Dealing with Disordered Eating When It Affects Friends and Family Members
By Heather Grimshaw
Recognizing a problem in someone you love is difficult. Acting on it is
harder, especially if you are unsure of what to say and concerned about
exacerbating the problem by taking the wrong approach. Eating disorders seem to
epitomize that dilemma with friends and family members immobilized by the
unknown. Young girls and boys slip through the cracks as a result.
"I really did want my parents to help me," says Lindsey Groem, a
25-year-old Colorado resident who enrolled herself in the Eating Disorder Center
of Denver last October after struggling for nine and a half years. Lindsey was
put on a diet in grade school, "because I was chubby," she says. Then,
when she was 16, she tried throwing up for the first time, which "sort of
set the course," she says.
Describing the disease as a dark voice that told her: "You're not
perfect yet. You need to be perfect." Lindsey ate steamed vegetables,
yogurt and fruit. She exercised excessively. As a professional exercise
specialist, she knew that she was depriving her body. "I learned in detail
how the body works, how miraculous it is. I knew I was hurting myself." But
the dependency on the behavior prevented her from seeking or accepting help that
was offered.
"It's a comfort source. It's hard to acknowledge (openly) that there's a
problem because you don't want to give it up. You don't want help when you're
deep in an eating disorder and you feel like you can't get away from it anyway.
Intervention," she admits, "is really tough."
Yet in October, Lindsey walked into the Eating Disorder Center of Denver on
her own, enrolled in the partial hospitalization program and addressed the
disease head-on. "I decided that I couldn't take it anymore," she
says. "(The disease) is scary. It makes you lie to people." There was
no specific turning point, Lindsey says. "I was stronger than this. I'm not
sure what happened but I was ready to change when I went in there. I made the
decision in my head and in my heart. I've started my life over and it's the best
feeling I've ever had."
Seeing Is Believing
Anorexia is a visual disease. You see skeletal versions of mothers and
fathers, friends, siblings, and children at work, school, and at home. What the
eye overlooks, however, are the underlying issues that fuel the food fears and
result in clinical disordered eating. Anorexia, bulimia, compulsive
overeating and the sub-clinical versions of each, all included in the term
disordered eating, affect an increasing number of Front Range residents at
younger ages.
Eight-year-old girls being hospitalized in Denver for severe anorexia, fourth
graders who diet regularly, and college students who are shrinking before the
eyes of friends and teachers, illustrate the widespread problem. One study shows
that young girls are more afraid of becoming fat than they are of getting
cancer, experiencing nuclear war, or losing a parent. Another study (available
online at www.dadsanddaughters.org) shows that by high school 40 to 60 percent
of girls consider themselves to be fat and try to lose weight.
Statistics talk for themselves and the story they tell is that eating
disorders are on the rise. The question is what parents and friends can do to
prevent clinical disordered eating from taking hold. Learning about the disease,
addressing the problem early and providing resources for therapy are the most
important first steps.
Lindsey encourages parents to recognize and respect each child for whom she
or he is and urges them to not make weight an important issue. "Make them
feel good about themselves. Don't emphasize the need to lose weight. Always let
them know how proud you are of them and love them no matter what."
"In high school all the girls were smaller and pretty and I didn't fit
into that group," she says. "But when I started to lose weight I
finally got the attention I had really wanted all those years. And I thought,
"I can't stop doing this because all my attention will go away."
When she began to lost weight Lindsey says she got compliments and was asked
out on lots of dates. "People would tell me that I looked really thin and I
heard, 'Yes!' "
Effective Action
On the Front Range there are eating disorder specialists who see children,
teenagers, and adults. They focus on clinical cases of anorexia, bulimia, and
compulsive overeating and counsel people with pre-clinical eating disorders.
There are partial hospitalization and outpatient programs, group and one-on-one
therapy sessions. In other words, there are plenty of resources to prevent
eating disorders from progressing and becoming fatal, which they can and do.
"I wouldn't waste my time with any counselor who isn't a specialist in
eating disorders," says Lindsey. "It's really not helpful. It isn't
specific enough. They don't understand the mindset."
Lindsey was discharged from the Center in November, and describes it as a
haven for support, recovery, friendship and understanding. "It was so
wonderful to talk to therapists who knew exactly what I was talking about and
asked all the right questions. They helped facilitate things in a safe and
supportive way. If you let them they can help so much."
