Hands grab a prison wall made of measuring tape.

Elizabeth Katz

Special to the Jewish News

Natalie, a high school senior who lives in Oakland County, says she wasn’t led to a fixation on food and looking thin by influence from the celebrity culture. She said it was triggered in part by being on social media and seeing peers who looked thin and seemed to “have it all” because they looked good in whatever clothes they wore.

Dinner place setting. A pink plate with silver fork and knife isolated on pink background with clipping path Getty Images

“I would say insecurity and mostly low self-esteem caused my eating disorder,” she said. Having the eating disorder “kind of caused more insecurity. I asked myself, ‘Why am I not seeing what I want to see?’ I wanted to see some change.”

Beginning in high school, Natalie (who asked that her real name not be used) found herself developing anorexia, throwing away food and wearing clothing that concealed her shrinking body.

“I think as soon as I hit high school, I became more critical of myself,” she said. “I thought I was fine and average, but I didn’t want to be average. It’s more of a control thing. It’s me comparing myself to other people.”

Natalie, who has been diagnosed with depression, anxiety and obsessive-compulsive disorder, would restrict her calories, eating a modest breakfast but skipping lunches entirely until dinner. She says there were days she knew she didn’t eat enough.

“I was cold a lot. I was always tired, and I was dizzy,” she said. This was problematic because she was also on the high school swim team, swimming for two-and-a-half hours each day.
Natalie is now working with a therapist, a nutritionist, a nurse practitioner and a psychiatrist to help her with her relationship with food and to keep her weight steady. She said she is more willing today to accept help and also credits her parents with her ongoing recovery.

“They’ve helped me by pushing me to get better,” she said. “I’m lucky that I have a good support system.”

Eating Disorders Defined
Body dissatisfaction among teens and young adults is nothing new and continues to give rise to eating disorders:
• Anorexia Nervosa is characterized by an abnormally low body weight, an intense fear of gaining weight and a distorted perception of weight.
• Bulimia Nervosa is characterized by an individual eating and then purging food by self-induced vomiting.
• Binge-Eating Disorder is the most common eating order in the United States, according to the National Eating Disorders Association. With this disorder, an individual eats large quantities of food, often very quickly and to the point of discomfort, though he or she does not engage in purging activities.
• Avoidant Restrictive Food Intake Disorder (ARFID), formerly known as “Selective Eating Disorder,” is similar to anorexia in that both disorders involve limitations in the amount and/or types of food consumed, but, unlike anorexia, ARFID does not involve any distress about body shape or size, or fears of fatness
• Orthorexia is a newer category in which an individual begins a diet change with the intention of eating more healthfully but then becomes very rigid in what they will and will not eat.

The National Eating Disorders Association (NEDA) reports that between 0.3-0.4 percent of young women and 0.1 percent of young men will suffer from anorexia nervosa at any given time.

For bulimia nervosa, 1.0 percent of young women and 0.1 percent of young men will meet diagnostic criteria for bulimia nervosa at any given point in time.
Although eating disorders in general affect more females, NEDA cites research that showed from 1999 to 2009, the number of men hospitalized for an eating disorder-related cause increased by 53 percent. ARFID also tends to affect more males.

Addressing Emotional Issues
Today, Natalie says she still battles her eating disorder but that working with her medical team, and especially her therapist Tammy Dines, LMSW, ACSW, she has been able to manage her depression and anxiety, and control that voice in her head that “tells” her to skip meals.

“At this moment, it’s just more frustrating dealing with the eating disorder,” Natalie said. “I have to tell myself to eat. I’ve gotten so used to being hungry. But, at this point, food is not always on my mind. Today, I see food as something that will fuel me and will keep me healthy.”

Natalie said she’s looking to the future, which includes going to college. She also has found greater purpose and meaning in helping to prepare students for their bat or bar mitzvahs.
Dines, who runs a private practice in Farmington Hills, said that treating an eating disorder is frustrating for the individual because progress can be slow. But she recommends a holistic approach in that the person with the disorder work with a team, such as a therapist, a psychiatrist, a nutritionist and a medical doctor.

