Other Topics
We have an 8-year-old daughter who simply is not interested in food. She actively avoids sitting down for meals and often does not eat at all. Body image is not an issue for any of us. We do not think that she has any weight problem - neither too thin nor too "fat' - but we are concerned that she does not eat enough healthy food. It is a regular problem at every meal. Should we be concerned and what should we do to allay our concerns?
Dear Concerned Parent,
It is not uncommon for children to be picky eaters but you are right to be concerned because eating disorders are becoming more common in younger children. While I cannot say if your daughter has an eating disorder and despite the fact that no one in your home has body image issues, unfortunately you cannot protect your daughter from encountering these issues outside of your home. It is possible that body image and dieting are popular topics among her peers at school, and she may even be exposed to this while visiting friend’s homes. This must be incredibly frustrating for you as a parent. I would suggest some exploration with your daughter to determine what might be causing your daughter’s resistance to eat.
Start with talking with your daughter. Has she expressed or explained why she is not interested in eating? What are her reasons? Is she a picky eater? Have you tried involving her in meal planning and food preparation? Could your daughter be stressed from academic pressure at school? Could she be depressed? Stress and depression can affect appetite. If those are not the problems, is she experiencing pressure from her friends about dieting? Are her friends dieting? Is your daughter being teased? Keeping open and honest communication with your daughter is important, and even discussing the dangers of not eating is also recommended. NEDA has terrific Information for Parents for parents on our website on how to discuss some of these issues with children.
After discussing your concerns with your daughter you may also want to consider a visit with her to the pediatrician, and if all fails and she is not showing improvement I would recommend you call NEDA’s toll-free helpline at 1-800-931-2237 so that you can get a referral for treatment in your area.
Danielle Z. Kassow, PhD
3/21/2006
back to top
Can you give literature references or information for spouses of those with eating disorders that address the connection between disordered eating/eating disorders and the marital relationship and how the dynamic of the relationship can contribute to the problem?
Dear Literature Seeker,
Although this area of literature is not my area of expertise, I am a researcher by trade and I was able to find some sources for you. I conducted a search on google, google scholar, the Library of Congress, a local university online catalog, and several major internet booksellers, using the following terms: “eating disorders and marriage” and “eating disorders and marital relationship.” Several titles appeared repeatedly and I crossed referenced those with titles available at Gurze Books, Gürze specializes in eating disorders publications. Gürze has quite a few books available under the topic of relationships but four of the titles seemed to be the most relevant to your question. Note that at least two of these books are written for the practitioner or researcher.
The references are:
- Eating Disorders and Marital Relationships (1997), Stephan Van den Broucke and Walter Vandereycken
- Eating Disorders and Marriage: The Couple in Focus (1993), D. Blake Woodside, Jack S. Brandes, Jan B. Lackstrom, and Lorie Shekter-Wolfson
- Appetite for Life: Inspiring Stories of Recovery from Anorexia, Bulimia, and Compulsive Overeating (2005), Margie Ryerson- this book includes practical advice for loved ones
- Honey, Does This Make My Butt Look Big?: A Couple’s Guide to Food and Body Talk (2005), Lydia Hanich- this book has information on how couples can support each other without contributing to the problem.
I would also encourage you to see what other titles Gürze has available - there may be others that I missed.
I would also offer one more suggestion. If you have access to a public or university library you could conduct a search on electronic databases such as PsycInfo, ERIC, PubMed, or Medline using the search terms I used or other ones you think of. These databases will allow you to see what research articles have been published on the topic you are interested in and often you can print the article from the database. If you are unsure how to do this the librarians should be able to help you. Best of luck to you on your quest for more information and knowledge!
Danielle Z. Kassow, PhD
5/1/2006
back to top
Help! I'm 30 years old and I have finally admitted to a handful of my closest friends and mother that I'm suffering from bulimia and how it has really taken over me physically and mentally. I know the first part to recovery is to admit you have a problem. This has become full blown over the past 3yrs and I read up about the causes, symptoms and treatments and even though I'm very knowledgeable about the disorder I can't force myself to go get the help I need. I would never think about committing suicide but deep down I don't care what happens or if I didn't wake up the next day. My stubborn ways and my willpower of thinking I can turn this around on my own has created a major hurdle. I don't know what to do without feeling like I'm being forced.
