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Ask Dr. Caroline Part I - Anorexia
Eating Disorders
Walk into a dorm room of an 18-year-old woman whether in Israel or at college and you will at some point hear a discussion about food and weight. “I think I gained some weight”, “I feel so fat”, “how many calories does that yogurt have in it?” are all common topics of conversation. In today’s day and age, Western women (and increasingly men) are preoccupied with their weight and often dissatisfied with their figures regardless of what size they where. Dieting has become a regular pastime of teenagers and adult women. One study from Israel found that a whopping 50 % of Israeli teenage girls are on a diet at any given time. The dieting preoccupation is only exacerbated in a female dormitory setting where talking about food and weight becomes contagious.
So with most women concerned about weight, calories and their figures, when does this preoccupation become a disorder? I will focus in this article on one type of eating disorder – anorexia.
First, let’s define anorexia. Full-blown anorexia is characterized by a significant weight loss (or failure to gain weight in developing teens) to the point that one’s weight is dangerously low (15% below ideal body weight). When an anorectic’s weight is too low, she will stop menstruating. In addition, the anorectic is preoccupied with food and weight. Despite her unusual thinness, she continues to perceive herself as overweight. Anorectics may lose weight by fasting and/or by excessive compulsive exercise (exercising 1-2 hours a day in a gym for example), vomiting, or use of laxatives/diuretics. What makes anorexia such a difficult illness to treat is that the anorectic usually does not see her behavior or weight as problematic. Even when she does, she is ambivalent about gaining weight.
Anorexia begins with a diet that may start out healthy but continues way past appropriate weight loss. It is a diet
gone awry. Signs that the dieter is in an anorectic process include:
Anorexia has multiple causes that include social messages and pressures (women must be thin to be attractive), family factors (e.g. difficulty surrounding separation from home), and individual personality factors (e.g. perfectionistic tendencies). Some claim there are also biological
contributions as well. In my extensive work with anorectics, I find that the physical symptoms and manifestations are symbolic expressions of underlying emotional issues.
Anorexia is a very serious and potentially life-threatening illness. Treating anorexia is challenging and requires coordination between a number of treaters including a psychotherapist, a nutritionist, a physician and at times, a psychiatrist (to treat the obsessive and depressive symptoms). The earlier the disorder is detected, the better the prognosis.
If you know that your daughter is beginning a diet or is on a diet, try to keep an eye on it. Ask her what her goal weight is. You can help her by reinforcing the message that her value is not determined by her weight and that you think she looks good the way she is (of course, the strongest message comes from the model that you show her of accepting your body and weight). I would strongly discourage parents from commenting on their daughter’s weight unless she asks for help or feedback. If she has gained weight, believe me, she knows it and will do something about it when the time is right.
If you suspect that your daughter is on her way to anorexia, you might speak to one of her friends/roommates to see if they are concerned about her as well (your daughter’s friends are the ones who will first notice that there is a problem). Alternatively you can speak to someone at the school. If there is a real concern, your daughter should be evaluated by a psychologist with experience treating eating disorders to determine if there is a disorder and how serious it is. If your daughter is in the midst of an anorectic process, she will need immediate intensive treatment by a multidisciplinary team. If she denies the problem and/or refuses treatment, or if outpatient treatment shows no improvement within a month trial period, she needs to be brought home so that you, her parents, can ensure that she gets the treatment she needs. Again, time is of the essence, and early intervention makes a full recovery more likely.
Occasionally, I have seen some young women who do not have true anorexia but have begun limiting their food intake or feel guilty about eating because of the preoccupation with dieting in their school and dormitory environment. They have become confused about how to eat and feel guilty about eating because they are in an environment that everyone is talking about food. These young women usually just need a few sessions speaking to a professional to help sort out how pressured they are feeling regarding their food and weight and to regain a more healthy perspective about food.
NEXT TIME: Bulimia Dr. Caroline Peyser is a licensed clinical psychologist. She can be reached at 054-725-3964. To contact us at this website, send an email to here4theyear@gmail.com |
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