Every person that comes to seek the counselors help belongs to some social group and has some specific beliefs and values, the same as the counselor does. In relationship with a client it is important for the counselor not to let those specific characteristics prevent or bias the therapy process. For to reach this goal the therapist should be well acquainted with the social and psychological characteristics of the representatives of the groups he/she is going to work with, about their values, needs, and specific personality characteristics. The goal of this paper is to get better acquainted with the specifics of counseling adolescent and young women who suffer from eating disorders.
To analyze the specific characteristics of this group of clients, we should first define what eating disorders are. According to the Diagnostic and Statistical Manual of Mental Disorders (DSM IV), fourth edition, there are two main types of eating disorders which are Anorexia Nervosa and Bulimia Nervosa. Anorexia Nervosa is characterized by a refusal eat that leads to a below normal body weight. Bulimia Nervosa is characterized by repeated binge eating followed by self-inducing vomiting, misusing laxatives, fasting, or excessive exercise. The DSM IV also says there exist Eating Disorders Not Otherwise Specified (NOS), which is also known as Binge-Eating.(APA, 2005).
According to the DSM IV, the symptoms of anorexia nervosa include:
- Resistance to maintaining body weight at or above a minimally normal weight for age and height
- Intense fear of gaining weight or becoming fat, even though underweight
- Disturbance in the way in which one’s body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or denial of the seriousness of the current low body weight
- Infrequent or absent menstrual periods (in females who have reached puberty)
The symptoms of Bulimia Nervosa are:
- Recurrent episodes of binge eating, characterized by eating an excessive amount of food within a discrete period of time and by a sense of lack of control over eating during the episode
- Recurrent inappropriate compensatory behavior in order to prevent weight gain, such as self-induced vomiting or misuse of laxatives, diuretics, enemas, or other medications (purging); fasting; or excessive exercise
- The binge eating and inappropriate compensatory behaviors both occur, on average, at least twice a week for 3 months
- Self-evaluation is unduly influenced by body shape and weight
Zwaan (2001) writes about binge-eating that: “Binge eating episodes (BEEs)1 are episodes of overeating characterized as the consumption of a large amount of food in a discrete period of time followed by a sense of lack of control over eating. When binge eating is persistent and recurrent (2 days with BEE per week in the last 6 months) and is not accompanied by compensatory behaviors to avoid weight gain, it constitutes a diagnostic category called binge eating disorder (BED).”
The University of Cincinnati researchers estimates that the quantity of women in the U.S who suffer from various eating disorders is nearly 10 million women, and one million men. (USA: Anorexic nation?, 2005). Thus, as you see, most of the patients with eating disorders are women, thus in this paper we are going to talk mostly about the specifics of counseling women.
Young women and adolescents are usually the ones very conscious about their appearance. Regardless of the race, ethnicity or the social status most young women all over the world long to look beautiful regardless of the price they would have to pay for it. The questionnaires show that more than sixty percent of women would agree to give a year of their lives in exchange to the ideal figure.
In our society slenderness is considered to be one of the main signs of women’s good looks and attractiveness, and it is widely promoted in the magazines, newspapers, and TV shows. Adolescent and young women long to look like the models do, regardless of the fact that most of those are considerably underweight. The statistic says that while the normal percentage of fat in a woman’s body is about 23%, top-models usually have no more than 10% of fat in their bodies. Besides, women who appear on the magazines’ covers usually have very long legs, and small breast, which is uncharacteristic for most of the females that dwell on our planet. Thus, it is no wonder that most women do not have any chances to look like the models do. (Costin, 1999)
Unfortunately, only a small part of adolescent and young woman realizes this fact. The statistic says that nowadays 80% of female eight-graders are conscious about their weight and are dieting for to reach the ideal body parameters. Of course most of them realize that the food limitations should be rational, and that maintaining health is of much greater importance than ideal parameters, but it usually happens much later, when lots of those dieting girls had already managed to spoil their digestive and endocrine system, together with the hair, nails and skin.
Eating disorders are not selective; they develop in women of all races and social statuses, as almost all of those women read magazines and watch the TV shows. The fact is that eating disorders rarely develop in women older than thirty. It may be explained by the fact that at this age most women are already positive about their body image, they have the experience of relationships, and they know that the size is not what matters the most for successful leaving.
