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Haverford College
Health Services

Resources: Eating Disorders

The transition to college can be a significant challenge. Being away from a familiar home environment for the first time can cause both excitement and anxiety. It is often difficult to balance the new-found freedom and independence while confronting new intellectual, social, and sexual situations. All of these significant changes can become overwhelming. Fear of change is sometimes reflected in a desire to control one's environment. Since no one of us can control external situations, we sometimes turn to control of our own intake and output to control the world of food. Feeling in control of your body can make the external world seem less chaotic and dull the internal world of feelings.

As a society we are conscious of what we put into our bodies, the amount of fat food it contains, and how much we exercise. However, what begins as a moderate concern with appearance and healthy living can quickly turn into an obsessive preoccupation with food and weight. Athletes are particularly susceptible to eating disorders because of their involvement in physical training and achieving the most competitively successful physique.

Eating disorders fall along a spectrum. Concern about weight, calories, diet or figure is extremely common, if not normative, especially among college age women. Likewise, an occasional pizza or ice cream splurge with friends does not necessarily make you a bulimic or an overeater. However, the specific diagnosis of anorexia or bulimic or compulsive overeating must be explored when the pursuit of thinness becomes entrenched, when obsessive restriction or consumption of food worsens, when binge and purge of food worsens, when binge and purge cycles are frequent, or when the body image is extremely distorted.

What are the signs of an eating disorder?

Health Care Providers usually rely on specific criteria for diagnosing someone with bulimia or anorexia. The diagnosis of compulsive overeating is less specific and more based on the clinician's judgment about the compulsive need to eat large quantities of food. Regardless of the diagnosis, no list of symptoms can ever convey the totality of the pain and suffering of the person and the people surrounding them. In addition, many people suffer from eating disorders and do not meet every criteria on a screening checklist.

Some of the signs of Anorexia:

  • Refusal to maintain normal weight for age and height.
  • Intense fear of gaining weight or becoming fat, even though underweight.
  • Undue influence of body weight or shape on self-evaluation, or denial of the seriousness of the current low body weight.
  • In females, absence of at least three consecutive menstrual cycles when expected to occur.
  • Some anorexics may also engage in recurrent episodes of binge eating and purging with the use of laxatives, exercise or vomiting.

Some of the signs of Bulimia:

  • Recurrent episodes of binge eating (eating in a discrete period of time an amount of food that is definitely larger than most people would eat in a similar period of time).
  • Feeling that one cannot stop eating or control what or how much one is eating during the episode.
  • A minimum average of 2 binge episodes a week for at least 3 months.
  • Self-evaluation is unduly influenced by body shape and weight.
  • Person purges through self-induced vomiting, laxative or diuretic abuse, exercise or strict dieting.

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What are the health risks of an eating disorder?

Individuals suffering from anorexia and or bulimia can have serious medical risks. Some of the medical complications from anorexia include: cardiac arrhythmia (irregular and/or slowed heart beat); electrolyte imbalance leading to fatigue; headaches, dizziness, and fainting; anemia leading to inertia and decreased interest in usual activities; decreased bone mass which increases proneness to fractures and stooping posture; osteoporosis; amenorrhea (loss of menstruation); decreased fertility and interest in sex; increased sensitivity to cold and the growth of fine baby-hair all over the body for insulation; higher cholesterol; insomnia; pallid complexions due to vitamin deficiencies; and possible eye and brain abnormalities.

Medical complications from bulimic include: peptic ulcers, and inflammation of the pancreas (this is the most common cause of death for bulimic); stomach dilation and rupture due to binges; electrolyte imbalances causing weakened muscles and sometimes epileptic seizures; chronic protein malnutrition leading to pasty, yellowish skin and hair loss; dental problems including erosion of the enamel of teeth, gum abscesses, and swollen salivary glands leading to a "chipmunk face"; anemia vitamin deficiency; and caffeine intoxication resulting from the excessive use of diet soda and coffee/tea resulting in tremors, jitteriness, anxiety and irritability.

Both anorexics and bulimic suffer from serious emotional and interpersonal difficulties which are often more obvious than the medical complications. People who develop eating disorders do not do so overnight and have often led very painful lives. Often they can hide their disorder from people for many years and function quite successfully on the surface. However, underneath there is a range of painful thoughts and feelings. The patterns of restriction and binge/purging can be linked to many disruptions in emotional stability such as: irritability, difficulty concentrating, moodiness, apathy, decreased sexual interest, obsessive preoccupation with food and weight to the exclusion of anything else. In addition, these individuals often become closer to their eating disorder than to their friends or family. They become reclusive and attempt to hide their eating patterns from other people by shunning company at meals and spending solitary time either exercising, binge eating/purging, or obsessing about their weight and body image.

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Who is susceptible to eating disorders?

