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Eating Disorders Mental Health Parenting Recovery Treatment

Stress, an Eating Disorder, and Mental Health

…Eating Disorder… (Photo credit: ĐāżŦ {mostly absent})

A while back, I wrote about a child of 8 years old who was showing early signs of disordered eating behaviors. As noted at that time, the behavior was fueled by a father with his own poor relationship around food and a mother who is also victimized by his negative body and food talk. I’ve watching this child over the last year, hoping I was wrong, but knowing more and more that the signs I was seeing were none other than an eating disorder being nurtured and fed by self-hatred, stress, and a negative environment. Her organization of food has gotten more intense, as has her open disgust around whatever is on her plate. It’s not so much about being “fat” but more about her discernment around eating a growing number of “certain” foods.

There’s stress all around this kid: her father is impatient and fixated on his own weight and body image. Her mom is reacting to his actions by persistently apologizing when she eats, joining Weight Watchers, and choosing to ignore the cry for help at the dinner table. As a regular in their household, it’s been hard to watch and harder still not to say anything for fear of being shut out entirely. I’ve used my presence as an opportunity to change the dialogue when I can, but it’s hard speaking to a room full of deaf ears. I finally did say something when the negative talk was directed at me and as expected, my comment, despite coming from love, was met with a “Nah, I’m not worried about that.”

 

Stress is a huge culprit here. According to the Eating Recovery Center, “childhood stress is typically: personal, interpersonal, interfamilial, or global (a stress reaction to national or world news).”

  • Age is not a factor: Children of all ages experience stress, though they may express it differently.
  • Children are vulnerable.
  • Children respond differently to the stress in their environment.
  • Stress is cumulative. Adults aren’t the only one’s who can “only take so much.”
  • Change is stressful. Even positive change. I am reminded here of reorganizing a room in my house and my son getting utterly overwhelmed even though the change was positive. Our nervous systems are indifferent to our whims and desire to pile on more and more and the fact that we all may have a different response is something to be noted and respected.

Parents and adults alike would be wise to open a dialogue with their kids about stress and one’s perceptions of how things are. In the case of my young eating disorder study, dad is never around and only available on weekends; when he is there, he’s impatient and obsessively exercising or on his computer—detached from everyone. This provides a huge source of stress for her and for the rest of her family. Unfortunately, this has been weaved into her negative self talk and commentary about her family and hinders her relationships with others and with food. She’s angry, stressed out, and starving herself in response.

What can we do? We can start with the following:

  • Be an example of positive body talk.
  • Talk to our kids. Be open and honest, but be loving.
  • Eat mindfully. Turn off the TV. Make mealtime a place of solace and connection.
  • Don’t talk about stressful subjects at the dinner table. In other words: keep it light.
  • Don’t use food or eating as a means of punishment. (You’re going to bed without dinner).
  • Encourage self-care and self-love: At dinner, ask each person to express one thing they are grateful for.
  • Cook together. Show them that food isn’t the enemy.
  • Go on hikes or family walks.
  • Have family meetings. We do them council style in my house. It makes a world of difference.
  • Don’t be afraid to ask for professional help.
  • Be honest with your therapist. They can’t help you if you hold back.
  • Find a support group—being alone with your child or family is in crisis is too much for anyone.
  • Take care of yourself so you can take care of those around you.

If you’re worried that your son or daughter might be developing an eating disorder (note: boys are not immune to this!), look out for some of these signs.

(Please note, certain behaviors are warning signs, but in combination and over time, they can become quite serious):

Behaviors specific to anorexia:

  • Major weight loss (weighs 85% of normal weight for height or less)
  • Skips meals, always has an excuse for not eating (ill, just ate with a friend, stressed-out, not hungry).
  • Refuses to eat in front of others
  • Selects only low fat items with low nutrient levels, such as lettuce, tomatoes, and sprouts.
  • Reads food labels religiously; worried about calories and fat grams in foods.
  • Eats very small portions of foods
  • Becomes revolted by former favorite foods, such as desserts, red meats, potatoes
  • May help with meal shopping and preparation, but doesn’t eat with family
  • Eats in ritualistic ways, such as cutting food into small pieces or pushing food around plate
  • Lies about how much food was eaten
  • Has fears about weight gain and obesity, obsesses about clothing size. Complains about being fat, when in truth it is not so
  • Inspects image in mirror frequently, weighs self frequently
  • Exercises excessively and compulsively
  • May wear baggy clothing or many layers of clothing to hide weight loss and to stay warm
  • May become moody and irritable or have trouble concentrating. Denies that anything is wrong
  • May harm self with cutting or burning
  • Evidence of discarded packaging for diet pills, laxatives, or diuretics (water pills)
  • Stops menstruating
  • Has dry skin and hair, may have a growth of fine hair over body
  • May faint or feel dizzy frequently

