Download Recovery from Eating Disorders is Possible

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.
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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
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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:
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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
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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
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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
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“
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.
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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:
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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:
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Osteopenia/osteoporosis/fractures
Cardiac (bradycardia/hypotension/hypothermia/arrhythmias)
Gastrointestinal (tears/gastritis/constipation)
Dental (enamel loss/caries)
Endocrine (hypoglycemia/amenorrhea)
Parotid and salivary gland swelling
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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.
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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.
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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
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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.
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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.
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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:
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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.
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“
“
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
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