WOULD AND EATINIG DISORDER CONSTITUTE, ONLY KEEPING STEAMED VEGGIES IN THE FRIDGE AND BARLEY EATING THOSE AND THEN WHEN YOU DO EAT THOSE PURGING THEM? I MEAN NOT TO BE STUPID I KNOW THAT THAT WOULD BE, BUT LIKE AFTER I WAS RAPED I PUT ON ALOT OF WEIGHT AND THEN LOSING IT, I WOULD RATHER NOT EAT ANYTHING TRYING TO GET TO WHAT I ONCE WAS ETC... DOES THAT MAKE SENSE??

DaisySue:
that makes a lot of sense to me. I had an ED before I got raped. I was anorexic, then bullimic. From what I understand, it's pretty common to switch and flip flop between the types kind of like in cycles. I continued to be bullimic after my rape but my ED got so out of control then I kind of switched to binge eating only without purging. I gained 30 lbs. I also understand it's really common to gain weight/ alter your appearance in other ways to make yourself feel "safe." It's a symton of trying to make myself unattractive to men so that wouldn't happen to me again. I finally changed my eating habits for the better and lost 20 lbs the right way... but then this summer, I slipped back into a number of unhealthy behaviors, one of which was purging. I didn't really binge though, just purge everything I ate most days... other days I wouldn't purge at all.

I was studying abroad this summer. Matt, I was wondering if you think this might be similar to what you describe in your book about being a survivor not really living up to what you imagine in your head... b/c I was away from my therapist all summer. And since being a "survivor" and acting like a "survivor" didn't live up to my expectations, I just turned back to unhealthy behaviors. I really think I use purging to self injure the way someone who cuts does. I notice that the urges come at times when I'm uncomfortable or experiencing emotions I don't want to feel. I think it's the only coping method I know how to use right now.

I'm back home though.... and starting my journal !!!
FINALLY!

I'm interested in talking about ED on this board if it's of interest to others/ and OK with everyone else.

About 50% of people with anorexia nervosa become bulimic along the way; bulimia is the more common of the two. There is a lot of confusion between bulimia and anorexia nervosa, purging type.

Anorexia and anorexia nervosa are different; the first is simply a loss of appetite. But anorexia nervosa is a form of deliberate food refusal because of underlying thought processes. Within AN, there are two subtypes: purging and non-purging type.

Purging type: using vomiting, enemas, diuretics or laxatives to vacate food. This is what Daisysue is describing: food restriction PLUS bingeing.
Non-purging type (also called "restricting type"): no purging is used; food is simply refused.

The difference between AN/Purging Type and Bulimia is that one of the diagnostic criteria for bulimia is a bingeing process before the purging. Without this exorbitant bingeing, a diagnosis of bulimia is not correct. Not all forms of bulimia involve purging by vomiting, either; over-compensatory exercise is a "non-purging" form of bulimia.

To summarize: any form of food refusal to the point of medical self-harm is anorexia. If binge-eating factors in, the diagnosis changes to bulimia. So it's the eating patterns, not the purging or starving patterns, that differentiate between the two. Not all bulimics are thin; about half actually maintain a normal body weight. In AN, though, body weight is 15% or more lower than normal.

There is a third class of ED that goes undiscussed, and it's "binge-eating disorder." That's what besidesthat is describing, and i also have a case of it in my group right now.

ALL forms of ED are ways to compensate for emotional discomfort and distress; body image and beauty are secondary (or lower) on the list of intentions.

Are you interested in knowing more about how these are diagnosed, or other factors about them?

yes please, I would like more info on the Purging type diagnonsis and factors.

Diagnostic Criteria

1. Refusal to maintain body weight at or above a minimally normal weight for age and height (e.g., weight loss leading to maintenance of body weight less than 85% of that expected; or failure to make expected weight gain during period of growth, leading to body weight less than 85% of that expected).
2. Intense fear of gaining weight or becoming fat, even though underweight.
3. Disturbance in the way in which one's body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or denial of the seriousness of the current low body weight.
4. In postmenarcheal females, amenorrhea, i.e., the absence of at least three consecutive menstrual cycles. (A woman is considered to have amenorrhea if her periods occur only following hormone, e.g., estrogen, administration.)

