People who are all about thinspiration engage in disordered eating in order to be as thin as possible — a common symptom of anorexia. But they don’t see it as a disorder or a problem, making this an insidious problem.

Nonetheless, such eating and self-image problems can result in health problems, even putting the individual’s life at risk.

Some people have sought to get common words or terms that people engaged in thinspiration use banned from social networking websites. One such woman is Torri Singer, a broadcast journalism major who has recently begun a petition to get such terms banned from Twitter.

Many social networks have already climbed aboard the bandwagon, including Tumblr, Instagram, Facebook and Pinterest. And while such policies have been implemented, thinspiration content is still easily found on many of these networks. I suspect that’s one of the challenges of implementing a policy like this — it’s extremely difficult to police, especially if people can just slightly alter the terms they use to talk about these issues.

But that hasn’t stopped Torri from putting Twitter on notice.

“[I want] to raise awareness about the harm of destructive thinspiration messages, and to prompt Twitter to make real change in order to stop the spread of this preventable growing trend,” Singer recently told me. Her inspiration for this campaign came from family:

My sister suffered on and off with eating disorders in her early adult life, so preventing other intelligent, strong, and beautiful girls from forming or elongating their disorders has always held a place of importance in my life. I know how difficult it is to be a girl and have constant exposure to beauty ideals, I don’t think we need any more pressure from self-generated pro-eating disordered “lifestyle” hashtags.

But when a website or social network changes its Terms of Use to remove such discussion from their networks, can it be an effective deterrent? “There is no doubt that other media sites such as Facebook, Instagram, Pinterest, and Tumblr have a long way to go before they are really safe and free of thinspiration triggers,” replied Singer.

“But they have made the first steps toward taking action and being responsible for the safety of their users.”

She also addressed people trying to change the spelling of terms they were using to get around the service’s policing efforts: “Instagram’s initial attempt to limit thinspiration led users to create new spellings (such as thynspo). Instead of giving up on the effort, Instagram revised the policy, stating it will disable “any account or hashtag found to be encouraging eating disorders.”

“The first step is ensuring that these messages are not readily available, and that is where policy change comes into play and really matters.”

Of course, trying to stamp out discussion of a topic on the Internet is impossible, given the hundreds of millions of websites, social networks, forums, and online communities. “By reducing the number of mainstream venues where these pro eating disorder messages are displayed,” Singer says, “we are reducing the exposure, and therefore the dangerous behavior that results (or continues) because of these online interactions.”

I agree — efforts such as Singer’s can make a perceivable impact on the popular, mainstream sites, reducing the likelihood of exposing this ideology to a new, naive audience. Especially when that site is a social network as large as Twitter.

“Banning thinspiration terminology means less accessibility to damaging phrases, encouragement, and images that propel disorders,” notes Singer. “It will prevent susceptible people from forming eating disorders, and people recovering/struggling with eating disorders from exposure to triggers.”

“In my mind, just getting people to have this conversation means that it has been some degree of successful. It is really amazing to see people who sign generating comments about their personal stories and their struggles. Many have said that thinspiration has been a big trigger in their lives and that they support any effort to ban it from impacting others like them.”

Efforts such as Singer’s are a good attempt at bringing attention to the problem and helping people understand that use of these kinds of keywords and hashtags only reinforce the disordered behavior — on a scale that wasn’t readily possible just five years ago. We applaud and support Singer’s petition and efforts to help reduce thinspiration messaging on mainstream social networks.

We encourage you to sign the petition:
Twitter: Restrict use of thinspiration language and hashtags

It’s the holidays.  Magazines focus on our waistlines and ways to survive the season while keeping a slender figure. I’m all for good health, but we’re frequently sold an image, product or diet that does not always result in good mental or physical health, particularly for women.

What’s your ideal weight?  In one alarming study, adolescent girls described their ideal girl as 5 feet 7 inches tall and weighing a mere 100 pounds.

This ideal is — at best — unhealthy and, for many, anorexic. 

And while it’s unattainable for most girls, they still hold it.  In doing so, they are more likely to be dissatisfied with their bodies, no matter their shape or size. They may feel disgust and revulsion toward themselves and envy and bitterness toward others.  Carrying this skin-and-bones ideal is associated with low self-esteem and the development of eating disorders.

Males also can hold unhealthy, unrealistic body ideals and suffer from similar dissatisfaction and distress.  According to one study, when boys experience body dissatisfaction, it is more likely associated with large, muscular bodies than a thin and skinny image.

Body image is believed to be a less prevalent issue for boys, who tend to view their bodies as a tool, rather than as a means of attracting others, but it is also a much less studied topic.

So where does the desire to be skinny come from?  The answer is both complex and simple.  It can be transmitted through family, peers, schools, athletics, business, and health care professionals.

But advertising is the most aggressive source of the overly slender image, according to a study in the International Journal of Eating Disorders. Thinness is equated with goodness and self-control.  Slender images are used to sell diets, cosmetics and exercise programs.  The female body is portrayed as an object of desire and when girls and women feel they don’t live up to the ideal, they are more likely to feel shame and anxiety.

Some simple strategies to improve body image include:

Putting down the magazine. 

Make a choice not to subject yourself to ideals and images that will make you feel worse about yourself.

Seeking healthy role models. 

Role models can help girls and women focus on eating to sustain healthy, functional bodies, rather than on dieting to become skinny.

Refusing to talk about dieting. 

Peers have a huge influence on adolescent girls, but our friends affect our worldview at any age. Resist the urge to talk about dieting, especially non-nutrition-based fad diets, with friends.

Not isolating yourself. 

Encouraging adolescent girls to develop healthy relationships with peers may prevent them from developing body dissatisfaction, according to one study.

If you or someone you know is struggling with body image problems or with an eating disorder, you can get more information from the National Eating Disorder Association.

Beautiful images of fashion, art, vacation destinations, and food: what’s not to love about Pinterest?

Well, after seeing several pins labeled “thinspiration,” displaying overly thin women and quotes like, “All I want is to be happy, confident, and skinny as hell,” I decided it was time to speak up.

The image in this post is of me, back in my modeling days. This photo was very popular with friends and family on Facebook and with my followers on a modeling website I was a member of at the time.

If Pinterest had been around back then, I definitely would have pinned it for all to see.

Some may look at this image and see a woman that offers “thinspiration,” but the truth is actually much darker.

See, for over a decade, I was obsessed with diet and exercise and was constantly skating on the edge of being diagnosed with an eating disorder.

For many years, the side effects of my lifestyle were of little concern. There was plenty of outside validation and even envy toward my dedication and discipline to diet and exercise. I even landed a modeling contract, receiving more encouragement to maintain my slender frame.

But after a decade of living this harsh and rigid lifestyle, I received a wake-up call that changed the way I viewed my body forever.

At the ripe old age of 26, I was diagnosed with Osteoporosis.

Often referred to as a “silent killer,” this bone-thinning disease had been developing for close to a decade without any pain or discomfort.

And that was only the beginning.

