Does My Friend Have An Eating Disorder?

Q: My friend is constantly worried about her weight but she’s really skinny, she barely eats, she vomits often and seems very fragile and sickly to me. Does she have an eating disorder?

A: There could be many illnesses or diseases that cause sickness and weight loss so a physician should be contacted to ensure her health. However, key words used here is that she’s “constantly worried about her weight” which makes it very possible that she does have an eating disorder.  It is important to realize however, that these disorders are not about food. Eating disorders are a way of coping with symptoms of something much deeper that a person finds too painful or difficult to deal with directly but which no amount of dieting or weight loss will cure.

Eating disorders frequently coexist with other illnesses such as depression, substance abuse, or anxiety disorders and may also be a way of distancing yourself from difficult emotions. When you spend most of your time thinking about food, dieting, and weight loss, you don’t have to face other problems in your life or deal. Dieting and weight loss can’t repair the negative self-image at the heart of anorexia. The only way to do that is to identify the emotional need that self-starvation fulfills and find other ways to meet it.

Many people with anorexia nervosa see themselves as overweight, even when they are clearly underweight. Eating, food, dieting and your body become obsessions and can take over your life. Your desire to lose weight and worrying about how your body looks can become more important than anything else so eating and mealtimes can become very stressful. There becomes a persistent obsession of thinness and going to extremes to lose weight, but no matter how skinny you become, it’s never seems to be thin enough.

Anorexia can damage your health and even threaten your life. Anorexics have the highest mortality rate of all mental illnesses, with as high as 1 in 5 people with the illness eventually dying from complications.

There is cultural pressure to be thin, as well as family and social pressures that can contribute to anorexia and activities that demand slenderness, such as ballet, gymnastics, or modeling. Sometimes parents can be overly controlling and put a lot of emphasis on looks, dieting, or criticizing their children’s bodies and appearance. Eating disorders affects every race, culture, and socio-economic areas of society, as well as affecting both men and women.

Research suggests that a genetic predisposition to anorexia may run in families. If a girl has a sibling with anorexia, she is 10 to 20 times more likely than the general population to develop anorexia herself. Brain chemistry also plays a significant role. People with anorexia tend to have high levels of cortisol, the brain hormone most related to stress, along with lower levels of hormones that are associated with feeling good.

Eating disorders are also beginning at alarmingly young ages. Research suggests that almost half of the girls in grades 1 -3 want to be thinner, over 80% of 10-year-olds are afraid of being fat, and most kids with eating disorders developed their disordered between the ages of 11 and 13.

Types of eating disorders

The most common eating disorders are Anorexia, Bulimia, and Binge eating disorder.

Anorexia:

People with anorexia starve themselves out of an intense fear of becoming fat. Despite being underweight or even emaciated due to starvation, they never believe they’re thin enough

There are two types of anorexia. In the restricting type of anorexia, weight loss is achieved by restricting calories (following drastic diets, fasting, and exercising to excess). In the purging type of anorexia, weight loss is achieved by vomiting or using laxatives and diuretics.

Anorexia nervosa is a complex eating disorder with three key features:

·         refusal to maintain a healthy body weight

·         an intense fear of gaining weight

·         a distorted body image

Signs and Symptoms of Anorexia

·         Strange or secretive food rituals – Refusing to eat around others or in public places

·         Going to the bathroom right after meals

·         Making excuses to get out of eating

·         Feeling overweight despite dramatic weight loss or being underweight

·         Extreme preoccupation with body weight and shape

·         Terrified of gaining weight

·         Lie about how much you eat or hide your eating habits from others

·         Friends and  family are concerned about their weight loss, eating habits, or appearance

·         Constant dieting, even when thin

·         Fixation on body image, weight, body shape, or clothing size, frequently weigh themselves and concern over tiny fluctuations in weight.

·         Dieting to extremes, usually coupled with excessive or compulsive exercise or purging

·         Obsession with calories, food, or nutrition

·         Feel powerful or in control when they go without food, over-exercise, or purge

·         Base their self-worth on your weight or body size

·         Refusal to keep body weight at or above the normal weight for one's body type

·         Loss of menstrual periods

Effects of anorexia

Severe calorie restriction has very harmful effects to both your body and mind. When your body doesn’t get the proper amounts of energy and proper nutrients to function normally, it goes into starvation mode and slows down to conserve energy and nutrients needed to function. Your body will take care of itself as best it can by consuming fat and muscle mass to feed itself the energy it needs to survive. However, if a person continues to be undernourished, at a certain point vital functions and physical attributes slowly begin to malfunction and medical complications begin to occur affecting both physical and mental health.

