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Eating Disorders: All Grown Up

Eating disorders have long been recognized as a disease that only affects white, adolescent girls. And while those are often the faces you will see in documentaries and after school specials on the topic, it’s important to know that anorexia, bulimia, binge eating and other eating disorders can, and often do, transcend this stereotype. Not only do eating disorders cross racial, ethnic and gender boundaries, they can also occur outside of the teenage years, developing or recurring during adulthood, mid-life and older adulthood. This may not be surprising considering the “fifty is the new thirty” cultural attitude which seems to keep extending the unrealistic physical demands placed on females by the media.

Adult women struggling with eating disorders can face a unique set of stressors and risks associated with the disease. Whether they are still battling an untreated eating disorder from adolescence, have had a recurrence of one that was previously under control or have developed one for the first time, the repercussions for themselves and their families can be overwhelming. Marriage, divorce, career, finances, or the death of a loved one can be contributing stressors in an adult woman’s life. The stress of pregnancy and parenting can be especially triggering, and yet, it is more important than ever at this time in a woman’s life that she is taking care of her body and modeling healthy behavior. Criticizing herself in the mirror or refusing to eat certain foods, or entire meals, will likely be observed and emulated in the attitudes and behavior of her own children. Wanting to break this cycle of negative self image and disordered eating can be a significant factor in motivating adult women to seek treatment.

Health complications associated with eating disorders are also likely to catch up with a woman in later adulthood and could motivate her to pursue treatment. Infertility, osteoporosis and severe tooth decay caused by years of acting on eating disorder symptoms are no longer just warnings from doctors but become painful realities as women age.

In the United States it is estimated that about 10 million women, throughout all ages, struggle with an eating disorder. Eating disorders can negatively impact all areas of adult life including intimacy, decision-making, social relationships and parenting competence. The good news is that more and more adult women are reaching out for help and getting the treatment they need to recover.

Want to find out more about this topic? Come hear Trisha Gura the acclaimed author of Lying in Weight: The Hidden Epidemic of Eating Disorders in Adult Women, speak during a special symposium at Sheppard Pratt on Sunday, October 5^th from 1:00 - 3:00 pm. Admission is free but pre-registration is required. Please call Iris Fisher at (410) 938-3157 to register.

Want to interact with Trisha Gura online? Chat with her live at the Center for Eating Disorders online discussion forum on Sept. 30th at 8 p.m. Check back soon for more details

Written by Kate Clemmer, Outreach Coordinator at The Center for Eating Disorders at Sheppard Pratt

Published by CED Editor
September 17th, 2008 in Editor's Picks
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Hungry for Gold: The Hidden Epidemic of Disordered Eating Among Athletes

Eating disorders affect 5 to 10 million men and women, so it is no wonder that athletes are not immune to developing one.

The 2008 Olympic Games remind so many of us what we enjoy about sports - the excitement, the competition, the love of the game. For many, underneath, there are secret obsessions, including disordered eating or eating disorders that some athletes use to “stay in the game,” when in reality, they are harming themselves and ultimately their sports performance through their eating behaviors.

Those particularly at risk are athletes who compete in judged sports where they are required to wear revealing uniforms or costumes. These generally include sports like gymnastics, diving, figure skating, etc. but an eating disorder can affect an athlete competing in any sport. This silent wave of disordered eating seems to come from the dual pressures to not only perform well, but also the pressure look good while competing, especially when the event is televised.

Certain sports carry individual expectations (and sometimes stereotypes), of weight, body size and shape that can be hard to achieve. For example, basketball players are often tall and lean, distance runners are expected to be thin, jockeys are thought to be short, and so on. At times athletes can go to extreme lengths to reach these expectations, and not without consequences.

The practices of disordered eating and exercise abuse in athletes can lead to health problems, such as decreased immunity, loss of bone density, stress fractures, menstrual irregularities, overuse injuries, and the list goes on…

Because athletes often appear to have things so “together” on the outside, it can be difficult for outsiders to pick up on disordered eating and the underlying health issues. For this reason, and because of their power and influence, coaches may be the most important factor in promoting or preventing poor eating and training habits in athletes. Thus, it is especially important for coaches to be able to identify the signs of disordered eating early so that athletes who need treatment can get it when the likelihood of success is at its highest.

