Transcript Eating Disorders

Eating Disorders
Brittany Jackson
Overview
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Types of Eating Disorders
Warning Signs
Developmental Issues
Counseling and Prevention Strategies
Types of Eating Disorders
Anorexia Nervosa
 Eating disorder characterized by the refusal to maintain a minimally normal
body weight, an intense fear of gaining weight, and a significant disturbance
in the individual’s perception and experiences of his or her own size. (Mash,
et al, 2010)
 2 types: restrictive type (individuals seek to lose weight primarily through
diet, fasting, or excessive exercise) and binge-eating/purging type
(individual regularly engages in episodes of binge eating or purging, or
both). (Mash, et al, 2010)
 Adolescents with anorexia are described clinically as being obsessive and
rigid, preferring the familiar, having a high need for approval, and showing
poor adaptability to change. (Mash, et al, 2010)
 In adolescents, a lack of menstruation can be a sign of anorexia. (Berger,
2008)
Treatments for Anorexia
 Hospitalization and
Refeeding – hospitalize the
patient and force him or her
to ingest food to prevent
death from starvation.
 Behavior Therapy – make
rewards contingent upon
eating. Teach relaxation
techniques.
(Nolen-Hoeksema, 2007)
 Techniques to help the patient
accept and value his or her
emotions – use cognitive or
supportive-expressive
techniques to help the patient
explore the emotions and
issues underlying behavior.
 Family Therapy – raise the
family’s concern about
anorexic behavior. Confront
the family’s tendency to be
over controlling and to have
excessive expectations.
Bulimia Nervosa
 An eating disorder that involves recurrent episodes of
binge eating, followed by an effort to compensate by
self-induced vomiting or other means of purging.
 Individuals with bulimia are influenced by body shape
and weight and are obsessed with food.
 Adolescents with bulimia are more likely to show
mood swings, poor impulse control, and obsessivecompulsive behaviors.
(Mash, et al, 2010)
Bulimia Danger Signs
 Regular binging (eating large amounts of food over a short period of time)
 Regular purging (by vomiting, using diuretics or laxatives, strict dieting, or
excessive exercise)
 Retaining or regaining weight despite frequent exercise and dieting
 Not gaining weight but eating enormous amounts of food at one setting
 Disappearing into the bathroom for long periods of time to induce vomiting
 Abusing drugs or alcohol or stealing regularly
 Experiencing long periods of depression
 Having irregular menstrual periods
 Exhibiting dental problems, swollen cheek glands, bloating, or scars on the
back of the hands from forced vomiting
(Mash, et al, 2010)
Treatments for Bulimia
 Cognitive-Behavioral Therapy –
teach the client to recognize the
cognitions around eating and to
confront the maladaptive
cognitions. Introduce “forbidden
foods” and regular diet and help the
client confront irrational cognitions
about these.
 Interpersonal Therapy – help the
client identify interpersonal
problems associated with bulimic
behaviors and deal with these
problems more effectively.
(Nolen-Hoeksema, 2007)
 Supportive-Expressive
Psychodynamic Therapy –
provide support and
encouragement for the client’s
expression of feelings about
problems associated with
bulimia in a nondirective
manner.
 Tricyclic antidepressants and
selective serotonin reuptake
inhibitors – help reduce
impulsive eating and negative
emotions that drive bulimic
behaviors.
Childhood Obesity
 Is considered to be a chronic medical
condition similar to hypertension or
diabetes, and is characterized by
excessive body weight.
 Is defined by a body mass index
(BMI) about the 95th percentile for
children of the same age and sex.
 Is not a mental disorder, but can
affect a child’s psychological and
physical development.
 Poses a risk for unhealthy dieting
problems, chronic health problems,
and later onset eating disorders.
 The causes of obesity include
genetic predisposition and family
influences such as poor
communication, lack of support, and
in extreme cases, sexual and
physical abuse.
 Treatment and prevention efforts
often are aimed at helping parents
take an active role in children’s
proper nutrition and activity level.
Schools contribute to this effort by
education children in nutrition,
exercise, and awareness of healthy
eating attitudes and body image.
(Mash, et al, 2010)
Obesity
 Assessment of Obesity
 Step 1: Initial Contact
 Step 2: Parent and Child Interventions
 Food Diary and Daily Activity
Record Handouts
 Step 3: Observation of the Behavior
 Step 4: Further Assessment
 Step 5: Referral to Allied Health
Professions
 Step 6: Communication of Findings
and Treatment Recommendations
(Schroeder, et al, 2002)
 Treatment of Obesity
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Basic Information
Intervention with the Child
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Self-Monitoring
Stimulus Control
Cognitive Reconstruction
Shaping
Developing Alternative Behaviors
Planning Ahead
Assertiveness Training
Relapse Prevention
Intervention with the Parents
Intervention with the Environment
Changing the Consequence of the
Behavior
Intervention in Medical/Health Aspects
Warning Signs
Physical Warning Signs
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Weight loss
Hair loss
Edema (swelling)
Skin abnormalities
Discolored teeth
Scarring on the backs of hands
Self-injury signs
(Erford, 2010)
Behavioral Warning Signs
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Frequent trips to bathroom
Avoiding snack foods
Frequent weighting
Substance abuse
Isolation
Abnormal eating habits
(Erford, 2010)
Psychological Warning Signs
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Low self-esteem
External locus of control
Perfectionism
Helplessness
Depression
Anxiety
Anger
(Erford, 2010)
Developmental Issues
Elementary School
 Children as young as 5 years old express concerns about
body image and becoming fat.
 By 6 years old, children use adult cultural criteria to judge
physical attractiveness.
