Feddersen Resources

Feddersen. (1986, November/December). Anorexia nervosa and bulimia—in the spectrum of eating disorders. School Nurse, pp. 26-33.

OVERVIEW

The aim of treatment involved assisting patients in becoming responsible for themselves—to like themselves well enough to make their own decisions, and to recognize how they’ve interrupted their own lives. We try to build up self concept and assertiveness.

"Control is a major issue in eating disorders," according to Feddersen. "The patients need and tend to be perfectionists, rigidly controlling the details of their lives, how they look, exercise, and eat or don’t eat. But often food and exercise are the only things in their lives that they actually feel in control of."

This article, aimed at helping school personnel identify and intervene with an eating disorder, provides definitions of anorexia nervosa and bulimia. One telltale sign of bulimia is weight that fluctuates wildly. Defining elements of bulimia are as follows:

• Recurrent episodes of binge eating.
• Awareness that one’s eating patterns are abnormal—and fear of not being able to stop eating willingly.
• Depressed mood and self-depreciating thoughts after eating binges.
• No known physical illness that would cause bulimic episodes.

Additionally, experiencing at least three of the following five practices indicates bulimic behavior:

• Consuming high caloric, easily ingested food during binge.
• Inconspicuous (secret) eating during binge.
• Ending such episodes by abdominal pain, sleep, social interruptions, and self-induced vomiting.
• Repeated tries to lose weight by severely restrictive diets, self-induced vomiting, or use of cathartics or diuretics.
• Frequent weight fluctuations greater than ten pounds.

Bulimia is frequently related to anorexia nervosa. The treatment of anorexics, bulimics, and overeaters is the same because it is believed that the eating disorder is usually the result of an addictive personality. The root of an eating disorder is not about food or weight. Those are just the manifestations of the underlying disorder. With no therapy the same issues are seething underneath: addiction, control, low self-esteem, anger, depression, grief, and family issues.

Because bulimia is so hard to detect, very often it goes untreated for years. Bulimics believe that they are simply and safely purging their bodies of calories—but actually only five percent of the matter purged is caloric. A sure sign that would be easy to detect is the habit of running to the bathroom for self induced vomiting after any meal. More subtle clues include severe tooth decay, extremely dry skin, fine rashes or pimples from laxative usage, chronic sore throat, congested sinuses, swelling of salivary glands from vomiting, and complaint of heart palpitations. Besides physical indications, there may be a decline in school work and a general sense of unhappiness.

Intervention should not be threatening, persuading, or shaming. Instead, the confrontation should be honest and straightforward—focusing on giving responsibility to the student for resolution. The student must admit that a problem exists. It is wise to include the family in any meaningful professional treatment. Since peers are essential, support groups play a crucial role in effective control of the disorders.

Where can people with bulimia or those concerned about an eating disorder get help?

• The National Association of Anorexia Nervosa and Associated Eating Disorders (ANAD) (312) 831-3438
• Bulimia and Anorexia Self Help (BASH) -- (800) 762-3334
• Overeaters Anonymous—any local chapter (look in your local phone book).

QUESTIONS FOR REFLECTION AND DISCUSSION

1. How well do you need to know a person before confronting her or him about a possible eating disorder?
2. If you suspected an eating disorder in the course of a conversation, what kind of questions would you ask to get further helpful or confirming information?
3. What are some of the other signs of an eating disorder apart from purging or bingeing? Are there any additional signs or symptoms you would seek?
4. What is the role of a youth leader or concerned adult in the life of a teen with an eating disorder?

IMPLICATIONS

1. Understanding, identifying, and being a conduit of healing is critical when helping a teen deal with an eating disorder.
2. Designing and creating environments where teenagers are "safe" to be themselves and accepted are important to the healthy development of one’s self-esteem.
3. Helping teens to recognize their value and develop a positive self image could curb the progression of an eating disorder.
4. Listening and being a willing agent who will enter into the painful process could mean the difference between life and death for a teen.
5. Here is a specific plan for one who aids teens struggling with eating disorders:

• • Create peer groups within a school where students with eating disorders can discuss their struggles and achievements with the disease.
  • During the healing process, use former or current bulimics and anorexics to reach out to others with similar eating disorders. Let them have the opportunity to be healed by entering the healing process of another.