Eating Disorders Kit

Eating Disorders Kit "Life itself is the proper binge." - Julia Child Mental Health Association NSW Inc Level 5, 80 William Street East Sydney NSW 2011 Tel: 1300 794 991 Fax: (02) 9339 6066 www.mentalhealth.asn.au info@mentalhealth.asn.au Page 1 of 14

Eating Disorders Kit Contents: 1. Introduction 2. Causes of Eating Disorders 3. Myths about Food, Weight and Body Image 4. Types of Eating Disorders a. Anorexia Nervosa b. Bulimia Nervosa c. Compulsive Overeating Disorder d. Binge Eating Disorder e. Nocturnal Sleep-Related Eating Disorder 5. Telling Someone About Your Eating Disorder 6. How You Can Help Someone with an Eating Disorder 7. Eating Disorder Test 8. Where to Get Help? 9. Further Research 10. Reading List Updated July 2010 by the Mental Health Information Service Mental Health Association NSW Inc Level 5, 80 William Street East Sydney NSW 2011 Tel: 1300 794 991 Fax: (02) 9339 6066 www.mentalhealth.asn.au info@mentalhealth.asn.au Page 2 of 14

1. What are Eating Disorders? There are three more common eating disorders; anorexia nervosa, bulimia and compulsive overeating, and other less common ones, such as nocturnal sleep-related eating disorder. All have quite distinct and separate characteristics. However, they all involve problems with food limiting the types of food eaten, losing control and eating too much or having to get rid of the food soon after eating. Eating disorders are not just about eating, they are also about being unhappy with body shape size or weight and the impact this has on selfesteem, relationships and ability to cope with life in general. It is thought that about 10% of the population has an eating disorder. Most people with an eating disorder are female, however, more males are now being diagnosed with eating disorders. Excessive exercise may also occur in order to lose weight. Males, in particular may work out in order to gain more muscle and no matter how muscular they become never feel they are big enough. This can lead to abuse of steroids. An obsession with muscle development can become dangerous if it goes unchecked. 2. Causes of Eating Disorders In spite of research and numerous publications over the past decade, there remains uncertainty about the exact causes of eating disorders. To date, evidence exists in support of a variety of risk factors that may contribute to the development of an eating disorder. The cause and influence of certain risk factors will differ from one person to another. Psychological factors - It is possible that feelings of anxiety, low self-esteem, selfcriticism, feelings of inadequacy, perfectionism, the need to achieve highly and to seek other people s approval can make you more vulnerable to developing an eating disorder. Socio Cultural factors - There is substantial pressure on women within western society to conform to the ideal of the waif look. Thinness is highly valued in our society. The beauty and fashion industries constantly persuade women to think that there is only one acceptable body image, despite the fact that the majority of women are not healthy at this size. The steroid muscle man image from cinema and magazines also influences boys to feel they need to build up their muscles to be attractive to women and to feel better about themselves. Naomi Woolf s book The Beauty Myth explains in detail the impact of sociocultural factors on women s lives. Personal factors - Often changes in life circumstances such as the breakdown of a relationship, changes in adolescence, or having been the victim of child abuse or rape can contribute to the development of an eating disorder. Such experiences may lead the person to seek control in some area of their lives such as their body weight. Biological factors - Some research suggests that hormonal or chemical imbalances in the body can play a role in developing an eating disorder. Page 3 of 14

