Eating Disorders: Decode the Controlled Chaos: Your Knowledge May Just Save a Life

Copyright © Erica Ives, M.A., MFT 2012, 2013

Rights to the Image used on the Cover belong to Erica Ives

All rights reserved. No part of this book may be used or reproduced by any means, graphic, electronic, or mechanical, including photocopying, recording, taping or by any information storage retrieval system without the written permission of the publisher except in the case of brief quotations embodied in critical articles and reviews.

ISBN: 978-1-4525-4826-5 (sc)

ISBN: 978-1-4525-4825-8 (e)

Library of Congress Control Number: 2012906817

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The author of this book does not dispense medical advice or prescribe the use of any technique as a form of treatment for physical, emotional, or medical problems without the advice of a physician, either directly or indirectly. The intent of the author is only to offer information of a general nature to help you in your quest for emotional and spiritual well-being. In the event you use any of the information in this book for yourself, which is your constitutional right, the author and the publisher assume no responsibility for your actions.

Balboa Press rev. date: 3/14/2013

CONTENTS

PREFACE

CHAPTER 1.   All About Eating Disorders

What is an Eating Disorder?

Causes and Risk Factors of Eating Disorders

Psychological and Emotional Factors

Interpersonal Factors

Biological/Genetic Factors

Social and Cultural Factors

Co-morbid Conditions and Eating Disorders

Athletes and Eating Disorders

Males and Eating Disorders

Severity and Prevalence of Eating Disorders

CHAPTER 2.   Early Warning Signs

Relationship with food

Preoccupation with weight, body, and appearance

Physical Changes

Shifts in Mood and Relationships

Self-harm or other self-destructive behaviors.

CHAPTER 3.   Types Of Eating Disorders

Anorexia Nervosa

Bulimia Nervosa

Binge Eating Disorder

Eating Disorder Not Otherwise Specified (EDNOS)

CHAPTER 4.   The Multi-Disciplinary Treatment Approach

Primary Care Physician

Registered Dietitian or Nutritionist

Psychiatrist

Therapist

CHAPTER 5.   Types Of Therapy

Cognitive Behavioral Therapy (CBT)

Dialectical Behavioral Therapy (DBT)

Family Therapy

Group Therapy

YALOM – Therapeutic Factors

-Interplay of Yalom’s Therapeutic Factors-

Twelve-Step Model of Treatment

Overeater’s Anonymous (OA)

Eating Disorders Anonymous (EDA)

Complementary and Alternative Therapies

Experiential Therapies

CHAPTER 6.   Levels Of Care For Treatment

Outpatient Treatment

Intensive Outpatient Program (IOP)

Partial Hospitalization Program (PHP)

Residential Treatment

Inpatient Treatment

CHAPTER 7.   Level Of Care Treatment Guidelines

CHAPTER 8.   The Clinical Interview

The Initial Clinical Interview

Self-Report Instruments

Motivation Assessments

Additional Patient Assessment Tools

CHAPTER 9.   Revisiting Vignettes In Recovery

Laura In Recovery

Rachel In Recovery

Epilogue: Last Words

About the Author

References

Resources

This book is written through my eyes, my soul, my heart, my mind, and my body, accompanied by the shared experiences of so many others, who have traveled on the path of recovery from an imprisoning eating disorder. My goal in writing this book is to help ensure that others TAKE NOTICE of these silent screams for help. I have touched the tears, seen the utter despair, heard the whispers of hell, and witnessed death within the realm of this disease. I have also held the hands of hope and courage, witnessed growth through trust and renewed faith, and seen others choose to live instead of simply exist. We need to open our eyes, we need to pay more attention, and choose to intervene. So, if I can reach one person who is willing to take extra notice then we have quite possibly saved a life.

PREFACE

Eating Disorders have a tremendous effect on the quality of life, and impact all levels of functioning. More often than not, however, there is a tendency to turn a blind eye to this deadly disease. By reading Decode the Controlled Chaos, one will gain knowledge about the diagnostic criteria utilized to classify different types of eating disorders, to instruct in the detection of early warning signs and symptoms, and to provide an understanding of the serious medical complications that can arise as a result of an active eating disorder. In addition, this book explains the importance of treatment using a multi-disciplinary team approach, identifies the Level of Care guidelines for patients suffering from eating disorders, and the most successful treatment options and protocols.

1

ALL ABOUT EATING DISORDERS

What is an Eating Disorder?

We cover up our wounds with healing ointment and gauze in an attempt to heal ourselves, but despite our efforts, an emptiness wells up inside. We try to fill this emptiness with food, self-destructive behaviors, and activities, but what we really yearn for is wholeness.

-Harville Hendrix

Eating disorders such as Anorexia, Bulimia, Binge Eating Disorder, and Eating Disorders Not Otherwise Specified are marked by severe and extreme disturbances in eating behaviors, related thoughts, and emotions. They are insidious, imprisoning, and pervasive. Eating disorders permeate all aspects of a sufferer’s life, and have profound effects on the individual who is suffering and that individual’s loved ones. Once it has its grip on oneself or a loved one, the sun stops shining and the flowers stop blooming. The eating disorder becomes the only thing that matters. Eating disorders do not discriminate; they are found in every culture, religion, ethnicity, and socio-economic group.