Specify type:

* Restricting Type: during the current episode of Anorexia Nervosa, the person has not regularly engaged in binge-eating or purging behavior (i.e., self-induced vomiting or the misuse of laxatives, diuretics, or enemas)
* Binge-Eating/Purging Type: during the current episode of Anorexia Nervosa, the person has regularly engaged in binge-eating or purging behavior (i.e., self-induced vomiting or the misuse of laxatives, diuretics, or enemas)


Anorexia nervosa was first described in 1686. but not formally introduced as a medical diagnosis until the mid-1980s. About 5-15% of ED cases are males; most are females. The average age of onset is between 13 and 24, and estimates for ED among young women range from 5% to 20%, depending on the definitions used to identify ED's.

Anorexia nervosa has the highest mortality rate of any psychiatric illness.

Other questions?

My daughter binges, but does not purge. Instead she exersizes an ungodly number of hours a day to work off what she eats. She recently started therapy for an eating disorder. I felt stupid not recognizing it as such. (I mean, I am married to a doctor and pretty well read and educated. How did I not see it in my own child?) Anyway, I just wanted to point out that you don't have to purge to have an ED

Iguess that is similar to what besides that described, but without noticable weight gain or loss.

Empowered: you say "during the current episode" I know nothing about this, so do ED's run in "waves" if you will? I certainly never really thought about what I was doing as an ED, however I did gain 70 lbs after my rape and two years ago lost 50 of it by tons of exercise and barely eating.

Yes, it can go in waves and cycles. Some people with bulimia, for example, describe themselves as "failed anorexics" who believe they have lost their struggle for control, so they alternate between the poles of bingeing and purging. And when an ED is a result of rape, the ED behaviors may last as long as it takes for the woman to either diet or binge herself into what she feels is a deliberately-unattractive body as a form of protection; the eating behaviors may come and go, but the ED mindset persists. This comes directly from the stuck point, "I was raped because I was pretty." That one stuck point alone is, I think, where I have a unique BENEFIT in being a male therapist, because I can show a patient a deep form of love, understanding, acceptance, respect, loyalty, and even friendship (yes, therapists DO offer friendship in certain contexts!), and she can see that it has NOTHING to do with how she looks. I don't want anything from her; I don't make her feel "obligated" to reciprocate for my love; I don't work with her because she looks a certain way; she can stand up to me and say "no" to me without destroying our alliance...and these strengths survive regardless of her looks. For many women, therapy with me is one of the first times they AREN'T treated or judged a certain way because of how she looks, whether she's pretty or not. And believe me--it crosses their minds: they want to know, "is Matt doing this because of how I look? Is it okay that he feels affection for me? Or does that mean something's wrong?" These are reasonable questions, and they pertain to that stuck point, and if she will discuss them with me openly she is usually very reassured afterward.

One interesting theory about ED is that it involves a split cognition, "two minds" if you will, between the "negative mind" and the "actual mind." This is basic cognitive-behavioral theory, but personified. These two mindsets do verbal battle in the head of the sufferer, with the negative mind supplying criticism, "shoulds", and scolding that you don't deserve to be nurtured, nourished, sustained, or given care. The negative mind is much stronger and in control by the time therapy begins, and the therapist has to anticipate the NM's tactics and ally him/herself with their patient's "healthy mind" and help it recover.

This is why women with anorexia nervosa (in particular) are SOOOO good at care-taking everyone else BUT herself. She will often have the family role of "invisible peacemaker," discouraging others from confronting or directly addressing obvious power struggles in the family ("don't say anything about it! You'll make it worse!"). She will be meek at home, absorbing tension and angst from others, but seldom or never speaking up about her OWN needs. Look for her to have a career as a nurse, a teacher, a youth worker, a therapist, a medical tech, or other care-taking position where the dependent needs of others are paramount. You can often see traits of this early in her childhood: she is extremely concerned, even distressed, by injustice: crime, the rainforests, litter, traffic, bullying (she will often be her younger siblings' protector in childhood), pollution, etc. She will want things to "be right," ordered, symmetrical, and planned: clean, tidy, low-volume, proper. If one family member is more controlling than the others, she will be very deferential around him/her, often being the one hurt the worst but assuring others, "I'm okay, it's fine, PLEASE don't say anything about it!"

