Eating Disorders

Eating disorders are, unfortunately, very common today. Most of us want to have healthy, well-functioning, and attractive bodies. However, our celebrity-smitten society places undue emphasis on the attractiveness part, and then tells us that to be attractive, we must be thin. Our normal desire to maintain a healthy body weight can become abnormal when we are constantly under peer and societal pressure to attain and maintain a weight and shape that is not natural for us.

Eating disorders include extreme emotions, attitudes, and behaviors surrounding weight and food issues, and are experienced by both women and men. They include anorexia nervosa, bulimia nervosa, and binge eating disorder. All are serious emotional and physical problems that can have life-threatening consequences.

Eating Disorders can occur at any age, but they most commonly begin during the teen years. Going away to college can almost be defined as a risk factor for developing an eating disorder in a young person who feels uncomfortable about his/her body and is not sure how s/he is going to 'fit in' and make new friends on campus.

Are you concerned about your eating or food-related habits, or those of a friend? Most of us know something about eating disorders, but our information is often incomplete and inaccurate. The following will provide basic facts about eating disorders, what you can, and cannot do for a friend who you think might have an eating disorder, and a list of resources that you can call upon for more information, for help for yourself, or to which you can refer a friend.

(Most of the following is provided by Eating Disorders Awareness and Prevention, Inc. (edap), Seattle, WA. The organization's address and website information is listed with the resources provided at the end of this section.)

The Basic Facts: Descriptions of the various eating disorders

Anorexia Nervosa is characterized by self-starvation and excessive weight loss.

Symptoms include:

• Refusal to maintain body weight at or above a minimally normal weight for height, body type, age, and activity level.
  
  
• Intense fear of weight gain or being "fat."
  
  
• Feeling "fat" or overweight despite dramatic weight loss.
  
  
• Loss of menstrual periods.
  
  
• Extreme concern with body weight and shape.

Bulimia Nervosa is characterized by a secretive cycle of binge eating followed by purging. Bulimia includes eating large amounts of food -- more than most people would eat in one meal -- in short periods of time, then getting rid of the food and calories through self-induced vomiting, laxative abuse, or over-exercising. People with bulimia are most often within 10 lbs. of normal weight, but may also appear over or under weight.

Symptoms include:

• Repeated episodes of bingeing and purging (2 or more a week).
  
  
• Feeling out of control during a binge and eating beyond the point of comfortable fullness.
  
  
• Purging after a binge, typically by self-induced vomiting, abuse of laxatives, diet pills and/or diuretics, excessive exercise, or fasting.
  
  
• Frequent dieting.
  
  
• Extreme concern with body weight and shape.

Compulsive Overeating (binge eating disorder) is characterized primarily by periods of uncontrolled, impulsive, or continuous eating beyond the point of feeling comfortably full. While there is no purging, there may be sporadic fasts or repetitive diets and feelings of shame or self-hatred after a binge. People who overeat compulsively may struggle with anxiety, depression, and loneliness, which can contribute to their unhealthy episodes of binge eating. Body weight may vary.

Other Eating Disorders can include some combinations of the signs and symptoms of anorexia, bulimia, and/or compulsive overeating. While these behaviors may not be clinically considered a full syndrome eating disorder, they can still be physically dangerous and emotionally draining.

What do I do next?

If you are reading this, you are probably worried about your own eating behaviors or those of a friend. If any of the above descriptions describe you, talk to someone, now! Addressing body image or eating problems in their early stages probably offers the best chance of working through these problems and becoming healthy again. Contact a local eating disorders resource group or a private or community agency counselor, or tell a friend, a trusted advisor or faculty member, and/or someone in your family. Your friends and/or family may not know exactly what to do, but they can give you support for seeking professional help. Individual and/or group counseling is recommended for people whose eating disorder has not developed to the point that their health is severely compromised. Inpatient or partial hospitalization may be necessary if the eating disorder is endangering a person's life.

If you are worried about a friend, the first thing you must realize is that you cannot force someone to get help or change her or his attitudes or behaviors. What you can do is honestly share your concerns, provide support, and help her or him get more information and find out what kind of help is available. The following suggestions have been found to be most useful in dealing with a friend with an eating disorder.

