eating disorders certification part 3

Dr. Dawn-Elise Snipes PhD, LPC, CRC, NCCClinical Director, AllCEUs.com

Unlimited CEUs for $99 per year. Copyright AllCEUs

Kierkegaard concluded that one root of all human misery and anxiety is the dilemma we confront when we must choose.

The eating disordered patient must try to make “good” choices about their bodies and remain true to their deepest needs and selves.

What are these deep needs and selves and how are they enhanced or thwarted by societal messages?

Discuss Societies relationship with food, compulsive eating, dieting and eating disorders


Fatness has traditionally been a greater preoccupation in western than in Third World countries

Investigators explored the body image concerns of immigrants from Africa to Great Britain.

African women in general enjoy their fuller figures. Kenyan women who have resided in Britain for only four

years will have adopted the British viewpoint. Hispanic women yielded similar results.


Eating disorders must also speak to the difficulties individual women have in regulating their self-esteem

“The likelihood of women betraying our bodies by any means increases when we find it difficult to be true to ourselves, because we have not had the resources to develop a sense of self”◦ Thinness and weight control is a “solution” to what

problem?◦ What role models that we have that perpetuate this? ◦ In what ways is betraying our bodies a “solution” if we

have no stable sense of self?◦ Have eating-disordered patients ever been true to their

bodies and selves? What about as infants?


One generally conceded risk factor in the development of eating disorders is the dissolution of family meal time.

When children are left to fend for themselves at meal times, the responsibility proves too great for most of them.

Many children will not only eat beyond their physiological needs but will also tend to make up for psychological deprivation by eating too much.

This is also compounded by family meal times that revolve around watching television when eating meals. Not only does this contribute to "mindless" eating, but it also conditions the television as a discriminitive stimulus to prompt a person to eat.


Dining together promotes interpersonal support for good times and bad.

The current pattern to the regular meals, nonstop eating throughout the day, lack of socialization during the all-time and the resulting need to fill one psychological hunger with food all paves the way for eating disorders.

Mealtimes punctuated by fighting and antagonism will exacerbate eating disorders.


Women have internalized the notion that the size and shape of a body was a measure of worth.

Those in the Victorian period believe that the process of losing weight to bring spiritual as well as physical transformation.

Think about early Victorian era when women who wore corsets, fainted easily, and prized pale, China doll like skin. ◦ What messages did this communicate? ◦ What was attaining this a solution to?◦ What was valuing these characteristics a solution to for

the men?


Is there a place for dieting?

In what ways does our society create a situation where dieting is a reasonable solution and an end in itself?

Left to their own devices, it is speculated that people would eat enough to fuel their bodies.

American media has created a climate that promotes irresponsible eating by:◦ equating food with comfort◦ supersizing everything◦ promoted indulgence and immediate gratification


A study completed at the University of North Carolina of the body weight and attitudes among 3100 grade school children. ◦ 40% of boys and girls believe their fat ◦ Of these 30% have dieted ◦ 10% have fasted◦ 5% had vomited

Youngsters were only 7 or 8 years old were as preoccupied with slimness and dieting as their adolescent counterparts.

Alarmingly, their parents often concurred with them.


It is thought the women of color in Western society have a lower incidence of eating disorders.

What cultural factors promote alternate solutions to problems reducing eating disorders in women of color?

In the United States to surveys of examined eating attitudes and behavior of African-American women. ◦ 3% of African-American women and diagnostic criteria for

bulimia which was significantly less than a comparable group of white students.

◦ Interestingly, African-American and white subjects binge with about the same degree of frequency

◦ African-American women reported less self induced vomiting, laxative abuse, and diuretic use.


The contemporary woman may choose anorexia to express her cultural dissatisfaction as a way to gain control of her life

Anorexic women have at their core, a deficit in the sense of self leads to an impaired identity.

The primacy placed on control of appetite and the willingness to surrender oneself to the attainment of an ideal are all attempts to feel more assured and self-reliant.

Women who find themselves held back may be more prone to a “solution” such as eating disorder that offers the illusion of bodily perfection and is a clearly measurable achievement.


In an environment that does not challenge the developing child’s sense of what is important, or effectively teach problem solving, ineffective solutions are bound to flourish.

The child may blame herself or her inability to consistently engage her parents.◦ How is an eating disorder a solution to this?

Other parallels have been drawn between eating behavior and femininity. ◦ In one study women who ate smaller meals while on a

date were rated is significantly more feminine, less masculine, and more attractive than women who ate large ones.


75% of women and 54% of men said that they often think about the physical appearance and would prefer that their bodies were different.

Among women, 78% a dissatisfied with their weight and 35% want to lose 25 pounds or more. Men were also dissatisfied with their physique: 56% would like more hair and 34% like to be taller.

