Eating disorders develop for a reason. They do not appear out of the blue. The reason may not be apparent initially though as many youth keep their concerns to themselves and don't share their self-doubt, fears and worries. Eating disorders develop as an attempt to feel better about something. They may be a way to try to feel more confident, decrease anxiety or worry, feel more in control, or be more socially popular with peers. They may be a way to try to feel more in control when there is a lot of change going on in life or may be triggered by upsetting situations. Many individuals with eating disorders are not very flexible or adaptable and lack self-esteem. They then may find it hard to cope with difficult situations such as: transitions or losses (change to high school, loss in the family through separation, death or moving) or teasing and bullying. Many youth facing eating disorders appear to be successful as children with high academic achievement, excelling in sports or other pursuits on the outside. However, on the inside, they may have a lot of self-doubt, may please others rather than know what their own real needs are, and may not have developed the skills to find a voice to speak up about these inner needs.
Some people can suffer with a combination of anorexia and bulimia, or anorexia can develop into bulimia. Dieting and food restriction can be triggers for bulimia because the body is starving and this can lead to binge behaviour. Binges are then followed by extreme guilt and vomiting provides relief. This release of food can provide not only physical relief but emotional release with a discharge of emotions that are held in.
It is important to understand the way these eating practices help each person as it differs between individuals. Because the problem does help in the short run, it leaves people feeling ambivalent about getting totally rid of this problem. In the long run the habit of either food restriction or binging and purging creates another problem requiring attention and is not effective as a coping strategy in the long run with the initial triggers. This means that treatment must include help that addresses the food and physical health but also the emotional health and coping strategies to replace the food habit as a way of coping with distress. Some people suffer with additional problems such as depression that pre-dates the eating disorder, anxiety problems or addiction issues. These all need to be addressed together as they interconnect.
Treatment initially involves an assessment with a team who specialize in Eating Disorders. They will suggest the intensity of treatment which may include outpatient medical and nutritional support as well as individual and family therapy. Family therapy is highly recommended with children and youth who are facing an eating disorder as parents are in a position to assist their son or daughter in dealing with the problem and they also need help themselves to cope as eating disorders profoundly affect all family members. Parent support groups can also be a great help for parents.
Patricia Roles, MSW, RSW, BCATR, is a registered social worker and registered art therapist who has worked in the field of eating disorders for 25 years as a family therapist and art therapist. She has worked at a tertiary care pediatric teaching hospital in eating disorders and is a social work supervisor. She has also has a private practice where she offers individual and family therapy and clinical supervision to therapists, and e-counseling through her website: http://www.e-mailtherapy.com . She can be contacted via email at: e-mailtherapy@shaw.ca