Eating Disorders and

Disordered EatingRachel Lawson, Louise Bennett and Heidi Brace, South Island Eating Disorders

Service, Canterbury District Heath Board

We are here to help

Four specialist eating disorders services

SIEDs, CREDs, Midland Region Eating Disorders Expert Hub and Waikato Specialist Eating Disorders Service, Tupu Ora Eating Disorders Service

Talk to the Eating Disorder liaison person

We need referral from a GP

Provide assessment, treatment of eating disorders and residential or inpatient facilities

Consultation, supervision and training from a Multidisciplinary team

Please call us

SIEDS: 03 3377707 CREDS: 04 461 6528 Waikato: 07 834 6902 Tupu Ora 09 623 4650

EDANZ

provides hope, information, support and resources to people supporting a loved one with an eating disorder

www.ed.org.nz

http://www.ed.org.nz/

Overview of the morning

0900 – 9.45 Understanding eating disorders and disordered eating

15 minutes for questions

10 minute break

10.10 – 10.55 Thinking about eating- sorting out fact from fiction

15 minutes for questions

10 minute break

11.20 – 12.05 Working with family/whanau- treatment options

15 minutes for questions

12. 20 CLOSING

Understanding Eating Disorders and

Disordered eating

Other Specified Feeding & Eating Disorders - OSFEDMixed behaviours / presentation, but serious illness:

→Atypical AN (AAN) – ‘normal’ weight AN→Sub-threshold BN→Sub-threshold BED→Purging Disorder→Night Eating Syndrome

Anorexia Nervosa

─ Restriction of Energy intake

→ significantly low body weight

→ less than minimally expected wt

─ Intense fear of weight gain / fatness→ behaviour that interferes with wt

gain, despite low wt

─ Disturbance in body image→ self evaluation unduly influencedby body weight / shape

→ persistent lack of recognition ofseriousness of low wt

Binge Eating Disorder

• Recurrent Binge-eating

• Abnormal eating behaviour with marked distress / guilt

→ Frequency ≥ 1 / week for 3 months

• Absence of:→ compensatory behaviours→ Anorexia Nervosa→ Bulimia Nervosa

Bulimia Nervosa

• Recurrent Binge-eating

• Inappropriate compensatory weight control behaviours → Frequency ≥ 1 / week for 3 months

• Self-evaluation unduly influenced by body weight / shape

• Absence of Anorexia Nervosa

Eating Disorders

Detection

Few young people will volunteer they have an eating problem

Their friends may know and tell the school counsellor

Parents/ family whanau

Warning signs can be physical, behavioural or psychological

Weight loss, stress fractures, narrowing of food choices, Increasing absences from family meals, Excessive exercise that is solitary, distorted body image, anxiety around meal times

See Appendix

Co-morbidity is common

For any young person presenting with anxiety or depression please ask questions about eating

Screening

“Many people have concerns about food and weight. Do you have any concerns or worries about these things?”

Yes – Follow up with the SCOFF questionnaire

S –Do you make yourself Sick because you feel uncomfortably full?

C- Do you worry you have lost Control over how much you eat?

O- Have you recently lost more than One stone (6.35kg)

F- Do you believe yourself to be Fat when others say you are too thin?

F – Would you say Food dominates your life?

* One point for every “yes”; a score of 2 or more indicates further questioning is warranted

What causes an Eating Disorder?

Multi-factorial and complex

No single cause of eating disorders has been identified; however, known contributing risk factors include:

Genetic vulnerability

edgi.nz

Psychological factors

E.g. perfectionism, low self-esteem

Socio-cultural influences

Media exposure and pressure for thinness

“In year seven they weighed me and then put all our weights up on the board. That was when I started thinking about seriously losing weight. Suddenly I was comparing myself to others”

The message “Some how I was less because I was bigger”

9

Central Cognitive Elements

Judging oneself largely, or exclusively, in terms of shape, weight, eating and the ability to control them

For Example

If I eat carbohydrates I will get fat

If I am fat I will be unacceptable

If I am thin I will be happy

If I am thin I am in control

What do I do?