Learn as much as you can about eating disorders. Read books, articles, and brochures. Search the 'net'. Know the differences between facts and myths about weight, nutrition, exercise, and eating disorders. For example, many people believe that everyone with an eating disorder is very thin. This is true of people with anorexia nervosa, but most people with bulimia nervosa or binge eating disorder are close to normal weight. It IS a fact that regular vomiting causes the enamel on the inside of the teeth to erode, and that this is permanent damage. Sometimes concern about their teeth is what motivates people to get help in the early stages of bulimia.

Honestly Express Your Concerns.

• Ignoring or avoiding the problem won't help. People who have recovered say that it was important that friends and family members kept trying to get through to them and kept delivering the same message over and over, because at some point, the messages began to get through.
  
  
• Use a calm, supportive, non-confrontational, but direct approach. Chose a peaceful time for a talk. Give a few examples of behaviors that have made you worry, using "I" statements. For example:
• "I'm concerned about you because you refuse to eat at breakfast or lunch."
• "I've heard you throwing up in the bathroom; it scares me. Let's get help."
• "I'm sorry, but I'm not going to work out with you any more because I feel like I'm helping you abuse yourself."
  
  
• Explain that you feel these behaviors may mean that s/he has a problem that needs professional help. Offer to go with your friend for a first appointment with any health professional that s/he feels comfortable visiting.
  
  
• Avoid getting into a battle of wills with your friend. If s/he refuses to acknowledge the problem, restate your feeling and the reasons for them, and continue to be open and available as a supportive listener. For example: "I know you say that I shouldn't be concerned and that I should mind my own business. But I am concerned and that is my business. In fact, to help me deal with that concern, I've consulted a doctor and a therapist."
  
  
• Caring about the person doesn't mean being manipulated by her/him. People with eating disorders often deny their problem, especially in the early stages of the disorder. Even if they are willing to admit it to themselves, they may deny the problem to others, for fear of being forced into treatment before they are ready to give it up.
  
  
• Avoid accusational "you" statements. For example
• "You have to eat something!"
• "You're out of control, you must be crazy!"
  
  
• Avoid simplistic solutions. For example: "Why don't you just stop? Then everything would be fine!"

Tell Someone: If you have done everything you can, and your friend is not responding, it is time to tell a trusted adult. Consider telling his/her parents, a teacher, doctor, counselor --- anyone who may be able to help your friend AND help you. Being close to someone with an eating disorder is a stressful and scary place to be. You shouldn't feel you have to solve the problem yourself. If you decide you want to tell your friend what you plan to do, you might say something like this: "Look, I think we're both at risk for getting caught up in some dangerous spiral here. I've been talking, and you've been tuning me out and insisting that there's nothing wrong. I'm really scared because I believe that something is very wrong and I'm so afraid of losing you. This is too much for me to handle alone, so I'm going to have to tell __________."

Eating disorder behaviors usually start out as a solution to a problem (allaying the fear of being fat), but end up becoming an enormous problem in their own right. Help is available; there is hope! If you are concerned for yourself or a friend, feel free to call the University Counseling Service for a consultation. We provide consultation and appropriate referrals, a bulimia therapy group, time limited individual therapy
(10 sessions), and educational/prevention/awareness programs upon request. Our services are free to registered students. We offer 1 free consultation to non-students. Call (319) 335-7294, Monday - Friday, 8:00 a.m. to 5:00 p.m. (including over the noon hour).

Recommended Resources

Note: Many private practitioners in the Iowa City area provide counseling for eating disordered individuals. You may contact them directly or request referrals from many of the agencies listed above.

Recommended Readings

Chernin, K. The hungry self. New York: Harper & Row, 1986

Hall, L. & Cohn, L. Bulimia: A guide to recovery. Santa Barbara, CA: Gurse Books, 1992

Kano, S. Making peace with food. Danbury, CT: Amity, 1989

This handout was created by Vivian Barnette, Ph.D.