Amenorrhea, digestive issues and painful intercourse were just a few of the other not-so-glamorous truths hidden in the above photo. Eventually, depression, chronic illness and overuse injuries would also be added to this list.

Think this can’t happen to you? Think again.

35 percent of “normal dieters” progress to pathological dieting. Of those, 20 to 25 percent progress to partial or full-syndrome eating disorders.¹

Up to 24 million people of all ages and genders suffer from an eating disorder in the U.S.² About half of young female patients with anorexia nervosa have osteoporosis.³ And some of the other side effects of eating disorders are just as common. For example, up to 50 percent of people with eating disorders meet the criteria for depression.⁴

Eating disorders have the highest mortality rate of any mental illness.⁵

Pinterest makes it clear they do not promote eating disorders right on their site, but images promoting “thinspiration” are still getting pinned.

And Pinterest is just one of several sites facing this “thinspiration” battle. Youtube and Livejournal are also on the list, as are many other sites, some dedicated completely to the “Thinspo” ideology.⁶

All of this indicates that more awareness needs to be raised about the negative side effects of overexercising and undereating.

So let’s start a Pinterest revolution.

Let’s see how many times we can get this image re-pinned, and let’s make it known that “thinspiration” is not as sexy as everybody thinks it is.

The last thing we need is more content promoting an unhealthy, unrealistic body image. What we do need, however, is a bit more inspiration to look within and develop a healthy, loving and understanding relationship with our own bodies.

1. Shisslak, C.M., Crago, M., & Estes, L.S. (1995). The Spectrum of Eating Disturbances. International Journal of Eating Disorders, 18(3):209-219.
2. The Renfrew Center Foundation for Eating Disorders, “Eating Disorders 101 Guide: A Summary of Issues, Statistics and Resources,” 2003.
3. Osteoporosis and Eating Disorders. Eating Disorders Review, 11 (5). Retrieved from http://www.eatingdisordersreview.com/nl/nl_edr_11_5_11.html on 12 November 2012.
4. Mortality in Anorexia Nervosa. American Journal of Psychiatry, 1995; 152 (7): 1073-74.
5. Mortality in Anorexia Nervosa. American Journal of Psychiatry, 1995; 152 (7): 1073-74.
6. Stonebridge, V. L. (2011). Thinspiration: New Media’s Influence on Girls with Eating Disorders. Thesis, Department of Public Relations College of Communication, Rowan University. Retrieved from http://dspace.rowan.edu/bitstream/handle/10927/188/stonebridgev-t.pdf?sequence=1 on 12 November 2012.

It’s been hard in recent years to ignore young entertainers’ breakdowns, drug habits, and bad behavior. Demi Lovato, a 20-year-old singer/songwriter, actress, and newly appointed judge on the talent show “The X Factor,” has endured much internal struggle.

But she has courageously sought mental health assistance and boldly documented her journey to share with others for inspiration. Along with her “stay strong” motto, she’s demonstrated that obstacles can be overcome, which is what ultimately highlights her as a different type of role model.

Katie Couric (who struggled with an eating disorder during her college days) interviewed Lovato earlier this year. In a heartfelt discussion, the young celebrity opened up about the origins of her body image issues, and the time she spent at an Illinois treatment facility for anorexia, bulimia and self-mutilation.

“I always had self-confidence issues in my body and self-image problems,” Lovato said. “It also didn’t help that I had kids at school at such a young age that were really, really naturally thin, so I always felt like I was the bigger one of the group.”

She initially dealt with her insecurities by overeating, which then turned into starvation, along with binging and purging. Lovato said that certain traumatic situations could trigger those destructive habits, and she candidly spoke about being teased and berated by other peers at school.

“People don’t realize how badly cyber-bullying and verbal harassment affects you,” she said.

With regard to her eating disorders, she confirmed that being in control was important, and those unhealthy patterns developed as a coping mechanism. “Some people don’t want to feel the emotions that they have — I think I just didn’t want to feel.”

After Lovato instigated a physical altercation with one of her friends, she realized her emotions were out of control, and she knew she needed to get help. She checked herself into a rehab center shortly after the incident.

“Treatment was so difficult at first,” she said. “I remember walking around saying ‘I’m in prison,’ and they needed to have strict rules in order for me to understand how sick I was.”

The “X Factor” judge admits that while she’s currently in a comfortable place, these issues most likely will stay with her for the rest of her life. She noted that during these past two years, however, a new mindset recently clicked; a mindset of acceptance and embrace for her natural body.

This past July, Lovato told “Good Morning America” that she’s happier allowing others to see her flaws, and that’s what defines her as a new kind of role model.

“That’s what being a role model is about,” she said. “It’s not about being perfect. It’s about speaking about your issues and inspiring others to get help.”

Our taste buds are chemical sensors that pick up on taste acutely for the first few bites.  After eating a large amount, we may taste very little of what we’re eating.

So what does this have to do with belly fat and mindfulness?

According to clinical psychologist Jean Kristeller, PhD, president and co-founder of The Center for Mindful Eating, many of us are eating too often and too much.

We’re bombarded by advertisements for unhealthy foods and confronted with restaurant portions appropriate for two or three people.  Then we eat for all sorts of reasons: it’s time to eat, food is available or offered or we’re angry, anxious, depressed or bored.

With so many reasons and opportunities to eat, Kristeller suggests in this month’s Monitor on Psychology that we have become disconnected from feelings of hunger and satiety.

Kristeller first connected the practice of mindfulness with eating while studying food intake regulation at Yale with Judith Rodin, PhD.  Rodin was linking disregulated eating to a disconnect with hunger signals.  Kristeller began using mindfulness practice as a strategy to reconnect people with the body’s experience of hunger and satiety.

In her 10-week course in mindful eating, Kristeller teaches participants how to increase their awareness of their drives to eat and the triggers for overeating.  And yes, that includes teaching participants to pay attention to those first few scrumptious bites, but also to notice as food begins to lose its taste.

It’s about finding satisfaction in quality, not quantity, Kristeller says. And other researchers are testing her theory.  In one study, Gayle Timmerman, PhD, RN found that with mindful eating training for restaurant meals, participants showed a significant impact on weight and food intake.

In a second study with obese women, Elissa Epal, PhD, and her associate Jennifer Daubenmier found that the more mindfulness the women practiced, the more their anxiety, chronic stress and belly fat decreased.

By eating mindfully, you gain awareness of your enjoyment of food and eating.  By practicing awareness of hunger, noticing what your body feels like when full, and learning to savor foods, you also can recognize when the food in front of you no longer is enjoyable.

“I wondered what would happen if people started engaging with foods in this way,” Kristeller says in The Monitor.  Epal’s research studies so far indicate that with attention to eating, people can change their relationship to food “very quickly, and within a few sessions.”

It’s no wonder we have both increasing incidents of eating disorders, such as anorexia and bulimia, as well as increasing prevalence of binge eating disorder and rates of obesity.

Navigating this confusing world without falling into an eating- or weight-related disorder does require a return to some basic facts.

There are truths about eating and bodies which seem to get lost somewhere between childhood and teenage years. Young babies and toddlers generally find joy in their bodies, no matter what their size or shape, and they listen to their bodily cues such as eating when they are hungry and stopping when they are full.

