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Disordered Eating: Implications for Midlife and Beyond
|NAADAC – October 2015
Upon completion of this workshop, attendees will be able to: 1) Explain the differences between disordered eating and eating disorders 2) Identify at least two themes unique to men who are dealing with disordered eating 3) Discuss the implications of complimentary weightism and negative commentary, and how these can be linked to disordered eating
Connie Ducaine, LPC, LCADC, ACS, BCPC, NCC
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Disordered Eating | Presentation Overview
Disordered Eating: Implications for Midlife and Beyond
Housekeeping Upon completion of this workshop, attendees will be able to:
1) Explain the differences between disordered eating an d eating disorders 2) Identify at least two themes unique to men who are dealing with disordered eating 3) Discuss the implications of complimentary weightism and negative commentary, and how these can be linked to
disordered eating Introductions and Interest
Discuss Concepts and Terminology Statistics and Issues Review Implications
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Feeding and Eating Disorders |DSM-5
Notable DSM-5 Changes
DSM-IV-TR: Feeding disorder of infancy and early childhood DSM-5: Avoidant/Restrictive food intake disorder
• Anorexia Nervosa • Bulimia Nervosa • Binge-Eating Disorder
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Allen, K. L., Byrne, S. M., Oddy, W. H., & Crosby, R. D. (2013). DSM-IV-TR and DSM-5 eating disorders in adolescents: Prevalence, stability,
psychosocial correlates in a population-based sample of male and female adolescents. Journal of Abnormal Psychology. 122, 720-732.
doi:10.1037/a0034004
Body Image: Attitudes towards the way one looks and the behaviors that we employ to maintain these self-perceptions (Grosick
et al., 2013)
Disordered Eating: Attitudes and behaviors that range from worries about body image to self-injurious behaviors like binging, purging, and extreme exercise (Ricciardelli & McCabe, 2004)
Feeding and Eating Disorders: “Characterized by persistent disturbance of eating or eating-related behaviors that results in the altered consumption or absorption of food and that significantly impairs physical health or psychological function” (American Psychiatric
Association, 2013, p. 329)
Definitions |Key Concepts
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American
Psychiatric Publishing.
Grosick, T.L., Talbert-Johnson, C., Myers, M. & Angelo, R. (2013). Assessing the landscape: Body image values and attitudes among
middle school boys and girls. American Journal of Health Education, 44, 41-52. doi: 10.1080/19325037.2012.749682
Ricciardelli, L.A. & McCabe, M.P. (2004). A biopsychosocial model of disordered eating and the pursuit of muscularity in adolescent boys.
Psychological Bulletin, 130(2), 179-205.
Lookism: a bias against people as a result of their appearance (Cavico, Uffler, & Mujtaba, 2012)
Weightism: discrimination based on body size (weight bias, obesity discrimination, size bias)
Definitions |A Few More Key Concepts
Cavico, F. J., Muffler, S. C., & Mujtaba, B. G. (2012). Appearance discrimination in employment: Legal and ethical implications of “lookism”
and “lookphobia”. Equality, Diversity and Inclusion: An International Journal, 32(1), 83-119.
.
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On-set | DE Starts Early
Child Identity Development
Industry vs. Inferiority - Egocentric to “who am I in relation to others” or a possibly a belief that “I am what I achieve”
Onset of Body Image Disturbance
Body dissatisfaction at five years old predicted disordered eating
attitudes and behaviors at age nine (Davison et al., 2003)
Disordered Eating Attitudes and Behaviors
By age of eight, children exhibited disordered eating habits including
food restriction and excessive exercise (Comb et al., 2011)
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Davison, K.K., Markey, C.N., & Birch, L.L. (2003). A longitudinal examination of patterns in girls’ weight concerns and body
dissatisfaction from ages 5 to 9 years. International Journal of Eating Disorders, 320-332. doi:10.1002/eat.10142
Combs, J. L., Pearson, C. M., & Smith, G. T. (2011). A risk model for preadolescent disordered eating. International Journal of Eating
Disorders, 44(7), 596-604. doi:10.1002/eat.20851
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Disordered Eating | More than Young White Middle Class Females…
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Similarities and Differences:
•Gender
•LGB
•Impact of Race and Ethnicity
•Adolescents & Emerging Adults Austin, S. B., Nelson, L. A., Birkett, M. A., Calzo, J. P., Everett, B. (2013) Eating disorder symptoms and obesity at the intersection of gender, ethnicity, and sexual orientation in US high school students. American Journal of Public Health, 103, e16-e22.
doi:10.2015/AJPH2012.301150
Goerke, C. K., Mazzeo, S. E., Stern, M. Palmberg, A. A., Evan R. K., & Wickman III, E. P. (2013). The stress process and eating pathology among racially diverse adolescents seeking treatment for obesity. Journal of Pediatric Psychology, 38, 785-793. doi:
10.1093/jpepsy/jst042
Norris, M. L., Apsimon, M., Harrison, M., Obeid, N., Buchhotz, A., Henderson, K. A., Spettigue, W. (2012). An examination of medical and psychological morbidity in adolescent males with eating disorders. Eating Disorders: the Journal of Treatment &
Prevention, 20, 405-415, doi: 10,1080/10640266.2012.715520
Thompson-Brenner, H., Thompson, D. R., Richards, L. K., Bulik, C. M., Devlin, M. J., Kristeller, J. L., Mitchell, J. E., Safer D. L., Wilfley, D. E., Franko, D. lL., Grilo, C. M., Roehrig, J. P., Bryson, S. w., Crow, S. J., Gorin, A. A., Masheb, R., Peterson, C. B.,
Striegel, R. H., Wilson, G. T. (2013). Race/ethnicity, education, and treatment parameters as moderators and predictors of outcome in binge eating disorder. Journal of Counseling and Clinical Psychology, 31, 710-721. doi: 10.1037/a0032946
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Adults | Statistics of Interest
• Among Adults from 1985 – 1997( Tiggerman, 2004):
– Satisfaction in overall appearance decreased – Desire to lose weight increased – If this analysis were done today – would it be
different?