Both men and women are preoccupied with getting older.

◦ Why? What do they hope to gain from that? ◦ Is weight loss a reasonable solution to providing this gain?


The time, attention, money, and energy spent on appearance necessarily shifts us away from discovering ourselves

◦ Solving what problem? What are alternate solutions?

This investment in the body masks a deeper dread of looking at the self starkly and honestly.

Could it be said that the eating disorder serves the escapism

purpose of an addiction?


In the book “The image and appearance of the human body" psychoanalyst Paul Schilder teaches us about ◦ how we form a mental picture of our body◦ why we value our body the way we do◦ what can go wrong with our body image in certain

psychological and neurological states.

How do we determine where we end and someone else begins?

How are eating disorders a solution to this?


"Every emotion changes the body image. The body contracts when we hate, becomes firmer, and its outlines towards the world are more strongly marked... We expand the body when we feel friendly and loving. We open arms, we would like to enclose humanity in them.“

Think about the child who is embraced by a mother who is unable to self-soothe, who becomes irritated and angry at the child's incessant crying, who subconsciously rejects it through her hardened nonverbals which only causes the child to cry more.

What messages does this send a small child?


According to Alfred Adler what an individual perceives one aspect of the body as inferior, the person tends to generalize this inferiority to the entire self-concept.◦ In what ways can a parent's or others communicate to a

child that part of them is inferior? ◦ Does it matter whether it is a physical parts, a cognitive

part or in emotional part that is communicated as inferior?

◦ In what ways does the eating disorder act as a solution in the person senses that he or she is inferior?


Eating disordered patients often talk about their bodies as hideous receptacles or as harboring parts that attack or otherwise persecutory.

One patient complains "my big stomach will make me explode" another explains that her body was "a gift for everybody else's enjoyment" but not her own

An anorexic patient may avoid interpersonal contact with her parent or peers because she must maintain a rigid wall or else others will fuse with her. ◦ This is one “solution” of trying to correct the familial

enmeshment.◦ The eating disorder may cause sufficient conflict to keep

others away


One patient said "I like to see what I put in when I throw up. I need to see every piece. I know exactly what I've eaten and that I can control whenever I take in because I can get it out when I want to.“◦ What is this a solution to?

Bulimic persons activities/”solutions” may revolve around the quest to feel alive as they normally experience oneself and one's body as inherently empty or dead


Women continue to shave because it's the norm, believing hairlessness is more appealing to men.

This illustrates that so many of our ideas about our body are conditioned or habitual.

Women are supposed to be thin, and if they are not, the culture assumes that they are unhappy, dissatisfied, lazy, sloppy, and ugly

Women with eating disorders have had personal experiences with social rejection in connection with appearance.


Studies on bulimic individuals show that they are inordinately concerned about shape and weight.

They frequently report that they "feel fat"

Fat is not a feeling.

Helping the patient ◦ use her menu of feelings◦ help her identify what feelings are related to "fat.“◦ Help her identify how “fatness” or food has been a

solution◦ Help her identify how she believes “thinness” will be a

solution


Anorexic and bulimic patients ◦ place a high personal value on body shape ◦ may exhibit depressed mood◦ low self-esteem is manifested in a more general state of

self-deprecation

They describe the terror of being touched lest someone see their cellulite even when they are attractive they believe they are ugly and unacceptable

Investment in one's body to the exclusion of other concerns provides the solution of avoiding connection or dependency on others.


Some schools of thought assert◦ Eating disorders are expressed aspects of body hatred

and masochism. ◦ The disorder comes to embody the quest for pleasure

and pain ◦ The individual consciously denies this aspect of the

disorder

Are they truly seeking pleasure from pain? Are they trying to find a rational explanation/ “solution” for

an intrapsychic pain for which they can find no cause or cure?


Patients with eating disorders describe a dreaded state of being with their own bodies. ◦ How is the ED a solution to this? (Hint: dissociation and

dissolution)

They lack an internal cohesiveness that allow them to understand when to eat or how much to consume. ◦ How is the ED a solution to this?

Body image difficulties stem from the earliest times of life and often reflect failures of the process of separating from the family of origin in an age-appropriate way and thereby attaining autonomous functioning. ◦ How is the ED a solution to this?

Because the separation problems occur so early, individuals may lack the ability and words to express their feelings. ◦ How is the ED a solution to this?


Feelings become concretely expressed through the body.

Some schools of thought postulate that the body is abused in part to engage the care taking persons.

Individuals must learn how they are using the eating disorder to make significant statement about their needs.

◦ List the emotional, interpersonal, behavioral and societal factors that may contribute to the development of eating disorders.


eating disorders certification part 3

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