Changing Face of Eating Disorders Eating Disorder Coalition

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Changing Face of Eating Disorders Eating Disorder Coalition of Iowa. Michelle Roling

Changing Face of Eating Disorders Eating Disorder Coalition of Iowa. Michelle Roling

Overview n n n Eating Disorder Categories Risk Factors Development of Self Esteem Golden

Overview n n n Eating Disorder Categories Risk Factors Development of Self Esteem Golden Rules How to help

Anorexia Restriction of food intake n Denied the essential nutrients the body needs to

Anorexia Restriction of food intake n Denied the essential nutrients the body needs to function normally n Forced to slow down in order to conserve energy n

Bulimia Nervosa A pattern changing from restriction to increased intake n Triggering a sense

Bulimia Nervosa A pattern changing from restriction to increased intake n Triggering a sense of lack of control n Compensatory behaviors include: n – Purging – Over-exercise – Starvation – Diuretics; laxatives

Binge Eating Disorder Intaking a large quantity of food n Feeling physically and emotionally

Binge Eating Disorder Intaking a large quantity of food n Feeling physically and emotionally out of control n NO compensatory behavior n

Other Specified Feeding and Eating Disorders (Osfed) People who have a few behaviors from

Other Specified Feeding and Eating Disorders (Osfed) People who have a few behaviors from each area n These individuals can have as many or more physical risks than others… n Just as serious of a concern!!! n

Emerging Eating Disturbances Avoidant Restrictive Food Intake DO n Adult selective eating n Orthorexia

Emerging Eating Disturbances Avoidant Restrictive Food Intake DO n Adult selective eating n Orthorexia n Diabulimia n Pregorexia n Drunkorexia n Bigorexia n

How do clients eating disorders develop over time? Eating Disorder Continuum

How do clients eating disorders develop over time? Eating Disorder Continuum

What are the risk factors?

What are the risk factors?

#1) Dieting = Greatest Risk Factor for the development of ED!

#1) Dieting = Greatest Risk Factor for the development of ED!

WHY? Leads to physiological/psychological changes n Sets up restricting, bingeing, purging cycle n Myths

WHY? Leads to physiological/psychological changes n Sets up restricting, bingeing, purging cycle n Myths about weight/dieting reinforce cycle n

Cycle of Behaviors… Compensation= Restriction Making it OK again! I’ve “earned it” UGH! Binge!

Cycle of Behaviors… Compensation= Restriction Making it OK again! I’ve “earned it” UGH! Binge!

Risk Factor #2 Society/Culture’s expectations………

Risk Factor #2 Society/Culture’s expectations………

Realities n Every 62 minutes, someone dies as a direct result of suffering from

Realities n Every 62 minutes, someone dies as a direct result of suffering from an eating disorder.

n Sadly, only 1 in 10 men and women with eating disorders receives treatment,

n Sadly, only 1 in 10 men and women with eating disorders receives treatment, and most medical doctors receive little to no training on eating disorders.

n Eating disorders have the highest mortality rate of any mental illness. And whilemore

n Eating disorders have the highest mortality rate of any mental illness. And whilemore prevalent than breast cancer or Alzheimer’s, eating disorders receive surprisingly few resources for research and prevention.

Changing face of ED clients… ? g n i l g g u r

Changing face of ED clients… ? g n i l g g u r t s s i o Wh EVE RYO NE

Men Newest study 25% of all ED n 40% of those with BED n

Men Newest study 25% of all ED n 40% of those with BED n BN tend to purge via exercise 2 -3% seven years ago n Numbers of men struggling with ED are increasing faster than women!!!! n

Women--Media Pressure--Average size women in U. S. : size 12 -14; 5’ 4” 145

Women--Media Pressure--Average size women in U. S. : size 12 -14; 5’ 4” 145 pounds n Average size model: industry standards 100 pounds for 5’, add 1 -2 pounds for every inch n Not realistic for 98% percent of people without genes for “model” body type n

Women of Color It FINALLY goes with out saying ALL women struggle n Additional

Women of Color It FINALLY goes with out saying ALL women struggle n Additional factors to consider in tx: n – differing worldviews, values, and beliefs; patterns of acculturation, assimilation, and immigration; effects of oppression and ethnic identity; as well as individual differences within every ethnic and racial group

