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Family in the crisis of eating disorders

Families often experience enormous stress when facing the fact that their loved ones are suffering from an eating disorder. Guilt, despair, fear, distress, anger, confusion, frustration, helplessness, shame and a sense of loss are the common negative emotions reported by families. Most families do not know what they should do, who they can turn to and how to cope with eating disorders that have taken control of their lives. If you are the family member of a sufferer, this programme can offer you useful information and suggestions about what you can do to help the person you care about and also to look after yourself.

This program contains family education materials which help you to gain control over eating disorders. Family members use this program will also be able to chat with other families whose members or relatives are having eating disorders. This enables the sharing of experience and enhances mutual support. The resources of this programme will provide you with information about the professional health services on eating disorders and useful references.

The facts about eating disorders

Eating disorders are illnesses of the body and mind. They involve disturbances in eating habits and excessive concerns about body weight and shape. They affect the physical health, thinking, attitudes, feelings, emotions, social relationship and quality of life of the sufferers of different gender, age group, nationalities, social classes and cultures. Female adolescents and young women are the most at risk. An increasing number of young men are reported to have the disorders. There are multiple factors contributing to the cause of the disorders, such as, dieting, genetics and biological factors, personality, low self-esteem, depression, family factors, peer influence, cultural factors, chronic illness and stressful life events. Eating disorders may occur with mood disorders, anxiety disorders, personality disorders, adjustment problems, and substance abuse. Though family problems can be the cause of the disorders ˇ§ families are not to be blamed ˇ¨ for the disorders. The disorders usually involve a combination of biological and sociocultural factors triggered by stress, and most families have tried their very best to do what they can. So don't blame yourself for causing the disorders.

Common risk factors for developing an eating disorder

  • Dieting
  • Low self-esteem
  • Feelings of lack of control
  • History of being teased as overweight
  • People's comment on the need to lose weight
  • Over emphasis on body image
  • Perfectionism/ high achievers
  • Fear of the responsibilities of adulthood
  • Participation in sports of activities that discriminates against people with a heavy build
  • Personal or family history of obesity
  • Personal or family history of depression
  • Family history of an eating disorder
  • Gay orientation in males
  • History of abuse
  • History of family conflict or excessive parental expectation
  • Culture which places a high value on external appearance or thinness
  • Psychological stress(e.g. major life changes, relationship breakdown)

Common eating disorders:

A) Anorexia nervosa
B) Bulimia nervosa
C) Binge eating disorder
D) Other specified feeding or eating disorder

(A) Anorexia nervosa

It is a potentially life-threatening illness because of the various medical and psychological complications it can cause to the sufferers. The affected individuals starve themselves in order to become thinner. They have an intense fear of gaining weight and a distorted view of their body image. They view themselves as fat despite being grossly underweight. The eating disorder is often used as a mean to cope with negative emotions. It may give a person a sense of control and mastery over her / his life.

Doctors diagnose a person with anorexia nervosa based on all of the following criteria:

  1. Restriction of energy intake relative to requirements leading to a significantly low body weight in the context of age, sex, developmental trajectory, and physical health.
  2. Intense fear of gaining weight or of becoming fat, or persistent behavior that interferes with weight gain, even though at a significantly low weight.
  3. Disturbance in the way in which one's body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or persistent lack of recognition of the seriousness of the current low body weight.

There are two recognized types of anorexia nervosa:

  1. Restricting Type

    During the last 3 months, the individual has not engaged in recurrent episodes of binge eating or purging behavior (i.e. self-induced vomiting or the misuse of laxatives, diuretics or enemas). Weight loss is accomplished primarily through dieting, fasting and/or excessive exercise.
  2. Binge-eating / Purging type

    During the last 3 months, the individual has engaged in recurrent episodes of binge eating or purging behavior (i.e. self-induced vomiting or the misuse of laxatives, diuretics or enemas).

(B) Bulimia nervosa

It is a serious eating disorder in which the affected individuals consume an enormous amount of food in a short period of time uncontrollably followed by self-induced vomiting, use of laxatives or diuretics, excessive exercise, or fasting. People with bulimia nervosa are very concerned about their body shape and weight. They fear gaining weight but they are often unsuccessful in losing weight. They are usually of normal weight or slightly overweight. Some of them have anorexia nervosa before the occurrence of bulimia nervosa. The binges in bulimia nervosa occur as a way to fulfill the suffererˇ¦s emotional needs and their loneliness but soon after they would develop feelings of guilt. Their attempt of inducing vomiting following a binge further increases their feelings of shame. Bingeing and purging can happen in repeated cycles and are ways sufferers cope with stress or deal with emotions and disappointments.

