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                |   | Frequently Asked Questions
 back to Help/Resources
 
 (provided by Craig Johnson, Ph.D. Laureate Psychiatric
                    Clinic and Hospital, Tulsa, Oklahoma)
 
 What are Eating Disorders?
 What Causes an Eating Disorder?
 Who Is Most at Risk for Developing an Eating
                        Disorder?
 What Are the Long-Term Medical and Emotional
                        Consequences of these Disorders?
 What Is the Treatment for Eating Disorders?
 How Do You Help Someone You Suspect Might Have an
                        Eating Disorder?
 
 
 What are Eating Disorders?
 An eating disorder is a collection of interrelated eating
                    habits, weight management practices, attitudes about food,
                    weight and body shape that have become disordered. Some
                    common features of eating disorders include an irrational
                    fear of fat, dissatisfaction with one's body often coupled
                    with a distorted perception of body shape, unhealthy weight
                    management, or extreme food intake. This disordered eating
                    behavior is usually an effort to solve a variety of
                    emotional difficulties in which the individual feels out of
                    control. Anyone can develop an eating disorder—males
                    and females of all social and economic classes, races and
                    intelligence levels.
 
 There are three primary eating disorders. They
                    are Anorexia Nervosa, Bulimia Nervosa and Binge Eating
                    Disorder.
 
 Anorexia Nervosa
 Anorexia nervosa is an emotional "weight loss" disorder
                    characterized by physical, social and psychological
                    symptoms. Weight loss is achieved by a variety of obsessive
                    behaviors. Most individuals with this disorder strongly deny
                    it. A feeling of control is gained by severely restricting
                    the amount of food eaten. The ability to do without food is
                    viewed as success in attempting to cope with life's
                    stresses. Because early detection is important to successful
                    recovery, it is important to recognize the common warning
                    signs of Anorexia nervosa.
 
 Major characteristics:
 
                      Important facts:An intense drive for thinness. 
                        An intense fear of gaining weight or becoming fat.
                        
A disturbance in body image. 
                      Anorexia nervosa should be considered when a normal-weight
                    person frequently:
                        It typically develops in early to mid-adolescents.
                        
It affects about 1 in 2400 adolescents. 
                        90-95 percent of individuals with anorexia nervosa are
                        female. 
                        It is usually preceded by dieting behavior. 
                        Psychological problems are displaced onto food. 
Unusual food behaviors are practiced. 
                        Need to vicariously enjoy food by cooking it, serving,
                        it or being around it, is common. 
Preoccupation with body weight and image. 
Dieting becomes increasingly important. 
Denial of the condition can be extreme. 
                        Body image disturbance (misperception of body size and
                        shape) is common. 
Pronounced emotional changes are common. 
                        Between one third and one half of anorexics subsequently
                        develop Bulimia nervosa.
                       
                      
                        Experiences significant or extreme weight loss with no
                        known medical illness.
Reduces food intake. 
                        Performs ritualistic eating habits (cutting meat into
                        very small pieces or excessive chewing )
Denies hunger. 
Is critical and intolerant of others. 
Exercises excessively. 
                        Chooses low-to-no-fat and low-calorie foods. 
                        Says he/she is too fat, even when this is not true.
                        
Practices highly self-controlled behavior. 
Hides feelings. Bulimia Nervosa
 Bulimia is an emotional "weight control" disorder
                    characterized by episodes of binge eating followed by some
                    form of purging or restriction. Binges are the secretive
                    periods of rapid consumption of high-caloric foods over a
                    discrete period of time. Most bulimics follow bingeing with
                    self-induced vomiting. However, the purging may take the
                    form of laxative, emetic or diuretic abuse, excessive
                    exercise, or fasting. The binge-purge cycle is normally
                    accompanied by self-deprecating thoughts, depression, and an
                    awareness that the eating disorder is abnormal and out of
                    control. Because most bulimics are within a normal weight
                    range, the illness may go undetected by others for years.
 
