Technical Assistance Partnership for Child and Family Mental Health

NOVEMBER2002

Q: What are eating disorders?

Eating disorders are characterized by negative, chronic, and potentially life-threatening eating patterns. The three major disorders are: Anorexia Nervosa, Bulimia Nervosa, and Binge Eating. Adolescent girls are disproportionately affected by these disorders. While the exact cause is not understood, it seems to be a combination of factors, including genetic, neurochemical, psychodevelopmental, and sociocultural factors. Eating disorders usually co-occur with other emotional disorders, especially depression, anxiety, substance abuse, and personality disorders.

Anorexia Nervosa

A. Refusal to maintain body weight at or above a minimally normal weight for age and height (e.g., weight loss leading to maintenance of body weight less than 85% of that expected or failure to make expected weight gain during the period of growth, leading to body weight less than 85% of that expected).

B. Intense fear of gaining weight or becoming fat, even though underweight.

C. Disturbance in the way in which one's body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or denial of the seriousness of the current low body weight.

D. In postmenarcheal females, amenorrhea, i.e., the absence of at least three consecutive menstrual cycles. (A woman is considered to have amenorrhea if her periods occur only following hormone, e.g., estrogen, administration.)

Bulimia Nervosa

A. Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following:

1. Eating, in a discrete period of time (e.g., within any 2-hour period), an amount of food that is definitely larger than most people would eat during a similar period of time and under similar circumstances.

2. A sense of lack of control over eating during the episode (e.g., a feeling that one cannot stop eating or cannot control what or how much one is eating).

B. Recurrent inappropriate compensatory behavior in order to prevent weight gains, such as self-induced vomiting; misuse of laxatives, diuretics, enemas, or other medications; fasting; or excessive exercise.

C. The binge eating and inappropriate compensatory behaviors both occur on average at least twice a week for 3 months.

D. Self-evaluation is unduly influenced by body shape and weight.

E. The disturbance does not occur exclusively during episodes of Anorexia Nervosa.

Source: DSM-IV.

Binge Eating

Binge Eating disorder is not included in the DSM-IV but is described in the "Surgeon General's Report on Mental Health." It is described as "episodic, uncontrolled consumption, without compensatory activities, such as vomiting or laxative abuse to avoid weight gain."

What Can Families Do? Survival Suggestions for Families

Do realize that there is no quick and easy solution. Don't panic. Look around for the help that you need. Do attend support groups. They are there for you. Don't isolate yourself from those who can help or whom you may be able to help. Do encourage your relative to get a professional assessment from a practitioner experienced in eating disorders. Don't ask, How can I help? What do you need? The person with the disorder usually does not know. Do express honest love by physical and verbal affection. Do value your relative with the disorder, so that he/she can learn to value himself or herself. Don't make your love a condition of the individual's appearance, health, weight, achievement, or any other attribute. Don't comment positively or negatively on his or her appearance or weight. Do realize that your relative is ambivalent about getting well and takes comfort in the control and rituals of the disorder. Don't let these peculiarities dominate the household. Do encourage decision-making and being responsible for those decisions. Require your relative to be responsible for his/her behavior. Don't be manipulated. Do allow your relative to be in charge of his/her routines of daily life. Don't force or encourage your relative to eat or to eat properly. Do realize that by giving you control, you are setting the stage for your relative to develop a healthy self-control. Don't try to control your relative's behavior. Attempting to do so can intensify the problem. Do seek life-saving treatment for anyone who is in jeopardy of endangering self and others. Don't impose rules except those that are necessary for the individual's or family's safety and well-being. Avoid power struggles. Do inform yourself about the disorders and their treatment. Don't feel guilty or dwell on the causes. Do accept yourself. Don't expect yourself to be a perfect parent. Do accept your relative. Don't expect (or hope for) your relative to be perfect. Do make time for yourself, spouse, friends, and other family members. Remember to provide yourself with rest, freedom from worry, and fun. Don't expect that the amount of time that you worry will help somehow. See to proper treatment, then help yourself relax. Do get help for yourself. The disorder disrupts the family too, and the family needs help coping with it.

Eating Disorders · Health Education Consultants · P.O. Box 22593 · Kansas City, MO 64113 · (913) 831-1393

What Can Professionals Do?