In a previous entry, Dr. Ron Thompson sheds some light on key signs to look for when trying to identify an athlete with an eating disorder or disordered eating. In that same entry, Dr. Thompson offers advice to athletes and coaches on how to minimize the risk of creating or developing unhealthy food relationships.

If you think you or someone you care about may be showing signs or symptoms of an eating disorder, take this quiz. Or, if you prefer, you can call the Center for Eating Disorders at 410-938-5252 to speak with someone in confidence about any questions or concerns you may have.

Published by CED Editor
September 12th, 2008 in Editor's Picks, Body Image
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Food Rituals: When Weird Becomes Harmful

The Center for Eating Disorders at Sheppard Pratt partnered with Seventeen Magazine to conduct a survey to look at disordered eating among young women between the ages of 13 and 20-years-old. Seventeen’s recent article, Are You a Freaky Eater?, published in the August 2008 issue, brings to light results gathered from the survey and also explores the nuances of, and behaviors associated with, “freaky eating” - systematic eating patterns categorized as “weird” and most frequently used as a coping mechanism to mask underlying mental health problems, such as depression or anxiety.

Certain experiences can trigger the onset of ritualistic eating patterns, such as a trauma or stressful event in a person’s life. One way an individual may cope with personal issues is by developing coping mechanisms like the one known as “freaky eating.” If not treated, these bizarre, yet calculated eating habits can spiral out of control, resulting in full-blown eating disorders.

When determining if an individual has developed obsessive regimented “rules” for eating, it’s best to look for common signs and symptoms that characterize their love/hate relationship with food. Recognizing these specific signs and symptoms can help individuals and families identify the need to seek appropriate professional treatment. “Freaky” eating behaviors and patterns to look out for include:

Cutting food into tiny pieces
Showing discomfort when eating in front of others
Labeling certain foods as good and other foods as bad - strictly avoiding the ‘bad’ foods
Not allowing certain foods to touch each other on the same plate
A desire to keep food habits or patterns as secretive or low-key as possible

A tumultuous relationship with food can cause an individual to experience low self esteem, cause social isolation due to avoidance of eating with others and can impair an individual’s mood as a result of decreased intake and/or concerns about intake.

If you’re concerned that a friend or family member may be developing an eating disorder as the result of unusual eating patterns, please take our online assessment.

Published by CED Editor
July 21st, 2008 in Editor's Picks, Body Image
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Muscle Dysmorphia: the Misconceived Notion of Not Measuring Up.

Muscle dysmorphia, a disorder most commonly experienced in males, is the obsession of feeling “too small” or belief that one has inadequate muscles. However, those with the disorder are usually not small, and have very well-developed muscles, but most are too self-conscious to recognize their muscular bodies.

Often referred to as “bigorexia” or “reverse anorexia,” those with this disorder constantly worry about how others perceive their appearance. They suffer from low self-esteem and a misconstrued body image, inflicted with constant self-doubt, causing them to exercise compulsively and adhere to a strict diet. These behaviors can even result in developing an eating disorder, such as bulimia. Those with this disorder can also experience depression or an anxiety disorder. Other risky behaviors employed to build bulk includes the use of steroids.

Muscle dysmorphia is attributed to genetics, psychological factors and/or societal pressures. The media barrage of images at all levels of our society send misguided messages that pressure individuals to try to measure up. The men who struggle with this illness view images that lead them to believe that “real men have muscles,” even in something that seems as innocuous as a toy like G.I. Joe. Women see similar messages, but most of the messages targeted towards women depict a different body, one that states that “beautiful women are thin,” with images like Barbie.

