Winter`s holidays, with their emphasis on jovial socializing and gift-giving, should be a period of happiness and loving relationships. But the season also revolves around food, and for people with eating disorders and their families, it can be anything but happy.
Clinical psychologist Laura Humphrey, director of the outpatient Eating Disorders Program at Northwestern University/Northwestern Memorial Hospital, says revelers with normal eating habits can enjoy the holidays and not dangerously overindulge if they try to eat regular meals rather than snacking constantly. If a party with a rich menu is on the agenda, they should eat less at other meals to remain within their normal daily calorie intake. Exercise also will help burn off extra calories and ease depression.
For a person with an eating disorder, however, these guidelines won`t solve the problems. Obesity requires long-term treatment. And for the person with disorders such as anorexia nervosa or bulimia (binging and purging), these suggestions might only aggravate the obsession that already rules his or her life. An anorexic, for example, might exercise to the point of exhaustion to rid the body of the perceived fat.
This might be just the time of year, however, to give someone with an eating disorder the prospect of a happier, healthier new year. Family members or friends who notice symptoms of these disorders can confront their affected loved ones with their concern and help them get treatment. These problems are more prevalent in teenage girls and young women than in boys and men, but can affect either sex.
FAMILY PRESSURES
”Getting together with the family for the holidays can create tensions,” Humphrey says. ”This can be especially true if it`s a young person`s first visit home after being away at school. At this time of life, she may be having difficulty with the process of separation and establishing her individual identity.”
If parents notice that their daughter has lost weight and isn`t eating, or suspect that she is binging and purging, they can at least suggest that she undergo a medical evaluation to determine if her weight loss is excessive.
Some of the symptoms to watch for are a preoccupation with weight in someone who is normal weight or underweight; weight loss or fluctuation in a person whose weight was previously stable; constant self-criticism of the person`s appearance; expressions of feeling ”fat and uncomfortable” after eating a normal meal; large quantities of foods, particularly starches and sweets, missing from cupboards; wide fluctuation in moods, from outgoing and charming to angry and depressed.
What is an anorexic or bulimic person demonstrating with these erratic behaviors? Several factors are involved.
”In society today, a young person is supposed to be able to `have it all,` and yet be very thin,” Humphrey says. ”That is the ideal of success. A young person growing up is trying to separate from the family, to become an individual in her own right. Meanwhile, her parents have high expectations for her and she sets high goals for herself. She begins to depend on outward appearances as the key to success, rather than building a solid personality foundation based on who she is and where she`s going.”
It is common for an anorexic to be ”the perfect little girl”–an excellent performer in school, sweet, compliant and deeply dependent on her family. With the pressures of adolescence, she is asked to make many important decisions about her life–about relationships with boys, career choices. For someone unaccustomed to being assertive and self-reliant, it`s a heavy burden. GREAT EXPECTATIONS
A bulimic also is achievement-oriented and expects a lot of herself. Her vulnerability occurs because she often sets goals that are too high and she finds it difficult to achieve them.
Bulimia, Humphrey believes, is symbolic of the person`s pattern of struggle: dieting followed by deregulation of control, then an ”undoing,” an attempt to repair the damage of that loss of control. The person may not have had the capacity to achieve a too-high goal. She gives up the standard, loses control, then tries to repair that in emotional ways: to return to friendships she has ended, to her family. She promises she`ll ”never to do it again.”
Anorexics never come on their own for treatment, Humphrey says. They don`t think they have a problem. The thinner they are, the more successful they perceive themselves to be in achieving their goals.
What can be done for these people?
”With bulimics, we try to find a better balance for their lives,”
Humphrey says. ”We work for less preoccupation with diet, new ways of coping with stress. We encourage them to develop relationships with people. Their problem is that they have turned to food as a friend. It`s always there. They can control it. It`s sometimes more dependable than people.
FOOD AS SUPPORT
”Eating can develop a life of its own. It adapts to a lot of stresses
–once again, disappointing relationships with family, boyfriends, girlfriends. It bolsters self-esteem and takes on a significant focus beyond what food really is–nutrition for your body. We try to help patients understand the ways they are using food for emotional support and comfort, and to persuade them that relationships will be more gratifying in the long run, if not in the short run.”
Studies, she says, have shown significant improvement in two-thirds to three-quarters of those who undergo treatment–intervention in the eating disorder, psychotherapy, medication, family involvement and hospitalization, if necessary–over a year or longer. Even after successful treatment, though, some remnants of the food disorder may remain. An anorexic, for example, may be a vegetarian. There`s nothing wrong with that as long as food-oriented behavior is not the focus of a person`s life.
Briefly, the program director recommended that ”two concerned people confront the person with the problem. Three people are a little overwhelming and one is not as convincing as two. Sit down with the person face to face, express concern a well as observations, that is, concrete evidence. Say you know a place where help is available and urge the person at least to get an evaluation. Say you will make the call if the person doesn`t want to. Expect the person, who will feel ashamed, not to take this confrontation well, to deny the problem. But continue urging that an evaluation be made.”
Cost of outpatient treatment depends on components put together in an individualized package. Initial psychiatric and preliminary medical evaluation, $100; ongoing individual and family psychotherapy, $60 per 50-minute session; group therapy, $30 per 60-minute session; individualized nursing management, $25 per 30-minute session in medication monitoring, meal and nutrition planning. Inpatient treatment also is available. Major medical insurance plans usually cover it, Humphrey says.
Confronting someone who has an eating disorder requires a certain technique. Advice on this can be obtained by calling the Eating Disorders Program, 908-7850.
To obtain further research data on these problems, Northwestern is seeking participants for a study sponsored by the National Institute of Health. Criteria for participation are a biologically intact family of mother, father and daughter in which the daughter is 14 to 22 years old and has anorexia nervosa, bulimia or depression, or has no problems whatsoever. Participants will receive a free preliminary evaluation and will be given a $50 honorarium. The daughter will be interviewed and questionnaires will be given to each family member to fill out and return. —
