Eating Disorders. Distributed By: Maine Parent Federation PO Box 2067 Augusta, Maine (Maine Only)

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1 Distributed By: Maine Parent Federation PO Box 2067 Augusta, Maine (Maine Only) Online community: Original: 01/2000 Updated: 0

2 Information Disclaimer The purpose of the information packet is to provide individuals with reader friendly information. We believe that a good overview is a realistic one. For this reason we have included a variety of information that may include the more difficult characteristics of a diagnosis or topic along with medical, educational and best practice information. All information contained in this packet is for general knowledge, personal education and enrichment purposes. It is not intended to be a substitute for professional advice. For specific advice, diagnosis and treatment you should consult with a qualified professional. When this packet was developed, Maine Parent Federation made every effort to ensure that the information contained in this packet was accurate, current and reliable. Packets are reviewed and updated periodically as changes occur. 09/2011 Disclaimer The contents of this Information Packet was developed under a grant from the US Department of Education, #H328M However, those contents do not necessarily represent the policy of the US Department of Education, and you should not assume endorsement by the Federal Government. Project Officer, Marsha Goldberg. 1 Distributed by Maine Parent Federation

3 Table of Content Page # Eating Disorders 3 Eating Disorders for Teens 9 State Resources 14 National Resources 14 Library Materials 15 2 Distributed by Maine Parent Federation

4 Eating Disorders Used with permission by The National Institute of Mental Health Website: What are eating disorders? An eating disorder is an illness that causes serious disturbances to your everyday diet, such as eating extremely small amounts of food or severely overeating. A person with an eating disorder may have started out just eating smaller or larger amounts of food, but at some point, the urge to eat less or more spiraled out of control. Severe distress or concern about body weight or shape may also characterize an eating disorder. Eating disorders frequently appear during the teen years or young adulthood but may also develop during childhood or later in life. 1,2 Common eating disorders include anorexia nervosa, bulimia nervosa, and bingeeating disorder. Eating disorders affect both men and women. For the latest statistics on eating disorders, see the NIMH website. It is unknown how many adults and children suffer with other serious, significant eating disorders, including one category of eating disorders called eating disorders not otherwise specified (EDNOS). EDNOS includes eating disorders that do not meet the criteria for anorexia or bulimia nervosa. Binge-eating disorder is a type of eating disorder called EDNOS. 3 EDNOS is the most common diagnosis among people who seek treatment. 4 Eating disorders are real, treatable medical illnesses. They frequently coexist with other illnesses such as depression, substance abuse, or anxiety disorders. Other symptoms, described in the next section can become life-threatening if a person does not receive treatment. People with anorexia nervosa are 18 times more likely to die early compared with people of similar age in the general population. 5 What are the different types of eating disorders? Anorexia nervosa Anorexia nervosa is characterized by: Extreme thinness (emaciation) A relentless pursuit of thinness and unwillingness to maintain a normal or healthy weight Intense fear of gaining weight Distorted body image, a self-esteem that is heavily influenced by perceptions of body weight and shape, or a denial of the seriousness of low body weight Lack of menstruation among girls and women Extremely restricted eating. Many people with anorexia nervosa see themselves as overweight, even when they are clearly underweight. Eating, food, and weight control become obsessions. People with anorexia nervosa typically weigh themselves repeatedly, portion food carefully, and eat very small quantities of only certain foods. Some people with anorexia nervosa may also engage in binge-eating followed by extreme dieting, excessive exercise, self-induced vomiting, and/or misuse of laxatives, diuretics, or enemas. Some who have anorexia nervosa recover with treatment after only one episode. Others get well but have relapses. Still others have a more chronic, or long-lasting, form of anorexia nervosa, in which their health declines as they battle the illness. 3 Distributed by Maine Parent Federation

