Transcript BODY IMAGE, WEIGHT AWARENESS AND ACCEPTANCE …

Dr. Julie M. Mullany – Postdoctoral Resident
Psychological Services Center
St. George’s University, Grenada
West Indies
Intro : my background & experience
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Prior Counseling Services work & collaboration with:
Wellness Education Services – nutritionists, dieticians
Student Health Services – medical perspective
Eating Disorder Treatment Team work
Goal of today’s Presentation is:
To provide information about body image & Eating
Disorders (focusing on mainly just Anorexia & Bulimia for
purposes today) as well as insight into some treatment
approaches. Will also review appropriate ways to talk to
your patients in a way that encourages and models
attitudes and behaviors that help prevent eating disorders
and body image issues and increase healthy self-esteem.
What is body image?
 “the
picture of our body which we form in
our mind”
 It involves our perception, imagination,
emotions, and physical sensations about
our bodies
 Changes / fluctuates throughout life
 Can be positive or negative!
Psychological in nature
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Influenced by self-esteem
Influenced by what is expected culturally
Both men and women can suffer from body
image dissatisfaction. (not liking one’s body
or specific body parts)
 Body
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image can help form self-image
Culturally some of us learn that how we look
defines who we are
 So…the
worse we feel about our body, the
worse we feel about ourselves
 Self-esteem
= how worthy one feels
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Media – often values an unattainable level of
thinness
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Culture – can vary based upon where you’re from
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Interpersonal messages – what values do you
hear from friends, family members, partners?
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Personal – what messages do you tell yourself?
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Diseases/health concerns – ex) cancer, pregnancy
 Culture
– Think about the US -
What are images of
successful men/women valued in US culture? What does that culture
say about heavy vs. thin, muscular vs. lean?
 Culture of “shame” around body image
 Size discrimination
 Fat stigma
 Hatred of fat prejudice
 Personal
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What personal characteristics contribute to a negative
body image?
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Perfectionism
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Low self-esteem
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All or nothing thinking
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Difficulty focusing on positive qualities
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“Life would be better if…”
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Listen to your body
Be realistic about size, appearance
Exercise regularly in an enjoyable way
Expect normal weekly and monthly changes
in weight and shape
Work towards self acceptance and self
forgiveness
Ask for support and encouragement from
friends, family, etc.
Decide how to spend your energy: -pursuing
the “perfect body image” or enjoying life!
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Eating disorders are illnesses with a biological basis that are
often influenced by emotional, cultural, environmental and
societal factors
In the US alone there are over 10 million females and 1
million males struggling with anorexia and / or bulimia
There are millions of others that struggle with binge eating
disorder as well
ED’s are the no. # 1 cause of death amongst all psychiatric
disorders
3 types were classified in the old DSM-IV – Anorexia, Bulimia,
& ED NOS (DSM-5 allows for more broader classifications)
BIOLOGY: current research indicates that brain chemistry is
altered in individuals with ED’s
ENDORPHINS released when restricting and bingeing occurs
GENETICS play a role: family members with ED’s, other
addictions or mental illness
CULTURAL/FAMILIAL INFLUENCE: focus on weight,
appearance, body image related to self-worth
o ENVIRONMENTAL: change in portion sizes, unhealthy
choices, culture of convenience & the decrease in activity
o SOCIETAL: thin messages, fit/healthy skewed, models with
ED’s, magazines digitally enhancing and altering photos,
women’s progression in work force often still based on looks
over ability
o CO-OCCURRING / CO-MORBID DISORDERS such as depression,
anxiety, bipolar disorder, OCD, low self-esteem, self-injury,
substance abuse
o EMOTIONAL TRAUMA: physical, emotional, sexual abuse
survivors, trauma, grief (sense of control)
o Utilizes ED as a MEANS OF COPING and surviving, control
Began as white middle to upper class female
disease – which led to a major paradigm shift
 ED’s currently do not discriminate
 Males, other ethnicities and races as well as
economic status & sexual orientation
 ED’s can be seen in those as young at 6 years
old to as old as 70 +
 Increase occurring for the first time with
middle aged women
 Increase in instances of ED’s among gay men
 Prevalence of ED’s with women in Substance
Abuse recovery –
 Athletes
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Dieting or restricting food
o Purging – self-induced vomiting, laxatives,
diuretics
o Exhaustion or chronic fatigue
o Excessive weight loss
o Loss of menses
o Changes in mood
o Lack of motivation
o Decreased concentration
o Fainting, dizziness or light-headedness
o Isolation/withdrawal from peers, or activities
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 Low
potassium
 Electrolyte Imbalance
 Heart attack
 Esophageal rupture
 Intestinal problems and disorders
 Hair loss
 Hair growth (Lanuga)
 Lower than normal bone destiny (Osteopenia)
 ..a precursor to bone disease (Osteoporosis)
 Anorexia
is disorder in which someone
refuses to eat, even though they may be
hungry. They choose not to eat because they
are afraid to gain weight, typically have a
distorted body image & carry emotional pain
 Some physical signs & symptoms specific to
Anorexia
- severe weight loss
- low blood pressure
- slow heartbeat
- growth of fine hair on body
 Anorexia:
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eats foods with low calories & low fat
cutting food into small pieces
playing with food rather than eating
cooking meals for others, not eating
compulsive exercise, skipping meals
dressing in layers to hide weight loss
becomes more isolated & secretive
increasing defensiveness
frequently weighing oneself
Bulimia is a disorder in which people will eat a
large amount of food in a short period of time
(binge episode) and then either take laxatives or
engage in self-induced vomiting (purging). Overexercise (for both those with anorexia or
bulimia) is also considered a form of “purging.”
