Attention Deficit Hyperactivity Disorder (ADHD)

Background

ADHD children are more active, less attentive, and more impulsive than most children of their age.  In the past, ADHD has been called ADD (Attention Deficit Disorder) and hyperactivity.  About 3% of children exhibit ADHD.  More boys are diagnosed than girls.

Characteristics of ADHD include fidgeting or squirmy, having difficulty remaining seated, being easily distracted, having difficulty waiting to take a turn, having a short attention span, shifting from one uncompleted activity to another, talking excessively, interrupting others, and engaging in physically dangerous activities without thinking of consequences.

Sometimes children are not hyperactive, but are distractible and have a short attention span.  This condition is more subtle but can interfere with day to day activities.  It is called undifferentiated attention deficit disorder.

Development

ADHD begins at an early age and is displayed in a wide variety of situations.  Many children exhibit some characteristics of ADHD at times, the ADHD child’s difficulties are extreme and regularly interfere with day to day activities.  The difficulties are typically most apparent in settings such as school.  As a result, many ADHD children are not identified until they enter school.  In some settings, ADHD children are able to pay attention quite well.  These include fast moving TV shows, video games, and novel situations.

ADHD is a chronic disorder which lasts through childhood and often into adulthood.  While some characteristics may seem less extreme as the child gets older.  ADHD students may experience other behavior and social-emotional disorders later in life.  Children with ADHD may also exhibit learning difficulties.  Testing by the school’s evaluation team may be appropriate if a child is having significant learning problems.

No one knows what causes ADHD.  Differences in brain structure and functioning and heredity are being studied.  However, it is very unusual to find treatable neurological difficulties as the cause of ADHD.  Claims that allergies to foods or additives or vitamin deficiencies are responsible for ADHD have not been supported by research and special diets do not typically result in drastic or long-lasting changes in an ADHD child’s behavior.

Often ADHD is treated with medication.  Not every ADHD child needs medication, but medications can be very effective in controlling some of the behaviors associated with ADHD.  The most commonly used medications for ADHD are Ritalin, Adderall, Concerta, and the extended release formulations of these medications.  These are known as stimulant drugs, and although it may seem like the last thing and ADHD child needs is stimulation, these medications reduce the characteristics of ADHD.  With the appropriate use, stimulant medications are reported to be safe and to have few side-effects.  At times, additional or other medications such as Cyleet, Respirdal, or antidepressants may be indicated.

How Do You Learn To Parent?

“Babies don’t come with a set of instructions.”  How many times have you heard these words of frustration from an overwhelmed parent?  You have probably said them yourself.

How Do You Learn To Parent?

I went to a local bookstore and counted the number of “How to Parent” books on the shelf.  I found 72 in just one bookstore.

What’s a parent to do?

Parents only need 2 guidelines for raising healthy, happy, well-adjusted children.

Consistency

Structure

That’s it!  Just these 2 guidelines.  OK, you ask.  What approach do we use?  Authoritarian, No Limits, Liberal?

The answer is — it doesn’t matter.

Research in child development shows that children raised in an authoritarian home and children raised in a liberal home both emerge as well-adjusted adults.

How can that be?  Back to the guidelines – structure and consistency.  These are the cornerstones of adjustment.  Either way will work if you stay structured and consistent.  That means that the child gets up at about the same time every day, goes to the same school or day care, has dinner at a regular time and goes to bed on the same schedule every day.

Problems come from being inconsistent and wishy-washy.  Without structure and consistency, kids get a double message.  They become confused and learn to manipulate to deal with the confusion.

So what’s the problem?  Simple – the world won’t tolerate manipulative and inconsistent behaviors.  Surviving in the real world requires expected, reliable behaviors.

The worst parenting occurs when children continually receive mixed messages.  Children are then forced to make their own choices and decisions when they do not have the intellectual or development skill to take charge of themselves.

Without structure and consistency, kids turn to whatever is available to remove them from an insurmountable task.  Enter drugs, alcohol, sex or whatever helps them escape from a task for which they are not prepared.

