National Eating Disorders Awareness Week

It’s National Eating Disorders Awareness Week, and a good time to reflect on how far we’ve come in understanding this complex problem.  And how far we have to go, because we still don’t have any sure-fire cures.  Fixing an eating disorder is a long slow frustrating process, requiring the complete cooperation and participation of the afflicted person.

Celebrity anorexia is unfortunately glamorized, so the term eating disorder usually conjures an image of a skeletal teenaged girl.  But there are other less glamorous faces of eating disorders.  Bulimia, which is bingeing and purging, is a severely distressing and debilitating behavior that comes with unique medical risks.  Binge eating, without purging, will soon be recognized as a distinct diagnosis.  Binge eaters are typically obese, and subject to social ridicule in addition to the health risks of obesity.  None of this is happy stuff, yet people persist in the disordered behavior.  Why?  Because they do get something out of it, strange as that may seem.  Eating disordered behaviors are a coping mechanism for stress.  Those stress-reducing psycho-biological rewards may be temporary, they’re strong and keep the behavior going.

While the myth persists that dieting or reading fashion magazines causes eating disorders, most experts now understand that there is a significant genetic component driving the behavior.  Eating disorders tend to run in families, and are frequently associated with mental health diagnoses like obsessive-compulsive disorder or depression.  But genetic vulnerability doesn’t necessarily doom anyone to an eating disorder.  Social and cultural environment, family life, peer groups and dieting are all part of the mix that can push a vulnerable person into an eating disorder.

Treatment always involves psychotherapy.  And therapy requires the cooperation of the patient.  People who resist treatment, because they don’t see a problem, are not good candidates.  This resistance may be the most stressful barrier for families and loved ones to deal with: getting the eating disordered person to recognize that the behavior is a problem and to work with a therapist on issues that will likely be uncomfortable and stressful.  If the person is severely medically compromised by the eating disorder, in-patient treatment may be necessary.

So what are families to do?  If the person in question is a minor child, parents are in charge of recognizing the problem, consulting with the pediatrician and finding a suitable treatment program.  If the person in question is 18 years or older, treatment can be a very touchy situation.  Unless the person is in severe medical crisis, there is no way to force someone into therapy.  Loved ones can have frank discussions and express concerns in a non-judgmental way, hoping to eventually convince the person to seek help.  In many cases, the eating disordered person has hidden the behavior successfully, but comes to the conclusion that treatment is essential and seeks help on his or her own.

There are lots of websites with extensive information on dealing with all these scenarios, as well as listing of local and national treatment resources.  Here are a few of the most prominent:

The Mayo Clinic has a list of typical symptoms of eating disorders (you can find similar lists elsewhere).  Keep in mind, the behaviors are not limited to teenaged girls.  Boys can be affected as well, and age is no limit.  Another issue that few people realize: an eating disorder can be triggered by anything that disrupts eating and leads to sudden weight loss, such as a medical crisis or severe stress from a life event.  Again, if you suspect a family member is dealing with an eating disorder, begin a discussion by expressing your concerns.  Calm, supportive and open communication will be an essential part of the treatment process.  As a very wise psychotherapist once told me, an eating disorder is like an invader, and must be dealt with by an army made up of the person with the disorder, the family, therapist, doctor, dietitian and friends.  No one of these people can win the war alone.

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