1.Understanding and responding to collegestudents with food and body imageissues Sara Weber, LPCCounseling & Mental Health Center, UT Austin

2. Overview Binge, Purge, StarveWhats the difference? Why does this happen? Beyond the behaviors College students and eating disorders Treatments for Eating Disorders The Phases of Recovery How to help a friend or loved one. Take Home Messages 3. Whats the Difference?Eating Disorders (anorexia, bulimia and binge eating) havemany things in common even though they manifestdifferently. All eating disorders: Seem like they are only about food and weight but it isntthat simple. Are a way of coping: using food, exercise, and weightobsession as a way to organize life & manage emotions. Create a sense of security, control, predictability, etc. Involve an intense emotional connection with food andweight. Can happen to men, women, old, and young. 4. AnorexiaAnorexia is characterized by the belief that If I can get thinenough, my life will be better. Start off as a desire to get thinner, lose some weight Stability and success in life is dependent on being thin. Even when others believe s/he is thin enough, s/he doesntfeel thin. Perception is warped by malnutrition. Restricting foods, fasting, over-exercising, purging to loseweight. Malnutrition can promote restriction via delusions. Physical complications complicate re-feeding. 5. Anorexia: Warning Signs Preoccupation with weight Rapid, significant weight loss Relentless drive to be thin Obsessively reading cookbooks Withdrawal from friends or Cooking for other peoplegroup activities Intense sensitivity to criticism Irritability or mood swings Intense fear of failure Fear of specific foods Food rituals Compulsive calorie or fat gram Rigid and compulsivecounting scheduling Lying about not eating Growth of fine hair (lanugo) on Preoccupation with how food is arms, face, or backprepared Hair loss Perfectionist standards; high Injuries (fractures, pulledachievementmuscles) 6. Anorexia: Medical Complications Weakening of the heart due to Osteoporosis (bone loss)malnutrition (possible heart Lowered immune systemfailure) function/ low resistance to Low blood pressure infection Low body temperature Low blood sugar Low heart rate Kidney impairment or failure Irregularities or loss of Bone, ligament, and tendonmenstruation injuries due to malnutrition Fertility problems Memory loss Dehydration Gastrointestinal disturbance Electrolyte imbalance Metabolic changes Anemia (low iron) 7. BulimiaBulimia is characterized by competing beliefs that food will solve everyproblem (binge) and that it is poisonous and must beavoided/eliminated (purge). Like Anorexia, most people start off with the desire to lose a little weight. Compensatory methods used to purge include: vomiting, laxatives, over-exercise, or restricting after a binge. Purging methods are usually less effectivethan the individual realizes. What constitutes a binge depends on the perspective of the person engaged inthe binge and the difference can be vast. Food is used to numb out but the anesthetizing effects are fleeting so theurgent need to get rid of the food emerges. Purging can also feel numbing. Typically average to high weight with sometimes dramatic weight changes .Underweight individuals have higher health risks. 8. Bulimia: Warning Signs Preoccupation with weight Intense sensitivity to criticism Binge eating Withdrawal from friends or Going to the bathroom rightgroup activitiesafter eating Irritability or mood swings Hoarding or stealing food Swollen facial glands (chipmunk Overuse of laxatives, water pills, cheeks)diet pills. Marks on knuckles Secretive eating Depression (suicidal thoughts) Eating when not hungry Feeling out of control with Water retention, swollen limbs eating or life Self-hatred or disgust Weight fluctuations Withdrawal or isolation Perfectionist standards; high achievement 9. Bulimia: Medical Complications Abnormal heart rate (possible Lowered immune systemcardiac arrest)function/ low resistance to Irregularities or loss ofinfectionmenstruation Kidney impairment or failure Fertility problems Gastrointestinal dysfunction Dehydration(ulceration, pain, bleeding, Electrolyte imbalancebloating, constipation, non- responsive bowels) Anemia (low iron) Metabolic changes Esophageal bleeding or rupture Tooth decay Increased risk of throat andmouth cancer 10. Eating Disorder NOSEating Disorder Not Otherwise Specified includes all othervariations of disordered eating: Sudden weight loss and restriction but not underweight orhasnt lost her menstrual cycle. Binge eating / purging infrequently. Binge eating but no purging, binge eating disorder. Chewing food and spitting it out. Chronic, excessive dieting, reducing quality of life. Orthorexia: A fixation with healthy or righteous eating.While an anorexic wants to be thin, an orthorexic does notdesire thinness but wants to feel pure, healthy and natural. 