5 Other symptoms may develop over time, including :6,7 Thinning of the bones (osteopenia or osteoporosis) Brittle hair and nails Dry and yellowish skin Growth of fine hair all over the body (lanugo) Mild anemia and muscle wasting and weakness Severe constipation Low blood pressure, slowed breathing and pulse Damage to the structure and function of the heart Brain damage Multiorgan failure Drop in internal body temperature, causing a person to feel cold all the time Lethargy, sluggishness, or feeling tired all the time Infertility. Bulimia nervosa Bulimia nervosa is characterized by recurrent and frequent episodes of eating unusually large amounts of food and feeling a lack of control over these episodes. This binge-eating is followed by behavior that compensates for the overeating such as forced vomiting, excessive use of laxatives or diuretics, fasting, excessive exercise, or a combination of these behaviors. Unlike anorexia nervosa, people with bulimia nervosa usually maintain what is considered a healthy or normal weight, while some are slightly overweight. But like people with anorexia nervosa, they often fear gaining weight, want desperately to lose weight, and are intensely unhappy with their body size and shape. Usually, bulimic behavior is done secretly because it is often accompanied by feelings of disgust or shame. The bingeeating and purging cycle happens anywhere from several times a week to many times a day. Other symptoms include :7,8 Chronically inflamed and sore throat Swollen salivary glands in the neck and jaw area Worn tooth enamel, increasingly sensitive and decaying teeth as a result of exposure to stomach acid Acid reflux disorder and other gastrointestinal problems Intestinal distress and irritation from laxative abuse Severe dehydration from purging of fluids Electrolyte imbalance (too low or too high levels of sodium, calcium, potassium and other minerals) which can lead to heart attack. 4 Distributed by Maine Parent Federation

6 Binge-eating disorder With binge-eating disorder a person loses control over his or her eating. Unlike bulimia nervosa, periods of binge-eating are not followed by purging, excessive exercise, or fasting. As a result, people with binge-eating disorder often are over-weight or obese. People with binge-eating disorder who are obese are at higher risk for developing cardiovascular disease and high blood pressure. 9 They also experience guilt, shame, and distress about their binge-eating, which can lead to more binge-eating. How are eating disorders treated? Adequate nutrition, reducing excessive exercise, and stop-ping purging behaviors are the foundations of treatment. Specific forms of psychotherapy, or talk therapy, and medication are effective for many eating disorders. However, in more chronic cases, specific treatments have not yet been identified. Treatment plans often are tailored to individual needs and may include one or more of the following: Individual, group, and/or family psychotherapy Medical care and monitoring Nutritional counseling Medications. Some patients may also need to be hospitalized to treat problems caused by mal-nutrition or to ensure they eat enough if they are very underweight. Treating anorexia nervosa Treating anorexia nervosa involves three components: Restoring the person to a healthy weight Treating the psychological issues related to the eating disorder Reducing or eliminating behaviors or thoughts that lead to insufficient eating and preventing relapse. Some research suggests that the use of medications, such as antidepressants, antipsychotics, or mood stabilizers, may be modestly effective in treating patients with anorexia nervosa. These medications may help resolve mood and anxiety symptoms that often occur along with anorexia nervosa. It is not clear whether antidepressants can prevent some weight-restored patients with anorexia nervosa from relapsing. 10 Although research is still ongoing, no medication yet has shown to be effective in helping someone gain weight to reach a normal level. 11 Different forms of psychotherapy, including individual, group, and family-based, can help address the psychological reasons for the illness. In a therapy called the Maudsley approach, parents of adolescents with anorexia nervosa assume responsibility for feeding their child. This approach appears to be very effective in helping people gain weight and improve eating habits and moods. 12,13 Shown to be effective in case studies and clinical trials, 14 the Maudsley approach is discussed in some guidelines and studies for treating eating disorders in younger, nonchronic patients. 11,12,15-18 Other research has found that a combined approach of medical attention and supportive psychotherapy designed specifically for anorexia nervosa patients is more effective than psychotherapy alone. 19 The effectiveness of a treatment depends on the person involved and his or her situation. Unfortunately, no specific psychotherapy \ 5 Distributed by Maine Parent Federation

