavior Therapy – make rewards contingent upon eating. Teach relaxation techniques. (Nolen-Hoeksema, 2007) • Techniques to help the patient accept and value his or her emotions – use cognitive or supportive-expressive techniques to help the patient explore the emotions and issues underlying behavior. • Family Therapy – raise the family’s concern about anorexic behavior. Confront the family’s tendency to be over controlling and to have excessive expectations.

6. Bulimia Nervosa An eating disorder that involves recurrent episodes of binge eating, followed by an effort to compensate by self-induced vomiting or other means of purging. Individuals with bulimia areinfluenced by body shape and weight and are obsessed with food. Adolescents with bulimia are more likely to show mood swings, poor impulse control, and obsessive-compulsive behaviors. (Mash, et al, 2010)

7. Bulimia Danger Signs Regular binging (eating large amounts of food over a short period of time) Regular purging (by vomiting, using diuretics or laxatives, strict dieting, or excessive exercise) Retaining or regaining weight despite frequent exercise and dieting Not gaining weight but eating enormous amounts of food at one setting Disappearing into the bathroom for long periods of time to induce vomiting Abusing drugs or alcohol or stealing regularly Experiencing long periods of depression Having irregular menstrual periods Exhibiting dental problems, swollen cheek glands, bloating, or scars on the back of the hands from forced vomiting (Mash, et al, 2010)

8. Treatments for Bulimia • Cognitive-Behavioral Therapy – teach the client to recognize the cognitions around eating and to confront the maladaptive cognitions. Introduce “forbidden foods” and regular diet and help the client confront irrational cognitions about these. • Interpersonal Therapy – help the client identify interpersonal problems associated with bulimic behaviors and deal with these problems more effectively. (Nolen-Hoeksema, 2007) • Supportive-Expressive Psychodynamic Therapy – provide support and encouragement for the client’s expression of feelings about problems associated with bulimia in a nondirective manner. • Tricyclic antidepressants and selective serotonin reuptake inhibitors – help reduce impulsive eating and negative emotions that drive bulimic behaviors.

9. Childhood Obesity • Is considered to be a chronic medical condition similar to hypertension or diabetes, and is characterized by excessive body weight. • Is defined by a body mass index (BMI) about the 95th percentile for children of the same age and sex. • Is not a mental disorder, but can affect a child’s psychological and physical development. • Poses a risk for unhealthy dieting problems, chronic health problems, and later onset eating disorders. • The causes of obesity include genetic predisposition and family influences such as poor communication, lack of support, and in extreme cases, sexual and physical abuse. • Treatment and prevention efforts often are aimed at helping parents take an active role in children’s proper nutrition and activity level. Schools contribute to this effort by education children in nutrition, exercise, and awareness of healthy eating attitudes and body image. (Mash, et al, 2010)

10. Obesity • Assessment of Obesity • Step 1: Initial Contact • Step 2: Parent and Child Interventions • Food Diary and Daily Activity Record Handouts • Step 3: Observation of the Behavior • Step 4: Further Assessment • Step 5: Referral to Allied Health Professions • Step 6: Communication of Findings and Treatment Recommendations (Schroeder, et al, 2002) • Treatment of Obesity • Basic Information • Intervention with the Child • Self-Monitoring • Stimulus Control • Cognitive Reconstruction • Shaping • Developing Alternative Behaviors • Planning Ahead • Assertiveness Training • Relapse Prevention • Intervention with the Parents • Intervention with the Environment • Changing the Consequence of the Behavior • Intervention in Medical/Health Aspects

11. Warning Signs

12. Physical Warning Signs • Weight loss • Hair loss • Edema (swelling) • Skin abnormalities • Discolored teeth • Scarring on the backs of hands • Self-injury signs (Erford, 2010)

13. Behavioral Warning Signs • Frequent trips to bathroom • Avoiding snack foods • Frequent weighting • Substance abuse • Isolation • Abnormal eating habits (Erford, 2010)

14. Psychological Warning Signs • Low self-esteem • External locus of control • Perfectionism • Helplessness • Depression • Anxiety • Anger (Erford, 2010)

15. Developmental Issues

16. Elementary School Children as young as 5 years old express concerns about body image and becoming fat. By 6 years old, children use adult cultural criteria to judge physical attractiveness. Children tease, shame, and avoid friendships with peers who are fat or who are not conventionally attractive. Children imitate actions and attitudes of parents and adults. (Erford, 2010)

17. Middle School Body image dissatisfaction increased from 40% on third graders to 79% in sixth graders. Self-esteem is directly linked to body satisfaction. Students with low self-esteem in other realms may be prime suspects. The top wish for 11 to 17 year old girls is to lose weight. (Erford, 2010)

