““GLAMOUR QUEENSGLAMOUR QUEENS IN SIZE 2 JEANS” IN SIZE 2 JEANS”

Steven G. Liga, MSW, LSW, LCADC, Steven G. Liga, MSW, LSW, LCADC, CPSCPS

CEO/Executive DirectorCEO/Executive Director

Course OutlineCourse Outline

IntroductionIntroduction What do you think of when I say “Eating Disorder?”What do you think of when I say “Eating Disorder?”

DefinitionsDefinitions What are we talking about?What are we talking about?

ConsequencesConsequences What’s the big deal?What’s the big deal?

CausesCauses How does this happen to someone?How does this happen to someone?

Prevention and TreatmentPrevention and Treatment What can be done, and where do we turn?What can be done, and where do we turn?

ConclusionConclusion What does this have to do with NCADD?What does this have to do with NCADD?

INTRODUCTIONINTRODUCTION

Eating DisordersEating Disorders

Let’s Brainstorm!Let’s Brainstorm!

What do you think of when I say What do you think of when I say “Eating Disorder?”“Eating Disorder?”

Facts and FiguresFacts and Figures

The average American woman is five feet, The average American woman is five feet, four inches and weighs 140 pounds. four inches and weighs 140 pounds.

The average American woman wears a The average American woman wears a size 14 dress.size 14 dress.

One-third of all American women wear a One-third of all American women wear a size 16 or larger.size 16 or larger.

The diet industry (diet foods, programs, The diet industry (diet foods, programs, drugs, etc.) takes in over $40 billion each drugs, etc.) takes in over $40 billion each year and it is still growing.year and it is still growing.

Facts and Figures (cont.)Facts and Figures (cont.)

50% of American women are on a diet at 50% of American women are on a diet at any one time.any one time.

75% of American Women do not like or are 75% of American Women do not like or are dissatisfied with their appearance.dissatisfied with their appearance.

90% of high school junior and senior 90% of high school junior and senior women diet regularly, although only 10-women diet regularly, although only 10-15% are over the weight recommended by 15% are over the weight recommended by doctors.doctors.

50% of nine year olds and 80% of 10 year 50% of nine year olds and 80% of 10 year olds have dieted.olds have dieted.

Facts and Figures (cont.)Facts and Figures (cont.)

1% of teenaged girls and 5% of 1% of teenaged girls and 5% of college aged women become college aged women become anorexic or bulimic.anorexic or bulimic.

Anorexia has the highest mortality Anorexia has the highest mortality rate of any psychiatric diagnosisrate of any psychiatric diagnosis 20%!20%! Suicide as a result of depression is only Suicide as a result of depression is only

15%15%

Glamour Queens in Size 2 Glamour Queens in Size 2 JeansJeans

Original poem by Nathalie Original poem by Nathalie GottliebGottlieb

www.feminist.com/resources/artspeech/body/www.feminist.com/resources/artspeech/body/voices.htmvoices.htm

DEFINITIONSDEFINITIONS

Which of these people has an Which of these people has an eating disorder?eating disorder?

Shelia eats so many French fries that she Shelia eats so many French fries that she wants to throw up. And she actually does.wants to throw up. And she actually does.

Marsha skips breakfast and lunch and eats Marsha skips breakfast and lunch and eats just a small salad with vinegar dressing for just a small salad with vinegar dressing for dinner.dinner.

Susan indulges in a hot fudge sundae (four Susan indulges in a hot fudge sundae (four scoops of ice cream, fudge, whipped scoops of ice cream, fudge, whipped cream, and cherry) every night for a week.cream, and cherry) every night for a week.

Profile of an AnorexicProfile of an Anorexic

Female (90%)Female (90%) PerfectionistPerfectionist Feels fat even though underweightFeels fat even though underweight Denies appetite (won’t eat even Denies appetite (won’t eat even

when hungry)when hungry) Preoccupied with food and weightPreoccupied with food and weight Sleep disturbancesSleep disturbances

Profile of an Anorexic (cont.)Profile of an Anorexic (cont.)

Inability to concentrateInability to concentrate Mood swings (irritable and depressed)Mood swings (irritable and depressed) Ritualistic food practicesRitualistic food practices Strict food rulesStrict food rules Excessive and rigid exercise routinesExcessive and rigid exercise routines Shops and cooks for others while not Shops and cooks for others while not

eating themselveseating themselves

What does she see in the What does she see in the mirror?mirror?

MythsMyths

Bulimics and Anorexics are underweight Bulimics and Anorexics are underweight and compulsive overeaters are and compulsive overeaters are overweight.overweight.

