“We turn skeletons into goddesses and look to them as if they might teach us how not to need.” ~ Marya Hornbacher, Wasted: A Memoir of Anorexia and Bulimia

In Part One of this two-part series the reader was introduced to Linda Wells, LCSW, Clinical Director of the Eating Disorder Center of Santa Barbara.  Ms. Wells has over 24 years of private practice experience specializing in the areas of eating disorders and child abuse.  She has been an outpatient therapist and supervisor for the Eating Disorder Center of California since 1992.  Ms. Wells is also the past President of IAEDP (International Association of Eating Disorder Professionals) Central Coast.

To review, according to Wikipedia “Eating Disorders refer to a group of conditions defined by abnormal eating habits that may involve either insufficient or excessive food intake to the detriment of an individual’s physical and mental health.”  Severe distress and concern over body weight, or shape, often characterizes an eating disorder.  Eating disorders affect both men (an estimated 1 million in the U.S.) and women (an estimated 5-10 million) and often appear during the teen or young adult years, but can also develop during childhood or later in life.  Anorexia Nervosa, Bulimia Nervosa, and Binge-Eating Disorder are the more common eating disorders found in the United States.  The precise cause of eating disorders is not entirely understood, but there is evidence that it may be linked to other medical conditions and situations as well as genetic factors.  Eating disorders are real, treatable medical illnesses. While proper treatment can be highly effective for many of the specific types of eating disorders, the consequences of eating disorders can be severe, including death.

My conversation with Ms. Wells continues in this second installment about Eating Disorders.

Dr. Miller:  What do family members and friends need to know in order to help their loved one that may be afflicted with an eating disorder?

Ms. Wells:  Eating disorders are serious medical, as well as psychological disorders, and can be life threatening.  If you are a parent of a child, friend, or a significant other, you may be able to help identify if someone you care about has, or is at risk for developing, an eating disorder. If you suspect that someone you care for is at risk, it is important that you speak up, even if you are not sure what the reaction will be. Eating disorders are serious and require professional help. Therefore, it is very important that family members and friends reach out, even if your concern or offer to help isn’t well received.  Many people who have recovered from an eating disorder report that knowing that someone cared about them and did not give up on them was crucial in their decision to seek professional help and eventually recover.

Dr. Miller:  What are some of the signs or behaviors that may mean someone is at risk?

 Ms. Wells:  Eating disordered behaviors are often elusive. What starts out as a desire to “eat healthy” or “wanting to lose a few pounds” may be the first step towards the development of an eating disorder. In The Eating Disorder Source Book, Carolyn Costin notes that the following observable and non-observable signs may be indicators of an eating disorder. These include:

– Does anything to avoid hunger and eating.

– Weighs compulsively and is terrified of gaining weight.

– Feels guilty when eating.

– Eats large quantities of food secretly.

– Disappears into the bathroom after eating.

– Counts calories obsessively.

– Is obsessive or preoccupied with food.

– Regularly takes laxatives, diet pills, or diuretics.

– Increasingly eliminates foods or only eats diet foods.

– Displays a ridged control around food (type, quantity, timing of eating).

– Isolates socially or eats in isolation.

– Needs constant reassurance regarding appearance.

Dr. Miller:  What is the best way to approach someone with an eating disorder?

Ms. Wells:  The first thing to remember when approaching someone is to be empathetic and supportive when expressing your concerns. Be prepared to talk about the observable and non-observable signs or behaviors you have noticed, in an honest and non-judgmental manner. Find a time and confidential place to discuss the issue without interruptions, and express your concern based on your own observations and your own experience.  It is more likely that your concerns will be heard as helpful if you use “I statements”—for instance, “I am concerned for you, love you and want to help you find support to deal with your disordered eating.”  Statements such as “You have an eating disorder and YOU need to get help,” tend to be interpreted as judgmental.  Avoid blaming, demanding or pleading with your loved one to STOP eating disorder behaviors.  Instead, try to help him or her recognize that there is a problem, and to seek professional help.

Dr. Miller:  What are the next steps?

Ms. Wells:  Asking for help is extremely hard for people suffering from an eating disorder.  Seeking help may be perceived as scary or threatening, or they may view doing so as an indication of “weakness.” You can play an important role by reframing their quest for treatment as an indication of strength. Often someone with an eating disorder feels that the “sense of control” that comes from controlling food has become their identity. Providing information, helping find a specialist, or offering to help make an appointment all can be helpful when someone is considering seeking help. If you are a parent of a minor, you will need to go to the first appointment and are likely to be involved to some degree in the therapeutic process. Be aware that insisting someone seeks treatment because they are “too thin” may actually reinforce their pursuit for (unhealthy) thinness.  Instead, calmly focus on the need to be healthy and seek help.  Try not to argue, but do not give up. Several conversations may be necessary before someone is able to recognize they have a health issue. Encourage your loved one to go to at least one appointment, and offer to go with them if they would like. Make sure this professional is an eating disorder expert. If you are worried about any medical concerns, try to encourage a medical evaluation as well. This will help rule out an immediate medical risk and determine if someone needs immediate medical care. Doctors can help encourage patients to admit themselves into an eating disorder treatment facility.

Dr. Miller:  What can parents do to help prevent their child or teen from developing an eating disorder?

Ms. Wells:  Work on creating a “positive body image culture” at home.  This culture shifts the focus from superficial concerns to genuine self-esteem, self-love and healthy relationships; it emphasizes the value of each family member’s character and interpersonal connections, rather than his or her appearance, beauty, and weight.  Parents thus need to monitor their own attitudes, behaviors, and comments.  Create a positive orientation toward healthful eating, one focused on nurturing and nourishing meals, cooking together, and sharing quality time. Make family meals an opportunity to share about one’s day and try to avoid emotionally-charged topics at the table.  Avoid talking about weight, one’s own or another’s, and refrain from making disparaging comments about one’s own body or weight.  Enjoy being active as a family, and encourage physical exercise that is not excessive.  Work on strengthening your family’s emotional connections by recognizing each person’s qualities, talents, and positive attributes.  Enjoy and cherish each person in all of their uniqueness, and the personal beauty that each person possesses.  Do not limit your concept of beauty, but instead seek to see beauty in everyone!

The Eating Disorder Center of Santa Barbara is located here in town at 27 East Victoria Street, Suite D.  Ms. Wells can be reached for a confidential consultation by calling (805) 965-1651.