Body Image and Eating Disorders

Parent ForumApril 17, 2013

MESSAGES IN THE MEDIA

From the About-Face organization: "400-600 advertisements bombard us everyday in magazines, on billboards, on TV, and in newspapers. One in eleven has a direct message about beauty, not even counting the indirect messages."

MEN AND MEDIA Muscle and fitness magazines Action figures have become increasingly

muscular and devoid of body fat Adonis Complex

obsessed with bulk and muscle mass over exercise dietary restriction abuse of anabolic steroids

FIJI Fiji in 1995 - Ethnic Fijians have traditionally

encouraged healthy appetites and have preferred a more rotund body type, which signified wealth and the ability to care for one’s family

One case of anorexia nervosa reported on the island prior to 1995.

In 1998, rates of dieting skyrocketed from 0 to 69%, and young people routinely cited the appearance of the attractive actors on shows like “Beverly Hills 90210” and “Melrose Place” as the inspiration for their weight loss.

For the first time, inhabitants of the island began to exhibit disordered eating.

EATING DISORDERS Anorexia Nervosa Bulimia Nervosa

Eating disorders have the highest

mortality rate of any mental

illness.

• It is estimated that 8 million Americans have an eating disorder – seven million women and one million men

• One in 200 American women suffers from anorexia

• Two to three in 100 American women suffers from bulimia

• Nearly half of all Americans personally know someone with an eating disorder (Note: One in five Americans suffers from mental illnesses.)

FACTS

BULIMIA NERVOSA Binge eating and

inappropriate compensatory methods to prevent weight gain

Excessively influenced by body shape and weight

Must occur, on average, at least twice a week for 3 months

Typically within normal weight!

Between binges, individuals usually restrict the number of calories consumed.

BINGE AND PURGE Binge: eating in a discrete period of

time an amount of food that is larger than most individuals would eat under similar circumstances

Purge: engagement in self-induced vomiting or the misuse of laxatives, diuretics, or enemas

BULIMIA FEATURES

Typically ashamed of their eating problems and attempt to conceal their symptoms

Binge eating usually occurs in secrecy Binge eating typically continues until the

individual is uncomfortably, or even painfully, full.

Binge eating us typically triggered by dysphoric mood, interpersonal stressors, intense hunger after dietary restraint, feelings related to body weight, shape and food.

Disparaging self-criticism and depressed mood often follow.

ESSENTIAL FEATURE

Recurrent use of inappropriate compensatory behaviors to prevent weight gain.

Most commonly vomiting, which is employed by 80-90% of individuals with bulimia.

Can also include misuse of laxatives and diuretics.

Some will also misuse enemas following episodes of binge eating.

Excessive exercise is another compensatory behavior often used by those with bulimia.

BULIMIA ASSOCIATED FEATURES Increased frequency of depressive

symptoms Increased frequency of anxiety

symptoms Depression and anxiety frequently

diminish following effective treatment Lifetime prevalence of substance

abuse is at least 30% among those with Bulimia.

Many have personality features that meet criteria for personality disorders, most frequently Borderline Personality Disorder.

PHYSIOLOGY

Fluid and electrolyte abnormalities Loss of stomach acid through vomiting Significant and permanent loss of dental

enamel, chipped teeth, increased frequency in cavities

Enlarged salivary glands Calluses or scars on the hands Loss of cardiac and skeletal muscle tissue Menstrual irregularities or amenorrhea Esophageal tears, gastric rupture, and

cardiac arrhythmias, and rectal prolapse

CULTURE, AGE, GENDER, AND PREVALENCE

Similar frequencies in most industrialized countries: U.S., Canada, Europe, Australia, Japan, New Zealand, and South Africa.

Individual with the disorder are primarily white. 90% are female. Lifetime prevalence for women is 1%-3% Prevalence for men is one tenth of that. Usually begins in late adolescence or early

adulthood. Periods of remission longer than a year are

associated with better long-term outcomes.

ANOREXIA NERVOSA Refusal to maintain a

minimally normal body weight

Intense fear of gaining weight

Significant disturbance in the perception of shape or size of his/her body

Amenorrhea: the absence of a menstrual period in a woman of reproductive age.

Weigh less than 85% of weigh that is considered normal for age and height

ANOREXIA NERVOSA Weight loss is usually accomplished by

reduction in total food intake Most eventually end up with a very

restricted diet that is sometimes limited to only a few foods

Intense fear of becoming fat not alleviated by weight loss

Concern about weight gain often increases as weight decreases

DIAGNOSTIC FEATURES Self esteem is highly dependent on

body shape and weight

Weight loss is seen as an impressive achievement and a sign of extraordinary self-discipline

Weight gain is perceived as an unacceptable failure of self-control

May acknowledge being thin, but typically deny serious medical implications.

ANOREXIA SUBTYPES Restricting Type

Eats very little and loses weight primarily through dieting, fasting, or excessive exercise. Calories consumed are insufficient to support bodily functions and activities.