People who have eating disorders are People who have eating disorders are weak-willed.weak-willed.

Eating disorders are a vain, attention-Eating disorders are a vain, attention-getting disease.getting disease.

People with eating disorders don’t want People with eating disorders don’t want anything to do with food.anything to do with food.

Eating vs. Eating DisordersEating vs. Eating Disorders

EatingEating AppetiteAppetite Food availabilityFood availability Family & cultural practicesFamily & cultural practices Voluntary controlVoluntary control

Eating vs. Eating Disorders Eating vs. Eating Disorders (cont.)(cont.)

Eating DisordersEating Disorders Obsession with:Obsession with:

FoodFood WeightWeight AppearanceAppearance

So much that health, relationships, and So much that health, relationships, and activities are affected.activities are affected.

BehaviorsBehaviors

Restrict food intakeRestrict food intake Binge eatingBinge eating Binge and purgeBinge and purge Abuse laxativesAbuse laxatives Compulsively overeatCompulsively overeat Exercise excessively Exercise excessively

Coping MechanismsCoping Mechanisms

PainPain SeparationSeparation Low self-esteemLow self-esteem DepressionDepression StressStress TraumaTrauma

DSM 307.1 Anorexia DSM 307.1 Anorexia NervosaNervosa

Refusal to maintain body weight at or above a Refusal to maintain body weight at or above a minimally normal weight for age and height.minimally normal weight for age and height.

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

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

In postmenarchal females, amenorrhea, i.e., the In postmenarchal females, amenorrhea, i.e., the absence of at least three consecutive menstrual absence of at least three consecutive menstrual cycles. cycles.

DSM 307.1 Anorexia Nervosa DSM 307.1 Anorexia Nervosa (cont.)(cont.)

Specify type:Specify type:

Restricting Type: during the current episode of Restricting Type: during the current episode of Anorexia Nervosa, the person has not regularly Anorexia Nervosa, the person has not regularly engaged in binge-eating or purging behavior (i.e., engaged in binge-eating or purging behavior (i.e., self-induced vomiting or the misuse of laxatives, self-induced vomiting or the misuse of laxatives, diuretics, or enemas)diuretics, or enemas)

Binge-Eating/Purging Type: during the current Binge-Eating/Purging Type: during the current episode of Anorexia Nervosa, the person has episode of Anorexia Nervosa, the person has regularly engaged in binge-eating or purging regularly engaged in binge-eating or purging behavior (i.e., self-induced vomiting or the misuse behavior (i.e., self-induced vomiting or the misuse of laxatives, diuretics, or enemas) of laxatives, diuretics, or enemas)

DSM 307.51 Bulimia DSM 307.51 Bulimia NervosaNervosa

Recurrent episodes of binge eating. An episode of Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the binge eating is characterized by both of the following: following: eating, in a discrete period of time, an amount of food eating, in a discrete period of time, an amount of food

that is definitely larger than most people would eat during that is definitely larger than most people would eat during a similar period of time and under similar circumstances a similar period of time and under similar circumstances

a sense of lack of control over eating during the episode a sense of lack of control over eating during the episode

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

DSM 307.51 Bulimia Nervosa DSM 307.51 Bulimia Nervosa (cont.)(cont.)

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

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

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

DSM 307.51 Bulimia Nervosa DSM 307.51 Bulimia Nervosa (cont.)(cont.)

Specify type:Specify type: Purging Type: during the current episode of Purging Type: during the current episode of

Bulimia Nervosa, the person has regularly Bulimia Nervosa, the person has regularly engaged in self-induced vomiting or the misuse of engaged in self-induced vomiting or the misuse of laxatives, diuretics, or enemaslaxatives, diuretics, or enemas

Nonpurging Type: during the current episode of Nonpurging Type: during the current episode of Bulimia Nervosa, the person has used other Bulimia Nervosa, the person has used other inappropriate compensatory behaviors, such as inappropriate compensatory behaviors, such as fasting or excessive exercise, but has not fasting or excessive exercise, but has not regularly engaged in self-induced vomiting or the regularly engaged in self-induced vomiting or the misuse of laxatives, diuretics, or enemasmisuse of laxatives, diuretics, or enemas

DSM 307.50 Eating Disorder DSM 307.50 Eating Disorder NOSNOS

For females, all of the criteria for Anorexia Nervosa For females, all of the criteria for Anorexia Nervosa are met except that the individual has regular are met except that the individual has regular menses.menses.

