“GLAMOUR QUEENS IN SIZE 2 JEANS”

1. “GLAMOUR QUEENS IN SIZE 2 JEANS” Steven G. Liga, MSW, LSW, LCADC, CPS CEO/Executive Director

2. Course Outline • Introduction • What do you think of when I say “Eating Disorder?” • Definitions • What are we talking about? • Consequences • What’s the big deal? • Causes • How does this happen to someone? • Prevention and Treatment • What can be done, and where do we turn? • Conclusion • What does this have to do with NCADD?

3. INTRODUCTION

4. Eating Disorders • Let’s Brainstorm! • What do you think of when I say “Eating Disorder?”

5. Facts and Figures • The average American woman is five feet, four inches and weighs 140 pounds. • The average American woman wears a size 14 dress. • One-third of all American women wear a size 16 or larger. • The diet industry (diet foods, programs, drugs, etc.) takes in over $40 billion each year and it is still growing.

6. Facts and Figures (cont.) • 50% of American women are on a diet at any one time. • 75% of American Women do not like or are dissatisfied with their appearance. • 90% of high school junior and senior women diet regularly, although only 10-15% are over the weight recommended by doctors. • 50% of nine year olds and 80% of 10 year olds have dieted.

7. Facts and Figures (cont.) • 1% of teenaged girls and 5% of college aged women become anorexic or bulimic. • Anorexia has the highest mortality rate of any psychiatric diagnosis • 20%! • Suicide as a result of depression is only 15%

8. Glamour Queens in Size 2 Jeans Original poem by Nathalie Gottlieb www.feminist.com/resources/artspeech/body/voices.htm

9. DEFINITIONS

10. Which of these people has an eating disorder? • Shelia eats so many French fries that she wants to throw up. And she actually does. • Marsha skips breakfast and lunch and eats just a small salad with vinegar dressing for dinner. • Susan indulges in a hot fudge sundae (four scoops of ice cream, fudge, whipped cream, and cherry) every night for a week.

11. Profile of an Anorexic • Female (90%) • Perfectionist • Feels fat even though underweight • Denies appetite (won’t eat even when hungry) • Preoccupied with food and weight • Sleep disturbances

12. Profile of an Anorexic (cont.) • Inability to concentrate • Mood swings (irritable and depressed) • Ritualistic food practices • Strict food rules • Excessive and rigid exercise routines • Shops and cooks for others while not eating themselves

13. What does she see in the mirror?

14. Myths • Bulimics and Anorexics are underweight and compulsive overeaters are overweight. • People who have eating disorders are weak-willed. • Eating disorders are a vain, attention-getting disease. • People with eating disorders don’t want anything to do with food.

15. Eating vs. Eating Disorders • Eating • Appetite • Food availability • Family & cultural practices • Voluntary control

16. Eating vs. Eating Disorders (cont.) • Eating Disorders • Obsession with: • Food • Weight • Appearance • So much that health, relationships, and activities are affected.

17. Behaviors • Restrict food intake • Binge eating • Binge and purge • Abuse laxatives • Compulsively overeat • Exercise excessively

18. Coping Mechanisms • Pain • Separation • Low self-esteem • Depression • Stress • Trauma

19. DSM 307.1 Anorexia Nervosa • Refusal to maintain body weight at or above a minimally normal weight for age and height. • Intense fear of gaining weight or becoming fat, even though underweight. • Disturbance in the way in which one’s body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or denial of the seriousness of the current low body weight. • In postmenarchal females, amenorrhea, i.e., the absence of at least three consecutive menstrual cycles.

20. DSM 307.1 Anorexia Nervosa (cont.) Specify type: • Restricting Type: during the current episode of Anorexia Nervosa, the person has not regularly engaged in binge-eating or purging behavior (i.e., self-induced vomiting or the misuse of laxatives, diuretics, or enemas) • Binge-Eating/Purging Type: during the current episode of Anorexia Nervosa, the person has regularly engaged in binge-eating or purging behavior (i.e., self-induced vomiting or the misuse of laxatives, diuretics, or enemas)

21. DSM 307.51 Bulimia Nervosa • Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following: • eating, in a discrete period of time, 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 • Recurrent inappropriate compensatory behavior in order to prevent weight gain, such as self-induced vomiting; misuse of laxatives, diuretics, enemas, or other medications; fasting; or excessive exercise.

22. DSM 307.51 Bulimia Nervosa (cont.) • The binge eating and inappropriate compensatory behaviors both occur, on average, at least twice a week for 3 months. • Self-evaluation is unduly influenced by body shape and weight. • The disturbance does not occur exclusively during episodes of Anorexia Nervosa.

23. DSM 307.51 Bulimia Nervosa (cont.) Specify type: • Purging Type: during the current episode of Bulimia Nervosa, the person has regularly engaged in self-induced vomiting or the misuse of laxatives, diuretics, or enemas • Nonpurging Type: during the current episode of Bulimia Nervosa, the person has used other inappropriate compensatory behaviors, such as fasting or excessive exercise, but has not regularly engaged in self-induced vomiting or the misuse of laxatives, diuretics, or enemas

24. DSM 307.50 Eating Disorder NOS • For females, all of the criteria for Anorexia Nervosa are met except that the individual has regular menses. • All of the criteria for Anorexia Nervosa are met except that, despite significant weight loss, the individual’s current weight is in the normal range. • All of the criteria for Bulimia Nervosa are met except that the binge eating and inappropriate compensatory mechanisms occur at a frequency of less than twice a week or for a duration of less than 3 months.

