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Nutrition&Health Tips for a good diet

Anorexia Bulimia and

Marzo 2018. Ediciรณn 50

In exclusive

Michelle

uncovers her most hidden story


INDEX 2 4 9 10 14 15 19 23

By: Juan Sebastian Salgado Navas. 6 C.


Many kids — particularly adolescents — are concerned about how they look and can feel self-conscious about their bodies. This can be especially true when they are going through puberty, and undergo dramatic physical changes and face new social pressures.

Unfortunately, for a number of kids and teens, that concern can lead to an obsession that can become an eating disorder. Eating disorders such as anorexia nervosa or bulimia nervosa cause dramatic weight fluctuation, interfere with normal daily life, and can permanently affect their health.

Parents can help prevent kids from developing an eating disorder by building their self-esteem and encouraging healthy attitudes about nutrition and appearance. If you become worried that your son or daughter might be developing an eating disorder, it’s important to step in and seek proper medical care.

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Nutrition and health | 3


Eating Disorders Generally, eating disorders involve self-critical, negative thoughts and feelings about body weight and food, and eating habithat disrupt normal body function and daily activities.

even years.People with anorexia have an extreme fear of weight gain and a distorted view of their body size and shape. As a result, they strive to maintain a very low body weight. Some restrict their food intake by dieting, fasting, or excessive exercise. People with anorexia try to eat as little as possible, and take in as few calories

While more common among girls, eating disorders can affect boys, too.

as they can, frequently obsessing over food intake.

They’re so common in the U.S. that 1 or 2 out of every 100 kids will struggle with one, most commonly anorexia or bulimia. Unfortunately, many kids and teens successfully hide eating disorders from their families for months or

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Bulimia is characterized by habitual binge eating and purging. Someone with bulimia may undergo weight fluctuations, but rarely experiences the low weight associated with anorexia.


Both disorders can involve compulsive

and are difficult habits to break. Eating

exercise or other forms of purging food

disorders are serious clinical problems

eaten, such as by self-induced vomi-

that require professional treatment by

ting or laxative use.

doctors, therapists, an nutritionists.

Although anorexia and bulimia are very similar, people with anorexia are usually very thin and underweight but those with bulimia may be a normal weight or even

overweight. Bin-

ge eating disorders, food phobia, and body image disorders are also becoming increasingly common in adolescence.

The causes of eating disorders aren’t entirely clear. However, a combination

It’s important to remember that eating

of psychological, genetic, social, and

disorders can easily get out of hand

Nutrition and health | 5


family factors are thought to be inved. For kids with eating disorders, there may be a difference between the way

may put some kids or teens at greater risk for eating disorders. There is also an increased inciden-

they see themselves and how they

ce of other problems among kids and

actually look. People with anorexia or

teens with eating disorders, like anxie-

bulimia often have an intense fear of

ty disorders and obsessive-compul-

gaining weight or being overweight

sive disorder. Sometimes, problems

and think they look bigger than they

at home can put kids at higher risk of

actually are. Also, certain sports and

problem eating behaviors.

activities (like cheerleading, gymnastics, ballet, ice skating, and wrestling) that emphasize certain weight classes

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Some research suggests that media images contribute to the rise in the


incidence of eating disorders. Most ce-

ting between the ages of 11 and 13.

lebrities in advertising, movies, TV, and sports programs are very thin, and this

Many kids who develop an eating di-

may lead girls to think that the ideal of

sorder have low self-esteem and their

beauty is extreme thinness. Boys, too,

focus on weight can be an attempt to

may try to emulate a media ideal by

gain a sense of control at a time when

drastically restricting their eating and

their lives feel more out-of-control.

compulsively exercising to build muscle mass.

Concerns about eating disorders are also beginning at an alarmingly young age. Research shows that 42% of firstto third-grade girls want to be thinner, and 81% of 10-year-olds are afraid of being fat. In fact, most kids with eating disorders began their disordered ea-


Effects of eating disorders

While eating disorders can re-

can affect the body in many ways:

sult from serious mental and behavio-

a drop in blood pressure, pulse, and

ral health conditions, as well as trauma

breathing rate hair loss and fingernail

(for example, sexual abuse), they can

breakage loss of periods lanugo hair, a

lead to very serious physical health pro-

soft hair that can grow all over the skin

blems. Anorexia or bulimia may cause

lightheadedness and inability to con-

dehydration and other medical compli-

centrate anemia swollen joints brittle

cations like heart problems or kidney

bones

failure. In extreme cases, eating disorders can lead to severe malnutrition and even death.

