by RO_Admin
With Thanksgiving right around the corner, and food being a big issue for lots of young people, we wanted to post this interview we did with Dr. Raine Weiner, a therapist who specializes in eating disorders. If you or someone you know is struggling with an eating disorder, please check out our resource page at ReachOut.com/eatingdisorders. And if you’ve overcome an eating disorder and would like to share your story to encourage others, submit it online here. We also encourage you to check out Proud To Be Me, a new site for teens about body image created by the National Eating Disorders Association.
Reach Out: Can you clarify the difference between bulimia and anorexia?
Dr. Raine Weiner: Distinguishing between anorexia and bulimia can be quite confusing. The symptoms of these two eating disorders often overlap. Bulimia Nervosa involves repeated food binges followed by self-induced vomiting, laxative/diuretic abuse, restrictive dieting, and/or over-exercise. Anorexia Nervosa occurs in people who refuse to maintain a healthy body weight. They often starve themselves or severely limit their intake of food. Anorexics obsessively fear gaining weight and often have a distorted self-image. The similarities between anorexia and bulimia are in that those suffering from these illnesses spend enormous amounts of time thinking about food, weight, and body size. With both eating disorders, people may use rigorous exercise, laxatives, food restriction, and diet pills in their attempts to control weight. They tend to be highly critical of their bodies. It is not uncommon for anorexics and bulimics to switch from one type of eating disorder to another or have symptoms of both, which sometimes makes separating the two illnesses virtually impossible.
RO: What are some of the dangers of being anorexic or bulimic?
RW: Since bulimia involves consuming large amounts of food, self-induced vomiting, and/or laxative abuse, it is not surprising that severe health issues can result. Vomiting can cause injury to the esophagus and the stomach lining. Purging increases acidity in the mouth, causing the tooth enamel to erode. Fasting and vomiting result in fluid and mineral loss which can lead to kidney stones and even kidney failure. These imbalances can contribute to irregular heart rate and sudden death. Laxative abuse can also cause mineral imbalances, dehydration, and constipation. The digestive tract can be harmed with significant damage to the colon.
The body needs food in order to function properly. Therefore, given the long periods of starvation, there are many medical complications arising from anorexia. For girls who have already started their periods, anorexia will usually cause amenorrhea (no periods). The lack of nutrition also leads to anemia (iron deficiencies), dehydration (fluid loss), flaky skin, hair loss on the scalp, and hair increase on the arms/legs/torso. Anorexics usually feel cold and their fingers can appear blue. Since they don’t eat enough calories, they don’t think clearly or quickly. The lack of calcium in their diets results in bone loss that can be permanent, leading to broken bones and curvature of the spine. Starvation also can result in heart rate abnormalities and even death.
RO: How do problems with body image relate to eating disorders?
RW: One characteristic that is common to all eating disorders is poor and distorted body image. People with eating disorders tend to be highly critical of their bodies. In trying to change their appearance, they sometimes go to extreme measures. We all know, however, that nobody is perfect. No matter how we try to change our bodies, if we are unhappy with whom we really are, no number on the scale will ever be OK. If you’re sad or anxious, it’s not really about your weight, even if it might feel like that’s the problem. Think about what is going on in your life that’s making you upset. Are there problems with friends? Is something going on at home or with your family? Are you stressed out at school or work? Maybe if you get some help with changing situations that make you unhappy, you’ll find your self-image and body-image will be more positive as well!
RO: Do you think the media has any influence over the prevalence of these disorders?
RW: The media has a huge affect on the prevalence of eating disorders. Television, magazines, music, art, fashion and almost everywhere you look, the emphasis is on thinness and weight loss. How are we supposed to feel good when we are comparing ourselves with airbrushed and digitally enhanced photos of models who have personal trainers, chefs, fashion consultants, make-up artists, etc.? We need more positive, realistic role models in the media and in our daily lives.
RO: What can people do if they have a friend or family member who is struggling with bulimia or anorexia?
RW: If you know someone with an eating disorder, the most important thing is to find the courage to say something to him or her. People with eating disorders might deny their problems at first, but they will take in what you have to say, and one day this may lead toward seeking help. Let them know how much you care and that you are concerned. If the person you are worried about is a teen or young adult, don’t be afraid to tell an adult. Don’t assume that his/her parents already know. Very often, friends are the first ones who notice, and for college students, the parents might be far away and unaware. If you are not sure what to say, call me or anyone at an eating disorders center close to you. We get numerous calls from people trying to figure out what to say to their friend or relative. Sometimes you just need some help with finding the right words.
RO: What are some of the biggest obstacles to recovery?
RW: There are many obstacles to recovery. Perhaps the biggest is denial. People with eating disorders often deny their problem. Sometimes even families are unable to see that a loved one is suffering or they are ashamed they can’t fix the problem by themselves. As a result, eating disorders continue to wear people down for a long time before treatment is sought.
Recovery is sometimes blocked or slowed because anorexics and bulimics tend to fear change and loss of control which they associate with letting go of their illness. They are terrified of gaining weight and living their lives without what feels like the “structure” and “comfort” of repeating their eating disordered patterns. The resulting anxiety makes them less motivated for recovery. It is only with great amounts of support and encouragement that the process of recovery can begin.
Another obstacle to recovery is financial. The recovery process can be a long one resulting in high costs for treatment. Insurance companies have been reluctant to pay for this necessary treatment or only cover therapy for a minimal length of time. Of course, many people do not have insurance coverage. As a result, too many of them are not getting the help needed to work toward recovery.
RO: What can a person expect if he or she decides to seek help from a therapist?
RW: It can be a bit scary to seek help from a therapist. However, it’s a lot less frightening once you get in the door, and we can really be warm and helpful. You pick your friends, so you should pick your therapist. Find someone with whom you feel a connection fairly early on in treatment. Every client is different as is every therapist, so it’s hard to say exactly what to expect in therapy. Chances are, your therapist will want to know why you came to therapy at this time. He or she will also want to know about your family, friends, and general activities (work, school, etc.). You’re always free to say whatever is on your mind. If there’s a question you’re not ready to answer, that’s OK, too. Over time, your therapist will help you understand why the eating disorder started in the first place and how to cope with stresses in your life in healthier ways as you work together through the recovery process. He or she might also want you to get a check up from your doctor, see a nutritionist, or maybe even get involved in a group with other people in recovery. Together you can work out what’s the best plan for you. Once you’ve gotten used to the idea, it feels good having someone you can talk to about all those thoughts circulating in your head. It takes courage to recover, and you won’t be alone in getting there.
What role does food play in your life? How do you maintain a healthy body image?
About Raine Weiner, PhD
Dr. Raine Weiner is a licensed clinical psychologist who graduated from the University of Michigan and received her doctorate from the California School of Professional Psychology in 1986. She ran a group home for emotionally disturbed adolescents in Los Angeles before moving her practice to Maryland in 1988. In 1991, she and Joan Hart, LCSW co-founded the Eating Disorders Center of Potomac Valley and Potomac Valley Psychotherapy Associates.
Top image by tollieschmidt
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