Eating to the Limit
When Controlling Food Becomes your own Cheer-Leader
Eating disorders are serious emotional and physical problems that can have life-threatening consequences for females and males. Eating disorders such as anorexia nervosa, bulimia nervosa, and binge eating disorder involve problems around eating behaviour, attitudes and beliefs about body shape and body image, unrealistic weight expectationsand unhealthy weight management. They also include extreme emotions, attitudes, beliefs and behaviors in relation to weight and food.
Sometimes people with eating disorders engage in compensatory behaviours aimed at compensating overeating. These behaviours may include: extreme dieting, fasting, use of laxative and diuretics, self-induced vomiting or excessive exercise.
These behaviours become a problem when people realize that they are starting to affect their physical health, their mental health, their work performance, their academic achievement or any engagement in their social activities.
There are many factors causing eating disorders and there is no single consensus among researchers or clinicians as to what the cause is. The development of an eating disorder may involve a combination of different factors.
They may include: the cultural ideal to be thin, problematic family relationships, transition periods across the life span, genetic vulnerability and neurochemical imbalance implying lack of serotonin.
Mental health conditions such as depression, anxiety disorders (Obsessive Compulsive Personality Disorder, Social Phobia, Social Anxiety, Agoraphobia and Generalised Anxiety Disorder),
The transition period between childhood and adolescence, as well as between adolescence and adulthood place young people more at risk of developing an eating disorder.
In addition, the pressures by the media and society to look ageless and beautiful indeed may exert body dissatisfaction and contribute to expose individuals to disordered patternsof eating.
Developmental transitions or life crises experiences that may trigger eating disorders include: the death of loved one, divorce or widowhood, marital difficulties, pregnancy, loss of youthfulness, menopause, physical signs of aging and medical illness. Unfortunately, these transition periods across the lifespan that may trigger the onset or relapse of eating disorderstend to be underdiagnosed in midlife and beyond.
Having awareness about signs of an eating disorder can make a huge difference to the duration and severity of the illness.
An individual suffering from an eating disorder may reveal one or any combination of the following warning signs:
- Preoccupation with eating, food, weight
- Having a distorted body image
- Extreme body image dissatisfaction
- Radical changes in food preferences
- Obsessive rituals around food preparation and eating
- Feeling anxious and/or irritable around meal times
- Intense fear of gaining weight
- Unable to maintain a normal body weight for their age and height
- Reduced capacity for thinking
- Increased difficulty in concentrating
- ‘Black and white’ thinking (rigid thoughts about food being ‘good’ or ‘bad’)
- Low self-esteem and perfectionism
- Increased sensitivity to comments relating to food, weight, body shape, exercise
- Dieting behaviour
- Deliberate misuse of laxatives, appetite suppressants, enemas and diuretics
- Repetitive or obsessive behaviours relating to body shape and weight
(CBT-E) for adults and adolescents suffering from bulimia nervosa, and individual and Family-Based Treatment for anorexia nervosa (FBT) for children and adolescents.
Beside addressing the issue directly, through the symptoms, the psychotherapy process revolves around at targeting the underlying causes of the eating disorder and focusing on the factors that maintain the eating disorder psychopathology.
By identifying, monitoring, and untangling maladaptive patterns of thoughts and perceptions, cognitive behavioural therapy (CBT) has demonstrated to be effective in enabling healthy schemas and leading to effective behavioural changes.
Dialectical Behavioral Therapy (DBT) is progressively being integrated into eating disorders treatment for identifying triggers, improving responses to stress, increasing self-awareness, applying mindful eating, adjusting rigid thoughts and improving coping strategies in dealing with conflicts.
Psychotherapy sessions mainly conducted one to one often involve family therapy sessions and educational programmes.
