Eating Disorders For Dummies®
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Library of Congress Control Number: 2008921210
ISBN: 978-0-470-22549-3
Manufactured in the United States of America
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Susan Schulherr, LCSW, is a licensed clinical social worker who has had a private psychotherapy practice in New York City for nearly 30 years. She has worked with people with eating disorders for over 20 of those years. Her chapter on treating binge eating disorder appears in the 2005 book, EMDR Solutions: Pathways to Healing (Shapiro, Norton). Her article, “The Binge–Diet Cycle: Shedding New Light, Finding New Exits,” was published in Eating Disorders: The Journal of Treatment and Prevention (1998). She has presented workshops at the local and national level on eating disorders and on issues of weight and eating to both professional and nonprofessional audiences.
Ms. Schulherr is a trained family and couples therapist. She has extensive experience in the trauma specialty approaches of EMDR and Somatic Experiencing, each of which she has adapted for the treatment of eating disorders.
I owe some particular thank you’s now that this project that once felt so far off is a reality. For the collaborative outpouring that became the text of this book, my thanks to the indefatigable editorial staff at Wiley Publishing: Tracy Boggier, Stephen Clark, Christy Pingleton, and to Misty Rees for her technical review. For presenting me with the opportunity to participate in the first place, my special appreciation to literary agent Margot Maley Hutchison from Waterside Productions, Inc. For concept-to-completion professional feedback and moral support without which my part in this project would have been impossible, endless gratitude to Nancy J. Napier, LMFT.
I always wish to extend heartfelt thanks to the many clients and others who have shared their eating disorder stories and struggles with me over the years. All that you have taught me has made its way into this volume and inspired me with the possibilities for healing even in the most difficult situations.
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Title
Introduction
About This Book
Conventions Used in This Book
What You’re Not to Read
Foolish Assumptions
How This Book Is Organized
Icons Used in This Book
Where to Go from Here
Part I : Eating Disorders: An All-Consuming World of Their Own
Chapter 1: Understanding Eating Disorders
Getting a Sense of the Problem
Classifying the Eating Disorders
Seeing What’s Behind the Symptoms
Seeing the Damage Eating Disorders Do
Scoping the Rise in Eating Disorders
Getting Better Is an Option
Chapter 2: Getting Insight into Anorexia Nervosa
Putting Anorexia Nervosa into Words
Looking at Anorexia’s Behavioral Traits
Seeing Anorexia’s Psychological Traits
Determining Whether You Have Anorexia
Chapter 3: Seeing Inside Bulimia Nervosa
Identifying the Many Faces 0f Bulimia
Recognizing Bulimia’s Behavioral Traits
Seeing Bulimia’s Psychological Traits
Determining Whether You Have Bulimia
Chapter 4: Understanding Binge Eating Disorder
Defining Binge Eating Disorder
Understanding the Behavioral Features of Binge Eating
Seeing BED’s Psychological Traits
Determining Whether You Have BED
Chapter 5: Eating Disorder Risk Factors
Looking at Family Traits that May Influence Eating Disorders
Looking at Your Individual Vulnerability
Zapping the Brain with Hormones
A Culture that Breeds Eating Disorders
Dieting as the Gateway to Eating Disorders
Chapter 6: Deconstructing Your Body with an Eating Disorder
Disordering Your Body from the Inside Out with Starvation
Wearing Your Body Down with Purging
Reversing the Effects with Recovery
Chapter 7: Sidekicks That Often Accompany Eating Disorders
Altering Thoughts and Perceptions
Recognizing Other Disorders That Require Treatment
Adding Addictions to Your Eating Disorder
Part II : Getting Well: Exploring Recovery and Treatment Options
Chapter 8: Seeing What Recovery Looks Like
Finding Balance in Recovery
Maintaining a Healthy Weight
Menstruating Normally
Seeing Bingeing or Purging Symptoms Subside
Getting Thinking Processes Normal
Eating Well with No Forbidden Foods
Exercising in a Healthy Way
Creating Healthy Relationships
Tolerating Your Emotions
Maintaining a Healthy Self-Image
Chapter 9: Deciding the Who, What, and Where for Treatment
Finding the Right Therapist
Assembling Your Team
Determining the Intervention You Need
Getting a Good Medical Work-Up
Making a Plan for Your Treatment
Choosing Where to Get Treatment
Exploring Experiential Therapies
Chapter 10: Finding the Treatment Approach That’s Right for You
Choosing Your Eating Disorder Treatment
Concentrating on Cognitive- Behavioral Therapy (CBT)
Delving into Dialectical Behavioral Therapy (DBT)
Setting Your Sights on Psychodynamic Therapy
Focusing on Feminist Therapy
Investigating Interpersonal Therapy (IPT)
Getting to the Bottom of “Bottom-Up” Therapies
Taking to the Trenches with Trauma Treatment
Chapter 11: Including Other People in Your Treatment
Family Therapy: Everybody Gets into the Act
Couples Therapy: Just the Two of Us
Group Therapy: Safety in Numbers
Self-Help Groups: Grass Roots Support
Chapter 12: Exploring Medication and Other Approaches
Getting Your Biology on Board with Medication
Exploring New Frontiers in Eating Disorder Treatment
Chapter 13: Making Good Use of the Approach You Choose
Letting Go of Magic for Reality
Substituting Recovery Goals for Eating Disorder Goals
Partnering with Your Therapist in a Treatment-Boosting Way
Making the Most of Groups
Chapter 14: Managing Early Stage Recovery and the Reality of Relapse
Stepping into the Unknown: A Recovery Overview
Building Recovery Habits and Skills
Dealing with Fear and Resistance
Rebounding from Relapse
Part III : Eating Disorders in Special Populations
Chapter 15: Eating Disorders in Males
Recognizing That Guys Suffer from Eating Disorders, Too!
