By Dr. Rachel Levy Lombara
PREVENTING EATING DISORDERS
Eating disorders involve extreme emotions, beliefs, and behaviors regarding eating, food and weight. They are a serious health risk, with the highest mortality rate of any mental illness and occur in boys as well as girls from a variety of ethnic and socioeconomic backgrounds. This article provides a summary of the eating disorders, major risk factors for their development (especially those we can influence), and suggestions for how to best protect children from developing them.
Denial and secretiveness can make eating disorders difficult to detect. Other than the obvious symptoms, any of the following may indicate a problem:
• Refusing to eat or denying hunger
• Excessive exercising
• Social withdrawal
• Development of lanugo (downy hair on body)
• Damaged teeth or gums
• Puffy cheeks (swollen salivary glands)
• Sores in the throat or mouth
• Scars or calluses on hands/knuckles
• Loose or baggy clothing (to disguise weight loss)
• Traces of vomit, laxatives, or unexplained missing food
If you are certain a child has an eating disorder, get professional help immediately. If you are concerned but not certain, be as nonjudgmental as possible when broaching the topic. Eating disorders are an illness. Treat them with the respect and concern you would any other illness.
Convey your genuine concern and desire to help. An ED is often a child’s best solution to a complex underlying problem, often a family one. If you are the parent, share in the responsibility for the problem (children are often the “identified patient” in a troubled family system) and be willing to seek help along with your child. With early detection and appropriate treatment, ED can be effectively resolved.
• Low Self-Esteem: A potent risk factor for a range of behavioral problems, low self-esteem occurs when children hear and internalize negative ideas about themselves.
• Criticism and Teasing: Children whose parents and siblings are overly critical or who tease them about their appearance are at a higher risk for developing an eating disorder.
• Perfectionism: The belief that nothing-but-perfect-is-good-enough is fertile ground for developing an ED.
• Dieting: Excessive food restriction leads to binge eating (even in people without ED); think of the pendulum effect. Our “old brain” ensures survival by stockpiling food in the face of real or perceived threat of starvation.
• Family Conflicts and Lack of Emotional Support: Ongoing, unresolved family conflicts are toxic for children. Lack of emotional support due to a family conflict–or any other reason–can leave a child vulnerable to using food to regulate their feelings and environment.
• Rewarding Weight Loss: The overwhelming positive response and attention children get when they lose weight may cause children to take dieting too far.
• Genetics: Children with a first degree relative with an eating or mood disorder are at higher risk for the development of one themselves. D
• Transitions: Transitions like moving, changing schools or divorce are often “the straw that broke the camel’s back,” directly precipitating an eating disorder. Everyone experiences emotional distress during transitions but children without a good emotional support system are particularly vulnerable.
• Activities such as ballet, gymnastics, running, wrestling: When appearance and weight requirements are rigorous, children are at risk for eating disorders. Coaches and parents may unwittingly contribute to eating disorders by encouraging young athletes to lose weight.
Too much outside control inadvertently distracts children from their internal instincts which, if heeded, naturally regulate eating and weight. (Think of a baby who eats with gusto then can’t be forced to take another bite when full.) Establishing healthy eating often requires parents do less not more. Consider the following suggestions:
1. Adults choose what food is bought, kept in the house and served at mealtimes. From these selections, children choose what and how much of what is served to eat.
2. Stay neutral about all foods. Demystify sweets.
3. Offer attention, praise, and hugs instead of food to placate or soothe a troubled child. When foods are used to reward children and show affection, they may start using food to cope with stress or other emotions.
4. Find things other than food, weight and body to talk about in social situations. Diet and weight talk can leave everyone feeling bad.
5. Encourage diversity by accepting your own and other people’s bodies as they are.
6. Do not participate in jokes that belittle another person, especially jokes based on appearance.
7. Be critical of messages from the media. Marketing is intended to make us feel as if we need whatever is being sold, even if that means making us feel bad about ourselves first.
8. Compliment children on things that truly matter, not a number on the scale.
9. Reduce competition. Your child does not have to the be the thinnest or best at anything to deserve your love and adoration.
10. Listen for and address thinking errors. How children interpret and respond to events, particularly difficult ones, powerfully predicts susceptibility to eating (and other) disorder. Inaccurate beliefs, negative thinking and faulty assumptions (termed cognitive distortions) left unchecked can leave a child feeling depressed and vulnerable to a host of self defeating behaviors.
The value our society places on an unrealistically thin ideal creates a baseline of dissatisfaction, putting children at risk for the development of an eating disorder. The best prevention tips work by fortifying a child’s self-esteem. Self-esteem is nothing more than a collection of thoughts that together form a general belief in oneself as capable, likable and worthy. Children often see themselves as the adults in their lives see them. As their mirror, ensure good health by making sure that your own focus is on your child’s strengths and unique abilities.
All-or-Nothing Thinking. Seeing things in black and white categories: “I blew the test,” in response to a single error.
Overgeneralization. Seeing a single negative event as a never-ending pattern of defeat: “I’m always late”-when rarely are such absolutes true.
Jumping to Conclusions. Assuming a negative outcome before sufficient data is available: “I’ll never get chosen” – unless one is either a mind reader or a fortune teller, it is impossible to know the outcome.
Disqualifying the Positive. Rejecting positive experiences or feedback as “not counting” to maintain a negative belief.
Personalizing. Seeing oneself as the cause of some negative external event: “The team lost because of me” when really everyone played a roll in the loss.
Catastrophizing. Exaggerating the importance of negative things: “My vacation is ruined” in response to a flight delay.
Labeling. Instead of describing an error, attaching a negative label: “I’m selfish,” rather than I want to enjoy my new doll today but will happily share it tomorrow.
Emotional Reasoning. Assuming negative emotions necessarily reflect the way things really are: “I feel fat” when one isn’t actually overweight.
Should Statements. Trying to motivate with “shoulds” as if one must be punished to get something done.
Mental Filter. Picking out a single negative detail and dwelling on it exclusively so that your vision of all reality becomes darkened: focusing on a single error in an otherwise beautiful performance.
TYPES OF EATING DISORDERS
ANOREXIA NERVOSA involves refusal to maintain body weight at or above a minimally normal weight for age and height, feeling or intense fear of becoming “fat” even though often dramatically underweight and, in menstruating females, loss of menstrual periods.
BULIMIA NERVOSA involves binge eating (eating an abnormally large amount of food in a discrete period of time) followed by purging to prevent weight gain. Purging is usually done by vomiting, laxatives, diuretics or excessive exercise. The bingepurge cycle feels “out of control” and is accompanied by dieting and extreme concern with body weight and shape.
BINGE EATING DISORDER involves recurrent episodes of binge eating. While there is no purging, sporadic fasts, repetitive diets, and feeling shame or selfhatred following a binge are common.
EATING DISORDER NOS is used to describe subclinical or mixed symptom eating disorders, as in someone who binges and purges but not frequently enough to warrant a diagnosis of bulimia nervosa.
Rachel Levy Lombara, Ph.D. is available to provide a seminar on the prevention of eating disorders in children, free of charge, to your nonprofit group or organization. Please contact her at (914) 773-4223 or DrLevyLombara@aol.com with your request.
For additional information:
·The American Psychological Association: http://www.apa.org
·The National Eating Disorders Association Helpline: 1-800-931-2237 Burns, D. Feeling Good . Harper, 1999.
The Yale Guide to Child Nutrition , Ed. by W. Tamborlane. Yale University Press, 1997.