There are few controlled studies on eating disorders in adolescents, but there is an indication that these interventions can be helpful with young women:

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	NOVEMBER2002 Q: What are eating disorders? Eating disorders are characterized by negative, chronic, and potentially life-threatening eating patterns. The three major disorders are: Anorexia Nervosa, Bulimia Nervosa, and Binge Eating. Adolescent girls are disproportionately affected by these disorders. While the exact cause is not understood, it seems to be a combination of factors, including genetic, neurochemical, psychodevelopmental, and sociocultural factors. Eating disorders usually co-occur with other emotional disorders, especially depression, anxiety, substance abuse, and personality disorders. Anorexia Nervosa A. Refusal to maintain body weight at or above a minimally normal weight for age and height (e.g., weight loss leading to maintenance of body weight less than 85% of that expected or failure to make expected weight gain during the period of growth, leading to body weight less than 85% of that expected). B. Intense fear of gaining weight or becoming fat, even though underweight. C. Disturbance in the way in which one's body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or denial of the seriousness of the current low body weight. D. In postmenarcheal females, amenorrhea, i.e., the absence of at least three consecutive menstrual cycles. (A woman is considered to have amenorrhea if her periods occur only following hormone, e.g., estrogen, administration.) Bulimia Nervosa A. Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following: 1. Eating, in a discrete period of time (e.g., within any 2-hour period), an amount of food that is definitely larger than most people would eat during a similar period of time and under similar circumstances. 2. A sense of lack of control over eating during the episode (e.g., a feeling that one cannot stop eating or cannot control what or how much one is eating). B. Recurrent inappropriate compensatory behavior in order to prevent weight gains, such as self-induced vomiting; misuse of laxatives, diuretics, enemas, or other medications; fasting; or excessive exercise. C. The binge eating and inappropriate compensatory behaviors both occur on average at least twice a week for 3 months. D. Self-evaluation is unduly influenced by body shape and weight. E. The disturbance does not occur exclusively during episodes of Anorexia Nervosa. Source: DSM-IV. Binge Eating Binge Eating disorder is not included in the DSM-IV but is described in the "Surgeon General's Report on Mental Health." It is described as "episodic, uncontrolled consumption, without compensatory activities, such as vomiting or laxative abuse to avoid weight gain." What Can Families Do? Survival Suggestions for Families Do realize that there is no quick and easy solution. Don't panic. Look around for the help that you need. Do attend support groups. They are there for you. Don't isolate yourself from those who can help or whom you may be able to help. Do encourage your relative to get a professional assessment from a practitioner experienced in eating disorders. Don't ask, How can I help? What do you need? The person with the disorder usually does not know. Do express honest love by physical and verbal affection. Do value your relative with the disorder, so that he/she can learn to value himself or herself. Don't make your love a condition of the individual's appearance, health, weight, achievement, or any other attribute. Don't comment positively or negatively on his or her appearance or weight. Do realize that your relative is ambivalent about getting well and takes comfort in the control and rituals of the disorder. Don't let these peculiarities dominate the household. Do encourage decision-making and being responsible for those decisions. Require your relative to be responsible for his/her behavior. Don't be manipulated. Do allow your relative to be in charge of his/her routines of daily life. Don't force or encourage your relative to eat or to eat properly. Do realize that by giving you control, you are setting the stage for your relative to develop a healthy self-control. Don't try to control your relative's behavior. Attempting to do so can intensify the problem. Do seek life-saving treatment for anyone who is in jeopardy of endangering self and others. Don't impose rules except those that are necessary for the individual's or family's safety and well-being. Avoid power struggles. Do inform yourself about the disorders and their treatment. Don't feel guilty or dwell on the causes. Do accept yourself. Don't expect yourself to be a perfect parent. Do accept your relative. Don't expect (or hope for) your relative to be perfect. Do make time for yourself, spouse, friends, and other family members. Remember to provide yourself with rest, freedom from worry, and fun. Don't expect that the amount of time that you worry will help somehow. See to proper treatment, then help yourself relax. Do get help for yourself. The disorder disrupts the family too, and the family needs help coping with it. Eating Disorders · Health Education Consultants · P.O. Box 22593 · Kansas City, MO 64113 · (913) 831-1393 What Can Professionals Do? There are few controlled studies on eating disorders in adolescents, but there is an indication that these interventions can be helpful with young women: Medications: tricyclic antidepressants, monoamine oxidase inhibitors, and SSRIs. Psychotherapy: family therapy, interpersonal therapy, cognitive-behavioral therapy, and biofeedback training.

Mental Health and Systems of Care Frequently Asked Questions