Dear 30 year old,
I am glad that you are able to confide in your friends and mother. I know how hard that was to do. Having a close network of family and friends to support you is very important. I am also glad that you have educated yourself about the disorder; Knowledge is power. What is interesting to me is that on the one hand you are seeking help by confiding in people who are close to you and by seeking out information, but you won’t seek professional help because it feels forced. But what feels forced to you? Is it that facing the problem is painful? Is facing the problem scary? It is fear of the unknown, perhaps of what treatment is really about? It is normal to feel these things about dealing with problems, and these feelings can become barriers. But I think that even though you say you don’t care what happens to you that deep down inside you do care because you are reaching out to those close to you. No matter how strong your willpower is eating disorders are not about a person being weak or strong, or having or not having willpower. Eating disorders are illnesses not choices, they are diseases, and like any disease they will not go away on their own. Unfortunately I don’t think your eating disorder will go away without professional help and my opinion is not a statement about you as a person but rather my opinion is about the disease. Think of treatment this way: If you were to seek out treatment, instead of thinking you don’t have willpower, think that you are very strong willed because you have the will to get help and survive.
I encourage you to think about this, and to contact our referral helpline at 1-800- 931-2237 or visit the Helpline webpage to find out about treatment in your area.
Danielle Z. Kassow, PhD
3/21/2006
back to top
My daughter is 7, almost 8, and for a few months now her appetite has decreased to the point where she barely eats a thing. All the foods that she used to love she will not touch. Is it uncommon for children her age to develop an eating disorder? I am very concerned. I don't want to bring this up to the doctors because I feel that they will think I am crazy suggesting the possibility of an eating disorder at such a young age. Please give me some advice.
Eating disorders certainly do occur in children as young as your daughter, and even in younger children. However, depending on growth patterns and growth spurts, children may eat less sometimes and more at other times or, for example, go on “food jags” where they’ll only want one or two specific types of foods for weeks at a time. I would wonder if your daughter is losing weight or if she is no longer growing according to what’s expected on her height and weight growth charts. You should ask your doctor to determine this using her past height and weight measurements
Children are highly sensitive to the parent-child feeding relationship. You could be influencing her eating habits in ways in which you are not aware. Visit specialist Ellyn Satter’s website at www.ellynsatter.com. She has useful articles and a number of excellent books that may help you. If it seems that your daughter is developing an eating disorder, you might want to read EDs: A Parent's Guide (revised) by Rachel Bryant-Waugh and Bryan Lask, or Help for Eating Disorders: A parents’ guide to symptoms, causes and treatments, by Debra K. Katzman, MD, FRCP(C) and Leora Pinhas, MD, FRCP, all available through www.gurze.com.
I am hoping that by the time you read this your daughter is back to her happy self, enjoying her meals. If not, speak to your pediatrician and consider requesting consultations with mental health clinicians and a dietitian skilled in the treatment of eating disorders. Even if your daughter does not have a specific eating disorder, these professionals should be able to help your daughter and you get back on target.
Karin Kratina, PhD, RD, LD/N
7/31/2006
back to top
I have a 38 year old client who gained 30 lbs in college and in response began to diet and became anorexic. She has been able to increase her eating and reduce her excessive exercising over the past 10 years. Although her weight seems to be normal, she currently has many strict rules about eating. For example, some foods she absolutely will not eat, she regularly eats only about 1200 calories a day, is terrified of eating, and has developed irritable bowel syndrome. She does not eat breakfast, eats a small lunch and a small dinner. Before dinner she becomes extremely anxious about what she will eat and in fact becomes anxious just about eating. She has huge control and perfection issues. Would this be considered an eating disorder or dysfunctional eating?
