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Some Basic Principles For Understanding, Referring, And Preventing Eating Disorders
General Perspective
2. Eating disorders command our attention because they are prevalent and serious, not because they constitute a dramatic, fascinating "epidemic of our time." Regardless of their good intentions, poorly prepared and titillating education/prevention programs carry the distinct possibility of legitimizing the disorders and/or teaching dangerous weight management practices. 3. Eating disorders and sub threshold variants are far too prevalent, but there is no "epidemic" of eating disorders. Such talk is counterproductive to a long-term and constructive solution to the problem of eating disorders on campus. 4. People with eating disorders are people struggling with fantasies, motives, anxieties, and coping mechanisms that are established and vigorously reinforced by our culture. They are not "ics" or "anorexics" or "bulimics". 5. People interested in eliminating eating disorders and in reducing the misery and ineffectiveness attendant to weight preoccupation, unhealthy weight management, and binge-eating must begin with an examination of their own attitudes, behaviors, and lifestyles.
6. It is useful to conceive of eating disorders as part of a spectrum of problems created by the intersection of: 7. Many more women than men suffer from eating disorders and disordered eating, but eating disorders are not "just a women's issue."
Identification And The Offering Of Help
9. Although people with eating disorders are typically frightened by their own behavior, they enjoy some aspects of it (e.g., losing weight) and they are convinced that stopping will bring the terror of "becoming fat." Ambivalence + secretiveness + cleverness + the overlap between the symptoms and culturally sanctioned practices = problems in detection. Even if you know a lot about eating disorders, and even if you know the person well, do not be too hard on yourself or others if you fail to detect the non-emergent signs in a timely fashion or at all. 10. Be aware that there are high-risk groups, but do not be misled by stereotypes. In general risk is increased significantly by an emphasis on the following combination: slender appearance + competition + perfectionist goals for achievement. 11. Know how the psychological effects of an eating disorder, including the effects of starvation (e.g., emotional instability, self-absorption), may reduce a person's ability to benefit from the concern and efforts of family, friends, and mental health professionals.
12. Remember that the purpose of detection and referral is not accurate labeling or other demonstrations of expertise about "eating disorders." It is:
13. Collaborate with concerned friends so as to 14. Collaboration (as opposed to "saviourism") is essential to effective and ethical identification and referral of eating disorders. Referral And Treatment 15. Most people (e.g., Parents, Deans, Teachers, Coaches) are not trained therapists. Thus, they should never become, either intentionally or inadvertently, the sole and private salvation of eating disordered individuals who need someone with whom to talk, who need a "break" with regard to course deadlines, who are afraid of their own parents, who don't like the counseling center personnel, etc. 16. Although not all people who evince warning signs of anorexia nervosa and/or bulimia nervosa actually have a serious eating disorder, it is good to remember that eating disorders are complex and potentially chronic problems. Consequently, they require professional evaluation and multidimensional treatment. 17. Family and friends neither cause nor cure eating disorders, but they contribute significantly to prevention and recovery. 18. Give serious consideration to the distinct possibility that the "chemical dependency model", currently so popular in the understanding and treatment of substance abuse is not appropriate for the treatment of eating disorders. 19. Staff should be trained and otherwise encouraged to collaborate with professional "counselors" in making effective referrals and receiving feedback about the process. If your school or organization has no "policy" for identification and referral of problems such as eating disorders, work to create one and be leery of implementing preventive lessons without one. Prevention 20. Eating disorders are not simply a "women's issue." Certain subgroups of males (e.g., wrestlers, gay men) are at risk for eating disorders, and there is no doubt that male-female interaction and relationships can influence how women think about and treat (or mistreat) their bodies. Consequently, prevention programs should target various groups of males, including athletes, fathers, fraternities, etc. 21. A campus committee on the prevention and treatment of eating disorders is a potentially useful way of developing programs which incorporate a broad range of faculty, staff, and students. 22. Prevention education should be carefully planned so as to avoid all of the following: histrionics, the unwitting transmission of distorted attitudes and weight management practices, and misinformation.
23. Given the current absence of an integrative theory about the emergence of eating disorders and related conditions during the adolescent or your adult years, no one currently knows how to prevent them. Nevertheless, action is necessary. It seems likely that adults and adolescents as models, teachers, advisors, and agents of social influence can play a role in prevention by helping people and social "systems" (e.g., schools, teams) to:
24. Considerable work remains to be done in creating prevention programs that: |