Behaviors specific to bulimia

  • Preoccupation or anxiety about weight and shape
  • Disappearance of large quantities of food
  • Excuses self to go to the bathroom immediately after meals
  • Evidence of discarded packaging for laxatives, diuretics, enemas
  • May exercise compulsively
  • May skip meals at times
  • Teeth may develop cavities or enamel erosion
  • Broken blood vessels in the eyes from self-induced vomiting
  • Swollen salivary glands (swelling under the chin)
  • Calluses across the joints of the fingers from self-induced vomiting
  • May be evidence of alcohol or drug abuse, including steroid use
  • Possible self-harm behaviors, including cutting and burning

If you notice even one of these, it’s time to address it. Talk to your daughter or son, talk to your doctor. If necessary, elicit the help of a treatment facility. In other words: Get help. Showing our kids that we care and are willing to stop our own negative behaviors in order to help them is invaluable. It’s a family problem, not an individual one.

Categories
Body Image Eating Disorders Mental Health Recovery

Eating Disorders: Recovery and Service

Eating disorders can breed contempt or denial in those that don’t understand them while feeding the silent devastation and fear in those who have them. This is an inherently challenging situation. Types of eating disorders vary but we are most familiar with Anorexia and Bulimia or a variation of the two. Still, there are some who suffer from disordered eating. I’ve heard it said that disordered eating is not an “actual eating disorder,” but rather a “phase” of bad eating behaviors.  However, the DSM and professionals in the field of addiction and mental illness have proven that not to be the case. For example, disordered eating has now earned the diagnostic term Eating Disorder Not Otherwise Specified or EDNOS.

For real clarification, the DSM descriptions of the various criteria for Anorexia, Bulimia, and EDNOS can be found below:

Eating disorder not otherwise specified includes disorders of eating that do not meet the criteria for any specific eating disorder.

  1. For female patients, all of the criteria for anorexia nervosa are met except that the patient has regular menses.
  2. All of the criteria for anorexia nervosa are met except that, despite significant weight loss, the patient’s current weight is in the normal range.
  3. All of the criteria for bulimia nervosa are met except that the binge eating and inappropriate compensatory mechanisms occur less than twice a week or for less than 3 months.
  4. The patient has normal body weight and regularly uses inappropriate compensatory behavior after eating small amounts of food (e.g., self-induced vomiting after consuming two cookies).
  5. Repeatedly chewing and spitting out, but not swallowing, large amounts of food.

The criteria for Anorexia Nervosa is:

  • Refusal to maintain body weight at or above a minimally normal weight for age and height: Weight loss leading to maintenance of body weight <85% of that expected or failure to make expected weight gain during period of growth, leading to body weight less than 85% of that expected.
  • Intense fear of gaining weight or becoming fat, even though under weight.
  • Disturbance in the way one’s body weight or shape are experienced, undue influence of body weight or shape on self-evaluation, or denial of the seriousness of the current low body weight.
  • Amenorrhea (at least three consecutive cycles) in postmenarchal girls and women. Amenorrhea is defined as periods occurring only following hormone (e.g., estrogen) administration.

And the criteria for Bulimia Nervosa:

  • Recurrent episodes of binge eating characterized by both:
  1. Eating, in a discrete period of time (e.g., within any 2-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
  2. A sense of lack of control over eating during the episode, defined by a feeling that one cannot stop eating or control what or how much one is eating
  3. Self-induced vomiting
  4. Misuse of laxatives, diuretics, enemas, or other medications
  5. Fasting
  6. Excessive exercise
  • Recurrent inappropriate compensatory behavior to prevent weight gain
  • The binge eating and inappropriate compensatory behavior both occur, on average, at least twice a week for 3 months.
  • Self-evaluation is unduly influenced by body shape and weight.
  • The disturbance does not occur exclusively during episodes of anorexia nervosa

Recovering from any of these eating disorders is hard work. We have to learn to navigate the food playing field with healthy awareness. One of the interesting things I’ve learned about recovering from my own eating disorder is that food is merely a symptomatic component of the greater problem: low self-esteem, an out of control environment, poor body image, fear, control. Not eating was always a way to control the chaos around me. What I was clueless about was the fact that I was created chaos within. The more out of control the outside environment is, the more control someone struggling with an eating disorder requires to simply survive. Yes, there’s deep irony in the use of “survive” here, because the end result of some severe eating disorders is ultimately death.

