Unhealthy Weight Loss or Gain from Eating Disorders

A reader sent me this link with a lot of helpful information about eating disorders, thank you!

By Pritikin Research 07/11/2013 Healthy Weight, Resources

An eating disorder is defined by the National Institute of Mental Health as an illness that results in a severe disturbance of one’s diet. These “disturbances” in diet are detrimental to the person’s health and interfere in their lives in general. They typically range from starving oneself to extreme overeating. Eating disorders can stem from an irrational desire to obtain an extreme body weight; however, they are often a form of coping mechanism used to help an individual deal with extreme emotional distress or loss of control. Eating disorders typically start during one’s teen years and, although more likely in women, they can affect both genders. Understanding common eating disorders is the first step in helping those who are affected by them.

Anorexia

Anorexia nervosa, which is most often referred to as simply anorexia, is a serious eating disorder that in five to twenty percent of cases ends in death. People who suffer from this disorder intentionally avoid eating and often starve themselves in order to achieve an excessive amount of weight loss. The way that they view themselves is often distorted and they have an overwhelming fear of weight gain. Typically, people with anorexia are at a lower than normal weight (less than eighty-five percent) for someone who is their height. In addition to self-starvation, people with anorexia may excessively exercise. The condition is dangerous as it can result in a number of complications. As previously mentioned, an individual with anorexia may die as a result of their condition; however, even those who do not die may suffer from anemia and bone loss. People with anorexia may suffer from malnutrition, which can cause damage to major organs such as the kidneys and brain. Gender-based problems may also occur. For example, the condition may cause men to experience a decrease in their testosterone levels. Gender specific complications for women include a loss of one’s period. Depression, anxiety, and obsessive-compulsive or other personality disorders often accompany anorexia.

• Anorexia Nervosa Fact Sheet
• Eating Disorders Among Adults – Anorexia Nervosa
• Eating Disorders – Anorexia Nervosa
• Medical Reference Guide: Anorexia nervosa
• Early Onset Anorexia

Bulimia

Like anorexia, bulimia nervosa is more common amongst women – particularly younger women and adolescent girls. With bulimia, the affected individual will secretly binge on foods that are typically high in calories. The individual then feels extreme guilt or disgust over her or his actions and will purge the food either by vomiting, using laxatives, or other methods. This type of behavior can occur several times a day. Excessive exercise also accompanies bulimia. It is often difficult to recognize someone with this condition as they often are a normal body weight even if they believe that they are overweight. Bulimic individuals will typically have dental issues such as tooth decay and gum problems. They may suffer from dehydration, lack of a menstrual cycle, digestive and/or heart problems.

• Bulimia Nervosa
• Diseases and Conditions: Bulimia
• Cedars-Sinai: Bulimia
• Health Information – Bulimia Nervosa
• Signs and Symptoms of Bulimia Nervosa

Compulsive Overeating/Binge Eating Disorder

Compulsive overeating and binge eating are disorders in which people experience periods of uncontrollable eating of large amounts of food. These episodes are often done in private, but unlike bulimia, the food is not expelled after. People with this disorder may feel anxiety, loneliness, and/or depression. They will eat even if they are not hungry or if they are already full. They are aware that their eating habits are abnormal and typically feel shame, guilt and disgust at their behavior. In terms of body weight, they may be a normal weight for someone their height, or they may be overweight or obese. Over-eaters may also go on frequent diets that are unsuccessful and that eventually worsen the overeating. Complications include an elevated risk of high blood pressure, diabetes, certain types of cancer, and weight gain.

• Mental Illnesses: Eating Disorders
• What is Binge Eating Disorder
• Compulsive Overeating
• Facts on Compulsive Eating
• Binge Eating Disorder

Orthorexia

Orthorexia differs from other types of food disorders in that eating healthy food is the problem. While at face value healthy eating cannot be considered a health or mental problem, it can and does become one when an individual becomes obsessed with healthy eating. With orthorexia, a person becomes obsessed to the point that he or she is refuses to eat anything that is not strictly considered healthy. This extreme response may find individuals skipping foods that are not certified organic or avoiding all foods that have been processed in any way. Even healthy items that have been minimally processed are shunned by orthorexic individuals. Statistically, women in their thirties are more affected by the condition than men.

