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Recovery from Eating Disorders is Possible Eating Disorder Resource Guide for Friends, Family and Professionals Anorexia | Bulimia | Binge Eating “ Be a Compassionate Witness Recovery is worth the fight. Once I entered recovery, I realized how much richness, sweetness, and depth can be derived from a life without an eating disorder. There is hope to be found amidst the pain. While it is a process of grieving, sometimes joy permeates sadness. Most importantly, it is important to know that there is a beautiful life after an eating disorder. ~ Anonymous “ Advice When Talking to a Loved One It is crucial to approach a family, friend, or loved one with an eating disorder with calmness, gentleness and compassion. Non-judgmentally listening to their perspective is of upmost importance. Convey concern and worry but always with care and love. Although it is extremely taxing for you (perhaps the parent, sibling, friend, teacher, or coach) to watch your loved one struggle, the most helpful approach you can take is to listen. It is okay to tell the person that you are scared for him/her; ask him/her how s/he feels you can support him/ her. Although it sounds like an arduous task, attempt to put yourself in his/her shoes and above all: be a compassionate witness. Page 2 Castlewood Treatment Center for Eating Disorders Signs and Symptoms of an Eating Disorder Anorexia Nervosa Treatment – What is Anorexia Nervosa? Anorexia Nervosa or Anorexia is an eating disorder characterized by self starvation, restriction of food intake, or calories, and sometimes excessive weight loss. Anorexia is a serious psychological disorder that goes well beyond out-of-control dieting. It is an inability to maintain a normal body weight for ones height. It is an intense fear of gaining weight or being fat, despites sometimes significant weight loss. Some women cease to have menstrual cycles. Often there is an extreme concern with body weight, shape, and or size. The person with anorexia may initially begin dieting to lose weight. Over time, the weight loss becomes an illusion of mastery and control. It can become an obsession and is similar to drug addiction. The person with anorexia loses perspective of his/her appearance because of distorted opinions about self image. No amount of dieting or starvation can satisfy the individual’s desire to be thin. Anorexia Signs & Symptoms Anorexia Nervosa has the highest mortality rate of all of the psychological disorders. Many of the symptoms of Anorexia can have life threatening consequences. Some of the sufferers will have some but not necessarily all of the following symptoms: • Restricting caloric intake to less than needed to maintain healthy ideal body weight • Following a severely limited diet even if underweight • Forced vomiting or other compensatory behaviors like laxative use, diuretic use or compulsive exercise • Absence of menstrual cycles for three or more consecutive months • Fear of eating in social places or in front of others • Increased isolation and depressive symptoms • Relentless pursuit of thinness • Obsessive thinking and talking about weight, shape, size, appearance, or food Call Toll-Free 888.822.8938 | www.CastlewoodTC.com | [email protected] Page 3 • • • • • • Rituals around body checking, exercise, or food Loss of interest in activities and relationships Body dissatisfaction, body image distortion Chewing and spitting as an attempt to control weight Taking in excessive amounts of fluid or restricting fluid intake Use or abuse of diet pills, herbal supplements, or teas Bulimia Nervosa Treatment – What is Bulimia Nervosa? Bulimia, or bulimia nervosa, is an eating disorder characterized by compulsive, secretive overeating or bingeing followed by purging through vomiting, or other compensatory behaviors. A person who suffers from bulimia disorder may even purge normal amounts of food with no bingeing behaviors. Individuals with bulimia often abuse laxatives, diet pills and diuretics, or engage in excessive exercise in order to neutralize food intake. Many individuals who struggle with bulimia maintain an average weight. Similar to anorexia, bulimia is a psychological illness. Both bulimia and anorexia extend beyond the scope of out-of-control dieting. The cycle of overeating and purging can quickly become an obsession in which one loses control over the behaviors and is unable to stop the cycle. Bulimia Sign & Symptoms The depression and guilt individuals with bulimia feel after a binge force them to go on crash diets, work out excessively, vomit, consume diuretics or laxatives, and resort to other extreme measures to compensate for their bingeing behaviors. If you or your loved one struggles with any of the following symptoms, bulimia