But somewhere in the preteen years, these certainties shift and doubt takes over. A negative body image can, and often does, lead to serious, life-altering illnesses in millions of Americans.

The National Eating Disorder Association (NEDA) is an organization that supports families and individuals who are battling eating disorders. NEDA offers information, resources, action-oriented advocacy and media campaigns to educate the public and policymakers about eating disorders. Another critical and vibrant part of NEDA relates to prevention of eating disorders, highlighted specifically during the Eating Disorder Awareness Week each February.

7 Steps for Success

Based on facts which have been promoted by NEDA, there are seven steps for success when it comes to preventing an eating disorder.

• Everybody is different. We all have a different set of genes which determine much of our size, weight and shape. Even if everyone started eating the same things and did the same amount of exercise for a whole year, we wouldn’t look the same at the end of the year. Your “ideal” body weight is the weight that allows you to feel strong and energetic and lets you lead a healthy, normal life. Be comfortable in your genes and jeans.
• Listen to your body. Eat what you want, when you are truly hungry. Enjoy wholesome, nutrient-rich foods. Know that there are no good and bad foods, but rather those which have more or less nutrient qualities. Stop when you’re full. Eat exactly what appeals to you in a moderate, balanced fashion.
• No dieting. Dieting doesn’t work. Many individuals were dieting at the time they developed their eating disorder.
• Move often. Enjoy regular, moderate exercise. Do things you enjoy. Exercise for fun, fitness and function, not for exhaustion, deprivation or punishment. This will help you be strong, fit and relaxed.
• Reject weight bias. We aim not to judge others by the color of their eyes or skin; can you avoid judging others or yourself on the basis of body weight or shape? Respect someone’s character traits and accomplishments rather than their body shape.
• Avoid comparing your body with your friends’ bodies or with the people you see in the media. Choose role models who reflect a realistic standard and who stand for values of importance. Become a critical consumer of media and recognize its influential power on you.
• Handle life difficulties with healthy coping techniques, not through over- or undereating. Problem-solve, rather than create problems to avoid dealing with the true source of stress. Seek true forms of happiness and fulfillment.

If men, women, parents, teachers, coaches, children, teens, doctors, movie producers, advertising agencies and everybody started absorbing and practicing these invaluable truths, we might begin the journey of ending the existence of eating- and weight-related disorders.

For more information about NEDA and related resources, visit this site.

In honor of this year’s message, “It’s your time,” I want to draw attention to the link between how we see ourselves and how we treat our bodies.

Currently, 80 percent of women in the U.S. are dissatisfied with their appearance. And more than 10 million are suffering from eating disorders.

So the question I have to ask, Why all the self-hatred?

Body Image and the Media

Historically, the ideal female body was strong and full-figured, as seen in icons such as Marilyn Monroe. Yet even as early as the 1800s, when painful, health-impairing corsets were used to accentuate the breasts, hips and buttocks, women were expected to strive for a specific ideal of beauty.

In the 1900s, the American public became more consumed with the thin, boyish physique, viewing full-figured women as indulgent and lacking in self-control – a trend that grew exponentially by the end of the century.

In modern times, we’ve witnessed a “thin at all costs” movement that now defines Western culture. The U.S. has the highest rates of obesity and eating disorders in the world. As a melting pot of people from all backgrounds, there is no genetic reason that explains this increased vulnerability to weight, body and food issues. Instead, we have to look at the messages our society sends about how we value our citizens.
From a young age, women aspire to Barbie-like measurements that are physiologically impossible without surgery and/or starvation:

• According to the National Eating Disorders Association, 42 percent of first- to third-grade girls want to lose weight, and 81 percent of 10-year-olds are afraid of being fat.
• According to a study in Pediatrics, about two-thirds of girls in the 5th to 12th grades said that magazine images influence their vision of an ideal body, and about half of the girls said the images made them want to lose weight.
• By adolescence, studies show that young people are receiving an estimated 5,260 “attractiveness messages” per year from network television commercials alone.
• According to Teen magazine, 35 percent of girls ages 6 to 12 have been on at least one diet, and 50 to 70 percent of normal-weight girls think they are overweight.

Over time, models have gone from thin to emaciated, which has been mirrored by a growing problem of eating disorders and body image dissatisfaction. In 1975 most models weighed 8 percent less than the average woman; today they weigh 23 percent less. Compared to the Playboy centerfolds and Miss America winners from the 1950s, at least one-quarter of present-day icons meet the weight criteria for anorexia. Meanwhile, the average woman’s weight has increased.

Today, the media is a far more powerful influence than ever before, sometimes taking precedence over friends, family or other real women. Whereas women used to look at role models who were average-sized, women are now comparing themselves with images (some of which are merely computerized conglomerations of body parts) that are unrealistically thin. In the old days, a young girl grew up wanting to look like her mother or best friend. Now she wants to look like Angelina Jolie.

Herein lies the real damage. The more an individual is exposed to the media, the more he or she believes it is reflective of the real world. What most people still don’t realize is that the majority of the pictures they see in magazines are altered in some way and that looking like their role models is physically impossible. It is a setup for self-hatred.

Genetics and Thin-Heritance

As a result of both genetic and environmental factors, body image issues and eating disorder behaviors may be passed down from generation to generation. This concept, recently labeled “thin-heritance,” explores how a mother’s views about food, dieting practices, and negative attitudes and comments about her own body or her child’s appearance increase her children’s risk for poor body image and eating disorders.

Cultural Messages

Body image also stems from cultural messages. For example, in Polynesian culture, bigger once meant being healthier and stronger. In a landmark 1998 study of girls in Fiji, Harvard researchers demonstrated how the introduction of television contributed to dramatic increases in eating disorders over a three-year period. In a culture that once valued a healthy, robust physique, girls began viewing themselves as fat, going on diets and feeling depressed about the way they looked, all in an effort to look more like the Western women they saw on shows like the original “Beverly Hills 90210.”

After three years, 74 percent of Fijian teenage girls described themselves as too fat. Those who watched TV three or more nights a week were 30 percent more likely to go on a diet than their peers who watched less TV. Being called “skinny” went from a cultural insult to a worthy life goal.

Similarly, African-American culture is beginning to see a shift. While there used to be greater acceptance of women who were full-figured, now the younger generations are buying into the thin ideal, and we’re seeing famous African-American singers and actresses advertising dramatic weight losses.

Relationships

In all relationships, whether a boyfriend, spouse, peer, coworker, sibling or parent, people look for acceptance and validation. When they receive criticism, rejection or judgment instead, they are at increased risk of a number of mental health issues, including poor body image and eating disorders. Troubling behaviors range from a dirty look when taking a second helping of food at the dinner table to persistent weight-related bullying by one’s peers. All of these exchanges, no matter how subtle, can have a lasting impact.