Uncovering Risk Factors for Eating Disorders in Males
Gaining Awareness of Special Issues for Treatment
Chapter 16: Athletes and Eating Disorders
Running a Greater Risk for Eating Disorders
Focusing on Female Athletes
Measuring Risk for Male Athletes
Recognizing an Eating Disorder in a Child Athlete
Scoring with the Right Coach
Tackling Special Issues for Treatment
Chapter 17: Eating Disorders on the Stage, Screen, and Runway
Discovering the Risks Behind the Scenes
Considering Eating Disorders as Part of the Job
Spotlighting Special Issues for Treating Performers
Chapter 18: Eating Disorders in Children
Becoming Informed about Childhood Onset Eating Disorders
Recognizing the “Grown Up” Disorder of Anorexia in Kids
Getting Treatment for Kids
Chapter 19: Eating Disorders Later In Life
Getting Older and Trying to be Thinner
Fighting the Loss of Youth and More
Eating Disordered Over 65
Treating Eating Disorders in the 30+ Set
Chapter 20: Eating Disorders and People Who Are Obese
Being Obese and Eating Disordered
Highlighting Special Issues for Treatment
Part IV : Advice and Help for Families and Others Who Care
Chapter 21: Forming a Plan to Help the Person with an Eating Disorder
Becoming Informed About Eating Disorders
Being Ready with Resources
Gathering Support
Chapter 22: Implementing Your Plan to Help
Knowing What You’re Out To Accomplish
Knowing Some Important Do’s
Avoiding Some Important Don’ts
Dealing with Anger and Denial
Chapter 23: Making Life Livable While Supporting Another’s Recovery
Letting Go and Ending the Food Wars
Taking “Fat Talk” Off the Table
Insisting on Accountability
Focusing Outside the Eating Disorder
Breaking through Recovery Traps
Chapter 24: Finding Support for Yourself While Supporting Another’s Recovery
Knowing When to Seek Treatment for Yourself
Turning Your Attention to Your Needs
Finding the Help That’s Right for You
Part V : The Part of Tens
Chapter 25: Ten Don’ts: Behaviors and Thoughts to Avoid
Don’t Diet
Don’t Try to Fix Your Eating Disorder by Yourself
Don’t Look for a Quick Fix
Don’t Do Anything that Feels Extreme
Don’t Believe Your Weight Determines Your Worth
Don’t Avoid Your Negative Feelings
Don’t Ignore Signs of Relapse
Don’t Nurture Your Fascination with “Thin”
Don’t Put Things Off Until You’re “Thin Enough”
Don’t Stop Treatment Too Soon
Chapter 26: Ten Do’s: Ways to Enhance Your Recovery
Do Practice Being Imperfect
Do Nurture Your Social Network as Part of Your Healing
Do Speak Up!
Do Be Truthful with Your Treatment Team
Do Experiment with Ways to Enjoy Being in Your Body
Do Use “Feeling Fat” as a Call to Awareness
Do Appreciate that Improvement Often Proceeds in Baby Steps
Do Keep Track of Your Accomplishments
Do Talk with Other Women about Social Pressures to Be Thin
Do Remember that People Can and Do Recover from their Eating Disorders
Resource Guide
Web Sites for Eating Disorder Information
Web Sites for Finding Treatment
Web Sites for Finding Local Support Groups
Web Sites for Size Acceptance and Self-Esteem
Self-Help Books
: Further Reading
Could this be you? You don’t have much self-confidence (this applies most often to females, but males are not immune). You’d love to feel in charge of yourself, your emotions, your life. You’d do anything to be someone others love and admire. You don’t feel any of these things are true — for you.