All of the criteria for Anorexia Nervosa are met except All of the criteria for Anorexia Nervosa are met except

that, despite significant weight loss, the individual’s that, despite significant weight loss, the individual’s current weight is in the normal range. current weight is in the normal range.

All of the criteria for Bulimia Nervosa are met except All of the criteria for Bulimia Nervosa are met except that the binge eating and inappropriate compensatory that the binge eating and inappropriate compensatory mechanisms occur at a frequency of less than twice a mechanisms occur at a frequency of less than twice a week or for a duration of less than 3 months. week or for a duration of less than 3 months.

DSM 307.50 Eating Disorder DSM 307.50 Eating Disorder NOS (cont.)NOS (cont.)

The regular use of inappropriate compensatory The regular use of inappropriate compensatory behavior by an individual of normal body weight behavior by an individual of normal body weight after eating small amounts of food (e.g., self-after eating small amounts of food (e.g., self-induced vomiting after the consumption of two induced vomiting after the consumption of two cookies). cookies).

Repeatedly chewing and spitting out, but not Repeatedly chewing and spitting out, but not swallowing, large amounts of food. swallowing, large amounts of food.

Binge-eating disorder (BED): recurrent episodes Binge-eating disorder (BED): recurrent episodes of binge eating in the absence of the regular use of binge eating in the absence of the regular use of inappropriate compensatory behaviors of inappropriate compensatory behaviors characteristic of Bulimia Nervosa. characteristic of Bulimia Nervosa.

CONSEQUENCESCONSEQUENCES

What’s the Big Deal?What’s the Big Deal?

Pick a letterPick a letter Except F, J, N, Q, R, U, V, X, Y, ZExcept F, J, N, Q, R, U, V, X, Y, Z www.edreferral.com/www.edreferral.com/

consequences_of_ed.htmconsequences_of_ed.htm

Dying to be Perfect:Dying to be Perfect:The Ellen Hart Pena StoryThe Ellen Hart Pena Story

CAUSESCAUSES

Bio-psycho-social ModelBio-psycho-social Model

Bio = heredityBio = heredity

Psycho = pain, separation, low self-Psycho = pain, separation, low self-esteem, depression, stress, traumaesteem, depression, stress, trauma

Social = media & culture (web sites)Social = media & culture (web sites)

PREVENTION & TREATMENTPREVENTION & TREATMENT

PreventionPrevention

Do not promote the belief that Do not promote the belief that thinness/weight loss is great and being thinness/weight loss is great and being large/weight gain is horrible.large/weight gain is horrible.

Avoid categorizing food as “good” and Avoid categorizing food as “good” and “bad”.“bad”.

Learn and discuss the genetic basis of Learn and discuss the genetic basis of different body types.different body types.

Prevention (cont.)Prevention (cont.)

Link respect for diversity in weight and shape with Link respect for diversity in weight and shape with diversity in race, gender, ethnicity, and intelligence.diversity in race, gender, ethnicity, and intelligence.

Help children understand the ways that the media Help children understand the ways that the media distorts the true diversity of human body types and distorts the true diversity of human body types and implies that a slender body means beauty, power, implies that a slender body means beauty, power, excitement, and sexuality.excitement, and sexuality.

Learn and discuss the dangers of trying to alter your Learn and discuss the dangers of trying to alter your body shape through dieting.body shape through dieting.

Take women seriously for what they say, feel, and do Take women seriously for what they say, feel, and do not in regard to their shape or looks.not in regard to their shape or looks.

Basic PrinciplesBasic Principles

Eating disorders are serious and complex Eating disorders are serious and complex problemsproblems

Warnings are not enough. We must address:Warnings are not enough. We must address: Our cultural obsession with slendernessOur cultural obsession with slenderness Roles of men and women in societyRoles of men and women in society Development of self-esteem that transcends Development of self-esteem that transcends

appearanceappearance Programs must include opportunities for Programs must include opportunities for

participants to speak with trained participants to speak with trained professionalsprofessionals

Warning SignsWarning Signs

Weighing self 2-3 times per dayWeighing self 2-3 times per day Choosing exercise over friends and familyChoosing exercise over friends and family Exercising after meals to burn caloriesExercising after meals to burn calories Exercising even when injuredExercising even when injured Weakness/dizzinessWeakness/dizziness Mood swingsMood swings Peculiar eating ritualsPeculiar eating rituals Difficulty eating in publicDifficulty eating in public Preoccupied with desire to be thinPreoccupied with desire to be thin Obsessed with fat grams and caloriesObsessed with fat grams and calories Fear of gaining weightFear of gaining weight

Warning Signs (cont.)Warning Signs (cont.)