A Glimmer of Hope

Amidst all of the negative media messages, there have been a few glimmers of hope in the past decade:

• In an effort to become ambassadors for the message of healthy body image, Voguerecently announced that it would no longer feature models under age 16 or those who appear to have an eating disorder.
• Fashion organizations in Spain and Italy have specified a minimum healthy body mass index for models.
• Israel’s government recently passed a law that requires a healthy body mass index for models as well as full disclosure if fashion media and advertising use Photoshop to change a model’s figure.
• Dove has been leading “real beauty” empowerment campaigns and taking a stand against Photoshopping for almost a decade.
• In 2002, actress Jamie Lee Curtis posed for a magazine both “glammed up” and in “real life” fashion to bring awareness to the way media images are digitally altered.
• Social media websites such as Facebook, Tumblr and Pinterest are increasingly banning pro-anorexia and pro-bulimia messages. At the same time, there are a growing number of websites dedicated to healthy portrayals of real women, including the I Am That Girl blog.

In spite of these trailblazing changes, a lot of progress has yet to be made. The majority of magazines and other media have not replaced unrealistic images with normal, average-sized people. Although awareness is growing, parents and other authority figures can do more to model healthy self-image and diet, limit exposure to media, openly talk about media messages and share daily family meals. What we need is a broad-scale cultural shift that will only come about when we start demanding it.

Everything was booked and set via email. My choice. I hate calling people. She mailed me all the paperwork from her office to bring with me on my first visit. What I loved when I first met her was that she didn’t even want to look at the filled-out documents during session; she was eager to get down to talking. I was nervous being there, naturally, it’s sensitive material being shared with a stranger. I remember which chair I sat in and how she sat on the couch.

Eager. Ready.

So I tried to fill her in on my 18-year history of eating-disordered behavior. I had no idea what she would react to or even if she’d react at all. Turns out, she wasn’t one of those therapists that stare you down for minutes at a time. She often looked down and away when she was trying to express something to me. I could see the wheels in her head spinning. She often pushed my buttons. Going into therapy not really being able to express how I feel, I was able to tell her in the second year that she really made me mad. I knew I was making good progress when I was finally able to be 100 percent honest about my feelings.

I was worried I would offend her or make her mad. I am a big people pleaser, even when I pay them. Turns out, the more I talked and yammered on, the more she listened. I think she appreciated what I had to say and that I was just getting it out and showing some vulnerability. I was actively engaging in psychotherapy. That was tough for me, but she always went with my pace. I always had something to work on each week like homework. Or, more frequently, a goal to accomplish.

Then she got pregnant.

She informed me early and made sure I had a therapist for the interim. But I felt like a pool of jelly when she told me. I would be on my own for a while. Not only that, I had to try to reestablish a trusting relationship with someone else. Given the amount of maternity leave and knowing she was coming back, I just waited for her. I felt a new therapist would not be wise at the time. I did see one for one visit, but I got a bad vibe and backed off. The click wasn’t there. For me, if I can’t feel that connection, I’m not going to bother. That paid off for me.

Over the course of my three continuous years of seeing her on a weekly basis, we identified main areas of concern. I had to learn that it’s OK to think about myself once in a while. I deserve love and healing as well. She never put up with any of my games that I tried to play. She called me out on lies and bad attitudes. I swore at her once, and she swore back at me. I quickly learned that she was always, always paying attention to what I was doing.

One year around Thanksgiving, I brought in crayons and some paper. I made her sit down and draw or write what she was thankful for. I loved seeing this “real person.” And I loved when she laughed. For me, when my providers show or tell me little things about what they like and believe in, my trust in them escalates. A relationship is a two-way street. And that’s how I built my trust with her and my other doctors.

I did a lot of things because goals were set, and it was very encouraging to have someone who believed in me follow up on that goal. I didn’t want to disappoint her or myself. After all, I was paying this woman to help me.

This past January she informed me she’s moving. Relocating. I just said, “What?” No way. You can’t go. I greatly appreciated the amount of notice she gave me so I had time to adjust and prepare. During this time I stopped and reevaluated why I always showed up, even when I told her I didn’t want to come sometimes.

It was the encouragement. The challenges. The dedication she put in. The comfort of having a friendly person working with me. It was the confidence in myself that continued to rise each time I saw her. It was her unshakable faith in me. She never gave up. Ever.

I always thought therapy was for nutty people. In the beginning I was embarrassed to tell people I was even going. By the end I often said, “My therapist told me…” and I would conduct my own little psychotherapy sessions with friends. Whether or not I always showed it, I always listened to her. Even when I would stare out the window, watching rain and snow blow, my ears were never closed.

I said goodbye this last Wednesday. I had a very fun visit with her and was sure to show my appreciation for all the help she’d been. I was stoked to be there. I was ready. And much to my surprise….

I cried all the way home.

Psychotherapy proved to be an extremely rewarding experience. I always tried to outsmart my therapist, but she always had a one-up on me. It just humbled me and helped me realize there are just some things I don’t know much about. When you trust, you build and grow. It’s hard, yes. Just do it one time, and you’ll notice yourself doing it again and again. Before you even know what’s going on, you’ll start feeling that little pinch inside….confidence. I can hold my head high.

I’m worth it. And so are you.

So what constitutes trauma?

Trauma comes in many forms, including childhood abuse or neglect, growing up in an alcoholic or dysfunctional home, environmental catastrophes such as Hurricane Katrina, a serious accident, loss of a loved one, and violent attacks such as rape and sexual assault. What all of these experiences have in common is that they leave the individual feeling helpless and out of control.

Trauma isn’t the same as having post-traumatic stress disorder (PTSD). PTSD is a specific diagnosis with distinct criteria, involving a serious or life-threatening experience that results in nightmares, flashbacks, attempts to avoid situations similar to those that led to the trauma and a hyperactive startle response, among other symptoms.

How Trauma Contributes to Eating Disorders

An eating disorder may develop in an attempt to cope with the trauma, suppress painful emotions or to regain a sense of control. Here are a few examples of how trauma manifests in eating disorders:

• Example 1:After the death of a parent, a child is sent to live with a grandparent who isn’t as loving and kind as her mother. She had pleasant memories around food, cooking and eating as a family, and used food to comfort herself through the sadness of losing her mom. After bingeing, she feels consumed by guilt and self-loathing and begins purging through self-induced vomiting, use of laxatives or excessive exercise.
• Example 2: A young adult woman was raped in college. Because she was powerless to prevent the attack, she began restricting her food intake to feel a sense of control over her body. Losing weight became a way to disappear or to appear childlike so she could be cared for by others or appear less attractive to men. Others who have been sexually abused or traumatized by the men in their lives may overeat, using their weight as a protective mechanism to avoid being hurt again.

Treatment for Trauma and Eating Disorders

Individuals with a history of trauma may not fully recover from an eating disorder, or may experience chronic relapse from their eating disorder, until they address the underlying trauma. As part of an integrative approach to eating disorder treatment, patients may participate in the following interventions.

Somatic Experiencing

Trauma is held in the body and often can’t be resolved solely with intellectual processing. Somatic experiencing is a body-awareness technique that was developed by Peter Levine, PhD. With guidance from a therapist, patients explore the sensations in the body as they work to recognize and regulate their feelings of distress.