18. High School Discontent about their bodies and feeling fat has become normative, particularly for girls. 67% of females and 82% of males in high school believe appearance influences romantic appeal. 72% of females and 68% of males attribute happiness to appearance. High school student have lower physical self-esteem and more unhealthy weight control behaviors. (Erford, 2010)

19. Counseling and Prevention Strategies

20. Individual Counseling Counselors must be aware of other helping professionals that students can be referred to if needed. Education about nutrition, exercise, self-acceptance, and the physical dangers associated with eating disorders are essential. Counseling should match student development levels. (Erford, 2010)

21. Group Counseling They provide students with opportunities to engage in activities and practice new behaviors with peers at a time when they are vulnerable to peer influences. It gives students a focused means of talking about ways to promote positive body image. Students learn about advocacy and the focus that influence their feelings about their bodies while learning how to cope with everyday interactions with others and teasing about their bodies. Counselors should exercise caution,patience and have appropriate supports in place for students in these groups. (Erford, 2010)

22. Involving Family Members • How to help families cope with eating disorders? • Educate families about eating disorders. • Send written correspondence home with students. • Facilitate family discussions about weight and health. • Alert families to how they might unintentionally send harmful messages. • Set limits and openly discuss issues. • Ascertain eating habits, and foster family relationships by suggesting that they spend mealtimes together. • Facilitate an examination of family members’ own feelings and prejudices about weight. • Make appropriate referrals to community medical and mental health professionals. • Emphasize that spending time with children can foster cohesive, warm relationships that protect students from eating disorders. • Discourage dieting. • Plan programs through parent-teacher association meetings. • Educate families about normal puberty and developmental changes. (Erford, 2010)

23. Classroom Guidance Programs School counselors can encourage teachers to combine issues of nutrition, exercise, and self-appearance into appropriate classes such that children learn about healthy, positive, and active lifestyles. The Making Choices program promotes self-acceptance through discussion of self-esteem, healthy dieting, and exercise. Classroom guidance programs addressing these topics create an environment in which students examine knowledge and attitudes about food and eating, develop positive and realistic attitudes toward their bodies, and gain accurate information. (Erford, 2010)

24. School-Based Changes • Initiatives to enhance systematic change • Provide training to become aware of the signs and symptoms of eating disorders. • Promote activities that foster healthy and realistic attitudes about weight, shape, growth, and nutrition. • Monitor how health and physical activity requirements are communicated to students and families. • Create an atmosphere in which students confront negative body talk. • Advocate for nutritional food and snack offerings. • Encourage the purchase of library and classroom materials with positive images about self-esteem and body image. (Erford, 2010) • Create a wellness program that will accomplish the following: • Focus on prevention and early intervention. • Involve teachers and administration. • Promote healthy attitudes and habits towards eating. • Encourage self-control. • Focus on improving self-esteem and autonomy. • Make appropriate material available in easy accessible areas. • Foster discussions among the whole school community. • Continually focus on the overall well-being of students.

25. How to Help a Friend With Body Image and Eating Disorders • Do… • Create a safe environment to talk. • Encourage the person to seek help from a professional counselor, physician, or friend. • Expect anger or rejection at first - this may be an embarrassing or frightening first encounter. • Be patient – this is a long process and difficult issue. • Express you concern and desire to help. • Plan your approach carefully. • Speak with concern and compassion. • Model positive actions. • Provide specific information and resources. • Be willing to spend time listening and talking about related personal problems. • Take a look at your own attitudes towards weight, shape, and dieting. • Attempt to discuss feelings. • Offer support. • Don’t… • Nag, argue, plead, or bribe. • Criticize yourself or anyone else for being overweight or underweight. • Blame yourself or anyone else for the persons difficulties. • Comment positively or negatively about others’ size and shape. • Comment on the person’s appearance. • Use scare tactics. • Spy or interfere. • Monitor eating. • Use food as a socializing agent. • Discuss weight, amount of calories or fat being consumed, or particular eating and exercise habits. • Expect 100% recovery immediately. (Erford, 2010)

26. References Berger, K. S. (2008). The developing person through the life span (7th ed.). New York, New York: Worth Publishers. 459-460. Erford, B. T. (2007). Professional school counseling: a handbook of theories, programs, and practices (2nd ed.). Austin, Texas: PRO-ED, Inc. 591-602. Mash, E. J., & Wolfe, D. A. (2010). Abnormal child psychology (4th ed.). Belmont, CA: Wadsworth, Cengage Learning. 397-425. Nolen-Hoeksema, S. ( 2007). Abnormal psychology (4th ed.). New York: The McGraw-Hill. 539-570. Schmidt, R. C., (2007). Counselors’ pages. Warminster, PA: MAR*CO Products. 112. Schroeder, S.C, & Gordon, B. N. (2002). Assessment & treatment of childhood problems- A clinician’s guide (2nd ed.). New York: The Guildford Press. 81-114.