Eating disorders are not by any means limited to women, but personal, social and family norms do challenge women in a different way. High functioning intellectual and athletic skills require aggression and self assertion. Often these skills are seen by society as "unfeminine", although they are an instinctual part of human nature. For many women, expressing thoughts and feelings directly can be conflictual. This can be linked to growing up in both familial and societal environments that are not optimally responsive to women's needs. Often women are rewarded more for taking care of others than for speaking out about themselves. This can lead to a loss of individual voice for a woman's frustrations and pain. An eating disorder is just one way that this voice cries out; it is a message that everything is not okay.

Sports emphasizing a lean body appearance predispose athletes to an increased risk of eating disorders. Coaches, although often perplexed by the development of an eating disorder, find themselves in the role of identifying them. People begin exercise with a healthy goal in mind only to develop compulsive, frenzied exercise routines that begin to control their lives. Because eating disorders are manifested by the pursuit of thinness and a denial of hunger and fatigue, an athlete may not at first recognize an eating preoccupation as unusual. In addition, athletes are often praised for their "healthy'' physiques and dedication to training. They are proud of their physical achievements, including thinness, and believe that their athletic identity is their true, total self.

When healthy discipline and a sense of purpose found in exercise gives way to an overriding desire to be thin, disordered eating has begun. These athletes often deny advice from coaches and teammates. Even when they become emaciated or fatigued, they may believe that they will increase their performance if they lose more weight and train harder. Life threatening complications like electrolyte imbalances and cardiac arrhythmias are more dangerous to someone who engages in strenuous activity. It is imperative that these individuals get help.

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How can I approach a friend if I am concerned?

It is natural to feel concern for a friend or to want to help a teammate when you suspect that s/he has an eating disorder.It is important to remember that no matter what you cannot cure your friend, - s/he has to do it her/himself. If you can remember that the thoughts and behaviors are a carefully guarded secret that is often shrouded with shame, then you can understand the difficulty your friend might have discussing the subject with you. As a rule, try to take an unobtrusively supportive and concerned role in helping your friend identify the issue and begin to find ways to seek help. It can be initially more effective to focus on how the particular behavior may be affecting you friend's health, relationships and/or intellectual growth.

In sharing your concern, you are creating a space between you and your friend, and giving her/him the option of filling that space with her/his worries about her/his "secret". Any rejection you might experience is not meant on a personal level; any denial of symptoms does not invalidate your concern. It is more reflective of the other person's struggle with coming to grips with her/his own pain than with your attempts to help. In addition, although she/he may be seeking treatment, it may take a long time before any observable changes are apparent. You may want to seek out counseling on ways to cope with your own feelings of rejection and invalidation, as well as the frustration of watching a friend not change her/his behavior quickly enough.

Even if the person is not willing to discuss her/his eating issues with you, there are many supportive things you can do. Respect her/his choices, continuing to express your interest, support and feelings without being controlling or judgmental. It is always helpful to emphasize your friend's positive qualities and strengths that go beyond physical appearance. Many of us who grow-up in a Western culture have quirky and often distorted views on food and weight; thus, examining your own aesthetic ideals can go a long way toward helping your friend. Monitor your own judgments of "good" and "bad" food, admiration of obsessive exercise, and judgments about fat and thin people. In addition, set a healthy example by eating in a relaxed and spontaneous way and do not voice worries or concerns regarding how much you eat or weigh. Emphasize to your friend the benefits of eating in this more relaxed way. You may also suggest activities that do not involve food such as going to movies, plays, listening to live music, spending time outdoors, and many other activities.

All of this can be enhanced by encouraging your friend to seek professional help. Although some people are able to overcome their eating disorders on their own, it is often more helpful to be in a supportive and knowledgeable environment. Individual counseling and group therapy are just two methods of support.

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How can I help someone with an eating disorder in the Haverford community?

If you become concerned that a fellow student has an eating disorder, the first step is to express your concern to the student directly. Encourage the person to consider seeking some support from a nurse in Health Services, a counselor in Psychological Services, a coach, a dean, or director of the Women's Center.

If you feel that expressing your concern to the student was ineffective, you may wish to seek additional support from these offices directly. The following offices can provide the kind of care that these sorts of problems require.

Health Services staff are available for confidential medical evaluations and nutritional counseling. They can also provide referrals to off campus medical facilities and work with counselors, deans, and coaches to help coordinate care.

Counseling and Psychological Services can provide confidential counseling, psychotherapy and referrals. They also provide consultative support for those concerned about friends with an eating disorder.

The Dean's Office and Women's Center can help to link a student with the appropriate caregiver. In addition, a dean may require either a medical or psychological evaluation if the situation is life-threatening.

Haverford College wants to ensure a reasonably safe and comfortable learning environment for all students, as well as to address the needs of each individual student. If you choose to involve the administration, they will work with you in your attempts to provide a safe environment for both the student concerned and the entire Haverford community. Eating disorders are an individual as well as a societal concern.

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Online Forum for Males with Eating Disorders

The National Association for Males with Eating Disorders (N.A.M.E.D.) has a new online forum for males with eating disorders and concerned others. The forum, located at www.NAMEDinc.org serves as an online support group for male students with eating disorders and body image issues; signing up for the forum is free. Contact Chris@NAMEDinc.org to receive news and free resources from N.A.M.E.D. for more information.

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