Pathways: Topics on Eating Disorders, Recovery and Life. by Rebecca Cooper

The Link Between Bullying & Eating Disorders on Kids.

Do you remember someone bullying you as an adolescent? I have asked this question to many of my adult patients and they can still vividly remember an incident that occurred in school or home that they cannot forget.

Today bullying is at a whole new level. Now we have cyber-bullying and even bullycide. The U.S. Department of Education’s defines bullying as follows:

• Bullying involves intentional, and largely unprovoked, efforts to harm another
• Bullying can be physical or verbal, and direct or indirect in nature
• Bullying involves repeated negative actions by one or more against another
• Bullying involves an imbalance of physical or psychological power

Verbal bullying include put-downs related to physical appearance, mannerisms, socioeconomic status, cultural diversity, gender, sexuality, religion, disabilities and IQ. The bullied are often called names, punched, teased, ganged up on, humiliated, ignored, gossiped about, and lied about in person or in social media. Victims often feel shamed, depressed, embarrassed, anxious, sad, lonely, rejected, angry, powerless, and fearful.

Bullying comments creates a double injustice. Most teenagers will not report that they have been bullied. They keep it a secret. They live in fear. When they have no outlet for these feelings they push their feelings down. Many start using emotional eating or focusing on their weight, diet, and body image to avoid their feelings. They look for external validation instead of developing a healthy sense of Self. Without this sense of Self they are vulnerable to assimilating other people’s beliefs, values, actions and opinions. They lose this valuable opportunity to develop a real and authentic Self. They conform to their external environment by putting on a mask that can become a prison.

Bullying can have serious consequences, including body image dissatisfaction, low self-esteem, depression, anxiety, obesity, anorexia, bulimia, drug abuse, mental disorders, and thinking about and attempting suicide. These symptoms are equally common among the bullies and the bullied victims.

During puberty dramatic physical occur that the adolescent is not prepared to deal with. A healthy girl will gain anywhere from 20-50 lbs. This is normal, as their bodies are developing and they are getting taller. They are increasing concerned about their appearance. They do not have a solid sense of Self and are very susceptible to thinking they should look like the models, even if they are airbrushed and really only fantasy. One study recently found that 70 percent of sixth-grade girls stated that they became concerned about their weight when they were about 9 to 11 years old, and that over half of these girls started dieting. Research now is showing that cyclical binge eating and restricting, i.e., dieting, can actually change the chemistry in the brain creating life-long battles with disordered eating.

Many of my patients report being told that they were fat or criticized at home. Unknowingly the remark is taken in and manifests itself later as an eating disorder. It is not always what was said, but what was heard. Eating disorders are a very complicated disorder and require professional help. At Rebecca’s House Eating Disorder Treatment Programs we provide a free support group for families who are having problems with a friend or family member with disordered eating. We also provide assessments for people who think they may have an eating disorder.

7 Tips to getting help for an Eating Disorder

Most people who have an eating disorder try to manage it on their own, go to therapy, see a registered dietitian or discuss it with their medical doctor. They may spend needless years of suffering trying to recover. The key to recovery is to start with a solid foundation of recovery at an eating disorder treatment center then step down to seeing a therapist, medical doctor and/or registered dietitian. If you want help for your eating disorder, it can be hard to decide which treatment center to go to. Here are some tips that will help you make the best choice:

1. Make sure the entire staff knows about eating disorders, not just one person. Many programs treat chemical dependency but employ only one or two staff members with some experience in eating disorders, or they may have a simple eating disorder track.

2. Although many people with eating disorders do have co-occurring disorders, it is almost always true that the eating disorder came first and is primary for the client. Substance abuse and other co-occurring disorders can be addressed in a good eating disorder treatment program.

