Article - Eating Disorders: How to Help

Does my friend or family member have an eating disorder?

Given that we live in a culture that is preoccupied with thinness and physical appearance, it may be difficult to tell if your family member or friend is struggling with an eating disorder. Eating disorders are life-threatening and have serious long-term health implications if left untreated. They have the best prognoses and cure-rates if detected and treated early. Below describes some signs that your loved one may have an eating disorder.

Anorexia Nervosa
In simple terms, anorexia is self-imposed starvation. It can lead to permanent, severe medical problems (e.g., infertility, osteoporosis) and death. In the short term, anorexia can cause the cessation of normal physical and psychological development, leaving the patient "stuck" at a certain developmental stage.

Some signs/symptoms:

1. Weight loss or in the case of the still-growing child, failure to gain weight.
2. Dieting or restricting food even if not overweight.
3. Preoccupation with thinness.
4. Distorted body image - a marked discrepancy between what she thinks she looks like and what others see.
5. Denies hunger.
6. Excessive exercise, and/or distress when she can't exercise.
7. Weighs herself frequently and/or does other "checking" behavior such as measuring, feeling abdomen, etc.
8. Thinning hair, a general appearance of not being "well."
9. Sadness, isolation (doesn't connect with friends in the same way), nervousness, agitation.
10. Becomes rigid about other things (e.g., grades, performance).
11. Rituals with food that weren't present before.
12. Cold intolerance.
13. Ceases menstruation, or has menstrual irregularities.
14. Just doesn't seem like herself.

Bulimia Nervosa
Bulimia is a cycle of repeated "out of control" eating followed by some sort of "undoing" behavior (self-induced vomiting, laxative abuse, excessive exercise). Bulimia Nervosa can also lead to severe medical problems and even death.

Some signs/symptoms:

1. Rapid, noticeable fluctuations in weight.
2. Guilt or shame about eating.
3. Body image distortion.
4. Obsessive concern about weight.
5. Frequently uses bathroom after meals.
6. Swollen gland in cheeks and neck.
7. Mood swings.
8. Low self-esteem.
9. Feels depressed or remorseful after eating.

For parents: Please note that while the above are all hallmarks of eating disorders, some people are very skilled at hiding their struggles with food and eating. If you have a concern about your child's eating behaviors/attitudes, even if she doesn't fit the symptom profile, pay attention to your instincts. A parental feeling of something being "not quite right" should never be ignored.

What to do if you suspect your child has an eating disorder

Seek professional help immediately. Ask your pediatrician for a referral to an Eating Disorders Specialist. A specialist should be a licensed psychotherapist who has received specialized training in the field of eating disorders, and who understands the physical implications of eating disorders, and has a well-articulated plan for your child's treatment. He/she should also have a good working relationship with a licensed dietitian who is also educated in the field of eating disorders. Don't rely on your insurance plan to provide you with a referral to such a practitioner, ask the questions yourself.

Treat your child with compassion. Understand that eating disorders are a disease, not a willful act on your child's part. Say, "I know this must be hard for you, but we are going to work it out," as opposed to "you need to start eating or all your hair will fall out."

Don't threaten or cajole. Again, your child does not intend to be self-destructive; rather, she is stuck in a pattern of dysfunctional coping that is worsened by malnourishment. No one thinks clearly when undernourished.

Remember that your child is feeling badly about herself. Treatment is helped by stressing your unconditional love and concern. Children with eating disorders are very quick to perceive criticism in even innocent remarks. For example, "you aren't going to be allowed to go to dance classes until you start eating" may be perceived as punishment for noncompliance. A better approach is, "I know it's disappointing that you can't go to dance right now, but I'm so proud that you are working on getting better."

Educate yourself about eating disorders. Here are some resources:

• www.bulimia.com has an excellent resource catalogue for books and other material about eating disorders.
• www.somethingfishy.org is an excellent website for people with eating disorders and their loved ones.
• www.renfrew.org is a treatment facility, but also publishes good information about eating disorders and treatment.
• www.aed.org-
  The Academy for Eating Disorders is a good source of information for professionals and laypersons.

Dr. Kelly Boswell, a leading provider of psychology services in North Florida and an expert in the treatment and prevention of obesity and eating disorders, heads the Boswell Center. The Center offers personalized treatment and follow-up processes that are second to none, with a full spectrum of services, including and registered dietitians.

For more information, call (904) 249-3881.

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