HealthyLife® Students' Self-Care Guide

Section V – Common Mental Health Problems

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Eating Disorders

Five to 10 million adolescent girls and women have an eating disorder. About 1 million males do. The 3 most common eating disorders are anorexia nervosa, bulimia nervosa, and binge eating disorder. These eating disorders are a coping mechanism. They result in an obsession with food and/or weight; anxiety around eating; guilt; and severe and adverse effects on psychological and physical health. Eating disorders should be taken very seriously.

Symptoms

For Anorexia Nervosa

	Loss of a significant amount of weight in a short period of time
	Intense, irrational fear of weight gain and/or of looking fat. Obsession with fat, calories, and weight.
	Distorted body image. The person feels and sees himself or herself as fat when below normal weight for his or her height and age.
	A need to be perfect or in control in one area of life
	Marked physical effects, including loss of hair, slowed heart rate, low blood pressure, feeling cold due to decrease in body temperature, and absence of menstrual periods in females

For Bulimia Nervosa

	Repeated acts of binge eating and purging. Purging can be through vomiting; taking laxatives, water pills, and/or diet pills; fasting; and exercising excessively to “undo” the binge.
	Excessive concern about body weight
	Being overweight, underweight, or normal weight
	Frequent dieting
	Dental problems, mouth sores, and chronic sore throat
	Frequent time spent in bathrooms
	Because of binge-purge cycles, severe health problems, such as stomach damage, an irregular heartbeat, and kidney and bone damage can occur.

eating disorders can lead to other unhealthy lifestyle behaviors.

For Binge Eating Disorder

	Periods of continuous and sporadic eating that are unrelated to hunger
	Impulsive binging on food without purging
	Repeated use of diets or sporadic fasts
	Weight can range from normal weight to mild, moderate, or severe obesity.

Causes

No specific cause has been found for these eating disorders. They affect persons from all socio-economic classes, ages, genders, and ethnic cultures. Risk factors include:

	Possible biological and genetic links, including a family history of eating disorders
	Pressure from society to be thin
	Personal and family pressures
	A history of sexual, physical, or alcohol abuse
	Fear of entering puberty or of sexual relations
	Pressure for athletes to lose weight (sometimes quickly to qualify for an event) or to be thin for competitive sports
	Chronic dieting

Treatment

	Counseling. This can be in individual, family, group, and/or behavioral therapy.
	Support groups
	Antidepressant medication
	Nutrition therapy
	Outpatient treatment programs or hospitalization, if the condition is severe enough

Questions to Ask

Do you hoard food and/or leave the table right after meals to “go to the bathroom” to induce vomiting and/or spend long periods of time in the bathroom from taking laxatives and/or water pills?

Have you lost a significant amount of weight (more than 10 pounds) by binging and purging, fasting, dieting, and/or exercising on purpose, with any of these problems? An intense fear of gaining weight or of getting fat You see yourself as fat even though you are at normal weight or are underweight. You continue to diet and exercise excessively even though you have reached your goal weight.

Do you have recurrent episodes of eating a large amount of food within 2 hours, are not able to control the amount of food you eat or to stop eating and do you do at least 3 of the following? Eat very fast Eat until you feel uncomfortably full Eat when you are not hungry Eat alone due to embarrassment Feel depressed, disgusted, and/or guilty after you overeat

Do you have a combination of the following problems with abnormal eating behaviors? Irregular heartbeat Slow pulse, low blood pressure Rapid tooth decay Low body temperature, cold hands and feet Thin hair (or hair loss) on the head, baby-like hair on the body (lanugo) Dry skin, fingernails that split, peel or crack Problems with digestion, bloating, constipation Three or more missed periods in a row or delayed onset of menstruation Periods of depression, lethargy, euphoria and/or hyperactivity Tiredness, weakness, muscle cramps, tremors Lack of concentration

Self-Help

Eating disorders are too complex and physically harmful to be treated with Self-Help alone. A professional experienced in the treatment of eating disorders should be consulted.

To Prevent an Eating Disorder

	Learn to accept yourself and your body. You don’t need to be or look like anyone else. Spend time with people who accept you as you are, not people who focus on “thinness.”
	Understand that your self esteem does not have to be dependent on your body weight.
	Eat nutritious foods. Focus on complex carbohydrates (whole grains, beans, etc.), fresh fruits and vegetables, low-fat dairy foods and low-fat meats.
	Commit yourself to the goal of normalized eating but realize that it will take time. It will also take courage to fight your fears of becoming fat or gaining too much weight.
	Eat at regular times during the day. Don’t skip meals. If you do, you are more likely to binge when you eat.
	Avoid white flour, sugar and “junk” foods high in calories, such as cakes, cookies or pastry, which have fat and sugar. Bulimics tend to binge on junk food. The more they eat, the more they want.
	Get regular moderate exercise 3 to 4 times a week. If you exercise more than your health care provider advises, make an effort to do non-exercise activities with friends and family.
	Find success in things that you do. Your work, school, hobbies and volunteer activities will promote self-esteem.
	Learn as much as you can about eating disorders from books and organizations that deal with them.
	Parents who want to help their children avoid eating disorders should promote a balance between their childs’ competing needs for both independence and family involvement.

If You Have an Eating Disorder

	Follow your health care provider’s treatment plan.
	Attend counseling sessions and/or support group meetings as scheduled.
	Identify feelings before, during, and after you overeat, binge, purge, or restrict food intake. What is it that you are hoping the food will do?
	Set small goals that you can accomplish easily and congratulate yourself for every success. This is a process. Accept set backs and learn from them.
	Talk to someone instead of turning to food.
	Learn to recognize your personal rights and to state how you feel. You have the right to say no, the right to express your feelings and your opinion, and the right to ask to have your needs met.
	Keep a journal of your experiences, feelings, thoughts, and insights, but not about what you eat. The journal is for your eyes only, not for others to read or judge. This is a safe place to be honest with yourself. The journal can also help you identify your “triggers” so that you may prepare yourself to choose alternative strategies.
	Don’t let the scale run your life. Better yet, throw out the scale!

eat at regular times, not skipping meals.

What You Can Do for a Friend or Relative

	Learn as much about the disorder as you can. Eating disorders are complicated matters that are not easily understood by someone who has never had the problem or been in contact with someone who has.
	Be supportive, not controlling. Avoid power struggles. The last thing an eating disorder sufferer needs is added “outside control.” Part of their eating disorder stems from feeling that others are in control of their lives. Eating (or not eating) is the only way they can gain some control. Offer your help by letting the person know you’re there if they want your help.
	Try to get your friend or relative to see that there is a problem and to seek professional help. These disorders are too complicated for self-help programs. You can, however, help your friend or relative learn more about their specific problem through books and articles related to the subject. Reassure your friend or relative that they will not be “judged” in treatment, but that they will be understood and helped.
	Don’t ignore or deny the problem. Often, the closest friends and/or family members are the last to accept that their child or friend has an eating disorder.
	Seek professional help yourself. If you feel the need to talk about your friend or relative’s problems with someone, contact a support group and/or mental health professional who deals with eating disorders. (See “ National Resources ”.)

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March 16, 2007

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