3. Therapists need specialized training to treat eating disorders, not just alcohol and drug training. It takes a team to treat eating disorders. The medical staff must understand the health complications that are caused by eating disorders and the proper medication, labs and testing protocols; the registered dietitians must understand re-feeding and nutritional maintenance for an ED client in addition to understanding the clients themselves and their difficulties in making a paced shift to a healthy relationship with food; and the therapists and clinical support staff have to understand the vast difference in treating the ED client verses the chemically-dependent client. Most eating disorder clients want help and are motivated, but have a hard time getting out of their own way -- this is part of their need for perfectionism and the constant eating disorder dialogue in their head. Empowerment, encouragement, understanding and commitment to go the distance from ALL staff are needed to help the eating disorder client make a lasting shift.

4. Ask if they have a registered dietitian, psychiatrist, medical doctor, and licensed therapist who has been certified as an eating disorders specialist (CED). Ask about their philosophy and approach to treating someone with an eating disorder.

5. Make sure there are different levels of care so the clients can transition to real-life experiences. Most clients can abstain from their eating disorder in treatment because of the close supervision, but without the supervision they relapse. The real recovery comes while doing "real" life without using the eating disorder.

6. Eating disorder treatment can be expensive -- ask the treatment center if they accept insurance. Billing for eating disorder treatment in some cases is more likely to be covered by an insurance company than chemical dependency treatment. Be sure the program you choose is set up properly to support the financial options for care for an eating disorder client.

7. A good program will have a strong family component. Family participation, healing, and growth are extremely beneficial to someone on their recovery journey. A strong family component should include family therapy sessions at the appropriate point in the client's care, family support groups, and family participation and communication throughout care as well as in discharge planning.

If you're struggling with an eating disorder, call the National Eating Disorders helpline at 1-800-931-2237.

Does the Sorority Culture Cause Eating Disorders?

“A binge-purge party is a harmless way to enjoy some fattening foods without getting fat”, my patient told me. “At my sorority a few of us girls would buy all of the forbidden and fattening foods we have been denying ourselves. Then we would have a binge-purge party. It’s a way to have your cake and not get fat. Three of us meet in my room. It was like a secret society. We ate donuts, chips, pizza, ice cream, fast foods and fried foods then we purged the food.”

My patient did not know that even occasional episodes of binging and purging could lead to an eating disorder. Once in the cycle of bulimia nervosa it is hard to get out. She had come to see me because she was binging and purging between the parties. She could not get food out of her mind. She had recently she been hospitalized for dehydration.

 Most first-year university students are typically away from their families and home for the first time. They have left their friends and primary support systems and are in search of finding a place to belong. One such place is to be part of a sorority. The pressure to fit in is extraordinary.

It is estimated that at least 20% of college would engage in bulimic behavior (Costin, 1996). But these numbers do not even begin to cover the multitude of individuals who do not meet diagnostic criteria, but are obsessed with poor body image, unhealthy and disordered eating habits.

There are few studies about the prevalence of eating disorders among females living in a sorority. Before we look at the results of these studies I would like to describe the factors of sorority life that would increase the likelihood of developing an eating disorder.

 During rush week Jane was hoping to join a sorority. The initiation process left her with decreased self-esteem and an increase in body dissatisfaction. She explained the process. She was asked to strip down to her underwear. The other girls then examined her. They pointed out areas that needed to be improved by taking a felt tip marker and circling the areas on her body. Jane stood in front of the girls whom she did not even know in humiliation. They explained this was a way to help her be perfect.

Brittney was the perfect student in high school. Her grades were excellent, she was president of the honor society, homecoming queen and very popular. Her perfectionism had taken her far. She soon found out that in high school she had been a big fish in a small pond. College life was a rude awakening. Here she was unknown and a very small fish in a big pond.

 She longed to be popular and thought joining the sorority would make her popular. She was accepted into the sorority, but to her dismay she was not the most popular one or the prettiest.  The grades did not come as easy as they did in high school and everywhere she looked she saw perfect thin women. That would be her ticket; she would become the skinniest one in the sorority.

The research of the prevalence of eating disorders suggests an increased risk of developing an eating disorder in a sorority setting. However there are many uncertain factors.