Doctors diagnose a person with bulimia nervosa based on all of the following criteria:

  1. Rapid consumption of a large amount of food in a discrete period of time
  2. A feeling of lack of control over eating behavior during the eating binges
  3. Recurrent inappropriate compensatory behavior in order to prevent weight gain, such as self-induced vomiting, use of laxatives or diuretics, strict dieting or fasting, or vigorous exercise
  4. The binge eating and inappropriate compensatory behaviors both occur, on average, at least once a week for three months
  5. Self-evaluation is unduly influenced by body shape and weight
  6. The disturbance does not occur exclusively during episodes of anorexia nervosa

There are two recognized types of bulimia nervosa:

  1. Purging Type

    The affected person has regularly engaged in self-induced vomiting or the misuse of laxatives, diuretics, or enemas
  2. Nonpurging Type

    The affected person has used other inappropriate compensatory behaviors, such as fasting or excessive exercise, but has not regularly engaged in self-induced vomiting or the misuse of laxatives, diuretics, or enemas
C) Binge eating disorder

People with binge-eating disorder have frequent episodes of binge eating with an inability to stop. Unlike people with bulimia nervosa, they do not engage in compensatory behaviors to prevent weight gain. Overweight happens in about 50% of people with a binge-eating disorder. Food is used by the sufferer to cope with strong emotions and problems. Dangerous complications can result from binge-eating, such as diabetes, a high blood pressure, high cholesterol level, gallbladder disease, heart disease, and certain types of cancer.

Doctors diagnose a person with binge-eating based on all of the following criteria:

  1. Rapid consumption of a large amount of food in a discrete period of time
  2. A feeling of lack of control over one's eating behavior during the eating binges
  3. The binge-eating episodes are associated with three or more of the following:
    • Eating much more rapidly than normal
    • Eating until feeling uncomfortably full
    • Eating large amounts of food when not feeling hungry
    • Eating alone because of being embarrassed by how much one is eating
    • Feeling disgusted with oneself, depressed, or very guilty after overeating
  4. Feeling of distress regarding binge-eating
  5. The binge-eating occurs, on average, at least once a week for 3 months
  6. The binge-eating is not associated with the recurrent use of inappropriate compensatory behaviors
    (e.g. purging, fasting, excessive exercise)
D) Other specified feeding and eating disorder

The affected person will have disordered patterns of eating, and a preoccupation with thoughts of food and body weight which interferes with his/ her daily life. The symptoms of the disorders, however, do not meet all the criteria of anorexia nervosa, bulimia nervosa or binge-eating disorder. The person may be anorexic but her current weight is still within or above the normal range. The person could be bulimic but her binge-eating behavior occurs less than once a week or for a duration of less than three months. Some people with the disorders could have recurrent purging behavior to influence weight or shape in the absence of binge eating or recurrent episodes of night eating, as manifested by eating after awakening from sleep or by excessive food consumption after the evening meal.

Physical complications associated with eating disorders

Anorexia nervosa

  • Growth delay in children and teenagers
  • Heart problems
    (e.g. smaller and weaker heart, slow heart rate, low blood pressure, cardiac arrhythmia)
  • Absent menstruation
  • Osteoporosis
  • Anaemia
  • Muscle weakness
  • Dehydration and potential risk of kidney problems and kidney failure
  • Delayed emptying of the stomach
  • Constipation
  • Dry skin
  • Dry hair and hair loss
  • Decreased immunity
  • Metabolic problems
    (e.g. low blood glucose level, decreased metabolic rate, low body temperature)
  • Obstetric problems
    (e.g. increased risk of infertility and obstetric complication)

Bulimia nervosa

  • Electrolyte disturbance from purging and leading to a low potassium level, cardiac arrhythmia and heart failure
  • Gastrointestinal problems(e.g. constipation or diarrhea)
  • Tears or rupture of the esophagus from repeated vomiting
  • Dental caries from exposure to gastric acid caused by vomiting

Binge-eating disorder

  • High blood pressure
  • Elevated cholesterol level
  • Heart problems
  • Joint problems
  • Diabetes

Psychological complications associated with eating disorders

  • Low self-esteem(e.g. in bulimia and binge-eating disorder)
  • Development of obsessions, compulsions and rituals in anorexia nervosa
  • Depression
  • Anxiety
  • Mood disturbance
  • Suicidal thoughts and feelings
  • Drug and alcohol abuse
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