treatment may be needed: • • • • • • • • • • Page 4 Unrestrained eating that may even be painful Unstable body weight Evidence of vomiting or laxative use Excessive exercise Hidden food wrappers or hidden food Obsessive thinking and talking about weight, shape, size, appearance, or food Loss of interest in activities and relationships Fear of eating in social places or in front of others Increased isolation and depressive symptoms Relentless pursuit of thinness Castlewood Treatment Center for Eating Disorders • • • • • Rituals around body checking, exercise, or food Body dissatisfaction, body image distortion Chewing and spitting as an attempt to control weight Taking in excessive amounts of fluid or restricting fluid intake Use or abuse of diet pills, herbal supplements, or teas What is Binge Eating? Binge eating is a pattern of disordered eating which consists of episodes of uncontrollable eating. Bingeing on food is a symptom of Binge Eating Disorder and Bulimia Nervosa. When the binge eating is followed by compensatory behaviors such as vomiting, laxative use or obsessive exercise, the person may be diagnosed with bulimia. During a binge eating episode, a person rapidly consumes large quantities of food. Or a person may consume normal amounts of food so quickly and mindlessly that this would be classified as a binge. Often the binge eating functions to help the sufferer manage overwhelming emotions or stressful life events. Binge eaters feel powerless and are unable to control their consumption of large quantities of food. Some people may engage in single episodes of binge eating while others may binge throughout the day. Binge Eating Signs and Symptoms • • • • • • • • • • • • • • Uncontrolled consumption of food even when full Obsessive thinking or talking about body weight, shape, size, appearance or food Depression, anxiety, or extreme mood swings Unstable weight Eating alone or secretive eating because of embarrassment or guilt Rapid eating pace, mindless eating Self-criticism, low self-esteem, or feelings of worthlessness Urges or desires to consume more and more food Body dissatisfaction, body image distortion Rituals around body checking, exercise, or food Loss of interest in activities, relationships or people Large quantities of money spent on food, restaurants, or at the grocery store Hoarding of food Hidden food or food wrappers Call Toll-Free 888.822.8938 | www.CastlewoodTC.com | [email protected] Page 5 “ Me s s a g e o f H o p e from a Mother I can’t fight my daughter’s battle with her eating disorder and I can’t save her. But I can work on being an emotionally healthy presence in her life. Unpack your emotional baggage. In looking back on the past few years, that is the single act that has been most important for me in helping my daughter as she fights against her eating disorder. Doing this isn’t fun or easy, but so necessary. To help my daughter I first needed to help myself. “ ~ Anonymous Mother Educate Yourself About Eating Disorders Eating disorders are not a character flaw, they’re a disease. Advocate. Persevere in the journey, which can be painful and long. Remember that walking through the really hard stuff is a crucial part of the process towards living in recovery for our loved ones. Be an encouraging presence in their lives and a good listener. Acknowledge how hard it is for them. Remember that there will be bumps in the road and even relapses. Trust your treatment team. Establish healthy boundaries with your loved one. Take care of yourself and most of all don’t lose hope, recovery is possible. Page 6 Castlewood Treatment Center for Eating Disorders Medical Signs and Symptoms by Dr. Dawn Holemon, M.D. For Friends and Family, awareness of the various eating disorders is often limited until it becomes vitally necessary. You may be the key to recognition in your loved ones life. It is important that you have the insight and intuition to address what you observe. Anorexia nervosa is a serious illness with a mean age of onset of 18.9 years and a lifetime prevalence of 0.9% in women and 0.3% in men. Bulimia has a mean age of onset of 19.7 years and a lifetime prevalence of 1.5% in women and 0.5% in men. Binge eating disorder is now also a separate diagnostic classification in the eating disorders with a mean age of onset of 25.4 years and a lifetime prevalence of 3.5% in women and 2.0% in men. Significant Behaviors to Watch For Include: • • • • • • • Restricted eating/fasting Bingeing Weighing, shape checking, comparison Making food rules, calorie counting Use of diet pills/stimulants/laxatives Excessive exercise Vomiting The Physical Complications of an Eating Disorder are Serious and Include: • • • • • • Osteopenia/osteoporosis/fractures Cardiac (bradycardia/hypotension/hypothermia/arrhythmias) Gastrointestinal (tears/gastritis/constipation) Dental (enamel loss/caries) Endocrine (hypoglycemia/amenorrhea) Parotid and salivary gland swelling Call Toll-Free 888.822.8938 | www.CastlewoodTC.com | [email protected] Page 7 These are only some of the many medical complications of this illness that may present when an eating disorder is present. If the diagnosis is on your radar, it may be possible to open the discussion about an eating disorder with your loved one. Awareness and detection are keys to early intervention. Be prepared to intervene by talking with your loved one about the possibility that he/she may have an eating disorder. Referral to a professional skilled in the treatment of an eating disorder is indicated to allow a thorough assessment and implementation of treatment as necessary. You could be the one and only step between recognition of a serious illness and the lifesaving care leading to recovery. Co-Occurring Eating Disorders by Nicole Siegfried, Ph.D, CEDS Most individuals with eating disorders have co-occurring or co-morbid disorders. When eating disorders occur with other diagnoses, it is referred to as “dual diagnoses.” Eating disorders and other disorders have a reciprocal relationship in which the eating disorder often exacerbates symptoms of co-occurring disorders, and symptoms of co-occurring disorders often exacerbate eating disorders symptoms. It is helpful for family and friends of individuals with eating disorders to become familiar with common co-morbid diagnoses so that they can feel better equipped to understand their loved one and provide support. Anxiety Disorders and Depressive Disorders Anxiety and depression are the most common co-morbid diagnoses in eating disorders. Approximately two thirds of those individuals admitting to eating disorder treatment programs also meet criteria for anxiety and/or depression. For half of these individuals, symptoms of anxiety and depression predated the development of the eating disorder, and there is some evidence that eating disorder symptoms are maintained as a way to help relieve symptoms of anxiety and depression. Page 8 Castlewood Treatment Center for Eating Disorders Obsessive Compulsive Disorder Approximately 40% of individuals with eating disorders also meet criteria for obsessive compulsive disorder, which is characterized by intense, repetitive thoughts (i.e., obsessions) and related behavioral compulsions. The obsessions and compulsions may be food-related (e.g., concerns that food may be contaminated) or non-food-related (e.g., concerns about germs). It is typically recommended that OCD symptoms are treated concurrently with eating disorder symptoms for best results. Substance Abuse Approximately 25% of individuals with eating disorders also abuse drugs and/or alcohol. Eating disorder symptoms can often be masked by drug/alcohol symptoms. When an individual enters drug and alcohol treatment, his or her eating disorder behaviors may often intensify in the absence of drugs/alcohol. Depending on the severity of their eating disorder behaviors, these individuals may need to be referred to an eating disorder treatment facility that can also provide support for the substance abuse. Self-Harm and Suicidality Approximately 40% of individuals with eating disorders engage in self-harm behaviors, which may include cutting, burning, and severe picking behaviors. Individuals who self-harm report that these behaviors achieve some of the same results as eating disorder behaviors, including numbing and relieving anxiety. Eating disorders also have a high rate of suicidality, including suicidal ideation, suicidal behaviors, and completed suicides. Assessment and treatment of self-harm and suicidality are necessary in the treatment of eating disorders. Call Toll-Free 888.822.8938 | www.CastlewoodTC.com | [email protected] Page 9 Posttraumatic Stress Disorder Approximately 40% of individuals with eating disorders also have comorbid trauma. Symptoms of PTSD include avoidance, numbing, and re-experiencing through nightmares and flashbacks. For individuals with PTSD, eating disorder behaviors are often maintained because they decrease re-experiencing symptoms and assist in numbing negative emotion associated with the trauma. Treatment for Eating Disorders and Co-occurring Disorders Families and friends of individuals with eating disorders and cooccurring disorders should search for treatment programs that address both disorders. Research shows that when the eating disorder is addressed in treatment, symptoms of co-occurring disorders often intensify and vice versa. If eating disorder treatment only focuses on remission of eating disorder symptoms, relapse in symptoms of the eating disorder and/or co-occurring disorder is likely. Co-occurring disorders must