Eating disorders are extremes in eating behaviors - a diet that never ends. Eating disorders involve intense preoccupation with behaviors and rituals surrounding food. Some examples include obsessively counting calories, binging on food in secret, throwing up after eating, and following rigid diets. However, while eating disorders may begin with a preoccupation with food, shape, and weight, they are about much more than food. People with eating disorders usually use food and the control of food in an attempt to compensate for emotions that may otherwise seem too overwhelming.

Eating disorders serve as an attempt to adapt and cope in a world in which the sufferer feels completely unequipped to navigate. This could cause anyone to feel out of control. The sufferer seeks control through food, but the truth of the matter is that the food is actually controlling them, and they are therefore, losing control. An eating disorder can also serve as an adaptive function by providing comfort in a world where the sufferer feels alone, unsupported, invalidated, and possibly unloved. The eating disorder can provide friendship, companionship, support, validation, and even love. This may seem an odd concept, but by reading further you will gain a further glimpse into the world of eating disorders.

Another adaptive function eating disorders may serve is as a distraction from the difficulties of life. The sufferer may feel overwhelmed by the responsibilities and demands of everyday life. They may lack a strong sense of self or identity. They have learned to shut down, shut out, disconnect, run away, avoid any possible perceived threat of abandonment, unpredictability, being too much or not enough, being smothered, controlled, or ignored, or any number of seemingly dangerous turns in the road. The eating disorder can provide an alter identity or its very opposite, a way to disappear. Either way, it serves as a way to cope with life.

Eating disorders can also serve as a way to communicate. They speak the unspoken. Every eating disorder has a voice, a story, and a thought, a feeling that the sufferer is trying to express. The deeper the sufferer has fallen into the grips of an eating disorder, the more disconnected they become from their voice, their story, their thoughts, and their feelings. The eating disorder speaks what one is truly missing and seeking in life. The sufferer is seeking comfort and safety from pain, to be understood, to feel worthy and accepted, an identity, and approval. They are seeking hope and relief from their inner confusion and turmoil.

Eating disorders affect individuals on a physical, emotional, cognitive, interpersonal, and spiritual level. The body begins to deteriorate, the senses become dulled, the ability to think clearly and rationally becomes impaired, cognitive processing actively slows, and access to one’s emotions diminishes. Depression and anxiety lead to isolation and exhaustion. These effects then set in even deeper, and the closest of relationships become less of a priority. Eating disorder sufferers focus all of their energy and attention into the dark world of their eating disorder, often leaving their family, loved ones, and friends behind. Eating disorder sufferers believe they have literally become their eating disorder. They are unable to decipher any separateness from the disorder that has become their sole identity. This all results in a complete disconnect from human experiences such as love, gratitude, honesty, compassion, and feeling a sense of life with meaning and purpose.⁸³

How do we characterize an eating disorder? At the very least, it is a scary, dark, secretive, lonely existence that is often glorified and pursued. Through the use of food and a complete preoccupation with weight, shape, and appearance, sufferers use eating disorders as a way of trying to make sense of a world that otherwise feels senseless, to feel hope in a world that feels hopeless, to feel successful in a world where sufferers believe they are never enough or simply too much. An eating disorder becomes an eating disorder, of course when all of the diagnostic criteria are met. Beyond the diagnostic criteria, when the eating disorder becomes the sole way of expressing what one believes cannot be expressed in any other way, it is most definitely time to reach out for help.

An eating disorder…when have I ever really not had an eating disorder. This craziness became my identity when I was just a child, a little girl. Actually, I don’t really remember much of my life without my eating disorder. I never felt like I fit in, not even at home- the place I would imagine I should feel the safest, whatever that really means. I just know I felt sad, lonely, and worried more often than not. I especially worried about my family. Maybe my mom told me, maybe she didn’t, but somehow I knew how to care for them, watch out for them, and even protect them. I don’t think anyone was really doing those things for me, but the message was that I am the stronger one, the more responsible one, and the more rationale one. So, the message was to stay in control, don’t fall apart, don’t cause problems, and in fact don’t let anyone see your weaknesses. BE IN CONTROL! So, I did what I thought I was told. I was the good girl, I kept things in control, everything from my room, my closet, my emotions, my food, my routine, my exercise, my thoughts. As much control as I thought I had, the world inside and outside of me felt crazy, scary and dark. I was screaming and crying inside but I did everything I could to turn it all off. While I thought I had CONTROL over my food, my weight, and my body, the CHAOS that was in my head NEVER stopped. This is the meaning of controlled chaos.

Causes and Risk Factors of Eating Disorders

Your present circumstances don’t determine where you can go; they merely determine where you start.

-Nio Dubei

There is no single cause of eating disorders. They are complex illnesses with numerous contributing factors. They arise from interplay of psychological, emotional, interpersonal, biological, social and cultural factors. No one factor means that someone will develop an eating disorder. Scientists and researchers are still learning about the underlying causes of these damaging disorders.

Case vignette of interplay of factors:

Marie, a 25-year-old woman who has struggled with anorexia for the past ten years remembers her problems