Even if you do not have a parenting model to follow, you DO have a feel for “what works” in your home.  Yes, there is a gut feel there – just stop and listen.

If you really can’t find a speck of direction, pick one approach and stick with it.  You will be successful in raising well-adjusted children if you adopt one approach and remain Consistent and Structured.

“I Can Quit Any Time”

Who’s Alcoholic?

The stereotyped picture of the drunken, skid-row bum is a myth. 95% of all alcoholics are employed.  45% of them hold management positions; 50% have college degrees.

Alcoholism may be defines as a disease, an addiction, or dependency, but the symptoms are the same:

  • an overwhelming desire to drink
  • ever-increasing tolerance for alcohol
  • personality changes caused by drinking
  • impaired judgment due to drinking
  • concealed drinking
  • emotional and/or physical isolation from friends and family
  • difficulty in daily functioning
  • physical problems
  • blackouts from drinking

The alcoholic drinks compulsively to the point of intoxication, over and over again, and continues to do so despite the concern of family and friends, physicians’ warning and that little voice inside that says “You’re killing yourself.”

How It Develops

Alcoholism is a chronic, progressive disease, just like Alzheimer’s or diabetes.  It begins with the discovery that drinking can produce a temporary mild euphoria, and progresses to looking forward to that feeling and then to seeking it out.  The need becomes an obsession, which becomes an addiction.

Social drinking leads to psychological addiction for the alcoholic, and at some point, the body’s metabolic processes are altered to include and depend upon alcohol.  This is where physical dependence – true addiction – begins.

Alcoholic Personality

Alcoholism may be caused by an inherited vulnerability to alcohol or may be passed from parent to child as a learned way of coping with discomfort and stress.

In either case, these traits characterize addiction personalities:

  • anxiety about personal relationships
  • emotional immaturity
  • excessive dependency
  • tendency to be smokers and/or heavy coffee drinkers
  • low tolerance for frustration feelings of loneliness & isolation
  • low self-confidence & self-esteem
  • impulsiveness
  • perfectionism
  • ambivalence towards authority
  • inability to express emotions
  • excessive guilt

Denial is the chief symptom of alcoholism.  “I can quit any time” is a typical statement.  This is not the same as lying – it is self-deception, a defense against unpleasant realities.  The alcoholic may be the only one who believes his denial, but his is often so vehement that friends and families remain silent.

Treating Alcoholism

Most treatment methods are based on the concept that alcoholism is a disease-physical, psychological, or both.  The goal of treatment is to break the alcoholic’s dependency on alcohol, and to remove the compulsive need to drink.  All treatment programs strive to restore adequate strength for the person to cope with life without the help of alcohol.  The earlier treatment is obtained, the greater the chances for recovery.

Short-term services to help break the alcohol habit include: detoxification, physical & psychological evaluation, and brief (10 days to 2 weeks) intensive hospital treatment programs that use individual, group, and family therapy as well as alcoholism counseling and education.

Long-term services to control addiction may include psychotherapy, medical care, drug therapy and self-help/support groups such as Alcoholics Anonymous.  Alcoholism treatment experts agree that AA is essential in maintaining sobriety.  AA now includes Al-Anon groups for spouses and adult family members of alcoholics; Ala-teen for children 11-21 yrs old; Ala-tot for younger children; and ACOA (Adult Children of Alcoholics) groups.

Other sources of help include the National Council on Alcoholism (733 Third Ave., NY 10017) which sponsors Alcohol Information Centers in cities and the Nat’l Clearinghouse for Alcohol Info. (Box 2345, Rockville, MD 20852).

Alcohol- & Drug-Use Disorders in Society

Alcohol and drug use disorders-which include misuse, dependence, or addiction to alcohol and/or legal or illegal drugs-remain a major public health problem in the United States. The social cost of alcohol and drug use in the United States is staggering, estimated at more than $294 billion in 1997.

How Common Are Alcohol and Drug Use Disorders?