Signs and Symptoms:

Checking themselves in a mirror up to 12 times a day.
Becoming distressed if they miss a .
Constant comparison of their own body to the bodies of others around them.
The use of anabolic steroids - check out Powered by Me for information about the side effects of anabolic steroids use.
Worrying about their percentage of body fat.
Psychological symptoms - Anxiety, depression, low self-esteem, or hiding away for days at a time due to embarrassment about their body shape.
Unlikely to come forward for treatment as they rarely see themselves as having a problem.

Diagnosis and Treatment: The disorder can be difficult to diagnose because patients often appear healthy. Many people with this disorder resist getting help as they are happy with the way they are, similar to individuals with Anorexia Nervosa. One way to help a family member or friend is to bring to their attention the negative impact the disorder has had on their lives, such as placing aspects of their personal lives on the backburner, like their career or relationships.

Studies have shown positive responses from individuals treated with a combiniation of antidepressant medication and cognitive behavioral therapy (CBT). CBT helps the patient to analyze their problem using logical steps to understand the thought process behind their behaviors and make changes in their thinking, which will allow them to subsequently change the behaviors that follow.

To begin to make changes, our culture needs to take a look at our priorities and the messages that it is imposing on its youth.

Published by Anthony1
June 20th, 2008 in Editor's Picks
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A Perfect 10.

(Photo from NYMag.com)

Just look at her. Whitney Thompson is stunning, she’s poised, she’s a size 10…. and she’s the winner of America’s Next Top Model. Although this shouldn’t be shocking, with the recent onslaught of extremely thin fashion models in the media, it is unusual for a size 10 model to come out of ANTM. Whitney Thompson is already making strides in the modeling industry and is proving that an emaciated body isn’t the necessary ingredient for a great photograph.

Already, Whitney has received letters from boys and girls, claiming that she has motivated them to seek help for eating disorders and body image issues. She is working to further debunk the wildly popular belief that a young woman’s body should be altered to fit the clothes, rather than the clothes altered to fit the woman.

We’re glad ANTM has selected a woman who is more representative of the typical American woman. But positioning Whitney as plus size is simply inaccurate. Size 10 is not plus-size! While we applaud Whitney for being comfortable in her own skin, we would urge her to distance herself from the plus-size label she has received and seems to accept. As she states in the interview linked above: “It’s about being healthy. Being obese is no better than being emaciated, and I have to keep telling people that. I don’t sit around and eat donuts all day. I still wear bikinis and look good in them. It’s just about being the best you can be, and you can’t do anything other than that. Another myth is that being a plus-sized model means you’re fat. Guess what: it doesn’t. It means that you’re normal…”

It’s clear that Whitney plans to knock down barriers within the fashion industry, but we’d like to see her start by first breaking herself out of the plus-size label. When clothing size dictates beauty and defines a person, it undermines individuality and uniqueness. Why must Whitney be referred to as a “plus size” model and not just a model?

Published by CED Editor
June 3rd, 2008 in Editor's Picks, Body Image, Celebrity Topical News
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Eating Disorder Epidemic: We Want to be FREED.

There’s been a lot of international news about eating disorders. From the French moving toward legislation to prosecute any promotion of extreme thinness, to former British deputy prime minister, John Prescott, coming forward about his past struggles with bulimia. And now, The Eating Disorders Coalition and Rep. Patrick Kennedy (D-RI) are working on The FREED ACT, a Federal Response to Eliminate Eating Disorders, the first piece of comprehensive Eating Disorders legislation in U.S. history.

The FREED Act will serve to address eating disorders through research, treatment, education and prevention. Among a number of action items, the FREED Act is structured to determine the prevalence of eating disorders within today’s society. Additionally, it will work to determine mortality rates associated with all eating disorders and provide a public report of this data annually. In an effort to increase training opportunities for research, fund research programs, and coordinate the development of a research infrastructure nationwide, centers will be established through an integrated system. The bill will also aim to educate health and higher education professionals and will serve to inform society about eating disorders through Public Service Announcements.

We applaud the actions of Rep. Kennedy and the Eating Disorders Coalition in bringing eating disorders to the attention of our national leadership through the FREED Act. The FREED Act will enable countless individuals to receive early diagnosis and treatment to bring greater chances for survival and complete recovery. Now, we like the sound of that.

