ERIC Identifier: ED260367 Publication Date: 1984-00-00
Author: Herbert, Deborah, Comp. Source: ERIC Clearinghouse
on Counseling and Personnel Services Ann Arbor MI.
Eating Disorders: Counseling Issues. In Brief: An Information
Digest from ERIC/CAPS.
Bulimia and anorexia are binge-eating and starving disorders afflicting
thousands of adolescent and young adult women each year.
CHARACTERISTICS OF BULIMIA AND ANOREXIA
Diagnostic criteria established in 1980 by the American Psychiatric
Association include the following:
The majority of bulimics binge in secret and resort to self-induced vomiting
or purging. A typical binge averages 4,000 calories, lasts an hour, and occurs
twice a day. Diagnostic criteria include recurrent episodes of binge-eating;
awareness that the eating pattern is abnormal and fear of being unable to stop
voluntarily; and depressed mood and self-deprecating thoughts after binging.
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.
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
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 involves journal keeping; nutritional intervention;
altering antecedent events; using cognitive-behavioral techniques; manipulating
consequences; and eliciting the support of family and friends.
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
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
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):
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.