Some of the physical effects of anorexia include:

·         Severe mood swings; depression

·         Lack of energy and weakness

·         Slowed thinking; poor memory

·         Dry, yellowish skin and brittle nails       

·         Hair gets thin and brittle

·         Low blood pressure, slowed heart rate, fluttering heart , heart failure

·         Anemia and other blood problems

·         Weak muscles, swollen joints, bone fractures, osteoporosis

·         Kidney stones, kidney failure

·         Girls period stops, bone loss, slow growth, difficulty getting pregnant, higher risk of miscarriage

·         Bruises easily, dry skin, gets cold easily, yellow skin, brittle nails

·         “Lanugo” hair, a soft hair that can grow all over the skin

·         Constipation and bloating

·         Tooth decay and gum damage

·         Dizziness, fainting, and headaches

·         Growth of fine hair all over the body and face

Bulimia Nervosa

Bulimia involves a destructive cycle of bingeing and purging. Following an episode of out of control binge eating, people with bulimia take drastic steps to purge themselves of the extra calories. This is usually done by self-induced vomiting, exercise, fasting, over use of laxatives, diet pills and diuretics.

Unlike anorexia nervosa, people with bulimia nervosa usually maintain what is considered a healthy or normal weight and some are slightly overweight. Yet, like people with anorexia nervosa, they usually fear weight gain, want desperately to lose weight, and are intensely unhappy with their body size and shape. Usually, bulimic behavior is done secretly because it is often accompanied by feelings of disgust or shame. The binge-eating and purging cycle happens anywhere from several times a week to many times a day.

Many of us eat when we feel a little stressed, lonely or bored and have a second helping. But when you suffer from bulimia, the craving to overeat becomes obsessive and you binge eat. What follows is that a bulimic person makes them self vomit, take laxatives, engage in long and intense exercise, fasting or, crash diets to get rid of the excessive calories that were consumed.  During an average binge, a person may consume as much as 3,000 to 5,000 calories in an hour.  This leaves the person feeling guilty and ashamed afterwards and more and more out of control but they can’t seem to control the urge. This vicious cycle of binging and purging is hard on your body and emotional well-being.  

It’s important to note that bulimia does not have to involve purging by throwing up. Compensating for binges by fasting, excessive exercising and crash diets also qualifies as bulimia.

Dieting is a strong trigger for bulimia’s destructive cycle of binging and purging. When you reduce your energy input your body reacts with cravings as a way of asking for the required nutrition and purging only reinforces binge eating. For every new diet you may tell yourself that this is the last time but a tiny voice in the back of your mind tells you that you can always throw up or use laxatives if you lose control again.

Purging does not prevent weight gain

Purging is not effective at getting rid of the unwanted calories from binging, so most people suffering with bulimia end up gaining weight over time. Vomiting immediately after eating eliminates maybe ½ of the calories or less from the food eaten because calorie absorption begins the moment you put food in the mouth. Laxatives only get rid of about 1/10 of the calories you’ve eaten, and diuretics only temporarily lower body fluid levels so they really do nothing at all.

Signs and symptoms of bulimia

Binge eating signs and symptoms

·         Lack of control over eating, the inability to stop eating or eating until the point of physical discomfort and pain

·         Eating secretly, perhaps  after everyone has gone to bed or going out alone on for food

·         Eating unusually large amounts of food with no obvious change in weight

·         Rarely eating normal meals, alternating between overeating and fasting

Purging signs and symptoms

·         Frequently disappears after meals or goes to the bathroom

·         Using laxatives, diuretics, or enemas after eating or taking diet pills to curb appetite

·         The bathroom or the person may smell like vomit and trying to cover up the smell with mouthwash, perfume, air freshener, gum, or mints.

·         Working out strenuously, especially after eating

Physical signs and symptoms of bulimia

·         Puffy “chipmunk” cheeks caused by repeated vomiting.

·         Discolored teeth from stomach acid when throwing up

·         Frequent fluctuations in weight due to alternating episodes of bingeing and purging.

Binge-eating disorder

Almost everyone overeats from time to time like taking an extra helping at Thanksgiving dinner, over eating a special food that is not served very often or at special occasions. But if over eating is a regular and uncontrollable habit, you may be suffering from binge eating disorder.

People with binge eating disorder compulsively overeat, rapidly consuming thousands of calories in a short period of time feeling out of control and powerless to stop. Despite feelings of guilt and shame over these secret binges, they feel unable to control their behavior or stop eating even when uncomfortably full. It is often triggered by chronic dieting and the need for comfort or to feel good.