Binge-Eating/Purging Type Regularly engage in binge eating or purging Self induced vomiting or misuse of laxatives,

diuretics, or enemas. Some do not binge eat, but do regularly purge

after eating small amounts of food. Has symptoms of anorexia and bulimia. About

50% of people with anorexia also develop bulimia

ASSOCIATED FEATURES AND DISORDERS Manifest depressive symptoms:

depressed mood, social withdrawal, irritability, insomnia, diminished interest in sex.

Depressive symptoms may be a result of semistarvation.

Obsessive-compulsive features are often prominent; when related to food, may be due to undernutrition.

PHYSIOLOGY Can affect most major organ systems

and produce a variety of disturbances.Anemia, dehydration, problems with liver

function, low estrogen levels, arrhythmias, electrolyte disturbances

Constipation, abdominal pain, cold intolerance, lethargy, excess energy, hypotension, hypothermia, dryness of skin, lanugo, bradycardia, edema, yellowing of the skin, hypertrophy of salivary glands, cardiovascular problems, dental problems, and osteoporosis.

PREVALENCE Anorexia is far more prevalent in

industrialized societies. U.S., Canada, Europe, Australia, Japan,

New Zealand, and South Africa. Rarely begins before puberty Lifetime prevalence is 0.5% among

females. Prevalence has increased in recent

decades.

COURSE

Usually begins between 14-18 Rarely occurs in women over 40 Onset may be associated with a stressful

life event Hospitalization may be required to

restore weight and to address fluid and electrolyte imbalances

Mortality from anorexia is over 10%!

Death most commonly results from starvation, suicide, or electrolyte imbalance.

OTHER FEATURES OF ANOREXIA: Concerns about eating in public,

feelings of ineffectiveness, a strong need to control one’s environment, inflexible thinking, limited social spontaneity, perfectionism, and overly restrained initiative and emotional expression.

A substantial portion have a personality disturbance that meets the criteria for a personality disorder, often Borderline Personality Disorder.

WHY?! Nurturing Addiction Trauma Survival Strategies Reenactment Suppression Disordered eating is an attempt to control, hide, stuff,

avoid and forget emotional pain, stress and/or self-hate

Short-term relief for long-term destruction Multi-factorial in origin: While family dynamics are

certainly important, so too are biological predisposition to anxiety and mood disorders, interpersonal effectiveness skills, and cultural expectations of beauty.

HOW WE CAN UNDERSTAND "Why are you doing this to yourself?"

"You have good things in your life, what's the problem?"

Not a conscious choice where a person suffering from an Eating Disorder would prefer that lifestyle as opposed to one filled with self-love and happiness

Coping mechanism a means for dealing with depression, stress and self-hate that has

been built up over many years It is a reflection of how the person suffering feels about

themselves inside Mothers, fathers, siblings, supportive friends have little

influence in creating the true self-esteem required for permanent recovery, to cope with life positively, and to learn to believe that we deserve good things in life and happiness.

These disorders are about the person suffering and how they feel about themselves.

Family• Families where children are not permitted to express emotions and are prohibited from expression of the natural frustrations and anger related to daily injustice, rage begins to develop.

• Because the natural responses are suppressed, strong emotions must seek

release in indirect ways. Strong emotion can be suppressed and satisfied by eating behavior.

"I am frustrated and overwhelmed."="I am hungry.""I am out of control."=“Control food intake.""I am lonely and afraid."="I am hungry."

MENTAL HEALTH AND DADS Research findings indicate the relationship between fathers

and daughters has a significant impact on the long term mental health of girls.

Positive reinforcement and lack of body image criticism is particularly important during a girl’s adolescent years

FAMILIES: PART OF THE PROBLEM OR SOLUTION Positive or negative image reinforcement Positive or negative behavior modeling Supportive or critical when a problem is evidenced Open or secretive Guiding versus controlling

ARE FAMILIES AT FAULT?"With a change in our understanding of the distress found within families of AN, our view of these families can be transformed from being part of the problem to being part of the solution."

WHAT CAN WE DO? Discourage dieting, as it rarely works in the long term.

Model healthy eating without restriction, self-criticism, or overeating.

Avoid focusing too much on appearance or weight, as perceived pressure to be thin can lead to disordered eating.

Encourage children to develop strengths such as music, art, or sports to foster healthy self-esteem.

Focus on mastery of an activity rather than comparing themselves to others.

Refer promptly for diagnosis and treatment when you suspect mood disorders or eating problems.

VIDEO: KILLING ME SOFTLY

http://www.youtube.com/watch?feature=player_embedded&v=jWKXit_3rpQ

RESOURCES

Life Without Ed, Jenny Schaefer Wasted, Marya Hornbacher Somethingfishy.org http://ap.psychiatryonline.org/article.aspx?articl

eID=50181 http://www.vanderbilt.edu/AnS/psychology/healt

h_psychology/famstruc.htm http://www.youtube.com/watch?v=U-N2Cv52gB8 http://www.youtube.com/watch?v=loszrEZvS_k

QUESTIONS? Jill Ahrens, M.Ed., LPC Beth Fowler, Ph.D. Rev. Adam Greene