3. Myths about Food, Weight and Body Image Myth: People are fat because they eat too much. Fact: In fact, most people who are large eat no more than normal weight people. Many different factors affect any individual s body size, including genes, medical conditions and medications, level of physical activity, etc. Myth: Anyone can be slim; it just takes a little self-control. Fact: Weight is extremely resistant to change. Dieting usually doesn't work; in fact, typically when dieters stop dieting they gain back all their weight plus a few pounds each time they diet. Each person's body seems to have a set point weight where it naturally tends to stay. Dieting actually moves this set point upward in response to the deprivation the body experiences as a threat of starvation. Myth: Being underweight is not bad for your health. Fact: Researchers are now finding that being underweight is just as bad for health as being overweight. The recurrent cycle of weight loss and gain (yo-yo dieting) is now thought to be more harmful than just being large and staying large. Myth: Large=out of shape. Fact: Not necessarily true. There are exercise and aerobics programs for large people, and some large people have excellent strength and endurance. (Conversely, some slim people have very poor levels of physical fitness.) Myth: You can find out your ideal weight by consulting a weight table. Fact: Weight tables disagree about ideal weights. If you have not distorted your natural healthy weight by yo-yo dieting and you build sensible, moderate eating and exercise habits and a positive body image, your body will naturally settle at its healthiest weight. This may not be the same weight as another person your height, but it will be right for you. Life insurance company weight tables have been revised upward in recent years as studies indicate that heavier people live longer. It has been realised that the weight tables of the past have been artificially and unhealthily low. 4. Types of Eating Disorders a. Anorexia Nervosa People who intentionally starve themselves suffer from an eating disorder called anorexia nervosa. The disorder, which often begins in young people around the time of puberty, involves extreme weight loss - at least 15% below the individual's normal body weight. Some people with the disorder look emaciated but are convinced they are overweight. Sometimes they must be hospitalised to prevent starvation. People with anorexia typically starve themselves, even though they may experience severe hunger pains. One of the most frightening aspects of the disorder is that people with anorexia continue to think they are overweight even when they are bone-thin. For reasons not yet understood, they become terrified of gaining any weight. Food and weight become obsessions. For some, the compulsiveness shows up in strange eating rituals or the refusal to eat in front of others. It is not uncommon for Page 4 of 14

people with anorexia to collect recipes and prepare gourmet feasts for family and friends, but not partake in the meals themselves. They may adhere to strict exercise routines to keep off weight. Loss of monthly menstrual periods is typical in women with the disorder. Men with anorexia often become impotent. Specific Symptoms of this Disorder A person who suffers from this disorder is typically characterised by their refusal to maintain a body weight, which is consistent with their build, age and height. Specifically, a person's body weight is 85% or less than that which is considered typical for someone of similar build, age and height. The individual usually experiences an intense and overwhelming fear of gaining weight or becoming fat. This fear is regardless of the person's actual weight, and will often continue even when the person is near death from starvation. It is related to a person's poor self-image, which is also a symptom of this disorder. The individual suffering from this disorder believes that their body weight, shape and size is directly related to how good they feel about themselves and their worth as a human being. People with this disorder often deny the seriousness of their condition and cannot objectively evaluate their own weight. Physical Effects Chronic indigestion Loss of motivation Chemical imbalances Severe sensitivity to the cold Loss or thinning of hair Skin and nail problems Growth of fine body hair known as lanugo Severe weight loss Treatment The treatment of this disorder is often difficult. Some individuals are notoriously difficult to help. This is because of the disorder's insidious nature that wreaks havoc not only with the body, but just as seriously with the individual's negative self-perception. Usually starvation is not an immediate concern of most individuals who present with this disorder, but body weight and nutrition should be thoroughly evaluated at the onset of therapy. A complete medical examination is usually warranted to evaluate the patient's health and medical status. Underweight individuals often suffer from medical complications. Psychotherapy Psychotherapy needs to focus on a number of issues after a therapeutic, trusting relationship has been established. The most powerful issue is the obsession with body image, which is also the most difficult to change. These individuals can be an extremely challenging group to work with. Page 5 of 14