  • More than 9 percent of the total population age 1 2 or older met the criteria for substance dependence or abuse in 2002.
  • An estimated 19.5 million Americans (8.3 percent of the population age 12 or older) were current users of illicit drugs in 2002, meaning they had used an illicit drug at least once during the month prior to being interviewed.
  • About 54 million Americans in 2002 (nearly 23 percent of the population age 12 or older) said they had participated in binge drinking (5 or more drinks on the same occasion) at least once in the last 30 days. Nearly 16 million said they were heavy drinkers (had 5 or more drinks on the same occasion on at least 5 days during the past month).

Who Is Affected by Alcohol and Drug Use Disorders?

Alcohol and drug use disorders can affect anyone. But those who are particularly vulnerable include people with a co-occurring mental disorder or those who have certain risk factors, including poverty or a family history of alcohol or drug use disorders.

Alcohol and drug use disorders affect not just the people who are in need of treatment, but also their family members. Clearly, the effects of helping one person achieve recovery from an alcohol or drug use disorder can improve a multitude of lives.

Youth

  • More than 36 percent of American 17-year-olds reported current alcohol use in 2002, and more than 11 percent of youths ages 12 to 17 reported current illicit drug use.
  • Some children are using drugs at age 12 or 13, and others may begin earlier. But families can help prevent alcohol and drug use disorders by creating strong bonds with their children, setting clear limits, and being actively involved with their children’s lives.
  • As many as one in four children-19 million children or 28.6 percent of children under the age of 18-lives in a home where problems with alcohol are a fact of daily life.
  • But not all the statistics are negative. Use of marijuana, Ecstasy, LSD, cigarettes, and alcohol decreased significantly from 2001 to 2002 among 8th, l0th, and 12th grade students in U.S. schools.

Seniors

  • Inadvertent misuse of prescription drugs is common among the elderly, who use prescription drugs three times more often than the general population does, and who may have difficulty complying with directions for taking a medication. Misuse of prescription drugs can lead to complications, including memory loss.
  • Only about 14 percent of treatment facilities have addiction treatment programs designed specifically for older adults.

Men vs. Women

  • Men are twice as likely as women to be considered to have an alcohol or drug use disorder, except among youths ages 12 to 17, when the prevalence of alcohol or drug use disorders is relatively the same for both genders.

People of Color

  • The rates of current illicit drug use in 2002 were highest among American Indians/Alaska Natives (10.1 percent) and people of mixed race (made up of two or more races) (11.4 percent).
  • Rates of illicit drug use were 9.7 percent for blacks, 8.5 percent for whites, and 7.2 percent for Hispanics. Asians had the lowest rate at 3.5 percent.

The impact of alcohol and drug use disorders is much greater than these numbers indicate. Alcohol and drug use disorders affect not just the people suffering from them, but also family members (particularly the children of those affected) friends, co-workers, and others who interact with them.

“Being a product of abuse and neglect, drugs seemed to be the thing that dulled the pain and that other people and myself had in common. Unfortunately, my addiction became serious -where death was a reality- and the party ended. It was a turning point where God had given me back my life. I chose to never do drugs again, because life and the people in it are more important. There was nothing spiritual about drugs, which in a way was abuse to myself -why ever continue that destructive process? Sobriety has been a hard road, but the most rewarding choice yet”   -Pam Killingsworth, Member of People With Recovery & Disabilities (PWRD).

For additional National Alcohol and Drug Addiction Recovery Month materials, visit our Web site at www.recoverymonth.gov or call 1-800-662-HELP.

 

Sources

Coffey, R.M., et 01. National Estimates of Expenditures For Substance Abuse Treatment, 1997. DHHS publication No. (SMA) 01-3511. Rockville, MD: U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Substance Abuse Treatment, Medstat Group, February 2001, section entitled “Key Findings,” para. 1.

Results From the 2002 National Survey on Drug Use and Health: National Findings. DHHS Publication No. (SMA) 03-3774. Rockville, MD: U.S. Department of

Health and Human Services, Substance Abuse and Mental Health Services Administration, Office of Applied Studies, September 2003, pp. 1, 2,4.

