The document outlines the complexities of eating disorders, discussing their symptoms, contributing factors, and the cultural context that influences their prevalence. It emphasizes that eating disorders are not solely defined by body weight and can affect individuals regardless of their size, while also detailing various treatment options and how to support those struggling. Additionally, it highlights the misconceptions surrounding eating disorders and the need for early intervention and professional help.

1. Counseling Center of Iowa City Striegel, Fisher, Young and Associates Presents Deanna James, LPC, R-DMT, Eating Disorders: Symptoms and Reponses

2. Overview Media, Culture, and Eating Disorder Contributing Factors What is an Eating Disorder- Myths, Symptoms, Health Consequences, Statistics, Warning Signs Philosophy of an Eating Disorder How to Intervene Treatment Options & Resources What you can do!

3. Media, Culture, & Eating Disorder This video illustrates our culture’s obsession with weight, shape, size, and appearance. Media messages screaming “thin is in” may not directly CAUSE eating disorders, but they help to create the context within which people learn to place a value on the size and shape of their body. To the extent that media messages like advertising and celebrity spotlights help our culture define what is beautiful and what is “good,” the media’s power over our development of self-esteem and body image can be incredibly strong.

4. Media, Culture, & Eating Disorder In order to understand ED we must understand the context of our culture. Western Culture: Focus on reason, Individualism, Disembodiment, achievement focused (capitalism), perfectionism. We are taught to ignore our bodies, our health, etc. and push forward towards performance and outcomes.

5. Results of Western Culture: Separation of Body and Mind The result is that we lose our center, even in the way we think. If we’re not thin, we’re fat. If we’re not winners, we’re losers. If we’re not good, we must be evil… and those who buy into this schema set themselves up for shame. No one buys in more whole-heartedly than people in the grip of anorexia and bulimia. As Marya Hornbacher ( Appetites ) writes [ It’s hard to describe how these two things can take place in the same mind, the arrogant, self-absorbed pride in yourself for your incredible feat, and the belief that you are so evil as to deserve starvation and any other form of self-mutilation.] They coexist because you’ve split yourself in two… This is not psychosis, this splitting. It is the history of Western culture made manifest. –Amy Liu Gaining

7. Media, Culture, & Eating Disorder Media images that help to create cultural definitions of beauty and attractiveness are often acknowledged as being among those factors contributing to the rise of eating disorders. However, Eating disorders are complex conditions that arise from a variety of factors, including physical, psychological, interpersonal, and social issues. - National Eating Disorder Association

8. Contributing Factors Eating disorder symptoms are accompanied by an underlying problem. The symptoms are like a red flag being waved saying there is something wrong which I cannot verbalize. Sometimes the client doesn’t know exactly what the problem is, but there is an underlying problem such as Depression, Anxiety, Obsessive-Compulsive Disorder, Social Anxiety or just feeling overwhelmed by the perceived need for perfectionism and the need to not disappoint others. Some clients have unfinished business with their families that make separation difficult, while others have unresolved grief or trauma.

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

11. Contributing Factors Social Factors that Can Contribute to Eating Disorders: - 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

13. Contributing Factors Scientists are still researching possible biochemical or biological causes of eating disorders. In some individuals with eating disorders, certain chemicals in the brain that control hunger, appetite, and digestion have been found to be imbalanced. The exact meaning and implications of these imbalances remains under investigation. Eating disorders often run in families. Current research is indicates that there are significant genetic contributions to eating disorders.

14. What is an Eating Disorder ?

15. What is an Eating Disorder ? Anorexia Nervosa –characterized by self-starvation and excessive weight loss Bulimia Nervosa –characterized by a cycle of bingeing and compensatory behaviors such as self-induced vomiting designed to undo or compensate for the effects of the binge eating. Binge Eating Disorder- characterized by recurrent binge eating without the regular use of compensatory measures to counter the binge eating.

16. Eating Disorder Epidemic “ Today we are faced with an eating disorder epidemic, an epidemic that takes in the full range of anorexia, bulimia, exercise bulimia, binge eating disorder and compulsive overeating. The eating disorder spectrum spans two extremes: on one end anorexia, where individuals are emaciated and malnourished; and on the other end compulsive overeating, where individuals are morbidly obese. Our society sees extreme thinness as positive and something to strive for and extreme obesity as very negative and something to be avoided. The reality is far more complex, as the spectrum itself shows, because these extremes are about far more then just some standard ideal; they are about identity.” Ira Sacker Regaining Your Self

18. Myth: People who are normal or overweight can not have eating disorders….. It is difficult to predict whether or not someone has an eating disorder because not all eating disorders are determined by the size and weight of a person. In the case of anorexia, an eating disorder may be easier to detect due to the presence of thinness. However, an eating disorder is not always easy to detect based on weight. Bulimics tend to be at an average, or even above average, weight. Compulsive overeaters are typically overweight rather than underweight.