Running water for a long time while in the Running water for a long time while in the bathroombathroom

Eating when lonely, stressed, tenseEating when lonely, stressed, tense Eating a lot without gaining weightEating a lot without gaining weight Wearing clothes to hide thinnessWearing clothes to hide thinness Hair loss, brittle nails, lanugoHair loss, brittle nails, lanugo Gray teeth from erosion of enamelGray teeth from erosion of enamel Hand sores, callusesHand sores, calluses Irregular or non-existent periodsIrregular or non-existent periods Irregular body temperatureIrregular body temperature

High Risk SportsHigh Risk Sports

GymnasticsGymnastics SwimmingSwimming BalletBallet WrestlingWrestling Body buildingBody building JockeyingJockeying RowingRowing DivingDiving Figure skatingFigure skating Long distance runningLong distance running

Treatment ResourcesTreatment Resources

Eating disorders ALWAYS require professional help!

The Renfrew Center of Northern New Jersey174 Union StreetRidgewood, NJ 07450Tel: 1-800-RENFREW Website: http://www.renfrewcenter.com

  University Medical Center at Princeton

Eating Disorders Program253 Witherspoon StreetPrinceton, NJ 08540Tel: (609) 497-4490Toll-Free: (877) 932-8935Website: www.princetonhcs.org

Treatment Resources (cont.)Treatment Resources (cont.)

Somerset Medical CenterEating Disorders Program110 Rehill AvenueSomerville, NJ 08876Tel: (800) 914-9444Website: www.somersetmedicalcenter.com

Overlook HospitalEating Disorders Program at Atlantic Health99 Beauvoir Avenue, Box 243Summit, NJ 07901908-522-5757 Website: www.goryebchildrenshospital.org

CONCLUSIONCONCLUSION

Eating Disorders & Eating Disorders & AddictionAddiction

Feelings of guilt and distressFeelings of guilt and distress Phases/StagesPhases/Stages Bio-psycho-social causesBio-psycho-social causes 12 steps12 steps Myths about weaknessMyths about weakness Important to recognize as a diseaseImportant to recognize as a disease CAN RecoverCAN Recover Can be deadly if not treatedCan be deadly if not treated Medical and social complicationsMedical and social complications

Eating Disorders & Addiction Eating Disorders & Addiction (cont.)(cont.)

Media plays a HUGE roleMedia plays a HUGE role PREVENTION WORKS!PREVENTION WORKS! DSM-IVDSM-IV Effects all cultures, genders, socioeconomic Effects all cultures, genders, socioeconomic

classesclasses Co-dependenceCo-dependence SecretSecret Relapse is commonRelapse is common LyingLying ExcusesExcuses

What To Learn More?What To Learn More?

National Eating Disorders AssociationNational Eating Disorders Association

http://www.nationaleatingdisorders.org http://www.nationaleatingdisorders.org

Eating Disorder Association of New JerseyEating Disorder Association of New Jersey

http://www.edanj.org http://www.edanj.org

Something Fishy Website on Eating DisordersSomething Fishy Website on Eating Disorders

http://www.something-fishy.org http://www.something-fishy.org

What To Learn More? (cont.)What To Learn More? (cont.)

Academy for Eating DisordersAcademy for Eating Disorderswww.aedweb.org www.aedweb.org

National Association of Anorexia Nervosa & National Association of Anorexia Nervosa & Associated DisordersAssociated Disorderswww.anad.orgwww.anad.org

United States National Library of MedicineUnited States National Library of Medicinewww.nlm.nih.gov/medlineplus/eatingdisorders.html www.nlm.nih.gov/medlineplus/eatingdisorders.html

What To Learn More? (cont.)What To Learn More? (cont.)

Eating Disorder Referral and Information CenterEating Disorder Referral and Information Centerwww.edreferral.com www.edreferral.com

National Institute of Mental HealthNational Institute of Mental Healthwww.nimh.nih.gov www.nimh.nih.gov

Anorexia Nervosa and Related Eating Disorders, Anorexia Nervosa and Related Eating Disorders, Inc.Inc.www.anred.com www.anred.com

ContactContactInformationInformation

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East Brunswick, NJ 08816East Brunswick, NJ 08816

732-254-3344 ext. 11732-254-3344 ext. 11

steve@ncadd-middlesex.comsteve@ncadd-middlesex.com

For more information or For more information or additional resources, call NJPN additional resources, call NJPN

atat

(732)367-0611 (732)367-0611

or visit or visit www.njpn.org

for the contact information of for the contact information of your local affiliate.your local affiliate.