Special Populations in Eating Disorders_Final
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>> Hi, everyone.
Last time, we talked a lot about
how to recognize an eating disorder.
In this lecture, we'll get a little more clarity around that
by looking at special populations
and then looking at what's healthy
versus what is disordered.
I'm sure that all of you know
that women aren't the only ones
who struggle with eating disorders, men get them too.
Men actually make up about 10% of this population,
although, often, we see only about 1% to 2%
in our practices.
Their behaviors and concerns around food and exercise
are pretty similar if not identical
to their female counterparts.
In general, we're all pretty familiar
with the pressure media puts on women to look a certain way,
and we're certainly well aware
of what the media does to images of women.
Let's look at this for example.
We're used to women getting messages
that their bodies aren't okay.
Kelly Clarkson has an amazing voice,
but apparently that wasn't good enough,
she also had to be thinner
in order to be considered successful.
On the left was how Kelly really looked
at the same time the cover came out on the right.
They airbrushed her
and thought it was perfectly acceptable to do so
stating, "We're making her look her personal best,"
except that it actually wasn't even her.
Then they went on to say this photo was the "truest"
that they've ever put out on the newsstand.
Okay then, I will let you form your own conclusions there.
The reality is we're subjected to false images every day
that set standards that we buy into
in terms of how we're supposed to look.
Let's look at another example
in Vibe magazine's portrayal of Serena Williams.
On the left, you see what she really looks like.
At the same time,
Vibe magazine put out the picture on the right.
Her muscles are gone,
and she is also apparently not allowed to have knees.
It's going to be really interesting
playing tennis without knees, don't you think?
Anyway, there's increasing awareness of these practices
when it comes to women.
But what about men?
Men are subjected to similar stereotypes.
Though we may not hear quite as much about it,
they're supposed to be "ripped" or "jacked"
with a six pack all the time.
They need form-fitting clothes that show their muscles.
There's a lot of pressure to be fit,
and strong, and healthy.
And there's also a lot of pressure to not show emotion.
So while it's socially acceptable and normal
if you will for a woman to cry,
it's not necessarily widely acceptable for men to cry.
The reality is we're all humans
and we all experience emotion.
If we can't express the emotion we feel,
that energy has to go somewhere.
And eating disorders are actually some of the places
that it might go.
Eating disorder behaviors are effective
or be it dangerous ways of modulating emotion,
we'll talk more about that later,
but for now, I'm just putting it out there as a way
of understanding why people develop eating disorders.
Sexual orientation and certain occupations are among factors
that apparently increase
the risk of eating disorders in men.
Statistically, homosexual, bisexual,
and asexual men are shown to be higher risk groups.
Men with appearance-oriented jobs such as modeling, acting,
and those employed in traditionally female occupation
like nursing, cosmetology, and food preparation
also seem to develop anorexia in particular
at a higher rate than the general male population.
Most at-risk men are engaged in sports
which require them to make weight
such as wrestling crew and gymnastics.
Swimmers and runners are also at higher risk.
However, despite these generalizations,
males of all ages,
from all backgrounds develop eating disorders.
Men and boys develop eating disorders
for many of the same reasons that women do,
and they experience similar behaviors and feelings.
Since eating disorders
have been primarily considered to be a women's disorder,
men may experience more shame and guilt
on top of their already low self-esteem.
While societal pressure around thinness
allows people to understand a woman's eating disorder,
similar compassion for man has been missing,
which may be the foremost reason why clinicians
have historically seen far less men in treatment.
When men do enter treatment
in a particular program or group,
they're likely to find themselves the only male there.
An all-male support group is pretty rare.
While eating disorder treatment centers abound,
Roger's Memorial is one of the only all-male programs
in the United States.
And while some men say that they greatly appreciated
the sensitivity of their female group members,
others only feel even more isolated
in their struggle to get well.
Also, there's not much information available for
and about men with eating disorders.
Although, bookshelves abound with books on eating disorders,
feminism, mother, father roles,
and cultural pressures on women,
there are less than a handful of books
specifically focused on males and food problems.
Furthermore, education and prevention efforts
have been primarily targeted at young women
when young men are as equally susceptible
to cultural stereotypes
and often resort to desperate means to change their bodies
such as abuse of steroids and growth hormones.