The key to recovery is catching the disease early and finding the right
treatment. "These are treatable illnesses," said Ken Weiner, psychiatrist and
medical director for The Eating Disorder Center of Denver. "And people need
to get better."
Weiner has worked in the field since the early '80s, drawn to the specialty
because "I wanted to know why the best and the brightest would get sick and
have such a difficult time getting well."
The question of why the disease affects certain people haunts parents who
blame themselves when children develop the disease. That same question torments
friends and partners snared in verbal dances about reality versus perception
with anorexics, bulimics, or compulsive overeaters.
Studies show that genetics play a large part in disordered eating but blame
should not and cannot be laid at a parent’s feet. "Families do not cause
eating disorders," Ken says, who describes the disease as a
"bio-psycho-social illness" because of its biological, psychological,
and social elements. "Genetics load the gun and social and or life triggers
pull the trigger," he added.
And while families do not cause anorexia they can--with the help of a
therapist-- become part of the solution. "Be loving, be direct, and don’t allow treatment to be optional even
when you encounter denial and resistance," Ken says, who likens a
confrontation with an anorexic to any type of substance abuse problem.
Rick Ginsberg, Ph.D., staff therapist at the Counseling & Behavior Center
at Denver University, concurs, explaining that people who struggle with eating
disorders fear any type of change in their behavior. "Many patients think
that this [anorexia] is a life or death behavior," he explained. "But
usually the issue of body image [or anorexia] comes out of other issues like
depression. So often [the eating disorder] is a symptom of something else. It’s
not necessarily about the food."
Timing Can Mean Everything
Ideally parents and friends recognize disordered eating patterns before they
become clinical problems. Warning signs can be subtle and include making
repeated derogatory and degrading comments about the body, dropping a
substantial amount of weight quickly, running to the bathroom after every meal,
and avoiding social situations where food is involved.
Unfortunately most people obsess about food, which makes deciphering
disordered eating habits difficult especially in a society that believes that
you can never be too rich or too thin. It’s become common, even
normal to hear people talk about needing to lose a few more pounds, about hating
their huge hips, fat cheeks, and thunder thighs even when they are thin.
Derogatory comments have become so familiar in our society that they sound
innocuous. But having a negative body image and talking about it freely is
insidious, " says Denise McGuire, Ph.D., a licensed psychologist with the
Aspen Grove group in Denver that specializes in eating disorders.
"It’s hard to be a woman and feel good about your body," she
adds. "Most people fall somewhere on an eating disorder continuum. Most
people are dissatisfied with their bodies." For mothers that can be
particularly dangerous.
Described as sponges by therapists, kids absorb messages from mothers who
exercise obsessively, prepare special meals for themselves while the family eats
something else, and make negative comments about their bodies.
"It doesn’t take much for a little girl to think, ‘maybe there’s
something wrong with me too,’ " Denise says. "Research definitely
shows that parents pass it on."
Males suffer from disordered eating as well but females comprise the largest
percentage of the statistic. Yet that seems to be changing. On Front Range
college campuses therapists see and hear about more men with eating disorders
though they are not as likely to seek therapy.
"There is an extra level of shame for men," says Steve Ross, Ph.D.,
clinical coordinator for the counseling center at Colorado State University who
specializes in disordered eating. Yet therapists hear of more men degrading
their bodies, talking about being too thin, too big, not enough muscle, too much
muscle.
Adjusting The Internal Mirror
Poor body image and inability to appreciate your body as it is intended to
look fuels disordered eating and leads to clinical disorders. "It's hard to
convince someone to like the way they are," Lindsey admits.
To counteract the disease therapists attempt to "fix the internal
mirror," Ken says. With different types of therapy--from art and
dance movement to body tracing, meal planning with registered dietitians, and
counseling sessions--patients begin to develop a well-rounded sense of
themselves. But recovery is a long process and requires support from friends and
family members.
Parents, siblings, friends, and colleagues can make a difference by
expressing concern in an empathetic manner, giving specific examples of behavior
that has concerned them, and providing well-researched resources for help.