Without a doubt, I would call this dysfunctional eating and it is likely your client is suffering from an eating disorder. Oftentimes professionals not skilled in treating eating disorders will overlook problems because a client’s weight appears “normal,” as does your client’s. But you cannot diagnose eating problems based on weight alone any more than you can tell if a person is fit based on her/his weight. I hope your client begins working with a therapist and dietitian skilled at treating eating disorders and that she has a consultation with a professional who is able to accurately diagnose her condition.
Karin Kratina, PhD, RD, LD/N
7/31/2006
back to top
Hello, I have a question regarding diagnosing eating disorders. If a type 1 diabetic binges frequntly (2-3 times a day) and skimps on insulin to lose/maintain a normal weight, would that still qualify him/her to be diagnosed with bulimia? The DSM-IV (the Diagnostic and Statistical Manual of Mental Disorders, Version 4) doesn't mention insulin skimping as a purging method, but I can see where it could be considered one.
Thanks for any help you can provide!
The short answer is ‘Yes.’ The longer answer is that the second DSM-IV criterion for Bulimia Nervosa requires ‘recurrent inappropriate compensatory behavior to avoid weight gain,’ and skimping on insulin certainly qualifies. While that method is not listed as one of the examples in the diagnostic criterion, it is mentioned in the text of the most recent revision of the DSM.
B. Timothy Walsh, MD
10/1/2006
back to top
I suffered from bulimia for two years starting when I was about 13. Now recovered at 15, I am three inches shorter than my mother and have never gotten a period. Is there any hope for me returning to normal?
You should talk to your pediatrician or gynecologist to ask about the fact that you have not resumed menstruation. You would need a bone examination (usually a bone age and growth plate evaluation) to answer your question about the potential for growth recovery at this point. Both of these tests as well as some others might provide an answer to your question.
James Lock, MD, PhD
1/4/2007
back to top
What defines recovered for eating disorders? Is it like something that exists below the surface but is kept in control? or are the feelings supposed to go away?
Recovery in eating disorders can be understood as both a process (of recovering) and an accomplished state (having recovered). The hallmarks of recovery involve the reversal of the pathological preoccupations and behaviors. In the case of eating disorders, the specific symptoms that characterize the various illnesses (AN, BN, BED) provide the benchmarks for assessing progress and recovery. Since all eating disorders involve some of the symptoms of disordered eating (bingeing, restricting, purging, laxative abuse, inflexible food and weight rules, etc), reducing these symptoms necessarily becomes a central focus in assessing the degree of progress and recovery.
The focus on specific symptoms, however, is only part of the story. Eating disorders do not develop in a vacuum. There is a bio-psycho-social context. The challenges of adolescence, separation, family strife, cultural pressures, depression or other psychological states are among the many underlying factors that can lead to the formation of an eating disorder. Recovery necessarily involves effectively addressing these underlying factors. Without such attention, unresolved factors can predispose to a relapse or the development of another set of symptoms (so called symptom substitution).
Active eating disorders are often so compelling that they take over the sufferer’s mental life and behavioral pattern to a marked degree. As a consequence her or his major concerns often relate primarily to food, weight and calories and underlying issues tend to become obscured or inaccessible, even in treatment settings.
However, first things first. It is my distinct clinical sense, formulated over many years of treating a large number of eating disordered patients, that until significant control of the behavioral symptoms (bingeing, purging, starving, refusal to maintain a nourished weight, etc) is achieved, recovery remains elusive.
The road to recovery can therefore be thought of as involving a three-step process:
- Gain control of the behavioral symptoms: This is a very challenging step, but one absolutely essential to recovery. The strategies to accomplish this step are varied and need to be tailored to each individual. Nonetheless, a fierce determination and commitment to accomplishing this is a basic prerequisite to recovery.
- Treat/Work Through the Underlying Issues: With the behavioral symptoms under control, the nature of the underlying problems comes into focus and facilitates more meaningful and effective treatment opportunities.
- Consolidate the Above Gains and Commitment to non disordered eating.