 Common purging behaviors include:
 
                      Important facts:Self-induced vomiting 
Emetic abuse 
Laxative abuse 
Diuretic abuse 
Fasting 
Excessive exercise 
                      Bulimia should be considered when a normal-weight person
                    frequently:
                        There are two types of bulimia nervosa; purging and
                        non-purging. 
                        It occurs in 0.5 percent to 2.0 percent of adolescents
                        and young adult women.
                        It appears to be relatively uncommon in men. 
                        It typically develops in early-to-mid-adolescents.
                        
                        It is usually preceded by dieting behavior. 
                        Bulimics are usually of average or above-average weight.
                        
                        Self-evaluation is unduly influenced by size and weight.
                        
                        A complex lifestyle develops to accommodate
                        eating-disorder behaviors. 
                        There are ongoing feelings of isolation,
                        self-deprecating thoughts, depression, and low
                        self-esteem.
                        There is full recognition of the behavior as abnormal.
                        
 
                      
                        Makes excuses to go to the bathroom after meals. 
Shows mood swings. 
                        Buys large amounts of food that suddenly disappears.
                        
Has unusual swelling around the jaw. 
                        Eats large amounts of food on the spur of the moment.
                        
                        Laxative or diuretic wrappers frequently found in
                        trashcan. 
                        If there is unexplained disappearance of food where the
                        person lives.
                       Binge-Eating Disorder
 Binge eating is the consumption of unusually large amounts
                    of food in a discrete time period. Individuals with Bulimia
                    nervosa and Binge-eating disorder practice binge eating.
                    Those with Bulimia nervosa follow binge eating with some
                    type of purging behavior (i.e. self-induced vomiting,
                    laxatives, etc.). Those with Binge-eating disorder do not
                    practice purging, but have feelings of lost control and
                    marked distress over their eating behavior. Normal or
                    overweight individuals who meet the criteria for Bulimia
                    nervosa, but who do not practice purging or other
                    compensating behaviors, are diagnosed with Binge-eating
                    disorder.
 
 The prevalence of Binge-eating disorder in the general
                    population is unknown, but studies suggest that
                    approximately 25-50 percent of obese individuals binge eat.
                    Studies also suggest that those suffering from Binge-eating
                    disorder have difficulties with impulse control in other
                    areas of their lives.
 
 Binge-eating should be considered when a person frequently:
 
                      
                        Eats an abnormal amount of food in a discrete period of
                        time. 
Eats rapidly. 
                        Eats to the point of being uncontrollably full. 
Eats alone. 
                        Shows irritation and disgust with self after
                        over-eating. 
Does not use methods to purge. What Causes an Eating Disorder?
 Anorexia nervosa and Bulimia are very complicated disorders
                    and the reasons for developing them can be different from
                    one person to the next. Although many view these behaviors
                    as self-destructive acts, most individuals who develop
                    eating disorders do not perceive their behaviors as
                    self-harmful. To the contrary, most patients feel that they
                    begin the behaviors to try to fix problems they are
                    experiencing in their lives.
 
 The most common reason that we hear from people about why
                    they develop anorexia or bulimia is that at one point in
                    time they felt terribly out of control. This loss of control
                    could be something they were feeling inside themselves or
                    something that was happening to them from their outside
                    environment. The experience of being out of control directly
                    affects their feelings about themselves and usually results
                    in low self-esteem. The following are some of the most
                    common causes of eating disorders.
 
 Major Life Transitions
 Most eating disorders patients have difficulty with change.
                    Anorexics, in particular, prefer that things be predictable,
                    orderly and familiar. Consequently, transitions such as the
                    onset of puberty, entering high school or college, major
                    illness, or death of a significant other can overwhelm these
                    individuals and result in their feeling out of control.
 
 The onset of puberty is arrested in many females with eating
                    disorders because their body weight and/or body fat is
                    lowered to the point where they lose their menstrual cycle.
                    Those whose body weight is below a menstrual threshold
                    essentially return to a more childlike state both physically
                    and psychologically. They neither feel nor look like
                    adolescent or young adult women, and therefore, postpone
                    making the transition to adolescence or young adulthood.
 