also be assessed and treated in treatment to achieve full recovery from the eating disorder. When families and friends are exploring options for treatment, they should search programs that also address co-morbid diagnoses to facilitate the best chance of recovery for their loved one. Advice for Family and Friends By Heidi L. Strickler, Ph.D., LCSW, CEDS, CART, CTLS Warning Signs Often when a person has an eating disorder, he/she will display certain signs of the disorder or demonstrate certain behavioral changes that can give the people around him/her subtle or overt hints that something is wrong. Some of these signs can be behavioral and disorder dependent. Someone who is struggling with anorexia nervosa may be avoidant of certain types of foods, especially sweets, fats, or carbohydrates. Some individuals, who struggle with anorexia, may avoid eating in front of others, seem to diet or talk about dieting a lot, and drink a lot of water or diet soda. Someone struggling with bulimia or binge eating Page 10 Castlewood Treatment Center for Eating Disorders disorder may also be secretive about eating or hide food. Money or food may be missing after someone has experienced a binge-eating episode. People who engage in self-induced vomiting may disappear after meals to engage in this behavior. Disappearances can also occur so that individuals with bulimia or anorexia can hide food that they pretended to eat. Keep in mind that not everyone who purges does so through self-induced vomiting, other people try to compensate for what they have eaten by restricting, exercising, or taking laxatives, diuretics, diet pills or other stimulants. Other behavioral changes can occur such as being overly focused on food. This focus may take the form of cooking for others, grocery shopping, engaging in a great deal of menu or meal planning, collecting recipes, watching cooking shows and talking about them at length, etc. The opposite can also be a sign of the development on an eating disorder: when the person becomes completely avoidant of life tasks such as cooking, grocery shopping, and meal planning. Equally challenging signs involve distinctive behaviors with food like making odd combinations with food, putting condiments of foods for which condiments wouldn’t usually be used, cutting food into very small pieces, trying to focus on what others are eating, chewing food and spitting into a napkin or other item, and other similar behaviors. People with eating disorders may also engage in excessive exercise. They often exercise alone, will become irritable or depressed when questioned about their exercise or with attempts to have their exercise limited, and will often continue to exercise when hurt or injured. Individuals with eating disorders often experience social and cognitive changes as well. Individuals who may have appeared outgoing may now seem withdrawn and resist engaging in activities with their family and even close friends. Often they will avoid activities that involve meals, but will consistently decrease engaging in any activities. They may become increasingly moody, especially seeming more irritable, and/or depressed. Anxiety is often experienced by people with eating disorders, not just around meal times, but in general around anything that involves socialization or emotional expression or conflict. People who struggle with eating disorders often think in extremes. They struggle with believing that the world and things in it exists in all-or-nothing, black and white terms. They often struggle with a great deal of self-hate and shame. Call Toll-Free 888.822.8938 | www.CastlewoodTC.com | [email protected] Page 11 While behavioral warning signs can be confusing and at times frustrating, often people become most frightened by witnessing physical changes in the people they care about who have an eating disorder. The person may exhibit weight loss or gain, bloodshot eyes, swollen glands, a slightly yellowish skin tone, bluish fingernails, and have soft fine hair grow on his/her body. He/she may complain of being tired often, complain of headaches and stomach aches, complain of symptoms related to dehydration, have difficulty regulating his/her body temperature, especially complaining of being chilly frequently, and overall complain of much gastrointestinal disturbance. If you suspect someone has an eating disorder, and they complain of chest pains or any type of heart beat irregularities, it is extremely important to get them to an emergency room immediately. Be sure to inform the emergency staff that the person has an eating disorder and continue to inform the staff until the potential for a heart abnormality or condition is taken seriously as heartbeat irregularities and related complications in people with eating disorders can be