A Practical Guide to Treating Eating Disorders E-Book

Patricia Furness-Smith

• Herausgeber: Icon Books
• Kategorie: Ratgeber
• Serie: Practical Guide Series
• Sprache: Englisch

Seitenzahl: 219

Veröffentlichungsjahr: 2014

Beschreibung

From comfort eating and skipping meals to anorexia nervosa and bulimia nervosa, our relationship with food is at breaking point. With expert advice from an experienced psychologist, this book will help you get back on track and get the help you need. BREAK BAD HABITS and replace them with better ones UNDERSTAND YOUR ISSUES so you can move forward LOVE YOUR BODY by learning to accept yourself OVERCOME YOUR FEARS and discover how to enjoy food again

Leseprobe

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ISBN: 978-184831-721-5

Text copyright © 2014 Patricia Furness-Smith

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About the author

Patricia Furness-Smith is a psychologist and accredited practitioner who has been involved with eating disorders for almost 25 years in both an academic and clinical capacity. For the past fourteen years she has held the position of clinical supervisor for the charity Eating Disorders Support. Her current research is within the field of depression, which frequently features as a co-morbidity factor within problem eating. She is often quoted in the media and has appeared in national and foreign newspapers and magazines and on radio, television and social media sites.

She is a Fellow of the Chartered Institute of Educational Assessors (CIEA), the Institute for Learning (IfL) and the National Counselling Society (NCS), and is a member of the British Association for Counselling and Psychotherapy (BACP) and the British Association for the Person Centred Approach (BAPCA). Her other specialisms involve relationship therapy, which she offers within her private practice, as well as in conjunction with a renowned national provider.

She also enjoys an international reputation as a specialist in hodophobia (the fear of travelling), treating private clients within her practice and in her role as consultant on British Airways’ ‘Flying with Confidence’ courses. She treats all types of phobias and has recently published a book on this subject: Introducing Overcoming Phobias: A Practical Guide.

Author’s note

In order to respect client privacy and anonymity within the case studies described, I have formed composite characters by scrambling personal details and changing names.

Dedication

This book is dedicated to all the brave clients I have met over the years who have taken the necessary courageous steps to take back control of their lives by addressing their problem eating.

I would also like to extend my dedication to the wonderful team of volunteers, past and present, who generously offer their time and resources to the charity Eating Disorders Support. Their contributions – be it as helpline volunteers, self-help group facilitators, committee members, secretary, marketing and finance support, fundraisers, educators, policymakers or general dogsbodies – are all deeply valued and hugely appreciated.

Finally, this dedication would not be complete without particular mention of a very special, spritely octogenarian, Angela Loewi. It has been Angela’s vision and determination to reach out to those who suffer from problem eating that has formed the backbone of the charity over the past decade and beyond. Angela deserves recognition for the inordinate amount of time and effort she has personally contributed, borne of her unswayable belief that someone must be there when people desperately need help. I can personally vouch for the fact that this indomitable, redoubtable and singularly stubborn lady has saved many lives, and we have the grateful letters and emails from survivors that prove it. She is an inspiration to us all with her tireless energy, enthusiasm and inability to accept defeat despite the paucity of services available for this cause. I wholeheartedly salute all the good she has achieved. I know that she will continue to lobby for better resources and education into problem eating right up to her very last breath.

I am only one, but I am one. I cannot do everything, but I can do something. And because I cannot do everything, I will not refuse to do the something that I can do.

Edward Everett Hale

Contents

Preface

PART ONE: Understanding Problem Eating

1. What is problem eating?

2. Overcoming ignorance and offering hope

3. Our relationship with food

4. History of problem eating

5. Anorexia nervosa

i. Understanding anorexia

ii. Practical ideas for understanding anorexia

iii. Diagnosis and symptoms of anorexia

6. Bulimia nervosa

i. Understanding bulimia

ii. Diagnosis and symptoms of bulimia

7. Binge eating disorder

i. Understanding binge eating disorder

ii. Diagnosis and symptoms of binge eating disorder (BED)

8. Pica disorder

i. Understanding pica disorder

ii. Diagnosis and symptoms of pica disorder

PART TWO: Treating Problem Eating

9. A note on the body mass index (BMI)

10. Treatments

11. Mainstream therapies and treatments

12. Other forms of help

13. Complementary therapies

14. The Maudsley approach

15. The carer’s charter

Useful contacts

Acknowledgements

Index

Preface

Nothing would be more tiresome than eating and drinking if God had not made them a pleasure as well as a necessity.