The definition of "stress" for an anorectic woman is unique: it pertains to what everyone ELSE is going through. See, if you ask ME if I'm stressed, I'll say "yes, because I got six new patients all at once, and I'm tired." But if you ask HER if she's stressed, she will say "yes, because my mom isn't feeling well...my grandmother is in the hospital...there's this kid at work who isn't doing well...dad is mad these days...my boyfriend failed a test..." Notice the contrast? Her stress is absorbed from OTHER peoples' predicaments. She symbolically ingests their stress, ruminates over it, and holds it within herself as she toils to straddle the schisms in her family, her job, and her world. This becomes the basis for food refusal: she cannot fill herself with a source of personal nourishment or nuturance, because it takes up space in her that she feels should be available to absorb everyone ELSE'S needs, and that makes her selfish. There is, as a result, very little arrogance or narcissism in anorectic women. Despite the cultural stereotype of these women as self-absorbed beauty wannabes, the reverse is true: they see themselves as fundamentally undeserving of personal care, and thus their self-worth comes from being others' caretakers rather than self-assured. This also makes it hard for her to ask for help: her worst nightmare is having her family/loved ones fear for HER, or become concerned for HER. It makes her feel guilty and selfish. The responses of loved ones to ED are crucial for this reason, and if a family is not well-guided by a therapist familiar with ED, their collective display of concern, grief, fear, and shock can inadvertently reinforce her ED, rather than soothing it.

As a result, you should expect to see the ED behaviors become more pronounced--worse--during times of distress or crisis in OTHER people. If her sibling is ill, she will become more stringent in her food refusal or purging. If her mother and father have had an argument 9or if there is violence at home), her own chances of purging increase. If her father is distant and unemotional, she will ingest this personally and become further entrenched in her disorder (this, by the way, is PRECISELY why stacks and stacks of new research suggest that a MALE therapist can be a preferred fit with an anorectic woman! It allows the transference to occur between patient and male therapist, in order to challenge and redesign her beliefs and feelings about male caretakers! For years, people assumed "female anorectics need female therapists so they will 'understand' each other." BZZZT! The problem is finding male therapists who are invested and trained in ED treatments! Maybe that should be my million-dollar specialty??). In therapy with an ED patient, the therapist and patient will collaborate on keeping a record of ED-related behaviors, and correlate that with external family/job/relationships stresses. That helps to pinpoint the etiology of the behavior: does daughter vomit more when mom is angry and fuming about something? Does daughter vomit more when a family member is depressed, in therapy, in a hospital, going through a breakup, etc.? Does food become more feared when dad is tense and easily angered this week?

As you can see, the dynamics to this are complex. This is NOT something that can be treated by saying, "your appointment is Thursday, 3-4 PM, and then we'll see you in a week."

Maybe it would be good to talk about the type of role the therapist should take in treating an eating disorder. But what other questions do you have?

Also, there are therapists who specialize in EDs at a lot of colleges and universities. My daughter is seeing a "nutritionist" at her school and is having great results.

True; in fact, I used to meet with the sports psychologist at OK (University of Oklahoma) to do in-services about sexual assault and ED. Their health services program recruited me in a few years ago to train their therapists in working with ED students. They didn't know I worked with ED at first; they initially invited me to do rape response training, and they learned about my work with ED and other issues and had me come back. The trouble with (some) campus counseling programs, though, is that ED treatments usually require a long-term investment from the therapist and family, beyond the one-hour weekly session; the therapist has to be willing to be "on-call" for the family, to meet with them, and even socialize with them.

ED and rape trauma are two specific types of therapy where therapists are SUPPOSED to form bonds that extend into the patient's outer life, as opposed to "we only see each other in therapy sessions, with no further outside interaction" like in drug/alcohol, anger management, and mainstream CBT counseling.

Empowered, I have an odd question: Is it possible that the same traits/characteristics that you described in a person with ED can exist in someone, and instead "show itself" in the form of another disorder (such as obsessive-compulsive disorder, in particular) ?

Oh, yes! In fact, OCD is an early clue to an eating disorder to the eye of a trained therapist. That's a "label" to describe the "I have to do things right or it'll be disastrous"-thinking of the ED sufferer.

Just for fun, here is something I wrote when I was working with ED in therapy. I began to notice certain repetitive traits in the families of origin of ED--rules and beliefs--that leaped out at me. Some of this is paraphrased from Alice Miller's work on child abuse, but it's not copied; I composed this in response to what I saw in ED families (you also see these rules in sexual abuse/incest families). BTW, you don't have to be the actual person with the ED to live in these rules; you could also be the sister, mother, or daughter of an ED sufferer and recognize them!