Binge eaters use food to cope with stress and other negative emotions, but their compulsive overeating just makes them feel worse. Binge eating disorder is more common than anorexia and bulimia and affects a significant number of men as well as women.

The symptoms of binge eating disorder usually begin in late adolescence or early adulthood, often after a major diet. A binge eating episode typically lasts around two hours, but some people binge on and off all day long. Binge eaters often eat even when they’re not hungry and continue eating long after they’re full. They may also gorge themselves as fast as they can while barely registering what they’re eating or tasting.

People with binge eating disorder are embarrassed and ashamed of their eating habits, so they often try to hide their symptoms and eat in secret. Most binge eaters are overweight or obese, but many are of normal weight. They worry about what the compulsive eating will do to their bodies and beat themselves up for their lack of self-control. They desperately want to stop binge eating, but feel like they can’t.

People with binge eating disorder report more health issues, stress, insomnia, and suicidal thoughts than people without an eating disorder. Depression, anxiety, and substance abuse are common side effects as well. But the most prominent effect of binge eating disorder is weight gain.

Key features of binge eating disorder:

·         Frequent episodes of uncontrollable binge eating.

·         Feeling extremely distressed or upset during or after bingeing.

·         Unlike bulimia, there are no regular attempts to make up for the binges through vomiting, fasting, or over-exercising.

Treatment

It’s important to seek professional help early, follow through with treatment, and resolve the underlying emotional issues that caused the eating disorder in the first place.

People with an eating disorder usually work very hard to keep it secret, may have difficulty acknowledging there may be a problem or may deny a problem even exists. This can make diagnosis and therefore treatment difficult, since the symptoms of eating disorders also often occur in combination with depression, anxiety and substance abuse.

Typically therapy, nutritional counseling, and group support in combination seems to work best.  In some cases, residential treatment or hospitalization may be necessary.

Hospitalization may be required in extreme cases if the person is:

·         Dangerously malnourished

·         Severely depressed or suicidal

·         Suffering from medical complications

·         Getting worse despite treatment

Medical Treatment is the first priority in eating disorder treatment is addressing and stabilizing any serious health issues.

Counseling and therapy is very important for identifying and addressing negative thoughts and feelings that stimulate your eating disorder, changing dysfunctional beliefs about weight, dieting, and body shape as well as learning how to deal with difficulties in daily living and the stresses in constructive, rather than self-destructive ways.

Nutritional treatment: is needed for nutritional counseling for consuming enough calories to reach and maintain a normal, healthy weight.

How to help a person with an eating disorder:

·         Talk to the person about your concerns and respect their privacy but eating disorders should never be ignored.  Eating disorders can be a cry for help and they will appreciate knowing that you are concerned.

·         Offer compassion and support and listen without judgment and make sure the person knows you care.

·         Avoid shame, blame, or guilt, criticizing, accusations, insults, or scare tactics, because it only shuts down discussion and makes people defensive. Eating disorders are often a caused by stress, low self-esteem, and shame, negativity will only make it worse.

·         Avoid comments on how they look because they are already very aware of their body and compliments may only reinforce their obsession with body image and weight.

·          Focus on feelings specific behaviors and relationships, not on weight and food. Talk about why they feel or want to lose weight, explore their fears about being fat, and what they think they can achieve by being thin.

·         Set a good example for healthy eating, exercising, and body image. Don’t make negative comments about your own body or anyone else’s.

·         Take care of yourself. Worrying and caring for a person with eating disorders can be difficulty emotionally.

Accept your limits. You can’t force a person with an eating disorder to change but you can help by offering your compassion, encouragement, and support throughout the treatment process.

·         Encourage him or her to seek help. The longer an eating disorder remains undiagnosed and untreated, the more difficult it will be to overcome, so urge your loved one to see a health professional.

My friend cuts herself and I'm worried!

Q: My friend has scars on her arms - she says she “cuts” herself. I’m worried about her!

A: Finding out that someone you know and care about is intentionally hurting themselves can certainly make you feel uneasy. That fact that you even know she’s cutting is awesome because that means she had taken that very difficult first step of starting to open up to someone. Secondly, she must trust you or she would never have told you. Thirdly just being there for her and listening is helping more than you can imagine. I will try to briefly explain the general aspects of self injury or self harm.

The fact is that everyone learns to cope with their experiences in different ways. Most people are able to find constructive and meaningful ways to deal with their negative experiences. There are others who use tears, they might get angry, fall into depression and withdraw, or turn to drugs or alcohol in order to find relief from their overwhelming feelings.