More information about the FREED Act and what you can do to support it can be found at www.eatingdisorderscoalition.org.

Published by CED Editor
May 30th, 2008 in Editor's Picks, Body Image
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Dr. Brandt & Dr. Crawford Publish Research Articles in May Issue of International Journal of Eating Disorders

The International Journal of Eating Disorders May issue features two articles that highlight findings from the recent multi-site Anorexia Nervosa study, of which the Center for Eating Disorders was one of the sites participating.

The research sought to identify genetic variants and personality features that are linked to an increased risk for developing Anorexia Nervosa, attempting to answer the question, “What in our genetic background makes us predisposed to an eating disorder?”

This article highlights that binge eating and purging behavior in Anorexia Nervosa increases the likelihood of additional problems such as depression, alcohol and/or drug abuse and obsessive-compulsive disorder.

The second article examined the influence of overanxious disorder on Anorexia Nervosa. It investigated childhood anxiety and its relationship to the onset of Anorexia. The research also explored attitudes and personality traits associated with eating disorders.

While prior research did not demonstrate a consistent relationship between anxiety disorders and increased severity of eating disorder symptoms, the findings from the genetic study did highlight a strong correlation between Overanxious Disorder of Childhood and more extreme eating disorder behaviors.

Drs. Brandt and Crawford are pleased that the Center for Eating Disorders at Sheppard Pratt has contributed to such important research. It is believed that the findings from these studies will lay the groundwork for improving early identification of at risk individuals and available treatment options.

Published by CED Editor
May 23rd, 2008 in Editor's Picks
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Parent/Child Co-Current Eating Disorder – Q&A with Janet Treasure

Dr. Janet Treasure, an internationally renowned expert in eating disorders, offers her insight on parent/child co-current eating disorder - a topic she will be discussing at the upcoming symposium on April 12, 2008, hosted by The Center for Eating Disorders at Sheppard Pratt.

The symposium will serve to educate the professional community on how to support and promote eating disorder prevention efforts. Keep an eye out for interviews with other experts as we get closer to the date!

How common is it to have parent/child co-occurring eating disorders?

Though there are no concrete figures, about less than 5% of eating disorder cases are parent/child co-occurring. This is not to say, however, that a parent’s eating disorder does not have a monumental impact on how a child perceives eating habits and body image.

Are children of parents with eating disorders more or less likely to receive treatment?

The good news is that preliminary findings show that children of parents with eating disorders are more likely to get treatment early. However, there is also evidence that the outcome of treatment is less successful if there is a family history of an eating disorder.

How does one intervene when the parent of a child is identified to have an eating disorder?

Unfortunately, there is no simple answer to this question. It depends on numerous things and its important to consider such things as:

Whether the parent themselves has acknowledged that they have an eating disorder;
Whether it is thought that the parental eating attitudes are acting as maintaining factors for the child’s eating disorder;
Whether or not the co-parent is involved.

The most important step is ensuring that the entire family is involved. Sharing common goals, such as working together to ensure that they are not maintaining the illness by enabling behaviors, and aiming to help the individuals with an eating disorder overcome eating disorder behaviors. Families need to make sure that the individuals are eating socially with sufficient amounts and nutrients. It is especially important for the parent without an eating disorder to play a key role. This may involve several stages:

1. Coming to terms with guilt or avoidance in the feeling that they have not been able to provide a safe protected environment for their child.

2. Understanding that their child’s eating disorder is different than that of their spouses and the realization that management plans in dealing with the eating disorders will have to be different.

3. The role of a spouse is very different from that of a parent in supporting an individual with an eating disorder. Developmental stages and emotional maturity will need to be factored at all times.

4. Understanding that while a spouse is dealing with an eating disorder, it will make it difficult for them to play a balanced care-giving role.

5. Providing balance in dealing with both eating disorder cases.

Read more about Dr. Janet Treasure.

If you are a mental health professional and are interested in hearing Dr. Treasure speak on this subject, you can register for the April 12th symposium.