• When Eating Healthy Becomes an Obsession
• The Downside of Eating Too Healthy: Orthorexia Nervosa
• Orthorexia Nervosa
• Orthorexia: Good Diets Gone Bad
• Orthorexia: An Obsession with Eating Pure

Additional Resources

• Types of Eating Disorders
• Avoidant and Restrictive Food Intake Disorder and Eating Disorder Not Otherwise Specified
• Warning Signs of an Eating Disorder
• The National Association for Males With Eating Disorders, Inc.: Male ED Differences
• Lesser Known Eating Disorders

Teen girls are more afraid of gaining weight than they are of cancer, nuclear war, or losing a parent

Teens are barraged with a constant stream of media and peer pressures related to body image. The media tells them their value is based on their outward appearance. Society tells them that they must be thinner or more muscular to be loved, accepted and successful in life. We tell them that beauty is more than skin deep. Book a speaker for your student assembly to empower your students to look beyond the media’s view of beauty and not fall into the traps of eating disorders and negative body image.

Read Don’t Buy the Lie for former Armani runway model Jennifer Strickland’s message on how the media attacks girls’ body image.

Self Image

Media, social and peer pressures influence the way teens see themselves. Their mental perception of what they look like can become distorted, leading them to engage in risk behaviors when they feel they don’t measure up to the impossible goal set in front of them. Self image issues can lead to eating disorders, drug and alcohol use, cutting, bullying and sexual addictions.

Media Influence

Studies prove that media can have a negative impact on self image. TV, movies, magazines and the internet all bombard teens with images and pressures about what their bodies should look like. The problem is, their version isn’t realistic. These images are air-brushed versions of models who weigh 23% less than the average woman. Nevertheless, millions of teens believe the lies and resort to unhealthy measures to try to fit themselves into that impossible mold.

Anorexia Nervosa

Those with anorexia suffer from a perception disorder called body dysmorphia. When they look at themselves, they think they look overweight. They severely restrict the amount of food they allow themselves to eat and often exercise excessively. This pattern can be life-threatening.

Warning signs: underweight, refusal to eat, over-exercise, unhealthy skin, hair and nails.

Bulimia Nervosa

Bulimia is usually more difficult to detect than anorexia. Bulimics tend to be a normal weight or even overweight. They attempt to control weight through purging or fasting. This usually comes after a period of binge-eating where they consume large amounts of food in a short time. While binge-eating, they feel out of control and will use fasting, exercise, induced vomiting or laxatives to regain control over their weight.

Warning signs: weight fluctuations, over-exercise, sneaking food, unhealthy skin, hair and nails.

The Facts about Self Image

• 40% of all 9 and 10-year-old girls have already been on a diet – Duke University
• 70% of 6-12-year-olds want to be thinner – National Eating Disorders Association
• In one study, 3 out of 4 women stated that they were overweight although only 1 out of 4 actually were – Rader Programs
• While only one out of ten high school girls are overweight, nine out of ten high school juniors and seniors diet – Rader Programs
• A study found that adolescent girls were more fearful of gaining weight than getting cancer, nuclear war or losing their parents – Rader Programs
• Teen pregnancy statistics show that girls who engage in unprotected sex often have lower self esteem - Family First Aid

The Facts about Media Influence on body image

• 69% of girls in 5th – 12th grades reported that magazine pictures influenced their idea of a perfect body shape - National Association of Anorexia Nervosa and Associated Disorders
• Following the viewing of images of female fashion models, seven out of ten women felt more depressed and angrier than prior to viewing the images – Rader Programs
• 80% of women who answered a People magazine survey responded that images of women on television and in the movies make them feel insecure – Rader Programs
• The body type portrayed in advertising as the ideal is possessed naturally by only 5% of American females – National Association of Anorexia Nervosa and Associated Disorders
• An average US woman is 5’4” tall weighing 140 pounds; the average US model is 5’11” weighing 117 pounds – West Virginia Dept of Education

The Facts about teens and Eating Disorders

• 90% of people with eating disorders are women between the ages of 12 and 25 - Family First Aid
• Over half of teenage girls and a third of teenage boys use unhealthy weight control behaviors such as skipping meals, fasting, smoking cigarettes, vomiting, and taking laxatives – National Association of Anorexia Nervosa and Associated Disorders
• Men are less likely to seek treatment for eating disorders because of the perception that they are woman’s diseases  – National Association of Anorexia Nervosa and Associated Disorders
• Anorexia has the highest mortality rate of any psychiatric illness - National Alliance on Mental Illness
• Anorexia is the 3^rd most common chronic illness among adolescents – National Association of Anorexia Nervosa and Associated Disorders
• Studies indicate that 50% of those who have anorexia nervosa later develop bulimia nervosa -  National Alliance on Mental Illness

What we do

Just Say YES speakers provide insight and relate personal experience to help students combat the pressures of conforming to a certain body image. Self Image programs offer encouragement and support for students dealing with eating disorders and other body image related risk behaviors. Learn more about how Just Say YES can empower your students to say YES to self-acceptance and no to negative body image.