 Family Problems
 Some individuals with eating disorders come from disordered
                    families. The families of anorexic patients are often
                    characterized by extremely controlling parents and poor
                    boundaries between the parents and the child. For many of
                    these individuals, the Anorexia nervosa is a misguided, but
                    understandable, attempt at differentiating from their
                    parents. Put another way, some anorexics are very protective
                    of their illness because they feel it is the first thing in
                    their lives that they have done that was truly "their own
                    idea."
 
 In contrast, individuals who struggle with Bulimia often
                    come from families where there is disconnection among the
                    family members. For these individuals the Bulimia can be a
                    desperate attempt to draw attention to themselves, or an
                    effort to fill up, numb, or distract themselves from the
                    feelings of emptiness related to the disconnection.
 
 Social/Romantic Problems
 Most people who develop eating disorders report painfully
                    low self-esteem prior to the onset of their eating problems.
                    Many patients report going through a painful experience,
                    such as being teased about their appearance, being shunned,
                    or going through a difficult break-up of a romantic
                    relationship. They begin to believe that these things
                    happened because they were fat and that if they become thin,
                    it will protect them from these experiences happening
                    again.
 
 Failure at School, Work, or Competitive Events
 Eating-disorder patients can be perfectionists with very
                    high achievement expectations. If their self-esteem is
                    disproportionately tied to being successful then any failure
                    can produce devastating feelings of shame, guilt, or
                    self-worthlessness. For these individuals, losing weight can
                    be seen as the first step to improving themselves. Binge
                    eating and purging can serve the purpose of proving their
                    worthlessness or it can provide an escape from these
                    feelings.
 
 Traumatic Event
 Evidence continues to accumulate that between one-third and
                    two-thirds of patients who present at treatment centers for
                    eating disorders have histories of sexual or physical abuse.
                    It appears, however, that the prevalence of sexual abuse in
                    eating disorders is about the same as that for other
                    psychiatric disorders.
 
 There is, however, a subgroup of patients whose
                    eating-disordered symptoms are a direct consequence of, or
                    an attempt to cope with, their sexual or physical abuse.
                    Such individuals may try to consciously or unconsciously
                    avoid further sexual attention by losing enough weight to
                    lose their secondary sexual characteristics (e.g. breasts).
                    Similarly, the consistency or type of some foods can
                    directly trigger flashbacks of abuse, resulting in an
                    individual avoiding certain foods altogether.
 
 Major illness or injury can also result in an individual
                    feeling extremely vulnerable or out of control. Anorexia and
                    Bulimia can be attempts to control or distract themselves
                    from the trauma.
 
 Biological Vulnerability to other Psychiatric
                      Illnesses
 We have also learned that some individuals develop an eating
                    disorder in response to other psychiatric symptoms that
                    develop before the onset of the eating-related problems. The
                    onset of these other psychiatric symptoms appear to be
                    triggered biologically and may or may not be related to
                    events that were occurring in the individual's environment.
                    Between one-third and one-half of eating-disorders patients
                    report struggling with significant depression or anxiety
                    prior to the onset of their eating disorder. These episodes
                    of depression and/or anxiety appear to be severe enough that
                    the individual felt extremely out of control and fearful
                    that they were falling apart. Once again, restrictive
                    eating, excessive exercise, and/or binge/purge behavior can
                    be attempts to contain or manage the depression and
                    anxiety.
 
 Furthermore, approximately one-third of eating-disorder
                    patients report struggling with obsessive-compulsive
                    symptoms before they developed their eating disorder. For
                    these individuals the obsessional fear of fat and compulsive
                    behaviors to control this fear are simply the outward
                    symptoms of the more central problem of obsessive-compulsive
                    disorder.
 
 These are just some of the reasons people develop eating
                    disorders. It is important to reiterate that while many
                    individuals with eating disorders think and act in very
                    similar ways, the reasons they have developed these thoughts
                    and actions can be quite different.
 
 
 Who Is Most at Risk for Developing an Eating Disorder?
 The following are the most common risk factors that have
                    been identified:
 
                      
                        Adolescent or young adult females from a
                        middle-to-upper-socioeconomic group in westernized
                        cultures. 
 