â?¢ The child is responsible for the parentâ??s anger. You must anticipate your parentsâ?? needs and feelings, and adjust yourself around them.
â?¢ The parent must always be protected, not confronted. Rules cannot be questioned, and the child must assist other family members in â??peace-keepingâ?? by encouraging quiet submission to how things are.
â?¢ The childâ??s life-affirming feelings pose a threat. Thus, a child must not become rowdy, impulsive, rambunctious, or powerfully emotional. â??Stop your crying or Iâ??ll give you something to cry aboutâ?? and â??You shouldnâ??t feel that way, thatâ??s ridiculous.â??
â?¢ The childâ??s will must be broken as part of the maturation process. Having childlike traits as an adult is evidence of flawed growth, not inner spirit. Youâ??re X years oldâ??you need to grow up and take control of your life now, putting away those foolish dreams.
â?¢ Hatred can be done away with by forbidding it.
â?¢ Anger can be banished by direct order, too.
â?¢ A feeling of duty produces love/autonomy produces guilt. â??Iâ??m not angry, Iâ??mâ?¦disappointed.â?? The child is there for the parent, rather than the parent for the child. As long as you detect and react to the needs of others, you will be valued in some way. Independence or rebellion becomes taboo (â??donâ??t confront Dad; youâ??ll only make it worse!â??)
â?¢ Being told you are loved is more likely after you have performed some act that conforms to the parentâ??s expectations of duty and correctness.
â?¢ Parents deserve respect simply because they are parents.
â?¢ Indeed, all adults must be respected and obeyed. (molesters LOVE kids raised with this rule!)
â?¢ Children cannot say â??no,â?? unless itâ??s to deprive themselves of something.
â?¢ Children are undeserving of respect because they are children.
â?¢ A pretense of gratitude is preferable to honesty and genuineness.
â?¢ A high degree of self-esteem is harmful.
â?¢ A low degree of self-esteem makes a person altruistic and kind.
â?¢ An angry parent will abandon their child or neglect their childâ??s needs until that parentâ??s anger subsides. Thus, children learn that anger equals rejection, and become frightened of making a mistake that might â??causeâ?? their parent to storm away from them. The child grow up to fear becoming angry themselves, from a belief that â??my anger makes me like an abuser.â??
â?¢ Obedience makes a child strong. Success is measured by accomplishment, not by inner quality of life.
â?¢ Tenderness, doting, and vulnerability are harmful and feminine. Indeed, all traits labeled â??feminineâ?? are devalued and stereotyped.
â?¢ Severity and coldness are good preparations for the real world. â??Building characterâ?? becomes code for harsh treatment.
â?¢ The way you perform and appear is more important than the way you really are.
â?¢ Your failure will embarrass the family.
â?¢ The body is dirty and disgusting; sexuality is dangerous and must be subdued.
â?¢ Strong feelings are harmful and must be repressed so you do not lose control.
â?¢ If the most powerful family figure does â??lose controlâ?? of their feelings, it was caused by the carelessness of the less-powerful subjects in the family.
â?¢ Parents are creatures who have mastered their drives and guilt, and thus are always right.
â?¢ Self-care is selfish, as long as any other personâ??s needs remain unmet.
â?¢ Donâ??t tell people outside the family about anything that dissatisfies you with the family. Protect the family image.
â?¢ People outside the family will not connect and bond with you from genuinely altruistic motives; they do so in response to secretly wanting something from you.

Oh, yes! In fact, OCD is an early clue to an eating disorder to the eye of a trained therapist. That's a "label" to describe the "I have to do things right or it'll be disastrous"-thinking of the ED sufferer.

Just for fun, here is something I wrote when I was working with ED in therapy. I began to notice certain repetitive traits in the families of origin of ED--rules and beliefs--that leaped out at me. Some of this is paraphrased from Alice Miller's work on child abuse, but it's not copied; I composed this in response to what I saw in ED families (you also see these rules in sexual abuse/incest families). BTW, you don't have to be the actual person with the ED to live in these rules; you could also be the sister, mother, or daughter of an ED sufferer and recognize them!

The child is responsible for the parentâ??s anger. You must anticipate your parentsâ?? needs and feelings, and adjust yourself around them.