Jennifer Strickland

Former runway model Jennifer Strickland gives incredibly powerful and life changing programs for students about the unrealistic expectations the fashion industry places on body image. She talks about how media influences can damage teens’ self image. She encourages both boys and girls to shift their focus away from how they don’t measure up to the images in the media, and instead focus on building up their strengths and being happy with who they are. For more information on Jennifer and her programs, visit her speaker page.

Body-Image Pressure Increasingly Affects Boys

Cultural ideals are becoming an equal opportunity anxiety-inducer, and eating disorders are increasingly common in men. But the symptoms in men and women don't look the same. 

JAMIE SANTA CRUZ MAR 10 2014, 9:00 AM ET

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G.I. Joe (mechnine/flickr) 

Culturally, we’re becoming well attuned to the pressure girls are under to achieve an idealized figure. But researchers say that lately, boys are increasingly feeling the heat.
A new study of a national sample of adolescent boys, published in the January issue of JAMA Pediatrics, reveals that nearly 18 percent of boys are highly concerned about their weight and physique. They are also at increased risk for a variety of negative outcomes: Boys in the study who were extremely concerned about weight were more likely to be depressed, and more likely to engage in high-risk behaviors such as binge drinking and drug use.
The trend toward weight obsession among boys is cause for worry, says Dr. Alison Field, an associate professor of pediatrics at Boston Children’s Hospital and the lead author of the study. “You want people to be concerned enough about their weight to make healthy decisions,” she says, “but not so concerned that they’re willing to take whatever means it takes—healthy or unhealthy—to achieve their desired physique.”
Of the boys who were highly concerned with their weight, about half were worried only about gaining more muscle, and approximately a third were concerned with both thinness and muscularity simultaneously. Meanwhile, less than 15 percent were concerned only with thinness. Those statistics reflect a major difference between boys and girls when it comes to weight concerns: whereas girls typically want to be thinner, boys are as likely to feel pressure to gain weight as to lose it.
“There are some males who do want to be thinner and are focused on thinness,” Field says, “but many more are focused on wanting bigger or at least more toned and defined muscles. That’s a very different physique.”

"The media has become more of an equal opportunity discriminator. Men's bodies are not good enough anymore either."

If boys are increasingly concerned about weight, changing representations of the male form in the media over the last decade or two are at least partly to blame. “We used to really discriminate—and we still do—against women” in terms of media portrayals, says Dr. Raymond Lemberg, a Prescott, Arizona-based clinical psychologist and an expert on male eating disorders. “If you look at the Miss America pageant winners or the Playboy centerfolds or the runway models over the years, there’s been more and more focus on thinness.”
But while the media pressure on women hasn’t abated, the playing field has nevertheless leveled in the last 15 years, as movies and magazines increasingly display bare-chested men with impossibly chiseled physiques and six-pack abs. “The media has become more of an equal opportunity discriminator,” says Lemberg. “Men’s bodies are not good enough anymore either.”
Even toys contribute to the distorted messages youngsters receive about the ideal male form. Take action figures, for example, which Lemberg suggests are the male equivalent of Barbie dolls in terms of the unrealistic body images they set up for young boys. In the last decade or two, action figures have lost a tremendous proportion of fat and added a substantial proportion of muscle. “Only 1 or 2 percent of [males] actually have that body type,” says Lemberg. “We’re presenting men in a way that is unnatural.”
In the face of the ideals they’re bombarded with, it’s no surprise that adolescent boys, like waves of girls before them, are falling prey to a distorted image of themselves and their physical inadequacies: Previous research suggests that up to 25 percent of normal weight males nevertheless perceive themselves to be underweight.
And given their perception of themselves as too small, it’s also no surprise that boys are searching out means to bring their bodies into conformity with the muscular ideal. A 2012 study of adolescents revealed that muscle-enhancing behaviors are pervasive among both middle school and high school-age males: More than a third reported downing protein powders or shakes in an effort to boost their muscularity; in addition, almost 6 percent admitted to using steroids and 10.5 percent acknowledged using some other muscle-enhancing substance.