                        Working or aspiring to work in a field that places high
                        emphasis on thinness, such as acting, modeling, ballet.
                        or gymnastics. 
 
                        Previous history of being overweight or teased about
                        weight that results in dieting behavior. 
 
                        Family history of eating disorders, weight
                        consciousness, alcoholism, depression or
                        obsessive-compulsive disorder. 
 
                        Low self-esteem, high achievement expectations,
                        perfectionism, social insecurity and difficulty
                        identifying and expressing feelings. 
 
                        Personality characteristics of an anorectic individual
                        may include being overly cautious, fearful of change,
                        hypersensitive and orderly.
 
                        Personality characteristics of a bulimic may include
                        being impulsive, disorganized, a risk-taker, easily
                        bored and having a preference for novel situations.
                        
 
                        Families that lean too much in the direction of being
                        either over-protective and controlling, or too
                        disengaged and uninvolved. 
 
                        History of physical, sexual or significant relational
                        trauma. 
 
                        Large discrepancy between how an individual presents
                        themselves to others and how they actually feel about
                        themselves. 
 
                        Difficulty identifying and/or verbalizing feelings,
                        particularly anger.
                       What Are the Long-Term Medical and Emotional
                        Consequences of these Disorders?
 The longer these illnesses persist, the greater the
                    impairment to the individual's ability to work, love, and
                    play. The course of these illnesses is very similar to other
                    psychiatric difficulties such as drug and alcohol abuse,
                    depression, anxiety, phobia, and obsessive-compulsive
                    disorder. The illnesses dramatically interfere with being
                    able to consistently work or go to school. They ruin
                    relationships and make it very difficult to experience
                    pleasure in life.
 
 In addition to being emotionally devastating, the illnesses
                    can create serious medical problems. Adolescence is a time
                    of rapid growth and development. The average weight gain for
                    girls between the ages of 11 and 14 is 40 pounds.
                    Approximately 90 percent of adult bone mass will be
                    established during adolescence. Osteoporosis ("porous bones"
                    that break easily) can begin early in both girls and boys
                    who are dieting or suffering from Anorexia nervosa. An
                    extended period of semi-starvation stunts growth, can delay
                    the onset of menstruation, and can damage vital organs such
                    as the heart and brain. Listed below are some of the most
                    common medical problems.
 
 Medical Consequences of Anorexia Nervosa:
 
                      Medical Consequences of Bulimia Nervosa:
                        Starvation deprives the body of protein and prevents the
                        normal metabolism of fat. In an effort to protect
                        itself, the body slows down. 
 
                        The heart muscle changes and its beat becomes irregular.
                        The ultimate result can be heart failure that results in
                        death. 
 
                        Menstruation often stops, even before extensive weight
                        loss. This is called amenorrhea. 
 
                        Dehydration, kidney stones and kidney failure may
                        result. 
 
                        A fine body hair, called lanugo, develops on the arms
                        and can even cover the face. 
 
                        Muscles atrophy or waste away, resulting in weakness and
                        lost muscle function. 
 
                        Delayed gastric emptying caused by a lack of energy and
                        slowed body function results in bowel irritation and
                        constipation. 
 
                        Loss of bone calcium leads to osteoporosis.
 
 
                      Medical Consequences of Binge-Eating Disorder:
                        Vomiting, laxatives and diuretics flush sodium and
                        potassium from the body resulting in an electrolyte
                        imbalance. Arrhythmia (irregular heartbeat) can result,
                        which can ultimately lead to heart failure and death.
                        
 
                        The stomach acids in vomit can erode tooth enamel,
                        resulting in damage such as cavities and discoloration.
                        
 
                        Self-induced vomiting can result in irritation and tears
                        in the lining of the throat, esophagus and stomach.
                        
 
                        Laxative abuse can create dependency and result in an
                        inability to have normal bowel movements. 
 
                        Abuse of emetics to induce vomiting can result in
                        toxicity, heart failure and death. 
 
 
                      
                        High blood pressure, elevated cholesterol levels, and
                        elevated triglyceride levels cause hardening of the
                        arteries, heart disease and heart attacks.
 