7 appears to be consistently effective for treating adults with anorexia nervosa. 20 However, research into new treatment and prevention approaches is showing some promise. One study suggests that an online intervention program may prevent some at-risk women from developing an eating disorder. 21 Also, specialized treatment of anorexia nervosa may help reduce the risk of death. 22 Treating bulimia nervosa As with anorexia nervosa, treatment for bulimia nervosa often involves a combination of options and depends upon the needs of the individual. To reduce or eliminate binge-eating and purging behaviors, a patient may undergo nutritional counseling and psychotherapy, especially cognitive behavioral therapy (CBT), or be prescribed medication. CBT helps a person focus on his or her current problems and how to solve them. The therapist helps the patient learn how to identify distorted or unhelpful thinking patterns, recognize, and change inaccurate beliefs, relate to others in more positive ways, and change behaviors accordingly. CBT that is tailored to treat bulimia nervosa is effective in changing binge-eating and purging behaviors and eating attitudes. 23 Therapy may be individual or group-based. Some antidepressants, such as fluoxetine (Prozac), which is the only medication approved by the U.S. Food and Drug Administration (FDA) for treating bulimia nervosa, may help patients who also have depression or anxiety. Fluoxetine also appears to help reduce binge-eating and purging behaviors, reduce the chance of relapse, and improve eating attitudes. 24 Treating binge-eating disorder Treatment options for binge-eating disorder are similar to those used to treat bulimia nervosa. Psychotherapy, especially CBT that is tailored to the individual, has been shown to be effective. 23 Again, this type of therapy can be offered in an individual or group environment. Fluoxetine and other antidepressants may reduce binge-eating episodes and help lessen depression in some patients. 25 FDA Warnings on Antidepressants Antidepressants are safe and popular, but some studies have suggested that they may have unintentional effects on some people, especially in adolescents and young adults. The FDA warning says that patients of all ages taking antidepressants should be watched closely, especially during the first few weeks of treatment. Possible side effects to look for are depression that gets worse, suicidal thinking or behavior, or any unusual changes in behavior such as trouble sleeping, agitation, or withdrawal from normal social situations. Families and caregivers should report any changes to the doctor. For the latest information visit the FDA website. How are males affected? Like females who have eating disorders, males also have a distorted sense of body image. For some, their symptoms are similar to those seen in females. Others may have muscle dysmorphia, a type of disorder that is characterized by an extreme concern with becoming more muscular. 26 Unlike girls with eating disorders, who mostly want to lose weight, some boys with muscle dysmorphia see themselves as smaller than they really are and want to gain weight or bulk up. Men and boys are more likely to use steroids or other dangerous drugs to increase muscle mass Distributed by Maine Parent Federation

8 Although males with eating disorders exhibit the same signs and symptoms as females, they are less likely to be diagnosed with what is often considered a female disorder. 27 More research is needed to understand the unique features of these disorders among males. What is being done to better understand and treat eating disorders? Researchers are finding that eating disorders are caused by a complex interaction of genetic, biological, behavioral, psychological, and social factors. But many questions still need answers. Researchers are using the latest in technology and science to better understand eating disorders. One approach involves the study of human genes. Researchers are studying various combinations of genes to determine if any DNA variations are linked to the risk of developing eating disorders. Neuroimaging studies are also providing a better understanding of eating disorders and possible treatments. One study showed different patterns of brain activity between women with bulimia nervosa and healthy women. Using functional magnetic resonance imaging (fmri), researchers were able to see the differences in brain activity while the women performed a task that involved self-regulation (a task that requires overcoming an automatic or impulsive response). 28 Psychotherapy interventions are also being studied. One such study of adolescents found that more adolescents with bulimia nervosa recovered after receiving Maudsley model family-based treatment than those receiving supportive psychotherapy, that did not specifically address the eating disorder. 29 Researchers are studying questions about behavior, genetics, and brain function to better understand risk factors, identify biological markers, and develop specific psychotherapies and medications that can target areas in the brain that control eating behavior. Neuroimaging and genetic studies may provide clues for how each person may respond to specific treatments for these medical illnesses. Citations 1. Becker AE, Grinspoon SK, Klibanski A, Herzog DB. Eating disorders. New England Journal of Medicine, 1999; 340(14): Steiner H, Lock J. Anorexia nervosa and bulimia nervosa in children and adolescents: a review of the past ten years. Journal of the American Academy of Child and Adolescent Psychiatry, 1998; 37: American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV). Washington, DC: American Psychiatric Press, Fairburn CG, Cooper Z, Bohn K, O Connor ME, Doll HA, Palmer RL. The severity and status of eating disorder NOS: implications for DSM-V. Behaviour Research and Therapy, 2007; 45(8): Steinhausen HC. Outcomes of eating disorders. Child and Adolescent Psychiatric Clinics of North America, 2008; 18: Wonderlich SA, Lilenfield LR, Riso LP, Engel S, Mitchell JE. Personality and anorexia nervosa. International Journal of Eating Disorders, 2005; 37:S68 S American Psychiatric Association (APA). Let s Talk Facts About Eating Disorders Available online at 8. Lasater L, Mehler P. Medical complications of bulimia nervosa. Eating Behavior, 2001; 2: National Institutes of Health National Heart Lung and Blood Institute. Why obesity is a health problem. Accessed on May 3, Walsh BT, Kaplan AS, Attia E, Olmsted M, Parides M, Carter JC, Pike KM, Devlin MJ, Woodside B, Roberto CA, Rockert W. Fluoxetine after weight restoration in anorexia nervosa: a randomized controlled trial. Journal of the American Medical Association, 2006; 295(22): Agency for Healthcare Research and Quality (AHRQ), Management of Eating Disorders, Evidence Report/Technology Assessment, Number 135, AHRQ publication number 06-E010, 7 Distributed by Maine Parent Federation