This may not immediately mean an absence of eating disordered thoughts or the temptation to indulge in symptomatic behavior. Clinical experience shows that healthy thoughts tend to follow behind healthy behaviors. With continued healthy eating and maintenance of adequate nutrition, the obsessive thoughts and symptomatic urges will gradually recede or extinguish.
Finally, it is important to remember, recovery is not a state of perfection. Normal eating -- the essence of recovery -- is flexible, forgiving and variable.
Charles A. Murkofsky, MD, FAED
12/1/2006
back to top
I am a 19 yrs old. My boyfriend and I have been living together for about 3 months but have been together for 3 years and lately I have been noticing his eating habits. I noticed this has been going on long before we started living together, he will eat some kind of snack food before dinner, he will have at least 2 to 3 servings of dinner and after dinner he will eat something else including dessert. Then afterwards he will be ok for about 10-20 minutes, then he will start getting grouchy and say he doesn’t feel comfortable, that he ate too much and he will go in the bathroom and throw it all up. He has been in the hospital 2 times because he was dehydrated after throwing up the food. It’s almost every dinner that this happens but he throws it up because he is uncomfortable and not in the fear of getting fat. Is that bulimia? If not I need to know what it is and what I should do. I can’t deal with him being mean to me because he ate too much and doesn’t feel well. By the way, he is not fat at all. He is a very big football player on his college team so I just don’t understand. Please help me! He has a doctors appointment for his cold today so should I bring it up to the doctor?? I don’t know. Please help!!!!
It certainly sounds like your boyfriend has an eating disorder, likely bulimia nervosa. However, it is difficult to be certain without talking to him about his thoughts, motivations, and concerns about his weight and eating. His current eating pattern is not healthy and can, as you already know, land him in the hospital. It may be difficult, but encourage him to bring it up with his physician and to talk to his physician frankly about his behaviors.
James Lock, MD, PhD
1/4/2007
back to top
My diabetic husband eats constantly. Yes, he is overweight but that wasn't an issue until he was diagnosed with diabetes. He does NOT have all these warning signs: purging by strict dieting, fasting, vigorous exercise, vomiting or abusing laxatives or diuretics in an attempt to lose weight, using the bathroom frequently after meals, preoccupation with body weight, depression, developing dental problems, heartburn and/or bloating, experiencing personal or family problems with alcohol or drugs. He simply loves to eat! Is this still a disorder? He is constantly eating something and wherever he is you can be guaranteed he has a box of cookies, crackers and cheese, salted peanuts or something to graze on. Almost every night also comes with a large bowl of ice cream with chocolate syrup. He is not depressed. He does not drink or smoke or do drugs and he is an absolutely wonderful man. I am afraid he will eat himself to death! Watching a football game without at least a few large quantities of some type of junk food would be impossible for him. One of him diabetic medications have suppressed his appetite somewhat so he doesn't eat as much at mealtime. He now eats normal portions for meals but all the snacks are still coming. My question is, is this an eating disorder that can be helped or simply over eating?
Your husband does have a problem with his eating and his weight. It appears that he may have binge eating disorder or something similar to it. Compulsive binge eating accelerates the development of obesity and its complications, such as diabetes. But even if your question of eating disorder vs. overeating cannot be definitively answered, he still has eating patterns that are leading to adverse health consequences, such as obesity and diabetes. He is now at greater risk for heart disease, stroke, and other major health problems. My advice is to urge him to consider treatment for his disturbed eating. Consulting a dietician might be a good first step. It is very possible that he would be able to adopt a healthier diet. If it turns out that he cannot control his eating and engages in binge eating, then treatments for binge eating disorder would include psychological approaches (such as cognitive-behavioral therapy), medications (such as topiramate and sibutramine), and surgery (usually reserved for those with severe obesity).