Chelsea Roff, a recovering anorexic, yoga teacher, speaker, and author, has come out publically with her story of recovery. Chelsea suffered from a stroke when she was 15 and ended up in a hospital for 18 months under constant care. Her essay, bravely discussing her story first appeared in the book 21st Century Yoga: Culture, Politics, & Practice. From there, she was swept into the fray of instant publicity and exposure, ranging from the Huffington Post to Dr. Sanjay Gupta on CNN. While being in recovery isn’t about celebrity, there’s something to be said for a young girl who is taking this exposure and using it for good. There’s something deeply inspiring about someone who came from near death and is now thriving and being of service. In the end, being of service is what it’s about.

Eating disorders have their way of creeping back in when we least expect it. When we are of service and helping others, our own transparency is paramount to that process. In other words, being of service helps keep us honest. We have to eat. We have to learn to develop healthy relationships with our bodies and with food. Here, instead of vigilantly controlling our intake of calories, we can direct our vigilance to being of service. I look to Voice in Recovery and Chelsea Roff as young women who give back what was so freely given to them. I look to Melanie Klein (also a contributor in 21st Century Yoga) and Claire Mysko to provide the education and passion for body image advocacy in order to help young people gain a better understanding of the deeply rooted, media-infused sources of poor body image and eating disorders.

Kindness starts from within. We can and will recover.

RESOURCES:

NEDA

NIMH

Proud2BMe

Voice in Recovery (ViR)

 

Categories
Body Image Eating Disorders Mental Health

Graduation: Europe or Lipo?

“Kid, you’ll move mountains!
So…be your name Buxbaum or Bixby or Bray or Mordecai Ale Van Allen O’Shea, 
You’re off to Great Places!
Today is your day!
Your mountain is waiting.
So…get on your way!” – Dr. Seuss
Image by MarinaCr via Flickr

Certainly, for some teens, plastic surgery can be positively life-changing. For example: a child who’s subject to excessive teasing because of an inordinately large nose may positively benefit from rhinoplasty; a burn victim can return to relative normalcy with appropriate plastic surgery; a breast reduction can allow a young girl to exercise without neck and back pain. On the other hand, what lies beyond what’s necessary for some is the skewed perceptions of beauty and perceived normalcy inadvertently thrust upon teens through social and mainstream media.  The innate dissatisfaction with how we look contributes to how we meet the world. To really illustrate this, we can look at the recent uproar that came about when a mother defended her decision to give her 8-year-old daughter Botox injections. Makes you wonder: What 8-year-old has wrinkles? Better yet, what 8-year-old is even aware of wrinkles?


 
“Statistics gathered over the last several years indicate a decrease in the overall number of cosmetic (aesthetic) surgeries of teenagers (those 18 and younger) having cosmetic surgery, with nonsurgical procedures including laser hair removal and chemical peels being the most popular in 2010.”

These statistics are both good and bad. I mean, the fact that less invasive surgeries are on the decline is certainly positive, but I am concerned about the remaining high numbers of girls seeking these procedures.  We know teens are up against extraordinary pressure to look and be a certain way–some of it is normal adolescence–but when parents start giving their kids gift certificates for a new nose or new breasts, the lesson becomes less about self-esteem and more about trying to attain the pop-culture paradigm of perfection.

So, what does this mean from a recovery standpoint?  Well, if we start by parenting our children with this idea that they aren’t enough, we end up sowing the seeds of self-hatred and dissatisfaction. Instead of laying a foundation of confidence and positive self-esteem, we end up paving a rocky road to addictive behaviors, which inevitably contributes to disordered eating and eating disorders alike. There’s no reason why this can’t be a springboard to have a heart-to-heart with your teen. It’s also an opportunity to look at what messages we are trying to give our kids. Being a teen is tough; let’s not contribute to the social tyranny by fanning the fires of social awkwardness. This too shall pass.

Bottom line? There are far more appropriate gifts for your teen than going under anesthesia and accumulating scars, no matter how small they are.  

