April 24, 2018
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When eating patterns turn deadly: How to talk about an eating disorder

By Dr. David Prescott, The Acadia Hospital


Eating disorders continue to be a major concern in America as people struggle to find a balance between combating obesity trends, developing a positive body image, and selecting healthy lifestyles. Friends and family members often are the first to suspect that a loved one has an eating disorder. Here are some tips for starting a conversation and  helping someone with an eating disorder get professional treatment.

How do I start a discussion about a possible eating disorder? The first time you raise a concern about an eating disorder with a family member or friend, realize that the conversation may be a starting point rather than an ending point.  Some useful strategies for having the first conversation include:

  1. Learn about eating disorders and treatment options before you talk. Having an understanding of the behaviors, feelings and treatment options for eating disorders will help you to feel more confident and supportive.
  2. Express your concerns without focusing on the eating behavior. Statements like “you are putting on weight” or “you are getting too thin” may backfire quickly. Rather, statements about your experience of what it is like to be around them (“a lot of times I think you are sad or unhappy”) may be a good starting point.
  3. Gently asking whether a person has considered that they might have a problem or if they have thought about talking to a health professional will often yield surprising answers. Typically, people with eating disorders have given the issue a great deal of private thought.
  4. Take a break if things get too stressful. Remember that control is usually an important issue in eating disorders.  Insisting that a difficult conversation be finished “here and now” can often lead to a control battle.  Coming back to the conversation later in a supportive way shows your commitment and willingness to have some give and take.

What are the types of eating disorders?
There are three major types of eating disorders:

  1. Anorexia nervosa involves having a distorted body image where a person sees themselves as overweight even when they are dangerously thin.  People with anorexia have an intense fear of gaining weight, and often develop unusual habits such as refusing to eat around other people.  Anorexia usually occurs in women, and is often accompanied by infrequent or absent menstrual periods.
  2. Bulimia nervosa involves eating excessive quantities of food, sometimes in secret, then trying to purge the body of the food and calories by using laxatives, vomiting, exercise or diuretics.  People with bulimia nervosa usually feel ashamed and disgusted as they binge and purge, yet also feel relieved of tension once the cycle is complete.
  3. Binge eating disorder involves frequent episodes of excessive, out-of-control eating. However, there is no attempt to purge the body of excess calories.

How do I know if I am at risk for an eating disorder?  The determination of when issues of food, eating and body image cross the line from “normal concern” to “psychological problem” varies from person to person.  However, if you answer “yes” to any of the following questions, it may suggest that you are at risk for an eating disorder:

Are you constantly preoccupied with weight and an intense fear of becoming fat?

Do you believe that your body weight needs to be below what is recommended by physician or dietitian?

If you are a woman, have you skipped or stopped a menstrual period when you were losing weight?

Do you frequently feel out of control when you eat?

How much of your eating is secretive or hidden from others?

Have you tried, or strongly considered, trying to lose weight by vomiting, using laxatives, or exercising according to how much you eat?

Is treatment for eating disorders necessary?
The sooner treatment starts for an eating disorder, the easier it is to treat. Eating disorders don’t usually go away by themselves. And, if left untreated, eating disorders can cause serious physical problems (like anemia, tooth decay, and hair and bone loss) as well as severe emotional distress, so getting help is vitally important. Treatment often involves working with a licensed psychologist or therapist, dietitian, and physician.

Where else can I find help?

Information about eating disorders is available from the American Psychological Association (http://www.apa.org), the National Institute of Mental Health (http://www.nimh.nih.gov/index.shtml) and the National Eating Disorders Association (http://www.nationaleatingdisorders.org).

Dr. David Prescott is director of psychology and clinical research at The Acadia Hospital in Bangor.

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