Excerpt
Inhalt
Introduction
Overview of Eating Disorders
Bulimia Nervosa
Anorexia Nervosa
Binge-Eating Disorder
Health Effects
Symptoms and Causes
Warning Signs for Caregivers
Causes of Eating Disorders
The genetic factor
The biological factor
The psychological factor
The environmental and social factors
The peer influence
Prevention
Three-Step Prevention
Prevention Programs in Schools
Treatment Methods
References
Introduction
Overview of Eating Disorders
Eating disorders have become a serious problem as a growing number of young women, children, and, increasingly, men, suffers from anorexia nervosa, bulimia nervosa, or binge-eating disorders. They are included in the category of mental and behavioral disorders and among the most common chronical health problems encountered in children and adolescents (Hölling & Schlack, 2007, p. 797). “Between the ages of eleven and thirteen, fifty percent of females see themselves as overweight, and by the age of thirteen, 80 percent have attempted to lose weight, with ten percent reporting the use of self-induced vomiting. Around thirty percent of college-aged women are engaging in weight-management techniques such as bingeing and purging” (Costin, 1999, pp. 18-19). Although girls are struggling with eating disorders ten times as often as boys, it is not to be labelled as a predominantly female problem, as men increasingly suffer from chronical obesity and other disorders. It should be a great concern to us all that eating disorders are omnipresent in the lifes of many teenagers. Because adolescents spend a huge amount of their time in schools, this topic needs to be discussed and not kept secret. It is absolutely essential that we as caregivers not only keep our eyes open but also inform and educate teenagers about the imminence of eating disorders, because schools can not only be a decisive factor in encouraging eating disorders but also in preventing them.
Bulimia Nervosa
Bulimia nervosa is probably the most common eating disorder. It begins when a person decides to diet in a very restrictive manner to lose weight and feel “good”. This behavior leads to strong feelings of hunger, which the person tries to satisfy by stuffing down large amounts of high calorie food in a short period of time. Bulimics love food, and also use it to cope with stress or similar symptoms. Bingeing, however, causes them to feel guilty and ashamed, and makes them “purge” themselves by fasting, extreme dieting, exercising, using laxatives, and, most popularly, self-induced vomiting after bingeing (The parenting for prevention information series, 1998, p. 8). Bulimia nervosa is not easy to detect, because most bulimics do not have an abnormal body size due to the purging rituals after eating. In average it takes up to seven years for patients to receive medical treatment (Berger & Sowa, 2008, p. 25).
Anorexia Nervosa
There is a fluent passage from bulimia nervosa to anorexia nervosa. Only anorexics are more likely to die. Crude mortality rates are four percent for anorexia nervosa and a little less for bulimia nervosa, which makes anorexia the most lethal mental disorder (Crow, S.J. & Peterson, C.B., 2009, pp. 1342-1343). Literally translated, anorexia means “lack of appetite”. In essence, it is self-imposed starvation. Anorexics have a distorted body image and see themselves as overweight even though dangerous underweight. They are driven by the irrational fear of gaining weight, which is not even to be lessened after a severe weight loss (The parenting for prevention information series, 1998, p. 3). Anorexia usually affects females in puberty, who refuse to keep their body weight over a minimal weight that is appropriate for their age and height1 ; for teenage girls older than sixteen years this will be a minimum BMI2 of 17.7 (Berger &Sowa, 2008, p. 24). Anorexics not only deny the seriousness of the situation but also their body, even when they are driven by hunger. Characteristic features of the eating disorder are self-induced vomiting and the misuse of laxatives on a regular basis.
Binge-Eating Disorder
n contrast to that, there is the binge-eating disorder. It is defined by the habit of uncontrolled eating even when not feeling hungry and the permanent gain of weight. Affected people eat much more and more rapidly in a certain period of time than most people would do under similar circumstances. This involves the feeling of uncomfortable fullness, guilt and disgust with oneself after eating. In contrast to bulimics, binge-eaters do not engage in compensatory behaviors or purging to maintain their body weight.
Health Effects
The health effects of eating disorders are not only wide-ranging but also destructive and not seldom followed by death. On a physical level, patients suffering from eating disorders are at higher risk to develop heart failure and cardiac arrhythmia, and are more likely to have strokes (Kasper & Burghardt, 2007, p. 281). Their blood pressure varies from extremely high (anorexia nervosa) to extremely low (binge-eating), which causes inadequate blood flow. Patients are likely to suffer from massive liver and kidney damage, dehydration and teeth decay due to vomiting. They show dry hair, skin, and nails. On top of that and in all likelihood, their bone density shrinks and their muscles will be reduced to a minimum, which makes them prone to accidents (The parenting for prevention information series, 1998, pp. 6-8). There are also a number of consequences on a psychological level: Beginning with anxiety or fear, eating disorders can lead to serious psychosomatic problems, social isolation, depression, and, of course, suicide.