Preventing Drug Use Among Children and Adolescents: A Research-Based Guide For Parents, Educators, and Community Leaders. NIH Publication No. 04-4212(B). Bethesda, MD: U.S. Department of Health and Human Services, National Institutes of Health, National Institute on Drug Abuse, printed 1997/second edition October 2003, p. 8.

Results From the 2002 National Survey on Drug Use and Health: National Findings, September 2003, p. 1.

Preventing Drug Use Among Children and Adolescents: A Research-Based Guide For Parents, Educators, and Community Leaders, p. 6.

You Can Help: A Guide For Caring Adults Working With Young People Experiencing Addiction in the Family DHHS Publication No. (SMA) 01-3544. Rockville, MD:

U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Substance Abuse Treatment, 2002, brochure.

Grant, B.F., Estimates of US Children Exposed to Alcohol Abuse and Dependence in the Family, American Journal of Public Health, January 2000, Vol. 90, No.1, p. 103.

Johnston, L.D., O’Malley, P.M. & Bachman, J.G. Monitoring the Future: National Results on Adolescent Drug Use; Overview of Key Findings, 2002. NIH Publication No. 03-5374. Bethesda, MD: U.S. Department of Health and Human Services, National Institutes of Health, National Institute on Drug Abuse, 2003, p. 3.

Prescription Drugs: Abuse and Addiction. National Institute on Drug Abuse Research Report Series. NIH Publication No. 01-4881. Rockville, MD: U.S. Department of Health and Human Services, National Institute of Health, National Institute on Drug Abuse, printed April 2001, pp. 1,6.

National Survey of Substance Abuse Treatment Services (N-SSATS): 2002. Data on Substance Abuse Treatment Facilities. DASIS Series: S-19, DHHS Publication No. (SMA) 03-3777. Rockville, MD: U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Office of Applied Studies, September 2003, p. 25.

Results From the 2002 National Survey on Drug Use and Health: National Findings, p. 26. ibid, p. 16.

Improving Substance Abuse Treatment: The National Treatment plan Initiative, Changing the Conversation. DHHS Publication No. (SMA) 00-3479. Rockville, MD:

U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, 2000, p. 29.

Alcohol Disorders

For many people, drinking alcohol is nothing more than a pleasant way to relax. People with alcohol-related disorders drink to excess, endangering both themselves and those around them. This question-and-answer fact sheet explains how psychotherapy can help people recover from these potentially life-threatening disorders.

When does drinking become a problem?

For most adults, moderate alcohol use—no more than two drinks a day for men and one for women and older people—is relatively harmless. (A “drink” consists of 1.5 ounces of spirits, 5 ounces of wine or 12 ounces of beer, which contain equal amounts of alcohol.) Moderate use, however, lies at one end of a continuum that moves through alcohol abuse to alcohol dependence:

  • Alcohol abuse is a drinking pattern that results in adverse consequences that are both significant and recurrent. Alcohol abusers may fail to fulfill major school, work or family obligations. They may have drinking-related legal problems, such as drunk driving arrests. They may have relationship problems related to their drinking.
  • People with alcoholism—technically known as alcohol dependence—have become compulsive in their alcohol use. Although they can control their drinking at times, they are often unable to stop once they start. As their tolerance increases, they may need more and more alcohol to achieve the same “high.” Or they may become physically dependent on alcohol, suffering withdrawal symptoms such as nausea, sweating, restlessness, irritability, tremors and even hallucinations and convulsions when they stop after a period of heavy drinking. It doesn’t matter what kind of alcohol someone drinks or even how much: alcohol dependent people simply lack reliable control over their drinking.

According to the National Institute on Alcohol Abuse and Alcoholism (NIAAA), one in 13 American adults is an alcohol abuser or alcoholic at any given time. A 1997 government survey revealed that drinking problems are also common among younger Americans—despite the fact that most states outlaw drinking under age 21. Almost five million youths aged 12 to 20 engage in binge drinking, for example, with females downing at least four drinks on a single occasion and males at least five.