The negative effects of steroid use can be particularly significant for adolescents.

Pharmaceutical-grade injectable steroids are a definite concern, says Dr. Rebecka Peebles, co-director of the Eating Disorder Assessment and Treatment Program at the Children's Hospital of Philadelphia, but they’re not the biggest worry, given that they’re difficult to obtain. Of more concern are the “natural” powders or shakes that teens can pick up at their local GNC. The problem, Peebles says, is that “natural” in this case simply means unregulated. “They actually can include all kinds of things in them,” says Peebles. In some cases powder or shake supplements “are actually anabolic androgens and just packaged as a natural supplement.”
The consequences can be severe: Long-term use of steroids is associated with depression, rage attacks, suicidal tendencies, and cardiomyopathies. And the negative effects can be particularly significant for adolescents, since their bodies are going through a period of major growth and development.
In many cases, of course, weight concerns among young males remain at relatively benign levels, and when teens attempt to control their weight, they often do so in comparatively innoccuous ways. But when adolescents demonstrate an extreme focus on physique and begin to engage in potentially dangerous behaviors, it can be a signal of an eating or weight-related disorder—in males just as much as in females.
“The misunderstanding has been the generalization that eating disorders are a woman’s issue,” says Lemberg. “What studies have shown is that, in the last 15 years or so, more men have eating disorders than ever before.” The oft-cited figure is that only about 1 in 10 eating disorders occur in males, but according to Lemberg, newer research suggests that the real ratio is probably closer to 1 in 4.

"Instead of doing something unhealthy to get smaller, they're using unhealthy means to become larger."

Although awareness of the risk of weight disorders among males is growing, there is still a problem with under-recognition, Field says, primarily because of the assumption that the disorders look the same in males as they do in females. Current assessments for eating disorders focus on the classical presentation typical of females, but since young men are often more concerned with gaining muscle than becoming thin, they typically don’t present as underweight, as girls often do. They’re also not as likely to starve themselves, use laxatives or induce vomiting; instead, they’re much more likely to engage in excessive amounts of exercise and steroid abuse. “Instead of wanting to do something unhealthy to get smaller, they’re using unhealthy means to become larger,” Field says.
But though the presentation might be different, excessive worries about weight, especially in combination with high-risk behaviors, are no less concerning in males than in females. According to Field, it’s time to sit up and take note of the boys. “Pediatricians and adolescent medicine docs and parents [need] to become aware that they should be listening as much to their sons’ conversations about weight as their daughters’.”

