1. Eating Disorders Presentation Becky Brandsberg-Herrera MSW, LCSW University Counseling Services 785-4014ucs.truman.edu

2. Goals of this Presentation To discuss and understand the difference between disordered eating and eating disorders. To discuss and understand the difference between disordered eating and eating disorders. To understand main types of eating disorders. To understand main types of eating disorders. To learn why people develop eating disorders. To learn why people develop eating disorders. To understand the different approaches to treatment. To understand the different approaches to treatment. To learn tips to help a student who may be experiencing an eating disorder. To learn tips to help a student who may be experiencing an eating disorder. To leave with excellent resources for future reference. To leave with excellent resources for future reference.

3. Disordered Eating vs. Eating Disorders A reaction to a life situation; a habit A reaction to a life situation; a habit Absence of compulsive thoughts or problems in regular functioning Absence of compulsive thoughts or problems in regular functioning Education, self-help can result in change Education, self-help can result in change An illness An illness Frequent and persistent thoughts and behaviors about body, food and eating that lead to problems in regular functioning Frequent and persistent thoughts and behaviors about body, food and eating that lead to problems in regular functioning Life-threatening Life-threatening Professional intervention Professional intervention

4. Eating Feelings, Attitudes & Behaviors Continuum Body Image Confidence Preoccupation with body shape/size & eating Distress about body shape/size & eating Eating Disorders Mostly positive feelings about body shape/size Mostly positive feelings about body shape/size No “good” or “bad” foods No “good” or “bad” foods Regular moderate exercise Regular moderate exercise Don’t like the way parts of body look or consistently feel like losing a few pounds Don’t like the way parts of body look or consistently feel like losing a few pounds Frequent thinking about food, eating and body Frequent thinking about food, eating and body Sometimes feel guilty or bad for what you have eaten and may “make up for it” Sometimes feel guilty or bad for what you have eaten and may “make up for it” Thinking about food, eating and body interferes with daily activities Thinking about food, eating and body interferes with daily activities Rigidity in eating patterns Rigidity in eating patterns Working hard to change body and compensating for eating (vomiting, fasting, extreme exercising) Working hard to change body and compensating for eating (vomiting, fasting, extreme exercising) No significant weight loss No significant weight loss Anorexia Nervosa Anorexia Nervosa Bulimia Nervosa Bulimia Nervosa Binge Eating Disorder Binge Eating Disorder Eating Disorder NOS Eating Disorder NOS

5. Types of eating disorders Anorexia Nervosa Anorexia Nervosa Bulimia Nervosa Bulimia Nervosa Binge Eating Disorder Binge Eating Disorder Not Otherwise Specified (NOS) Not Otherwise Specified (NOS)

6. Dying to be Thin Written, Produced and Directed by Larkin McPhee; a NOVA production (2000)

7. Anorexia Nervosa: What is it? Eating Disorders: Causes, Symptoms and Treatment Produced and Edited by Constance M. Jones (2004)

8. Anorexia Nervosa: Warning Signs Dramatic weight loss Dramatic weight loss Refusal to eat certain foods or food categories (e.g. no fats, no carbs) Refusal to eat certain foods or food categories (e.g. no fats, no carbs) Consistent excuses to avoid situations involving food Consistent excuses to avoid situations involving food Excessive and rigid exercise routine Excessive and rigid exercise routine Withdrawal from usual friends/relatives Withdrawal from usual friends/relatives Source: National Eating Disorders Association Website

9. Health Risks with Anorexia Heart failure Heart failure Kidney failure Kidney failure Low protein stores Low protein stores Digestive problems Digestive problems Electrolyte imbalance Electrolyte imbalance

10. Bulimia Nervosa: What is it? Eating Disorders: Causes, Symptoms and Treatment Produced and Edited by Constance M. Jones (2004)

11. Bulimia Nervosa: Warning Signs Wrappers/containers indicating consumption of large amounts of food Wrappers/containers indicating consumption of large amounts of food Frequent trips to bathroom after meals Frequent trips to bathroom after meals Signs of vomiting e.g. staining of teeth, calluses on hands Signs of vomiting e.g. staining of teeth, calluses on hands Excessive and rigid exercise routine Excessive and rigid exercise routine Withdrawal from usual friends/relatives Withdrawal from usual friends/relatives Source: National Eating Disorders Association Website

