Identification and Treatment of Eating Disorders: Help for Parents

A Family Guide to Eating Disorders, Part 2: Identification and Treatment

In Part I of this Guide, we focused on strategies for preventing the development of eating disorders in children. In Part 2, we will turn to the warning signs of eating disorders, how to get help, and some Internet resources for families in need.

Signs and Symptoms of Eating Disorders

Here are lists of some of the “red flags” you might notice with eating disorders.

Anorexia Nervosa:

• Weight loss;
• Loss of menstruation;
• Dieting with great determination, even when not overweight;
• “Fussy” eating -- avoiding all fat, or all animal products, or all sweets, etc.;
• Avoiding social functions that involve food;
• Claiming to “feel fat” when overweight is not a reality;
• Preoccupation with food, calories, nutrition, and/or cooking;
• Denial of hunger;
• Excessive exercising, being overly active;
• Frequent weighing; “Strange” food-related behaviors;
• Complaints of feeling bloated or nauseated when eating normal amounts;
• Intermittent episodes of binge eating;
• Wearing baggy clothes to hide weight loss; and
• Depression, irritability, compulsive behaviors, and/or poor sleep.

Bulimia Nervosa:

• Great concern about weight;
• Dieting followed by eating binges;
• Frequent overeating, especially when distressed;
• Binging on high calorie salty or sweet foods;
• Guilt or shame about eating;
• Using laxatives and/or vomiting and/or excessive exercising to control weight;
• Going to the bathroom immediately after meals (to vomit);
• Disappearing after meals;
• Secretiveness about binging and/or purging;
• Feeling out of control;
• Depression, irritability, anxiety; and
• Other “binge” behaviors (involving, for example, drinking, shopping, or sex). Getting Help

Many parents or concerned others do not know how to approach a person they’re worried about and getting them the help they may need. People can feel very helpless, scared, and, at times, angry when someone they love develops an eating disorder. Help is available, however, and many people and families can grow stronger as a result of seeking help.

If you notice several “red flags,” tell the person displaying these behaviors that you are concerned about what you have observed. People with more restrictive (or anorexic) symptoms are much more likely to deny a problem and to resist suggestions that they eat more or see a therapist. The restriction may actually be making them feel “good” in a way, and they may be terrified of losing the “control” they feel they’ve begun to achieve. It can be helpful to provide information and educational materials, or to suggest that the person see a nutritionist for a consultation.

If denial of the problem persists, and the restricting behavior continues or worsens, younger people may have to be told that they need to see someone for help. They can be given choices: whether they are more comfortable seeing a female or male therapist, for example, or whether they prefer to go alone or with family. With older family members, intervention may not be so simple. In these cases, it may be like dealing with someone who has a drinking problem: you can repeatedly remind the person of your concern and encourage help, you can get help for yourself, but you may not be able to “make” that person change. If you are concerned about imminent dangers to health (as when a person has lost a great deal of weight and looks unwell), bringing a person to a doctor or even a hospital emergency room for evaluation is appropriate.

Individuals who binge and purge are often very distressed about what they are doing and may be afraid of confronting the problem (for example, they may be afraid that they will get fat if they stop purging). They are, however, somewhat more likely to agree to explore options for getting help. In that case, getting educational materials, therapist referral lists, and information about groups can be helpful. It is important to stay as non-judgmental as possible, even if you feel that the person’s behavior is “disgusting” or strange.

People are sometimes reluctant to talk to a therapist or counselor. If they are more comfortable starting with a doctor or nutritionist, that’s at least a first step. It can be useful, though, to make sure the person understands that feelings, relationship issues, and self-esteem are almost always involved to some extent in these situations and should not be ignored, no matter what course of action the person decides to initially pursue.

by Terese Katz

Part I ~ Part II

Resources and Supports

The following resources can offer guidelines for families and friends, articles on particular issues (for example, athletes or men with eating disorders), educational brochures, therapist referral lists, etc.:

Eating Disorders Awareness and Prevention, Inc. (EDAP)(www.edap.org)  -- The nation’s largest non-profit organization dedicated to the awareness and prevention of eating disorders; provides information on many aspects of eating disorders, including useful guidelines for parents.

Eating Disorder Referral and Information Center (www.edrefferal.com) -- A website dedicated to eating disorder resources, including articles and a nationwide therapist referral listing.

Anorexia Nervosa and Related Eating Disorders, Inc. (www.anred.com) -- Includes various educational materials about eating disorders.

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