What causes alcohol-related disorders?

Problem drinking has multiple causes, with genetic, physiological, psychological and social factors all playing a role. For some alcohol abusers, psychological traits such as impulsiveness, low self-esteem and a need for approval prompt inappropriate drinking. Others drink as a way of coping with emotional pain. Still others use alcohol to “medicate” psychological disorders. Once people begin drinking excessively, the problem can perpetuate itself. Heavy drinking can cause physiological changes that make more drinking the only way to avoid discomfort.

Genetic factors render some people especially vulnerable to alcohol dependence. (Contrary to myth, being able to “hold your liquor” means you’re probably more at risk—not less.) Yet a family history of alcoholism doesn’t mean that children of alcoholics will automatically grow up to become alcoholics themselves. Environmental factors such as peer pressure and the easy availability of alcohol can also play key roles. Although alcohol-related disorders can strike anyone, poverty and physical or sexual abuse also increase the odds.

How do alcohol-related disorders affect people?

While small amounts of alcohol may have some beneficial physical effects, heavy drinking can cause serious health problems and even death. In fact, 100,000 Americans die from alcohol-related causes each year. Short-term effects include distorted perceptions, memory loss, hangovers, and blackouts, many problems aren’t apparent until they become serious, however. Over the long term, heavy drinking can cause impotence, stomach ailments, cardiovascular  problems, cancer, central, nervous system damage, serious memory loss and liver cirrhosis. It also increases the chances of dying from automobile accidents, homicide and suicide. Although men are much more likely than women to develop alcoholism, women’s health suffers more even at lower levels of consumption.

Although moderate drinking may result in relaxation and euphoria, heavy drinking also has a very negative impact on mental health. In fact, alcohol abuse and alcoholism can worsen existing conditions, such as depression or schizophrenia, or induce new problems, such as serious memory loss, depression or anxiety.

People with alcohol-related disorders don’t just hurt themselves, however. According to NIAAA, more than half of Americans have at least one close relative with a drinking problem. The results can be devastating. Spouses are more likely to face domestic violence. Children are more likely to develop psychological problems, suffer physical and sexual abuse and neglect and—because of the combination of genetic vulnerability and social learning—grow up to be alcoholics. Women who drink during pregnancy run a serious risk of damaging their fetuses. It’s not just relatives who suffer. Heavy drinkers often kill strangers through accidents or homicide.

When should someone seek help?

Because some in our society view alcohol-related disorders as a sign of moral weakness, individuals often hide their drinking or deny they have a problem. How can you tell if you or someone you know is in trouble? Signs of a possible problem include having friends or relatives express concern, being annoyed when people criticize your drinking, feeling guilty about your drinking and thinking that you should cut down but finding yourself unable to do so. Needing a morning drink to steady your nerves or relieve a hangover is another warning sign.

Alcoholics usually can’t stop drinking through willpower alone. Most need outside help. They may need medically supervised detoxification to avoid potentially life-threatening withdrawal symptoms such as seizures, for instance. Depending on the problem’s severity, treatment can take place during office visits, hospital stays or residential treatment programs. Once people are stabilized, they need help resolving psychological issues that may be associated with problem drinking.

How can a psychologist help?

Psychologists play a vital role in the successful treatment of alcohol-related disorders, serving as integral members of the multidisciplinary team that may be required to provide care. Be sure to choose a psychologist who is experienced in working with alcohol-related disorders. To improve the chances of recovery, seek help early.

Using individual or group psychotherapy, psychologists can help people address psychological issues involved in their drinking. They can help people boost their motivation, identify situations that trigger drinking and learn new coping methods. They can also provide referrals to self-help groups such as Alcoholics Anonymous, a crucial part of any recovery program. The treatment process doesn’t end once drinking does, however. To help prevent relapses, psychologists typically keep working with people as they begin new lives. Even after formal treatment ends, many people seek additional support through continued involvement in self-help groups.

