The Truth About Eating Disorders: Unmasking Myths & Facing Facts

Laura Sabin CabanillasMA, LMHC, NCC

Professional Relations Coordinator Eating Recovery Center

Bellevue, WA

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I HAD NO IDEANational Eating

Disorders Awareness Week Feb. 23-March 1

Get in the KNOW: NEDAwareness.org

Did You Know…

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• More young women die from eating disorders than any other psychiatric illness

• Between 5-20% of those struggling with anorexia will die from the disorder

• Approximately a half million teens (ages 13-18) struggle with eating disorders or disordered eating

• Pre-teen girls report that they are more afraid of fat than cancer

www.nationaleatingdisorders.org

Did You Know…

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• 60% of teen girls report feeling fat despite being normal weight

• 80% of 10-year-old girls have been on a diet• 40-60% of elementary school girls are concerned

with their weight • 33% of adolescent males use unhealthy weight

control behaviors• Approximately 50% of people in the U.S. either

know someone with an ED or have been personally affected by one

www.nationaleatingdisorders.org

5 Most Common Eating Disorder Myths

1) EDs are a choice2) You can tell someone has an ED simply by looking at them3) EDs revolve around food 4) EDs are a female thing5) EDs in adolescents are a phase and a way to seek attention

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Truth: EDs are complicated Biopsychosocial Disorders – no one chooses to have an eating disorder!

DNA Loads the Gun – Life Pulls the Trigger

Myth #1: Eating Disorders are a Choice

A few facts about EDs• An eating disorder is an Impulse Control Disorder

– NOT an addiction• They are complex disorders and should be treated

by a multidisciplinary team: medical, mental health and nutrition providers

• The more risk factors in place, the higher likelihood an ED could develop

• They run in families• They are lethal and should always be taken

seriously

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• Family history of eating disorders or chemical dependency: genetic contributions as high as 40%

• American Psychological Association: A Genetic Link to Anorexia , DeAngelis March 2002, Vol 33, No. 3: http://www.apa.org/monitor/mar02/genetic.aspx

• Individuals with a mother or sister who had suffered from Anorexia Nervosa are:– 12 times more likely to develop Anorexia Nervosa– 4 times more likely to develop Bulimia Nervosa

• Anxiety, depression or other mood disorder

Predisposing Biological Factors

Predisposing Psychological Factors

• Anxiety or mood disorder• Obsessive Compulsive personality• Highly sensitive (emotionally)• Poor distress tolerance skills• Perfectionistic temperament• People pleaser

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• Family history of severe dieting/exercise• Family constellation—enmeshed or disengaged• Go fast, highly competitive academic/social

environment• High risk sports (wrestling, gymnastics, football,

swimming, track)• Dieting culture - unrealistic then ideals promoted• Social media & pro-ana websites (blogs, chat

rooms, facebook, tumblr, twitter - it’s everywhere!)

Predisposing Sociological Factors

Myth #2: You can tell someone has an eating disorder by looking at them

Truth: Individuals struggling with bulimia and binge eating disorder will often appear to be of average

body weight

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Anorexia Nervosa

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• Low body weight (<85%)• Intense fear of gaining

weight• Distorted body image• Extreme Focus on

shape/weight• Denial of seriousness of

illness• Anemia• Age at onset typically

between 12-25

Bulimia Nervosa

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• Recurrent binge-eating– Unusually large amount of

food (by social comparison) in a short amount of time

• Feeling out of control• Compensatory behavior

– Vomiting– Laxative abuse– Excessive exercise– Fasting

• Extreme focus on shape/weight

Binge Eating Disorder

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- Recurrent binge-eatingUnusually large amount of food (by social comparison) in a short amount of time

- Feeling out of control

- NO Compensatory behavior

- Can be of normal or heavier than average weight

Myth #3: Eating Disorders revolve around food

Truth: Behaviors associated with EDs may begin with a fixation on calories

and weight, but stem from issues beyond food & body size.

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• Harm avoidant• Neurotic/need to control• Obsessional• Anxious• Reward dependent• Perfectionistic• Low novelty seeking• Very Low self-esteem

(though they may seem confident)

Temperament in Anorexia Nervosa

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• Harm Avoidant• Obsessional• Perfectionistic• Depressed and anxious• Low self-esteem• Higher novelty seeking• Impulsive• Affective dysregulation

Temperament in Bulimia Nervosa

Temperament in Binge Eating Disorder

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• Dependent• Avoidant• Depressed• Low self-esteem• Passive-aggressive• Impulsive• Affective

dysregulation• Black & White/All

or nothing thinking

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Internal or external experience(s) of feeling out of control can include:

• Onset of puberty between the ages of 11-14: in four years the average young woman gains 40 pounds with a disproportionate fat ratio