Hospitalisation Hospitalisation of anybody for a mental disorder can often be a confusing and emotionally wrought decision. Family members or significant others may need to intervene in the patient's life to ensure they do not starve themselves to death. In these cases, hospitalisation is not only necessary but also a prudent treatment intervention. Family members should be aware that individuals who suffer from anorexia nervosa will often resist treatment of any sort, especially hospitalisation. It is important, therefore, to come to an agreement about the need for such a step and not be swayed by the patient's pleas for seeking alternative treatment options. Often these have already been tried with no success. Medications Some medications can be extremely helpful in treatment of a person who suffers from anorexia nervosa. As always, the medication should be carefully monitored especially since the patient may be vomiting which may impact on the medication's effectiveness. A trusting and honest relationship must be established between the physician and the individual or medication compliance will almost certainly become an issue. Anti-depressants (such as selective serotonin re-uptake inhibitors, e.g. Prozac or Zoloft) are the usual drug treatment and may speed up the recovery process. Chlorpromazine may be beneficial for those individuals suffering from severe obsessions and increased anxiety and agitation. Self-Help Self-help methods for the treatment of this disorder are often overlooked by the medical profession because very few professionals are involved in them. Self-help support groups are an especially powerful and effective means of ensuring long-term treatment compliance and decrease the relapse rate. Individuals find they can bounce ideas off of one another, get objective feedback about body image, and just gain increased social support. Many support groups exist within communities throughout the world that are devoted to helping individuals with this disorder share their common experiences and feelings. b. Bulimia Nervosa People with bulimia nervosa consume large amounts of food and then rid their bodies of the excess calories by vomiting, abusing laxatives or diuretics, taking enemas, or exercising obsessively. Some use a combination of all these forms of purging. Because many individuals with bulimia binge and purge in secret and maintain normal or above normal body weight, they can often successfully hide their problem from others for years. Family, friends, and physicians may have difficulty detecting bulimia in someone they know. Many individuals with the disorder remain at normal body weight or slightly above. Dieting heavily between episodes of binging and purging is also common. Eventually, half of those with anorexia will develop bulimia. Page 6 of 14

As with anorexia, bulimia often begins during adolescence. The condition occurs most often in women but is also found in men. Many individuals with bulimia, ashamed of their strange habits, do not seek help until they reach their thirties or forties. By this time, their eating behaviour is deeply ingrained and more difficult to change. Specific Symptoms of this Disorder This disorder is characterised by recurrent episodes of binge eating, occurring at least twice a month for a minimum of three months, which consists of: Eating, in a discrete period of time (e.g., within any two-hour period), an amount of food that is definitely larger than most people would eat during a similar period of time and under similar circumstances. The food that is eaten is often the type which the person would usually try to avoid such as sweet or junk food. A sense of lack of control over eating during the episode (e.g. a feeling that one cannot stop eating or control what or how much one is eating). Individuals who suffer from this disorder often try to prevent themselves from gaining any weight. This behaviour may include such things as self-induced vomiting; overusing laxatives, diuretics, enemas, or other medications; refusing to eat (fasting); or excessive exercise. A person's self-image is usually directly correlated with their weight, with a great deal of attention focusing on how their body looks. This disorder can only be diagnosed if it is not better accounted for by anorexia nervosa. There are two major sub-types of disorders found within bulimia nervosa: Purging Type: - The person regularly engages in self-induced vomiting or the misuse of laxatives, diuretics, or enemas Non-purging Type: - The person has used other inappropriate compensatory behaviours, such as fasting or excessive exercise, but has not regularly engaged in self-induced vomiting or the misuse of laxatives, diuretics, or enemas Physical Effects Chronic sore throat Burning or rupturing of oesophagus Cessation of menstruation Strain on the body organs Delay in puberty Decreased bone mineral density Swollen salivary glands Erosion of dental enamel due to constant purging Weight fluctuation Page 7 of 14