For some however, particularly teens, experiences of intense and painful emotions can continuously build up inside of them, but they can see no way to escape these locked up feelings or releasing the emotional storm raging inside of them. For these people, the release of this pressure is done by cutting, burning or other self harming acts. This self injury is an act of temporary relief, kind of like opening a relief valve long enough to let the extra pressure that has built up inside of them to a bearable level again. It provides some immediate relief until the painful feelings swell up again along with the urge to reopen their relief valve.

The act of self-harm for the first time can vary for each person. This first act and later acts are usually “triggered” by other stressful events of daily living that raise that intense level of internal emotional pain and turmoil passed the point that they can bear or contain any longer. For others, they have passed a point of feeling anything at all and have become so numb to the world that they simply want to feel again, to feel alive, for even a short time. However it’s like putting a band-aid on a broken leg; it doesn’t fix the more important underlying problem which is the cause of the emotional pain and the lack of constructive coping mechanisms for dealing with the pain without self harming. So the solution then is to understand what caused the internal emotional pain in the first place and then help the person address it in constructive ways and start to heal and feel better.

Self injury is not a new phenomenon, but it is becoming more and more common. It is estimated that as many as 15% of teens currently self harm or have in the past, but it is difficult to assess because they tend to harm themselves alone and secretly, taking great care in hiding their injuries and scars through shame, embarrassment or fear by making up excuses and explanations.

What Are Some of the Types of Self-harm?

·         Biting at their skin

·         Burning or scalding the skin

·         Hitting yourself or banging their head

·         Punching things or throwing their body against walls and hard objects

·         Intentionally preventing wounds from healing

·         Swallowing poisonous substances

·         Putting themselves in danger or at risk - driving recklessly, binge drinking, taking too many drugs, and having unsafe sex.

• Picking at their skin
• Severely scratching their skin
• Neglecting oneself

·         Cutting their skin with knives razor blades, glass pieces or other sharp objects

·         Sticking objects into their body or under your skin

• Deliberately falling when doing something like extreme sports
• Swallowing sharp and inappropriate objects
• Pulling out their hair

What are Some Possible Underlying Causes of Self Harm?

·         Childhood abuse

·         Sexual assault

·         Bullying

·         Stress

·         Low self esteem

·         Family breakdown

·         Dysfunctional relationships

·         Mental health illness

·         Financial worries.

Self harm is a way some people try to cope with the pain that either seem too difficult to bear or are bad situations they think can't change. They may not know any other way to relieve the emotional pain or haven’t been taught ways to cope effectively and constructively. Perhaps they do have coping skills and support systems but the emotions may be too intense and they feel like they have lost control. For some, it’s a way of regaining that sense of control over the pain.

Some people who cut have had a traumatic experience, such as living through sexual or physical abuse or violence, or they may feel numb after a traumatic experience. It can also be a way of inflicting the previous pain they went through, expressing anger over it, or trying to get control of the situation in their mind.

Self-harm is usually conducted at times of anger, distress, fear, emotional worry, depression or low self-esteem in order to manage negative feelings that they can find no other way of dealing with in a rational or constructive way. Alternatively, self-harm can be used as a form of self-punishment for something that the self-harmer has done, thinks they have done, or that they have allowed to be done to them.

People who cut and self-injure do not do it for attention but is more like a silent cry for help – a need to express a pain that they know no other way of expressing. You can imagine that if someone goes to these extremes it is clear that they are in distress. They are not trying to draw attention to themselves and in fact the shame and fear can make it very difficult for them to talk about their feelings and ask for help.

Self harm is not about liking pain but is rather a way to cope with thoughts and feelings and an attempt to regain feeling of some control over themselves. It’s a way to feel something because of the emptiness and emotional numbness they are experiencing. Some people have said that they don’t feel any pain at all when they self harm, just a sense of relief. It is not until later that they feel the physical pain and begin to regret their actions.

Sometimes a person self harms to punish themselves due to feelings of guilt or shame. This is common where sexual abuse or sexual assault have occurred during childhood and almost everyone says that they were discouraged from expressing emotions, especially anger and sadness. However, it is important to know that there are many different triggers. Abuse, whether physical, sexual, or emotional is only one of them.

Another important point is that when someone self-injures they are not trying to kill themselves they are trying to cope with life. They want the internal pain to stop and hurting themselves is the only way they know to get relief. Self injury is a coping mechanism to prevent suicide, to feel better and help them continue to live.

