Eating Disorders - Help for Your Teen

Teens Get Help with Eating Disorders at the Sheppard Pratt Clinic
By Joyce Heid

Every day, we are bombarded with unrealistic and unhealthy images of thin celebrities. The average American woman is 5’4” and weighs 140, yet the average model is 5’11” and weighs 117. Diets and weight loss products form a $40 billion industry. An obsession with being thin is part of everyday life for many people. Often it progresses beyond counting calories to a life of vomiting, abusing laxatives or binge eating. According to the National Eating Disorders Association, millions of people in the United States are in a life and death struggle with an eating disorder. The most common are anorexia, bulimia and binge eating disorder.
Parents who feel their child has a problem should begin by contacting their child’s physician for help. There are also many support groups and organizations dedicated to helping those with eating disorders. Fighting this problem is not something that families can do alone. It is a medical condition that needs intervention. If a child had strep throat you wouldn’t try to heal them without medical help. Eating disorders must be viewed in the same light though unfortunately they cannot be cured with a 14-day course of antibiotics.
In the Baltimore area we are fortunate to have a comprehensive program available to help adults, adolescents and children combat these life-threatening conditions. The Center for Eating Disorders at Sheppard Pratt is a program tailored to meet each patient’s individual needs. Inpatient and outpatient services are available. The Center for Eating Disorders has helped people since 1989. It moved to the Sheppard Pratt campus in January 2005. According to Dr. Steven Crawford, associate medical director of the program, “The relocation allowed for significant expansion of services to meet the growing needs of the community.”
While it is a good idea to initially contact your child’s primary care physician for advice, you can come to the Center by self-referral. The Center can be contacted directly by calling 410-938-5252. An intact coordinator will return the call, conduct a phone screening and arrange for an initial evaluation.
Crawford describes, “The screening and the evaluation assess the level of care indicated. During this evaluation there is an attempt to assess the extent of the illness and the individual’s motivation to change. Family members are also interviewed to obtain a complete history. Progress in treatment is continually reassessed and the treatment plan is updated to meet the ongoing medical and psychological needs of the individual.”
While most patients are treated on an outpatient basis if a patient’s eating disorder is considered life threatening or has caused serious medical complications, referral to the inpatient, day hospital or intensive outpatient program is recommended. A multi-disciplinary team of psychiatrists, psychologists, nurses, social workers, nutritionists and expressive arts therapists provide treatment. Depending on the patient’s individual needs, treatment may include one or more of the following: individual, family or group therapy, expressive arts, nutritional counseling, psycho-education and medications.
By providing an individualized treatment plan, the Center gives patients the ability to gradually develop new, more effective coping skills while remaining in a supportive and safe environment. If a patient has undergone inpatient or partial hospitalization treatment, outpatient treatment follows to consolidate treatment progress. Many times therapy is gradually tapered. This allows for testing of newly acquired abilities with careful, ongoing monitoring of eating disorder symptoms. Free weekly support groups are led by the staff.
According to Crawford, “Families coming to the Center for Eating Disorders are typically seeking answers. There is frequently a desire to confirm that an illness is present. As eating disorders can be and frequently are illnesses of secrets, families may suspect that there is a problem but are uncertain. They are looking for confirmation as to whether there is actually an eating disorder present and if so how severe it is.”
He continues, “Family members are frequently confused as to what may have caused the eating disorder and how to best manage it at home. They are looking for guidance as to how to best assist their child with this problem.”
While many families are under the impression insurance coverage for eating disorders is limited, the Center does participate in most third party and managed care plans.
Again eating disorders are serious and possibly life threatening conditions. Crawford stresses, “…treatment is a process and not an event and as such it takes time for recovery to occur. Patience is an essential part of treatment.”

For more information, contact Center for Eating Disorders at Sheppard Pratt, 410-938-5252, www.eatingdisorder.org.

The Center for Eating Disorders is currently participating in an international multi-site NIH funded research project working on identifying the gene associated with anorexia nervosa. Families that have had more than one family member with anorexia nervosa and are willing to participate in the study are encouraged to conduct Sarah Hubbard, Ph.D. at 410-938-5252.

