So how do you know if you have an eating disorder? Let's figure out what they are
first and then maybe some things that you can do to find out.
So in an earlier
life, when I had a traditional psychotherapy practice, I got to work
with all kinds of different diagnoses and conditions and part of that
experience, I got to work on an eating disorders unit in an inpatient
psychiatric setting for eating disorders and I learned a lot during that time.
First of all, I got to tell you just from a personal standpoint, one of my dear
friends when I was back in high school was hospitalized for bulimia, I didn't
even know what bulimia was at the time and I did a little searching and figured
out, oh, this is what they call an eating disorder. Now I had never
encountered one of those before but this friend,
as I went to visit her at the hospital, opened my eyes to something I was never
even aware of before and I got to visit not only her but I got to sit in on some
group therapy sessions, I got to experience what treatment is like for
eating disorders and it was shortly after that that I changed my major to
psychology. I actually started schooling Chemical Engineering as my major and
that's because back in high school I had great grades and I was really good at
the math and science and what do you do is you come out of high school? Well,
you're going to engineering. I didn't have any passion for that but as I had
this experience with eating disorders for the first time, that was really my
first introduction to clinical psychology and it turned my brain on
about some ways that I might be able to assist people in a way that would be so
meaningful to me later. So doing this video is kind of a fun little flashback
for me even though I don't work with eating disorders routinely anymore, I've
got that experience and I've got a soft spot in my heart for those who are
suffering from eating disorders. Now the two most common ones are the ones that
we most commonly associate with eating disorders are called anorexia and
bulimia. Sometimes anorexia nervosa is the four word that you'll hear or
bulimia nervosa but that just has to do with the neurotic element that's
attached to the eating disorder and they both have to do with disorders that have
become so prevalent. Some of the estimates out there place the number at
upwards of 20 million Americans who are afflicted by some form of eating
disorders and there's others besides anorexia and bulimia but we'll talk
about those two mainly today and I think part of what I want to do is just raise
some awareness so that we know what this thing is.
In fact, I've grabbed a copy of the diagnostic criteria that I can share
with you. This comes from the Diagnostic and Statistical Manual of Mental
Disorders and this is basically the Bible of diagnosis for the fields of
psychiatry and psychology, these are the disorders that are recognized by the
professional industry and so looking first at anorexia, there are three
primary symptoms that we're looking for or diagnostic criteria is a better way
to describe that. The first one is, restriction of energy intake relative to
requirement. Don't you love the way they word these things? Basically, all it means
is you're not getting enough fuel, okay. You've got to have a certain amount of
fuel to survive and to thrive. In anorexia, there's a restriction of the
fuel intake typically food so that usually manifests in a very
significantly low body weight in the context of age and sex and stage of life
and things like that and an intense fear, this leads to the
second one actually, an intense fear of gaining weight or becoming fat and can I
just tell you the distortion in this fear hits levels that you can hardly
even imagine. I taught a course in abnormal psychology for a few years at
one of the local universities and I used a textbook that had an image in it of a
woman who was severely anorexic, she was, wow, I don't even remember what
she weighed, I think it was in the 80's. Okay, not 180, 80 pounds.
An adult woman, this is not enough weight to support life and in this
picture, it shows just how emaciated and thin she is but to ask her what is her
problem, oh, I'm just so fat. Look at these thighs, I mean things like that are
the description so that the self-image is very very distorted. She in this
textbook was actually at a point of near-fatal conditions in her own body
because when this gets severe enough, there's a condition called hypokalemia
for example and that's when there's a deficiency in some of the minerals
specifically potassium that your heart needs to function and when you get that
deficient in it, you can have heart failure just like that in a person who's
young, you know, and shouldn't be experiencing heart failure but this is
some of the severe consequences that can happen. The third criterion for anorexia
is a disturbance in the way in which one's body weight or shape is
experienced and I just gave you a good example of that because even though
anyone who you would ask to observe her and comment about her weight would say
that she is underweight and probably severely underweight. Her own perception
is exactly the opposite and she thinks or believes that her problem is that
she's too fat. So how do these distortions happen? Before we go into the
diagnostic criteria for bulimia, I'll share those with you too, I just want to
comment about that because they had an opportunity on my podcast just maybe two
months before he passed away, I got to interview
Ron Zeller who is a world-class leadership trainer and coach and an inspiring
person in my life and and Ron agreed to an interview, I went and visited with him
in his home and as I entered his home, Ron asked me, said, "Paul, how old are you?"
