EATING  DISORDERS

 

Eating disorders are becoming much more prevalent, and can be devastating to all involved, even leading to the death of those who struggle to put food in a healthy perspective. The following is by no means everything you’d need to know on eating disorders, but I wanted to give a basic primer, because there is so much mis-information about what eating disorders are. This information was originally presented to the Dallas Independent School District teachers and administrators.

 -Megan Johntz

 

 

From the Diagnostic and Statistical Manual of Mental Disorders, IV, published by the American Psychiatric Association, the following criteria must be present in order to warrant a diagnosis of an eating disorder.

 

THE  DEFINITIONS

           

Anorexia Nervosa (DSM IV 307.1)

Refusal to maintain a body weight at or above a minimally normal weight for age and height;

Intense fear of gaining weight or becoming fat, even though underweight;

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;

In postmenarcheal females, amenorrhea (loss of menstruation cycle)

Types:

            Restricting Type

            Binge-Eating/Purging Type

 

Bulimia Nervosa (DSM IV 307.51)

Recurrent episodes of binge eating. An episode is characterized by both:

(1) eating, in a discrete period of time an amount of food that is definitely larger than most people would eat during a similar period of time and under similar circumstances;

(2) a sense of lack of control over eating during the episode

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;

The binge eating and inappropriate compensatory behaviors both occur, on average, at least twice a week for 3 months;

Self-evaluation is unduly influenced by body shape and weight;

The disturbance does not occur exclusively during episodes of Anorexia Nervosa.

            Types:

                        Purging Type

                        Nonpurging Type

 

Compulsive Overeating

No DSM IV diagnosis

Medication of feelings

Trauma aspects

Self-esteem issues

Femininity fears

 

 

PSYCHOLOGICAL  DYNAMICS

  • This is not a diet gone out of control

  • Usually it’s an attempt to find a solution to personal difficulties

  • Often people with eating disorders feel helpless and ineffective

  • They focus on the needs and demands of others, and are often unable to identify own needs/feelings

  • Weight becomes only measure of self-esteem and success

  • Rigid discipline gives experience of being in control

  • Paradox: In trying to gain control, they lose it

  • There is an increased incidence of depression, perfectionism, dependency needs, need for approval, coupled with lowered self-esteem, poor assertiveness, and underdeveloped interpersonal skills with heterosexual relationships.

  • For bulimia, there is an anxiety-binge-anxiety-purge-guilt cycle

  • Anorexia = trying to be in control

  • Bulimia = feeling out of control

 

FAMILY DYNAMICS

  • Enmeshment between family members

  • Overprotectiveness of the child by one or both parents

  • Conflict-Avoidance is a theme in most eating disordered families

  • Rigid boundaries and rules also is a theme in most eating disordered families

  • Usually there is spoken or unspoken parental conflict

           

SOCIAL DYNAMICS EFFECTING PERCEPTIONS OF IDEAL BODY WEIGHT

  • Media

  • Female and male cultural stereotype

  • Peer influences

 

TYPICAL INTERVENTIONS

  • Hospital stabilization

  • Medical interventions

  • Psychoeducation

  • Therapy

            Cognitive/Behavioral

            Family Systems

            Group Therapy

          

 

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