11. Why does this happen?Contributing factors are varied: Physical changes in puberty Brain Chemistry Family Changing family roles Personality Characteristics Overwhelming events Cultural FactorsDieting is a risk factor. Almost all EDs start with dieting. 12. BiologyPubertyBrain Chemistry Both men and women Anxiety & depression areexperience dramatic changes in dictated by brain chemicalstheir body during puberty. called neurotransmitters. Women need to increase body Serotonin- Regulates hungerfat in order to initiate and fullness. Disturbances aremenstruation.associated with binge/purge. Women often dont realize the Norepinephrine- Regulatesnecessary changes of puberty mood, alertness, & response toand resort to drastic behaviors to stress. Disturbance connected togo back to pre-pubescent shape.Anorexia. Genetics are a factor. 13. FamilyFamily RelationshipsChanging Family RolesFamilies of people with eatingNormal development ofdisorders have some independence and identity is acommonalities:product of familys teaching. Difficulty expressing Too much, too soon:emotions. Expecting child to be Lack healthy bonds: Too close independent and responsibly(enmeshed), Too distant too quickly.(neglect) or an erratic Overprotecting: Not trustingcombination of both.the child to make good choicesRemember families are typically on their own.doing the best that they can! 14. Personality and Life EventsPersonality Characteristics Overwhelming EventsThere are varied personalities in Precipitated by an event that feelsthose with ED but there are someoverwhelming or traumatic.commonalities: Leaving home for the 1st time Perfectionist Death in the family/ friend Highly-driven Bullying or teasing Ambitious Verbal or physical abuse Anxious or high strung Sexual trauma Sensitive Moving homes Intuitive Divorce People pleasing Marriage Self-doubting & insecure 15. We wonder why women and men hate themselves? 16. Cultural FactorsAlthough it hasnt always been this way, a persons valueis often associated with thinness, fitness. Many of usbase our self-worth on the extent to which we canconform to societys idea of the perfect body. 17. Cultural FactorsWomen: Unrealistic standards of thinness, beauty, &shape Female thin-ideal: thin, toned, busty Thin = happy, successful, loved, accepted, desired.Men: Unrealistic standards of strength, power, andsuccess Male buff-ideal: cut, lean, muscular 18. Cultural FactorsCould we be part of the problem? Thin Ideal worship Dieting Fat Talk 19. Do I Fat Talk? 20. The Language of Fat1. How many times this week have you had negative thoughts about your body or someone elses body?2. How many times this week have you thought about a better life five pounds from now or when you are prettier, sexier, more fit?3. How many conversations have you had with other people this week about food, weight, exercise, or dieting?4. How many times this week have you compared yourself to other people or to images in the media?5. How many hours each day do you spend wishing you looked different? 21. You can be part of the solution 22. The Eating Disorder is a life Saver! 23. Beyond the BehaviorsThe eating disorder is an adaptive behavior:self-preservation. Life is extremely intense for someone who develops anED. S/he wasnt sure how to handle life before the ED. The eating disorder is a source of support. Best friend : shielding him/her from theoverwhelming parts of life that s/he cant face alone. Helping numb out when things get to be too much. 24. Beyond the BehaviorsEmotions Feel emotions very intensely Lack confidence in ability to tolerate emotions ED behaviors numb out and the emotions areavoided for the time being. Stuffing with food.Purging my feelings out. Starving denies I havefeelings. I feel fat is a cover up for emotions that are hard toface. Lost the ability to identify, face, and manage emotions. 25. Beyond the BehaviorsSelf-ConceptLoss of identity: interests, personality, etc. Focus on food andappearance as the solution to problems, prevents normaldevelopment of self-concept and eats away at existing identity.Life is the ED.Negative self-concept: never good enough, smart enough, prettyenough. Arguably a way to appease their drive (perfection) but itactually sabotages success in life.Perfection: Be perfect, or be nothing.Innate inadequacy: Fraud myth- one day, pe0ple will discover thetruth and abandon me.Body Image: Bases self-worth on body size. 26. Beyond the BehaviorsRelationships Relating to others can be confusing, frightening, and distressing. Values relationships greatly. People pleasing and very good at reading others needs andresponding to them. Doesnt accept help/love very easily b/c of fear of beingvulnerable. Vulnerability is debilitating so they often end relationshipsbefore they get too close. Doubts of their worth and fear of abandonment prevent themfrom feeling safe or secure in relationships. 