Eating Disorders: Counseling Issues

Anorexia

Anorexics may also binge/purge and abuse physical exercise. Usually, they suffer from more severe psychological and medical problems than bulimics.

Diagnostic criteria include a 25% weight loss or a body weight 25% below normal; an intense fear of becoming obese that does not diminish with weight loss; a distorted body image (feeling fat or "just right" even when emaciated); and a refusal to maintain weight above a minimum norm for age and height.

Extent of Bulimia and Anorexia

Estimates of the extent of eating disorders range from 500,000 for bulimia and anorexia combined to 5 million for bulimia alone. Estimates of incidence also vary, from 3.8% to 13% for bulimia and .6% to 11% for anorexia. The lack of consensus on data derives from variables inherent in victims' self-reports, an inconsistency among operational definitions of the disorders, and the differences between clinical and non-clinical populations.

Psychosocial Profile

The typical image of the eating disordered is the "model child" or "perfect little Princess"; behind this image lies a poor sense of self, intense need for approval; and compulsive high-achievement. Because flaws are seen as failures which can invite rejection, a pervasive anxiety dominates their lives. To cope socially, bulimics tend to be gregarious impression-managers, while anorexics may simply withdraw.

The wider context for these disorders, according to some theorists, is women's social dependency in a culture that idealizes thin female bodies. In this view, dependency defines females in terms of "other" rather than "self," making them highly responsive to external demands and rewards, less likely to develop internal resources, and especially vulnerable to perceived failure and rejection.

Family Profile

Some research shows that bulimics and anorexics typically come from families who depend excessively on each other and cannnot handle stess and anger. "Enmeshed" is an apt description: what they consume, wear and do and how well they appear, behave, and perform are all regarded as everybody's business and extremely important.

Paradoxically, the eating disorder functions to preserve family stability. The victim secures some sense of identity, approval, and control through the special attention her illness requires; other members acquire a unifying focus for their own roles. The net effect is to reinforce the family's mutual dependencies and to hide underlying conflicts.

Role of Counseling Programs

Multidisciplinary intervention programs offering individual and family or group counseling, as well as adjunct self-help or support groups, are able to help significant numbers of the eating disordered. The most successful program combines individual with family counseling and uses a team approach that includes a physician and nutritionist. Chemical dependency programs often provide useful models. The core elements of the three types of counseling programs are individual counseling, family counseling, and group counseling.

Individual Counseling

Individual counseling involves journal keeping; nutritional intervention; altering antecedent events; using cognitive-behavioral techniques; manipulating consequences; and eliciting the support of family and friends.

Family Counseling

Family counseling involves discussing realistically how the disorder affects each member; designing tasks to fit the developmental level of each member; providing alternate ways to respond to the illness; establishing rules of eating conduct to clarify areas of control and responsibility; helping members meet each others' emotional needs; and looking for abusive or addictive patterns in other members.

Group Counseling

Group couseling involves educating the group on family dynamics, dependency, stress management, nutrition, womens' issues, depression, feelings, sexuality and assertiveness; using a mix of therapeutic devices, such as rational-emotive techniques, gestalt and process techniques, spiritual counseling, neurolinguistic programming, behavior modification, desensitization and confrontation.

Among client populations of bulimics, 63% to 80% eventually become binge/purge-free; among anorexics, 50% regain normal weight and eating habits, 25% improve but have pronounced weight and/or eating habit problems, and 25% are resistent to intervention. Early identification and treatment are crucial to a successful outcome for both disorders.

For More Information

Basow, Susan A., and Renae Schneck. EATING DISORDERS AMONG COLLEGE WOMEN. Paper presented at the annual convention of the Eastern Psychological Association, Philadelphia, Pennsylvania, April 6-7, 1983. ED 243 049.

Bauer, Barbara G. BULIMIA: A MODEL FOR GROUP THERAPY. Paper presented at the annual convention of the American Personnel and Guidance Association, Washington, D.C., March 20-23, 1983. ED 236 467.

Doane, H. Mitzi. FAMINE AT THE FEAST: A THERAPIST'S GUIDE TO WORKING WITH THE EATING DISORDERED. Ann Arbor, MI: ERIC Clearinghouse on Counseling and Personnel Services, 1983. ED 239 191.

Gordon, Donna P., Katherine A. Halmi, and Paula M. Ippolito. PSYCHOLOGICAL EVALUATION OF ADOLESCENT PATIENTS WITH ANOREXIA NERVOSA AND WITH CONDUCT DISORDERS. Paper presented at the annual convention of the American Psychological Association, Anaheim, CA, August 26-30, 1983. ED 243 050.

Katzman, Melanie, and Lillie Weiss. A MULTIFACETED GROUP TREATMENT OF BULIMIA. Paper presented at the annual convention of the Western Psychological Association, Los Angeles, CA, April 1984. ED 246 382.

Katzman, Melanie, and Sharlene Wolchik. "Bulimia and Binge Eating in College Women: A Comparison of Personality and Behavioral Characteristics." JOURNAL OF CONSULTING AND CLINICAL PSYCHOLOGY 52 (June 1984): 423-428.

Leclair, Norma J., and Belinda Berkowitz. "Counseling Concerns for the Individual with Bulimia." THE PERSONNEL AND GUIDANCE JOURNAL 61 (February 1983): 352-355.

Odebunmi, Akin. SYMPTOMS, CAUSES AND POSSIBLE TREATMENT OF ANOREXIA NERVOSA. Doylestown, PA: Delaware Valley Mental Health Foundation, 1983. ED 237 870.

Yudkovitz, Elaine. "Bulimia: Growing Awareness of an Eating Disorder. SOCIAL WORK (November/December 1983):472-478.