9 12. Eisler I, Dare C, Hodes M, Russell G, Dodge E, and Le Grange D. Family therapy for adolescent anorexia nervosa: the results of a controlled comparison of two family interventions. Journal of Child Psychology and Psychiatry, 2000; 1: Lock J, Le Grange D, Agras WS, Dare C. Treatment Manual for Anorexia Nervosa: A Family-based Approach. New York: Guilford Press Russell GF, Szmuckler GI, Dare C, Eisler I. An evaluation of family therapy in anorexia nervosa and bulimia nervosa. Archives of General Psychiatry, 1987; 44: Lock J, Agras WS, Bryson S, Kraemer HC. A comparison of short-and long-term family therapy for adolescent anorexia nervosa. Journal of the American Academy of Child and Adolescent Psychiatry, 2005; 44: Lock J, Couturier J, Agras WS. Comparison of long-term outcomes in adolescents with anorexia nervosa treated with family therapy. Journal of the American Academy of Child and Adolescent Psychiatry, 2006; 45: National Institute for Clinical Excellence (NICE). Core interventions in the treatment and management of anorexia nervosa, bulimia nervosa, and binge eating disorder. London: British Psychological Society Eisler I, Simic M, Russell G, Dare C. A randomized controlled treatment trial of two forms of family therapy in adolescent anorexia nervosa: a five-year follow-up. Journal of Child Psychology and Psychiatry, 2007; 48(6): McIntosh VV, Jordan J, Carter FA, Luty SE, McKenzie JM, Bulik CM, Frampton CM, Joyce PR. Three psychotherapies for anorexia nervosa: a randomized controlled trial. The American Journal of Psychiatry, 2005; 162: Halmi CA, Agras WS, Crow S, Mitchell J, Wilson GT, Bryson S, Kraemer HC. Predictors of treatment acceptance and completion in anorexia nervosa: implications for future study designs. Archives of General Psychiatry, 2005; 62: Taylor CB, Bryson S, Luce KH, Cunning D, Doyle AC, Abascal LB, Rockwell R, Dev P, Winzelberg AJ, Wilfley DE. Prevention of eating disorders in at-risk college-age women. Archives of General Psychiatry, 2006; 63(8): Lindblad F, Lindberg L, Hjern A. Improved survival in adolescent patients with anorexia nervosa: a comparison of two Swedish national cohorts of female inpatients. American Journal of Psychiatry, 2006; 163(8): Wilson GT and Shafran R. Eating disorders guidelines from NICE. Lancet, 2005; 365: Romano SJ, Halmi KJ, Sarkar NP, Koke SC, Lee JS. A placebo-controlled study of fluoxetine in continued treatment of bulimia nervosa after successful acute fluoxetine treatment. American Journal of Psychiatry, 2002; 151(9): Arnold LM, McElroy SL, Hudson JI, Wegele JA, Bennet AJ, Kreck PE Jr. A placebo-controlled randomized trial of fluoxetine in the treatment of binge-eating disorder. Journal of Clinical Psychiatry, 2002; 63: Pope HG, Gruber AJ, Choi P, Olivardi R, Phillips KA. Muscle dysmorphia: an underrecognized form of body dysmorphic disorder. Psychosomatics, 1997; 38: Anderson, AE. Eating disorders in males: critical questions. In R Lemberg (ed), Controlling Eating Disorders with Facts, Advice and Resources. Phoenix, AZ: Oryx Press, 1992; Marsh R, Steinglass JE, Gerber AJ, Graziano O Leary K, Wang Z, Murphy D, Walsh BT, Peterson BS. Deficient activity in the neural systems that mediate self-regulatory control in bulimia nervosa. Archives of General Psychiatry. 2009; 66(1): Le Grange D, Crosby RD, Rathouz PJ, Leventhal BL. A randomized controlled comparison of family-based treatment and supportive psychotherapy for adolescent bulimia nervosa. Archives of General Psychiatry. 2007; 64(9): For more information on eating disorders Visit the National Library of Medicine's: MedlinePlus For information on clinical trials for eating disorders National Library of Medicine Clinical Trials Database Clinical trials at NIMH in Bethesda, MD nimhinfo@nih.gov Website: Revised Distributed by Maine Parent Federation

