A Parent's Guide to Understanding Anorexia Part 1/2

What is Anorexia?

Anorexia Nervosa, often just called Anorexia, is an eating disorder wherein an individual has a distorted body image. This misperception leads to an avoidance of food and severely restricted caloric consumption. Low body weight and an intense fear of gaining weight are characteristic traits. Anorexia is a psychophysiological disorder which, if left untreated, can eventually lead to death.

Who might be at risk of developing Anorexia?

Anyone can develop an eating disorder, however there are certain individuals who seem to have an increased risk. Women are, of course, more likely to develop an eating disorder than are men. That said, the rates of Anorexia Nervosa in men is increasing somewhat. More research is needed to determine the cause of eating disorders, however those at risk may include high strung individuals with a stringent set of ideals. People who exhibit perfectionism in their pursuits both academically and extracurricular. Someone with a family history of obesity. An individual prone to dieting on a regular basis. A history of physical or sexual abuse. Someone who has been subject to bullying and/or teasing. Elite athletes who believe their success depends on maintaining and achieving a certain ideal weight. Aspiring to a profession which focuses on weight and appearance (dancers, models, actresses, etc.) Someone who struggles with depression or anxiety. A tendency toward addictive behaviors, perhaps manifest in alcohol or substance abuse.

What are the signs and symptoms of Anorexia?

The symptoms of Anorexia can be easy to hide, initially, but to a concerned and watchful parent they should become relatively easy to spot, particularly as the disorder progresses. Keep in mind, however, that generally the person suffering from the eating disorder will feel guilt and shame and will try to prevent anyone from noticing their struggles. Warning signs may include;

  • A refusal to eat certain foods. This may be in the form of cutting out an entire food group, i.e. carbohydrates, sugar, fat. It may also be just individual foods like no longer eating beef or refusing to eat bread.
  • Always being ''on a diet''. This can become a common excuse for avoiding food and social situations where food may be served. It is so common for young women, in particular, to be on a diet that until the weight loss becomes excessive this may not be considered a problem.
  • Strange eating patterns. Cutting up food into tiny pieces, chewing each bite a certain number of times, eating only one food at a time, refusing to let foods touch, pushing food around the plate.
  • Excessive exercise. Anything more than an hour per day of high intensity exercise would be considered excessive. Many elite athletes do exercise more than this, but for the average young woman this could be cause for concern. Current recommendations are 2-3 days per week of weight bearing exercise with 8-12 repetitions of the exercise per body part. 3-5 days of cardiorespiratory training for 20-60 minutes per session. 2-3 days per week of flexibility training.
  • Wearing baggy clothes to hide her figure. This could be because the individual feels fat and wants to hide her supposed horrible figure. It could also be an attempt to hide the excessive weight loss from not eating. Additionally, sometimes there is a desire to avoid growing up and baggy clothing can hide the fact that a womanly figure is emerging.
  • Preoccupation with food. Wanting specific information on nutritional values of foods, knowing the exact fat and calorie content of foods, talking about and thinking about food all of the time.
  • Weight loss. This is a relatively obvious sign, however initially the weight loss may be seen as a good thing. If the young woman was somewhat overweight, the initial weight loss may be complimented. This acknowledgment and attention may feed the desire to lose even more weight. Anorexics typically can get down to less than 85% of normal height and weight for age.
  • Sensitivity to cold. Loss of body fat leaves the body sensitive to temperature and feeling cold when everyone around is comfortable.
  • Labeling foods ''good'' ''bad'' etc. Giving a moral connotation to the foods available and feeling guilty for eating ''bad'' foods. Eventually even healthy foods can be designated as ''bad'' because of a high calorie content. Good examples of this would be nuts and avocado.? Dizziness or lightheadedness. Drop in blood pressure, dehydration, iron deficiency anemia. All can lead to dizziness and lightheadedness. This may be particularly sensitive to change in position.
  • Frequent headaches.
  • Avoidance of social situations which may involve food. As mentioned above, the excuse that she is "on a diet" may be used to avoid social situations. People who have Anorexia don''t necessarily want people watching them eat. This may be because they don''t want people analyzing what, if anything, they are eating. Additionally, it could just be a way of avoiding the temptation of food. It is a common misperception that Anorexics don''t get hungry. This is not the case. They do feel hunger, but their fear of weight gain and desire to be ''in control'' of their appetite is stronger than their hunger.
  • Absence of menstrual periods (amenorrhea). Strict dieting and excessive exercise can lead to a disruption in the flow of hormones. Consequently, the body doesn''t produce enough estrogen and progesterone. Ovulation is suppressed and menstruation stops.
  • Anxiety and/or depression. This is a vicious cycle in regards to eating disorders. Feelings of anxiety, depression, and low self worth can lead to Anorexia. The physical and mental effects of the Anorexia can lead to even more depression and anxiety. The eating disorder and depression continue to feed off of each other, each aggravating the other.
  • Eating rituals such as only using a certain cup to drink out of or always insisting on a certain fork. These are small methods of exerting control over the environment where food is involved.
  • Increased interest in food, cooking, collecting cook books etc. Although someone with Anorexia will avoid eating, the hunger causes a huge interest in food. Being around food and providing food for others become almost an obsession as the body fights for the nutrients it needs but is being deprived of.

