By Deneice Fujii A group of young women enter a room. Some come in talking and laughing while others stare at the floor reluctant to participate. Each woman takes a seat on chairs have been placed in a circle and waits for another round of group therapy to begin. For the most part, these women look like any other women in any other town– except some have tubes in their nose, some are waifs with skin pulled tightly over their skeletons, and others look relatively “normal.” This scenario is played out over and over again in various eating disorder treatment centers all over the world. And while an outsider (and often an “insider” as well) would look in and the state these women are in due to their own vanity, a therapist running the group would tell you, “It’s not about the weight at all.”
What is an Eating Disorder?
An eating disorder is much more than just being on a diet; it’s an eating disorder is an illness that permeates all aspects of each sufferer's life. While the illness may involve an individual choice on some level because of the emotional factors and influences, sometimes the “choice” to engage in this behavior is involuntary. Eating disorders have profound effects on the people suffering as well as their friends and family.
Those who suffer from eating disorders often believe the following, but may not consciously realize these beliefs:
“Eating disorders are about trying to make my whole life better through (lack of) food and eating.”
“Eating disorders are about how my life won't be good until a bit (or a lot) of weight is lost. There’s little concern for what kind of damage I do to get myself there.”
“Eating disorders are about being convinced that my whole self-esteem is hinged on how much I weigh and how I look.”
“Eating disorders are about attempting to control my life and emotions through food/lack of food and are a huge neon sign saying, ‘Look how out of control I really feel.’”
“Eating disorders are about everything going on in my life — stress, coping, pain, anger, acceptance, validation, confusion, fear — cleverly (or not so cleverly) hidden behind phrases like ‘I'm just on a diet.’” (Adapted from www.something-fishy.org.)
Also, before we get into the bulk of the article, here are some things that one neED’s to keep in mind:
Eating disorders are a disease and not entities named “Ana” and “Mia.”
Eating disorders are not primarily caused by the media. One will find females and males that are affected by magazines, movies, etc. and others that are not.
Eating disorders turn a simple trip to the grocery store into an anxiety producing “event.”
Eating disorders lead to isolation, lying, stealing (at times) and a host of physical dangers.
Eating disorders can and do kill, but most of the time not when someone is in an emaciated state.
While it still sounds as if an eating disorder is about food and weight, remember an eating disorder is the symptom of something deeper going on inside.
If teenager is starving, excessively exercising or purging (ridding the body of food by vomiting, using laxatives to make bowel movements, etc.), then she doesn’t have to worry about her parents’ divorce, her boyfriend breaking up with her, how much pressure she are under at school (both real and imagined) and so on. If she is engaging in eating disorder behaviors then she doesn’t have to deal with the shame of being molested, raped, or abused in other ways. If she can control what goes into her body then the chaos going on around her can be managed. Unfortunately, the control she thinks she has is an illusion. Just like a porcelain doll, it only takes a slight bump to send that control crashing to the floor and shattering into a million pieces.
Types of Eating Disorders
For this article, I will only be writing about two types of eating disorders– anorexia and bulimia. While Compulsive Overeating (COE), Binge Eating Disorder (BED) and several others are just as valid eating disorders, which come with their own set of dangers, symptoms, and mindsets, most youth workers are going to encounter (and be able to visibly observe) forms of anorexia and bulimia. While males are also more and more showing signs of and are being diagnosed with eating disorders at a high rate as compared to years past, this story will also concentrate more on the female side of the disease. YMX hopes to address the male component to eating disorders in the future.
The following is considered the “text book” definition of eating disorders (ED’s) to assist doctors in making a clinical diagnosis.
1. Refusal to maintain body weight at or above a minimally normal weight for age and height (e.g., weight loss leading to maintenance of body weight less than 85% of that expected; or failure to make expected weight gain during period of growth, leading to body weight less than 85% of that expected).
2. Intense fear of gaining weight or becoming fat, even though underweight.
3. Disturbance in the way in which one's body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or denial of the seriousness of the current low body weight.
4. In postmenarcheal females (women who have not yet gone through menopause), amenorrhea (the absence of at least three consecutive menstrual cycles).