Analyzing the symptoms described we can conclude that eating disorders are not only physically and psychologically harmful, but they also affect the social image of people who are suffering from them. Eating disorders are still considered to be something disgraceful in our society, thus the women who suffer from it are often ashamed to turn for the counselor for help. Unfortunately, eating disorders are still seen as something a person develops consciously, thus he or she might be blamed for his/her condition. Besides, the symptoms of bulimia and the results of anorexia arouse antipathy in most people. Those are the main reasons for which women with eating disorders usually suffer not only of their condition, but also of the perception their surroundings have of it.
One of the most scaring things about the eating disorders is that a person can live with it for years, even if she is sharing the apartment with parents or partner, and no one will notice it. It’s still in our society that eating habits are considered to be private and not a subject for criticism; questions and comments on the eating habits may be handled as a the interference to the private life, and thus ignored. Many people whose parents, children, siblings or partners have the symptoms of eating disorders prefer not to notice them, as they are afraid that comment on this topic may insult the person and ruin the relationship. Thus women who suffer from eating disorders often do not get any psychological help or support in their families.
While the signs of anorexia become noticeable in a couple of month, the symptoms of bulimia can be noted only accidentally or by the indirect evidence, like the problems with digestion, rotten teeth or little wounds on the fingers. The bulimics eat the same amount of food as the others do when there are people around them; they demonstrate the symptoms of their illness only when they are alone.
For to treat people with eating disorders successfully, the patients have to trust their counselor. They know that n the surrounding society people will throw stones at them, and it is the counselor who has to help them feel they are not alone, and that their deeds are not as bed as they seem. One of the main aims a counselor has to put in the beginning stages of the therapy is to persuade the patient that the condition she has is an illness, and that she’s not guilty for developing it and living with it.
Considering all of the factors listed it’s obvious that most of the patients who would turn for help would want to maintain confidentiality. It’s vital for the counselor to assist them in it, as the successful treatment often depends of it. Most women who turn for help on their own don’t want their parents or partners know about it, as they feel it would change the attitude their close ones have towards them. This change of attitude often enhances the existing condition, as food is the only comforting thing for the bulimics, and the source of all problems for the anorexics. It’s obvious that eating disorders the illnesses of the psychic, thus normal psychological condition is vital for their successful treatment.
The first thing those women should be taught in order to maintain cover their illness is that they have to learn to control their urges. The main reason, for which the anorexics and bulimics don’t want their close ones to know about the fact that they are ill, is that they are afraid their parents or loved ones will suffer because of it. It’s important to persuade the patient in the fact that if she will continue to refuse from food or vomit it, sooner or later the surroundings will notice it, and it will actually hurt those who love her. The patient should also be informed on the consequences of her eating habits, such as starvation of the organism, sterility, and possible death for anorexics; the problems with digestive system, dental caries and even the bursting of the gullet for bulimics. Those who suffer from Binge-Eating should be notified that there are under the threat of obesity, problems with their cardiac, digestive and endocrine system.
The thing is that lots of girls and young women who have anorexia and bulimia at early stages are still able to stop by themselves, without pharmaceutical treatment. The important thing is to persuade them that the condition they have is dangerous for both their physical health and emotional well-being.
Laura J. Goodman, Mona Villapiano, the authors of the Eating Disorders: The Journey to Recovery Workbook note, that even taking into consideration that most women nowadays know what anorexia and bulimia are, those of them who suffer from some of this disorders often refuse to confess it even to themselves. One of the tasks of the counselor is to help them realize they are really ill, and they have to do something about it. It is not an easy thing to do, as for to ensure that the patient agrees to the treatment the counselor has to make sure that he/she hasn’t insulted the feelings of the patient.
The thing that is vital for the counselor to remember while working with the patients who have eating disorders is the attitudes those people have to food. For those who suffer from any of the disorders mentioned, food is much more than it is for the ordinary people. Anorexics blame food for all the problems and difficulties the encounter on their life path, they feel that food is what makes them ugly, eating makes them feel guilty, thus they try to consume as little food as it is possible.
For them food is an enemy they are unable to defeat, as their body betrays them and longs for nutrition. It is known that 10% (Costin, 1999) of anorexics die from their illness, as there happen to be no one near them for to note that their weight is too low, and that they eat too little for to maintain normal existence. Those are the people who actually managed to win in their fight with food, and the counselor should remember that every anorexic is potentially capable of it. Thus he/she should try to persuade his/her patient suffering from anorexia, to confess the condition to relatives or friends, especially if it is enhancing, for not to let her starve and die in case the patient decides to refuse from counseling and treatment.