12. Health Risks with Bulimia Electrolyte imbalance Electrolyte imbalance Laxative dependence Laxative dependence Dental problems Dental problems Stomach rupture Stomach rupture Menstruation irregularities Menstruation irregularities

13. Binge Eating Disorder: What is it? Eating Disorders: Causes, Symptoms and Treatment Produced and Edited by Constance M. Jones (2004)

14. Binge Eating Disorder: Warning Signs Wrappers/containers indicating consumption of large amounts of food Wrappers/containers indicating consumption of large amounts of food MAY be overweight for age and height MAY be overweight for age and height MAY have a long history of repeated efforts to diet-feel desperate about their difficulty to control food intake MAY have a long history of repeated efforts to diet-feel desperate about their difficulty to control food intake MAY eat throughout the day with no planned mealtimes MAY eat throughout the day with no planned mealtimes Source: National Eating Disorders Association Website

15. Health Risks with Binge Eating Disorder High blood pressure High blood pressure High cholesterol High cholesterol Gall bladder disease Gall bladder disease Diabetes Diabetes Heart disease Heart disease Certain types of cancer Certain types of cancer

16. Eating Disorder Not Otherwise Specified (NOS) NOS category is for disorders of eating that do not meet the criteria for any specific Eating Disorder NOS category is for disorders of eating that do not meet the criteria for any specific Eating Disorder Examples include: Examples include: –For females, all of the criteria for Anorexia Nervosa are met except that the individual has regular menses OR despite significant weight loss the individual’s current weight is in the normal range. Source: Adapted from the Diagnostic and Statistical Manual of Mental Disorders-IV

17. Body Dysmorphic Disorder Excessively concerned about an imagined defect in appearance Excessively concerned about an imagined defect in appearance Muscle Dysmorphia Obsess about being small and underdeveloped Obsess about being small and underdeveloped

18. What is the situation at Truman? In the Spring of 2006, 552 Truman students completed the National College Health Assessment (NCHA). The following are the findings: 1.8% of students reported experiencing Anorexia 1.8% of students reported experiencing Anorexia 2.9% of students reported experiencing Bulimia 2.9% of students reported experiencing Bulimia 2.4% of students reported that their eating disorder/problem affected their academics 2.4% of students reported that their eating disorder/problem affected their academics

19. What is the situation at Truman? Within the last 30 days, Truman students reported: MaleFemale Exercising to lose weight 38.264.4 Dieting to lose weight 24.341.4 Vomiting or taking laxatives to lose weight 0.03.6 Taking diet pills to lose weight 0.03.9 Doing none of the above 57.430.8

20. Why do people develop eating disorders? Behaviors are unhealthy coping mechanisms Behaviors are unhealthy coping mechanisms  Factors to consider  Psychological  Interpersonal  Social/Cultural  Biological

21. Psychological factors Low self-esteem Low self-esteem Feelings of inadequacy or failure Feelings of inadequacy or failure Feeling out of control Feeling out of control Response to change (puberty) Response to change (puberty) Response to stress (sports, dance) Response to stress (sports, dance) Personal illness Personal illness

22. More psychological factors: Vulnerable Personality Characteristics Identity difficulties Identity difficulties Need for approval Need for approval Perfectionist Perfectionist Obsessive tendencies Obsessive tendencies Irrational thinking Irrational thinking Difficulty coping Difficulty coping Inability to accept self Inability to accept self

23. Interpersonal Factors Troubled family and personal relationships Troubled family and personal relationships Difficulty expressing emotions and feelings Difficulty expressing emotions and feelings History of being teased or ridiculed based on size or weight History of being teased or ridiculed based on size or weight History of physical or sexual abuse History of physical or sexual abuse

24. Social and Cultural Factors Cultural pressures that glorify thinness and place value on obtaining the perfect body Cultural pressures that glorify thinness and place value on obtaining the perfect body Narrow definitions of beauty that include only women and men of specific body weights and shapes Narrow definitions of beauty that include only women and men of specific body weights and shapes Cultural norms that value people on the basis of physical appearance and not inner qualities and strengths Cultural norms that value people on the basis of physical appearance and not inner qualities and strengths

25. Barbie and Bodies Seven feet tall Seven feet tall 38 inch chest 38 inch chest 21 inch waist 21 inch waist 36 inch hips 36 inch hips Virtually unattainable for an adult woman Virtually unattainable for an adult woman