What  are the criteria for finding a control sample? Second, eating disorder behavior is hard to evaluate because testing is based on self –reporting; and third, the diagnostic criteria of the DSM does not include the factors of disordered eating, yo-yo dieting, food addictions or other disordered relationships with food.  

 

Male Anorexia: A Troubling Trend

When in history has a male ever been concerned about fitting into a pair of skinny jeans? Media has hyper-focused on the skinny male model. Today's fashion is geared towards the emaciated male in a pair of skinny jeans. This male body image does not occur naturally unless someone is ill. We now have a whole culture of men trying to obtain an impossible body image.

There appears to be a rise in the number of males with eating disorders. According to NEDA, at least one million males in the United States have an eating disorder such as anorexia or bulimia. But these numbers are skewed due to the high prevalence of undiagnosed males with eating disorders.

Twenty years ago, very few people even knew what an eating disorder was. Today, the public awareness of eating disorders has allowed some men with anorexia to come forward. But most males will not seek treatment for eating disorders because of the shame, the fact that there are fewer male residential treatment centers and the misperception that eating disorders only occurs in females or gay men.

How can you tell if someone has anorexia nervosa? A male with anorexia nervosa is less than 85 percent of normal body weight. He avoids eating, has poor body image and may exercise obsessively. He is intensely concerned about losing flab or building muscle. He believes he is fat when others are telling him that he is too thin. It is important to note that he really does see himself as fat. It is caused by deficiencies in the brain brought on by starvation. Anorexia nervosa may actually compromise the ability to reason in its victims.

People with anorexia usually also have one or more co-occurring disorders such as anxiety, obsessive-compulsive disorder or depression. Males and females both suffer many of the same symptoms of anorexia, such as:

• Dehydration (fainting)
• Performing food rituals
• Bursts of energy followed by fatigue
• Constantly talks about body image, weight and diets
• Avoids eating
• Purges (anorexia nervosa -- purge type)
• Isolates
• Thin hair and brittle nails
• Excessive movements even when seated to burn calories

When someone with anorexia under-eats, the brain may dispense feelings of euphoria that briefly counteract anxious or depressed feelings. In this way, food restriction is used as an anti-depressant or a way to "zone out." A male with anorexia uses the obsessive thoughts of weight, diet, food (not eating) and body image as a way of pushing down feelings or past traumas. This is common for all types of eating disorders.

The highest number of males with eating disorders have binge eating disorder, compulsive overeating or obesity. These boys and men often do not get treatment until they have diabetes, heart attacks or other weight-related diseases.

There are many causes of eating disorders. Genetics can make a person more predisposed to acquiring an eating disorder. This usually occurs in families who have eating disorders or other addictions.

The desire for control makes a male more vulnerable to the disease. This is often the result of feeling smothered or abandoned and misunderstood by their families. Many males report that they had parents who overemphasized physical appearances. In these families, the individual learned to keep his feelings, doubts, fears, anxieties and imperfections hidden. There may be family issues that they try to avoid by focusing on their disorders and their ability to control their food intake.

Having a perfectionistic personality type can be a factor in the development of anorexia. Most males with anorexia are above average students and may have excelled at sports. Some say perfectionism is the leading cause of male anorexia. Perfectionism leads to the desire to be good, accepted, perfect and in control -- all of which are prerequisites of anorexia.

Male anorexia is lethal. When the body is not fed it will take fat from the muscles and organs to sustain life. Males generally have less fat than females, so there is the added complication of losing muscle mass. The heart is an important muscle that may be affected. In addition, potassium and electrolyte imbalances may be a risk factor for cardiac problems such as heart attacks.

With the rise in male eating disorders and associated risks, it is imperative that men with eating disorders seek help!

If you or a loved one needs more information Rebecca's House Eating Disorder Treatment Programs offers free eating disorder assessments and information, call 800-711-2062.

If you're struggling with an eating disorder, call the National Eating Disorders helpline at 1-800-931-2237.