James I. Hudson, MD, ScD
2/1/2007
back to top
Formerly recovering from an eating disorder, I have decided to embark upon creating a documentary about eating disorders for a class in high school. I wanted to focus on how the media affects eating disorders and bring awareness to this issue because I attend a school where it is a very large issue that is never spoken of. I was just curious what is acceptable and what is not to present with a crowd that is so sensitive to the subject and perhaps what boundaries I should not cross? I know this seems like an odd questions but I’m not quite sure as of how the class will react and want to present it in the most sensitive way possible. Thanks!
My first piece of advice would be to let your personal experience fuel your drive and inform what you want to say, but don’t make yourself the main focus of the documentary. As much as possible, present the ideas you want to convey through the words and stories of others, as well as through media images. Remember, the best documentaries are about the story, not the storyteller. Second, I’d also suggest that you start with portraying preoccupations with food, weight, and body weight—here you can engage your audience and can illustrate in many ways—and then move later into clinical eating disorders. Third, shock is not necessary and has a great chance of backfiring. If things are too personal or too graphic, your audience will become uncomfortable and will not be receptive to your message. I don’t know exactly what you mean in terms of boundaries, but if it’s a close call in your mind, I’d err on the side of toning it down. Finally, I’d suggest you involve a teacher or counselor as well as a friend, particularly on the issue of how much of your own story to disclose and in what manner. They should be able to gauge the appropriateness of your approach.
James I. Hudson, MD, ScD
2/1/2007
back to top
Hi, I am a 25 year old female. I recently lost my father to a very horrible disease this past summer. Three months after he passed I married my husband and moved to a different city, away from my family. It has been a difficult move for me, I am out of my comfort zone and don't have a lot of friends around. I have dealt with my emotions through food my entire life. I can remember taking a diet pill as young as 15 and haven't looked back sense. I used to use laxatives, but I no longer do. I exercise around 2-3 hours a day six days a week. Things just seem to be getting worse for me and I just really want to move beyond this. I want to be happy in my life and with myself. I no longer want to be held down by my obsession to be thin and fighting myself and my emotions with food. I just don't know what to do and who to look to for help. I don't have insurance so I can't afford to go to some doctor, but I am desperate to find help. Please...
You describe several recent challenges and changes: the loss of your father to a difficult disease, getting married soon thereafter, and moving to a new city where you do not have a lot of friends. Understandably, such changes and losses always tax one’s ability to cope and there is a tendency at times like this to resort to personally familiar strategies of coping, even if these strategies do not work constructively in the long run. For you, as you describe, these survival strategies include over-exercising, body weight and food preoccupation, as well as disordered eating patterns. At the same time, reading your message, I am struck by your strengths. First, you seem to be a good self-observer: you notice when your way of coping becomes challenged and you need to take action. Second, you care about your well-being and you reach out for help at times of crisis, such as writing this letter. Third, you describe the key challenges for you at this time with great clarity: losses, changes, emotions/mood, food obsession, relationships, and self worth. Fourth, you seem to be determined to change: to be happy with your life and yourself, to deal with your emotions differently and to accept your body and yourself. All these strengths are very important in the recovery process, which will probably involve several components. One thing you may find valuable is to engage in activities or work, other than food- or weight- related, that give you a sense of positive self-esteem. In the letter, you have not described your interests, work, or even wishes and hopes in the area of activities. Try to pursue these types of activities or interests, and, remember, it is fine to take such pursuits one step at a time. In addition, you should explore ways to reduce your isolation and make connections with others in your new environment. Engagement in different activities, as suggested above, can be a way of meeting others. Further, you should attend to your emotions and needs. With your husband, with other significant people in your life, in new relationships, and in selecting your activities, try to be aware of your needs and express them. Similarly, be aware of your emotions, examine what affects your mood both positively and negatively, and aim to spend more time in situations, other than food or exercise-related, that make you feel more positively about yourself. Sometimes keeping a diary about situations, people, and activities that make you feel good (or bad) about yourself can help guide you about what situations are good for you and what situations you should avoid. Try ending every day with writing down one good thing you found about yourself or your actions that day (e.g., reaching out to others, expressing needs not through food, asserting yourself, being brave).
Niva Piran, PhD
4/1/2007
back to top
|
 |