Eye Movement Desensitization and Reprocessing

In EMDR, the patient focuses on past memories, present triggers or experiences they anticipate in the future while focusing on an external stimulus (e.g., eye movements, tones or taps). For example, the patient may be asked to focus on a particular thought or bodily sensation while simultaneously moving their eyes back and forth, following the therapist’s fingers as they move across the patient’s field of vision for about 20-30 seconds. Each session is guided by a therapist to help the patient develop new insights or associations surrounding their experience of trauma.

Cognitive-Behavioral Therapy

Individuals who have experienced trauma often struggle with self-blame or feeling responsible for what happened to them. This maladaptive thought process may follow them into adulthood. Trauma victims may recreate the trauma in some form for themselves or by perpetrating the act of their abuser on others.

Cognitive-behavioral therapy helps patients work through anger, shame, guilt and other emotions by replacing negative thought and behavior patterns with new skills and problem-solving strategies. It is backed by extensive scientific research and is widely used to treat trauma, eating disorders and a variety of other mental illnesses. In a safe, supportive therapeutic setting, patients are able to openly talk about their traumatic experiences and disordered eating behaviors.

Coping Skills Training

Eating disorders frequently develop as a way to cope with trauma. If trauma occurs at a time in life when the individual lacks the coping mechanisms to process it, they may use food to feel a sense of control.

Rather than judging the coping mechanism as good or bad, the therapist helps the patient identify the purpose the eating disorder has served and recognize that it has begun to cost more than it helps. As an adult, the patient can develop more mature coping strategies and call upon different skills than they could at the time of the traumatic event.

Dialectical-behavior therapy helps trauma sufferers build the skills of mindfulness, distress tolerance, emotional regulation and interpersonal effectiveness to improve body image, manage painful feelings associated with trauma and guard against relapse. Learning how to trust and express anger in a healthy way are other important recovery tools.

Self-Help Support Groups

Social support is a major determinant of successful coping. A number of 12-step support groups exist for those suffering from an eating disorder, including Eating Disorders Anonymous, Overeaters Anonymous, and Anorexics and Bulimics Anonymous. Many eating disorder treatment programs invite family members to be part of the treatment team and to address their own emotional and psychological issues while their loved one is in treatment.

Nutritional Therapy

Beginning to address trauma can lead to an increase in eating disorder behaviors. By educating patients about nutrition and fueling the body with wholesome foods, patients can practice healthier patterns and boost their energy and mood.

Exercise

When a patient is working to manage their anger, certain forms of exercise may be a tool for healthy release of anger.

Nutraceuticals

Use of nutraceuticals – amino acids, nutrients and dietary supplements that improve overall health – can decrease distractions from trauma work and reduce some of the physical complaints of eating disorder recovery, such as bloating and constipation. Certain supplements and herbal remedies may also assist with symptoms of depression and co-occurring mood disorders.

Mind-Body Therapies

A number of mind-body therapies can aid in stress management and boost mood and memory. Meditation, acupuncture, yoga, massage, energy healing, self-hypnosis and breath work are a few examples of therapies that have been helpful in treating eating disorders and trauma.

The human mind is complex. A traumatic experience in childhood can manifest as an eating disorder years later. Both trauma and eating disorders can have profound, long-term consequences that make recovery challenging. Once the issues have been identified and are being treated simultaneously by a multidisciplinary team of professionals, lasting recovery is possible.

Q. Why doesn’t the current model of treating obesity — only telling people what and how much to eat — work for most people?

A. Great question, because the current model definitely doesn’t work. I can’t remember who said it, but there’s a saying that if you want to gain weight, go on a diet. Diets have a failure rate of about 95 percent. People may lose weight initially but then they usually gain it back and then some.

So this model doesn’t work for many reasons. For one thing, genetics plays a prominent role in our weight. This is why you can have two people who eat the same foods in the same quantities look very different. One may be thin; the other may be considered “overweight.” Our bodies are more complicated than the “calories in, calories out” equation assumes.

Instead of putting people on diets, which don’t work anyway, why not promote engaging in healthy behaviors directly? (By the way, many people have to do some pretty unhealthy things to lose weight and maintain that weight loss.) Instead of focusing on weight loss, focus on moving your body by doing activities that you enjoy — research has shown that fitness is critical for health — eating nutritious foods, getting enough sleep and listening to your body, along with other healthy self-care habits. Practicing these habits does help a person become healthier, whether they lose weight or not.

On a side note, there are plenty of skinny people who aren’t healthy, who smoke, lead sedentary lives and don’t nourish their bodies. But because they’re genetically predisposed to a slimmer frame, we don’t single them out and just assume that they’re healthy. The key is to encourage everyone to engage in healthy habits.

Health At Every Size is an approach that shifts the focus from weight to health. You can learn more here.   Also, check out these interviews on Weightless with Linda Bacon, author of Health At Every Size: The Surprising Truth About Your Weight — Part 1 and Part 2 and Evelyn Tribole, co-author of Intuitive Eating: A Revolutionary Program That Works — Part 1  and Part 2.

I also just wrote a post about healthy eating  on Weightless, which readers might be interested in.

Q. Are there reliable predictors for individuals who may become anorexic or bulimic?

A. Eating disorders are complicated and serious illnesses. A variety of complex factors contribute, including genetics, neurobiology and the environment. There’s a saying that genetics load the gun, and environment pulls the trigger.

Eating disorders tend to run in families. Also, traits such as perfectionism and cognitive rigidity can increase risk. Our appearance- and diet-obsessed culture serves as a trigger along with dieting. For people who are genetically and biologically vulnerable to eating disorders, dieting can serve as a gateway to an ED. But, again, there must be a genetic or biological vulnerability in order for the environment to play a role.

Q. Is there a relationship between ethnicity and anorexia? Or ethnicity and bulimia?

A. In the past, eating disorders were thought of as illnesses that solely strike white women. While the rates of eating disorders seem to be lower in ethnic groups like Asians and African-Americans, eating disorders can affect anyone, regardless of race, ethnicity, age, income, size, shape or sex. As one of my fave bloggers, Carrie Arnold of ED Bites, wrote in a post, “If you’re human, you can get an eating disorder.”

Q. What is the most commonly diagnosed eating disorder? Is there a substantial difference between the number of men and women diagnosed?

A. The most common eating disorder is binge eating disorder. According to the Binge Eating Disorder Association, it affects more than eight million men and women.

In general, more women do struggle with eating disorders. But plenty of men do, too. We used to think that about 10 percent of people with eating disorders were men. But it may be as high as 25 percent. Again, anyone can struggle with an eating disorder.

Q. What is your resolution for the new year?

A. My resolution is to listen to myself and my needs more when it comes to the decisions in my life, big or small. It could be everything from moving my body to eating to pursuing certain creative projects.

Q. Where do you see yourself in five years?

A. I see myself running after a few kids and writing my heart out.

Complementary and alternative therapies used in integrative medicine can include acupuncture, chiropractic, herbal medicine, dietary supplements and others that give the clinician a wide array of treatments for difficult conditions. This is particularly true in the integrative medicine approach to eating disorders.