Treatment As in treatment for anorexia nervosa, a supportive and trusting therapeutic relationship and good rapport must be established before any serious therapy gains can be made. Many of the same issues of a distorted self-esteem and self-perception that are relevant to anorexia treatment are similar to bulimia treatment. A complete medical examination is usually warranted to evaluate the patient's health and medical status. Underweight or overweight individuals often suffer from medical complications, especially if the person is using laxatives or vomiting as a method of controlling their over-eating behaviours. Therapy is most effective when it doesn't so much focus on the actual eating behaviours, although they are important, but instead examines the causes of those behaviours, such as poor self-perception. Medication Some medications can be extremely helpful for a person who suffers from bulimia. As always, the medication should be carefully monitored especially since the patient may be vomiting or taking large amounts of laxatives which may impact on the medication's use and effectiveness. A trusting and honest relationship must be established between the physician and the individual or mediation compliance will almost certainly become an issue. Anti-depressants (selective serotonin re-uptake inhibitors such as Prozac or Zoloft) are the usual drug treatment and may speed up the recovery process. Phenytoin and carbamazepine may also help reduce the frequency of the binging behaviours. Self-Help Self-help methods for the treatment of this disorder are often overlooked by the medical profession because very few professionals are involved in them. Self-help support groups are an especially powerful and effective means of ensuring long-term treatment compliance and decrease the relapse rate. Individuals find they can bounce ideas off one another, get objective feedback about body image, and gain increased social support. Many support groups exist within communities throughout the world that are devoted to helping individuals with this disorder share their common experiences and feelings. c. Compulsive Overeating Disorder It seems that in our society, people with compulsive overeating are not taken seriously in spite of the fact that they have a serious eating disorder. While many women suffer from this illness, there are a high number of men that also suffer. Our society glorifies thinness whilst not tolerating people who are obese. Compulsive overeating is a serious eating disorder that should not be taken lightly by those who suffer or by the people who love and care about them. Overeating is characterized by episodes of gorging, continuous eating and of weight gain. Please note, that there is a difference between compulsive binging and the occasional overindulgence we can all enjoy once in awhile. The weight of an individual suffering from compulsive overeating may vary from normal to severe obesity. A sufferer may be over exercising or compulsive exercising in an attempt just to burn calories and lose weight. Often they will sneak away behind closed doors to exercise in privacy. Where the average person can enjoy exercising for health benefits, the sufferer often does not and seems to forget that exercising can be fun and enjoyable. By over exercising, the sufferer seems to feel they are in Page 8 of 14

control and they gain a sense of self-respect. Like anorexia and bulimia, the sufferer is driven and fuelled by their fear of gaining more weight. It is easy to see how many over eaters can later develop bulimia or anorexia. Eating disorders are the preoccupation with body shape, food, thinness and control and it's no surprise when in today's world we all seem to want the perfect body and shape in which we can feel good and accepted. d. Binge Eating Disorder Binge eating disorder probably affects millions and is the newest recognisable eating disorder and perhaps even the most common. While people with bulimia are perfect examples of binge eating, it is rare for people with binge eating disorders to purge (self-induced vomiting) or use laxatives or diuretics. However, just because someone overeats does not mean they suffer from binge eating disorder. Some victims of binge eating disorder may show behaviours or have feelings such as: They eat faster than usual. Eat in privacy (usually over guilt and embarrassment about how much food is being consumed). They often feel they cannot control how much they eat. They will frequently eat when they are not hungry. Episodes of eating large quantities of food. Frequent feelings of disgust, self-hate or guilt after eating. Most sufferers of binge eating are obese. This is slightly more common in females than males. It is even more common in those who suffer from severe obesity. This disorder can be very difficult for those who have it and many who attempt to try and control it usually fail. There are times where victims may not attend social functions, school or even work so they stay in privacy to binge eat. Many feel embarrassed and ashamed and conceal their problem from others thus making them feel isolated and even depressed. Since so many binge eaters are preoccupied about their body weight and size, they may avoid or be absent from family gatherings or social functions. Close friends and family members of the sufferer are often unaware of the disorder. e. Eating Disorders Not Otherwise Specified (ED-NOS) Sometimes a person can experience symptoms of an eating disorder but not meet the criteria for a diagnosis of anorexia, bulimia or compulsive overeating. The fact that they do not meet recognised criteria does not mean that a problem may not exist. Many people have disordered eating patterns, such as being overly concerned with eating healthily, or having strict rituals around eating. If left untreated, such eating patterns can develop into disorders. Even if they don t, ED-NOS can have a negative effect on both mental and physical health. 5. Telling Someone about Your Eating Disorder Tell someone you trust. First, you can start by telling a close friend or family member that you trust. It is important that you feel comfortable with that person and feel comfortable talking to them. Bring someone with you. If you are telling your family and think you will have great difficulty, consider having a friend with you for support and encouragement. Having a therapist present while you talk to your family can also provide you with more security. The therapist can offer information, help discuss feelings and be there to answer questions. Page 9 of 14