fatal. Interventions Intervening with someone you care about who has an eating disorder can be very challenging. The first thing to remember is that you have no control over someone else’s behavior. While it is frustrating to watch someone you love struggle with an eating disorder, it is very important to remember that the only thing you have power over is how you act in the situation. When you talk to someone you love about their eating disorder, you want to choose a place and time when you will be alone and have enough time to talk about the situation completely. You want to be prepared and knowledgeable about eating disorders so that you can address your loved ones behaviors and compare them with the facts about which you have become knowledgeable. You want to present this information in a compassionate, empathetic, curious way and be sure that you do not appear to be judgmental or blaming. Keep in mind, the person with the eating disorder believes that the eating disorder is needed to help him/her survive, so he/she is likely to be scared. Be prepared to present resources that you believe could be helpful to your loved one. Also be prepared to be rejected, as denial is a large part of the eating disorder. Remember that you want to continue to be supportive throughout the conversation, so arguing or getting into a power struggle will not be helpful or productive. As mentioned before, the person with the eating disorder sees it as something that has helped him/her survive and may still believe it is needed for survival. As a loved one your goal is to help the suffer see that people are also available for true understanding and connection, not just the eating disorder. This can help loosen the eating disorder’s hold. Page 12 Castlewood Treatment Center for Eating Disorders Finding a Treatment Team The first step in finding a treatment team is to determine the appropriate level of care your loved one needs. Contacting the intake department of a treatment center for an initial screening or meeting with a therapist who specializes in eating disorders will help your loved one determine what level of care is appropriate for them. It may also be necessary for your loved one to have a complete medical examination by a physician who has an understanding of eating disorders. Levels of care for treatment are based on the severity of the eating disorder and medical complications. Available Treatment Options: • • • • • Outpatient treatment Intensive outpatient Day treatment (partial hospitalization) Residential treatment Inpatient hospital care Regardless of the level of care, the treatment team needs to include a therapist who specializes in eating disorders and a dietitian who specializes in eating disorders. Further, because of the potential medical complications of the eating disorder, a medical physician is needed to monitor for symptoms routinely. A psychiatrist is often needed to help with symptoms of co-occuring psychological disorders, Additional therapists with other specialties may become part of the treatment team if your loved one has additional issues such as severe anxiety or problems with drugs and alcohol. Parents of minor children have the final say; however, it is important for the child/adoles¬cent to be a collaborator in the process. If the child/adolescent is participating in outpa¬tient treatment, it is important for the child/adolescent to have a good working relationship with the therapist/dietitian. Divorced or separated parents should not promise to keep se¬crets from the other parent. Parents will need to work together to help their child recover. If you have a friend or family member with an eating disorder, do not make promises that you can’t keep. Be sure to never promise to keep the eating disorder a secret – it could potentially be fatal. True recovery from an eating disorder is often a long-term process. It takes a lot of support and hard-work. Full recovery can often take up to four to seven years, but it is possible. Re¬member to be patient and supportive toward your loved one during his/her process of re¬covery. During this time, remember to also be patient and to find support and help for you as well. Call Toll-Free 888.822.8938 | www.CastlewoodTC.com | [email protected] Page 13 “ “ Habit is habit, and not to be flung out of the window by any man, but coaxed down-stairs one step at a time. –Mark Twain Eating Disorder Treatment for Men & Women St. Louis, MO | Monterey, CA | Birmingham, AL Residential Partial Hospitalization Free Transitional Living Intensive Outpatient www.CastlewoodTC.com | 888.822.8938 Affiliations & Accreditations TheHighlandsTC.com Birmingham, AL MonarchCoveTreatment.com Monterey, CA EDCMO.com St. Louis, MO Castlewood Treatment Center Castlewood & Monarch Cove Treatment Centers