Voltaire

Although the overwhelming majority of us would agree with Voltaire, there exists a sizeable percentage of the population for whom eating is not a pleasure but a source of considerable distress.

According to the National Institute of Health and Clinical Excellence (NICE), a conservative estimate of the number of people in the United Kingdom who suffer from an eating disorder is well in excess of 1.5 million. But it is recognized that these statistics do not take into account those with eating disorders who have not sought medical attention, are being treated in the community or are receiving private treatment. In addition, these statistics do not include those who suffer from what is known as ‘disordered eating’ – conditions similar to eating disorders but towards the milder end of the spectrum. We live in a conflicted world where obesity is on the rise as well as eating disorders, and the real extent of problems with eating is far greater than the figures convey.

Whether the issue is a full-blown eating disorder or problem eating, in many countries there is often both a profound lack of resources and, even more worryingly, a severe lack of understanding of the need for early diagnosis and treatment. Treatment for problem eating is practically non-existent, and sufferers of eating disorders must meet stringent criteria before they are entitled to treatment. By this stage, when their illness is sufficiently severe, a considerable amount of damage has already been caused that could easily have been avoided by earlier intervention.

Prevention and early detection are always far cheaper options in terms of both personal and financial cost.

Who is at risk of eating problems?

The National Eating Disorders Collaboration of Australia cites 9 per cent of the population as suffering from an eating disorder, and around the world problem eating is affecting increasingly younger populations. According to the Canadian Mental Health Association, 40 per cent of nine-year-old girls have tried to lose weight. Similarly alarming statistics are seen worldwide, and there is no doubt that body image issues and problem eating have increased over recent decades.

The escalation in problem eating is worrying enough for the individuals concerned, but we must also factor into the equation the inordinate distress this causes for the families and friends of the sufferer, especially in those cases where the sufferer has not yet sought, or been allocated, appropriate help.

And that’s why I’ve written this book. Clearly, it would be impossible to cover specific eating problems in tremendous depth or give detailed explanations of the various treatments available in such a small book as this. However, it is my fervent belief as a practitioner that there is an urgent need for a simple, down-to-earth book to address this dangerous and escalating problem. My intention is to provide accessible information about the different types of problem eating, which will promote a general understanding of problem eating along with an awareness of the treatments available and where to find help. Whether you are worried about your own eating or the eating of a relative, partner or friend, I hope you’ll find reassurance and assistance here.

Despite these alarming and escalating trends in the incidence of problematic eating, there is also every reason to be positive, since eating distress can be overcome, providing that it is recognized and treated.

In the past, educational messages have enabled us to make informed choices about whether we choose to indulge in smoking, binge drinking or recreational drug-taking, having had the consequences spelled out to us. But similar knowledge about problem eating is thin on the ground, and it’s my hope that by having the requisite knowledge about triggers which may lead to problem eating, we are more likely to shun these destructive behaviours in the first place.

There are a number of books available on the subject of eating disorders, many of them written by research academics, medical experts and numerous specialists in the field, offering insight into problem eating from their various philosophical orientations and approaches. Other books are written from the personal standpoint of individual sufferers or carers, who generously share their unique journeys through the landscape of problematic eating. Many of these books have great value in describing specific eating difficulties and will inform the reader of the minutiae of how to recognize and treat the specific eating disorder under discussion.

But this book is different because it provides a simple overview to enable you to recognize the wide variety of types of problem eating. It also includes information regarding the latest diagnostic criteria used to define an eating disorder, early warning signs and available treatments for specific eating disorders.

This book is intended to be an easily accessible resource for all those who are suffering from problem eating, caring for someone with eating distress or providing support in an educational or medical capacity to others on this subject.

In addition, parents, teachers, youth workers, school matrons, doctors, nurses, counsellors and psychotherapists are the intended audience for this book. Finally, this book is also aimed at interested members of the general public, who wish to augment their understanding of problem eating.