"Just be loving and understanding," Lindsey says. "Tell them,
'I'll do whatever it takes, I'll be with you every step of the way.' If you open
up the opportunity for the sufferer to confide in you it's better than trying to
confront someone." But do not get angry, she says. Aggressive or emotional
confrontation "doesn't make you want to stop. It just makes you feel
bad," she explains.
Patients and therapists urge support members to approach a sufferer carefully
and to realize that confrontation is just the first step. It is not going to shake a
person out of a disordered eating
mindset. It may, however, point him or her in the right direction.
For Lindsey, that direction came from the Center. "It was amazing to sit
there with friendly, wonderful women who were struggling with the same problem,
to see that it's not so weird. I made some of the best friends I've ever
had."
Providing local resources or names of local specialized therapists may be the
best way to help. Experts suggest that friends and family keep the focus on feeling healthy,
not on weight. While they are visual
diseases, weight is only one component of disordered eating.
"Weight is only one piece. If you spend too much time on it you’re
missing the bigger picture," says Denise, who recommends focusing on
lifestyle changes that resulted from the eating disorder. "Point out
behavioral signs," she suggests. "Talk about the fact that the person
doesn’t seem to be as happy, that she’s avoiding going out with friends when
there’s food involved."
And timing is important. "It’s better to catch this stuff early,"
Steve says. "The longer it goes the harder it is to turn back."
Picture Perfect
On average anorexic patients are 20 and 30-year-olds though the disease can
start in the early teens with the onset of puberty, which can be seen as a loss
of control.
Anorexia seems to prey on "good girls" who like to please and seek
societal approval, Type A personalities who strive for the best grades, the
neatest rooms; who grasp for control over their lives and settle for control
over their bodies. Ironically those with clinical anorexia, defined by the loss
of 15 to 20 percent of normal body weight, lose that as well.
"They’re people who have a high need for perfection and picked up some
messages along the way that they’re not quite good enough," Denise says.
"They’re always working to be better, to reach their ideal."
These perfectionists "stick to a diet perfectly," Steve says, until
they cross a line where it becomes impossible to see their bodies accurately. "There’s a fundamental change in thinking that distorts reality,"
Denise says. "They see fat when they look in the mirror [even when] they’re
80 pounds. Once that starts to happen it’s hard to rework the physiological
effects."
At the core of this multi-layer disease is the belief that a patient never
reaches his or her ideal; that a thin physique will somehow catapult him or her over
that final hurdle.
"They talk the societal talk, ‘I have to be thin to be loved, to have
a boyfriend,’" Steve says. "It’s important to start to unwrap that
[thinking]" and understand what led to it.
From emaciated television actresses to waif-thin models, and the American
obsession with being thin, negative body images are constantly lobbed at young
girls and boys. "It has become an undercurrent of our society," Rick
says. "Americans’ relationship with food is as complex as their
relationship with sex. It’s hard to find a healthy balance."
But weight, while the most obvious sign of disordered eating, is just one
component of the disease. Deciphering the internal motive, they say, is the best
way to help someone recover.
Steve noted that many women with the illness are frequently unable to
recognize emotions like anger and frustration that fuel the disease. "In
therapy we help clients access and label their own emotions and help them look
inside themselves for approval."
Sub-Clinical Eating Disorders: A Growing Problem
In addition to severe--or clinical cases--of disordered eating, there
is an increasing number of women and men who teeter on the edge of clinical
eating disorders.
"There’s been explosive growth in the sub-clinical [category] over the
last 10 years," Steve says, "and the trend is toward continued
growth."
On college campuses it seems to be especially evident. "It’s pandemic
among college women," Rick says. "I see more body image problems." And because so many people talk about dieting and
about their dissatisfaction with their bodies, it’s hard to differentiate
those with eating disorders. "It’s become a prevalent culture on campus
so it’s hard for them [women] to know what is normal thinking," adds Rick, who specializes in
disordered eating in his private practice and sees
an increasing number of sub-clinical patients at the University of Denver clinic
with "really bad relationships with their bodies, food, and exercise. It
runs like a virus through the sorority houses. The behavior gets picked up and
passed on. It’s insidious."
This problem is a long story with many chapters, Rick says, who warns that it may take several attempts to get someone into
therapy and even then patients may just be placating someone else.