Anorexics actually don’t have any interests in their lives rather that loosing weight or maintaining the “healthy” level of it. They are mostly talking about diets and dieting, spending their time in endless workouts and conversations about healthy food. For to maintain contact with them it is a good idea to offer them some tips about healthy dieting and exercising. It will in the same time keep the conversation to the topic, which is interesting for the patient, and present her with some helpful tips for coping with her disorder and restoring her health.
For bulimics food is also special, but not in the way it is for anorexics. For them eating is the only thing that comforts them, but it is that they always feel guilty after they consumed food. At the beginning those people vomit or take laxatives only when they eat too much, but then they begin to do it after every meal. It is also that most bulimics begin to overeat regularly, as it seems to them that they’ve found the way to eat tasty food without the damage for their figure.
For this category of patients food is in an inextricable connection with guilt and satisfaction in the same time. Eating for to get satisfaction, regain one’s temper or just for fun, and then feeling guilty about is the most important thing bulimics have in their life, this combination is like a drug for them. Bulimics are over concentrated on food, eating, and the consequences of eating. It is a good idea for the counselor to suggest the patient to engage in something else, for to help her distract from this damned cycle.
For those who have Binge-Eating Disorder food is just the only way to get satisfaction or to calm down. They relax only when they are eating, and their thoughts most of the time are about food. Binge-eaters sometimes even cannot concentrate on anything except for food, and this fact makes them stressed. As you already know, food is the only instrument for stress-management for them, and eating makes them stressed. Binge-eaters also live in a damned cycle they can’t break.
Patients suffering from eating disorders need various treatments for to restore the healthy eating habits. Therapy of this type of disorders has to be complex, thus the counselors has to develop a comprehensive treatment plan, which involves food counseling, psychological interventions, and, when appropriate, medication management. (Eating Disorders: Facts about Eating Disorders and the Search for Solutions, 2001).
The treatment of anorexia has three main phases which are:
- restoring weight
- treating psychological disturbances such as distortion of body image, low self-esteem, and interpersonal conflicts
- achieving long-term remission and rehabilitation, or full recovery.
Severe weight loss is usually treated in the hospital setting, and sometimes even the intravenous feeding is recommended. The psychological aspects of therapy are applied only after the weight gain has begun; it is usually interpersonal psychotherapy or cognitive-behavioral therapy.
The primary goal on the first stages of treating bulimia is to eliminate binge eating and purging behavior. To reach this aim usually food counseling and psychological interventions are used, together with the medication management strategies. The patient is taught to eat regular, non-binge meals, she is encouraged to do healthy exercising, and her self-image is improved. (Eating Disorders: Facts about Eating Disorders and the Search for Solutions, 2001).
As you see, eating disorders are hard to treat; they require complicated interventions and lots of work both towards the patient and the counselor. Adolescent and young women are the group that suffer most frequently, and this the treatment of this group has its specifics. The counselor has to make sure he is not hurting the feelings of his/her patient, and that they understand each other. For to reach it, the counselor has to be acquainted with the patient’s cultural and social origin, and understand the specifics of the disorders he/she is treating.
Zwaan, M. (2001) Binge eating disorders and obesity Int J Obes. 25(Suppl 1), 51-55
APA (2000). Diagnostic and Statistical Manual of Mental Disorders DSM-IV-TR. American Psychiatric Association
n.d. (2005). USA: Anorexic nation? myDNA News Retrieved December, 4, 2005 from URL: http://newsletter.mydna.com/health/weight/resources/news/200511/news_20051102_anorexicnation.html
Goodman, L. Villapian, M. (2001). Eating Disorders: The Journey to Recovery Workbook. Brunner-Routledge
n.d. (2001). Eating Disorders: Facts about Eating Disorders and the Search for Solutions. National Institute of Mental Health. Retrieved December, 4, 2005 from URL: < http://www.nimh.nih.gov/publicat/eatingdisorders.cfm>
Costin, C. (1999). The Eating Disorder Sourcebook: A Comprehensive Guide to the Causes, Treatments, and Prevention of Eating Disorders. McGraw-Hill.
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