Bring information with you. The person you choose to tell may not know a lot about eating disorders and maybe even nothing at all. It would be a good idea to bring a book or sheets of information you have about eating disorders. Write a letter. When it is too difficult to say things verbally to someone, writing a letter can be a great way to communicate. You can tell someone about your eating disorder in a letter and express your thoughts, feelings and fears. You can take time to write your letter and give more thought as to how to say things. This also gives the recipient of your letter time to react and think about your letter and they can even reread your letter if they wish and need to. A letter is a good idea if you are too afraid to tell but want someone to know. 6. Families and Friends Communicate Try to talk to your friend or loved one in a gentle and loving manner. There isn't anything wrong with going to them and telling them you are worried and concerned about them. You can also let them know that you are there to listen if they want to talk about anything. Research Another thing you can do is to educate yourself on the topic of eating disorders. There are many books available at your local library or bookstore. They will offer information on a variety of issues pertaining to Eating Disorders. The more educated you are, the more of a help you will become to your friend or loved one. There are also many websites on the Internet about Eating Disorders. Not only can you find support for the sufferer but you may have the opportunity to seek support from others that have endured the same experience as you. Chat rooms can be a great way to meet others and a great way to communicate. Listen Learn to be a great listener. Eating disorders are not just about food. They are about a way to feel in control, a way to hide; a way of coping and dealing with emotional pain, low self-esteem, stress and depression. It may be difficult but try to pay more attention to what comes out of their mouth rather than what's going in. Telephone Interpreter Service 131 450 If English is not your first language please call the Mental Health Information Service through the Telephone Interpreter Service (TIS).This service is free to non-english speaking Australian citizens or permanent residents. TIS have access to interpreters speaking more than 120 languages and dialects. Page 10 of 14

7. Eating Disorder Test This test is to help you determine if you may have an eating disorder. Answer YES or NO to the following questions: Do you feel out of control when you eat? Do you starve yourself? Do you feel in control when you don't eat? Do you feel you don't deserve to eat? Do you have an intense fear of gaining weight? Do you believe you are fat even though others disagree? Do you use diet pills or laxatives to control your weight? Do you feel guilt after eating? After eating, do you binge and self-induce vomiting? Do you binge if you are feeling sad? Do you feel food and weight are the only things that you have control over? Do you tell yourself you're ugly, fat, worthless, etc.? Do you avoid social gatherings or meals because of food? Are you ashamed of your eating habits? Do you think about food constantly? Do you exercise excessively to lose weight? Do you believe you will be happier if you lose weight? Do you get angry with people if they ask you about your eating habits? Are you secretive about what you eat or don't eat? Do you have a need to be perfect? Do you lie about your weight loss and make efforts to hide it from others? Do you constantly think about food, calories and recipes? Do you think that you may have an eating disorder? If you have answered YES to four or more of the questions then you may have an eating disorder. It is suggested that you discuss matters with your health care provider, therapist or someone who specialises in eating disorders. Also consider talking to a close friend or family member who may help lead you in the right direction to get help. 8. Where to Get Help? Your local GP. Community Health Centre (under Community Health Centres in the White Pages). School counsellor or teacher. The Centre for Eating and Dieting Disorders: (02) 9515 5843 or www.cedd.org.au Telephone Counselling Services eg. Lifeline 131 114, Salvo Careline 02 9331 6000, Kids HelpLine 1800 551 800. Many hospitals have Eating Disorder Units, contact them directly for details. Mental Health Information Service 1300 794 991 (for services in your area). The Butterfly Foundation on (02) 9412 4499 or www.thebutterflyfoundation.org.au Page 11 of 14

