Information for friends and family

The following information is from the Parent and Family Survival Package (The PDF version can be downloaded here) -

Facts about Eating Disorders:

• 80-90% of women believe they are too fat
• 85% of Canadian women are dissatisfied with their bodies and 40% of adolescent boys are dissatisfied with their bodies
• Girls and women make up 90-95% of those struggling with anorexia and bulimia. The other 5-10% is comprised of boys and men.
• While eating disorders affect all ages, typically the age of onset is between 14-25 years old.
• 1-2% of women in North America between the ages of 14-25 experience anorexia nervosa, 3-5% experience bulimia and 10-20% of women engage in many of the behaviours associated with both eating problems.
• The death rate for eating disorders is up to 20%
• Socio-cultural pressures to be thin are strongly linked to the development of eating disorders
• 95% of people who diet will eventually gain back the lost weight
• Successful weight management comes through life-style changes regarding food, exercise and stress management
• 80-90% of eating disorders begin with a diet
• 70% of eating disorders last longer than five years , with almost one quarter lasting more than 15 years
• The complexity of eating disorders requires a multi-disciplinary approach to treatment, this includes medical monitoring, nutritional counselling, and group and/or individual counselling
• The resolution of an eating disorder is not just a matter of willpower
• Experienced help is needed to overcome an eating disorder
• The first step to wellness is to STOP RESTAINED EATING and to BREAK THE BINGE-PURGE CYCLE
• Long term goals include: conflict resolution, stress management, improving self-esteem, addressing family and inter-personal relationship difficulties, resolving abuse issues and providing body image therapy.

What is an Eating Disorder?

Definitions:

Eating disorders are serious conditions in which an individual becomes preoccupied with food and weight. Ultimately, this obsession can be life threatening.

There are three types of eating disorders:

• Anorexia Nervosa:

The main feature of this disorder is the maintenance of a low body weight; often leading to life threatening weight loss. It is also accompanied by excessive exercise. This quest for thinness becomes associated with extreme fears about eating, gaining weight, and getting fat and losing control over food consumption.

• Bulimia Nervosa:

This disorder is characterized by binge eating in which large amounts of food are consumed quickly and often in private. In an attempt to counteract the binge, individuals will purge by vomiting, strict dieting or vigorous exercise. With bulimia nervosa, body weight is not dangerously low but it is not necessarily healthy either.

• Binge Eating:

This disorder is characterized by binge eating in which large amounts of food are consumed quickly and often in private. It is usually accompanied by the feelings of being “out of control” during binges. After the binge the person usually has feelings of shame, disgust or guilt. Binge eating disorder often results in some of the health risks associated with clinical obesity.

Warning Signs of Anorexia and Bulimia:

• Excessive concern with weight
• Distorted body image
• Obsession with food and dieting
• Denial of hunger
• Abnormal weight loss or fluctuation
• Unusual eating habits or rituals
• Extreme physical activity
• Overuse of laxatives, diuretics, emetics or diet pills
• Social isolation
• Denial of the problem

Symptoms / Effects of Eating Disorders:

Anorexia:

Bulimia:

Can someone overcome an Eating Disorder?

It is very important to realize that treatment often takes time, but that. It is counter-productive and frustrating for individual with eating disorders, families, or professionals to expect recovery overnight. Often the individual needs to be reminded of her own progress: reduction in the frequency of binges for those with bulimia, and a gradual increase in caloric intake for those with anorexia, and ability to experience and express feelings are some signs of improvement which need to be acknowledged.

Progress is also noted when the person begins to separate self-esteem and identity from her weight, or when she begins to become more confidant, self-assertive and interactive with people in her life and less absorbed by a relentless pursuit of thinness.

Individuals with eating disorders are often wary of those wishing to help them, believing they only want them to gain weight or "fatten me up". The therapist should be seen as one who is there to help her understand her behavior and who is not interested in controlling her, but only in helping her to resolve her struggle.

