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Lee Capristo
Director of Publications
Anne Arundel 100

Poor Self-Esteem Feeds Eating Disorders

Written by Kyle K. Bishop and M.J. Raleigh, SMCM Counseling Center

A yellow ribbon was chosen by Austria to symbolize the problem at the International Conference on Eating Disorders in Seattle last year.

Terry was a 20-year-old college junior when we found her sitting in the reception area of the counseling center reading Glamour magazine. At our first session Terry talked about her family, her studies, and her significant other. She was about 5 feet 3 inches tall with a petite frame and appeared to be of normal weight. However, she looked tired with badly damaged hair, dry skin, sunken eyes, and a pale complexion. She made little eye contact throughout the first session.

Terry (not her real name) shared that she struggled with her boyfriend's academic success and overall driven personality, and that she felt she was never going to be good enough for him. He repeatedly told her she didn't need to compete with him and that he loved her just the way she was.

Over the course of our next sessions Terry admitted that she began to feel "not good enough" right before her parents divorced. At first she was just too upset to eat normally, and then after receiving positive attention from her father and other people about her weight loss she began to change her eating patterns. After losing over 30 pounds, just restricting food intake no longer reduced her weight. She began to exercise up to 45 minutes every day before bedtime. Eventually, this became 90-120 minutes every night. She admitted that she was sleeping less than four hours a night, weighed herself 10-15 times a day, knew the caloric value of everything she ate, and hated the "fat" body she saw in the mirror.

She began forcing herself to vomit several times a day. Ultimately, her inability to concentrate, chronic feelings of exhaustion, and tension with her boyfriend brought her into therapy. Terry did graduate from college the following year and had started to create healthy eating patterns, but she was still struggling with an eating disorder. Sadly, Terry's is not an unusual or uncommon story.

Eating disorders often begin to emerge between the ages of 14-23 and can take hold during the college years. An individual struggling with an eating disorder is probably dealing with underlying self-esteem and relationship troubles as well. Support, positive feedback, and inspiring that person to get help can be the greatest gifts you give to someone dealing with destructive eating patterns.

Many people are familiar with the eating disorders anorexia nervosa (the extreme restriction of food intake) and bulimia (binging and purging). However, before a full-blown eating disorder is evident, many students begin a pattern of what is called "disordered eating." Disordered eating can be found in more than half (57%) of college students, and may be present for a signifi cant period before developing into a diagnosable eating disorder. Some individuals with disordered eating never develop an eating disorder. However, disordered eating still presents severe consequences, such as long-term damage to mental and physical health.

Look for the signs: Disordered eating can take many forms, including skipping meals, excessive exercise, andcyclical dieting. One of the common forms of disordered eating that is cropping up on college campuses is restriction of calorie intake on days students plan to consume alcohol. A recent psychological study in the Journal of American College Health found that about 40% of college drinkers (male and female) reported restricting food, fat, or calories on days they were planning to drink. Negative consequences that result from this behavior, says the study, are an overall increased vulnerability to becoming intoxicated, and an 80% increase in physical altercations, as well as an increase in memory loss, being hurt or injured, being taken advantage of sexually, and having unprotected sex.

If disordered eating grows into a clinically signifi cant eating disorder, the symptoms can be alarming. Eating disorders are potentially lifethreatening conditions that affect the emotional and physical health of about 17% of the U.S. population. Symptoms include extreme sensitivity to cold, dry skin, brittle hair and nails, lowered blood pressure, heart palpitations, difficulty thinking, impaired judgment, and mood swings. Health risks include heart disease, diabetes, osteoporosis, muscle loss, kidney failure, hair loss, and irregular menstruation.

Contrary to popular belief, individuals with eating disorders are not afraid of gaining weight, they fear failure. Common characteristics of a person with an eating disorder may include a high level of intelligence, perfection tendencies, unrealistic goal setting, the need to be in control, and excessive compliance to significant others, family members, and authority figures.

Also contrary to popular belief, eating disorders do not affect only women. About 5-10% are men and there is evidence to suggest that the statistic may be even higher, according to T.M. Gadalla in the International Journal of Men's Health. Men are less likely to seek treatment for disordered eating and clinicians are less likely to diagnose a man with an eating disorder. The warning signs are not all that different. Men struggle with distorted body image, food restrictions, purging behaviors and self-esteem issues too.