It is true that people who self-injure have a much higher risk of suicide, because sometimes they feel they can’t escape the emotional problems and pain. That is why it is so important for self harmers to seek help. Some individuals that self harm may go on to complete a suicide attempt but suicidal feelings are not caused by the self harm. They are caused from the underlying reasons that became bottled up inside of them resulting in a coping mechanism of self harm. However, sometimes self harmers do die because they accidentally take an act of self-harm too far and they lose their lives before help can be found.

Another thing that is important to keep in mind is that you cannot determine how much a person is suffering by the severity of their wounds. Specifically, don’t assume that if the wounds and injuries are minor, there’s nothing to worry about. The severity of the wounds have very little to do with how much a person may be suffering inside.

Sadly, cutting behavior can spread, to the point where there are now teens discussing cutting on-line and forming cutting clubs at school. The danger of these groups is that they can attract vulnerable teenagers who may go on to develop severe problems with self-harm. The greatest danger is that the underlying cause of their pain is not being addressed.

Self-harm can also become a habit and a form of addiction because the more a person does it, the more they feel the need to do it. Once started, it can take very little stress or emotional pain in normal daily living to trigger an episode of self harming. They may want to stop, but they don’t know how or it may be the only thing keeping them from completely losing control. The urge to cut can seem too hard to resist. A behavior that starts as an attempt to feel more in control can end up controlling you.

Most people who self harm keep it a secret because they fear if they tell anyone, they might be locked away. People who intentionally self-harm do so as a way to cope, because they may never have been taught how to deal with intense feelings and emotions in healthy ways. Unfortunately, the public still tends to place labels on them as being “crazy” so many people will not reach out for help and stay silent.

What are the Warning Signs?

·         Unexplained frequent injuries, such as cuts, burns or bruises, usually on the wrists, arms, thighs, or chest.

·         Low self esteem

·         Problems handling emotions

·         Problems with relationships

·         Frequent wounds like cuts, burns or bruises that they can’t explain

·         Covering their body with long sleeves or long pants even during warm weather

·         Blood stains on clothing, towels, or bedding; blood-soaked tissues.

·         Possessing sharp objects or cutting instruments, such as razors, knives, needles, glass shards, or bottle caps

·         Claiming frequent accidents or claims of being clumsy to explain injuries.

·         Being irritable, needing to be alone for long periods of time, especially in the bedroom or bathroom.

What can be done?

Understanding the person and their pain is an important first step in helping someone. Being there, listening and relaying understanding is so important.

The earlier a person can deal with the underlying issue causing the self harming behavior, the less self harm will take place and perhaps the self harm can be stopped before it becomes a habit for coping or an addiction. Some teens stop injuring themselves once their behavior is out in the open. Also, once it is out in the open others who care can offer a supportive network of family, friends, teachers, counselors and doctors further reducing their need to harm themselves. Once the self harm is disclosed then other issues like mental illnesses such as depression or anxiety may be revealed and can be treated.

Changing any kind of behavior is difficult, and deciding to change is a decision that only they can make for themselves. It is very difficult to stop self-harming without having other ways of coping to replace it so the key to recovery is finding better ways to deal with the internal pain. Self-injury can get out of control really quickly, and then it is difficult to stop. That’s why seeking help is so important. The thought of telling someone might scare them at first, so help them take little steps to start. If not you then perhaps another person they trust and feel they can talk to. It could be a friend, counselor, teacher, parent, or a coach.

As a friend you can:

• Educate yourself about self-harm
• Avoid anger and judgment.  Your child isn’t trying to hurt you, make you feel guilty or get attention
• Focus on their concerns or issues, not the act of self-harm
• Encourage positive, healthy coping methods. It takes time to learn the positive coping skills that can replace harmful coping skills.
• Let them know you’re willing to listen, but don’t force them to talk
• Encourage them to seek professional help

If someone who self harms decides to open up to you:

Telling somebody for the first time you self-harm can be a very scary situation and takes a lot of courage. It can be hard for both for the person who is sharing and the person who is listening but it is an important key step to transforming a situation. Listening can be scary, especially if it is someone you care about and want to protect. But try to remember that them coming forward to talk is a really good thing.

·         Be that someone that they can trust

·         Choose a good time when you won’t be interrupted

·         Allow them to write down what they want to say if their scared or if it helps them feel prepared

·         Let them know you are there for them and will stand by them as they move forward.

·         Be patient and listen – this is a really big step for them!

·         Try not to make demands or ultimatums

·         Ask them what help they would like

·         Be honest – if you need to tell somebody else then let them know

·         Know that it’s ok if you don’t have all the answers – the listening is the help