 Some physical signs & symptoms specific to
bulimia sufferers:
- damaged teeth or gums from acid in vomit
- persistent sore throat
- dehydration
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 Bulimia
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 - secretive about food
 - spends time planning next binge
 - taking many trips to the bathroom
after eating
 - take food or hoard in strange places
 - compulsive / impulsive eating habits
 Learn
as much as you can about Eating
Disorders
 Voice your concern in a non-judgmental,
caring, open and honest manner
 Serve as a healthy role model to the
individual
 Inform someone else if necessary
 Assist the individual with referrals/info on
where to go for help (individual counseling,
nutritionist, group &/or family therapy)
 Address
immediate health problems first
 Make long term treatment plan:
- inpatient treatment
- Individual & or group therapy
- family therapy
- eating disorder education
- nutritional counseling
- continued medical monitoring
For Anorexia and Bulimia:
- family therapy - addresses unhealthy family
dynamics at play / allows eating patterns &
routines to be observed (Maudsley model)
- Cognitive behavioral therapy or DBT – can help
individuals change the unrealistic negative
thoughts they have about their appearance &
gradually change destructive eating behaviors
- Interpersonal therapy – helps individuals
improve quality of their relationships, learn how
to address conflicts head-on, expand social
network & deal with emotions more effectively
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Ideally, and proven the most effective – is an
Eating Disorder Treatment Team approach: A
multi-systemic approach to treatment and
includes:
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Mental Health Counseling – individual & group
Psychiatry
Nutritional Counseling
Medical Monitoring
Further Linkages and referrals
 Focus
on health rather than weight or looks
 Do not blame, criticize or judge the patient
 Check your misconceptions about ED’s
 Do no minimize or joke, listen & be patient
 Redefine rather than confront resistance
 Avoid argumentation or defensiveness
 Empathize self-efficacy, will-power, selfdetermination & empower the patient
 Develop discrepancy between their present
behavior & patient’s personal goals
Do not instantly jump to give advice & opinions
 Avoid talking in great detail of weight or food &
eating habits as these aren’t the real issues but
symptoms of deeper, more complex underlying
emotional issues (& often trauma)
 Do not get angry with these individuals
 Encourage them to seek help but never try to
force them to eat
 Assure them they are not alone, that you care &
want to help them in any way you can.
 Expect reactions of anger or denial – don’t push
them but say you are there if they want help
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 Assume
cognitive distortions & reasoning
errors, don’t assume they know facts, clarify
 Educate about health risks but utilize
warmth, compassion & nurturing empathy
 Discuss a Team approach w/patient to allow
them to feel they have control rather than
that they are being controlled
 Validation and good communication reduces
defensiveness & splitting behaviors, increases
trust & can provide hope & empowerment
One
of the biggest changes in the
new DSM-5 is the removal of the
multiaxial system in place of the
establishment of 20 diagnostic
classes or categories of mental
disorders – categories based on
groupings of disorders sharing
similar characteristics that are not
given particular rank.
 While
the DSM-IV(TR) considered 3 Eating
Disorders and were listed under the Axis 1
disorders section:
- Anorexia Nervosa
- Bulimia
- or ED-NOS – has characteristics of both
…they are now found in Feeding and Eating
Disorders and include more types - allowing
for additional diagnostic nuance.
 This
diagnostic category includes the
following list of specific Feeding & Eating
disorders
- Anorexia Nervosa
- Bulimia Nervosa
- Binge Eating Disorder (lacks purging component)
- Pica, Rumination Disorder
- Avoidant/Restrictive Food Intake Disorder
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Note - binge-eating disorder has been taken out
of the Appendix & has become its own freestanding diagnosis in the new DSM-5.
- Psychological Services Center (PSC) at SGU
Campeche Hall (2nd Floor)
North & South Wings
(473) 439-2277
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Search online at eating disorder websites
Consult with counselor, MD, nurse, or PCP
Call the National Eating Disorders Association
hotline no# - 1-800-931-2237