In Your Face Youth Care In Your Face Youth Care Conference:Conference:

A Practical Approach to A Practical Approach to Eating Disorders Eating Disorders

Patty Yoon and Marlena DumasPatty Yoon and Marlena Dumas

Providence Health CareProvidence Health Care

November 7, 2009November 7, 2009

“ THE AREA OF APPEARANCE SEEMS TO BE ONE WHERE WOMEN FEEL THAT THEY CAN MOST EASILY EXERT SOME CONTROL OVER HOW THEY WILL BE RESPONDED TO”

from “THE BEAUTY MYTH”

Naomi Wolf

The Beauty MythThe Beauty Myth

What Is the Difference Between What Is the Difference Between Disordered Eating and an Eating Disordered Eating and an Eating

Disorder?Disorder?

Disordered Eating Disordered Eating

Complex problem that arises from a combination of psychological, biological, interpersonal and social factors

A range of behaviours characterized by weight consciousness and attempts to control eating

Can include eating disorders spectrum

Disordered Eating Disordered Eating

A coping strategy– a way to deal with issues that renders one powerless- an inability to communicate effectively

Attitudes, beliefs and behaviors that result in a range of dysfunctional coping strategies – yo yo dieting, AN or BN, compulsive eating, fasting, binge eating, etc

Kate MossKate Moss

The Perfect ModelThe Perfect Model

What is the reality?What is the reality?

less than 5% of women less than 5% of women have these body shapes have these body shapes

““NATURALLYNATURALLY

THAT IS THAT IS ----

without dieting starvation without dieting starvation or purgingor purging

School based studySchool based study

Disordered eating attitudes and behaviours were present in over 27% of girls 12-18 years old and were seen to increase gradually throughout adolescence

Current dieting to lose weight was reported by 23% or participants

Binge-eating with associated loss of control was reported by 15%

Self-induced vomiting reported by 8.2% Use of diet pills reported by 2.4%

Canadian Medical Association Journal Sept. 2, 2001

Adolescent surveyAdolescent survey

Results of the 2008 BC Adolescent Health Survey showed that school-age boys reported higher overall satisfaction with their body than girls and were twice as likely as their female peers to report being highly satisfied with their body image

(Smith et al., 2009) (Smith et al., 2009)

Eating DisordersEating Disorders

The incidence of EDs among Canadian children and youth is growing (Canning et al., 2004). Eating disorders are presently the third most common chronic health condition for females between the ages of 15 and 19 living in North America (Johnston, 2004).

Eating DisordersEating Disorders

Considered a psychiatric defined condition DSM IV– Anorexia Nervosa, Bulimia Nervosa,

Eating Disorder not otherwise specified (EDNOS)

A person has extreme concern about weight and shape and is practicing extreme weight control behaviors

There are medical complications arise due to the nature of the methods utilized to control weight

Anorexia Nervosa- Diagnostic Anorexia Nervosa- Diagnostic CriteriaCriteria

Refusal to maintain body weight at or above a minimally normal weight for age and height (Body Mass Index 17.5)

Intense fear of gaining weight or becoming fat even though underweight

Denial of the seriousness of the current low body weight

Anorexia Nervosa- Diagnostic Anorexia Nervosa- Diagnostic CriteriaCriteria

Disturbance in the way one’s weight or shape is experienced-

Amenorrhea: absence of 3 consecutive menstrual cycles

Anorexia Nervosa - SubtypesAnorexia Nervosa - Subtypes

Restricting type: During current episode, individual has not regularly

engaged in bingeing or purging behavior

Binge eating/purging type: During current episode, individual has regularly

engaged in binge eating or purging behaviour (i.E. Self induced vomiting or misuse of laxatives, diuretics or enemas)

Anorexia NervosaAnorexia Nervosa

Is characterized by extreme weight loss from a self-imposed and severe restriction of foods and fluids

Distorted body image Intense fear of becoming fat Low self-esteem Half of these people may binge and purge They diet to extremes and will commonly over-

exercise in an effort to lose weight

AnorexiaAnorexia

Early onset: 12 – 16 y.o., pre-puberty (transition from child to adolescence)

Refusal to maintain body weight Pride in hunger, self denial and self

discipline Control of intake=superiority and mastery Perfectionist and obsessive tendencies Socially introverted

Bulimia NervosaBulimia Nervosa

Characterized by regular periods of uncontrolled binge eating followed by some form of purging in an attempt to prevent weight gain- usually very chaotic patterns of eating