• Middle aged women may have higher frequency of BED (Mangweth-Matzek et al., 2014)
• Less disordered eating in women over 65 than in women 50 – 65 (Tiggerman, 2004)
• Dieting may present health risks (e.g.
nutritional deficiencies)
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Mangweth-Matzek, B., Hoek, H. W., Rupp, C. I., Lackner-Seifert, K., Frey, N., Whitworth, A. B., & ... Kinzl, J.
(2014). Prevalence of eating disorders in middle-aged women. International Journal Of Eating Disorders,
47(3), 320-324. doi:10.1002/eat.22232
Tiggemann, M. (2004). Body image across the adult life span: Stability and change. Body Image, 1(1), 29-41.
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Adults | Statistics of Interest
• Women 50+ = 13% reported behaviors associated with ED (N = 1849) (Gagne et al., 2012)
• Sample over age 65 reported a later on-set of BED and longer duration (N = 20) (Guerdjikova et al.,
2012)
• One in two seniors (N= 1793) were dissatisfied with their weight mirroring the rates of younger groups (Roy et al., 2014)
• Approximately 1/3 of weight loss in older adults is caused by depression (Morley, 2012)
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Gagne, D. A., Von Holle, A., Brownley, K. A., Runfola, C. D., Hofmeier, S., Branch, K. E., & Bulik, C. M. (2012). Eating disorder symptoms and weight and shape concerns in a large web-
based convenience sample of women ages 50 and above: Results of the gender and body image (GABI) study. International Journal Of Eating Disorders, 45(7), 832-844.
doi:10.1002/eat.22030
Guerdjikova, A. I., O'melia, A. M., Mori, N., Mccoy, J., & Mcelroy, S. L. (2012). Binge eating disorder in elderly individuals. International Journal of Eating Disorders, 45(7), 905-908.
doi:10.1002/eat.22028
Morley, J. (2012). Anorexia of aging: A true geriatric syndrome. Journal of Nutrition, Health & Aging, 16(5), 422-425. doi:10.1007/s12603-012-0061-9
Roy, M., Shatenstein, B., Gaudreau, P., Morais, J. A., & Payette, H., (2014). Seniors' body weight dissatisfaction and longitudinal associations. Journal of Aging and Health, 1, 1-19.
Biological Psychological Sociocultural
Adults | Implications of Physiological Changes Associated with Aging
* Body Dissatisfaction * Disordered Eating * Middle Age
Slevec, J., & Tiggermann, M. (2011). Predictors of body dissatisfaction and disordered eating in middle-aged women. Clinical
Psychology Review, 31(4). 515 – 524. doi:10.1016/j.cpr.2010.12.002
Adults | Midlife - Women
Factors Impacting Body Image in Older Women
Pregnancy Those who dieted before pregnancy are more
dissatisfied after childbirth After birth - increases in disordered eating
Aging Importance of appearance may change Becoming Invisible
Menopause Closer monitoring for health complications may be warranted
Newton, J. R. (2013). Presentations of eating disorders later in life. Journal of Pharmacy Practice & Research, 43(3), 231-236.
Slevec, J., & Tiggermann, M. (2011.) Predictors of body dissatisfaction and disordered eating in middle-aged women. Clinical Psychology
Review, 31(4), 515-524. doi:10.1016/j.cpr.2010.12.002
Adults |Midlife - Men
Themes The Lone Wolf
Limited Experiences
Body Image
Bigorexia
Body Hair
Penis Size
Emotions Treatment Efficacy (< 50%)
Russell, L., & Laszlo, B. (2013). A group for men with eating disorders: when “Lone Wolves” come together. Men & Masculinities, 16(2), 252-
259. doi:10.1177/1097184X13487911
Schuster, E., Negy, C., & Tantleff-Dunn, S. (2013). The effects of appearance-related commentary on body dissatisfaction, eating pathology
and body change behaviors in men. Psychology of Men & Masculinity, 14(1), 76-87. doi:10.1037/a0025625
Adults | Factors to Consider
Self-Objectification Complimentary Weightism
Sexually Objectified Negative Commentary
Cognitive Control Perfectionism
Self Esteem/Global Self Esteem Aging Anxiety
Appearance Management Strategies
Body Surveillance
Appearance Investment Boredom
Lack of Willpower Habit
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Implications | As counselors what can we do?
Let’s Talk – What do you think? Section 2
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Implications | As counselors what can we do?
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Image from Brainden: http://brainden.com/word-illusions.htm#prettyPhoto
As Practitioners We Can…
Learn more
Be prepared
Advocate
Reflect on our perspective regarding
this topic
Consider our own biases
What about Educators and Supervisors?
Education/Training/Coaching
Populations and Characteristics
Skills - Evidence-based
Technical (e.g. medical implications)
Supervisor
Coping Skills
Managing Negative Reactions
Maintain Realistic Sense of Body Image
Countertransference
Boie, I., & Lopez, A. (2011). Supervision of counselors working with eating disorders: Utilizing the integrated developmental model. Clinical Supervisor, 30(2), 215-234. doi:10.1080/07325223.2011.607744 Delucia-Waack, J. l. (1999). Supervision for counselors working with easting disorder groups: Countertransference issues related to body image, food and weight. Journal of Counseling & Development, (77(4), 379 – 388.
You can make a difference….
Disordered Eating | For more Info…