• Body dissatisfaction• Bullying or teasing by peers or siblings related

to weight, size or shape• Innocent weight loss via increased exercise

(sports) or illness that results in compliments

Common Precipitants

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• Abuse: physical, sexual, emotional• Traumatic events leading to feelings of

rejection or failure as perceived by the child/adolescent

• Major life stage transitions: identity formation, individuation

• Family difficulty: severe conflict, separation or divorce, disengagement of a parent/caregiver

Common Precipitants

Myth #4: Eating Disorders are a “female thing”

Truth: ED’s are no longer a “princess disease”Current statistics show that male eating

disorders account for:• 10% of all cases of Anorexia Nervosa• 20% of all cases of Bulimia Nervosa

• 40% of all cases of Binge Eating Disorder

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Myth: Eating Disorders are a female thing

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- A recent national survey indicated that41% of men are dissatisfied with theirweight (nationaleatingdisorders.org)

- Adolescent boys who participate in football, track,and wrestling have increased risk factors of developingan eating disorder if biological and psychological predisposition is already in place

- The muscularity of ideal male body representations in the media (even in our favorite cartoon characters!) has increased exponentially since the 1970’s, presentinga largely unattainable body type

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Myth #5: EDs in adolescents are a phase and a way to seek attention

Truth: Approximately a half million teens (13-18) struggle

with eating disorders or disordered eating.

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MIT Raising Teens Project: 10 Tasks of Adolescence

1) Adjust to sexually maturing bodies and feelings2) Develop and apply abstract thinking skills3) Develop and apply new perspectives on human

relationships4) Develop and apply new coping skills in decision

making, problem solving, and conflict resolution5) Identify meaningful moral standards, values, and

belief systems

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MIT Raising Teens Project: 10 Tasks of Adolescence

6) Understand and express more complex emotional experiences7) Form friendships that are mutually close and supportive8) Establish key aspects of identity9) Meet the demands of increasingly mature roles and responsibilities10) Renegotiate relationships with adults in parenting roles

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• Weight loss with inability to re-gain• Medical instability (dizziness, fainting, chest pain)• Suicidality/cutting• Inability to contain purging behaviors• Physical Signs (cold intolerance, brittle hair & nails,

pale/grey skin, scars on knuckles, chronic sore throat, swollen glands)

• Decreased Motivation/falling grades• Fatigue• “3 week rule”• Guidelines for Assessing Eating Disorders Card

Symptoms to Watch: When to Refer

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• Full Continuum of Care:

– Medical Unit with Eating Disorder and Psychiatric Expertise

– Inpatient and/or Residential– Partial Hospitalization (Day treatment)– Intensive Outpatient Program– Interdisciplinary approach should include medical

providers, therapists, and dietitians

Clinical Components of Good Treatment

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• Phase 1: - Connect, Build Trust, Take in Nutrition

and Stop Behaviors • Phase 2:

- Awareness and Practice New Skills• Phase 3:

- Make Good Plans for How to Continue to be in Recovery in the “Real World”

Phases of Treatment

Support Plan for Students• Approach – don’t avoid! (Shame & EDs thrive in silence)• Express your concerns compassionately• LISTEN! • Refer them to an outpatient therapist who works with ED’s • Agree on support person (parent/other family member)• Accountability – lunch partner• Promote a healthy balanced culture at your school - Organize ED Awareness Day for Students & Parents (PTO)- Promote a fat talk free week at your schoolhttp://bi3d.tridelta.org/ourinitiatives/fattalkfreeweek

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What is Fat Talk?Fat Talk describes any statement that reinforces the thin-ideal standard of beauty and contributes to women and men's dissatisfaction with their bodies. Examples include: • “I’m so fat.“• “Do I look fat in this?”• "She should not be wearing that!"• "Does this make my butt look big?"• "I need to lose 10 pounds before I wear that."http://www.operationbeautiful.com/release-form/how-to-become-fat-talk-free/http://www.succeedfoundation.org/work/fat_talk_free_week

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ED Prevention & OB Prevention

• It’s NOT a competition! Both “camps” want the same goal – healthy kids. There is a disconnect between how healthy lifestyles are promoted by professionals. How can we work together?

Reference: “War on Weight: Reframing the Tension between the Eating Disorders and Obesity Fields”, (Ferrari, McVey, Rice, Piran) – Oral Scientific Paper at Int. Conf. on ED’s 2013: aedweb.org/ICED2013/paper4.pdf

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• Eating Recovery Center: www.EatingRecoveryCenter.com/category/resources-eating-disorder-recovery/for-families/

• National Eating Disorders Association (NEDA): www.nationaleatingdisorders.org

• Academy for Eating Disorders (AED): http://www.aedweb.org/web/index.php

• International Association of Eating Disorder Professionals (iaedp): www.iaedp.com

• Eating Disorders Information Gateway: www.EatingRecoveryCenter.com/EDIG

Online Resources

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Questions

For more resources, referral information or assistance with eating disorder awareness and education opportunities, email me: lcabanillas@eatingrecoverycenter.com