Purging can include self induced vomiting, abuse of laxatives or diuretics, strict dieting, fasting, and/or excessive exercising

Dieting usually follow an episode of bingeing and purging

Bulimia NervosaBulimia Nervosa

May initially lose weight but will likely regain it May be under, normal or over weight Later onset, post puberty, age 16-25 Secretive: due to shame, guilt, fear of weight gain

– usually feel this is a “disgusting” behaviour Impulsive: instant gratification, self harming

behaviour, drugs and alcohol may be present Generally more extroverted

Bulimia Nervosa - SubtypesBulimia Nervosa - Subtypes

Purging subtype During the current episode, the person has

regularly engaged in self induced vomiting or the misuse or laxatives, diuretics or enemas

Non-purging type During the current episode of bulimia nervosa,

the person has used other inappropriate compensatory behaviours such as fasting or excessive exercise, but has not regularly engaged in the above stated purging behaviours

Who Develops Eating Disorders?Who Develops Eating Disorders?

A person is predisposed to the development of an eating disorder as a result of a combination of individual, family and societal factors

The eating disorder is precipitated by a stressful event(s)

Genetic disposition – family history The eating disorder is perpetuated by factors such

as low self esteem, family, society, depression

Common Thoughts and Feelings of those Common Thoughts and Feelings of those Suffering from Eating DisordersSuffering from Eating Disorders

The need to assert control over food intake and

body weight Only thing they have control over is eating/food –

but eventually this feels out of control too Lack of control over environment Fears of eating and weight gain Anger towards the body or parts of the body

Common Thoughts and Feelings of those Common Thoughts and Feelings of those Suffering from Eating DisordersSuffering from Eating Disorders

A sense of personal ineffectiveness A drive for Perfection Internal Confusion Feelings of guilt Low self esteem, a sense of worthlessness

“We have learned that we are responsible for the poor imaging and retouching that resulted in a very distorted image of a woman’s body,”

Ralph Lauren’s storyRalph Lauren’s storyThe underlying message:The underlying message:

We really aren’t sorry but we need to save We really aren’t sorry but we need to save our assour ass

We hope our sales don’t go down. We hope our sales don’t go down. No one is perfect so we retouch them so that No one is perfect so we retouch them so that

they are perfect they are perfect Okay so we went a bit crazy with the re-Okay so we went a bit crazy with the re-

touching, but she was too fat at a size 4 so touching, but she was too fat at a size 4 so we had to we had to dodo something! something!

Words from the modelWords from the model

“It’s not a good example when you see this picture, every young woman is going to look at it and think that it is normal to look like that. It’s not. I saw my face on this super-extremely skinny girl, which is not me. It makes me sad. It makes me think that Ralph Lauren wants to have this kind of image. It’s an American brand ... and it’s not healthy, and it’s not right.”

““Modeling is about illusion. It’s a fantasy world where Modeling is about illusion. It’s a fantasy world where models play various roles…………”models play various roles…………”

I think women see me on the cover of magazines I think women see me on the cover of magazines and think I never have a pimple or bags under and think I never have a pimple or bags under my eyes. You have to realize that's after two my eyes. You have to realize that's after two

hours of hair and makeup, plus retouching. Even hours of hair and makeup, plus retouching. Even I don't wake up looking like Cindy Crawford.I don't wake up looking like Cindy Crawford.

What Is It All About Then?What Is It All About Then?

NOT about food- even though the focus is on food

Eating is the symptom of other issues It is a life threatening illness It is a coping strategy for dealing with life

stresses Interpersonal distrust

What Is It All About Then? What Is It All About Then?

It can often be a way to express feelings Inability/difficulty in identifying inner

feelings Lack of assertiveness skills Fear of growing up Personal trauma Abuse – physical, emotional, sexual

What Is It All About Then? What Is It All About Then?

It can become an addictive cycle - a way to cope with internal struggles

Coping strategies to help with anxiety and dealing with life stressors – or it can mask other psychiatric disorders I.e. OCD, Anxiety Disorders, Bi-polar Disorder

Way to “numb-out” feelings or memories A way to have an identity

What should you do?What should you do? Know your own reaction and biases – we all have

them but it is important to know how they may interfere with care

Be a listening ear Pick and choose your battles- do not get into a power

struggle Refer patients to a medical professional Be curious instead of stereotyping –people who suffer

from eating disorders or disordered eating are different in what they have experienced in life

Provide feedback of what you are observing

Can you tell who suffers from an eating disorder?