Effect of Media on Teens

Media's Effect on Body Image The popular media (television, movies, magazines, etc.) have, since World War II, increasingly held up a thinner and thinner body image as the ideal for women.  In a survey of girls 9 and 10 years old, 40% have tried to lose weight, according to an ongoing study funded by the National Heart, Lung and Blood Institute. In a study on fifth graders, 10 year old girls and boys told researchers they were dissatisfied with their own bodies after watching a music video by Britney Spears or a clip from the TV show "Friends". A 1996 study found that the amount of time an adolescent watches soaps, movies and music videos is associated with their degree of body dissatisfaction and desire to be thin.  One study reports that at age thirteen, 53% of American girls are "unhappy with their bodies." This grows to 78% by the time girls reach seventeen. Source: National Institute on Media and the Family A Focus on Appearance A Kaiser Foundation study by Nancy Signorielli found that: In movies, particularly, but also in television shows and the accompanying commercials, women's and girls' appearance is frequently commented on: 58 percent of female characters in movies had comments made about their looks, as did 28 percent in television shows and 26 percent of the female models in the accompanying commercials. Mens' and boys' appearance is talked about significantly less often in all three media: a quarter (24%) of male characters in the movies, and 10 percent and 7 percent, respectively, in television shows and commercials. One in every three (37%) articles in leading teen girl magazines also included a focus on appearance, and most of the advertisements (50%) used an appeal to beauty to sell their products. The commercials aimed at female viewers that ran during the television shows most often watched by teen girls also frequently used beauty as a product appeal (56% of commercials). By comparison, this is true of just 3 percent of television commercials aimed at men. Source: National Institute on Media and the Family Eating Disorders The National Institute of Mental Health estimates that eating disorders affect more than 5 million Americans each year.   An estimated one thousand women die each year of anorexia nervosa. As many as one in ten college women suffer from a clinical or nearly clinical eating disorder, including 5.1% who suffer from bulimia nervosa.  Approximately five percent of adolescent and adult women and one percent of men have anorexia nervosa, bulimia nervosa, or binge eating disorder.  Fifteen percent of young women have substantially disordered eating attitudes and behaviors. The National Center for Health Statistics estimates that about 9,000 people admitted to hospitals were diagnosed with bulimia in 1994, the latest year for which statistics are available, and about 8,000 were diagnosed with anorexia. Males account for only 5 to 10 percent of bulimia and anorexia cases. While people of all races develop the disorders, the vast majority of those diagnosed are white. Studies indicate that by their first year of college, 4.5 to 18 percent of women and 0.4 percent of men have a history of bulimia and that as many as 1 in 100 females between the ages of 12 and 18 have anorexia. Statistics from the National Center for Health Statistics show that "anorexia" or "anorexia nervosa" was the underlying cause of death noted on 101 death certificates in 1994, and was mentioned as one of multiple causes of death on another 2,657 death certificates.  In the same year, bulimia was the underlying cause of death on two death certificates and mentioned as one of several causes on 64 others. Five to ten million adolescent girls and women struggle with eating disorders and borderline eating conditions.  Each year millions of people in the United States are affected by serious and sometimes life-threatening eating disorders. More than 90 percent of those afflicted are adolescent and young adult women.   According to The Center For Mental Health Services 90 percent of those who have eating disorders are women between the ages of 12 and 25. Source: National Institute of Mental Health, National Center for Health Statistics, National Eating Disorders, SAMHSA'S National Mental Health Information Center 8,000,000 or more people in the United States have an eating disorder.  90% are women.  Eating disorders usually start in the teens but may begin as early as age 8.  Source: National Association of Anorexia Nervosa and Associated Disorders Article from:  http://depts.washington.edu/thmedia/view.cgi?section=bodyimage&page=fastfacts

Surviving Your Child's Adolescence: Adolescence and Self-Esteem

Teach adolescents how to maintain healthy self-esteem. 

Published on September 6, 2010 by Carl E. Pickhardt, Ph.D. in Surviving (Your Child's) Adolescence

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The concept of self-esteem is a very American one, particularly at home in our culture during the century that has followed its invention by psychologist William James.
Perhaps justified as part of our right to the pursuit of happiness and self-fulfillment, rooted in our emphasis on individualism, and nourished by our belief in self-improvement and material success, self-esteem is a notion that seems here to stay.
In addition, it has a certain common sense appeal and validity, if not a scientifically verifiable one. Given a choice, most people would rather have high self-esteem than low because they link it to personal well being and effectiveness.
From my view in family counseling, self-esteem can have significant impact on relationships. It generally seems that family members are more prone to act badly toward each other when they are feeling bad about themselves. The worse they feel about themselves, the worse they often treat others, the worse they get treated in return, the worse they end up feeling about themselves, the worse they treat others, and round and round the cycle of unhappiness goes. In low-esteem families, relationships can become mutually destructive.

In high esteem families, however, the reverse seems more likely to occur. The better family members feel about themselves, the better they treat each other, the better they get treated in return, the better off everyone tends to become. In high esteem families, relationships can become mutually affirming. Members seem more inclined to bring out the best in each other, not the worst.
So positive self-esteem is not some kind of popular fad or new-age frill. Upon its existence, the happy and healthy functioning of individuals and families partly depend, particularly during children's teenage years.
I have seen two major self-esteem drops during the normal course of adolescence.
The first drop occurs at the outset in early adolescence (ages 9-13) when the young person's separation from childhood creates a loss of contentment with being defined and treated any longer as just a child. In this process, many components of self-definition now considered "childish" - beloved interests, activities, and relationships that supported self-esteem - may be sacrificed for the sake of future growth and acting older. A lot of "kid stuff" of significant psychological value can be thrown away. Old toys and hobbies can be abandoned, and even cherished grandparents can be put at a distance.
The second drop in self-esteem occurs during the end of adolescence, trial independence (ages 18-23), when the young person is confronted with the daunting reality of independence and feels overwhelmed and diminished by the future shock mentioned in my previous blog. Feeling not up to this challenge and sometimes acting this way, it is easy to feel disappointed in them selves, to get down on them selves, and even to punish them selves, esteem falling in the process. "Here I am 22 years old, still messing up, and I can't get my life together!"
So what is self-esteem? It is not real in the sense that it can be visually examined, physically touched, or directly observed. Similar to notions like ‘intelligence' or ‘conscience', self-esteem is an abstract psychological concept made up to describe part of a person's human nature. It's existence and utility is inferred through actions and expressions considered evidence of its presence.
Just as solving a problem may be considered evidence of intelligence, or acting in accord with one's ethical beliefs may be considered evidence of conscience, insisting on being dealt with fairly or respectfully may be considered evidence of self-esteem, the young person acting as though they are worth treating well.
More specifically, "self-esteem" is two words compounded into one. Separate them, and the meaning of the larger term comes clear. "Self" is a descriptive concept: By what specific characteristics do I identify who I am? "Esteem" is an evaluative concept: How do I judge the value of who I am?
Self-esteem has to do with how a person identifies and evaluates his or her definition of self.