Usually they cover the follow issues:
- Establishing healthy patterns of eating
- Education around realistic weight expectations
- Education of appropriate exercise
- Identifying distortions in thoughts and beliefs
- Identifying factors that cause and aspects maintain disordered eating
- Challenging distorted assumptions
- Changing behaviour that maintains the eating disorder
- Identifying and addressing interpersonal difficulties
- Gaining insight and addressing issues around role transitions, grief and loss, unresolved relationship issues
- Learning emotion regulation skills
- Improving self-esteem, self-acceptance and self-worth
- Improving communication skills
childhood sexual abuse, self-harming and suicidal ideation or substance use disorders are often key factors involved in eating disorders as well as psychological and social difficulties.
Moreover, interpersonal dependency, non-assertive communication style, avoidance of interpersonal conflict, competition and rivalry, difficulties in recognising and controlling emotions, feelings of inadequacy or loneliness are further aspects involved in eating disorders.
People in these circumstances deal with their painful emotions by means of gaining a sense of control and by adopting perfectionistic attitudes to cope with their low self-esteem, self-acceptance, self-worth and their sense of insecurity.
Therefore, eating disorders become a coping mechanism for people attempting to gain control of their situations when they feel helpless in the face of other aspects of their life. When this quest for control goes too far, the risk of developing an eating disorder can dramatically increase.
Sometimes psychological issues start before eating disorders develop and at other times emotional difficulties can be the result of eating disorders.
In both cases they are factors that maintain them.
There are many symptoms that are common to eating disorders. They may include: dieting or avoiding food, eating rituals, playing with food rather than eating it, distorted body image, preoccupation about food and body weight.
Although eating disorders are typically thought to occur in adolescent girlsor young adulthood females, they also occur in young boys, young adulthood males, children, middle aged people and the elderly.
- Spending more and more time alone
- Eating in private and avoiding meals with other people
- Secrecy around eating
- Compulsive or excessive exercising and distress if exercise is not possible
Many people with eating disorders do not seek for help. However, it is imperative that people struggling with these issues receive treatment sooner rather than later, especially in childhood and in adolescence.
Research has demonstrated that seeking help at the first warning sign is much more effective than waiting until the illness is in full swing. It is vital to seek help and support as early as possible: the longer these difficulties are present the more entrenched the thoughts and behaviour becomes, the harder it is to make changes.
The most effective treatment for curing an eating disorder generally includes a team approach with different clinicians with multi-disciplinary specialties: a general practitioner, a psychiatrist, a clinical psychologist, a dietician and a nutritionist.
Visiting any of these professionals to discuss and assess disordered eating is a good start in identifying the eating disorder and the more appropriate treatment plan. In fact,symptoms of eating disorders are unique to every patient.
The clinical treatment depends on the specific type of eating disorder. But in general, it typically includes psychotherapy, nutrition education and medication.
In case of serious health problems, such as anorexia nervosa that has resulted in severe malnutrition, hospitalization on a medical or psychiatric ward may be also recommend.
Psychological treatment includes Motivational Interview (MI), Dialectical Behavioral Therapy (DBT) techniques,Cognitive-Behavioural Therapy Enhanced
- Managing conflicted relationships
- Developing coping strategies
- Developing problem-solving skills
- Building autonomy
- Preventing relapse
Eating disorder recovery consists of different transitions and levels of care, relapse included.The experience of relapse is a natural aspect of the recovery until the remission of the symptoms is fully achieved.
The highest risk for relapse for individuals recovering from Anorexia and Bulimia has been identified in the 6-7 months following partial symptom remission.Understanding that relapse may be part of the recovery journey, it is important to identify ways to continue to support the healing process.
Some important factors to make the transition through treatment levels towards an eating disorder recovery are:
- Following the guidance of the treatment team in establishing psychological stability in order to maintain the recovery outside treatment.
- Learning about situations, circumstances, and emotions that trigger eating disorders.
- Establishing healthier coping skills to work through triggers rather than engaging in eating disorder patterns.
- Envisaging a plan for any type of “emergency” through the recovery
- Keeping on truck by means of continuing support.
Eating disorders are so challenging with their unique needs and concerns. Long term commitment in therapy is a fundamental requisite for a comprehensive treatment involving a multi-disciplinary team engaging deeply both patients and their relatives to cope with their devastating illnesses and restore their lives.