Symptoms and Causes
Warning Signs for Caregivers
As parents, teachers, and other caregivers, we need to do everything in our power to prevent kids from developing eating disorders. Being on high alert is the first step, the second is to perceive alarming warning signs. Some of the symptoms listed in the following are hardly noticeable, others are easy to detect. Vomiting on a regular basis, for example, often causes dehydration, broken blood vessels in the eyes and a swelling of the parotid gland3. A loss of hair, dizziness, and cracked lips can be an indicator of dehydration. In addition to this, the skin is often dotted with red marks and appears to be very dry. In the same manner, dehydration often leads to headaches and poor concentration. On top of that, eating disordered persons sometimes show other symptoms such as racing heartbeat or sweaty palms (Costin, 1999, p. 242). If adolescents come up with such manifestations, they do not necessarily suffer from an eating disorder. As a matter of fact, it may not be harmful at all. The importance of perceiving the signals and knowing that some of them usually come together, however, is still given. It is also significant to know where eating disorders come from so that we can identify them as soon as they occur.
Causes of Eating Disorders
Eating disorders are caused and influenced by many factors. The most significant risk factors and reasons for developing disorders will be listed in the following. It is important to be mentioned, however, that the existence of risk factors do not necessarily lead to the outbreak of an eating disorder, and an existing disorder can be influenced in multiple ways and emerge for various reasons (Berger & Sowa, 2008, p. 33).
The genetic factor
Relatives of eating disordered people are at higher risk for developing the same or a similar disorder. Although eating disorders are not directly heritable or genetically predestinated, it is more likely for relatives, because eating attitudes and behaviors are substantially heritable (Costin, 1999, p. 70). This is a highly controversial issue and not yet scientifically sound enough. It is comparable to families within certain profession groups, such as, for example, teachers. Their children are preoccupied by their parent’s profession.
The biological factor
Equally important, body activity and energy supply are decisive components in connection with weight control. A lack of motion and excessive food intake come together with a positive energy balance4, and can easily lead to overweight, abnormal eating habits, or, more specifically, purging rituals after eating (Berger & Sowa, 2008, p. 17).
The psychological factor
Often, both mental and eating disorders are usually defense reactions against inner feelings and used to maintain individual self-esteem. Moreover, eating disorders compensate for developmental deficits, underlying psychological problems, and traumatic experiences in early childhood such as sexual abuse. Additionally, eating disorders emerge as fear reaction to dramatic, traumatic, and often life-changing events like the end of a significant relationship, the move to a new house or school, change or death in family structure, or simply the onset of puberty (The parenting for prevention information series, 1998, p. 4). Teenagers develop eating disorders to distract, to comfort, to soothe inner emotional disturbance, and to overcome fear, anger, or anxiety. Often it is used as rebellion, self-punishment, or cry for attention and help (Costin, 1999, pp. 50-51; pp. 61-65). In addition, hormones influence the perception of hunger, appetite, and satiety. Leptin and dopamine, for example, decrease appetite and the desire for food. A high level of adrenaline, however, increases the energy turnover within the body, and is followed by the feeling of hunger.
The environmental and social factors
Above all, environmental and social factors play major roles in developing eating disorders. Media and society “form” a perfectly shaped body image. Costin (1999) states that “in today’s culture, thinness represents not only attractiveness but also self-sacrifice, virtue, success, and control. The pervasive attitude seems to be that the more fat one has on her body, the more unattractive, self-indulgent, lazy, and out of control one is. Culturally dictated definitions such as these are portrayed to us in various ways through the media” (p. 53). It seems that approval and acceptance in both career and private life are gained by being thin and attractive. Especially school-aged adolescents are victims of these cultural perceptions of body images. Teenagers are all over magazines, stuffed with alarmingly perfect looking pictures of their favorite popstars, models and actors, conveying that attractiveness means to be super thin and super sexy. It is no wonder that teenagers are so obsessed with their body image, and trying to starve themselves to a more “acceptable” or “trendy” body shape.
The peer influence
Likewise, the influence of peers is highly relevant. Crandall (1988) and Pike (1995) have observed a positive correlation between a girl’s binge-eating behavior and those of her friends. “Particular vulnerability to body dissatisfaction and dieting may be conveyed to girls who inhabit multiple subcultural environments that each strongly endorse thinness as an ideal […]. Teasing may be another, less subtle, way in which peers reinforce the thin body-image ideal,” says Paxton (1999, p. 136). Especially girls live in a highly comparative world, and frequently compare their own bodies to those of their friends. Research has shown that body comparison in the social environment such as peers and schools is an important predictor of body dissatisfaction (Stormer & Thompson, 1996, pp. 197-201). Paxton (1999) explains two possibilities with different, yet not incompatible, implications; Girls either adopt the behaviors of their peers (peer influence) or, alternatively, they choose their friends according to their attitudes (peer selection). Not seldom, however, friendship environment turns out to be helpful in providing emotional support, and, what is more, it has the potential to offer a healing environment for already affected victims and protection against eating disorders (Rorty, Yager & Rossotto, 1993). Wertheim (1997) found that a number of girls reported that other girls had stopped vomiting after friends dissuaded them from such weight-loss strategies. In connection with the time that teenage girls spend with their friends in schools, this shows the significance of prevention programs in the environment of school.
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1 minimum healthy weight = fifteen percent below the average weight of the respective age group
2 BMI: body mass index – a measure and value derived from the weight and height of an individual. It is defined by the body mass (in kg) divided by the square of the body height (in cm²)
3 parotid gland: in the neck, behind the cheek bone and below the ear
4 positive energy balance: energy intake exceeds energy consumption. Both positive and negative energy balances are not to maintain permanently but rather to be equalized.