Transcript Slide 1

The Truth About Eating Disorders:
Unmasking Myths & Facing Facts
Laura Sabin Cabanillas
MA, LMHC, NCC
Professional Relations Coordinator
Eating Recovery Center
Bellevue, WA
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Get in the KNOW: NEDAwareness.org
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Did You Know…
• More young women die from eating disorders
than any other psychiatric illness
• Between 5-20% of those struggling with anorexia
will die from the disorder
• Approximately a half million teens (ages 13-18)
struggle with eating disorders or disordered
eating
• Pre-teen girls report that they are more afraid of
fat than cancer
www.nationaleatingdisorders.org
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Did You Know…
• 60% of teen girls report feeling fat despite being
normal weight
• 80% of 10-year-old girls have been on a diet
• 40-60% of elementary school girls are concerned
with their weight
• 33% of adolescent males use unhealthy weight
control behaviors
• Approximately 50% of people in the U.S. either
know someone with an ED or have been
personally affected by one
www.nationaleatingdisorders.org
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5 Most Common Eating Disorder Myths
1) EDs are a choice
2) You can tell someone has an ED simply by
looking at them
3) EDs revolve around food
4) EDs are a female thing
5) EDs in adolescents are a phase and a way
to seek attention
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Myth #1: Eating Disorders are a
Choice
Truth: EDs are complicated
Biopsychosocial Disorders – no one
chooses to have an eating disorder!
DNA Loads the Gun – Life Pulls the Trigger
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A few facts about EDs
• An eating disorder is an Impulse Control Disorder
– NOT an addiction
• They are complex disorders and should be treated
by a multidisciplinary team: medical, mental
health and nutrition providers
• The more risk factors in place, the higher
likelihood an ED could develop
• They run in families
• They are lethal and should always be taken
seriously
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Predisposing Biological Factors
• Family history of eating disorders or chemical
dependency: genetic contributions as high as 40%
• American Psychological Association: A Genetic Link to
Anorexia , DeAngelis March 2002, Vol 33, No. 3:
http://www.apa.org/monitor/mar02/genetic.aspx
• Individuals with a mother or sister who had suffered from
Anorexia Nervosa are:
– 12 times more likely to develop Anorexia Nervosa
– 4 times more likely to develop Bulimia Nervosa
• Anxiety, depression or other mood disorder
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Predisposing Psychological Factors
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Anxiety or mood disorder
Obsessive Compulsive personality
Highly sensitive (emotionally)
Poor distress tolerance skills
Perfectionistic temperament
People pleaser
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Predisposing Sociological Factors
• Family history of severe dieting/exercise
• Family constellation—enmeshed or disengaged
• Go fast, highly competitive academic/social
environment
• High risk sports (wrestling, gymnastics, football,
swimming, track)
• Dieting culture - unrealistic then ideals promoted
• Social media & pro-ana websites (blogs, chat
rooms, facebook, tumblr, twitter - it’s
everywhere!)
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Myth #2: You can tell someone has an
eating disorder by looking at them
Truth: Individuals struggling with
bulimia and binge eating disorder
will often appear to be of average
body weight
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Anorexia Nervosa
• Low body weight (<85%)
• Intense fear of gaining
weight
• Distorted body image
• Extreme Focus on
shape/weight
• Denial of seriousness of
illness
• Anemia
• Age at onset typically
between 12-25
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Bulimia Nervosa
• Recurrent binge-eating
– Unusually large amount of
food (by social comparison)
in a short amount of time
• Feeling out of control
• Compensatory behavior
– Vomiting
– Laxative abuse
– Excessive exercise
– Fasting
• Extreme focus on shape/weight
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Binge Eating Disorder
- Recurrent binge-eating
Unusually large amount
of food (by social
comparison) in a short
amount of time
- Feeling out of control
- NO Compensatory
behavior
- Can be of normal or
heavier than average
weight
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Myth #3: Eating Disorders revolve
around food
Truth: Behaviors associated with EDs
may begin with a fixation on calories
and weight, but stem from issues
beyond food & body size.