Start with self-esteem as identification. When the adolescent commits his or her identity to just one part of life - to having friends, to competitive sports, to high academic achievement - then when friends are lost, when injury ends athletics, when academic performance drops, esteem comes crashing down. "I'm nothing without my friends!" "I'm worthless without my sport!" "I'm a failure if I don't make an A!" To maintain relative constancy of well being through the normal ups and downs of adolescence, it really helps to have multiple pillars of self-esteem.
Consider self-esteem as evaluation. When the adolescent is routinely hard on him or herself - from insisting on excellence, from criticizing failings, from punishing mistakes - then when expectations are unmet, when imperfections become apparent, when human errors occur, esteem comes crashing down. "I'm so stupid!" "What's wrong with me!" "I can't do anything right!" To maintain constancy of well being during the trials of adolescence, it really helps when life goes badly to treat oneself with tolerance and understanding.
Particularly in the response to a bad experience where impulsive or unwise decision making led to error, disappointment, or trouble, an adolescent can get into some pretty harsh self-evaluation, descending common steps that systematically lower self-esteem.
They are:
Make a bad choice,
Suffer hurt feelings,
Take burden of guilt,
Self-criticize or blame,
Punish self for acting badly,
Treat this mistreatment as deserved,
Spend more energy on penance than recovery.
Should your son or daughter proceed to beat up on themselves for choosing unwisely or for life going badly, you might suggest this to them: "To hurt yourself when you are already hurting only makes the hurt worse. When you're hurting is a time not to treat yourself badly, but well. That way you can motivate yourself to do better."
So what might you say to your adolescent about self-esteem? "The more narrowly you define yourself and the more negatively you evaluate yourself, the more at risk of lowered self-esteem you are likely to be. In that unhappy state, you may also be more at risk of treating yourself and others badly. Therefore, do yourself a favor. To maintain positive self-esteem, define yourself broadly and evaluate yourself kindly and most of the time you will appreciate the value, and enjoy the company, of who and how you are."
Is there such a thing as having too much self-esteem? Yes. People who prize themselves too highly often believe they are superior, are always right, are owed special consideration and treatment, need allow no disagreement, know it all (or at least all worth knowing), deserve be given their way, and should be allowed to rule over the lives of others. Many tyrants, petty and great, from the entitled child to the cruel despot, have had extremely high self-esteem -- to other people's cost.
Within the matrix of concepts that explain psychological functioning, I believe self-esteem has a useful place. Important as it is, however, strong self-esteem is not everything.
For example, it is independent of morality. Strong self-esteem does not prevent wrongdoing. People who feel extremely positive about who and how they are can still become bullies, criminals, and even destructive zealots. Evil can claim strong self-esteem as easily as can good.
Self-esteem is also independent of outcome. It does not assure accomplishment. People who feel confident about performing well are still capable of making misunderstandings, miscalculations, and mistakes. Strong self-esteem can lead a person into failure as well as to success.
My favorite prescription for preserving strong self-esteem was reported in the New York Times a number of years ago (September 28, 1999, p. C31.) "There's a lot of talk about self-esteem these days...It seems pretty basic to me. If you want to feel proud of yourself, you've got to do things you can feel proud of. Feelings follow actions."
This statement was made by Oseola McCarty, a washerwoman who gave her life savings of $150,000 to fund scholarships at the University of Southern Mississippi.
For more about parenting adolescents, see my book, "SURVIVING YOUR CHILD'S ADOLESCENCE" (Wiley, 2013.) Information at: www.carlpickhardt.com 

Body Dysmorphic Disorder (BDD)

Body Dysmorphic Disorder (BDD)

by ADAA (Anxiety and Depression Association of America)

Most of us have something we don't like about our appearance — a crooked nose, an uneven smile, or eyes that are too large or too small. And though we may fret about our imperfections, they don’t interfere with our daily lives.

