Eating Disorders: A Spectrum Illness

According to US estimates from The National Institute of Mental Health, between 5 per cent and 10 per cent of girls and women (i.e. 5-10 million people) and 1 million boys and men suffer from eating disorders, including anorexia, bulimia, binge eating disorder, or other associated dietary conditions. Estimates suggest that as many as 15 percent of young women adopt unhealthy attitudes and behaviors about food. Amongst psychological disorders, they are the most deadly. A common misconception is that eating disorders are about weight, shape, size, and food. Actually, they are not at all about any of these. Instead, these things are only what is visible and the underlying development of eating disorders is related to much deeper rooted factors. Eating disorders are a spectrum illness meaning that the different types of diagnoses exist along a continuum. Eating disorder like behavior occurs as part of a spectrum of self destructive acts. There are different degrees of severity and varying phases of the illness and recovery process.

These illnesses affect one’s psychological and biological well being and unless appropriately diagnosed and treated, the illness cycle can continue to affect every aspect of a person’s life. Treatment needs to focus on the care and feeding not only of the body and mind, but also of one’s soul.

If you or someone you know is struggling with any of these issues, it is essential to ask for help from an appropriate professional. The treatment and recovery of eating disorders needs to be multidimensional including nutritional rehabilitation, symptom management, cognitive behavioral therapy, and psychotherapy to discover the function that the bingeing, starving, or purging is fulfilling. Despite much debate, it is possible for someone with an eating disorder to recover!

Discussed below are descriptions of the various diagnoses along this spectrum of illnesses.

ANOREXIA NERVOSA

The term Anorexia comes from Greek origin (privation, lack of) anorexia (appetite). This means a lack of a desire to eat but this term is not sufficient to describe the illness. The addition of the word Nervosa describes the condition more completely (lack of desire to eat due to a mental condition). Persons with this disorder struggle with much more than loosing their appetites, they actually have a longing desire to eat. Some often give in to their rigid behaviors and eat with no control as a result of being starved. Eventually a person with Anorexia may actually lack their appetite because their body has become so confused through the restricting, possible binging and purging. Despite not feeling hungry, the mind sends constant impulses to eat because starvation is against what the normal body instincts are. Most clearly stated, this syndrome is due to a psychological disturbance where food is the outer expression of the problem. A person believes that they are in control if they are thin. Anorexia is the most rare of eating disorders and also the most deadly. Many anorexics develop bulimia nervosa at some point because of the body’s inability to maintain starvation that is self induced.

BULIMIA NERVOSA

The term bulimia comes from Latin and means “hunger of an ox.” People with this diagnosis often have tried to control their weight by restricting their food and have been unable to do so. The result is bingeing and then purging out of a fear that they will gain weight from the binge. Bulimics are usually at or above a normal weight but still try to restrict their intake to keep a weight that is too low to maintain. A key feature of this illness is that although it appears to be about dieting and weight control end up becoming a way to regulate one’s feelings of anxiety and depression. The act of purging can become addictive. Bulimics are often more ashamed of their illness and because they have such a sense of being out of control, they usually come into treatment more willing than anorexics to end the behaviors.

BINGE EATING DISORDER

This disorder is comprised of individuals who binge on large amounts of food with no efforts to compensate for their excessive intake of calories. BED is usually associated with people who are overweight and/or obese but is not limited to this population. The eating is often associated with a specific triggering event and usually followed by self loathing and physical discomfort. The health consequences are also critical for this illness and the behaviors are debilitating in terms of the likelihood of social isolation and guilt that are often associated with these behaviors. At this point the knowledge about the psychosocial risk factors is still limited and further research needs to be done to understand the factors associated with the development of the illness.

When dealing with these illnesses it is clearly necessary for the person to receive the appropriate medical and therapeutic care. Although they can be a life long struggle it is so important to understand that an individual with one of these diagnoses can recover. The road to recovery is usually long but extremely worthwhile. The personality traits that may have led a person into an eating disorder are also the traits that can be used as the willpower to recover and lead a productive and fulfilling life.

