Eating Disorder Awareness

1. Eating Disorder Awareness Jennifer Richards

2. Prevalence Up to 24 million people suffer from eating disorders in the U.S. 1 in 5 women struggle with eating disorders or disordered eating. 95% of those who have eating disorders are between the ages of 12 and 25. 25% of college-aged women engage in bingeing and purging as a weight-management technique. Anorexia nervosa is the 3rd most common chronic illness among adolescents. About 72% of alcoholic women younger than 30 also have eating disorders. Men and women with higher levels of femininity have greater levels of dieting behaviors. Renfrew Center Foundation

3. Mortality Rate Eating disorders have the highest mortality rate of any mental illness. The mortality rate associated with anorexia nervosa is 12x higher than the death rate of ALL causes of death for females 15- to 24-years-old. 20% of people suffering from anorexia nervosa will prematurely die from complications related to their eating disorder, including suicide and heart problems. The fatalities associated with eating disorders are primarily from cardiovascular collapse and suicide. Renfrew Center Foundation

4. Men and Eating Disorders An estimated 10 to 15% of people with anorexia nervosa or bulimia nervosa are male. Among gay men, nearly 14% appeared to suffer from bulimia nervosa and over 20% appeared to suffer from anorexia nervosa. Renfrew Center Foundation

5. Media There is now a $40 billion diet industry which was non-existent 20 years ago. The body type portrayed in advertising as the ideal is possessed naturally by only 5% of the American females. Renfrew Center Foundation

6. Anorexia Nervosa Anorexia nervosa is defined as a serious life-threatening disorder characterized by deliberate self-starvation and the following: Refusal to maintain body weight at or above a minimally normal weight for age and height (< 85% of that expected) Intense fear of gaining weight or becoming fat, even though underweight A disturbance in the way one’s body weight/shape is experienced (self-evaluation, denial of seriousness of current low body weight) Amenorrhea (absence of at least 3 consecutive periods) Anorexia nervosa is then subdivided into a restricting type and a binge eating/purging type. restricting – individual has not regularly engaged in binge-eating or purging behavior (self-induced vomiting or misuse of laxatives, diuretics, or enemas) binge-eating/purging – individual has regularly engaged in binge-eating or purging behavior (self-induced vomiting or misuse of laxatives, diuretics, or enemas) DSM-IV-TR American Psychiatric Association

7. Bulimia Nervosa Bulimia nervosa is a serious life-threatening disorder characterized by recurrent episodes of binge eating usually followed by self-induced vomiting or some form of purging as a means of controlling weight (ex. vomiting, laxatives, diuretics, other medications, fasting, excessive exercise). Recurrent episodes of binge eating. Binge eating is characterized as: • Eating, in a discrete period of time (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 • A sense of lack of control over eating during the episode (a feeling that one cannot stop eating or control what or how much one is eating Recurrent inappropriate compensatory behavior in order to prevent weight gain, such as self-induced vomiting; misuse of laxatives, diuretics, enemas, or other medications; fasting; excessive exercise The binge eating and inappropriate compensatory behaviors 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 Bulimia nervosa is subdivided into purging and non-purging types. • purging – individual has regularly engaged in self-induced vomiting or the misuse of laxatives, diuretics, or enemas • nonpurging – individual has used other inappropriate behaviors, such as fasting or excessive exercise, but has not regularly engaged in self-induced vomiting or the misuse of laxatives, diuretics, or enemas DSM-IV-TR American Psychiatric Association

8. Eating Disorder (NOS) Eating Disorder Not Otherwise Specified is for disorders of eating that do not meet the criteria for any specific Eating Disorder. Examples: 1. For females, all criteria for Anorexia Nervosa is met except that the individual has regular periods 2. All of the criteria for Anorexia Nervosa are met except that, despite significant weight loss, the individual’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 at a frequency of less than twice a week or for a duration of less than 3 months 4. The regular use of inappropriate compensatory behavior by an individual of normal body weight after eating small amounts of food (e.g., self-induced vomiting after the consumption of two cookies). 5. Repeatedly chewing and spitting out, but not swallowing, large amounts of food 6. Binge-eating disorder: recurrent episodes of binge eating in the absence of the regular use of inappropriate compensatory behaviors characteristic of Bulimia Nervosa DSM-IV-TR American Psychiatric Association

9. Disordered Eating in Athletes Disordered eating - food restriction, excessive avoidance of certain types of food, or consuming fewer calories than needed for basic daily functions and sports activity, binge/purging, misuse of laxatives, diuretics, medications. Athletes suffering from disordered eating can experience chronic and substantial distress and impairment. Coaches and Teachers are around athletes/students enough that they can help recognize symptoms if they know what to look for. Recognize & Consider Circumstances injuries (e.g., fractures, sprains, etc.) excessive fatigue passing out/fainting moodiness or inconsistent personality NEDA