Published by CED Editor
April 11th, 2008 in Editor's Picks
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Night Eating Syndrome – Q&A with James Mitchell

Dr. James Mitchell, an internationally renowned expert in eating disorders, discusses the two most common types of night eating syndrome. He will be presenting this topic at the upcoming symposium on April 12, 2008, hosted by The Center for Eating Disorders at Sheppard Pratt.

What is night eating syndrome?

There exist at least two forms of night eating syndrome, or NES. The first, most commonly referred to as NES, involves people who overeat late in the day and/or get up during the night to eat. These people also have marked problems with insomnia and are fully aware of what they are doing when they wake up to eat. The other form of night eating is usually related to a sleep-related eating disorder. Those individuals wake up and eat during the night, but many times are amnestic for it and are only partially aware of what they are doing. This type of night eating is a parasomnia, much like sleepwalking.

How does an individual identify that they are struggling with this issue?

People with NES are usually fully aware of their problem. Those with a sleep-related eating disorder may be amnestic for the eating episodes, but may discover evidence the following day that they have been eating during the night; such as food that has been left out, or that the oven has been left on.

Is there effective treatment available for NES?

There is a structured form of counseling which has been manualized and is available as a self-help manual by Allison & Stunkard for NES. For sleep related eating disorder, medications are usually indicated and can be quite effective.

Read more about Dr. James Mitchell.

If you are a mental health professional and are interested in hearing Dr. Mitchell speak on this subject, you can register for the April 12th symposium online at www.eventville.com/sheppardpratt

Published by CED Editor
April 9th, 2008 in Glossary Definitions, Editor's Picks
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Borderline Personality Disorder – Q&A with Randy A. Sansone

Dr. Randy A. Sansone, an internationally renowned expert in eating disorders, talks about borderline personality disorder and the unique challenges those who suffer from it may face. He will discuss this topic at the upcoming symposium on April 12, 2008, hosted by The Center for Eating Disorders at Sheppard Pratt.

What is borderline personality disorder?

Borderline personality is a longstanding dysfunction in personality that is characterized by three fundamental features: (1) a superficially intact social facade or veneer; (2) longstanding difficulties in self-regulation (i.e., an inability to effectively regulate oneself, which might emerge as eating disorders, alcohol/drug problems, promiscuity, difficulty regulating money, chronic pain syndromes); and (3) chronic self-harm behavior (e.g., self-mutilation such as cutting, hitting, burning, or scratching oneself; suicide attempts; engagement in abusive relationships; high-risk hobbies/behaviors with the intent of gambling with death).

How frequent does this co-occur in individuals with eating disorders?

The data indicate that about one-quarter to about one-third of individuals with eating disorders have co-morbid borderline personality disorder. The disorder is less common among those with restricting anorexia nervosa and more common among eating disorder syndromes characterized by impulsivity (such as anorexia nervosa, binge-purge type; bulimia nervosa, purging type).

What unique challenges face this population in learning to manage their eating disorder?

While standard eating disorder treatment is helpful, it must be augmented with psychotherapy intervention for the personality disorder. In many cases, the function of the eating disorder symptoms extends beyond food/body/weight issues and may relate, in addition, to self-harm behavior. In addition, there are oftentimes adjunctive self-regulatory and self-harm issues that must be addressed in treatment (e.g., substance abuse, suicide attempts). Because borderline personality is oftentimes associated with early developmental trauma, these issues must be taken into account, as well.

**Some data suggests that individuals with eating disorders and borderline personality may have more severe symptoms as well as less robust treatment outcomes, compared to individuals with eating disorders, alone. Other data suggests that the treatment response to the eating disorder symptoms may improve equally well, but the individual’s overall functionality is less.

Read more about Dr. Randy A. Sansone, M.D.

If you are a mental health professional and are interested in hearing Dr. Sansone speak on this subject, you can register for the April 12th symposium online at www.eventville.com/sheppardpratt.

Published by CED Editor
April 8th, 2008 in Glossary Definitions, Editor's Picks
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