Avalon Hills Eating Disorder Treatment Center is located in Utah and has two eating disorder clinics for anorexia and bulimia. Learn more about anorexia symptoms

Singing and Eating Disorders


Eating disorders are now epidemic. Singers and others in the entertainment business with its requisite media exposure are, I believe, especially vulnerable to these debilitating secret illnesses.

No one can approach their full vocal potential while chained to an eating disorder. Why? Because the voice will have problems in these areas:

  • Breathing (Power)
  • Tone (Path through an open throat)
  • Communication (Performance)

That''s right --- with an eating disorder --- everything I teach in Power, Path & Performance vocal training ... everything necessary to the workings of your voice ... is compromised and plagued with problems; some very pesky to diagnose and correct.

From denial to her long-term recovery from anorexia/bulimia, I''ve been Jenni Schaefer''s voice teacher and friend. Jenni recovered using a unique therapeutic approach that involved treating her eating disorder as a relationship, rather than an illness or condition. Jenni actually named her anorexia/bulimia, "Ed," an acronym for "eating disorder." She and I co-wrote the song "Life Without Ed" which is also the title of her McGraw-Hill book endorsed by Dr. Phil and many others.

Testimonials tell us her story is powerful, so here it is from both our points of reference:

What I noticed the first time I met Jenni was her strange numbness. She couldn''t move out of the ''guarded stance:'' slumped shoulders, head hung forward, eyebrows frozen, jaw clenched, spine and hips frozen, arms limp and legs locked. She was like a stick figure. Her voice was thin, colorless. She complained that her throat hurt when she sang. Her range was limited, and she had several ''breaks'' in her voice. I tried to help her loosen up, but I could barely get her to lift her arms from her sides to allow ribcage expansion. She inhaled from the upper chest in short gasps.

Jenni speaks... "With Ed, I was disconnected from my body... felt like a floating head. I was rigid and had difficulty moving. In therapy sessions, I was encouraged to ''just move'' --- anything."

I also had a lot of trouble helping Jenni connect to her songs. When I asked her to visualize singing "Valentines Day" to someone she loved, she couldn''t think of anyone! Finally she began to connect by imagining singing to children in a cancer ward where she had worked. An odd thing... She didn''t want me to look at her when she sang.

Jenni... "I was disconnected from feelings. I lived in my head. A big purpose of my eating disorder was to starve and stuff feelings --- to keep me out of my emotions. So when I was supposed to connect with feelings in a song, it was not only completely foreign to me, it was also terrifying."

Jenni was easily deflated and crushed. I had to be very careful not to push her too far with exercises. She somehow needed to sing, but music didn''t seem to move her. Because she didn''t have the energy to keep her posture erect and flexible, she usually just stood still and lifeless. Or walked like a zombie.

Jenni..."I had no energy --- restricting, bingeing and purging requires a lot of energy (physical and emotional) and leaves little left for anything else."

Jenni couldn''t understand why she didn''t feel something. She would watch me express feelings she couldn''t experience, and I think that was a big part of why she reached out for help. She asked me to pray for her. She thought since she didn''t feel something, she couldn''t pray herself.

Jenni... "Singing is spiritual. An eating disorder kills all spiritual connection. This was a huge hurdle."

Little by little, as Jenni got help, she got stronger. However, voice lessons became even harder. She developed a diaphragmatic spasm of some kind and a kind of fatalism took hold, making her expect the strange uncontrolled vibrato weirdness to happen at a certain place in her range. I sent her to Vanderbilt Voice Clinic. Only when they couldn''t find anything organically wrong did Jenni start to believe she could beat this strange vocal problem. Soon after, I was able to coach her into the flexible rib stretch necessary to allow the issue to completely disappear.

Jenni... "Anorexia is characterized by intense perfectionism. While singing, I would concentrate more on being perfect than on getting a greater message across."

Jenni kept improving, but it was two-steps forward, one-step back. It was hard for her to picture singing to someone. She was stuck in self-consciousness. She began to experience feelings, but with the feelings came anger at being critiqued, which made her feel judged. At one point, I suggested she practice differently and she flew into a rage. I didn''t see it coming. I didn''t read the signs that said I was pushing too far, and the lesson ended in disaster.