Add to this that you live in a culture that tells you the world is yours if you’re thin. That you, or anyone, can become model-thin (or fat-free buff) if you just diet and exercise enough.
You may be a little precise or obsessive by nature. And you may have fewer of the natural brain hormones that buffer most people in life. You may even have a history of some kind of trauma that you have yet to resolve.
These characteristics are the ingredients for making an eating disorder. Because you feel vulnerable, an eating disorder is, above all else, the way you struggle against internal doubts, trying to cope. Dieting is how you try to put together a sense of control and self-esteem. Bingeing is how you comfort yourself or respond to the extremes of dieting. You have come to rely on your eating disorder symptoms so completely that the thought of surrendering them is terrifying — even when they begin to cause a lot of physical and emotional trouble.
If you recognize yourself — or someone you love — in this portrait, you’ve come to the right book! Although the culture offers plenty to keep an eating disorder going, the pages that follow supply you with lots of ingredients to counter those effects from the inside. Or to start you on that path. I describe the eating disorders from the inside out so you can make sense of what you or your loved one is experiencing. I tell you about what you need for recovery. I describe the process and personnel of treatment in detail. I advise you as a family member or other caring person how to help the person you care about and how to take care of yourself at the same time.
Eating disorders are treacherous. They destroy and even take lives, and they make sufferers doubt and hate themselves. But the happy news is that the majority of people who pitch into treatment and stay with it through recovery get better. They go on to think about and engage in other things, become successful and fulfilled, and leave their eating disorders behind. So can you.
This book is aimed at helping you recover from your eating disorder (or helping someone you love recover). I build two big assumptions about what’s necessary for recovery into the organization of the book:
The way you think about a problem determines how you try to solve it. For instance, if you think your eating disorder shows you don’t have enough willpower to control your eating, you may search for bigger and better ways to put controls on yourself. If, on the other hand, you understand that your disorder reflects low self-esteem and problems handling emotions, you can go to work on improving your life in these areas.
I spend a lot of time going over the ways of thinking and looking at yourself that make you vulnerable to an eating disorder. I spend at least as much time describing ways of thinking and behaving that can build inner reserves and make an eating disorder much less likely. This building process can be exciting and gratifying at times. But it can be frustrating and slow-going at others. Knowing what you’re doing and why can help you to keep plugging.
Studies show that people who stay in eating disorder treatment long enough to build up inner strengths, rather than just manage outer symptoms (like bingeing or starving), are more likely to get better and stay better.
For most people, recovering from an eating disorder isn’t a self-help operation. (You can read about the exceptions to this rule in Chapter 12.) You need to hire experts and invest a lot of yourself and your time in your treatment. I devote a lot of space to taking you through the treatment process, step-by-step, from beginning to end. This includes understanding treatment options and when to choose them, selecting a therapist and other members of your treatment team, and understanding your own role in the treatment process. I want you to have the best possible chance of being successful.
If you’re a family member, I go over in detail how to approach the person you love about treatment. I discuss your role in treatment and how to support recovery in day-to-day living.
I’ve written Eating Disorders For Dummies so that you can jump in wherever your interest takes you — you don’t have to read this book from start to finish. Each section includes references to other parts of the book that have more information on the subject you’re reading about.
Many times in this book, particularly in the treatment sections, I use fictional people to illustrate a point I’m making. These people represent composites of people I’ve met and/or worked with over the years. In no case do they represent real people.
From time to time, I introduce new terms as I explain ideas important to your understanding of the eating disorders. Mostly I do this when you’re likely to run into the term elsewhere and it may be helpful for you to know it. Each time I first use a new term, I italicize it, and usually follow it with an explanation.
Eating disorders are still primarily a female affair. So I make my life, and hopefully your reading, easier by using all female pronouns: her, hers, she. That doesn’t mean I’m not aware that men can develop eating disorders, too. If you’re a guy, your disorder is just as serious! (See Chapter 15.)
It would have made for easier language to refer to people with anorexia as anorexics, people with bulimia as bulimics, and so on. I avoid this streamlined language to make a crucial point: Saying you are a person with an eating disorder serves as a reminder that there’s more to you, much more, than your eating disorder. Also, there’s no reason to assume your disorder is a permanent part of your identity, the way you do when you say you’re a woman, or a Latina, or American-born. Saying you’re a person with an eating disorder is more like saying you have a major illness. Beating your eating disorder may be a big battle, but your eating disorder is not who you are.
You’re not to read anything that isn’t crucial to understanding eating disorders and their treatment if you don’t feel like it. Sometimes I add some extra information that’s a little more in-depth but not essential. I mark all such in-depth detours with a Technical Stuff icon.