“We have to address emotional, nutritional and physical aspects of the disorder,” she said, adding that her role is to address the emotions that come about with eating disorders.

“I think for some eating disorders, it’s societal pressure to look a certain way and to be thin,” Dines said. “There’s a lot of family dynamics and eating disorders occur more in chaotic families or families with eating disorders. We’re seeing with anorexics [a desire for] perfection and wanting that control. Eating becomes a way to be in control.

“With some bulimics, there’s a lot of anger and rage and this is one way of externalizing it, by vomiting. With exercise bulimia, it’s calories in, take it off. A lot of these people are rigid.”

A Mother’s Take
Natalie’s mother, who also asked to be anonymous, said she began noticing emotional changes in her daughter, that she always seemed angry and sad, as her eating disorder developed.

“Puberty hit Natalie really hard, physically and mentally,” she said. “For Natalie, finding happiness is difficult.”

Natalie’s mom, who also dealt with anorexia as a young person, said that helping Natalie has taken an emotional and financial toll on the family, but that she has been proactive in her daughter’s ongoing recovery.

“With Natalie’s eating disorder, it’s not just about being skinny,” she said. “You have to focus on their mental health. Don’t be afraid to snoop. I snooped. I’m a concerned mother. Ask questions of your child and keep questioning them. Don’t just let it go. Seek medical help sooner rather than later.”

Getting Help
One center in Bloomfield Hills is addressing the unique issues surrounding eating disorders. The Center for Eating Disorder Assessment, Recovery & Support (CEDARS) is run by Kristine Vazzano, Ph.D., and registered dietitian Patrizia Jesue.

The center provides outpatient services, including a therapeutic meal support program, which helps individuals successfully manage, confront and overcome difficulties and anxieties of meal time. It also helps individuals manage their disordered thoughts about and behaviors around eating and food. Additionally, CEDARS offers different types of behavioral therapy and various support groups, as well as therapeutic yoga, meditation, culinary art therapy and creative art therapy.

Taylor Beardsall is an art therapist at CEDARS and says those who are more creative have a higher risk of developing an eating disorder.

“There tends to be a lot of anxiety and perfectionism” in these individuals, she said. “Having an eating disorder can lead to feelings of depression and really high anxiety.”

Beardsall said that using the creative process can help individuals cope with the feelings of having an eating disorder.

“The art process can be a source of grounding,” she said, adding that when individuals see their own artwork, it often gives them a sense of strength and shows them positive aspects of themselves.

Long Road To Recovery
As therapist Dines mentioned, the recovery process from an eating disorder is slow and challenging. Laurie Jablonski, a mother of two grown daughters who lives in Warren, knows this is true.

Jablonski, who was raised Jewish and attends Temple Israel in West Bloomfield, has dealt with anorexia and, to a lesser extent, binge-eating for decades, dating back to her high school years. She’s worked with various therapists over the years but has found greater success working with Dr. Vazzano and Jesue. She also has utilized CEDARS services, including art therapy and mindfulness practices.

“I’ve learned how to look at things differently, how not to blame myself over everything,” she said. “There’s still a lot of work to do, but I feel so much better. My relationship with food is I can eat anything I want, in proportion. There’s no such thing as a good or bad food.”
She also has advice for younger people coping with an eating disorder.

“If the young person is ready for recovery, I would tell them to listen to their therapist and to work harder than their therapist,” she said. “If you want recovery, you have to work at it every day.” ■


• Changes in the food choices a child/young adult makes
• Comments about their relationship with food
• Loss of period if a young woman has begun menstruation
• Body changes
• Changes in apparel, where the individual wears clothing that conceals his or her body
• Young children who express a desire to go on a diet
• Kids who play with their food
• Kids who sleep a lot and show low energy\

For details, go to www.nationaleatingdisorders.org.

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