 Children tease, shame, and avoid friendships with peers
who are fat or who are not conventionally attractive.
 Children imitate actions and attitudes of parents and
adults.
(Erford, 2010)
Middle School
 Body image dissatisfaction increased from 40% on
third graders to 79% in sixth graders.
 Self-esteem is directly linked to body satisfaction.
 Students with low self-esteem in other realms may be
prime suspects.
 The top wish for 11 to 17 year old girls is to lose
weight.
(Erford, 2010)
High School
 Discontent about their bodies and feeling fat has
become normative, particularly for girls.
 67% of females and 82% of males in high school believe
appearance influences romantic appeal.
 72% of females and 68% of males attribute happiness
to appearance.
 High school student have lower physical self-esteem
and more unhealthy weight control behaviors.
(Erford, 2010)
Counseling and Prevention
Strategies
Individual Counseling
 Counselors must be aware of other helping
professionals that students can be referred to if
needed.
 Education about nutrition, exercise, self-acceptance,
and the physical dangers associated with eating
disorders are essential.
 Counseling should match student development levels.
(Erford, 2010)
Group Counseling
 They provide students with opportunities to engage in activities
and practice new behaviors with peers at a time when they are
vulnerable to peer influences.
 It gives students a focused means of talking about ways to
promote positive body image.
 Students learn about advocacy and the focus that influence their
feelings about their bodies while learning how to cope with
everyday interactions with others and teasing about their
bodies.
 Counselors should exercise caution, patience and have
appropriate supports in place for students in these groups.
(Erford, 2010)
Involving Family Members
 How to help families cope with
eating disorders?
 Educate families about eating
disorders.
 Send written correspondence home
with students.
 Facilitate family discussions about
weight and health.
 Alert families to how they might
unintentionally send harmful
messages.
 Set limits and openly discuss issues.
 Ascertain eating habits, and foster
family relationships by suggesting
that they spend mealtimes together.
 Facilitate an examination of family
members’ own feelings and prejudices
about weight.
 Make appropriate referrals to community
medical and mental health professionals.
 Emphasize that spending time with
children can foster cohesive, warm
relationships that protect students from
eating disorders.
 Discourage dieting.
 Plan programs through parent-teacher
association meetings.
 Educate families about normal puberty
and developmental changes.
(Erford, 2010)
Classroom Guidance Programs
 School counselors can encourage teachers to combine issues of
nutrition, exercise, and self-appearance into appropriate classes
such that children learn about healthy, positive, and active
lifestyles.
 The Making Choices program promotes self-acceptance through
discussion of self-esteem, healthy dieting, and exercise.
 Classroom guidance programs addressing these topics create an
environment in which students examine knowledge and
attitudes about food and eating, develop positive and realistic
attitudes toward their bodies, and gain accurate information.
(Erford, 2010)
School-Based Changes
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Initiatives to enhance systematic change
 Provide training to become aware of the signs
and symptoms of eating disorders.
 Promote activities that foster healthy and
realistic attitudes about weight, shape, growth,
and nutrition.
 Monitor how health and physical activity
requirements are communicated to students
and families.
 Create an atmosphere in which students
confront negative body talk.
 Advocate for nutritional food and snack
offerings.
 Encourage the purchase of library and
classroom materials with positive images about
self-esteem and body image.
(Erford, 2010)
 Create a wellness program that will
accomplish the following:
 Focus on prevention and early
intervention.
 Involve teachers and administration.
 Promote healthy attitudes and habits
towards eating.
 Encourage self-control.
 Focus on improving self-esteem and
autonomy.
 Make appropriate material available
in easy accessible areas.
 Foster discussions among the whole
school community.
 Continually focus on the overall wellbeing of students.
How to Help a Friend With Body
Image and Eating Disorders
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Do…
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Create a safe environment to talk.
Encourage the person to seek help from a
professional counselor, physician, or friend.
Expect anger or rejection at first - this may be
an embarrassing or frightening first encounter.
Be patient – this is a long process and difficult
issue.
Express you concern and desire to help.
Plan your approach carefully.
Speak with concern and compassion.
Model positive actions.
Provide specific information and resources.
Be willing to spend time listening and talking
about related personal problems.
Take a look at your own attitudes towards
weight, shape, and dieting.
Attempt to discuss feelings.
Offer support.
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Don’t…
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Nag, argue, plead, or bribe.
Criticize yourself or anyone else for being
overweight or underweight.
Blame yourself or anyone else for the persons
difficulties.
Comment positively or negatively about others’
size and shape.
Comment on the person’s appearance.
Use scare tactics.
Spy or interfere.
Monitor eating.
Use food as a socializing agent.
Discuss weight, amount of calories or fat being
consumed, or particular eating and exercise
habits.
Expect 100% recovery immediately.
(Erford, 2010)
References
 Berger, K. S. (2008). The developing person through the life span (7th ed.).
New York, New York: Worth Publishers. 459-460.
 Erford, B. T. (2007). Professional school counseling: a handbook of theories,
programs, and practices (2nd ed.). Austin, Texas: PRO-ED, Inc. 591-602.
 Mash, E. J., & Wolfe, D. A. (2010). Abnormal child psychology (4th ed.).
Belmont, CA: Wadsworth, Cengage Learning. 397-425.
 Nolen-Hoeksema, S. ( 2007). Abnormal psychology (4th ed.). New York: The
McGraw-Hill. 539-570.
 Schmidt, R. C., (2007). Counselors’ pages. Warminster, PA: MAR*CO Products.
112.
 Schroeder, S.C, & Gordon, B. N. (2002). Assessment & treatment of childhood
problems- A clinician’s guide (2nd ed.). New York: The Guildford Press. 81-114.