In the same spirit, along the way I offer extra nuggets of information on the subject you’re reading about tucked away in gray boxes called sidebars. Read them. Don’t read them. The choice is yours. It won’t make a difference in your understanding of the subject at hand.
I assume if you’re reading this, you’re one of the following people:
You have or suspect you have an eating disorder: You want to know there’s hope, get a better handle on your problem, be pointed in the right direction for treatment, and get a preview of the recovery process.
You have a family member, friend, or roommate who has an eating disorder: You want to understand her problem better, know how you can help, understand treatment options if you’re the parent of a minor, and get some ideas about support for yourself.
You’re a professional who works in some way with people with eating disorders: You need a quick reference and overview to help you understand the problem and how you can help in your particular role.
If any of these descriptions sound like you, you’ve come to the right book!
Eating Disorder For Dummies is organized into 5 parts with 27 chapters. What follows is a description of what you can find in each part.
Part I intends to help you really get what eating disorders are about. Chapter 1 gives you the big picture and previews what you find in the rest of the book. Chapters 2 to 4 introduce you to the three major eating disorders: anorexia, bulimia, and binge eating disorder. These chapters each come with a questionnaire so you can judge whether you’re at risk for one of these disorders. Chapter 5 reviews the risk factors that make a person vulnerable to developing an eating disorder — genes, brain chemistry, family background, personality characteristics, trauma history, and dieting behavior. In Chapter 6 you can find out about the physical toll eating disordered behavior takes on your body. Finally, Chapter 7 describes other psychological disorders that typically accompany an eating disorder, such as anxiety, depression, addiction, and compulsive exercise.
Part II is your treatment handbook. I start you off with a map of recovery goals, so you know what you’re aiming at. If you like, you can use the charts I provide to map yourself: Where are you now and what would you like to work on next in relation to each goal?
If you’re just thinking about treatment or want to review the treatment you’re in, Chapter 9 goes over all your treatment options. This includes treatment experts and facilities. It also includes a discussion of why you might make each choice. Chapter 10 helps you pick the approach to individual therapy that’s right for you. It takes you right inside an imaginary session for each approach so you can get a feel for what it may be like. Chapters 11 and 12 explore additional options: family, couples, and group therapies; support groups; medication; and online treatments.
In Chapter 13 I help you think about your own role in using your treatment team and getting better. I follow this up with a chapter on managing early stage recovery successfully, including dealing with relapse.
This part focuses on special groups in the population who are at high risk for eating disorders or whose eating disorder risk has been under-recognized. I highlight special treatment considerations for each group. These groups include
Men
Athletes
Dancers, models, and actors
Children
Middle-aged and elderly people
People who are obese
Part IV is intended to help families and other people who care about someone with an eating disorder. I write as if you are a parent responsible for a minor child. But I stop along the way with special advice for others: siblings, partners, friends, roommates, and so on.
This is a how-to part, covering everything from getting informed to approaching someone for the first time about their eating disorder to managing life in recovery in a day-to-day way. The final chapter in Part IV focuses exclusively on your well-being and what services you may need to support it.
This is your at-a-glance part for quick ideas to inspire you or keep you on track in recovery. Ten don’ts remind you of recovery-interfering thoughts and behaviors. Ten do’s give you the other side of the coin: ten thoughts and practices to keep your recovery cooking. Finally, I offer you a guide of resources to help you throughout your recovery.
Throughout this book, I use figures in the margins — icons— to quickly point out the type of information you find in a particular paragraph. Here are the icons you see, along with a definition of what each one means:
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Eating Disorders For Dummies is written so you can start wherever you want. You don’t have to read the book in order. If you’re urgent about getting treatment right now, you probably want to start with Chapters 9 to 11. If you’re a family member, you may want to start with Part IV, which is written for you. Which chapter you choose depends on whether the person you love is already in eating disorder treatment or not. If you’re still facing treatment choices, you’re likely to find Chapter 9 a useful starting place.
In this part . . .
I introduce you to eating disorders and explain how they differ from less-worrisome eating problems. I describe how increasing pressures on women to achieve ideal bodies have contributed to a rise in eating disorders over the last 40 years. I go over the three major eating disorders — anorexia, bulimia, and binge eating disorder (BED) — in detail. I include tools to help you decide whether you may have one of these disorders or be at risk for developing one. I discuss the major risk factors that make a person vulnerable to developing an eating disorder, including genes, family style, cultural pressures, personality, and dieting behavior.
I include chapters that tell you how eating disordered behaviors harm your body and affect your thinking processes. I also review psychological and behavioral problems that commonly accompany eating disorders, such as addiction, compulsive exercise, depression, and suicidal tendencies. For all of these companion disorders, I provide tools to help you decide whether they apply to you (indicating you should seek evaluation and treatment).