19. Myth: Eating disorders are not life threatening…. Every eating disorder can be potentially life threatening if not treated in time or with the proper care. Even if death does not occur, permanent physical and neurological damage can happen. These complications include heart disease, a ruptured esophagus, diabetes, cancer and stroke. An eating disorder is a life threatening disorder.

20. Anorexia Nervosa Has four primary symptoms: Resistance to maintaining body weight at or above a minimally normal weight for age and height Intense fear of weight gain or being “fat” even though underweight. Disturbance in the experience of body weight or shape, undue influence of weight or shape on self-evaluation, or denial of the seriousness of low body weight. Loss of menstrual periods in girls and women post-puberty.

21. Anorexia nervosa involves self-starvation. The body is denied the essential nutrients it needs to function normally, so it is forced to slow down all of its processes to conserve energy. This “slowing down” can have serious medical consequences.

22. Health Consequences of Anorexia Nervosa: Abnormally slow heart rate and low blood pressure, which mean that the heart muscle is changing. The risk for heart failure rises as heart rate and blood pressure levels sink lower and lower. Reduction of bone density (osteoporosis), which results in dry, brittle bones. Muscle loss and weakness. Severe dehydration, which can result in kidney failure. Fainting, fatigue, and overall weakness. Dry hair and skin, hair loss is common. Growth of a downy layer of hair called lanugo all over the body, in an effort to keep the body warm.

23. Statistics About Anorexia Nervosa: Approximately 90-95% of anorexia nervosa sufferers are girls and women (American Psychiatric Association, 1994). Between 0.5-1% of American women suffer from anorexia nervosa. Anorexia nervosa is one of the most common psychiatric diagnoses in young women (Hsu, 1996). Between 5-20% of individuals struggling with anorexia nervosa will die. The probabilities of death increases within that range depending on the length of the condition (Zerbe, 1995). Anorexia nervosa has one of the highest death rates of any mental health condition. Anorexia nervosa typically appears in early to mid-adolescence.

24. Warning Signs of Anorexia Nervosa: Dramatic weight loss. Preoccupation with weight, food, calories, fat grams, and dieting. Refusal to eat certain foods, progressing to restrictions against whole categories of food (e.g. no carbohydrates, etc.). Frequent comments about feeling “fat” or overweight despite weight loss. Anxiety about gaining weight or being “fat.” Denial of hunger. Development of food rituals (e.g. eating foods in certain orders, excessive chewing, rearranging food on a plate). Consistent excuses to avoid mealtimes or situations involving food. Excessive, rigid exercise regimen--despite weather, fatigue, illness, or injury--the need to “burn off” calories taken in. Withdrawal from usual friends and activities. In general, behaviors and attitudes indicating that weight loss, dieting, and control of food are becoming primary concerns.

25. Myth: You can never exercise too much…. While in most cases exercise can be very beneficial, too much exercise, and not enough calorie absorption in the body, is harmful. Excessive exercise can be very unhealthy causing problems such as stress fractures, chronic pain, osteoporosis, menstrual dysfunction and even death.

26. Myth: Those with eating disorders are vain…. While an eating disorder may start out as a form of dieting, eating disorders are far more than acts of vanity. Often, eating disorders are coping mechanisms used to deal with stress, anxiety, self-hatred, control issues and shame. Eating disorders are not about a struggle with vanity, but rather a distraction from the problems of life.

27. Bulimia Nervosa Has three primary symptoms: Regular intake of large amounts of food accompanied by a sense of loss of control over eating behavior. Regular use of inappropriate compensatory behaviors such as self-induced vomiting, laxative or diuretic abuse, fasting, and/or obsessive or compulsive exercise. Extreme concern with body weight and shape.

28. Bulimia nervosa can be extremely harmful to the body. The recurrent binge-and-purge cycles can impact the entire digestive system and purge behaviors can lead to electrolyte and chemical imbalances in the body that affect the heart and other major organ functions.

29. Health Consequences of Bulimia Electrolyte imbalances that can lead to irregular heartbeats and possibly heart failure and death. Electrolyte imbalance is caused by dehydration and loss of potassium and sodium from the body as a result of purging behaviors. Inflammation and possible rupture of the esophagus from frequent vomiting. Tooth decay and staining from stomach acids released during frequent vomiting. Chronic irregular bowel movements and constipation as a result of laxative abuse. Gastric rupture is an uncommon but possible side effect of binge eating.