Stuffing Your Feelings

“Nobody Can make you feel inferior without your consent”

- Eleanor Roosevelt.

Some people try to control their feelings. The way they usually do this is to resist, ignore, reject or repress them. Repressing your feelings does not usually eliminate them and trying to hide your feelings or emotions becomes a struggle. As the suppressed emotions build, we have to fight to stay in control.  Repressed feelings can motivate much of our behavior.

Some of us have used food and obsessive thoughts for dieting, our weight, and our body image so often that we don’t even know how to label a feeling. A feeling may surface, and we immediately replace it with food, action, obsessive thoughts, etc. The ways we repress feelings are many and we call them defenses. Each defense prevents us from knowing what we are actually feeling.

Sometimes we have the false belief that we can control events or people, However, most of us have a hard time controlling ourselves, much less someone else. We get so caught up in the final outcome and making that outcome happen. We lose ourselves in a frantic attempt to control. Our whole focus is on controlling the person or event. On the other hand, some of us give our power away. We let someone else control our lives, make all our decisions, and speak for us.  They may heavily influence the self we present to the world. After a while we don’t know where they end and we begin. We lose our self. We also lose our ability to enjoy our life journey and be in the present.          

Manipulation can be summoned up as the covert actions we take to get what we want without being direct. This is especially true if our assertiveness skills are lacking. This can take a lot of energy. If we are constantly manipulating our world we don’t have the time or energy to look at ourselves. On the other hand we can also be manipulated by others if we don’t have a sense of self or of our needs. If we are not connected to our feelings we may not know that we’re being manipulated. Not being aware of this manipulation can make us feel crazy, since someone else is directing your life. You feel like a puppet. If your life is full of manipulation there is no room or time for your internal guidance system to grow.

I will continue this article in my next blog post and connect the dots as how this relates to many eating disorders and disordered eating.

Intuitive Eating, learning all over again!

When we come into this world we know when we are hungry and when we are full. We come into this world in touch with our appetite. We are intuitive eaters by nature, but some lose that ability. The primary reasons we have problems with intuitive eating are:

• Using food to stuff our emotions
• Not eating throughout the day because of a hectic schedule
• Using food as a distraction to get through some part of our life
• Food addictions that we are not aware of
• Using food as a way of procrastinating
• Not taking care of ourselves in other ways
• Being too hurried to eat properly
• Eating fast foods
• Eating everything on your plate
• Using food as a reward
• Mealtimes being an unpleasant experience
• We are bombarded with food images in the media
• We are bombarded with idealistic body images
• Prepackaged portion control

Today families seem to be disconnected from internal control as it relates to eating habits. Intuitive eating requires the ability to be in touch with your appetite and body. Dieting is the ultimate vehicle to disconnect from our appetite. It is impossible to eat intuitively while on a diet. When we are hungry we praise ourselves that we are not eating. Then we avoid all the foods that we like and eat foods we do not like. Eventually we get fed up and go off the diet and eat all the foods we have been denying ourselves.  

We should try to reconnect to our appetite to be able to eat freely and stop overthinking what we eat. Here are some steps families can take towards a healthy relationship with food:

• Eat breakfast, it starts the metabolism
• Carry healthy snacks with you
• Take care of yourself as you would someone else you loved
• Eat at the table instead of in front of the television
• Make mealtimes a pleasant experience
• Pay attention to feelings and deal with them. Journaling is a great way to express feelings.
• Eat healthy or your body will crave the missing nutrients
• Don’t beat yourself up if you over indulge, just eat when you are hungry again
• If you want something and you are not really hungry have it with your next meal!

 

One of the best things we can do for our self and our family is to have a sit down dinner at the table with all family members present. I know it is not possible every night, but as many nights as possible. Different members of the family can take on different duties so there is not one person who is being overloaded. Everyone can help with cleanup.