With bulimia, frequent vomiting and lack of nutrients can cause: constant stomach pain damage to the

With anorexia, the body goes into star-

stomach and kidneys tooth decay (from

vation mode and the lack of nutrition

exposure to stomach acids) “chipmunk cheeks,� when the salivary glands per-

Nutrition and health | 9


manently expand from throwing up so

with others, and talk about dieting,

often loss of periods loss of the mineral

this doesn’t necessarily mean they

potassium (this can contribute to heart

have eating disorders. Kids with eating

problems and even death).

disorders show serious problems with

Warming Signs It can be a challenge for parents to tell the difference between kids’ normal self-image concerns and warning signs of an eating disorder.While many kids and teens — girls in particular — are self-conscious, compare themselves

their eating and often have physical signs. Someone with anorexia might: become very thin, frail, or emaciated be obsessed with eating, food, and weight control weigh herself or himself epeatedly count or portion food carefully only eat certain foods, avoid foods


like dairy, meat, wheat, etc. (of course,

off calories withdraw from social activi-

lots of people who are allergic to a par-

ties, especially meals and celebrations

ticular food or are vegetarians avoid

involving food. If You Suspect an

certain foods) exercise excessively

Eating Disorder, If you suspect your

feel fat withdraw from social activities,

son or daughter has an eating disorder,

especially meals and celebrations

it’s

involving food be depressed, lethargic (lacking in energy), and feel cold a lot.

important to intervene and help your child get diagnosed and treated.

Someone with bulimia might: fear wei-

Kids with eating disorders often react

ght gain be intensely unhappy with body

defensively and angrily when confron-

size, shape, and weight make excuses

ted for the first time. Many have trou-

to go to the bathroom immediately after

ble admitting, even to themselves, that

meals only eat diet or low-fat foods

they have a problem. Sometimes get-

(except during binges) regularly buy

ting a family member or friend who has

laxatives, diuretics, or enemas spend a been treated for an eating disorder can lot of time working out or trying to work help encourage someone to get help. A

Nutrition and health | 11


fear of being fat or overweight is a core

than “you” statements. For example,

problem for anyone with an eating di-

steer clear of statements like “you have

sorder. So it’s understandable that kids

an eating disorder” or “you’re too thin,”

with eating disorders don’t want to go to

which may only prompt anger and de-

a clinic and “get fat.”

nial. Instead, try “I’m worried that you have lost so much weight so quickly.”

Trying to help when someone doesn’t

Cite specific things your child has said

think he or she needs it can be hard.

or done that have made you worry,

Still, getting the professional assistan-

and explain that you will be schedu-

ce needed, even if your child resists, is ling a doctor’s appointment to put your essential. Enlist help from friends and

onwmind at ease. If you still encounter

family that your son or daughter trusts

resistance, talk with your doctor or a

and loves — people known to have

mental health care professional about

your child’s best interests at heart.

Your child may be more receptive to a conversation if you focus on your own concerns and use “I” statements rather

12 | Nutrition and health

other approaches.


Treating Eating Disorders Treatment focuses on helping kids cope with their disordered eating behaviors and establish new patterns of

perception about body size, shape, eating, and food. Kids who are severely malnourished

thinking about and approaching food. may require hospitalization and onThis can involve medical supervision, nutritional counseling, and therapy. The professional will address a child´s

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going care after their medical condition stabilizes.


other approaches.

body image is normal and acceptable.

At a time of great societal concern Generally, the earlier the intervention

about obesity, it can be tricky for pa-

(ideally, before malnutrition or a con-

rents to talk with their kids about their

tinual binge-purge cycle starts), the

eating habits. It’s best to emphasize

shorter the treatment required.

health, rather than weight. Make sure your kids know you love them for who

Preventing Eating Disorders

they are, not how they look.

You can play a powerful role in your

It’s OK to appreciate attractiveness

child’s development of healthy attitudes

in celebrities — if your kids (and you!)

about food and nutrition. Your own body

feel fine about how they look, it won’t

image can influence your kids. If you

prompt them to try to change to be like

constantly say “I’m fat,” complain about

someone else. Getting the message

exercise, and practice “yo-yo” dieting,

that they’re great as they are and that

your kids might feel that a distorted

their bodies are healthy and strong is

Nutrition and health | 15


a wonderful gift that parents can give

to set good limits, encourage healthy

their kids.

eating, and avoid fighting over food issues. Kids can catch on pretty quickly Try to avoid power

if their parents panic over one skipped

struggles regarding

meal. Try to gain perspective and talk to

food — if your teen

your kids about what’s going on if they

wants to “go don’t want to eat with the family. Finally, take an active role in creating a healthy lifestyle for your family. Involve your kids in the preparation of healthy, nutritious meals. Let them know that it’s OK to eat when hungry and refuse food when they’re not. Also, make exercise a fun, rewarding, and regular vegetarian,” be supportive even if you’re an avid meat-eater. Teens frequently go through trendy eating periods, so try

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family activity.


In exclusive

MICHELLE

uncovers her most hidden story family activity.