Links that may be of interest:
Categories
Body Image Eating Disorders Mental Health Recovery Therapy

Starving at 8

image © sarit photography

I know an 8-year-old who’s been known to choose an outfit specifically because it makes her “look thin.” This same 8-year-old often doesn’t finish meals because she thinks she’s fat. She’s the same 8-year-old that has begun to develop food rituals, often leaving the table with a reorganized plate full of uneaten food. Simply put, she already has an irrational fear of getting fat.
It’s hard being a girl. It’s hard to find a way to look at your unique self without comparing it with images of Barbie or Bratz. It’s hard to accept that  the beauty standard set by Cinderella or Sleeping Beauty isn’t actually real. But children, whose minds are filled with wonderful imagination and fantasy, aren’t going to cognitively recognize images that are potentially harmful. Instead, many will attempt to achieve the pink, thin, fluffiness of a Disney princess, or the skinny sass of a Bratz doll. Often times, even when parents are encouraging a healthy body image, the education on the school yard has a dramatically different lesson plan than the one from home. I’ve overheard conversations on the school yard that have made me pause – -it’s clear that body-image issues are in abundance and the pressure to look thin and svelte is invasive and intense.

So what can parents do? Start with eliminating the shame game. This might mean letting your daughter dump that maple syrup on her pancakes or having a cupcake at a birthday party. It’s a treat, not a vehicle for punishment!  Encourage healthy eating, but can you do it with compassion rather than the mallet of criticism?  Eliminate “fat talk”: your kids don’t need to hear it and frankly, it’s not good for you either. Stop trying to control what those around you eat. It’s not your job!  I’ve seen dads controlling the food intake of their wives and daughters to the point of devastating eating disorders (my dad was one!); and I’ve seen moms spewing “fat talk” or signing up for any and every diet fad while their daughters learn to eat in secret or restrict because they’re terrified of the incendiary reaction of their parental food monitors. These behaviors certainly don’t encourage self-love. If anything, they sow the seeds of self-destruction.

If you’re worried that your son or daughter might be developing an eating disorder (note: boys are not immune to this!), look out for some of these signs.

(Please note, certain behaviors are warning signs, but in combination and over time, they can become quite serious):

Behaviors specific to anorexia:

  • Major weight loss (weighs 85% of normal weight for height or less)
  • Skips meals, always has an excuse for not eating (ill, just ate with a friend, stressed-out, not hungry).
  • Refuses to eat in front of others
  • Selects only low fat items with low nutrient levels, such as lettuce, tomatoes, and sprouts.
  • Reads food labels religiously; worried about calories and fat grams in foods.
  • Eats very small portions of foods
  • Becomes revolted by former favorite foods, such as desserts, red meats, potatoes
  • May help with meal shopping and preparation, but doesn’t eat with family
  • Eats in ritualistic ways, such as cutting food into small pieces or pushing food around plate
  • Lies about how much food was eaten
  • Has fears about weight gain and obesity, obsesses about clothing size. Complains about being fat, when in truth it is not so
  • Inspects image in mirror frequently, weighs self frequently
  • Exercises excessively and compulsively
  • May wear baggy clothing or many layers of clothing to hide weight loss and to stay warm
  • May become moody and irritable or have trouble concentrating. Denies that anything is wrong
  • May harm self with cutting or burning
  • Evidence of discarded packaging for diet pills, laxatives, or diuretics (water pills)
  • Stops menstruating
  • Has dry skin and hair, may have a growth of fine hair over body
  • May faint or feel dizzy frequently

Behaviors specific to bulimia

  • Preoccupation or anxiety about weight and shape
  • Disappearance of large quantities of food
  • Excuses self to go to the bathroom immediately after meals
  • Evidence of discarded packaging for laxatives, diuretics, enemas
  • May exercise compulsively
  • May skip meals at times
  • Teeth may develop cavities or enamel erosion
  • Broken blood vessels in the eyes from self-induced vomiting
  • Swollen salivary glands (swelling under the chin)
  • Calluses across the joints of the fingers from self-induced vomiting
  • May be evidence of alcohol or drug abuse, including steroid use
  • Possible self-harm behaviors, including cutting and burning

If you notice even one of these, it’s time to address it. Talk to your daughter or son, talk to your doctor. If necessary, elicit the help of a treatment facility. In other words: Get help. Showing our kids that we care and are willing to stop our own negative behaviors in order to help them is invaluable. It’s a family problem, not an individual one.

Some helpful links:

NEDA
WebMD
Voice in Recovery
Peggy Orenstein
maudsleyparents.org
Also, check out “Brave Girl Eating: A Family’s Struggle With Anorexia” By Harriet Brown