26. G. I. Joe 1970-GI Joe was 5 ft. 10 inches, 32 inch waist and 12 inch upper arms 1970-GI Joe was 5 ft. 10 inches, 32 inch waist and 12 inch upper arms 2000-29 inch waist and 16 ½ inch arms 2000-29 inch waist and 16 ½ inch arms

27. Biological Factors Eating disorders often run in families (learn coping skills and attitudes in family) Eating disorders often run in families (learn coping skills and attitudes in family) Genetic component—research about brain and eating in taking place (certain chemicals in the brain control hunger, appetite and digestion have been found unbalanced). Genetic component—research about brain and eating in taking place (certain chemicals in the brain control hunger, appetite and digestion have been found unbalanced). Source: www.NationalEatingDisorders.org

28. More on biology Dying to be Thin Written, Produced and Directed by Larkin McPhee; a NOVA production (2000)

29. Consequences of eating disorders -Tearing up the mind and body -Tearing up the mind and body -Mind- distorted and obsessive thoughts regarding food, exercise, body image, -Mind- distorted and obsessive thoughts regarding food, exercise, body image, -Takes over your life—loss of life in other areas: social, financial, spiritual, professional, academic -Takes over your life—loss of life in other areas: social, financial, spiritual, professional, academic -Anything that pulls you out of balance can destroy your life—or at least make it miserable -Anything that pulls you out of balance can destroy your life—or at least make it miserable -Physical-amenorrhea, dehydration, electrolyte imbalances, dry skin, long lasting disruptions of normal bowel functioning -Physical-amenorrhea, dehydration, electrolyte imbalances, dry skin, long lasting disruptions of normal bowel functioning Source: Academy For Eating Disorders http://www.aedweb.org)

30. Treatment options Help comes in different forms including : Psychotherapy Psychotherapy Support or self-help groups Support or self-help groups Medical treatment Medical treatment Nutritional treatment Nutritional treatment Medication Medication Hospitalization Hospitalization Help is available. Get help if you need it. Encourage a loved one to get help if they need it.

31. A little more personal now…

32. Deciding If You Abuse Food I often deal with difficult feelings with food I often deal with difficult feelings with food I think constantly about my weight and appearance I think constantly about my weight and appearance I give too much time and thought to food I give too much time and thought to food I have lied or been secretive about my eating behavior I have lied or been secretive about my eating behavior I have gone on eating binges that I felt I might not be able to stop I have gone on eating binges that I felt I might not be able to stop I have used vomiting, laxatives, water pills, and/or diet pills to control my weight I have used vomiting, laxatives, water pills, and/or diet pills to control my weight

33. How to Help Family and Friends “Tips for Talking to a Friend Who May Be Struggling with an eating Disorder” “Tips for Talking to a Friend Who May Be Struggling with an eating Disorder” *Set a time to talk *Communicate your concerns *Ask your friend to explore these concerns *Avoid conflicts or a ballet of the wills *Avoid placing shame, blame, or guilt *Avoid giving simple solutions *Express your continued support Knowledge Knowledge Awareness Awareness Support Support Boundaries Boundaries By National Eating Disorders Association www.NationalEatingDisorders.org

34. Body Image Not the entire solution, but if we have a healthy, realistic body image we are less prone to use food as a way to cope with our emotions, stress and problems. Not the entire solution, but if we have a healthy, realistic body image we are less prone to use food as a way to cope with our emotions, stress and problems.

35. Web Resources Anorexia Nervosa and Related Eating Disorders Anorexia Nervosa and Related Eating Disorders –www.anred.com www.anred.com National Eating Disorders Association National Eating Disorders Association –www.NationalEatingDisorders.org www.NationalEatingDisorders.org American Dietetic Association American Dietetic Association –www.eatright.org www.eatright.org Something Fishy Web Site on Eating Disorders Something Fishy Web Site on Eating Disorders –www.something-fishy.org www.something-fishy.org

36. Truman State University Resources University Counseling Services University Counseling Services –785-4014 –ucs.truman.edu Student Health Services Student Health Services –785-4182 –studenthealth.truman.edu

37. Thank You!! Becky Brandsberg-Herrera, MSW. LCSW University Counseling Services brandsberg@ truman.edu 785-4014 http://ucs.truman.edu http://ucs.truman.edu/howwasit