Eating disorders have been documented in adolescents and adults for many years. More recently, there is evidence that these disorders can also affect young children.

The cornerstones of an integrative medicine model for eating disorders includes some components that are found in every approach to the treatment of eating disorders, but may be used in a unique manner. Others are more specific to the use of complementary and alternative medicine (CAM) therapies. The most important difference in this model when compared to other treatment strategies is the philosophical underpinning of integrative medicine — that is, the belief in the self-healing nature of body, mind and spirit.

The integrative medicine philosophy holds that the body, mind and spirit are able to heal with support from conventional and alternative therapies, given needed changes in lifestyle. These changes happen in concert with the therapeutic relationship the patient has with his or her therapist, physician or other healer.

The cornerstones of this integrative medicine approach can include:

• Medical treatment that focuses on reducing the risk of, detecting and treating complications of the disease and on improving overall health status.

• Nutritional therapies to improve nutritional status, help women improve their relationship with food, and improve digestion and absorption of needed nutrients.
• The use of botanical therapies to reduce side effects of pharmacological therapies.
• Body movement to help patients get back in touch with physical cues and learn healthy behaviors.
• Psychological testing to identify co-occurring diagnoses, including mood and personality disorders, and inform treatment strategies.
• Skills training, which may include the use of cognitive behavioral therapy or dialectical behavior therapy, to enable patients to cope more effectively with stressors in their lives and with situations and emotions that may trigger relapse.
• Complementary and alternative therapies, which may include massage, mind-body, chiropractic, acupuncture and energy medicine therapies.
• Prescription medications, which are used cautiously in children and adolescents and should be prescribed only to manage behavior that is life-threatening or therapy interrupting.

Eating disorders comprise a spectrum of disorders that are difficult to treat and have a high risk for morbidity and mortality. The integrative medicine approach offers many options to explore. While research into these therapies is still in the early stages, the benefit-to-risk ratio is favorable. Recovery from eating disorders is possible and the earlier they are treated, the better the prognosis.

The “residential” treatment approach has long been available for eating disorders, since the treatment of these disorders tends to be long and complicated. Andrew Pollack writing for the New York Times notes how these kinds of programs have now become the focus of insurance companies looking to cut back on treatment options.

It’s no surprise, really. With the rollout of mental health parity — requiring that insurance companies can no longer discriminate against people with mental disorders for their treatment options — those companies are looking for other places they can cut costs. Residential treatment for eating disorders appears to be one obvious area.

So is residential treatment a legitimate modality for helping people with eating disorders? Should insurance companies cover the costs of such care?

According to one study (Frisch et al., 2006), the average length of stay in a residential treatment center for an eating disorder is 83 days. That’s nearly 3 months of full-time, round-the-clock treatment and care. The cost for such care? On average, it’s $956 per day. You read that right — nearly $1,000/day is the average cost for such care. That means a single patient at such a treatment center is bringing in, on average, $79,348.

Proponents of residential treatment admit there’s little research to back its use for eating disorders, but are adamant such programs are effective and needed:

Dr Anne E. Becker, president of the Academy of Eating Disorders and director of the eating disorders program at Massachusetts General Hospital, said that despite a paucity of studies, “There’s no question that residential treatment is life-saving for some patients.”

Okay. But so is spiritual healing, according to many spiritual healers. What separates belief (the mainstay of religion) from fact (the mainstay of science) is data. Without data, we operate in a vacuum of knowledge.

Ah, but we apparently do have some data. Just not the kind that a residential treatment center wants to hear:

Ira Burnim, legal director of the Bazelon Center for Mental Health Law, which litigates for better mental health treatments, said that while he was not familiar with eating disorders, “study after study” had shown that residential centers for other mental or emotional disorders were not as effective as treatment at home. [...]

“There’s a wide variation in licensing across the country,” said Jena L. Estes, vice president for the federal employee program at the Blue Cross and Blue Shield Association. “There’s a lack of oversight of many of those residential treatment centers.”

There is some research data in the literature. But surprisingly very little, and nothing approaching a randomized controlled study — the gold standard of research. For instance, in Bean et al. (2004), the researchers did a 15-month phone followup with folks who had anorexia who had stayed at their residential treatment center. According to this study, women experienced a 7 lb weight gain, while men experienced an average of a 19 lb weight gain.

But we have no idea whether these are good or bad numbers. Would someone in outpatient treatment over the same time period experience more or less weight gain? Are these numbers even accurate, given they are self-reported by the patient over the telephone (and the research was conducted by biased researchers at their own treatment center)? So we have “data” here, but without context, it’s next to meaningless.

Another study by Bean & Weltzin (2001) showed that after a 6 month followup, anorexic and bulimic women retained some, but not all, of the improvements they made while in treatment. Again, without an outpatient or control group, it’s hard to say whether this is a good or bad finding.

There’s also a few dissertations that offer similar evidence — when pre- versus post- measures are used in a residential treatment program, most patients are improved at discharge. This is hardly a surprising finding. But is it due to the “treatment” portion of the program, or the “residential” component — or some important combination thereof — remains unanswered.

So I hate to say it, but the insurance companies in this case appear to have a pretty good case, at least based upon the paucity of research. I always say to people, if you want to shut up an insurance company, show them the research that your treatment modality works (and works better than cheaper treatment X).

For better or worse, judges don’t have to care about the research, and in this case ruled against the insurance company where the issue of paying for residential treatment for an eating disorder was brought to court:

The Ninth Circuit Appeals judges, based in San Francisco, ruled that residential treatment was medically necessary for eating disorders, and therefore had to be covered under the state’s parity law, even if no exact equivalent existed on the physical disease side.

Eating disorders are unique, and perhaps even more unique than drug and alcohol problems — therefore deserving of special treatment. After all, unlike alcohol or drugs, we all have to eat. The way eating disorders wrap themselves up into the person’s mind and their body image is very difficult to untangle.

But if we want people to have access to residential treatment centers to help with their eating disorders, shouldn’t the industry support far more well-designed, scientific studies to examine the effectiveness of this modality? I don’t think anybody would question these centers if such research existed today, but the fact that it doesn’t after more than 25 years raises more than just a few eyebrows.

Read the full article: Ruling Offers Hope to Eating Disorder Sufferers

References

Bean, Pamela; Loomis, Catherine C.; Timmel, Pamela; Hallinan, Patricia; Moore, Sara; Mammel, Jane; Weltzin, Theodore; (2004). Outcome Variables for Anorexic Males and Females One Year After Discharge from Residential Treatment. Journal of Addictive Diseases, 23, 83-94.

Bean, P. & Weltzin, T. (2001). Evolution of symptom severity during residential treatment of females with eating disorders. Eating and Weight Disorders, 6, 197-204

Frisch, Maria J.; Herzog, David B.; Franko, Debra L.; (2006). Residential Treatment for Eating Disorders. International Journal of Eating Disorders, 39, 434-442.