Treatment can’t occur in a vacuum. Because families influence both drinking and recovery, marital and family therapy are also key. Psychologists can help families repair relationships and navigate the complex transitions that occur as recovery begins. They can help families understand alcoholism and learn how to support family members in recovery. And they can refer family members to self-help groups such as Al-Anon and Alateen.

Does treatment really work?

Yes. Evidence strongly suggests that many people— especially those with jobs, families and other forms of social stability—recover after their first attempt. Not everyone is so fortunate. Some cycle between relapse and recovery several times before achieving long-term sobriety. What’s important is for the person to stop drinking again and get additional support.

While alcoholism is treatable, so far no cure has been found. That means people remain susceptible to relapses even after they’ve been sober for a long time. Reducing alcohol consumption doesn’t work. Most experts agree that the goal should be complete avoidance of alcohol.

Alcohol-related disorders can severely impair people’s functioning and health. But the prospects for long-term recovery are good for people who seek help from appropriate sources. Qualified psychologists with experience in this area can help those who suffer from alcohol-related disorders stop drinking and start regaining control of their lives.

Alcohol-Related Facts & Figures

Alcohol & Your Health

Alcoholism kills 100,000 to 200,000 Americans a year.  There are 13 million alcoholics: 34 out of 35 of them will die from their drinking either directly or indirectly.  Consider the following:

  • Alcohol abuse is second only to Alzheimer’s disease in causing mental deterioration in adults.
  • Fetal Alcohol Syndrome is the 3rd leading cause of birth defects.
  • Alcoholics are 10 times as likely to die from fires as non-alcoholics, and 5 to 13 times as likely to die from falls.
  • Alcoholics commit suicide 6 to 15 times more often than the general population.
  • Alcoholism is a factor in 40% of all suicide attempts; 67% of homicides; 54% of all violent crimes; 80% of domestic violence; 60% of emergency room admissions; 40% of industrial accidents; 50% of all traffic accidents; 38%-50% of hospital admission-although most are never so identified.

Alcoholism in the Workplace

American industry has a multi-billion dollar hangover. Estimates of the annual cost to business of alcohol-related problems on the job range from $25 billion to as much as $100 billion per year.  60% of all substandard job performance is alcohol-related and the cost of lost productivity alone has been estimated at $31-65 billion a year.

An alcoholic employee costs his company 25% of his salary in lost productivity, absenteeism, medical costs, poor performance and industrial accidents, as well as the additional supervisory time required by erratic, uneven performance and attendance.  When employees’ alcohol problems are identified and treated, these costs go down and production goes up.  cost savings from reduced absenteeism alone are estimated at $1,000 per employee treated.

Alcoholics value their jobs more than anything else, including their health or even their families, so job performance is usually the last area to be affected by their drinking.  Although often the last to realize that a problem exists, employers are frequently the first and most effective in seeking a constructive solution.  Employers recognize that is is more cost effective to treat an alcoholic employee than to replace him.  They recognize that alcoholism is a disease and are becoming increasingly active in offering treatment options for employees with drinking problems.

Many companies has Employee Assistance Programs which provide counseling and referral services for substance abuse and emotional problems.  These are very effective in treating alcohol abuse: 6 to 8 of every 10 referred patients return to their jobs with successful long term recoveries.  For every dollar invested in EAPs, employers realize returns ranging from $2 to $20.

Alcoholism & The Family

Alcoholism is a family disease.  Living with an alcoholic means constant stress, anxiety, and uncertainty for everyone in the family.

Families develop various strategies for coping with the alcoholic:

  • Denial: Everyone in the family denies that anything is wrong, yet no one feels right.
  • Adaptation: Making excuses for alcoholic behavior, lying to cover the drinking, becoming absorbed in other activities.
  • Verbal Strategies: such as lectures, threats, pleas of self-respect, or promises.
  • Behavioral Strategies: such as hiding for refusing to buy alcohol, marking bottles, avoiding the alcoholic, or staying away from home.
  • Disengagement: withdrawing socially from friends and community activities and emotional withdrawal characterized by emotional numbness.