10. What to look for in Athletes Anorexia Nervosa – extremely thin, often become so thin that they develop lanugo (fine hair on their body, often on the face, to help keep the body warm). They may suffer from extreme electrolyte and hormonal imbalances, cardiac arrhythmias, low blood counts, anemia, osteopenia, or osteoporosis. Bulimia Nervosa - common and hard to detect in athletes because of intense training can mask and coincide with purging. The ease of avoiding detection may keep the athlete in denial as well. Athletes suffering from bulimia nervosa may have some or all of the general disordered eating signs and symptoms, but also are at higher risk for esophageal tears from vomiting, gastrointestinal complications such as diarrhea or constipation, dental caries, and calluses on their hands from induced vomiting. NEDA

11. Eating Disorders can be Prevented What is Eating Disorder Prevention? Prevention is any systematic attempt to change the circumstances that promote, initiate, sustain, or intensify problems like eating disorders. Primary prevention designed to prevent the occurrence of eating disorders before they begin. Secondary prevention (sometimes called “targeted prevention”) designed to recognize and treat an eating disorder before it spirals out of control. The earlier an eating disorder is discovered and addressed, the better the chance for recovery. NEDA

12. Basic Principles for the Prevention of Eating Disorders Eating disorders are serious and complex problems. We need to avoid thinking of them in simplistic terms, like “anorexia is just a plea for attention,” or “bulimia is just an addiction to food.” Eating disorders are not just a “woman’s problem” or “something for the girls.” Males who are preoccupied with shape and weight can also develop eating disorders. In addition, the objectification and other forms of mistreatment of women by males can contribute directly to two underlying features of an eating disorder: obsession with appearance and shame about one’s body. As teachers – prevent by example - if you hear it, stop it NEDA

13. Basic Principles for the Prevention of Eating Disorders Prevention efforts will fail, or worse, may encourage disordered eating, if only warning signs, symptoms, and dangers of eating disorders are addressed. Effective prevention programs must also address: Our cultural obsession with slenderness as a physical, psychological, and moral issue. The roles of men and women in our society. The development of people’s self-esteem and self-respect in a variety of areas (school, work, community service, hobbies, etc.) that transcend physical appearance. Encourage speaking to counselor - opportunities for participants to speak confidentially with a trained professional with expertise in the field of eating disorders, and, when appropriate, receive referrals to sources of competent, specialized care. NEDA

14. Factors that may Contribute to Eating Disorders Complex conditions that arise from a combination of long-standing behavioral, biological, emotional, psychological, interpersonal, and social factors. begin with preoccupations with food and weight, are most often about much more than food often use food and the control of food to compensate for feelings and emotions that may otherwise seem over-whelming dieting, bingeing, and purging may begin as a way to cope with painful emotions and to feel in control of one’s life, but ultimately, will damage a person’s physical and emotional health, self-esteem, and sense of competence and control NEDA

15. Factors that may Contribute to Eating Disorders Psychological Factors: • Low self-esteem • Feelings of inadequacy or lack of control in life • Depression, anxiety, anger, or loneliness Interpersonal Factors: • Troubled personal relationships • Difficulty expressing emotions and feelings • History of being teased or ridiculed based on size or weight • History of physical or sexual abuse

16. Factors that may Contribute to Eating Disorders Social Factors: • Cultural pressures that glorify “thinness” and place value on obtaining the “perfect body” • Narrow definitions of beauty that include only women and men of specific body weights and shapes • Cultural norms that value people on the basis of physical appearance and not inner qualities and strengths Biological Factors: • Still being researched, certain chemicals in the brain that control hunger, appetite, and digestion have been found to be unbalanced. • Eating disorders often run in families. Current research indicates that there are significant genetic contributions to eating disorders.

17. Body Image is: • How you see yourself when you look in the mirror or when you picture yourself in your mind. • What you believe about your own appearance (including your memories, assumptions, and generalizations). • How you feel about your body, including your height, shape, and weight. • How you sense and control your body as you move. How you feel in your body, not just about your body.

18. Negative vs. Positive Negative body image is . . . – A distorted perception of your shape-- you perceive parts of your body unlike they really are. – You are convinced that only other people are attractive and that your body size or shape is a sign of personal failure. – You feel ashamed, self-conscious, and anxious about your body. – You feel uncomfortable and awkward in your body. Positive body image is . . . + A clear, true perception of your shape--you see the various parts of your body asthey really are. + You celebrate and appreciate yournatural body shape and youunderstandthat a person’s physical appearance saysvery little about their character andvalue as a person. + You feel proud and accepting of yourunique body and refuse to spend anunreasonable amount of time worryingabout food, weight, and calories. + You feel comfortable and confident inyour body. NEDA

19. Accept yourself - Accept your body.Celebrate yourself - Celebrate your body. Evaluate your own body image Reminder to think about it We all have those days when we don’t like the way we look Encourage others – students! NEDA

20. References American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (Revised 4th ed.). Washington, DC: Author. Levine, M., and Maine, M. (2005). Eating Disorders can be Prevented. Retrieved from http://www.nationaleatingdisorders.org NEDA (2011). http://www.nationaleatingdisorders.org The Renfrew Center Foundation (2011). http://www.renfrew.org/