Children As young as 7 – full dx n Avoidant n Mood changes n

Children As young as 7 – full dx n Avoidant n Mood changes n

Women 50+ 13 % experience some sort of disordered eating behavior n 70 %

Women 50+ 13 % experience some sort of disordered eating behavior n 70 % actively trying to lose weight n 60 % anxiety around body weight n

LGBTQ Transgender students were more than four times as likely to report an eating

LGBTQ Transgender students were more than four times as likely to report an eating disorder diagnosis n Rates for females similar to straight females n Male rates much higher- linked to culture and co morbid prevalence of methamphetamine use and addiction. n

Risk #3 Biology

Risk #3 Biology

Biological Components Deficit in neurotransmitters in brain n Selective Serotonin Reuptake Inhibitors effective in

Biological Components Deficit in neurotransmitters in brain n Selective Serotonin Reuptake Inhibitors effective in treatment n SSRI treatment: impacting comorbid depression/anxiety or eating disorder? n

Risk #4 Personality Traits

Risk #4 Personality Traits

Personality Correlates “Pleasing” personality: very concerned with others’ opinions n Perfectionistic standards n Perceived

Personality Correlates “Pleasing” personality: very concerned with others’ opinions n Perfectionistic standards n Perceived lack of control n Possible childhood abuse (emotional, sexual, or physical) n – Peers, family, etc.

Goal. Development of Self-esteem a new them! n n 1) 2) 3) 4) Breaking

Goal. Development of Self-esteem a new them! n n 1) 2) 3) 4) Breaking down Self-esteem Each phase must develop in order and be attained in order to progress— Self-awareness Self-cohesion Self-agency Self-esteem

Self- Awareness n Recognitions, babies looking in mirrors, feeling beloved, a mirroring process of

Self- Awareness n Recognitions, babies looking in mirrors, feeling beloved, a mirroring process of “I am”. Vast differences depressed parent/healthy parent

Self- Cohesion n Consistency over time…if caregivers have different expectations, different environment, then difficult

Self- Cohesion n Consistency over time…if caregivers have different expectations, different environment, then difficult for them to define self. If I’m not in a “role” for someone who am I?

Self-Agency Ability to act on your environment, power, control, ability to impact the environment

Self-Agency Ability to act on your environment, power, control, ability to impact the environment and make a difference. n When someone is stuck in this phase then perfectionism develops. n

Self-Esteem n Pleasure in achieving goals, satisfaction with yourself and who you are.

Self-Esteem n Pleasure in achieving goals, satisfaction with yourself and who you are.

Golden Rules for helping those struggling with eating disorders

Golden Rules for helping those struggling with eating disorders

# 1 Don’t allow the individual to “be a number”. NO NUMBERS as a

# 1 Don’t allow the individual to “be a number”. NO NUMBERS as a focus of discussion or goals!

#2 Avoid commenting on external appearance, size…. “Beauty is more than Flesh”

#2 Avoid commenting on external appearance, size…. “Beauty is more than Flesh”

#3 Everything we try is an experiment………

#3 Everything we try is an experiment………

#4… Assert yourself against ED’s ideas…. .

#4… Assert yourself against ED’s ideas…. .

#5 You Can’t make assumptions about someone’s health or ED behaviors based on Body

#5 You Can’t make assumptions about someone’s health or ED behaviors based on Body Size/Body Shape.

#6… remember- they are NOT a Diagnosis!!!

#6… remember- they are NOT a Diagnosis!!!

#7 Purging means more than vomiting…

#7 Purging means more than vomiting…

 RELATIONSHIPS with the individual are the most important factor for success and RECOVERY!!!

RELATIONSHIPS with the individual are the most important factor for success and RECOVERY!!! #8

#9 People need to hear the healthy message over and over…

#9 People need to hear the healthy message over and over…

#10 RECOVERY HAPPENS!!!

#10 RECOVERY HAPPENS!!!

Now, take a leap of faith!

Now, take a leap of faith!