28.6 million children have alcoholic parents.  They live in a state of constant tension and anxiety.  Each day, they worry about whether their parents will be drunk or sober.  They feel trapped in a hopeless situation, rarely bring friends home, and usually have no one to talk to about the chaos at home.  80%-90% of teenage suicides are related to alcoholism in the family.

Children receive conflicting messages from an alcoholic parent:  Leave me alone/I need you; I love you/Go away.  As a result, the primary trait of children of alcoholics is low self-esteem.

Children of alcoholics are 4 to 5 times more likely to become alcoholics than children of non-alcoholic parents.  They are also more likely to marry an alcoholic, even though they rarely know about the condition going into the marriage.

Adult Children of Alcoholics

The impact of an alcoholic parent continues to be felt in adult life.  The most prevalent feature of Adult Children of Alcoholics (ACOAs) is their confusion about what constitutes “normal behavior.” They know that their family wasn’t typical but they don’t know what “normal” is.

Adult Children of Alcoholics are characterized by:

  • difficulty completing projects
  • habitual lying
  • harsh self-judgments
  • being irresponsible or overly responsible
  • taking themselves very seriously
  • difficulty with intimate relationships
  • excessive need for control
  • impulsive behavior without thinking about the consequences
  • constant need for approval
  • feeling “different” from others
  • extreme loyalty, even when undeserved

 

Eating Disorders: Psychotherapy’s Role in Effective Treatment

In a society that continues to prize thinness even as Americans become heavier than ever before, almost everyone worries about their weight at least occasionally. People with eating disorders take such concerns to extremes, developing abnormal eating habits that threaten their well-being and even their lives. This question-and-answer fact sheet explains how psychotherapy can help people recover from these increasingly common disorders.

What are the major kinds of eating disorders?

There are three major types of eating disorders.

  • People with anorexia nervosa have a distorted body image that causes them to see themselves as overweight even when they’re dangerously thin. Often refusing to eat, exercising compulsively, and developing unusual habits such as refusing to eat in front of others, they lose large amounts of weight and may even starve to death.
  • Individuals with bulimia nervosa eat excessive quantities of food, and then purge their bodies of the food and calories they fear by using laxatives, enemas, or diuretics, vomiting and/or exercising. Often acting in secrecy, they feel disgusted and ashamed as they binge, yet relieved of tension and negative emotions once their stomachs are empty again.
  • Like people with bulimia, those with binge eating disorder experience frequent episodes of out-of-control eating. The difference is that binge eaters don’t purge their bodies of excess calories.

It’s important to prevent problematic behaviors from evolving into full-fledged eating disorders. Anorexia and bulimia, for example, usually are preceded by very strict dieting and weight loss. Binge eating disorder can begin with occasional binging. Whenever eating behaviors start having a destructive impact on someone’s functioning or self-image, it’s time to see a highly trained mental health professional, such as a licensed psychologist experienced in treating people with eating disorders.

Who suffers from eating disorders?

According to the National Institute of Mental Health, adolescent and young women account for 90 percent of cases. But eating disorders aren’t just a problem for the teenage women so often depicted in the media. Older women, men and boys can also develop disorders. And an increasing number of ethnic minorities are falling prey to these devastating illnesses.

People sometimes have eating disorders without their families or friends ever suspecting that they have a problem. Aware that their behavior is abnormal, people with eating disorders may withdraw from social contact, hide their behavior and deny that their eating patterns are problematic. Making an accurate diagnosis requires the involvement of a licensed psychologist or other appropriate mental health expert.

What causes eating disorders?

Certain psychological factors predispose people to developing eating disorders. Dysfunctional families or relationships are one factor. Personality traits also may contribute to these disorders. Most people with eating disorders suffer from low self-esteem, feelings of helplessness and intense dissatisfaction with the way they look.