One important concept for the person to understand is that her feeling of being in control over her food and weight may sometimes control her. She can only gain control over her life back when she begins to overcome her eating disorder. The therapist's role is to empower her to regain a sense of control over her life. The goal of pursuit of happiness, not thinness, is to be shared by both the women struggling with the issues and the therapist.

The treatment of eating disorders requires a multidisciplinary approach with a Physician; Clinician, Dietician and as required a Family therapist.

Food is not the problem, it is the symptom!

• Don't keep extra food in the house, which would encourage binging for the bulimic.
• Don't put down the child by comparing her to her more "successful" siblings or friends. Her self-esteem is a reflection of your esteem of her.
• Do not neglect your marriage partner or other children. Focusing on the sick child can perpetuate her illness and destroy the family. The anorexic must be made aware by your actions and attitudes that she is important to you, but no more important than every other member of the family is. Do no commiserate (sympathize): this only confirms the child in her illness. She knows you love her.
• Do Not be afraid to have the chid separated from you, either at school or in separate housing. Also it may be necessary for the individual to receive treatment in a residential intensive treatment program.

Survival notes for familes

LOVE your child as you should love yourself. You must love yourself before loving another. Spiritual guidance may help. Love makes everyone feel worthwhile

GIVE you child a goal (not a weight goal.) Get her involved in a hobby, keep her busy. Don't do anything that centers on food.

TRUST your child to find her own values, ideals and standards rather than insisting on yours. Your own behaviour should not be adulterated with self-serving rewards or guilt.

Do everything to ENCOURAGE her initiative, independence and autonomy. Be aware though, that anorexics tend to be perfectionists so that they are never satisfied with themselves. Perfectionism justifies their dissatisfaction with themselves.

Be AWARE of the long-term nature of the illness. Anorexics do get better, very few die. But families must face months and sometimes years of treatment and anxiety.

The Do's and Don't's

Predisposing Factors:

It is difficult to outline what causes eating disorders. There is a combination of societal, individual and family factors, which play a role in the development of an eating disorder.

1. Societal Influences
• media portrayal of women
• pressures to be thin
• changing roles of women
• prejudice against obesity
• glorification of eating disorders
2. Individual Influences
   • lack of a personal identity
   • low self-esteem
   • need for perfectionism
   • high standards
   • fear of maturation
   • black or white thinking
3. Family Influences
   • lack of conflict resolution
   • parental over protectiveness
   • no compromise
   • unclear roles
   • high parental expectations
   • family history of depression or alcoholism
   • a history of sexual or physical abuse

• Studies have shown that 95-98% of people, who diet, gains all the weight back they lose and more. Many researches think this due to the fact that the human body has a "set point" weight range at which it naturally settles. This weight range is genetically inherited which means there is little a person can do to permanently change it.
• Dieting makes the body hungry, which often leads to irritability, depression, fatigue and binge eating. As a result, it simply sets a person up for failure.

What to Do When: The Eating Disordered Adult Refuses Therapy*

1. The individual needs unconditional love during this difficult time. A love based on weight/food/eating will make her feel manipulated and controlled.
2. Denial happens because the individual is afraid… afraid of having to give up control that she fought for… afraid no one would understand.
3. Give her some information about eating disorders.
4. Talking to the individual about food, weight, or eating will usually turns into a power struggle. She will feel defensive, hostile and resentful. If you confront her about eating or behaviour, she will resort to lying and avoid confrontation; or she may feel embarrassed and attack you instead.
5. Remember that food is not the issue. It only cover up underlying problems such as:
   • feelings of inadequacy and inferiority
   • perfectionism and never feeling good enough
   • low self-esteem and low self-wroth
   • feelings of lack of control of one's life
   • fear of making decisions
6. Accept whatever she says as true and valid only to her. Say to her; "I know you feel afraid. I will be there to help you through the scary parts."
7. Listen to her. Don't interrupt, criticize or tell her how she feels. Sit silently facing her or holding her if she wants to. Let her know you are there for her.