 

This can be a time of sharing your day, talking about current events, or something that one of the members is interested in. You can make it a game. There are some important guidelines:

• This is not the time to scold or belittle a family member
• Everyone (of age) is responsible for their portions and how much they eat
• Keep the atmosphere light
• Dessert is not a reward for finishing the plate.
• If you notice eating problems talk about them later
• Try to include everyone in the conversation
• No watching TV while at the table
• Let phone calls go to the answering machine for these few minutes

As I write this I think of a less busy time—a time when we had time for each other. I know many will think this is impossible to do so they will not even try to have a family meal. If you need to start with just once a week or month that’s ok too.

Rebecca Cooper is a California licensed therapist, Certified Eating Disorder Specialist, and the author of Diets Don’t Work®. www.DietsDontWork.org. She the founder of Rebecca’s House Eating Disorders Treatment Program™. www.Rebeccashouse.org. 800-71

Eating Disorders and Substance Abuse

An estimated 23 million Americans abuse -- or are dependent upon -- either alcohol or illicit drugs. And more than 12 million Americans currently suffer from eating disorders.

Up to half of all people with eating disorders abuse substances and up to half of women who abuse substances suffer from eating disorders.

Between 12 and 18 percent of individuals with anorexia and between 30 and 70 percent of those with bulimia abuse tobacco, alcohol, pills, illegal drugs or "over-the-counter" substances.

FACT: The adolescent years are when women are at greatest risk of eating disorders. These are precisely the years when they are at greatest risk of substance abuse.

FACT: During substance abuse treatment and early recovery, it is not unusual for an individual to turn to binge eating.

FACT: A student who has dieted in sixth grade is more than 20 percent more likely to drink alcohol in the ninth grade than one who has never dieted.

FACT: The more often and more severely an incoming college female diets, the more likely she is to use drugs and abuse alcohol. Seventy-two percent of severe freshmen dieters and bulimics have used alcohol in the past month, compared with less than 44 percent of those who did not diet. Freshmen women with bulimia are more than four times likelier to have smoked in the last month than those who did not diet. The more severe the dieter, the more likely the abuse will involve more than one substance.

FACT: More than twice as many individuals with a history of weight control respond positively to two or more questions on the CAGE Questionnaire assessing alcoholism, signaling the likelihood of a serious alcohol problem, than those without such a history.

FACT: A People magazine survey revealed that 12 percent of women consider smoking a weight reduction method.

FACT: Girls who smoke to suppress their appetites are among the largest group of new nicotine addicts. Among white teenagers who smoke, girls are three times likelier than boys to smoke to suppress their appetites.

FACT: Women who smoke are more than twice as likely as men to cite weight concerns as a reason not to quit.

The tobacco companies understood the relationship between smoking and weight control long before the public health experts. Nicotine pushers began pitching cigarettes as a route to thinness in the 1920s when they first tried to reach women as a market. Lucky Strike ads told women to "Reach for a Lucky instead of a sweet."

When the 1964 Surgeon General's report spotlighted the harmful effects of smoking and the male market leveled off, tobacco companies targeted women.

They created Virginia Slims with its tagline "slimmer, longer, not like those fat cigarettes men smoke." They placed their ads in women's magazines that rarely reported on the health dangers of tobacco. Thanks in part to these ads, the rate at which girls started smoking rose sharply between 1967 and 1973. Among 12-year-old girls it jumped by 110 percent; among 17-year-old girls the numbers leaped 35 percent.

Polls repeatedly show that the number one wish for females ages 11 to 17 is to lose weight. Sixty percent of 12- and 13-year-old girls with low self-esteem are watching their weight and on diets. Tobacco companies manipulate this desire, capitalizing on girls' low self-esteem, a risk factor for both eating disorders and substance abuse.

The slogan for Misty cigarettes is "Slim n' Sassy." Capri claims, "There's no slimmer way to smoke" and calls its cigarettes, "The slimmest slim in town." Virginia Slims' famous tagline is "You've come a long way, baby." But as Gloria Steinham once pointed out, "If we've come such a long way, why are we still smoking?"