Specific traits are linked to each of the disorders. People with anorexia tend to be perfectionist, for instance, while people with bulimia are often impulsive. Physical factors such as genetics also may playa role in putting people at risk.

A wide range of situations can precipitate eating disorders in susceptible individuals. Family members or friends may repeatedly tease people about their bodies. Individuals may be participating in gymnastics or other sports that emphasize low weight or a certain body image. Negative emotions or traumas such as rape, abuse or the death of a loved one can also trigger disorders. Even a happy event, such as giving birth, can lead to disorders because of the stressful impact of the event on an individual’s new role and body image.

Once people start engaging in abnormal eating behaviors, the problem can perpetuate itself. Binging can set a vicious cycle in motion, as individuals purge to rid themselves of excess calories and psychic pain, then binge again to escape problems in their day-to-day lives.

Why is it important to seek treatment for these disorders?

Research indicates that eating disorders are one of the psychological problems least likely to be treated. But eating disorders often don’t go away on their own. And leaving them untreated can have serious consequences. In fact, the National Institute of Mental Health estimates that one in ten anorexia cases ends in death from starvation, suicide or medical complications like heart attacks or kidney failure.

Eating disorders can devastate the body. Physical problems associated with eating disorders include anemia, palpitations, hair and bone loss, tooth decay, esophagitis and the cessation of menstruation. People with binge eating disorder may develop high blood pressure, diabetes and other problems associated with obesity.

Eating disorders are also associated with other mental disorders like depression. Researchers don’t yet know whether eating disorders are symptoms of such problems or whether the problems develop because of the isolation, stigma and physiological changes wrought by the eating disorders themselves. What is clear is that people with eating disorders suffer higher rates of other mental disorders — including depression, anxiety disorders and substance abuse — than other people.

How can a psychologist help someone recover?

Psychologists play a vital role in the successful treatment of eating disorders and are integral members of the multidisciplinary team that may be required to provide patient care. As part of this treatment, a physician may be called on to rule out medical illnesses and determine that the patient is not in immediate physical danger. A nutritionist may be asked to help assess and improve nutritional intake.

Once the psychologist has identified important issues that need attention and developed a treatment plan, he or she helps the patient replace destructive thoughts and behaviors with more positive ones. A psychologist and patient might work together to focus on health rather than weight, for example. Or a patient might keep a food diary as a way of becoming more aware of the types of situations that trigger binging.

Simply changing patients’ thoughts and behaviors is not enough, however. To ensure lasting improvement, psychologists and patients must work together to explore the psychological issues underlying the eating disorder. Psychotherapy may need to focus on improving patients’ personal relationships. And it may involve helping patients get beyond an event or situation that triggered the disorder in the first place. Group therapy also may be helpful.

Some patients, especially those with bulimia, may benefit from medication. It’s important to remember, however, that medication should be used in combination with psychotherapy, not as a replacement for it. Patients who are advised to take medication should be aware of possible side effects and the need for close supervision by a physician.

Does treatment really work?

Yes. Most cases of eating disorder can be treated successfully by appropriately trained health and mental health care professionals. But treatments do not work instantly. For many patients, treatment may need to be long-term.

Incorporating family or marital therapy into patient care may help prevent relapses by resolving interpersonal issues related to the eating disorder. Therapists can guide family members in understanding the patient’s disorder and learning new techniques for coping with problems. Support groups can also help.

Remember: the sooner treatment starts the better. The longer abnormal eating patterns continue the more deeply ingrained they become and the more difficult they are to treat.

Eating disorders can severely impair people’s functioning and health. But the prospects for long-term recovery are good for most people who seek help from appropriate professionals. Qualified therapists such as licensed psychologists with experience in this area can help those who suffer from eating disorders regain control of their eating behaviors and their lives.

 

The American Psychological Association Practice Directorate gratefully acknowledges the assistance of Kelly D. Brownell. Ph.D.; Kathy J. Hotelling, Ph.D.; Michael R. Lowe. Ph.D.; and Gina E. Rayfield, Ph.D., in developing this fact sheet.