Looking Into The Face Of Eating Disorders

Are you aware you are among the first line of defense against eating disorders?   The face of an eating disorder in your office may be smiling, but underneath the mask may be depression, fear, and obsessions; crippling panic attacks; confusion and isolation.   It can raise its head subtly, over time. Or, emerge swiftly like a tornado taking one captive along with their loved ones in its destructive course.   

Anorexia Nervosa is one of the mental health illnesses affecting youth with the highest mortality rate of all psychiatric disorders. Caught early, a prognosis for recovery is much higher.  Left untreated, recovery can take up to 7+ years to successfully treat with a course of waxing and waning symptoms before solid recovery is obtained. Intervention, treatment, and recovery become more complicated when trauma and substance use/abuse are factors of concern.  

Pediatricians, Family Physicians, and Dentists are often the Medical care providers to spot signs of an eating disorder. How you approach potential concerns with patients and family members can make a tremendous difference in linking them to necessary treatment toward recovery; and, halting newly blossoming eating disorders in their tracks.  

How do you know if you are looking into the face of an eating disorder?  ASK THE RIGHT QUESTIONS.  Integrating these targeted questions into your assessment in a thoughtful, caring and sensitive manner is of primary importance.

  • How do you feel about your weight?
  • How often do you weigh yourself?
  • How much has your weight been fluxuating recently?
  • Do you feel out of control when you eat?
  • Do you ever do anything to eliminate or burn off what you have just eaten?
  • Are other people concerned about how you eat or your weight?

The following is a brief screening tool to help guide your inquiry as well. The SCOFF questionnaire:

  • Do you make yourself Sick because you feel uncomfortably full?
  • Do you worry you have lost Control over how much you eat?
  • Have you recently lost more than 14 pounds in a 3-month period?
  • Do you believe yourself to be Fat when others say you are too thin?
  • Would you say that Food dominates your life?

*One point for every “yes”; a score of ≥2 indicates a likely case of anorexia nervosa or bulimia.  Source: BMJ1999; 319:1467    

Presenting symptoms often correlated with an Eating Disorder include, but are not limited to the following:

  • Weight loss/or weight gain “of uncertain etiology”
  • Bradycardia
  • Lanugo
  • Ongoing constipation or diarrhea
  • Dizziness/Fatigue
  • Callouses on the back of hands
  • Dental caries/Mouth ulcers
  • Edema
  • Chronic sore throat
  • Reflux
  • Vomiting/Nausea
  • Heart disease/Type 2 diabetes/Ongoing Sleep Disruption Complications

A multidisciplinary team of providers includes a Therapist, Primary Care Provider, Dietitian and, often, Psychiatric provider. Regular and ongoing monitoring of medical, psychological and familial stressors/complications are imperative.  

Some of the best advice you can give is:

1.  Don’t try to do this alone. Share your struggle with loved ones. Your family/other loved ones are an important resource in your recovery.  

2.  Find right counsel.  Professionals who are skilled in treating eating disorders will assist whole families to access the strengths they have to beat it, while obtaining proper direction. Family members need support, psychoeducation and treatment.  Family wellness oriented support groups can decrease feelings of isolation and provide hope and direction.

3. Believe you can live without an eating disorder.  Seek and find a Spiritually based community of others who can lift you up and support you in your healing.       

Many people I treat say they don’t ask for help because they fear rejection, being imperfect, or being judged that they are not exactly who or what others may think they are.  Some are just purely afraid to give up the eating disorder face for fear they won’t survive without it.  They believe they should be victorious over all that ails them and appear perfect in front of others.  Hiding behind the face of an eating disorder is their protection, their ally. It may not be about weight or food at all, but about the important function the habits/behaviors serve. Taking off the mask that hides painful self-destructive thoughts, feelings and behaviors is a very courageous venture.       

I often remind patients/families that their victory is in their healing journey. It comes with the fire, and the wound.  The fire molds and grows us.  We can’t go around it; we must go through it to emerge into our greatest potential.  We are all ordained by God to live purposeful and fulfilling lives amidst the challenges and ups and downs we may endure in life. There is help, hope, healing and freedom from an eating disorder.

“But he said to me, my grace is sufficient for you, for my power is made perfect in weakness. Therefore, I will boast all the more gladly about my weaknesses, so that Christ’s power may rest on me. That is why, for Christ’s sake, I delight in weaknesses, in insults, in hardships, in persecutions, in difficulties. For when I am weak, then I am strong.” - 2 Corinthians 12:9-10, New International Version

The information contained in this article is intended to provide readers with helpful information and inspiration. Consult licensed medical, and mental health professionals for assistance.  www.tapestryassociates.com.

Guest post by Dr. Deborah Russo. Dr. Russo is a Licensed Clinical Psychologist and a CMDA Member.  She has been treating individuals and families for over 25 years. Her specialties include eating disorders, addictions, anxiety and depression, family and parent communication skill building and women’s health and wholeness.   In addition to Psychotherapy, Dr. Russo provides Didactic and Activity based workshops for fellow professionals, families, churches, schools and community agencies.  She has a counseling practice at Tapestry Psychological Associates, a Christian counseling center in Marietta Square.  Dr. Russo resides with her husband Jeff, oldest son Gabriel and twins Ava and Liam in Marietta as well.  Her family are members of Holy Family Catholic church and their children are all students at St. Jude Catholic School where their dad is Music Director and Teacher. They have a special love for the Blessed Mother as she has separately and collectively blessed them throughout their young adult years… and into parenthood, gently reminding them to keep their eyes on the Prize of Jesus Christ.