27. College Survey ~ 1,000 students 20% of respondents believe that at some point they have sufferedfrom an eating disorder . National research says it is only .05-4%. More than half of those polled said they know at least oneperson who has struggled with an eating disorder. Almost 80% of students have dieted & avoided or skipped meals. 45% of the students know someone who compulsively exercises,almost 40% know someone who purges by vomiting, and 25%know someone who abuses laxatives. Among those who confirmed they have had an eating disorder orstill suffer from it, nearly 75% of that group never receivedtreatment. National Eating Disorders Association, 2007 28. College- Unique Challenges Significant transition- academically, socially, time-management, responsibility (bills, car, health), self-care (eating,sleeping). Communal eating. Eating schedule may depend on peers.Roommates influence eating and body image. Consistent interpersonal challenges- constant social interaction. Getting lost in the crowd: Once the big fish in a little pondbut now a little fish in a big pond. Losing identity from highschool (sports, cheerleader, popular, best atetc.) Coping with and managing long-distance family & friendrelationships. 29. College- Unique ChallengesThe college environment is especially toxic for body image: Body change between age 18-22 years is normal yetunexpected for most college students. Fear of the freshman 15 Shopping together, sharing clothes, high pressure fashionbubble. Events focused on body image: Rush, socials, football,parties, going out. Prime-time for dating creates an incubator for dialogue &concern about body and appearance. Going back to home town during break encouragescomparison of body changes with peers from high school. 30. TreatmentEating Disorder specialists are necessary.Choose a team from the beginning: Psychotherapist license not as important as training. Dietitian Using nutrition info for good and not evil Physician Medical monitoring is key! Psychiatrist Optional (as needed) Group Reducing shame, not feeling alone. Family therapy- If needed, crucial for some people. 31. The Mindful Eating Program Outpatient light Assessment focused Academic Success is our main goal Strength-based Not a treatment program. Recovery support. Services: Bi-weekly therapy group counseling, and medical monitoring. 32. ME: Assessment & ReferralStudents are asked to complete a thorough assessment. Psychological Medical Dietetic Sometimes psychiatric and/or off-campus specialists(cardiologist) are required for the full assessment.After this assessment we provide feedback about the next stepsand offer guidance in developing a treatment plan.If a student is outside of our scope of care, they are given treatment recommendations by the team. Off-campus, outpatient treatment team (weekly, ongoing) Intensive Outpatient Therapy Inpatient treatment 33. The Phases of RecoveryStabilization: Medical, behavioral, nutritional, &psychological (anxiety/depression, insight, communication,changing thinking, working with emotions).Exploring: gaining a deeper understanding of how the ED functions in their life. Developing healthier coping strategies. Addressing body image.Recovering life: 1) maintain progress, 2) resume life activities & develop new ones, 3) become fully engaged in life without relapse. 34. When a friend or a loved one is facing eating issues. 35. As a professional, you can help Know about eating disorders Warning signs Health risks Costs (personal, financial, emotional) of the struggle Bring it up (if it is your role) Do you have any concerns about your relationship with food or exercise? Do not focus on weight Focusing on weight, size, or good/bad eating is not helpful. Instead the focus should be on health behaviors- movement, nutrition, self-care. Listen and dont judge Remind yourself that they are struggling with an eating disorder because they are trying to manage something that must be very challenging for them right now. Have compassion for their struggle. Acknowledge your emotions & take care of yourself 36. As a friend, you can help Learn about eating disorders Talk to him/her Be and stay aware Break through secrecy Listen Help him/her get support Acknowledge your emotions Take care of yourself Focus on life beyond the illness Encourage authenticity 37. You can help! 