10 Eating Disorders for Teens Used with permission by the Nemours Foundation Website: Kidshealth Website: Eating disorders are so common in America that 1 or 2 out of every 100 students will struggle with one. Each year, thousands of teens develop eating disorders, or problems with weight, eating, or body image. Eating disorders are more than just going on a diet to lose weight or trying to exercise every day. They're extremes in eating behavior the diet that never ends and gradually gets more restrictive, for example. Or the person who can't go out with friends because he or she thinks it's more important to go running to work off a snack eaten earlier. The most common eating disorders are anorexia nervosa and bulimia nervosa (usually called simply "anorexia" and "bulimia"). But other food-related disorders, like binge eating, body image disorders, and food phobias, are becoming more and more common. Anorexia People with anorexia have a real fear of weight gain and a distorted view of their body size and shape. As a result, they can't maintain a normal body weight. Many teens with anorexia restrict their food intake by dieting, fasting, or excessive exercise. They hardly eat at all and the small amount of food they do eat becomes an obsession. Others with anorexia may start binge eating and purging eating a lot of food and then trying to get rid of the calories by forcing themselves to vomit, using laxatives, or exercising excessively, or some combination of these. Bulimia Bulimia is similar to anorexia. With bulimia, someone might binge eat (eat to excess) and then try to compensate in extreme ways, such as forced vomiting or excessive exercise, to prevent weight gain. Over time, these steps can be dangerous both physically and emotionally. They can also lead to compulsive behaviors (ones that are hard to stop). To be diagnosed with bulimia, a person must be binging and purging regularly, at least twice a week for a couple of months. Binge eating is different from going to a party and "pigging out" on pizza, then deciding to go to the gym the next day and eat more healthfully. People with bulimia eat a large amount of food (often junk food) at once, usually in secret. Sometimes they eat food that is not cooked or might be still frozen, or retrieve food from the trash. They typically feel powerless to stop the eating and can only stop once they're too full to eat any more. Most people with bulimia then purge by vomiting, but may also use laxatives or excessive exercise. Although anorexia and bulimia are very similar, people with anorexia are usually very thin and underweight but those with bulimia may be a normal weight or can be overweight. 9 Distributed by Maine Parent Federation

