September 1996
Anorexia nervosa involves extreme self-starvation. Often the victims feel their lives are out of their control and that the only control they can exert is over their eating and exercising. The anorexic tends to be a perfectionist who is eager to please his or her parents. He/she values achievement and outward appearances to the detriment of developing a sense of self-worth. Anorexics refuse to maintain a normal weight for their age and height believing that they are too fat even when it is obvious to others that they are excessively thin. They are intensely afraid of becoming fat or gaining weight. The most telling feature in girls is the absence of at least three consecutive menstrual cycles. Females with the disorder always lose their menstrual cycles (amenorrhea).
Anorexia nervosa is difficult to diagnose because almost all girls and women are dieting to lose weight. Continual weight loss and comments about being fat or having fat areas of the body when this is not the case are signs. Anorexics tend to play with their food rather than eat it. They will prepare elaborate meals for the family but not eat any of it. They will exercise excessively to burn off any calories consumed and they know the calorie content of every food they eat. Their exercise is solitary and they usually dislike functions or events that involve food thus often avoiding social activities. They will often dress in baggy clothes which serves to hide their weight loss.
The malnutrition and amenorrhea that accompany anorexia nervosa are serious. Anorexia nervosa can cause death. Treatment usually requires professional help from psychological counselors, physicians, nurses and dietitians. Treatment is aimed at developing the victim's feelings of self-worth and autonomy. The entire family should be involved to help them learn how to provide the victim with positive reinforcement while altering patterns that lead to disordered eating behaviors.
Bulimia is more common than anorexia nervosa and it is more difficult to recognize. Usually the victim is female and somewhat older than the anorexic. Sometimes recovering anorexics develop bulimic tendencies and those with bulimia may also exhibit some behaviors common to anorexics. Bulimics have recurrent episodes of eating large quantities of foods - sometimes 10,000 or more calories in a very short period of time - which they feel they cannot control. The guilt and discomfort from eating such large quantities lead to purging which can involve self-induced vomiting, use of laxatives or diuretics, fasting or vigorous exercise as a means to prevent weight gain. Bulimics are overly concerned about their body shape and weight but tend to be normal weight or slightly under weight.
The cost of bulimia is high since binges usually occur at least twice a week. The foods chosen are generally high fat, smooth textured foods. For most bulimics, the binge eating interferes with work and social activities. Purging behaviors are socially unacceptable and are conducted in private. Bulimics are aware that their behavior is abnormal and are ashamed of it. They tend to be depressed, impulsive and susceptible to other compulsive behaviors such as alcohol and drug abuse and sexual promiscuity.
Signs of bulimia are less clear because weight loss is either not achieved or not extreme. Constant trips to the bathroom after eating and bruises or lacerations on the hands are common. Frequent trips to the grocery store but little food in the kitchen might be a clue. Even though bulimia is more difficult to spot, treatment is often easier than with anorexia nervosa because the bulimic knows her behavior is abnormal and is more willing to cooperate. Treatment takes the form of helping the victim establish control and adhere to regular eating patterns. The bulimic must learn to eat the quantity of food that will be nourishing, satisfying but not bring on weight gain.
Nancy Betts, PhD, RD
UNL Associate Professor
Nutritional Science and Dietetics
Take stress as an example. Your adolescent may handle stress by yelling or daydreaming. These character traits could be exhibited by an adolescent whose feelings get hurt very easily. Bruised feelings may cause the child to scream or escape the hurt by fantasizing about a more harmonious world. Guiding this personality type away from an explosive yell or fantasy retreat can be done by allowing him or her to express hurt feelings with a follow-up hug.
Another adolescent may have a boisterous personality and add spice to any assembly of people. Stress for this child may bring out rude behavior or quitting before a job is completed. Sound familiar? Try humor to diffuse a disruptive situation or devise short competitive activities spiced up with fun.
A third adolescent may handle stress by wallowing in self- pity or worrying. Consistency, fairness, and orderliness will help this child feel more in control of a frustrating situation.
A parent could have a child whose words under stress are crispy with sarcasm or withdraw with cool disdain. This child may be lacking in social skills and needs frequent validation of his or her ideas.
With some guidance by parents the thin-skinned child can be very loving. The cool withdrawal or crispy sarcasm of one child can be channeled into innovative ideas. A parent of a boisterous teenager can appreciate the cleverness of his or her child. The precise details and orderly completeness of a task by the fourth child allows him or her to shine as a leader among the others.
A variety of recipes for directing adolescents out of stressful situations can be a delight for parents.
4-H Matrix System Handbook, National Curriculum & Training Institute, Phoenix, AZ, 1994.
Supervision by the coach or a watchful parent is essential because children do not instinctively drink enough fluid to replace water loss after physical activity. Thirst does not indicate when an athlete needs to rehydrate.
Plain, cold water is the best and most economical source of fluid. A sports drink or diluted fruit juice may be used if your child needs encouragement to drink more fluids.
Beware of carbonated sodas and caffeinated beverages, they may cause stomach cramps, nausea, diarrhea or cause further dehydration during exercise.
Oranges, grapes, watermelon, tomatoes, apples and lettuce can help to rehydrate the body after exercise.
Fluids play a critical role in maintaining the health and optimal performance of an adolescent athlete.
Sports Nutrition for the Child Athlete, The American Dietetic Association, 1993.
Guidelines for reflective listening:
Use reflective listening when: the other person -
or when you -
Written by Sheryl Carson, Extension Educator
North Panhandle EPU, Sheridan County