Restrict, binge, purge, exercise etc...

Central Cognitive Elements

Self-Evaluation I am now going to ask you a rather hard question –you may not have thought

about this before. Over the past four weeks has your weight/shape been important in influencing how you feel about/ think about yourself as a person?

For example, friend who loves their job

Take a moment to think about yourself?

What influences how you feel about/ think about yourself as a person?

Self-Evaluation

Client's Current Self-Evaluation

Pie ChartRelationship

Family

Friends

School

Weight and

Shape

Client's Ideal Self-evaluation Pie

Chart

Family

Friends

Relationship

School

Wgt/Shape

Hobbies

Eating Disorders – A range of different

presentations

Anorexia Nervosa-Restricting subtype

Obsessive compulsive personality traits

Like order and are highly organised

focus on detail,

perfectionist,

value mental and interpersonal control

Anxious

Social anxiety

GAD

OCD

Anorexia nervosa –Binge purge subtype

More impulsive, less introvert

Eating Disorders – A range of

presentations

Trauma group with or without PTSD

disordered eating , e.g. don’t eat when anxious, low mood

Some adolescents

Binge and purge for affect regulation as part of a picture of self harm

E.g. overdosing, self-cutting

Tend to fast

Some drive for thinness

DBT program

Eating Disorders and sexual trauma

Causes of eating disorders are multidimensional

May add to a person’s risk of developing an ED

About 40% will report sexual abuse

Higher in those with Bulimia nervosa, BED and AN-BP subtype than AN restricting subtype

DSM-5 CSA and CPA increase the risk of developing BN in adolescence

Eating Disorders and sexual trauma

Negative perception of the body

Shame

Restrict eating, vomiting and laxatives as a form of punishment

“It was my fault I do not deserve to live”

Aversion to sexual activity

With low weight comes reduced sexual interest

Fear of future sexual trauma

Defensive strategy is “become unattractive”

- become bigger to be intimidating

- underweight to lose signs of sexual maturity

Way to cope with psychological difficulties

Need for control

Regulation of emotion

Physical Risk

All clients with eating disorders are at medical risk to some degree

BED – longer term risks associated with obesity

Weight or BMI is only one aspect of this

e.g., A patient with a BMI of 15 but who is losing weight at a kilo a week is likely to

be more at risk than someone who has kept a stable BMI of 14 over many years

Frequent use of purging (vomiting, laxatives) greatly increases physical risk,

especially if patient underweight

What to do?

All patients should have had a physical examination by their GP to establish their level of physical risk

If on-going risk the GP needs to continue to be involved (or medical staff in DHBs)

Speciality services offer advice on medical monitoring

Your part

Provide education about risks to adolescent and family

www.cci.health.wa.gov.au

Monitor risk during treatment

purging increases or weight is dropping ; patient reports fainting dizziness, blackouts

Contract at start of treatment

Disordered Eating and

Body Dissatisfaction

What is disordered eating?

A disturbed and unhealthy eating pattern that can include restrictive

dieting, compulsive eating or skipping meals

Implications

For some can be the entry point to an eating disorder

Dieting implicated in weight gain and obesity

Psychological impact

Feelings of guilt and a sense of failure

Diets fail people; People don’t fail diets

What’s happening out there?

High rates of body image concerns

• Adolescent body dissatisfaction in Australia:

50% adolescent boys

75% adolescent girls

• Of adolescents in a healthy weight range

33% boys believe they’re overweight

50% girls believe they’re overweight

High and increasing rates of disordered eating

• National sample of adolescent girls:

Year 2000: 10% showed disordered eating behaviour

Year 2006: 18% showed disordered eating behaviour

What’s happening out there?

Unhealthy weight control behaviours among NZ adolescents are common

More than one third of males and two thirds of females had attempted

weight loss

A high proportion had used unhealthy and potentially dangerous methods

to try an loose weight

Fasted, skipped meals, smoked cigarettes, vomited, diet pills

Female, reported Maori or Pacific ethnicity

And/or had a BMI in the overweight or obese range

Media exposure and poor dietary behaviour predicted DE

Who is at risk?