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Temperament in Anorexia Nervosa
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Harm avoidant
Neurotic/need to control
Obsessional
Anxious
Reward dependent
Perfectionistic
Low novelty seeking
Very Low self-esteem
(though they may seem
confident)
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Temperament in Bulimia Nervosa
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Harm Avoidant
Obsessional
Perfectionistic
Depressed and anxious
Low self-esteem
Higher novelty seeking
Impulsive
Affective dysregulation
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Temperament in Binge Eating Disorder
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Dependent
Avoidant
Depressed
Low self-esteem
Passive-aggressive
Impulsive
Affective
dysregulation
• Black & White/All
or nothing thinking
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Common Precipitants
Internal or external experience(s) of feeling out
of control can include:
• Onset of puberty between the ages of 11-14:
in four years the average young woman gains
40 pounds with a disproportionate fat ratio
• Body dissatisfaction
• Bullying or teasing by peers or siblings related
to weight, size or shape
• Innocent weight loss via increased exercise
(sports) or illness that results in compliments
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Common Precipitants
• Abuse: physical, sexual, emotional
• Traumatic events leading to feelings of
rejection or failure as perceived by the
child/adolescent
• Major life stage transitions: identity formation,
individuation
• Family difficulty: severe conflict, separation or
divorce, disengagement of a parent/caregiver
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Myth #4: Eating Disorders are a
“female thing”
Truth: ED’s are no longer a “princess disease”
Current statistics show that male eating
disorders account for:
• 10% of all cases of Anorexia Nervosa
• 20% of all cases of Bulimia Nervosa
• 40% of all cases of Binge Eating Disorder
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Myth: Eating Disorders are a female thing
- A recent national survey indicated that
41% of men are dissatisfied with their
weight (nationaleatingdisorders.org)
- Adolescent boys who participate in football, track,
and wrestling have increased risk factors of developing
an eating disorder if biological and psychological
predisposition is already in place
- The muscularity of ideal male body representations
in the media (even in our favorite cartoon characters!)
has increased exponentially since the 1970’s, presenting
a largely unattainable body type
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Myth #5: EDs in adolescents are a
phase and a way to seek attention
Truth: Approximately a half
million teens (13-18) struggle
with eating disorders or
disordered eating.
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MIT Raising Teens Project:
10 Tasks of Adolescence
1) Adjust to sexually maturing bodies and feelings
2) Develop and apply abstract thinking skills
3) Develop and apply new perspectives on human
relationships
4) Develop and apply new coping skills in decision
making, problem solving, and conflict resolution
5) Identify meaningful moral standards, values, and
belief systems
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MIT Raising Teens Project:
10 Tasks of Adolescence
6) Understand and express more complex emotional
experiences
7) Form friendships that are mutually close and
supportive
8) Establish key aspects of identity
9) Meet the demands of increasingly mature roles
and responsibilities
10) Renegotiate relationships with adults in
parenting roles
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Symptoms to Watch: When to Refer
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Weight loss with inability to re-gain
Medical instability (dizziness, fainting, chest pain)
Suicidality/cutting
Inability to contain purging behaviors
Physical Signs (cold intolerance, brittle hair & nails,
pale/grey skin, scars on knuckles, chronic sore throat,
swollen glands)
Decreased Motivation/falling grades
Fatigue
“3 week rule”
Guidelines for Assessing Eating Disorders Card
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Clinical Components of Good Treatment
• Full Continuum of Care:
– Medical Unit with Eating Disorder and Psychiatric
Expertise
– Inpatient and/or Residential
– Partial Hospitalization (Day treatment)
– Intensive Outpatient Program
– Interdisciplinary approach should include medical
providers, therapists, and dietitians
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Phases of Treatment
• Phase 1:
- Connect, Build Trust, Take in Nutrition
and Stop Behaviors
• Phase 2:
- Awareness and Practice New Skills
• Phase 3:
- Make Good Plans for How to Continue to
be in Recovery in the “Real World”
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Support Plan for Students
• Approach – don’t avoid! (Shame & EDs thrive in silence)
• Express your concerns compassionately
• LISTEN!
• Refer them to an outpatient therapist who works with ED’s
• Agree on support person (parent/other family member)
• Accountability – lunch partner
• Promote a healthy balanced culture at your school
- Organize ED Awareness Day for Students & Parents (PTO)
- Promote a fat talk free week at your school
http://bi3d.tridelta.org/ourinitiatives/fattalkfreeweek
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What is Fat Talk?
Fat Talk describes any statement that reinforces the thinideal standard of beauty and contributes to women and
men's dissatisfaction with their bodies. Examples include:
• “I’m so fat.“
• “Do I look fat in this?”
• "She should not be wearing that!"
• "Does this make my butt look big?"
• "I need to lose 10 pounds before I wear that."
http://www.operationbeautiful.com/release-form/how-tobecome-fat-talk-free/
http://www.succeedfoundation.org/work/fat_talk_free_wee
k
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ED Prevention & OB Prevention
• It’s NOT a competition! Both “camps” want the
same goal – healthy kids. There is a disconnect
between how healthy lifestyles are promoted by
professionals. How can we work together?
Reference: “War on Weight: Reframing the Tension between
the Eating Disorders and Obesity Fields”, (Ferrari, McVey,
Rice, Piran) – Oral Scientific Paper at Int. Conf. on ED’s 2013:
aedweb.org/ICED2013/paper4.pdf
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Online Resources
• Eating Recovery Center:
www.EatingRecoveryCenter.com/category/resour
ces-eating-disorder-recovery/for-families/
• National Eating Disorders Association (NEDA):
www.nationaleatingdisorders.org
• Academy for Eating Disorders (AED):
http://www.aedweb.org/web/index.php
• International Association of Eating Disorder
Professionals (iaedp): www.iaedp.com
• Eating Disorders Information Gateway:
www.EatingRecoveryCenter.com/EDIG
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Questions
For more resources, referral information or
assistance with eating disorder awareness and
education opportunities, email me:
[email protected]
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