What are the warning signs and symptoms of eating disorders?
Eating disorders can go undetected for several reasons:
•It can be difficult to distinguish a warning sign or symptom from a consequence.
•Eating disorders are secretive by nature.
•Some warning signs (such as moodiness) can be consistent with normal adolescent development, making it difficult to distinguish an eating problem from normal behavior.
•Early detection can be improved by being aware of clusters of symptoms from behavioral, physical, social and emotional or psychological categories.

People develop and experience eating disorders differently. Therefore, some people exhibit many of the following warning signs or symptoms, while others may exhibit only a few.
Emotional and Psychological Warning Signs of Eating Disorders
•preoccupation with body appearance or weight
•moodiness, irritability
•reduced concentration, memory and thinking ability
•anxiety, depression or suicidal thoughts
•anxiety around meal times
•guilt or self-dislike
Behavioral Warning Signs of Eating Disorders
•dieting or making frequent excuses not to eat
•overeating
•obsessive rituals such as drinking only out of a certain cup or eating certain foods on certain days
•wearing baggy clothes or a change in clothing style
•hoarding food
•trips to the bathroom after meals
Social Warning Signs of Eating Disorders
•social withdrawal or isolation
•avoidance of social situations involving food
•decreased interest in hobbies
Physical Warning Signs of Eating Disorders
•weight loss or rapid fluctuation in weight
•changes in hair, skin, and nails (dry and brittle); dehydration
•edema (retention of body fluid, giving a ”puffy” appearance)
•loss or irregularity of menstrual periods (females)
•reduced metabolic rate (can lead to slow heart rate, low blood pressure, reduced
body temperature and bluish-colored extremities); sensitivity to the cold
hypoglycemia (low blood glucose levels), which can cause confusion, illogical thinking, coma, shakiness and irritability
•faintness, dizziness or fatigue
•reduced concentration, memory and thinking ability
•bowel problems such as constipation, diarrhea or cramps
•sore throat, indigestion and heartburn
•easy bruising

From the website www.helpguide.org, a non-profit group offering professional, non-commercial information on mental health and lifelong wellness.

Seven Steps to Prevent Eating Disorders
Underage and Overweight (Hatherleigh Press, 2006), by Frances M. Berg, offers a seven-point plan for raising healthy-weight children. These seven steps can help both parents and children understand what a healthy weight is and prevent eating disorders before they develop.
1. Normalize activity. Active living is basic to good health. Plan a goal of 30 minutes of moderate activity for preteens, teens and adults, and at least one hour for younger children. At home, try to break to up long stretches of inactivity with short walks or other easy activities.
2. Normalize eating. Establish regular mealtime eating habits—at least three meals a day and one or two snacks. Stop all dieting and food restriction and teach your children to respond to their own bodies' signals of hunger and fullness. Promoting the benefits of normal eating can help prevent potential eating disorders.
3. Balance sound nutrition. Balance, variety and moderation are key nutrition principles. Balance means eating at least the recommended amounts from all five food groups in the Food Guide Pyramid.
4. Feel good about yourself. Body image is a major factor in eating disorders. A nurturing environment in home, school and community is absolutely essential to promoting a healthy body image for your child. Your child will learn to reflect the way you feel about your own body and weight.
5. Communicate feelings. Promote communication and sharing of feelings from the time children are young. Good communication builds healthy relationships and keeps parents in touch with how children are feeling. This can help you identify an eating disorder early on and work through it together with your child.
6. Feel good about others. Help your child develop good relationships, not only with peers, but also with caring neighbors and other adults. Promote acceptance, respect and tolerance of diversity—and set a good example.
7. Balance the dimensions of wellness. As we consider the whole child in body, mind and spirit, keep in mind that weight and eating are only part of wellness and need to be kept in perspective. Over-obsessing about weight and healthy eating can also lead to the development of a dangerous eating disorder.

Frances M. Berg., M.S., L.N., a licensed nutritionist and adjunct professor at the University of North Dakota School of Medicine, is the founder of Healthy Weight Journal and author of Children and Teens Afraid to Eat and Women Afraid to Eat (Healthy Weight Publishing Network, 1999).

Oct., 2006