Jenni... "All eating disorders are characterized by constant self-criticism. It is difficult to sing when a negative voice is constantly screaming in your ear."

The trust and friendship Jenni and I had developed made the misunderstanding short-lived. We got back to the business of vocal training and then another challenge set in. It was a long season of intense sadness. I was afraid for her; she would cry, literally for days, and then go numb. She pushed people away, saying she had no friends. For a while, she stopped singing and cancelled voice lessons.

Jenni... "Depression is often an underlying symptom of an eating disorder. When lost in despair and hopelessness, singing can seem too vulnerable because emotions might leak out. So Ed would often build yet another ''protective'' wall."

Jenni and I began working together again, and this time every lesson seemed to break new ground. Her recovery was solid, her physical and emotional health much more stable. I watched her persevere with great courage through those monumental battles of recovery. And I listened to her find her voice at last.

One of the last pieces in the puzzle was put in place by the brilliant performance coach Diane Kimbrough. Diane told Jenni to stop worrying about ''going there'' every time she sang. She said this is way too much pressure for an artist to have to re-experience the emotional scene during every performance. Instead, Diane suggested, forget yourself and make THEM (the audience) feel something! It was a miracle.

Jenni stopped focusing inward and made the connection, through the song, to someone else. Her voice is now strong, controlled, confident and beautiful. She FEELS joy, frustration, anger, and love. All of this is giving her a voice with which to rock the world. She speaks and sings all over the country to entertain, teach and prove that recovery from an eating disorder is indeed possible. And oh, I so love to hear her laugh!

For those struggling with an eating disorder, we hope you read in our story that it''s never too late to reach out for help, start healing- and start singing your heart out!

Judy Rodman - singer/songwriter/producer/vocal instructor, developer of... Power, Path & Performance? vocal training - Website, Newsletter and Blog: http://www.judyrodman.com Jenni Schaefer - singer, songwriter, speaker, author of "Life Without Ed" Website: http://www.jennischaefer.com

Eating Disorder Predisposing Factors

Written by: Fabio Piccini, doctor and Jungian psychotherapist, in charge of the "Centre for Eating Disorders Therapy" at "Malatesta Novello" nursing home in Cesena. Works privately in Rimini and Chiavari. E-mail: piccini@anoressia-bulimia.it
First version: 26 Nov 2006. Latest revision: 26 Nov 2006.

Question(s):
Which factors make it more likely that a person will get an eating disorder?

Answer:

Research on eating disorders has shown that it is not possible to attribute only one cause to an eating disorder development.

Eating disorder development has been described as a three-phase process where the presence of certain risk factors creates a predisposition to fall ill; for this reason some people become more vulnerable to eating disorder development.
When these more vulnerable people have to face up to very stressful events, there is a high probability that they will develop an eating disorder rather than psychological, psychosomatic or other kinds of pathology.

When the eating disorder is stable, it is prone to self-maintenance.

There are different factors that predispose people to develop an eating disorder. Some predisposing factors are:

* Being a woman. It is undeniable that a woman is more subject to the slimness cult than a man.
* Being between the ages of 15 and 35. Eating disorders reach their peak in this age bracket.
* Suffering from depressive disorders and having particular personality traits.
* Being overweight. It has been noticed that many eating disorders begin with a strict diet in overweight people.
* Having a family where weight and body fitness are considered important problems.
* Having been victims of sexual abuse during childhood and adolescence. An incidence of abuse victims is of statistical importance in eating disorder patients.
* Growing up in a family that had not transmitted enough self-esteem, trust in oneself and the capacity to recognize and elaborate emotions.

The presence of two or more factors will create in people a predisposition to suffer from eating disorders that will be stronger as the factors increase.

Causes of Eating Disorders and Obesity in Children and Adults


Written by: Gunborg Palme, certified psychologist and certified psychotherapist, teacher and tutor in psychotherapy.

First version: 26 Nov 2006. Latest revision: 04 Jul 2007.


Question(s):


What are the causes of eating disorders and obesity in Children and Adults?

Answer:

There are various contributory causes of eating disorders and often several of these may act in combination.

* The ability to distinguish between hunger, satisfaction and other feelings is learned when one is very young. Faulty upbringing can interfere with this. The effect is often not noticed until later in life.

* Eating disorders often arise when a person tries to reduce to an abnormally low weight. The unnatural slim ideal may be therefore a contributory cause of eating disorders.


* Many people with eating disorders are not aware of their physical feelings of hunger and satisfaction. Thus, they lack a natural control of their eating. Such people will easier be pulled into eating disorders, where they use eating to conceal feelings and escape from constructive problem solutions.


* Both overeating and fasting can stimulate the reward centre in the brain. Eating disorders therefore function in the same way as alcoholism and drug addiction. The same personality traits which increase the risk of alcoholism and drug addiction also increase the risk of eating disorders.