Cigarettes and eating disorders are linked in more ways than the tobacco companies let on. Cigarette smoking and eating disorders share many of the same health consequences such as osteoporosis, heart problems and infertility.

The most sordid exploitation of the connection between eating disorders and substance abuse is found in the fashion industry. Drug use, especially heroin and cocaine, is not uncommon. And for many models it is the chosen route to wafer thinness.

Grotesque as it may be, heroin chic -- the thin, hollow-eyed, emaciated figure caricatured as social X-rays by novelist Tom Wolfe -- has been promoted as the standard of beauty by fashion photographers and their principals.

Researchers have discovered that dieting attitudes and behaviors in young women may be related to increasing susceptibility to alcohol and drug abuse. Other research shows that some people abuse illicit drugs because they think the stuff will help them lose weight.

We have the facts, the research continues, but the ignorance of our society also continues. The promotion of perfection, not progress, will haunt us as long as we hang on to the denial about the consequences of any self-destructive behavior.

The Freedom of Eating Disorder Recovery

It is hard to explain to someone who has never had an eating disorder the freedom it is to be out of one. Everyone in recovery will tell you that it's not necessarily all the behaviors that accompany the eating disorders but it is the obsessive, continual chatter that is in your head about food, weight, diet, and body image. Even the person that is restricting, dieting or suffering from Anorexia, has the same

Many people start the disordered eating when we were around 13 to 15 years old. It usually begins with a diet or restricting food. At this time in your life you do not have the coping skills necessary to address the many stressors in your life. So you use the one coping skill that you know will give you a few seconds of relief of not feeling, the eating disorders. You spend our younger years using the eating disorder to cope with hard situations in your live rather than learning new healthy skills and implementing them. As time passes, the only coping skills you have is the eating disorder.

Early recovery is difficult. When we stopped the eating disorder, feelings start to surface. Many times you do not even know what the feeling is. So one of the first new skills in recovery is to be able to identify your feelings. You cannot take care of yourself if you don't even know what you are feeling. What makes this even more difficult is that the feelings you have been suppressing with the eating disorder now start to surface.

The next new coping skills you need in early recovery is how to deal with the stress and anxiety of everyday living. You need to be comfortable around other people and implement new ways of taking care of yourself. It can be hard not having your usual coping mechanism and feeling so raw. You need to be able to identify your stressors and deal with them in a healthy manner.

One of the most important new skill is in eating disorder recovery is learning to identify your negative self-talk. Again, some people are not even aware of the messages they are telling themselves. This can be one reason why you are using the eating disorder to just stop that negativity going on in your head. If the negative self-talk is not addressed to it can lead you back into the eating disorder. I will discuss more on this issue in my next article.

The Destructive Culture of Dieting

Weight problems and food addictions have become a national epidemic.  At any given time, twenty five million Americans are seriously dieting.  Only 1 out of every 200 dieters lose their weight and keep it off for a year or more.  Although there are more diet programs and weight loss products than any other time in history, recent studies show that roughly sixty percent of adult Americans are overweight and one third are obese.

America’s obsession and preoccupation with food and body image is often a precursor to the development of an eating disorder.  Statistics show that thirty-five percent of normal dieters progress into an eating disorder.   Approximately eight million people in America have an eating disorder and eighty-six percent started by age twenty.

When you diet, you set yourself up to overeat because you subconsciously rebel over restricting your food. You are discounting your appetite, your internal guidance system. You no longer eat when you are hungry or stop when you are full. You let the external source, the diet, determine when, what, and how much to eat. You may no longer know what it feels like to be hungry or full. Due to the food restrictions of the diet, your metabolism slows down. Your body thinks it is experiencing a famine; it is in starvation alert mode and is trying to store every calorie. Then you “slip” or eat normally. Your body then stores as much fat as it can because it thinks there may be another famine just around the corner. The result is that you gain weight with a vengeance, faster than before dieting.