Here are a couple of insights from two men.
"Anorexia, once you get into the behaviors
and the underlying issues
is pretty much the same whether you're male or female.
I never tried to find an all-male support group
or treatment center.
I never felt that would be necessary.
I found the women I was in treatment with
to be very helpful.
They always tried to understand me and I think they did."
Sometimes, it's harder to get people to understand
that you're worried about your weight
and that, yes, you're a man.
It doesn't seem to be the sort of thing
that you can just say to people
and expect them to be empathic,
where a woman can say to someone, "I'm anorexic,"
and have people acknowledge the severity of her situation.
A guy can say the same thing
and people just sort of stare back with this question mark
in their eyes.
Athletes are another special population
whose risks for developing an eating disorder
are higher than their non-athletic counterparts.
Some of you may have heard of something known at one time
as the female athlete triad
which referred to eating disorders,
amenorrhoea, which is the absence of menses,
and osteoporosis.
This has been replaced by REDS
which stands for Relative Energy Deficiency in Sports.
It was changed because scientific evidence
proved that underpinning the triad
as an energy deficiency relative to the balance
between dietary energy intake or AI
and the energy expenditure required to support homeostasis,
health, and the activities of daily living,
growth, and sporting activities.
In reality, it was never a triad of three entities
but rather a syndrome resulting
from relative energy deficiency
that affects many aspects of physiological function,
including metabolic rate, menstrual function,
bone health, immunity, protein synthesis,
and cardiovascular and psychological health,
and it also happens to men.
That's how the new term
or new clinical term REDS came to be.
A benefit of REDS education has helped screening disorders.
It teaches a continuum that starts with appropriate eating
and exercise and then moves to some acceptable dieting
to the occasional use of more extreme weight-loss methods
like short-term restrictive diets
and then ends with clinical eating disorders,
abnormal eating behaviors,
distorted body image, weight fluctuations,
medical complications, and fluctuating athletic performance.
Factors specific to sports like dieting
to enhance performance result in pressures to lose weight,
frequent weight cycling,
early start of sport specific training,
over-training, recurrent and non-healing injuries,
and inappropriate coaching behavior,
and regulations in some sports
have been suggested as causes
of eating disorders in athletes.
Gymnastics, wrestling, running, weightlifting,
and swimming are sports
where athletes are at particular risk.
That's not to say that other athletes
don't develop eating disorders,
I've seen hockey players, basketball players,
soccer players, and more.
Many decide that they're going to be faster
if they lose weight not really realizing
that losing muscle mass is not helping their performance.
The other interesting fact worth mentioning
is that very often the act of dieting itself
seems to set off a cascade of biological functions
that pull the trigger
and activate the eating disorder genes.
So keep an eye out for the athletes you work with,
keep an eye out for food choices.
Really low fat, lots of vegetables, lean proteins,
no or hardly any carbs with no variation,
these are all cues
that you may have an eating disorder on your hands.
It's also important to watch out
for ethnic and racial stereotypes.
In a book written by Becky Thompson some years ago,
she very aptly pointed out that certain minorities
aren't screened simply
due to the stereotypes of their ethnicity.
In her book, A Hunger So Wide and So Deep,
all of the people in her study
met DSM criteria for an eating disorder,
yet none of them were diagnosed
although they all had regular medical care.
She points out that Asians are typically thin,
so they don't even get screened.
And she also notes that blacks are stereotyped
as "larger boned" and "larger body,"
and therefore, they weren't screened.
Just be aware that everyone regardless of weights,
ethnicity, sex, age, and socioeconomic class
can develop an eating disorder.
In summary, you're looking for common threads
or patterns like these.
How often are they engaged in a pattern that looks abnormal?
How severe is it?
How long has it been going on?
Is it chronic?
Is it entrenched?
Can they stop?
Is it impeding their functioning?
Does it cause significant distress
or impair the quality of their daily life?
Are they fatigued all the time?
Is it affecting their relationships?
These are all really important cues
that tell you that they need a formal assessment.
And again, remember,
you can work with someone with an eating disorder
as long as you're communicating openly with his or her team.
Thanks for joining me.
Until next time.