He calls me Pauly actually, he's one of the only people in the world that calls
me Pauly, I thought that was a parrots name. Anyway said, "Pauly, how old are you?"
I'm like and I'm joking with him right, so I said, "Well, my twin sister just
turned 50." Then he laughs, this is really funny "But what you're talking about is
the chronological age of your carbon-based earth suit." "What do you mean?"
"Your body is 50 years old, is that what you're telling me? That wasn't my
question. I asked how old are you." Ron's whole
point was that I am ageless, okay, because he has a belief that there's a soul or a
spirit inside of people that is ageless and that soul or spirit is you and you
have a body but you are not your body, that's why he called it your earth suit
which was kind of interesting to think about but that's one of the problems
that I think comes up in a typical eating disorder because we identify so
much with this body that we start to think that this body is me when really,
I'm inside of here and you are not your body. Consider that for a minute and just
see where you can go with it, that's for your G wiz collection, let's go on with
the eating disorders for a moment. Diagnostic criteria for bulimia
again, from the dsm-5, recurrent episodes of binge eating. Some of you are already
nervous because you're like "I binge all the time." This gets to be really severe.
When I was working in the hospital, I heard all kinds of stories about some
of the binges that can happen, we're talking like a full
half-gallon of ice cream in one fell swoop, a complete box of
donuts. Do you see what I'm talking about? I'm talking an extreme kind of a binge and
then number two, recurrent inappropriate compensatory behaviors. Who writes this
stuff? These are just big words that says, look, once they binge, they then try to
counteract the binge with some kind of a purge. That's what it means by
compensatory behaviors like vomiting, use of laxatives, fasting, excessive exercise
because what they're trying to do is prevent the weight gain that's implied
if I binge eat. So it's this cycle of binging and
purging and that has to occur regularly at least one time a week for three
months in order to make the diagnostic criteria and then number four is, similar
to what we heard in anorexia. There is a self evaluation that is unduly
influenced by body shape and weight and number five, the disturbance does not
occur exclusively during episodes of anorexia so in other words, if you're
seeing these behaviors but you already meet the criteria for anorexia then
they're going to give you that diagnosis instead of bulimia. Now why did I share
these criteria with you? I think information and knowledge are
potential power, knowing that some of your own behaviors or someone that you
know, because you're watching this video for a couple of different reasons, either
you're a raving fan of Dr. Paul which case, thank you, I love you, or you found
this video because you're interested in anorexia, bulimia, eating disorders and
you might be concerned about yourself or someone else. How can you tell if you've
actually got one of these disorders? Here's a couple of things to pay
attention to, the diagnostic criteria can be a guideline and those are there for
professionals to know how to accurately diagnose the condition. If it feels to
you like some of those might match with you or that person that you are
concerned about, there are so many resources now available online where you
can do a little quiz or a self-assessment. Now a little word
of warning about some of those, some of them are supported and provided by
service providers who want you to come to their facility for treatment. I just
want to give you that little flag because it doesn't mean that it won't be
useful to you to go through the self-assessment but it will probably put
you into a sales funnel where they may want to get you into their treatment
program. Just be aware of that and then use it to your advantage that there
are these assessments available because it will give you a sense of, how does my
particular situation compare to something that might be clinically
indicated, you know, through those criteria that I shared with you, how does
it compare? And you'll get a little bit of a sense that way. There is so much
help available and it's important to get the help that you need
because this is not a light issue, this is something that needs to be taken very
seriously because lives are lost to these disorders tragically and
unnecessarily. There are so many good treatments available that it would be
unwise to not take advantage of those treatments and I would strongly
encourage you to do that. If anything that I've shared with you today about
eating disorders sounds familiar or like something that that might apply to you
or your loved one, please take that next step, every community is at least close
to some kind of great help so do some searching and researching in your own
community, find out what's available and let's spread the word about some
disorders that unnecessarily take people out of the game, people who are amazing
and can contribute some some wonderful things to all of us. The bad news,
this is a really prevalent problem, the good news, there is so much that you can
do and I bet you know someone who could benefit from this information, please
share this video with them.