* The personality traits which increase the risk of eating disorders are partly hereditary. Addictive problems or affective disorders (depression, etc.) are more common among relatives.


* Some of the personality traits involved are: a tendency to please others and a low ability to assert one's own needs; a need to reduce unsettling feelings of anxiety, depression and low self-confidence; perfectionism and problems with impulse control. More about personality.


* Eating disorders are more common among women and those who are affected by social attitudes and body ideals and who also lack the ability of following their own feelings and needs.


* Children of overweight parents, and parents with an exaggerated interest in body shape, more often get eating disorders. Also, demands from the family and insecure family circumstances increase the risk.


Overweight occurs if you eat more fat than your body can consume. Both biological (somatic) and life-style factors can cause overweight. Eating disorders (see above) can also cause overweight. There are also some illnesses and drugs which can make a person more susceptible to overweight.

Causes of Addiction and Eating Disorders


Written by: Gunborg Palme First version: 26 Nov 2006. Latest revision: 14 Sep 2007.

Question(s):


Is there any connection between eating disorders, alcoholism, smoking and drug addiction? Are the causes of anorexia, bulimia and binge eating the same as the causes for alcoholism, smoking and other addictions?


Answer:

Research on eating disorders has shown that there are similarities between many cases of eating disorders and addictive conditions such as alcoholism and drug addiction. The human brain has special reward centres and these are normally activated when a person feels well, takes care of the body, behaves sensibly, is praised, is in love, exercises, etc. More.

It is also possible to stimulate these reward centers by artificial means. Drugs of all kinds forbidden and permitted, produce chemical stimulation which is an important part of the cause of addiction. Stimulation also blocks unpleasant feelings and therefore those with eating disorders, as well as those with other addictive disorders, may use them to block unbearable feelings.

Normal people get their stimulation of the reward center by doing good things. They are stimulated by exercise because it is good for the body to get exercise. They are stimulated by eating, because it is good for the body to get nourishment. They are stimulated by being in love, because it is good for the survival of the human race that people mate. They are stimulated when they have achieved something or when they get appraisal because it is good that people do constructive things.

However, if the reward centre is stimulated by drugs, alcohol or abuse of food, they cease to function in the way they should. Abuse is a short cut to false happiness, a happiness which doesn't come from doing something good.

Incorrect usage of the reward centres is especially common with people who have a personality requiring a lot of reward effects in order for them to feel well, and also have worry and stress which can be reduced by drugs.

There is accordingly a common factor with many types of addiction:

  • Alcoholism and drug disorders
  • Eating disorders
  • Compulsive sex dependence
  • Compulsive gambling
  • Compulsive exercising
  • Self-injury and anorexia nervosa (even body injury can stimulate the reward centre in order to protect the body from pain).

This means that much of what is known about the treatment of alcoholism and drug addiction can be used for eating disorders. The patient's own ego must be strengthened and taught to refuse the kind of eating pattern which tempts with quick artificial solutions.


A similarity between eating disorders and drug addiction is that the addiction is compulsively developed into an even stronger form regardless of the effect on the patient's health. Despite serious medical complications, it is difficult for addicts to give up their addiction. Starvation in anorexia reduces the activity of the hormone Serotonin and this in turn reduces anxiety in a patient with an overactive nervous system. Patients with anorexia are, less often than others, drug addicts and alcoholics while those with other eating disorders more often are so. Those anorectics who alternate between eating attacks and starvation are more like bulimics.

Research shows, for example, that personality types that more often feel stress and anxiety, need more stimulation in order to feel well.

Research also shows that those with eating disorders often have excessively low values for dopamine and CSF-5-HIAA as well as Serotonin which causes them to feel more stressed than others and that many drug addicts began with compulsive eating before going over to drugs and furthermore that certain hereditary characteristics increase the risk of eating disorders and drug addiction.

However, everybody with these hereditary characteristics does not become an addict as there are other ways of managing the problem, e.g., medicine which stabilises the concentration of Serotonin in the brain may help (in combination with other treatment) those who have eating disorders.

Anorexia Can Give You a Feeling of Satisfaction


Written by: Gunborg Palme, certified psychologist and certified psychotherapist, teacher and tutor in psychotherapy.
First version: 27 Nov 2006. Latest revision: 25 Jul 2007.

Question(s):

Is anorexia similar to drug addiction?

Answer:

People who fast can get high from starvation. Many anorectics describe how starvation reduces psychic anguish and how the anxiety returns when they begin to eat again. It seems as if anorexia stimulates those substances in the brain which affect the pleasure and reward centre, and thereby enables them to control and avoid psychic anguish in the same way as alcoholics and drug addicts do.