I have arranged this book in two parts. In part one, I will be exploring our relationship with food and the potential triggers, causes and history of different types of problem eating. I will then discuss four of the most common types of eating disorder: anorexia nervosa, bulimia nervosa, binge eating disorder and pica disorder. If you know you are dealing with one of these in particular, you might want to just read that section, but otherwise I would recommend reading them all to find out which parts apply to you. In the second part of the book, I will cover the various treatments available, along with other methods of help. And finally, we will look at how carers can support sufferers with problematic eating. At the very back of the book is a list of useful contacts and advice on where to go next.

As in all things in life, forewarned is forearmed. By knowing the signs and symptoms of problem eating, early detection is facilitated, thus enabling people to seek help sooner rather than later. Indeed, by knowing the serious consequences of these debilitating illnesses, I hope that many people will be empowered to avoid them in the first place.

To solve a problem you must first acknowledge it, understand it and acquire the knowledge and skills needed to defeat it.

Only the educated are free.

Epictetus

PART ONE Understanding Problem Eating

1. What is problem eating?

When you first looked at the title of this book, perhaps you were puzzled. What does ‘problem eating’ actually mean? You might have asked yourself, ‘do I have a problem?’, or perhaps you’re curious to find out whether someone you know, whose eating behaviour is odd, has a real problem.

Opinions range far and wide as to whether problem eating relates to what we eat, how much we eat, how often we eat, or the time that we eat, and so on and so forth. In truth, all of these factors may play a part; problem eating is a spectrum ranging from the temporary, developmentally acceptable faddishness of a seven-year-old who only wants to eat hot dogs, right through to recognized mental health disorders such as bulimia nervosa. (Please note that for the purposes of this book the terms ‘anorexia’ and ‘bulimia’ should be taken to mean ‘anorexia nervosa’ and ‘bulimia nervosa’.)

What is disordered eating?

In this book I will talk about both ‘disordered eating’ and ‘eating disorders’. On the problem eating scale, eating disorders are at the severe end and disordered eating is at the milder end, though it can still be very damaging. Disordered eating is far more prevalent than eating disorders are and consists of an enormously varied range of irregular eating patterns.

Some of these behaviours are relatively benign and short-lived, and while they can lead to weight gain or weight loss, they do not necessitate professional interventions as they are not psychologically damaging.

This category could include people who are building up their muscle tone in anticipation of running a marathon, actors losing weight to look the part for a particular role, people shedding a few pounds in anticipation of a beach holiday or brides-to-be trying to lose weight before their weddings. Future brides prove to be particularly susceptible to this, and a relative of mine even refers to it as ‘getting down to marrying weight’! In a similar vein, I have had a number of clients who have been refused operations until they have lost sufficient weight to make the intended surgery less risky and more viable. Or someone might be neglectful about eating regular meals because they are obsessively busy with a project, ecstatically in love or feeling under the weather. The reasons why we eat irregularly are legion and are usually done on a consciously temporary basis.

When disordered eating becomes a problem

Disordered eating becomes harmful when our unusual habits regarding food begin to have a psychological effect on us. The most common issue here is the use of food to comfort, celebrate, reward or punish. Many people might overeat or under-eat from time to time in response to stress or sadness. They use food as a means of comforting or punishing themselves, or they may eat excessively as a way of celebrating or rewarding themselves. I often refer to this as the ‘mood-food trigger’, as palatable foods with an addictive quality release endorphins, dopamine and other chemicals that result in feelings of well-being, thus temporarily alleviating stress and pain.

Eating can be used as a replacement activity when we are trying to avoid facing up to our problems. Instead of using food to nourish our body we use it to silence our pain, frustration and anger.

Some of these triggers are more common than others. For example, in January there is usually a backlash against the over-indulgence of December, which results in shoals of people enrolling in gyms and abstaining from alcohol consumption in an attempt to lose the extra pounds gained. And even the most scrupulously regimented person may occasionally skip breakfast if they have slept in. All of these examples demonstrate a degree of disordered eating.

Although you may not have an eating disorder, many of us still feel out of control around food and experience discontent about our bodies or shame about our hunger. These are the prime causes of disordered eating.

Disordered eating

Stress and neglect

Marcia’s 75-year-old husband, Oswald, suffered a severe heart attack while they were on holiday in Europe. Fortunately, he was taken to hospital in time and underwent life-saving surgery. Once released from hospital, Oswald was transferred to a rehabilitation centre where he remained for several months. During this time, Marcia visited Oswald daily and returned to her hotel accommodation each evening too distraught and exhausted to look after her own needs.