IDEAL-ED Treatment Services Assessment n Individual therapy n Group therapy n Use of Treatment

IDEAL-ED Treatment Services Assessment n Individual therapy n Group therapy n Use of Treatment Team n – Physician – Therapist – Nutritionist – Personal Trainer? -Support system -Spiritual Leader? -Recovery Mentor?

Physician on Team Medical stabilization n Vital they have experience with ED population n

Physician on Team Medical stabilization n Vital they have experience with ED population n Medication management n

Nutritionists as Team Member Fundamental role in recovery from ED. n Assessing current relationship

Nutritionists as Team Member Fundamental role in recovery from ED. n Assessing current relationship with food and moving toward competent eating patterns. n

Why the possible need to involve a trainer on the team? n n Exercise

Why the possible need to involve a trainer on the team? n n Exercise concerns — Issues we’re looking at: – – – Compulsive Obligatory Excessive

Why the possible need to involve a spiritual leader to the team? n n

Why the possible need to involve a spiritual leader to the team? n n n Looking for purpose/meaning of life Lack of earthly healthy support system Transformational time and need for strong foundation

Why the possible need to involve a recovery mentor to the team? n n

Why the possible need to involve a recovery mentor to the team? n n n Living proof recovery is real Easier to hear feedback from someone who has walked the journey before you Lack of healthy support in their current relationships

How can”support system” help? ? n n n Be a witness to their pain

How can”support system” help? ? n n n Be a witness to their pain and emotion Validate their experience- I am sorry things are so hard! Challenge negative, internalized views of self- “That’s not how I see you”. Empower the wise voice– they do know what they need- help them listen in! Assist in creation of a new empowered self- Who are they without the eating disorder?

Clinician 1 st Job n Assessment regarding appropriate level of care – – –

Clinician 1 st Job n Assessment regarding appropriate level of care – – – http: //www. eat-26. com/ http: //nedawareness. org/get-screened http: //mybodyscreening. org/

Where do you start? n “coach” – Cheerleader/ & promotions Baseline n Micro skills

Where do you start? n “coach” – Cheerleader/ & promotions Baseline n Micro skills n Start where they are motivated n Clinical contracts/agreements n

ROLE MODELS in the TEAM n FIRST!!!! Take care of yourself– Physically – Emotionally

ROLE MODELS in the TEAM n FIRST!!!! Take care of yourself– Physically – Emotionally – Spiritually – Socially NO fat talk n Surround yourself with positive energy n

Mahatma Gandhi Be the Change you want to see in this world.

Mahatma Gandhi Be the Change you want to see in this world.

Support EDCI’s Vision EDCI envisions an Iowa without eating disorders— Help us reach this

Support EDCI’s Vision EDCI envisions an Iowa without eating disorders— Help us reach this VISION!

RESOURCES n n n AED – Academy For Eating Disorders www. aedweb. org Alliance

RESOURCES n n n AED – Academy For Eating Disorders www. aedweb. org Alliance For Eating Disorder Acceptance www. allianceforeatingdisord ers. com ASDAH – Association for Size Diversity and Health www. sizediversityandhealth. org n n Binge Behavior. Com www. bingebehavior. com BEDA – Binge Eating Disorder Association www. bedaonline. com Diabulimia Helpline www. diabulimiahelpline. org FEAST – Families Empowered & Supporting Treatment of Eating Disorders www. feast-ed. org

n n n IAEDP – International Association of Eating Disorders Professionals www. iaedp. com

n n n IAEDP – International Association of Eating Disorders Professionals www. iaedp. com MAED – Mothers Against Eating Disorders Facebook Page NAMED – National Association for Males with Eating Disorders www. namedinc. org n n n Maudsley Parents www. maudsleyparents. org National Association of Anorexia Nervosa & Associated Disorders (ANAD) www. anad. org Ed referral Sources www. edreferral. com

n n NEDA – National Eating Disorders Association www. nationaleatingdisorders. org EDCI- Eating Disorder

n n NEDA – National Eating Disorders Association www. nationaleatingdisorders. org EDCI- Eating Disorder Coalition of Iowa www. edciowa. org n n T-FFED – Trans Folx Fighting Eating Disorders www. transfolxfightingeds. org Project Heal www. theprojectheal. org