30. Statistics about Bulimia Bulimia nervosa affects 1-2% of adolescent and young adult women. Approximately 80% of bulimia nervosa patients are female (Gidwani, 1997). People struggling with bulimia nervosa will often appear to be of average body weight. Many people struggling with bulimia nervosa recognize that their behaviors are unusual and perhaps dangerous to their health. Bulimia nervosa is frequently associated with symptoms of depression and changes in social adjustment.

31. Warning Signs of Bulimia Evidence of binge-eating, including disappearance of large amounts of food in short periods of time or the existence of wrappers and containers indicating the consumption of large amounts of food. Evidence of purging behaviors, including frequent trips to the bathroom after meals, signs and/or smells of vomiting, presence of wrappers or packages of laxatives or diuretics. Excessive, rigid exercise regimen--despite weather, fatigue, illness, or injury--the need to “burn off” calories taken in. Unusual swelling of the cheeks or jaw area. Calluses on the back of the hands and knuckles from self-induced vomiting. Discoloration or staining of the teeth. Creation of complex lifestyle schedules or rituals to make time for binge-and-purge sessions. Withdrawal from usual friends and activities. In general, behaviors and attitudes indicating that weight loss, dieting, and control of food are becoming primary concerns.

33. Myth: All bulimics purge by self-induced vomiting. Bulimics typically binge and purge, but sufferers do not always purge by self-induced vomiting. In some cases over exercising, fasting, or diuretics and laxatives are used.

34. Myth: Laxatives prevent calorie absorption…. Many people with eating disorders, primarily those in need of bulimia help, use laxatives. These laxatives are used in an attempt to rush food out of the body before its calories are absorbed. In reality, laxatives begin their work in the body’s colon where calories can not even be absorbed. Laxatives only assist in draining the body of its necessary fluids and in causing colon problems.

35. Binge Eating Disorder Frequent episodes of eating large quantities of food in short periods of time. Feeling out of control over eating behavior. Feeling ashamed or disgusted by the behavior. There are also several behavioral indicators of BED including eating when not hungry and eating in secret.

36. Health Consequences of Binge Eating Disorder The health risks of BED are most commonly those associated with clinical obesity. Some of the potential health consequences of binge eating disorder include: High blood pressure High cholesterol levels Heart disease Diabetes mellitus Gallbladder disease

37. Statistics about Binge Eating Disorder The prevalence of BED is estimated to be approximately 1-5% of the general population. Binge eating disorder affects women slightly more often than men--estimates indicate that about 60% of people struggling with binge eating disorder are female, 40% are male (NIH, 1993). People who struggle with binge eating disorder can be of normal or heavier than average weight. BED is often associated with symptoms of depression. People struggling with BED often express distress, shame, and guilt over their eating behaviors.

38. Warning Signs of Binge Eating Disorder Evidence of binge-eating, including disappearance of large amounts of food in short periods of time or the existence of wrappers and containers indicating the consumption of large amounts of food. Withdrawal from usual friends and activities. Dramatic weight gain or weight fluctuations. Eating large amounts of food when not physically hungry. Eating much more rapidly than normal. Eating until the point of feeling uncomfortably full. Often eating alone because of shame or embarrassment. Feelings of depression, disgust, or guilt after eating.

39. Myth: Compulsive overeaters have no self-control and are lazy…. Compulsive overeaters are not lazy or merely people without self control. For most compulsive eaters, food is used as a way of coping with stressful situations or overwhelming emotions. Just like any other eating disorder, compulsive overeaters need assistance and a helpful eating disorder treatment center.

41. Philosophy of my Eating Disorder I can’t control the world around me, but I can control myself My worth is conditional I am separate and alone. No one understands me. I am powerless. The agendas of others prevent me from living my life how I want to. I believe in shoulds, oughts, and musts.

42. Philosophy of my Eating Disorder I am lacking and flawed, and if I cannot fix my weaknesses, then I must hide them. I have high standards for myself, and people only think they are irrational because they cannot meet them. It’s never enough- I am not enough. Satisfaction prevents me from improving myself. Life is empty and meaningless, and at times cruel and unfair.

43. Philosophy of my Eating Disorder I am guilty for my actions, the world around me, and simply because I exist. I must fix the outside because the inside is beyond repair. I am weak and incapable so I must disconnect from things to survive. Life is a battle. I am not a fighter. I must project an image of perfection and togetherness to hide my flaws and vulnerability.