11 Binge Eating Disorder This eating disorder is similar to anorexia and bulimia because a person binges regularly on food (more than three times a week). But, unlike the other eating disorders, a person with binge eating disorder does not try to "compensate" by purging the food. Anorexia, bulimia, and binge eating disorder all involve unhealthy eating patterns that begin gradually and build to the point where a person feels unable to control them. Signs of Anorexia and Bulimia Sometimes a person with anorexia or bulimia starts out just trying to lose some weight or hoping to get in shape. But the urge to eat less or to purge or over-exercise gets "addictive" and becomes too hard to stop. Teens with anorexia or bulimia often feel intense fear of being fat or think that they're fat when they are not. Those with anorexia may weigh food before eating it or compulsively count the calories of everything. People to whom this seems "normal" or "cool" or who wish that others would leave them alone so they can just diet and be thin might have a serious problem. How do you know for sure that someone is struggling with anorexia or bulimia? You can't tell just by looking a person who loses a lot of weight might have another health condition or could be losing weight through healthy eating and exercise. But there are some signs to watch for that might indicate a person has anorexia or bulimia. Someone with anorexia might: become very thin, frail, or emaciated be obsessed with eating, food, and weight control weigh herself or himself repeatedly deliberately "water load" when going to see a health professional to get weighed count or portion food carefully only eat certain foods, avoiding foods like dairy, meat, wheat, etc. (of course, lots of people who are allergic to a particular food or are vegetarians avoid certain foods) exercise excessively feel fat withdraw from social activities, especially meals and celebrations involving food be depressed, lethargic (lacking in energy), and feel cold a lot Someone with bulimia might: fear weight gain be intensely unhappy with body size, shape, and weight make excuses to go to the bathroom immediately after meals only eat diet or low-fat foods (except during binges) 10 Distributed by Maine Parent Federation

12 regularly buy laxatives, diuretics, or enemas spend most of his or her time working out or trying to work off calories withdraw from social activities, especially meals and celebrations involving food What Causes Eating Disorders? No one is really sure what causes eating disorders, although there are many theories about it. Many people who develop an eating disorder are between 13 and 17 years old. This is a time of emotional and physical changes, academic pressures, and a greater degree of peer pressure. Although there is a sense of greater independence during the teen years, teens might feel that they are not in control of their personal freedom and, sometimes, of their bodies. This can be especially true during puberty. For girls, even though it's completely normal (and necessary) to gain some additional body fat during puberty, some respond to this change by becoming very fearful of their new weight. They might mistakenly feel compelled to get rid of it any way they can. When you combine the pressure to be like celebrity role models with the fact that bodies grow and change during puberty, it's not hard to see why some teens develop a negative view of themselves. Celebrity teens and athletes conform to the "Hollywood ideal" girls are petite and skinny, and guys are athletic and muscular, and these body types are popular not only in Hollywood but also in high school. Many people with eating disorders also can be depressed or anxious, or have other mental health problems such as obsessive-compulsive disorder (OCD). There is also evidence that eating disorders may run in families. Although part of this may be genetics, it's also because we learn our values and behaviors from our families. Sports and Eating Disorders Athletes and dancers are particularly vulnerable to developing eating disorders around the time of puberty, as they may want to stop or suppress growth (both height and weight). Coaches, family members, and others may encourage teens in certain sports such as gymnastics, ice skating, and ballet to be as thin as possible. Some athletes and runners are also encouraged to weigh less or shed body fat at a time when they are biologically destined to gain it. Effects of Eating Disorders Eating disorders are serious medical illnesses. They often go along with other problems such as stress, anxiety, depression, and substance use. Eating disorders can lead to the development of serious physical health problems, such as heart conditions or kidney failure. Someone whose body weight is at least 15% less than the average weight for that person's height may not have enough body fat to keep organs and other body parts healthy. In severe cases, eating disorders can lead to severe malnutrition and even death. 11 Distributed by Maine Parent Federation