Over 30 factors identified by research as eating disorder risk factors

Media exposure

Risk factor target

Media Internalisation

When an individual invests in societal ideas of size and appearance to the point they become rigid guiding principles

Girls and women – thin ideal

Men – Muscular ideal

What can we do about this?

Media Literacy

Encourage students to adopt a critical approach so they can identify, analyse

and challenge ideal body image seen in the media

Through evidenced based prevention programs

Media Smart

Media Smart

8 lessons media literacy program taught in school

Developed by Dr Simon Wilksch and Prof Tracey Wade

For intermediate and early high school students

Topics covered include:

techniques used by the media to manipulate images (e.g., airbrushing);

ideas on how to analyse and challenge media messages,

tips for handling pressure placed on young people

planning for how to move through adolescence and beyond as a skilful and

confident person

Media Smart

Been researched with over > 3000 participants

MS significantly reduced risk factors related to eating disorders and obesity

Reductions in dieting, depression, body dissatisfaction, shape and weight

concerns and over-evaluation of shape and weight

96% of boys and rated the program as both being valuable and enjoyable

“I used to get upset all the time because I couldn’t look perfect (no one knew

how I felt)

“Even though I sometimes feel jealous of people, I think about the lessons and

feel better about myself”

“I never knew how much the media changed the pictures before they went in

the magazine

Media Smart coming to NZ

Research trial in 2020 for Year 7and Year 8 pupils

Efficacy vs Effectiveness

Media smart program delivered by researchers or psychologists

Effectiveness trials examine whether interventions produce effects when

delivered by non-specialists presenters and under real world conditions in

natural settings

Canterbury and Nelson Marlborough

Range of non-specialists presenters

Funding ? Roll out to rest of NZ

Researchers are investigating two versions of Media Smart Online. This program has been found to reduce a range of eating disorder risk factors and symptoms, and prevent the onset of related problems (e.g., depressive symptoms).

Want to feel better about your body?

Worry less about your eating? Exercise?

Be able to think about other things without getting stuck on worries about your shape or weight?

You will be compensated with a $30 voucher for completing the study. Participation is fully confidential.

The study is open to 13–25 year-olds of any gender across Australia/NZ and is starting soon.

Register your interest now by email mediasmart@flinders.edu.au

mailto:mediasmart@flinders.edu.au

What can help?

For yourself and your family whanau

For children, adolescents and their family whanau

What can help? Work toward acceptance rather than satisfaction

Focusing away from looks and towards function

What does my body enable me to do? Allow me to enjoy?

E.g. Legs for walking, my eyes allow me to see beautiful colours

The Role of genetics

Helping the individual see how their body shape (or parts of) have been inherited

My favourite aunt

Comparison

exploration of whether this is useful

Comparison is the thief of joy

who does the young person tend to compare herself against, and is this adaptive?

What else could you look at?

Positive and accurate body language

No such thing as a ‘”cankle”

List five positive things about my body and five about my self

What can help?

Remember those life pies

Complimenting non-appearance attributes

Emphasize positive qualities and talents

Act as a positive role model

Eat regular meals and snacks

No complaining about your own body

No weight related compliments

Have you lost weight?

Be aware of how “health” is being taught in your school

check anti-obesity message not being delivered “too strongly”

The pizza example

What can help?

Understanding what social media young people are using

Encourage a healthy skepticism of media messages

What are the family rules around access to sites? Parental control

Send parents to netsafe.org.nz

Protective

Eating with the family

Family connectedness

Our next presentation is going to step you through these factors

Questions

Appendix

NINE TRUTHS ABOUT EATING DISORDERS

Truth #1: Many people with eating disorders look healthy, yet may be extremely ill.

Truth #2: Families are not to blame, and can be the patients’ and providers’ best allies in treatment.

Truth #3: An eating disorder diagnosis is a health crisis that disrupts personal and family functioning.