38. Dont Diet Avoid categorizing foods as good/safe vs. bad/dangerous.Remember, we all need to eat a balanced variety of foods. You will not be happier just because you are thin, busty, orfit. Look around and consider examples of thin people who aremiserable and large people who are happy. Dieting harms your body- yes even so-called healthydiets. Your body needs variety and nutrition- dont sacrifice yourhealth to be thin. Larger people can be healthy too. Eating nutritious foods andstaying active is the prescription for health- regardless of yoursize. Encourage a culture that values a healthy relationship withfood. Slow down, enjoy food, & listen to your body. 39. Fat Talk Stop it!Begin listening more closely to the language other womenand men are using to speak to each other and the languageyou are using with yourself.Decide to avoid judging others and yourself on the basisof body weight or shape. Turn off the voices in your headthat tell you that a persons body weight says anythingabout their character, personality, or value as a person.Pay attention to the media messages that reinforce Fat Talk.Begin to explore the emotions that are going on behind FatTalkare you feeling scared, ashamed, vulnerable?Request honesty and intimacy with others- change thesubject when the Fat Talk takes over your conversations. 40. What you need to know! Anyone can recover from an eating disorder. Recovery is a tough road but a journey worth taking! College is a prime time to develop an eating disorder(or for an old struggle to come back). Professionals can offer compassion for patients so thatthe patients can have compassion for themselves. Talk about eating disorders, weight, and food in waysthat challenge the status quo & change the paradigm. Reach out to people you see struggling- you mightplant a seed, you might save a life. 41. Why She Feels Fat by McShane & Paulsonwww.gurze.comwww.austineds.comwww.edin-ga.orgwww.nationaleatingdisorders.orgwww.endfattalk.comwww.somethingfishy.orgwww.eatingrecoverycenter.comwww.cmhc.utexas.edu/mindfuleating.html 42. As a friend, you can help Learn about eating disorders Talk to him/her Be and stay aware Break through secrecy Listen Help him/her get support Acknowledge your emotions Take care of yourself Focus on life beyond the illness Encourage authenticity 43. You can help Learn about eating disorders Websites, books, talking to a therapist and someone who has been through it before. Talk to him/her Remember that they feel the ED is vital to their survival and will feel threatened if you criticize it. Use I statements, I feel when you or I am worried about .(specific behavior). Remind him/her that you are there to listen and check in occasionally so that s/he doesnt feel like you are ignoring the issue now that you brought it up. 44. You can help Be and stay aware Keep your eyes open for subtle improvements Stay tuned into possible relapse behaviors and bring them up the same way you did when you initially confronted him/her. Break through secrecy There is a strong drive to hide the ED, even after admission that s/he wants to recover. Talk about this struggle to keep the ED a secret and offer compassion for this desire while also challenging him/her to be as transparent as possible. Listen Listening is one of the most important things you can do. This is hard if you dont know how to help or dont understand what they are going through but listening openly is still a valuable support to offer. 45. You can help Help him/her get support Offer your support in any way possible. Ask often if there isanything you can do for him/her. Help him/her find things to enjoy again- hobbies, activities,interests. Encourage putting time and energy into things s/hemight enjoy and offer to go too. Acknowledge your emotions & Take care of yourself It can be maddening to be in a support position of someonewith an ED. Take care of yourself and get support whenneeded. It is ok if you cant be the primary support person all the time. You can model emotional awareness and self-care. Rely on your own support system. 46. You can help Focus on life beyond the illness Plan activities and enjoy time together that isnt related to the ED at all. These may need to be non-food events. Dont put life on hold for the ED (although be mindful of limitations of recovery length, e.g. dont start a new degree). Focus on aspects of your friend or loved one that were there before the ED took over (personality or interests) Encourage authenticity There is a tendency to deny that they are really struggling so look ways s/he may be trying to look fine and intervene to offer help and challenge them to acknowledge their struggles. 47. http://www.youtube.com/watch?v=QSqtVDIwnHo