13 With anorexia, the body goes into starvation mode, and the lack of nutrition can affect the body in many ways: a drop in blood pressure, pulse, and breathing rate hair loss and fingernail breakage loss of periods lanugo hair a soft hair that can grow all over the skin lightheadedness and inability to concentrate anemia swollen joints brittle bones With bulimia, constant vomiting and lack of nutrients can cause these problems: constant stomach pain damage to the stomach and kidneys tooth decay (from exposure to stomach acids) "chipmunk cheeks," when the salivary glands permanently expand from throwing up so often loss of periods loss of the mineral potassium (this can contribute to heart problems and even death) A person with binge eating disorder who gains a lot of weight is at risk of developing diabetes, heart disease, and some of the other diseases associated with being overweight. The emotional pain of an eating disorder can take its toll, too. When someone becomes obsessed with weight, it's hard to concentrate on much else. It can be exhausting and overwhelming to monitor food intake and exercise, and be in a constant state of stress about food and how your body looks. It's easy to see why when you develop an eating disorder you could become withdrawn and less social. It gets too hard to join in on snacks and meals with friends or families, or too hard to stop the addictive exercising or working out to have fun. Having an eating disorder also can use up a lot of mental energy planning what to eat, how to avoid food, planning a binge, getting money to buy food or laxatives or other medications, making up reasons to use the bathroom after meals, or figuring out how to tell people around you that you want to be alone after a meal. Treatment for Eating Disorders Fortunately, eating disorders can be treated. People with eating disorders can get well and gradually learn to eat well and more like their family and friends again. Eating disorders involve both the mind and body. So medical doctors, mental health professionals, and dietitians will often be involved in a person's treatment and recovery. Therapy or counseling is a very important part of getting better in many cases, family therapy is one of the keys to eating healthily again. Parents and other family members are important in supporting people who have to regain weight that they are afraid of, or to learn to accept the body shape that their culture, genes, and lifestyle allows for. 12 Distributed by Maine Parent Federation

14 If you want to talk to someone about eating disorders but are unable or not ready to talk to a parent or close family member, try reaching out to a friend, teacher, school nurse or counselor, coach, neighbor, your doctor, or another trusted adult. Remember that eating disorders are very common among teens. Treatment options depend on each person and their families, but many treatments incorporate journaling, talking to therapists, and working with dietitians and other professionals. Learning to be comfortable at your healthy weight is a process. It takes time to unlearn some behaviors and relearn others. Be patient, you can learn to like your body, understand your eating behaviors, and figure out the relationship between feelings and eating all the tools you need to feel in control and to like and accept yourself for who you are. Reviewed by: Michelle New, PhD Date reviewed: January Distributed by Maine Parent Federation

15 State Resources The New England Eating Disorders Program 144 State St Portland ME Phone: (207) Website: Mainely Girls P.O. Box 793 Rockport, ME Phone: (207) Website: GEAR Parent Network: Phone: Website: National Resources National Institute of Mental Health Website: National Eating Disorders Association Website: Kidshealth Website: 14 Distributed by Maine Parent Federation

16 Maine Parent Federation Lending Library Procedures The MPF Library is a valuable resource to families and professionals in Maine. The success of the library is greatly determined by the quality and availability of the materials we offer. To help us maintain our library, we ask that you follow these guidelines. How to Request Materials Call: (Maine Only) dnewcombe@mpf.org Fax: Write: MPF Library Visit: 484 Maine Ave. #1 PO Box 2067 Farmingdale, Maine Augusta, Maine Hours: 8:30-4:30 Mon. Fri. Library Policy The complete library list is available in print or online at. You may borrow two materials at a time. You are responsible for the cost of return postage. Materials will be mailed out on the day you request them if they are available. Materials are loaned for a two-week period. If you need to renew them, call to check with us, we may be able to extend the due date as long as there is not a waiting list for the material. If materials are more than one week late we will ask you for a $5 late fee donation, payable to the MPF Library for every week the material is overdue. A reminder card will be mailed during the first week that materials are overdue. We keep a waiting list for materials that are already on loan when you request them. You can ask that your name be added to the waiting list and materials will be mailed to you as soon as they become available. About the Library List The library list is arranged by topic then listed alphabetically by title. Materials are not cross-referenced, so each title appears only once and you may have to check other sections. Please remember - we are always adding new materials and updating the library list. 15 Distributed by Maine Parent Federation

17 16 Distributed by Maine Parent Federation