Eating Disorders - fieldi

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2 Recovery Through Nutritional Counseling annika kahm The nutritionist opened my eyes to a new world—how to eat normally. —Outcome Study by the Wilkins Center, 1987 Is there really a need to educate eating disordered patients about nutritional balance and healthy eating habits? Don’t they know this already? Haven’t they read books about dieting, and haven’t they been counseled about the importance of good eating habits by physicians and therapists? Frequently, they do know. However, in my experience their nutritional knowledge is mostly related to how they can diet to lose weight in order to feel better about themselves and to give them a sense of control. An educational approach emphasizing the value of nutritional counseling may therefore be helpful to resistant patients when their denial of nutritional needs impedes recovery. However, good nutritional knowledge may not automatically lead to healthy eating behavior. Nutrition, the physical nurturance of the body and mind, is a reflection of personal growth. How one nourishes oneself with food
18 Recovery Through Nutritional Counseling mirrors how one feels and cares about oneself. Taking risks with food paves the way for taking parallel risks in our lives. But in today’s society many have a goal to be thin. We certainly are given enough messages telling us that “thin is in” and “if you are thin you will be happy, marry the right upper-class man, get a better job, and be able to fit into the clothes the models advertise on television and in magazines.” Being thin today means being thinner than ever. Twenty-five years ago Miss America would be roughly 5 feet, 10 inches, and weigh about 140 pounds. Today our models at that height have lost 25 pounds and weigh a mere 115 pounds—if not less. Although we would all like to be slender we must realize that less than 2 percent of the population is naturally “model thin”; the rest of us have to like ourselves because of who we are—not because of how thin we are. To gain control over our weight, we need to be able to listen to the body’s signals of hunger and satiety (being full). It is important to realize that not all of us eat only when we are physically hungry; few of us stop when the body tells us it has had enough. For someone suffering from anorexia, bulimia, or a binge-eating disorder, hunger can either be denied, tuned out, or will often be experienced as a bad feeling—a feeling of being out of control. Some of the anorexics with whom I have worked are incapable of tuning in to the hunger and instead learn to live with it, getting used to being hungry all the time. Because they may feel out of control regarding certain issues in their lives (for example, parents’ separation, loss of a boyfriend, and so forth), starvation often becomes part of their control. It feels safe for them because they will remain thin and will thus be accepted. But because her body never received the food it tried to get by sending hunger signals that she denied, the anorexic will have to live with a constant food obsession. I have been told by many that, as long as they keep denying their hunger by restriction, food obsession is their enemy, following them day and night. Some bulimics, on the other hand, will eat continuously to avoid this scary sensation and then are likely to purge when they feel too full. This makes sense since their ultimate fear is to gain weight. Reaching satiety may mean to them that they have had too much, especially since their goal usually is to lose weight.
Page 1 and 2: editor BARBARA P. KINOY EATING DISO
Page 4 and 5: Eating Disorders New Directions in
Page 6: To our patients’ children and gra
Page 9 and 10: viii Contents 3. Psychiatric Consul
Page 11 and 12: x Foreword Although serious deficie
Page 14 and 15: preface In 1994, in the first editi
Page 16 and 17: Preface xv psychological hazards to
Page 18 and 19: Preface xvii partial, complete, or
Page 20 and 21: acknowledgments We wish to acknowle
Page 22 and 23: contributors Debra Bader, CSW, BCD:
Page 24 and 25: Eating Disorders
Page 26 and 27: Introduction diane w. mickley I am
Page 28 and 29: Introduction 3 needs of patients wh
Page 30 and 31: Introduction 5 therapy or on medica
Page 32 and 33: 1 Medical Aspects of Anorexia and B
Page 34 and 35: Medical Aspects of Anorexia and Bul
Page 44 and 45: Recovery Through Nutritional Counse
Page 46 and 47: Lesson 1: Daily Caloric Need and Me
Page 54 and 55: ical activity to a normal level. If
Page 56 and 57: patient who binges, it may be helpf
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Page 60 and 61: Figure 2.3 Typical Hunger and Food
Page 62 and 63: herself. She frequently feels hopel
Page 74 and 75: 3 Psychiatric Consultation with Eat
Page 76 and 77: Psychiatric Consultation 51 standab
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Page 82 and 83: 4 A Family Systems Perspective on R
Page 84 and 85: A Family Systems Perspective on Rec
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A Family Systems Perspective on Rec
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5 Relationship to Food as to the Wo
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iors—somehow to integrate the fra
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treatment, Theresa wanted to see an
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Relationship to Food as to the Worl
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6 The Therapeutic Use of Humor in t
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The Therapeutic Use of Humor 91 Amy
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The Therapeutic Use of Humor 93 was
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The Therapeutic Use of Humor 95 ass
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The Therapeutic Use of Humor 97 Ron
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Jodie’s Story 99 capacity to make
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Jodie’s Story 101 house and a ter
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Jodie’s Story 103 She did not do
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adness. The dream also revealed tha
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8 Eating Disorders and Managed Care
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Eating Disorders and Managed Care 1
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Eating Disorders and Managed Care 1
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Cognitive-Behavioral Therapy and Ot
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10 The Nurse’s Role in a Pilot Pr
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The Nurse’s Role in a Pilot Progr
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The Nurse’s Role in a Pilot Progr
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11 Individual Psychotherapy: A Long
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Individual Psychotherapy 135 Such p
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Individual Psychotherapy 137 empath
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weight and shape, as well as change
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Individual Psychotherapy 141 vomiti
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Individual Psychotherapy 143 During
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Individual Psychotherapy 145 and re
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Individual Psychotherapy 147 Mitche
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Young Adult Women 149 to surface an
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Young Adult Women 151 with their at
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Young Adult Women 153 ing; in fact,
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Young Adult Women 155 doomed, and a
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part of a treatment team where the
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13 Recovery margaret goldkopf-woodt
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Recovery 161 I can appreciate both
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Recovery 163 meant. I certainly cou
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Recovery 165 ate other uncomfortabl
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Recovery 167 connection between my
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Recovery 169 safe place, and our ow
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Recovery 171 My pregnancies and mot
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Recovery 173 They seem to be living
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Recovery 175 Self-disclosure remain
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nel. All that I feared, the hurts I
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Afterword 179 surprisingly rapidly
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Afterword 181 With eating disorders
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Treatment helped me to face life, i
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AA/BA. See American Anorexia/Bulimi
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37; prevention of, 29-31; rigid die
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problems and, 19; events triggering
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Keel, P. K., 180 Keller, H., 133 Ke
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Psychoeducational group therapy, 12
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112-20; IPT, 121-22; psychoeducatio
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