"Because recovery can take so long, people with eating disorders burn out
the people around them," Rick says who advises people to approach a
person suffering with the illness in a gentle and honest way. Most
importantly, he says, stay calm and speak from the heart.
Anorexia and other forms of disordered eating are shame-based disorders so it
may help to talk about the disease as its own entity, to separate it from the
person so that you avoid tapping into feelings of shame and guilt. Use language
like, "I know you are struggling with this thing," he advises.
Select a safe environment to talk, start out by saying how concerned you are
using specific examples, and approach the person in a non-threatening and
non-emotional manner. "I recommend that people say, ‘I am here to support
you if you think this is a problem,’ and leave it at that. Let the person
initiate his or her own autonomy," Rick suggests.
Therapists also encourage a support person to recognize the limitations
and enable the person with an eating disorder to help him or herself. "Be
loving and empathetic," Rick says, who also recognizes how frustrating
it is to try and counteract or listen to someone make derogatory comments about
his or her body. "It’s like someone telling you red is blue," Rick
says.
When the exchange becomes repetitive, friends and family lose patience with
what Rick describes as a verbal dance of one person lobbing negative
comments about his or her body and another trying to refute them.
In truth, Ken says, there are no good answers to questions
from a person with an eating disorder about whether he or she looks fat. "They
are not going to like what they hear," so he suggests the following
language: "We both know that your internal way of hearing this is damaged
and I’m not going to go down that road with you."
People who suffer with eating disorders talk about their bodies incessantly
because the nature of the disease feeds on doubt about themselves, their bodies,
and whether they really have a problem.
"There is a predisposition toward obsessive thoughts," Steve says.
It’s like "playing a tape over and over again."
When faced with constant questions, Rick suggests the following:
"Address the problem, say ‘I’m concerned about you. You’re always
saying this [I’m so fat, other derogatory comments], and I don’t have the
energy to constantly negate this [but] I don’t want you to take my silence as
agreement.’"
Prevention
There are ways to protect kids from eating disorders or as Ken says, eating
disorder-proof your kids. "Focus on who they are, not what they are,"
he says, "and don’t put them on a diet." Ken has created eating disorder programs for hospitals, run a
private practice, and dealt with all levels of the disease for more than 15
years. Diets, he argues, are ineffective and a waste of energy. "Accept
what your body is supposed to look like," he urges.
Rick believes that the focus should be on the body as a tool
not a decoration. "I think we should think of the body as something that
can help you achieve what you want. How high can it jump? How fast can it run?
It’s not an end in and of itself."
Lindsey agrees. "You need to love yourself and love your body. It's so
miraculous. It allows you to succeed and educate yourself. It's there for you
all the time. You take care of it and it takes care of you. It's such a gift and
people don't realize it until it's taken away." The most important message,
she says, is, "Respect yourself for who you are."
Where To Turn
Effective therapy for disordered eating is usually a smorgasbord of
approaches from which patients can choose. Local therapists like Steve work with
registered dietitians and other specialists to address issues that lead to
clinical eating disorders.
The Eating Disorder Center of Denver (www.edcdenver.com)
opened in September of 2001 and counsels
patients aged 16 and older. The partial hospitalization program costs $800 daily
while outpatient services range from $50 to $150, depending on the services
provided. The partial hospitalization program is 11 hours a day, 7 days a week
program and includes meals that "allows patients to practice everyday life
and get the treatment they need to get better," Ken says. Lindsey says the
intensity of the program was especially helpful to her. Their location is 950 S.
Cherry St. Suite 300, Denver, 80246. Phone is 303-771-0861, e-mail is info@edcdenver.com.
Children’s Hospital in Denver (www.tchden.org)
has an eating disorder center for children
under the age of 16 who need intensive treatment and private practice
psychologists and psychiatrists with eating disorder specialties have joined
forces with dietitians to provide group services. The phone number of their
program is 303-764-8521.
When dealing with eating disorders it is important to seek a therapist who
specializes in the illness.
Events coming up: January 25, 2003, Body Image: Distortion to Dysmorphia
presented by Katharine A. Phillips, M.D., director of the Body Dysmorphic
Program at Butler Hospital. Children' Hospital, Vestal Education Center, 6th
floor, 1056 E. 19th Avenue, Denver, Colorado, 80218.