Other individuals at high risk for developing an eating disorder are student athletes. Contributing factors are a desire for performance thinness and appearance thinness. Often times, the result is stress fractures due to the development of osteoporosis, which can develop in as short a time period as one year, and is frequently accompanied by loss of menses.

Treatment protocols for eating disorders have different success rates depending on one's defi nition of success. A study by P.S. Richards in the Journal of Eating Disorders states that 40-50% of individuals regain normalized eating patterns, about 30-40% fully recover, about 30-35% exhibit various forms of improvement, while 20-25% maintain a chronic disorder. However, with the emergence of social networking web sites that promote eating disorders, treatment rates may decline. The web sites provide a forum to connect with other individuals with eating disorders and provide what some call "thinspiration" to each other. A recent study in Pediatrics magazine found that 96% of individuals diagnosed with an eating disorder who visited pro-eating disorder web sites learned new dieting and purging techniques and 50% learned new weight-loss tips. However, eating disorders vary in severity and most often recovery depends on the seriousness of the condition. Treatment options include psychotherapy, with special attention to medical and nutritional needs, hospitalization when the symptoms become life threatening, and long-term inpatient care, where individuals are able to live for extended periods of time while receiving therapy and ongoing supervision.

Most experts agree that food is not the primary problem when treating an eating disorder. Psychological, emotional, and physical issues are often contributing factors. Psychological issues that may contribute are troubled interpersonal relationships, feelings of inadequacy, depression, anxiety, or severe loneliness. Individuals who receive family messages about constricting emotion, perfectionism, and negative body image are at higher risk for developing an eating disorder than families who promote emotional expression, are fl exible, and reinforce a positive body image. If you are a parent, friend, sibling, or family member, remember to promote positive and healthy body images. It is the messages we receive from others that reinforces love for self.

How to Help Someone with an Eating Disorder
HelpIf you think that someone you know is suffering from an eating
disorder, keep these thoughts in mind when confronting the situation:
Realize you may be rejected and the person may become highly defensive. Don't take it personally. This may be a very difficult issue for that person to confront and talk about to another person, so practice patience. Don't back down' remain consistent and repetitive. Encourage others in his or her life to talk about the issue openly.

Don't try to monitor his or her food intake or exercise regime. Don't force that person to eat with you or report back to you about eating, exercise or purging behaviors.

Don't try to cure it on your own or analyze/interpret the situation. Make appropriate referrals and remain a source of support for the individual.

Even though eating disorders and disordered eating are becoming more and more common in our communities, you can do something to help. If you are concerned about someone, inspire that person to take better care of him or herself. Educate yourself and that individual on eating disorders and the treatments available in your area. You can call 1-858-481-1515 to speak with someone at the National Eating Disorder Referral and Information Center and be provided with information on referrals and prevention information. Above all else, remember there are people available to help. For the young college men and women affected by this disorder, college counseling centers are a great place to be evaluated and to start treatment.

To learn more about eating disorders:

Brandon, C.W. (1993). Am
I Hungry...or Am I Hurting?

San Diego: Recovery

Cash, T.F. (1997). The
Body Image Workbook:
An 8-step Program for
Learning to Like your Looks.

Oakland: New Harbinger

Freedman, R. (1989).
Bodylove: Learning to Like our
Looks and Ourselves.
York: Harper & Row.

Hall, L. & Ostroff, M.
. Anorexia Nervosa:
A Guide to Recovery

(5th ed.). Carlsbad,

Koenig, K.R. (2005). The
"Rules" of Normal Eating.

Carlsbad, CA: Gurze

Mendelsohn, S.J. (2007).
It's Not about the Weight:
Attacking Eating Disorders
from the Inside Out.
NE: iUniverse.

Minirth, F., Meier, P.,
Hemfelt, R., & Sneed,
S. (1990)
Love Hunger:
Recovery from Food Addiction
Nashville: Thomas Nelson

Smeltzer, D., Costin, C.,
Smeltzer, A.L. (2006).

Andrea's Voice: Silenced
by Bulimia
. Carlsbad, CA:
Gurze Books.