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Be sure to watch this segment live on FITM this Monday, 11-06-06 between 8:00 and 8:30a.m.
Background: 14 year-old Karen recently told her best friend Stephanie that she is "fat" and needs to lose at least 15 pounds. Stephanie's eye's grew quite large as she responded to Karen with "are you crazy, you are too skinny as it is". Despite Stephanie's accurate assessment of Karen, these two girls have completely different perceptions of what Karen's body actually looks like. Over the next two months, Karen decided to eliminate all carbohydrates and fats in her diet and when she would eat, only would ingest salads, fruits, and liquids, such as Crystal Light. Sure enough, she did lose about 15 pounds but also stopped menstruating. Her physique to all outside of her view was dangerously thin, yet Karen thought she still had at least 5 to 10 pounds to go before she felt she looked "okay". In addition to the loss of her monthly period, her grades in school began to slip due to Karen developing concentration problems during class and when attempting to do her homework. Her loss of energy made it difficult to complete her assignments and subsequently her straight A's were moving downward towards B's and C's. Despite these changes, Karen was convinced it was all worth her feeling thin and no longer fat. Obviously her parents were concerned and one afternoon, Karen's mother pulled Karen into the bathroom with her and looked in the mirror together. "How can you feel fat?", Karen's mother stated. "Look mom, see these folds of skin on my stomach"? "No Karen, I don't, those are your ribs not folds of skin". "No mom, it's fat and I hate my body for doing this to me!". At this moment, Karen's mom knew that Karen had a real problem hightlighting that even Karen's perception of herself was distorted.
Leading up to Karen’s present disorder were some important developmental experiences beginning early in her life. As a toddler, her parents were very concerned about her tantrums and subsequently set very stringent limits when she would express any sort of anger and opposition. Here it seems that Karen internalized that anger was a “bad” emotion that should be inhibited and repressed. During her childhood and early adolescent years, Karen never expressed her anger in spoken words. In fact, she continued to fear punishment if she were to express her feelings directly. This led to experiences of being manipulated by many of her peers for not speaking up for herself.
Eating had also been a point of contention. Concerned that she would not grow to her full capacity, a family rule was that she must “clean her plate” at each meal before being excused from the table. Over the years, this became a dreaded experience for she felt forced to eat even at times when she did not feel hungry. This led to a general dislike of almost all forms of food.
Finally, Karen’s mother has been a habitual dieter and exercise guru expressing frequent concerns about gaining weight and looking “fat”. Over the years her mother would encourage Karen to watch what she eats and mandated that she exercise at least three days a week since she was 8 years old.
Taking this history together illustrates how certain external experiences must become internalized and processed. But exactly how do these eating disorders develop? Despite some attempts to portray some sort of classic syndrome, the truth is that the eating disorders are no different than any other psychiatric symptom. In other words, there could be a number of different underlying conflicts which give rise to the development of this type of syndrome just like when an adolescent develops a depression. However, when an adolescent develops an eating disorder, the condition can become very serious and frequently can cause physical health as well as psychological problems. In other words, it is a very serious condition that always will warrant professional help once it has developed. The treatment protocol for the eating disorders frequently combines medication (usually antidepressants) and psychotherapy aimed at helping the individual both understand the causes of the condition as well as helping them develop an accurate view of themselves which has frequently become distorted.
Although there can be a variety of different conditions and conflicts that can cause the development of an eating disorder which could include: conflicts over aggression, control, sexuality, growing up and moving out of childhood, just to name a few, there are certain measures that parents can take in their roles as caregivers that could help to prevent eating disorders from manifesting in their child. These include the following:
1. do not battle over food consumption
2. never criticize your child's body
3. encourage your child to express feelings to you always
4. be accepting to your child's feelings towards you
5. be careful about dieting in front of your children
6. always encourage acceptance of the natural body
7. educate about mature bodily development over time
Following these guidelines help the child and adolescent both accept themselves in a healthy manner, allow for some uniqueness and differentiation, and promote the healthy expression of feelings which often offsets the development of many psychological disorders including the eating disorders.
Dr. Keith Kanner
Show Host
Your Family Matters
Fox6 News - San Diego
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About drkanner
Dr. Kanner is a Licensed Clinical Child, Adolescent, and Adult Psychologist and Psychoanalyst with a full time private practice in Rancho Santa Fe, California. He is also an Assistant Clinical Professor of Psychiatry in the School of Medicine at U.C. San Diego and a Clinical Instructor and Supervisor at the San Diego Psychoanalytic Society and Institute. Recently, he has become the Director of Clinical Counseling for La Jolla Country Day School and has been named to the National Board of Directors for KidsKorps, USA. He continues as a Consultant for many public and private schools in San Diego and has also received distinguished teaching awards over the past seven years. He is a published author and a sought after speaker on topics pertaining to childhood, adolescence, and parenthood. He is also presently writing a book for Fox based on his show, Your Family Matters.
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