Truth #4: Eating disorders are not choices, but serious biologically influenced illnesses.

Truth #5: Eating disorders affect people of all genders, ages, races, ethnicities, body shapes and weights, sexual orientations, and socioeconomic statuses.

Truth #6: Eating disorders carry an increased risk for both suicide and medical complications.

Truth #7: Genes and environment play important roles in the development of eating disorders.

Truth #8: Genes alone do not predict who will develop eating disorders.

Truth #9: Full recovery from an eating disorder is possible. Early detection and intervention are important.

~~

Produced in collaboration with Dr. Cynthia Bulik, PhD, FAED, who serves as distinguished Professor of Eating Disorders in the School of Medicine at the University of North Carolina at Chapel Hill, “Nine Truths” is based on Dr. Bulik’s 2014 “9 Eating Disorders Myths Busted” talk at the National Institute of Mental Health.

Leading associations in the field of eating disorders also contributed their valuable input.

The Academy for Eating Disorders along with other major eating disorder organizations (Families Empowered and Supporting Treatment of Eating Disorders, National Association of Anorexia Nervosa and Associated Disorders, National Eating Disorders Association, The International Association of Eating Disorders Professionals Foundation, Residential Eating Disorders Consortium, Eating Disorders Coalition for Research, Policy & Action, Multi-Service Eating Disorders Association, Binge Eating Disorder Association, Eating Disorder Parent Support Group, International Eating Disorder Action, Project HEAL, and Trans Folx Fighting Eating Disorders) will be disseminating this document.

Impact of Eating Disorders

Psychological Poor sense of identity; inadequacy & ineffectiveness; guilt; anxiety; rumination; compulsive behaviour; poor problem

solving; poor emotional coping; poor emotional regulation;

unsatisfactory relationships

•Depression, anxiety

•PD, DSH, suicidality

•Substance use

Medical •Malnutrition & growth delay

•Acute medical instability / problems

•Health problems 20 to malnutrition: osteoporosis, impaired

fertility, G/I problems

Psycho-social,

life stage,

quality of life

•Incomplete / disrupted education

•Work / school issues / skills

•Social isolation, restricted life experience

•Self neglect, personal austerity

•Burden of ED symptoms on personal time

•Housing, financial & legal issues

Family •High Burden of care

•Unhelpful Beliefs about illness & response to illness

Physical Warning Signs

❖Sudden weight loss/gain/fluctuation

❖Dehydration

❖Dry hair or skin

❖Sensitivity to the cold

❖Feeling faint, cold or tired

❖Injuries relating to over-exercising

❖Stress fractures

❖Muscle cramps

❖Dental problems

❖Gastrointestinal

problems e.g.

Feeling full or

bloated

❖Knuckle calluses

❖Abdominal pain

❖Sores on hand

Psychological Warning Signs

❖Obsessive pre-occupation with foods

❖Negative body image

❖Distorted body image

❖Negative comparisons with others

❖ Low self esteem

❖ Feelings of lack of control

❖Depression

❖Anxiety

❖Perfectionism

❖Guilt – especially around food

❖Not enjoying normal activities

❖Heightened anxiety around meal times

Behavioural Warning Signs

❖Restricted/rigid diet

❖Fussy eater/banned foods

❖Throws away food

❖Social isolation

❖Frequent weighing

❖Constantly talks about food and diets

❖Wears baggy clothing

❖Constant preoccupation with food or exercise

❖Makes excuses not to eat

❖Calorie counting

❖Excessive use of the toilet

❖Excessive exercise

❖Use of diet pills, supplements and laxatives

❖Wrappers/food

disappearing

❖Denies problem

❖Trains through injury

Detection

Families get it right

Gradual changes in behaviour and appearance occurring over months or years

A narrowing of food choices

Increasing absences from family meals

Prolonged visits to the toilet

Excessive exercise that is solitary

Gradual withdrawal from social activities, particularly involving eating or drinking

For AN persistent and noticeable weight loss (may attempt to conceal)

Excellent Teacher Resource.

www.nedc.com

http://www.nedc.com/