Marcia skipped breakfast and would arrive at the rehabilitation centre first thing in the morning to keep her husband company throughout the entire day. Apart from a cup of coffee and a sandwich at lunchtime, Marcia neglected to eat and retired straight to bed on her return to the hotel each evening.

As soon as Oswald was deemed fit enough to travel, the couple returned to their home in England. They both underwent health checks by their family doctor, which showed that Oswald’s condition was stable and Marcia was slightly anaemic. Marcia had lost over a stone in weight as a result of the stress she had been under. The GP recommended that Marcia should take iron tablets and eat a healthy balanced diet, and within a few months Marcia regained the stone in weight.

In this instance, Marcia’s disordered eating had nothing to do with her body image or a desire to lose weight. Her failure to eat appropriately was purely down to self-neglect as a consequence of her preoccupation about her husband’s serious health scare.

What is an eating disorder?

An eating disorder is a far more serious condition than disordered eating, and thankfully it is far less common. An eating disorder, described at the simplest level, involves an unhealthy and obsessive preoccupation with food, which can manifest itself in excessive concerns about calorie intake, weight, exercise, purging, bingeing and body image.

The key factor of eating disorders is that they can radically interfere in a harmful way with how an individual engages with their social life, family life and working life, as well as how they perceive themself. An eating disorder negatively impacts on all four of the key domains: how we are physically, mentally, emotionally and behaviourally.

An obvious example of this would be a person suffering from the eating disorder anorexia. The brain alone requires approximately 500 calories per day to function effectively. Sufferers of anorexia frequently consume significantly fewer calories than this. As a consequence of the lack of nutrients, physical changes take place in the brain structure which cause a negative knock-on effect to the individual’s social functioning – for instance, decreasing their ability to concentrate, learn and remember, among other issues.

Although eating disorders can happen to anyone, there are some groups of people who are more at risk than others. Risk factors for developing an eating disorder include:

Being femaleBeing an adolescentBeing a perfectionistBeing competitiveHaving low self-esteemFearing conflictBeing worried about others’ opinionsBeing a people-pleaserHaving anxiety or depressionHaving poor coping strategiesBeing unable to express emotionsBeing fearful about adult responsibilityBeing subjected to intense pressure to succeedBelonging to a profession that sets great store on body image and weight, for example models, athletes, dancers, skaters, synchronized swimmers and jockeysHaving family members or peers with an eating disorderComing from a family where overt dieting is promotedHaving parents who are substance abusers, mentally ill, alcoholics, overly controlling or emotionally detachedBeing or having been obeseHaving been abused, neglected or bulliedHaving suffered traumaBeing confused about sexual identity.

Why is problem eating more common in women?

In the relatively recent past, problem eating was seen as a predominantly female issue, with the ratio of male-to-female sufferers being roughly 1:10. But the 2007 Adult Psychiatric Morbidity Study revealed a dramatic change in this demographic, with 25 per cent of those suffering from eating distress being male. Still, the majority of sufferers are female, and there are a number of proposed reasons for this, including:

The greater emphasis placed on females with regard to the importance of how they lookGreater right brain activity in females than in males, which enables them to be more intuitive but also more susceptible to social comparison. This is particularly damaging in cultures that promote an ideal size for women, e.g. size 10. There is no such equivalent ideal size for men.The encouragement of the role of nurturer in females makes them more tuned in to meeting other people’s needs and guilty about meeting their own. This makes them more vulnerable to food abuse as a coping mechanism for meeting their own unmet wants.In some cultures, females are seen as less important than males and may not have the same degree of autonomy. Their desire for control over their life may be displaced by control over their food intake.

Anorexia

Sub-type: Binge eating and purging type

Yanis was the youngest of four boys whose parents were both sports professionals. They had been successful competitors in their youths and now earned their living by offering coaching in their respective fields of expertise. Yanis’s two eldest brothers, Antoine and Julien, followed in their parents’ footsteps and acquitted themselves with honour on the sports field, as well as winning individual events in tennis and gymnastics.