I mean, even those who claim they are normal may, in fact, be the most neurotic among us, swimming with a nice pair of scuba fins down the river of Denial. Having my psychiatric file published online and in print for public viewing, I get to hear my share of dirty secrets—weird obsessions, family dysfunction, or disguised addiction—that are kept concealed from everyone but a self-professed neurotic and maybe a shrink.

“Why are there so many disorders today?” Those seven words, or a variation of them, surface a few times a week. And my take on this query is so complex that, to avoid sounding like my grad school professors making an erudite case that fails to communicate anything to average folks like me, I often shrug my shoulders and move on to a conversation about dessert. Now that I can talk about all day.

Here’s the abridged edition of my guess as to why we mark up more pages of the DSM-IV today than, say, a century ago (even though the DSM-IV had yet to be born).

Most experts would agree with me that there is more stress today than in previous generations. Stress triggers depression and mood disorders, so that those who are predisposed to it by their creative wiring or genes are pretty much guaranteed some symptoms of depression at confusing and difficult times of their lives.

I think modern lifestyles — lack of community and family support, less exercise, no casual and unstructured technology-free play, less sunshine and more computer — factor into the equation. So does our diet. Hey, I know how I feel after a lunch of processed food, and I don’t need to the help of a nutritionist to spot the effect in my 8-year-old son.

Finally, let’s also throw in the toxins of our environment. Our fish are dying… a clue that our limbic systems (brain’s emotional center) are not so far behind.

Maybe the same amount of people have genes that predispose them to depression as in the Great Depression. But the lifestyle, toxins, and other challenges of today’s world tilts the stress scale in the favor of major depression, acute anxiety, and their many relatives.

Of course we can’t forget today’s technology and cutting-edge research of psychologists, neuroscientists, and psychiatrists. Because of medical devices that can scan our brains with impressive precision and the arduous work of scientific studies done in medical labs throughout the country, we know so much more about the brain, and its relationship with other biological systems within the human body: digestive, respiratory and circulatory, musculoskeletal, and nervous. All of that is a very good thing, as is knowledge and awareness.

A few years ago, psychiatrist and bestselling author Peter Kramer penned an interesting article for Psychology Today rebutting the claims of popular authors — spawning a new genre of psychological literature — that doctors are abusing their diagnostic powers, labeling boyishness as “ADHD,” normal sadness and grief as “major depression,” and shyness as “social phobia.” Because of their rushed schedules and some laziness, doctors are narrowing the spectrum of normal human emotion, slapping a diagnosis on all conditions and medicating people who would be better served with a little coaching, direction, and psychotherapy.

As I explained in my piece, “Are We Overmedicating? Or Is Our Health Care System Inadequate?,” I believe the problem is far more complicated than overmedication. I’d be more comfortable labeling it “really bad health care.” And if I had to pick a culprit, I’d point my finger at our health care insurance policies, not the doctors themselves. But I don’t even want to get into that, because it causes my blood pressure to rise and I’m trying really hard lately to live like a Buddhist monk.

What I liked about Kramer’s article is that he doesn’t deny that there are more diagnoses today, and yes, some people may feel the damaging effect of stigma. However, more often than not, diagnosis brings relief and treatment to a behavior, condition, or neurosis that would otherwise decay certain parts of a person’s life, especially his marriage and relationships with children, bosses, co-worker, and dare I say in-laws? Kramer writes:

Diagnosis, however loose, can bring relief, along with a plan for addressing the problem at hand. Parents who might have once thought of a child as slow or eccentric now see him as having dyslexia or Asperger’s syndrome—and then notice similar tendencies in themselves. But there’s no evidence that the proliferation of diagnoses has done harm to our identity. Is dyslexia worse than what it replaced: the accusation, say, that a child is stupid and lazy?

People afflicted by disabling panic or depression may fully embrace the disease model. A diagnosis can restore a sense of wholeness by naming, and confining, an ailment. That mood disorders are common and largely treatable makes them more acceptable; to suffer them is painful but not strange.

Then Kramer asks this question: What would it feel like to live in a world where practically no one was normal? Where few people are free from “psychological defect?” What if normalcy was a mere myth? He ends the article with this poignant paragraph:

We are used to the concept of medical shortcomings; we face disappointing realizations—that our triglyceride levels and our stress tolerance are not what we would wish. Normality may be a myth we have allowed ourselves to enjoy for decades, sacrificed now to the increasing recognition of differences. The awareness that we all bear flaw is humbling. But it could lead us to a new sense of inclusiveness and tolerance, recognition that imperfection is the condition of every life.

Amen to that.

Not only do they have to contend with serious, disruptive symptoms, they still have to deal with rampant stigma. Sadly, mental illness is still largely shrouded in stereotypes and misunderstanding.

Stigma also can lead to discrimination. Yes, even in this enlightened day and age, it doesn’t appear as though prejudice and discrimination against individuals with mental illness are decreasing. (This study shows in some cases, it might even be increasing.)

We see stigma everywhere. Every time violence is automatically connected to mental illness in an article or news report, we see it.^*

We see it in movies and other forms of media. We see it at work where stereotypes might be perpetuated, where employees are afraid to “come out” with their diagnosis.

We see it with our families or friends, who might say versions of “just snap out of it” or “get over it already” or offer “advice” like sleep more, eat less, look on the bright side and try harder.

There’s also just pure ignorance, especially when it comes to serious mental illness such as bipolar disorder and schizophrenia. As E. Fuller Torrey, M.D., wrote in Surviving Schizophrenia: A Manual for Families, Patients, and Providers, “Schizophrenia is the modern-day equivalent of leprosy, and in the general population the level of ignorance is appalling.”

But what happens when that stigma comes from within — when people with mental illness internalize these negative public perceptions?

An excellent article in Esperanza magazine — whose tagline is “hope to cope with anxiety and depression” — explored the issue of self-stigma. Not surprisingly, internalized stigma can worsen a mental health condition. How?

According to the article, self-stigma makes people less likely to seek treatment. (Other studies have confirmed these findings as well.) From the article:

“For example, a 2009 study from Leipzig University in Germany identified internalized stigma as ‘an important mechanism decreasing the willingness to seek psychiatric help’—and of far more influence than ‘anticipated discrimination.’ Likewise, a U.S. study of college students, published in Medical Care Research and Review in May 2009, found that personal stigma (as opposed to perceived stigma) was ‘significantly’ associated with unwillingness to seek help.”

Even medical students — who suffer from depression at high rates — report concerns about stigma. In a recent study published in the Journal of the American Medical Association, 53.3 percent who reported high levels of depressive symptoms worried that disclosing their diagnosis would be risky.

Also, 34.1 percent of first- and second-year students and 22.9 percent of third- and fourth-year students reported that they’d feel less intelligent if they sought help. And these are the individuals who’d presumably be more comfortable than the average person in seeing a professional.

Self-stigma also can lead to isolation, lower self-esteem and a distorted self-image. “People with a mental illness with elevated self-stigma report low self-esteem and low self-image, and as a result they refrain from taking an active role in various areas of life, such as employment, housing and social life,” according to David Roe, professor and chair of the department of community mental health at the University of Haifa. He and other researchers are exploring the efficacy of a new intervention to minimize self-stigma.