                        Over-eating simple carbohydrates—sweets and junk
                        food—places stress on the pancreas. At first there
                        is an abnormally low amount of glucose in the blood.
                        Later in life, secondary diabetes can result.
                       What Is the Treatment for Eating Disorders?
 Tragically, eating disorders are quite lethal. The death
                    rate is about 12 times higher than for other women of
                    similar ages. One in ten will die from the illness. Anorexia
                    nervosa ranks as the third most common chronic illness among
                    adolescent females in the United States.
 
 There is hope and help for eating disorders. Early
                    intervention is the key. A team of professionals,
                    specifically trained in eating disorders, will be able to
                    evaluate and set up an individualized treatment plan. This
                    should include a comprehensive multi-dimensional assessment
                    and a coordinated care plan.
 
 Comprehensive Multi-Dimensional Assessment
 A comprehensive, multi-dimensional assessment will include a
                    full physical exam and laboratory studies to determine the
                    patient's physical status and risk of death. The assessment
                    should also include a meeting with a nutritionist to help
                    re-establish a safe diet plan and provide ongoing
                    nutritional counseling.
 
 In addition, the assessment should include a complete mental
                    health evaluation. This psychiatric evaluation should
                    include a review of the patient's symptoms, current life
                    situation, treatment history, personal and family history,
                    and a thorough examination of the patient's thoughts,
                    feelings and behaviors. The mental health evaluation is
                    extremely important because a proper diagnosis is essential.
                    Research shows that nearly 50% of individuals with eating
                    disorders suffer from at least one other psychiatric
                    disorder. It is important that these co-occurring disorders
                    be identified and treated.
 
 Coordinated Care Plan
 After the assessment, a coordinated Care Plan will be
                    established. A team of experienced eating disorders
                    professionals will work together to assist the patient in
                    recovery. Treatment is tailored to the individual and may
                    include an internist, nutritionist, individual or group
                    therapist, psycho-pharmacologist, and family therapist.
 
 Treatment interventions are first aimed at nutritional
                    rehabilitation and the restoration of normal eating patterns
                    to correct the biological and psychological effects of
                    malnutrition. The long-term goals are to diagnose and help
                    resolve the associated psychological, family, social and
                    behavioral problems so that relapse does not occur.
 
 Psychotherapy
 There are many types of psychotherapy or "talking therapy"
                    used in the treatment of eating disorders. We can only touch
                    on a few here. Two types of psychotherapy, cognitive
                    behavioral therapy, and interpersonal therapy are now
                    proving to be very effective in the treatment of eating
                    disorders. Cognitive behavioral therapy is designed to help
                    the patient gain control of unhealthy eating behaviors and
                    to alter the distorted and rigid thinking that perpetuates
                    the syndrome. The treatment uses a combination of behavioral
                    and cognitive procedures to change the patient's behavior,
                    their attitudes about shape and weight, and where relevant,
                    other cognitive distortions such as low self-esteem and
                    extreme perfectionism. In interpersonal therapy, the focus
                    is on the patient's current circumstances and relationships.
                    The initial sessions are typically devoted to a detailed
                    analysis of the interpersonal context in which the eating
                    disorder has developed and been maintained.
 
 These types of therapy can take place in individual, family,
                    or group sessions and it is likely that a combination of the
                    three will be recommended. The goals of individual
                    psychotherapy are to help the patient regain physical
                    health, reduce symptoms, increase self-esteem and proceed
                    with personal and social development. Family therapy
                    attempts to establish more appropriate eating patterns,
                    facilitate communication and permit family members to feel
                    more connected to one another. Group therapy allows the
                    patient to feel less alone with his or her symptoms, to get
                    feedback from his or her peers, and to enhance social
                    skills.
 
 Typically, therapy takes place on an outpatient basis.
                    However, hospitalization may be necessary when an eating
                    disorder has led to physical problems that may be
                    life-threatening or when associated with severe emotional
                    distress.
 