25. DSM 307.50 Eating Disorder NOS (cont.) • The regular use of inappropriate compensatory behavior by an individual of normal body weight after eating small amounts of food (e.g., self-induced vomiting after the consumption of two cookies). • Repeatedly chewing and spitting out, but not swallowing, large amounts of food. • Binge-eating disorder (BED): recurrent episodes of binge eating in the absence of the regular use of inappropriate compensatory behaviors characteristic of Bulimia Nervosa.

26. CONSEQUENCES

27. What’s the Big Deal? • Pick a letter • Except F, J, N, Q, R, U, V, X, Y, Z • www.edreferral.com/consequences_of_ed.htm

28. Dying to be Perfect:The Ellen Hart Pena Story

29. CAUSES

30. Bio-psycho-social Model • Bio = heredity • Psycho = pain, separation, low self-esteem, depression, stress, trauma • Social = media & culture (web sites)

31. PREVENTION & TREATMENT

32. Prevention • Do not promote the belief that thinness/weight loss is great and being large/weight gain is horrible. • Avoid categorizing food as “good” and “bad”. • Learn and discuss the genetic basis of different body types.

33. Prevention (cont.) • Link respect for diversity in weight and shape with diversity in race, gender, ethnicity, and intelligence. • Help children understand the ways that the media distorts the true diversity of human body types and implies that a slender body means beauty, power, excitement, and sexuality. • Learn and discuss the dangers of trying to alter your body shape through dieting. • Take women seriously for what they say, feel, and do not in regard to their shape or looks.

34. Basic Principles • Eating disorders are serious and complex problems • Warnings are not enough. We must address: • Our cultural obsession with slenderness • Roles of men and women in society • Development of self-esteem that transcends appearance • Programs must include opportunities for participants to speak with trained professionals

35. Warning Signs • Weighing self 2-3 times per day • Choosing exercise over friends and family • Exercising after meals to burn calories • Exercising even when injured • Weakness/dizziness • Mood swings • Peculiar eating rituals • Difficulty eating in public • Preoccupied with desire to be thin • Obsessed with fat grams and calories • Fear of gaining weight

36. Warning Signs (cont.) • Running water for a long time while in the bathroom • Eating when lonely, stressed, tense • Eating a lot without gaining weight • Wearing clothes to hide thinness • Hair loss, brittle nails, lanugo • Gray teeth from erosion of enamel • Hand sores, calluses • Irregular or non-existent periods • Irregular body temperature

37. High Risk Sports • Gymnastics • Swimming • Ballet • Wrestling • Body building • Jockeying • Rowing • Diving • Figure skating • Long distance running

38. Treatment Resources • Eating disorders ALWAYS require professional help! • The Renfrew Center of Northern New Jersey174 Union StreetRidgewood, NJ 07450Tel: 1-800-RENFREW Website: http://www.renfrewcenter.com • University Medical Center at Princeton Eating Disorders Program 253 Witherspoon Street Princeton, NJ 08540 Tel: (609) 497-4490 Toll-Free: (877) 932-8935 Website: www.princetonhcs.org

39. Treatment Resources (cont.) • Somerset Medical CenterEating Disorders Program 110 Rehill AvenueSomerville, NJ 08876Tel: (800) 914-9444Website: www.somersetmedicalcenter.com • Overlook Hospital Eating Disorders Program at Atlantic Health 99 Beauvoir Avenue, Box 243 Summit, NJ 07901 908-522-5757 Website: www.goryebchildrenshospital.org

40. CONCLUSION

41. Eating Disorders & Addiction • Feelings of guilt and distress • Phases/Stages • Bio-psycho-social causes • 12 steps • Myths about weakness • Important to recognize as a disease • CAN Recover • Can be deadly if not treated • Medical and social complications

42. Eating Disorders & Addiction (cont.) • Media plays a HUGE role • PREVENTION WORKS! • DSM-IV • Effects all cultures, genders, socioeconomic classes • Co-dependence • Secret • Relapse is common • Lying • Excuses

43. What To Learn More? • National Eating Disorders Association http://www.nationaleatingdisorders.org • Eating Disorder Association of New Jersey http://www.edanj.org • Something Fishy Website on Eating Disorders http://www.something-fishy.org

44. What To Learn More? (cont.) • Academy for Eating Disorders www.aedweb.org • National Association of Anorexia Nervosa & Associated Disorders www.anad.org • United States National Library of Medicine www.nlm.nih.gov/medlineplus/eatingdisorders.html

45. What To Learn More? (cont.) • Eating Disorder Referral and Information Center www.edreferral.com • National Institute of Mental Health www.nimh.nih.gov • Anorexia Nervosa and Related Eating Disorders, Inc. www.anred.com

46. Contact Information 152 Tices Lane East Brunswick, NJ 08816 732-254-3344 ext. 11 steve@ncadd-middlesex.com

47. For more information or additional resources, call NJPN at (732)367-0611 or visit www.njpn.org for the contact information of your local affiliate.