Medicare Rebates and Accessing Private Practitioners What is the difference between psychiatrists and psychologists? Psychiatrists are medically trained doctors who specialise in the treatment of mental illness. Like GPs they can prescribe, administer and monitor medication. Psychiatrists do not advertise so it is up to your GP to refer you to someone appropriate. Psychologists are trained in human behaviour and use a range of therapies to treat patients. They provide services including assessment, psychological testing, and various types of psychotherapy and counselling. Medicare rebate for psychologists A Medicare rebate is now available for a number of sessions per calendar year with a registered psychologist* with a Medicare Provider Number. To obtain the rebate you must be referred by an appropriate medical practitioner, i.e. a GP, psychiatrist or paediatrician. The practitioner will ensure that you meet the eligibility requirements and develop a management plan for your condition. The cost and rebate from Medicare can vary depending on the consultation length and fee charged. If the psychologist bulk bills there will be no extra cost. For further information about the rebate or to locate a psychologist in your area contact the Australian Psychological Society on 1800 333 497 www.psychology.org.au. * Similar Medicare rebates also exist for mental health accredited social workers and occupational therapists. 10. Further Reading Anatomy of Anorexia, by Steven Levenkron, published by W.W. Norton, 2001, ISBN 0393321010 Anorexia and Bulimia in the Family One Parent s Practical Guide to Recovery, by Grainne Smith, published by Wiley, 2003, ISBN 0470861614 Anorexia Nervosa and Bulimia How to Help, by Duker and Slaed, published by Open Uni Press, 2000, ISBN 0335212034 Lazy Person s Guide to Beating Overeating, by Gillian Riley, published by New Leaf Pub, 2002, ISBN 0717132692 Fighting with Food Overcoming Bulimia Nervosa, by Huon and Brown, published by New South Wales University, 1999, ISBN 0868400513 About Anorexia and Bulimia, written and published by ARAFMI. This title is available for purchase from the Mental Health Information Service The Beauty Myth, by Naomi Wolf, Vintage Publishing, 1990, ISBN: 0060512180 Page 12 of 14

Mental Health Information Service Tel: 1300 794 991 Largest information data base of government and non-government mental health services in NSW Extensive range of mental health publications & videos Mutual support & self help groups Referral for a wide range of mental health services Library & Resource Centre Mental Health Information Service Mental Health Association NSW Level 5, 80 William Street East Sydney NSW 2011 email: info@mentalhealth.asn.au website: www.mentalhealth.asn.au Page 13 of 14

Mental Health Resource Centre The Resource Centre contains material that promotes a better understanding of mental health issues. New books and DVDs are purchased on a regular basis and visitors are welcome to come in and browse. Members of MHA, CAG and ARAFMI may check-out resources on loan. The length of the loan is 3 weeks. Membership costs between $10 - $30 per individual per annum. Please note that most of the reference books are not available for loan You will find the Resource Centre Booklist on our website: www.mentalhealth.asn.au for further information contact 1300 794 991. Disclaimer This information is for educational purposes. As neither brochures nor websites can diagnose people it is always important to obtain professional advice and/or help when needed. The listed websites provide additional information, but should not be taken as an endorsement or recommendation. This information may be reproduced with an acknowledgement to the Mental Health Association NSW. This and other fact sheets are available for download from www.mentalhealth.asn.au. The Association encourages feedback and welcomes comments about the information provided. This fact sheet was last updated in July 2010. Mental Health Information Service Mental Health Association NSW Inc Level 5, 80 William Street East Sydney NSW 2011 Phone: 1300 794 991 Fax: (02) 9339 6066 Email: info@mentalhealth.asn.au Web: www.mentalhealth.asn.au Page 14 of 14