But people who have body dysmorphic disorder (BDD) think about their real or perceived flaws for hours each day.

They can't control their negative thoughts and don't believe people who tell them that they look fine. Their thoughts may cause severe emotional distress and interfere with their daily functioning. They may miss work or school, avoid social situations and isolate themselves, even from family and friends, because they fear others will notice their flaws.

They may even undergo unnecessary plastic surgeries to correct perceived imperfections, never finding satisfaction with the results.

Characteristics of BDD

BDD is a body-image disorder characterized by persistent and intrusive preoccupations with an imagined or slight defect in one's appearance.

People with BDD can dislike any part of their body, although they often find fault with their hair, skin, nose, chest, or stomach. In reality, a perceived defect may be only a slight imperfection or nonexistent. But for someone with BDD, the flaw is significant and prominent, often causing severe emotional distress and difficulties in daily functioning.

BDD most often develops in adolescents and teens, and research shows that it affects men and women almost equally. About one percent of the U.S. population has BDD.

The causes of BDD are unclear, but certain biological and environmental factors may contribute to its development, including genetic predisposition, neurobiological factors such as malfunctioning of serotonin in the brain, personality traits, and life experiences.

Symptoms

People with BDD suffer from obsessions about their appearance that can last for hours or up to an entire day. Hard to resist or control, these obsessions make it difficult for people with BDD to focus on anything but their imperfections. This can lead to low self-esteem, avoidance of social situations, and problems at work or school.

People with severe BDD may avoid leaving their homes altogether and may even have thoughts of suicide or make a suicide attempt.

BDD sufferers may perform some type of compulsive or repetitive behavior to try to hide or improve their flaws although these behaviors usually give only temporary relief. Examples are listed below:

• camouflaging (with body position, clothing, makeup, hair, hats, etc.)
• comparing body part to others' appearance
• seeking surgery 
• checking in a mirror 
• avoiding mirrors 
• skin picking
• excessive grooming 
• excessive exercise
• changing clothes excessively 

BDD and Other Mental Health Disorders

People with BDD commonly also suffer from the anxiety disorders obsessive-compulsive disorder (OCD) or social anxiety disorder, as well as depression and eating disorders.

BDD can also be misdiagnosed as one of these disorders because they share similar symptoms. The intrusive thoughts and repetitive behaviors exhibited in BDD are similar to the obsessions and compulsions of OCD. And avoiding social situations is similar to the behavior of some people with social anxiety disorder.

Diagnosis and Treatment

To get an accurate diagnosis and appropriate treatment, people must mention specifically their concerns with their appearance when they talk to a doctor or mental health professional. A trained clinician should diagnose BDD.

However, you can take a self-test that can help suggest if BDD is present, but it will not offer a definitive diagnosis.

• Self-test for adults
• Self-test for adolescents

If your child is preoccupied with appearance so that it interferes with concentration in school or if behaviors listed above appear, talk to a mental health professional.

Effective treatments are available to help BDD sufferers live full, productive lives.

• Cognitive-behavioral therapy (CBT) teaches patients to recognize irrational thoughts and change negative thinking patterns. Patients learn to identify unhealthy ways of thinking and behaving and replace them with positive ones. Find out about ACT with CBT.
• Antidepressant medications, including selective serotonin reuptake inhibitors (SSRIs), can help relieve the obsessive and compulsive symptoms of BDD.

Treatment is tailored to each patient so it is important to talk with a doctor to determine the best individual approach. Many doctors recommend using a combination of treatments for best results.

Find out more

• The Broken Mirror: Understanding and Treating Body Dysmorphic Disorder, by Katharine Phillips, MD (Oxford University Press, 2005)
• Understanding Body Dysmorphic Disorder, by Katharine Phillips, MD (Oxford University Press, 2009)
• Body Image Program, Rhode Island Hospital
• BDD Central
• Massachusetts General Hospital BDD Clinic

http://www.adaa.org/understanding-anxiety/related-illnesses/other-related-conditions/body-dysmorphic-disorder-bdd