So what can you do? The Esperanza article suggested these tips to combat self- and social stigma:

“Explore therapy to help you reframe your life experience, improve your self-image and replace negative self-talk with more positive language.


Use the Internet for peer support. Twitter with others who have depression, trade recovery stories with Facebook friends, or join an online mental health forum (such as those at psychcentral.com or Esperanza’s new peer-to-peer forum at hopetocope.com or hopetocope.ca).

Practice strategic disclosure. Tell your story to a peer or person with a realistic view of depression.

Get involved in outreach. Join advocacy groups. Participate in or help organize a walkathon or mental health fair. Write protest letters to media outlets or companies that spread negative stereotypes.”

Whether you have a mental illness or not, push past the misperceptions, and educate yourself with the facts.

Realize, for instance, that someone with depression isn’t able to just snap out of it. (Trust me, if they could, they would!) Realize, too, that eating disorders are serious illnesses; the person can’t just eat to fix it. (Anorexia nervosa has the highest mortality rate of any mental illness.)

Such is the same with all mental illnesses.

Educating yourself about what mental illness is and what it isn’t can help tremendously. So can spreading the word to others and getting involved in advocacy.

And, importantly, remember that you are not alone! Mental illness is common, and it touches everyone’s lives in one way or another. Consider checking out support groups or online forums to connect with others who are in similar spots.

Have you experienced stigma? Have public perceptions of mental illness affected you or your seeking treatment?

* – Research has shown no causal link; risk for violence increases with drugs and alcohol, which is true for people without mental illness, and with the presence of past violent behavior.

This week is National Eating Disorders Awareness Week, which is sponsored by the National Eating Disorders Association (NEDA).

Like I said in my post on Weightless, I believe that awareness means spreading accurate information about eating disorders.

One of the biggest misconceptions is that parents cause eating disorders. They don’t!

In fact, many complex factors are involved in predisposing a person to an eating disorder. According to eating disorder specialist Sarah Ravin, Ph.D:

“…the development of an eating disorder is influenced very heavily by genetics, neurobiology, individual personality traits, and co-morbid disorders. Environment clearly plays a role in the development of eating disorders, but environment alone is not sufficient to cause them.”

(Check out her blog post for more.)

But while parents don’t cause eating disorders, they can make a difference in their child’s life by creating a safe, diet-free and nurturing environment.

As Kenneth L. Weiner, M.D., co-founder and CEO of the Eating Recovery Center, said recently:

“Because eating disorders are genetic, an individual who has a family history is much more likely to be sensitive to others’ words and actions surrounding food and body image. It’s important for families to talk about these deadly diseases and avoid behaviors and actions that could act as eating disorder triggers.”

Below Dr. Weiner and other eating disorder specialists from the Eating Recovery Center share some of the ways you can help your child. (I think these tips are relevant for all kids):

Keep an eye out on changes. “Parents should be aware of drastic changes in eating habits like vegetarianism or vegan outside of family norms; it can be a red flag even if for health or humanitarian reasons. Many young adults will start on a ‘health kick’ with dietary modifications or a ‘commitment to exercise’ on their way to an eating disorder,” says Ovidio Bermudez, M.D., medical director of child and adolescent services at the Eating Recovery Center.

Focus on the inside. According to Dr. Weiner, “Families and parents don’t cause eating disorders, but if they are extremely health conscious or appearance focused, it can contribute to the development of an eating disorder. It’s important to focus on the inside, not the outside. It’s who children are, not what they are.”

Avoid negative appearance-based comments. “Negative comments about your child’s body (looks, weight, size, shape, etc.) could cause him or her to feel the need to look a certain way in order to be accepted and popular, remember to focus on his or her inner qualities,” says Carolyn Jones, R.N., director of nursing at the center.

Also, don’t make disparaging comments about other people’s appearance, even if it’s meant to be a joke.

Teach your kids about the realities of the media. “Help your child be ‘media literate,’ meaning he or she questions what we see in the media and realizes it can create unrealistic expectations,” Jones adds.

Inform them that all images in magazines and ads are extensively airbrushed. Tell them to be critical about what they hear in the media, and to question a company’s motives.

Diet and weight-loss companies profit when people feel badly about their bodies. They profit when we internalize the thin ideal. So have kids question where the thin-is-in and pro-dieting messages are coming from.

Make sure your child knows that there are no “good” or “bad” foods, and avoid being restrictive. According to Enola Gorham, MSW, the clinical director at the center: “Parents should be careful what sort of ‘rules’ they set around food. Here in the United States, we’re lucky enough to have an array of food choices, which causes us to set ‘rules’ for how and what we eat. For example, ‘I only eat whole wheat,’ or ‘I won’t eat fish grown in farms,’ to help us manage the vast amount of choices we face daily. However, if you have a child that has a genetic predisposition for an eating disorder, he or she may try to gain control of a fast-paced, stressful environment by following all the rules, including the good food versus bad food ‘rules.’”

Additional Actions to Avoid

The Eating Recovery Center included other valuable insights in their article.

Below are seemingly harmless behaviors that can put an already vulnerable child at risk (these are taken verbatim):

• The use of food as a reward or a punishment. When parents use food as a reward or punishment, it can teach their child to turn to food for comfort, tie emotions to eating and permanently affect a child’s relationship with food.

• Dieting. Not only does dieting keep people from listening to what their bodies need, 95 percent of individuals who go on a diet actually put the weight back on in the next two or three years. Furthermore, for an individual who is genetically predisposed to an eating disorder, dieting can be a gateway to disordered eating behaviors.

• Ignoring genetics. An individual with an immediate family member who had anorexia nervosa is 12 times more likely to develop the disease; and four times more likely to develop bulimia nervosa. Individuals with a family history should be especially vigilant of disordered eating behaviors if their loved one is involved in sports – especially those with a focus on weight management such as ballet, gymnastics or wrestling.

Healthy Eating

Today, thanks to our diet-obsessed society and the hysteria over “childhood obesity,” it can be especially difficult for parents to know how to feed their kids without imposing potentially harmful rules.

On Weightless, my blog about body image, the skinny fad and freedom from numbers, I interviewed feeding expert Katja Rowell, M.D., for insight. See what she had to say about healthful feeding in part 1, part 2 and part 3 of our interview. (She provides many valuable tips.)

What if your child is struggling with an eating disorder?

If your child does develop an eating disorder, it’s important to remember that it’s not your fault!

But you can do so much to help. Again, you play a pivotal role in supporting your child and finding him or her effective treatment.

For more information on effective treatment, warning signs, the highly effective family-based treatment (for anorexia) and what you can do, please check out the below posts from Weightless:

• What Parents Need To Know About Eating Disorders: Q&A with Jane Cawley

• Helping Your Child Recover from an Eating Disorder: Part 2 of Q&A with Jane Cawley

• Brave Girl Eating: Interview with Author Harriet Brown, Part 1

• Demystifying Anorexia & Family-Based Treatment: Part 2 with Harriet Brown

• The Rise of Eating Disorders in Kids