44. Philosophy of my Eating Disorder I am taking care of myself and need my eating disorder to function. If there is Divinity in me, then I might reveal it by shedding the layers that are concealing it. I don’t think that there is anything good or living inside me anymore. I am an empty shell. Being thin gives me freedom to do whatever I want. Eating fuels the pain.

45. How to Intervene?

46. How to Intervene If you are worried about your friend’s eating behaviors or attitudes, it is important to express your concerns in a loving and supportive way. It is also necessary to discuss your worries early on, rather than waiting until your friend has endured many of the damaging physical and emotional effects of eating disorders. In a private and relaxed setting, talk to your friend in a calm and caring way about the specific things you have seen or felt that have caused you to worry.

47. How to Intervene Set a time to talk. Set aside a time for a private, respectful meeting with your friend to discuss your concerns openly and honestly in a caring, supportive way. Make sure you will be some place away from other distractions. Communicate your concerns. Share your memories of specific times when you felt concerned about your friend’s eating or exercise behaviors. Explain that you think these things may indicate that there could be a problem that needs professional attention. Ask your friend to explore these concerns with a counselor, doctor, nutritionist, or other health professional who is knowledgeable about eating issues. If you feel comfortable doing so, offer to help your friend make an appointment or accompany your friend on their first visit.

49. How to Intervene Avoid conflicts or a battle of the wills with your friend. If your friend refuses to acknowledge that there is a problem, or any reason for you to be concerned, restate your feelings and the reasons for them and leave yourself open and available as a supportive listener. Avoid placing shame, blame, or guilt on your friend regarding their actions or attitudes. Do not use accusatory “you” statements like, “You just need to eat.” Or, “You are acting irresponsibly.” Instead, use “I” statements. For example: “I’m concerned about you because you refuse to eat breakfast or lunch.” Or, “It makes me afraid to hear you vomiting.” Avoid giving simple solutions. For example, "If you'd just stop, then everything would be fine!" Express your continued support. Remind your friend that you care and want your friend to be healthy and happy.

50. Treatment Options

51. Treatment Options Most individuals with Eating Disorders are treated successfully on an outpatient basis. Patients with eating disorders typically require a treatment team consisting of a primary care physician, or psychiatrist, dietitian, and a licensed mental health professional knowledgeable about eating disorders.

52. Treatment Options Individuals with medical complications due to severe weight loss or due to the effects of binge eating and purging may require in-patient hospitalization or residential treatment. Other individuals, for whom outpatient therapy has not been effective, may benefit from, an intensive outpatient program, day-hospital treatment, residential treatment or in-patient hospitalization. - Academy of Eating Disorders

53. Treatment Options The most effective and long-lasting treatment for an eating disorder is some form of psychotherapy or psychological counseling, coupled with careful attention to medical and nutritional needs. Ideally, this treatment should be tailored to the individual and will vary according to both the severity of the disorder and the patient's particular problems, needs, and strengths. – National Eating Disorder Association

54. Treatment Options Psychological counseling must address both the eating disordered symptoms and the underlying psychological, interpersonal, and cultural factors that contributed to the eating disorder. Typically care is provided by a licensed health professional, including but not limited to a psychologist, psychiatrist, social worker, licensed professional counselor, nutritionist, and/or medical doctor. Care should be coordinated and provided by a health professional with expertise and experience in dealing with eating disorders. - National Eating Disorder Association

55. Resources National Eating Disorder Association www.nationaleatingdisorders.org Academy of Eating Disorders www.aedweb.org International Association of Eating Disorder Professionals www.iaedp.com ED Referral www.edreferral.com Somethings-Fishy www.something-fishy.org

56. What can you do? Encourage the media to present more diverse and real images of people with positive messages about health and self-esteem. This may not eliminate eating disorders entirely, but it would help reduce the pressures many people feel to make their bodies conform to one ideal, and in the process, reduce feelings of body dissatisfaction and ultimately decrease the potential for eating disorders.

58. What Can You Do? Be a model of healthy self-esteem and body image. Recognize that others pay attention and learn from the way you talk about yourself and your body. Choose to talk about yourself with respect and appreciation. Choose to value yourself based on your goals, accomplishments, talents, and character. Avoid letting the way you feel about your body weight and shape determine the course of your day. Embrace the natural diversity of human bodies and celebrate your body’s unique shape and size. Encourage open discussion about feelings, emotions, opinions. The more we talk and express what we feel the less we have to bury it away in our bodies.

59. Fat Talk Free Video