The parent must always be protected, not confronted. Rules cannot be questioned, and the child must assist other family members in â??peace-keepingâ?? by encouraging quiet submission to how things are.

The childâ??s life-affirming feelings pose a threat. Thus, a child must not become rowdy, impulsive, rambunctious, or powerfully emotional. â??Stop your crying or Iâ??ll give you something to cry aboutâ?? and â??You shouldnâ??t feel that way, thatâ??s ridiculous.â??

The childâ??s will must be broken as part of the maturation process. Having childlike traits as an adult is evidence of flawed growth, not inner spirit. Youâ??re X years oldâ??you need to grow up and take control of your life now, putting away those foolish dreams.

Hatred can be done away with by forbidding it.
Anger can be banished by direct order, too.

A feeling of duty produces love/autonomy produces guilt. â??Iâ??m not angry, Iâ??mâ?¦disappointed.â?? The child is there for the parent, rather than the parent for the child. As long as you detect and react to the needs of others, you will be valued in some way.

Independence or rebellion becomes taboo (â??donâ??t confront Dad; youâ??ll only make it worse!â??)

Being told you are loved is more likely after you have performed some act that conforms to the parentâ??s expectations of duty and correctness.

Parents deserve respect simply because they are parents.
Indeed, all adults must be respected and obeyed. (molesters LOVE kids raised with this rule!)

Children cannot say â??no,â?? unless itâ??s to deprive themselves of something.
Children are undeserving of respect because they are children.

A pretense of gratitude is preferable to honesty and genuineness.

A high degree of self-esteem is harmful.
A low degree of self-esteem makes a person altruistic and kind.

An angry parent will abandon their child or neglect their childâ??s needs until that parentâ??s anger subsides. Thus, children learn that anger equals rejection, and become frightened of making a mistake that might â??causeâ?? their parent to storm away from them. The child grow up to fear becoming angry themselves, from a belief that â??my anger makes me like an abuser.â??
Obedience makes a child strong. Success is measured by accomplishment, not by inner quality of life.

Tenderness, doting, and vulnerability are harmful and feminine. Indeed, all traits labeled â??feminineâ?? are devalued and stereotyped.

Severity and coldness are good preparations for the real world. â??Building characterâ?? becomes code for harsh treatment.

The way you perform and appear is more important than the way you really are.
Your failure will embarrass the family.

The body is dirty and disgusting; sexuality is dangerous and must be subdued.
Strong feelings are harmful and must be repressed so you do not lose control.
If the most powerful family figure does â??lose controlâ?? of their feelings, it was caused by the carelessness of the less-powerful subjects in the family.

Parents are creatures who have mastered their drives and guilt, and thus are always right.
Self-care is selfish, as long as any other personâ??s needs remain unmet.

Donâ??t tell people outside the family about anything that dissatisfies you with the family. Protect the family image.

People outside the family will not connect and bond with you from genuinely altruistic motives; they do so in response to secretly wanting something from you.



P.S.: in the early days of ED treatment, most people focused on the "overbearing and hysterical mother" as the root cause. I never felt this was true, and rebelled against using that hypothesis/bias in my own therapy. I did see, however, a lot of recurring traits of controlling, cold, and narcissistic FATHERS in ED families. An Lo! and behold, if I don't come across this just today (in a book I've read 3-4 times since 2002):

"Even though early researchers focused on mothers and mothering, over the last few years there has been more emphasis on the role of fathers in the development of eating disorders. One issue where the effect of the father's role has been discussed is when a father applies his sense of values, achievement, and control to areas where they are misinterpreted or misused. For example, achievement and control should not be values to strive for in the area of weight, body image, and food." (Dr. Costin, p. 171)

As for the OCD stuff, there is a psychological AND medical component. Medically, OCD relates to serotonin errors in the brain, and drugs like prozac seem to work well with OCD and ED as long as the patient's weight is at normal limits (prozac doesn't work in malnourished patients). Psychologically, it fits hand-in-glove with the ED sufferer's "quiet desperation" to do things precisely right: organizing, mirror-checking, counting, tapping patterns, teeth-grinding patterns, etc. This is a symbol for the greater fear of being "wrong" as a person--a living mistake--and hoping to compensate by finding a combination of correct performances and actions. Thus, the emphasis not only on ritual, but on care-taking and nurturing of others.

Stupid DS can't decipher quote marks. Sorry.