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Couple Counseling

By Don Damsteegt, PhD • 20 Sep, 2023
By Don Damsteegt, PhD Relationships are the greatest source of joy in our lives and the greatest source of pain. When couples come to Family Psychology Associates for assistance with their relationship, they experience caring counselors whose goal is to create a safe environment in which to talk to one another, to improve communication, and to improve problem-solving. A specialized technique for couple counseling is Imago Relationship Therapy. This counseling approach emphasizes the importance of listening to one’s partner and validating what is heard for the purpose of one’s own and the other’s growth. When people come for counseling they will be encouraged to practice dialogical communication, which means not immediately responding, but first listening and then acknowledging what was heard. This makes it safe for the speaker to speak and it allows the listener to understand the speaker at a deeper level. For example, a common pattern is for Partner A to say, “I’m frustrated about X.” Partner B may then say, “Why are you frustrated?” or “Just get over it.” or “What did you do to make the other person react that way?” All of these responses invalidate what the speaker has said. We might say this is normal communication, but it is not helpful communication. In couple counseling, the counselor emphasizes listening and validating what the speaker has said. For example, if one partner (the speaker) says, “I’m frustrated about X,” the other partner (the listener) seeks to respond with empathy and understanding. “So you are frustrated about X. Did I get that right? Is there more to that?” Then the listener will seek to validate and empathize with the speaker. “If I were in your shoes I would feel frustrated too. It makes sense that you would want X not to do that. I can imagine that makes you feel hurt.” This is called “Mirroring, Validating and Empathizing (MVE)” This style of communication is rare. One of the gifts that couple counseling offers is a chance to be able to express yourself in a vulnerable manner and to know that your partner will receive the communication with empathy and without judgment. This style of communication allows for safety and opens the possibility of more emotional intimacy. This is a tool that partners can use in situations where emotions run high, such as hurt feelings or feeling very grateful. Research has shown that learning to understand your partner’s inner world and communicating one’s understanding in an empathic way improves relationships. If you are struggling with frustration in a relationship, please feel free to call Family Psychology Associates (319-378-1199) to set up a counseling session with your partner.

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Pain Management

By redilson • 15 Dec, 2013
By Bud Perschek In the spring of 2014 while living in Oregon, I was recruited for and asked to participate and help pioneer a new program. At that time, more emphasis was being placed on the negative and long last effects that opiates were having on patients. Physical dependence on opiates affected all who were placed on them. Psychological addiction was also becoming prevalent. Physicians, who had been previously encouraged to prescribe pain medications, were now being instructed wean their patients with chronic pain off of them. This proved to be a dilemma for those who had been on these medications, sometimes for years. In response it was suggested that much of the perceived physical pain may be able to be addressed with a more natural and effective behavioral approach. I remember when I went in to discuss the program. I said to them: “But I don’t know anything about Chronic Pain.” They all said “Yes you do.” I know now that the skills they were looking for had nothing to do with medications or traditional medical treatment. It had to do with an approach that would address the additional psychological pain many chronic pain sufferers endure. There was a mandate to get chronic pain sufferers off of opiate medication, but how we going to do it? Given this I agreed to help establish a pain management program that covered the Northwest portion of the state. We did have an initial model to draw from on the structure of the Program. It would be conducted in groups of 5 to 10 clients. It would run weekly for 10 sessions. I remember that there was a lot of initial tweaking to the program to help make it educational, informative and effective for the participants. My learning curve was never so steep. I must admit, I had my doubts. Why would I say that? It seemed like an insurmountable task. Deep breathing; restructuring the way you think; laughter; diet; sleep hygiene; body movement? What? Body movement for a person in pain??? No one was more surprised than me when we started getting good results. 95% of the participants reported that the program was “very helpful” to them and I was tickled pink. I don’t think we cured their chronic pain, but it was successful in helping them perceive pain differently. As the program progressed, we began noticing something else. We had a number of participants who were also in mental health treatment. Their therapists began noticing that their psychological symptoms had improved, and a lot of the improvement was attributed to their participation in the pain clinic program. I guess it makes sense, physical and psychological pain have a lot of the same characteristics. So, we began to expand the program to include and address those with psychological pain. I really hated to leave the program, but it was time to relocate back to Iowa. After moving I contacted the director of The Wellness Center in Cedar Rapids. I had heard that they were interested in a pain management program. I volunteered my time and we successfully graduated two classes. Then Covid hit. Since doing the pain management program, I have become a firm believer in a more holistic approach in working with our clients. The pain clinic opened my eyes to explore other more natural ways to address the whole person. I am trying to incorporate the principles I have acquired from the pain clinic to individual therapy. I do believe, however, that a group model is more conducive primarily because of peer interaction. I hope soon to re-establish a pain management group at Family Psychology Associates in Cedar Rapids. We shall see.

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