But Guillaume, the third brother and six years older than Yanis, suffered from asthma attacks, which demanded a great deal of attention from Yanis’s busy parents. As a consequence, Yanis frequently found that his parents were unable to take him to his gym classes. Yanis loved these classes and showed as much, if not more, promise than his two oldest brothers. But as Guillaume’s health deteriorated, Yanis missed more and more classes and eventually was taken off the junior squad due to not achieving the minimum attendance rate in accordance with the club rules.

Yanis was devastated by this and began to assuage his frustration by comfort eating. Although at one level he understood the reasons why his parents could not ferry him to classes, he nevertheless felt insignificant and neglected. It seemed that all his brothers had received more of his parents’ attention and that he was just less important than the others.

Approximately six months after leaving the squad, Yanis and his family attended the championship in which his brother Antoine was competing. At the event he bumped into some of his old squad mates who were unable to conceal their surprise at the considerable amount of weight Yanis had put on since they had last met. He saw the junior squad captain, Jerome, point in his direction and then loudly whisper to his friend, Evan, ‘The Incredible Hulk!’ He recoiled at their subsequent laughter and felt ashamed and humiliated at how he was now perceived by his former squad-mates.

From that day, Yanis made a pledge to himself that he would lose weight, so that he would never again be the butt of unkind jokes about his appearance. Immediately, Yanis started to restrict his food intake to a level significantly below the requirements for a developing teenage boy. This, not unnaturally, caused him to experience acute pangs of hunger, which reached a level of such discomfort that he would then capitulate and eat excessively. Immediately after bingeing, the guilt and shame he experienced at the prospect of becoming fat became totally unbearable. So intense and obsessive was his fear of gaining weight that he fell into the habit of purging by self-induced vomiting and excessive exercising.

Yanis’s schoolwork began to deteriorate and he steadily withdrew from all of his friendship groups. Increasingly Yanis’s free time was taken up with long solitary runs in the evening or being alone in his bedroom, claiming that he was tired or had a headache. The family had noticed Yanis’s mood swings and lack of sociability but had put it down to the fact that he was going through adolescence.

Thankfully, Guillaume eventually became suspicious about Yanis’s instant visits to the bathroom after having eaten and challenged his younger brother. By this stage, Yanis’s weight had fallen considerably below the recommended BMI for his age and height. Yanis confided in Guillaume about his hurt and disappointment at having to give up gymnastics and his humiliation by Jerome.

Guillaume, as a result of his own experience with illness, listened to Yanis with patience and empathy and managed to persuade him to tell his parents immediately. They were aghast when they heard about their youngest child’s suffering and took instant steps to get the necessary help for Yanis.

As Yanis was given cognitive behavioural therapy (which will be discussed in chapter 11) to overcome anorexia at such an early stage, he made a relatively rapid recovery. This was also due in part to his parents’ promise that he could resume gymnastic training as soon as he was fit and well enough to do so.

As we shall see later in the book, one of the prime motivations for helping someone recover from any eating disorder is to put the sufferer back in touch with themself as a whole, unique person, not just a physical entity, obsessed with weight and body shape. Yanis was lucky that he had something in his life that he felt passionately about, and this was his love of gymnastics. By recognizing his own abilities and talents, Yanis had the determination and strength to quell the anorexic voice in his head and re-establish his own autonomy. Yanis was also fortunate in having the support of his siblings and parents, who played a key role in helping him towards recovery.

An eating disorder is a type of mental illness

An eating disorder is largely used to displace painful emotions, which the sufferer feels unable to face, thus affording them a temporary sense of control, relief or release. This sense of control, albeit false and a form of self-harm, becomes all-consuming and is in short a mental illness.

People do not develop an eating disorder by conscious choice but rather as an unconscious protection from emotional pain.

Examples of such eating disorders are binge eating disorder, anorexia and bulimia. Notable exceptions to the description of an eating disorder in the previous section are conditions such as rumination disorder or avoidant/restrictive food intake disorder, in which concern for body image and shape is not a factor.

An eating disorder is analogous to tears or laughter in that it is merely a symptom or sign of the individual’s emotional state. To offer a handkerchief to wipe away tears, without finding out why the person is upset, is as superficial as trying to treat an eating disorder by regulating the food intake without addressing the underlying emotional issues.

Can dieting lead to an eating disorder?