 Medication
 In addition to therapy, medication may be helpful in the
                    treatment of eating disorders. Patients with severe eating
                    disorders appear to have abnormalities in brain
                    neurotransmitter systems, as do patients with depressive
                    disorder, obsessive-compulsive disorders, and anxiety
                    disorders. Because these illnesses are thought to have
                    biological roots, they respond well to medications that work
                    by affecting brain chemistry.
 
 Although the use of medication is more common for patients
                    with Bulimia than with Anorexia, there is evidence that some
                    medications do assist with recovery in both illnesses.
                    Anti-depressants are helpful for patients with significant
                    symptoms of depression, anxiety, or obsessions. They may
                    also have a specific role in reducing the binge purge cycle
                    in Bulimia nervosa. In Anorexia nervosa, use of medication
                    is usually best assessed following weight gain, when the
                    psychological effects of starvation are resolving, although
                    some anti-depressants appear to help stabilize weight
                    recovery. In addition to anti-depressants, a variety of
                    other psychotropic agents are sometimes used.
 
 Medication is generally used in conjunction with
                    psychotherapy and a coordinated treatment plan. Before
                    medication is prescribed, a psychiatrist or family physician
                    will discuss any co-existing medical problems, review
                    current medications being taken, and assess the patient's
                    physical health in order to ensure proper dosage and
                    minimize potential negative interactions or side effects.
                    Several medication trials are sometimes necessary to
                    establish the proper dosage. It is important for the patient
                    to continue seeing a psychiatrist or family physician to
                    monitor these medications.
 
 Whether with therapy, medication, or a combination of both,
                    eating disorders can be successfully treated. Seventy to 80
                    percent of people respond to treatment. Relapses can occur,
                    but the sooner treatment begins, the better the chances for
                    recovery and a return to a healthy life.
 
 
 How Do You Help Someone You Suspect Might Have an
                        Eating Disorder?
 If you are concerned about your friend, don't keep your
                    suspicions to yourself. Being healthy means accepting and
                    nourishing your body. Someone who is not eating, or is
                    eating too much, may need help. In a calm and caring way,
                    tell your friend what you saw or heard. Use "I" statements
                    and let your friend know that you are concerned. Here are
                    some suggestions:
 
                      "I'm worried about you because you haven't eaten lunch
                      this week."What if they get mad or deny it? It is very common for
                    people with problems to say that there is nothing wrong.
                    They might beg you not to tell. Or they may promise they
                    won't do it anymore. Your friend may get angry because of
                    fear, shame or other strong emotions.
 "I heard you talking about taking laxatives...(or diet
                      pills) and that scares me."
 
 "Are you OK? Were you vomiting after lunch? I am concerned
                      about you."
 
 Listen carefully to what your friend says. Think about how
                      your friend might feel. Your friend might feel ashamed or
                      scared. Your friend may feel unimportant or think that
                      life doesn't matter. Feeling out of control is also
                      common. Not eating, or eating too much, may be your
                      friend's way of coping with problems at home or at school.
 
 What your friend is doing is scary and unhealthy. Tell your
                    friend that you care and that you want her or him to get
                    help. Encourage your friend to talk to a grown-up. Say you
                    would be willing to go along to provide support.
 
 Tell your friend that you want to help and don't want to
                    keep your concern a secret. Your friend's health might be in
                    danger. You may decide to tell your friend that you want to
                    talk to a grown-up about it.
 
 Being worried about your friend and wanting to help is a
                    good thing. Consider telling your parents or your friend's
                    parents, a teacher, or the school nurse or counselor, what
                    you know. Tell someone who will understand and can get help
                    for your friend. It is not "tattling" or "ratting" on your
                    friend if you are worried about her or his health.
 
 Here are some suggestions of what to say:
 
                      "I'm worried about ______ because I saw her (him) throw up
                      on purpose/take a laxative/talk about taking diet
                      pills/throw away her (his) lunch."Knowing what your friend is doing and telling someone about
                    it might be stressful for you. You might decide to talk to
                    someone, such as a counselor, about your experience with
                    trying to help your friend. You are doing the right thing.
                    Others will be glad to know and want to help you as well.
 "I'm concerned about ______ because she (he) always
                      complains about being too fat/seems so sad/says she (he)
                      never can do anything right."
 
 
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