* Restricting Type: during the current episode of Anorexia Nervosa, the person has not regularly engaged in binge-eating or purging behavior (i.e., self-induced vomiting or the misuse of laxatives, diuretics, or enemas)
* Binge-Eating Type or Purging Type: during the current episode of Anorexia Nervosa, the person has regularly engaged in binge-eating OR purging behavior (i.e., self-induced vomiting or the misuse of laxatives, diuretics, or enemas)
1. Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following:
* eating, in a discrete period of time (e.g., within any 2-hour period), an amount of food that is definitely larger than most people would eat during a similar period of time and under similar circumstances
* a sense of lack of control over eating during the episode (e.g., a feeling that one cannot stop eating or control what or how much one is eating)
2. Recurrent inappropriate compensatory behavior in order to prevent weight gain, such as self-induced vomiting; misuse of laxatives, diuretics, enemas, or other medications; fasting; or excessive exercise.
3. The binge eating and inappropriate compensatory behaviors both occur, on average, at least twice a week for 3 months.
4. Self-evaluation is unduly influenced by body shape and weight.
5. The disturbance does not occur exclusively during episodes of Anorexia Nervosa.
* Purging Type: during the current episode of Bulimia Nervosa, the person has regularly engaged in self-induced vomiting or the misuse of laxatives, diuretics, or enemas
* Non-purging Type: during the current episode of Bulimia Nervosa, the person has used other inappropriate compensatory behaviors, such as fasting or excessive exercise, but has not regularly engaged in self-induced vomiting or the misuse of laxatives, diuretics, or enemas
ED-NOS is diagnosed when a person does not fit the exact diagnostic criteria for anorexia, bulimia, COE or binge eating disorder. It is often referred to by its sufferers as the stepchild of ED’s because at times it may seem as if the medical/psychiatric community doesn’t take it as seriously. However, a large portion of those with eating disorders fall into the ED-NOS category.
1. All of the criteria for Anorexia Nervosa are met except the individual has regular menses.
2. All of the criteria for Anorexia Nervosa are met except that, despite substantial weight loss, the individual's current weight is in the normal range.
3. All of the criteria for Bulimia Nervosa are met except binges occur at a frequency of less than twice a week or for the duration of less than 3 months.
4. An individual of normal body weight who regularly engages in inappropriate compensatory behavior after eating small amounts of food (e.g., self-induced vomiting after the consumption of two cookies).
5. An individual who repeatedly chews and spits out, but does not swallow, large amounts of food.
6. Binge eating disorder; recurrent episodes of binge eating in the absence of the regular use of inappropriate compensatory behaviors characteristic of bulimia nervosa.
Who do ED’s Affect?
EVERYONE. It used to be thought that eating disorders were a disease of middle class females brought on by overbearing parents, coaches and teachers; by significant childhood trauma; and by the media. As time goes by, researchers are finding that is not always the case. Women and men from all walks of life, backgrounds, and situations suffer from eating disorders.
Eating disorders can start at any age. Sadly, professionals are seeing the age of those with ED’s getting younger and younger. Remuda Ranch, one of a few faith-based treatment centers, now has a program geared towards girls ages 10-13. There is also an upswing of “older” adults being diagnosed with ED’s.
In the church it often seems as if eating disorders are an “acceptable” disease. As one looks through blogs, web sites, Facebook and MySpace profiles/groups, it is amazing how many in churches (both teens and adults) suffer or have suffered, are suffering, or in varying stages of recovering from an ED. Even with significant weight loss, it is a disease that, for a long time, can be very easy to hide. Otherwise honest people learn to hide, manipulate, and find ways to fuel the disease.
Eating disorders also affect family and friends. Many think if they can just get their loved one to eat, stop purging, quit exercising to excess, etc. that everything will be okay. Often those reactions just spurn the person with the ED to continue (“I’ll show you!”) or to continue to isolate herself from those who love and care for her most. Loved ones think if they become “food police” they can control their loved one’s weight problems. Those with ED’s wish it were that easy
Like many diseases, eating disorders do take a toll on families and family therapy is often an important though hard part of treatment. Parents (especially mothers) are no longer held 100% responsible for their child’s disease. Family dynamics can and do play a part in eating disorders, but are not always the main cause of one. In fact, sometimes the exact cause may never be totally uncovered.
In Part 2 of this series we will take a look at what the signs and symptoms to look for in students (and even volunteers) and things that you should and should not do when you suspect an eating disorder.