Michelle is 14 years old and is in hospital due to her deteriorating physical condition. She weighs only 32 kilos (70 pounds), and yet refuses to eat; she hasn´t had her period menstruated for several months. A therapeutic team was organized to treat her, consisting of a psychiatrist, a psychoanalyst (this author), a general medical clinician and a nutritionist. Michelle’s hospital room is always full of food. However ,

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the delicious treats, fresh fruit and fine

of getting fat and ugly.

chocolates seemed to be met with dis-

In spite of her physical condition, the

dain in her faraway gaze. When I see

attractive features of this young woman

her for the first time, still in the hospital,

lady caught my attention.

she´s being fed through a gastric tube inserted into her side. I recommend the

She was dedicating a great deal of

family to remove any kind of food from time every day to physical exercises the room. Three weeks later she´s re-

and said that they made her feel “relie-

leased from the hospital and continues

ved.” After finishing college her episo-

her treatment at my private office.

des of bulimia soon thwarted her hopes of going into graduate school. She very

Another patient, Ligia, came to analy-

reticently began her analysis and said

sis feeling very depressed and was ta-

that she had already been in therapy

king anti-depressive medication. She

twice before, but, she said, “Neither ex-

was eating and vomiting as many as

perience did me any good.”

seven or eight times a day. Scrawny

Renata also considers herself de-

looking, she talked about her great fear

pressed. At our first interview she


other later, I could see that Renata was talking about the fact that she had broken up with her boyfriend and that she felt responsible for the separation. She made this decision after an accident that left her bed-ridden for several months. But I became intrigued when she told me that, during the first months after the end of the affair, she felt fine and was at peace with her decision. Only with time did she begin to “torture herself” and become overly concerned complained of feeling bashful, and with her physical condition and her bethis had made it very dificult for her to ing overweight, often feeling “ugly, fat relate to others “the way she used to”. and unattractive.” When trying to understand the “continental divide” that let her set down

What I intend to bring up for discus-

anchor, with one side before and the

sion her these young women, as well

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as from so many others, about their

has to do with ideals, differentiation,

suffering, their obstinacy, their utter hel-

autonomy, time and death.

plessness and their intense will to live. It was this learning process that enabled

In my most recent book I investigated

me to establish the working hypotheses

and

that I will present briefly in this text. The

these many different aspects and their

diversity of psychopathologies found in

clinical resonances. But, of course,

psychoanalytic clinical work with anore-

it would be impossible to discuss all

xia and bulimia inevitably brings up the

of these aspects in the limited space

question of the body and the specific

of the present article. We will thus

aspect of processes during adolescen-

focus basically on the question of the

ce, especially in girls. These specific

perception of the body in anorexia and

pathologies seem to indicate difficulties

bulimia, and point out the difficulties

in early relationships with the mother

in managing the transference in such

regarding the management of the dri-

metapsychologically

articulated

cases.

ves and their connection with primary identification. This consequently also

Nutrition and health | 21


Everyday Life in the Clinic cases.

anti-metaphorical

way.

Our

young

women seem have been deprived of The difficulty in perceiving physical

their internal space, dispossessed of an

feelings is accompanied in these young

interior life. According to Bidaud (1998),

women by another, equally important

this dispossession of space refers to the

difficulty, namely, to perceive their interior

body, to the affects and to thinking.10

world and their emotional needs. What stands out is that, even though there

The analyst’s sensitivity and careful

are apparently complex phantasmic

handling will guide him or her through

activities involved, these do not seem the dryness of these hard-to-reach to favor any process of enrichment of places that are unaccustomed to imagination and relationships. The

contact with others. The analyst must

fantasies seem to be imprisoned in the be sparing as he or she doses out emerging body, often in a concrete, interpretations. It is exactly when the

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transferential experience begins to

these young patients is in finding the

move out of its initial frozen situation

right dose, or the right balance, between

that the bond between the two may proximity

and

distance,

between

become potentially destructive and

silence and speaking. The paradox

threatening. The main difficulty in

resides precisely in the fact that interest

conducting the analytic process of

in the analytic work and the pleasure in

24 | Nutrition and health


the contact with the analyst can also

control over the body repeats, in

simultaneously become a source of

the

anxiety, probably because they bring

experienced with the mother. It is a

transference,

the

relationship

to the fore the threat of differentiation relationship marked by absence and and fusion that the patient experienced

intrusion, helplessness and despair,

with their mother. The omnipotent

and all this demands sensitivity and

Nutrition and health | 25


patience from the analyst. Nothing

time of the sessions will gradually be

should be hurried along!

occupied by attempts to name what is being experienced between analyst

The paradoxical dimensions of this transference,

oscillating

and analysand. It is almost like an effort

between

to “think out loud,” to “give voice,” about

fascination and terror, love and hatred,

what is being experienced. It first acts

life and death, mean that the analyst

through feelings in the body, which

must be able to exercise the “protective

open the path to thoughts that can then

shield” function in its triple dimension of

flow through, fed by affects, nighttime

protection, mediation and libidinization.

dreams and daydreams. It is a slow and

This allows the analytic situation to

delicate process, and the analyst must

function as a reorganizer in libidinizing

often go into detail about subjective

the body. Only under these conditions

experiences,

can phantasmic activity re-emerge in all

these young people to explain to us

its virtuality and diversity.

what they want to say and what they

patiently

accustoming

It is along this tenuous fine line of are feeling. Talking about oneself is also opposing forces that the space and

26 | Nutrition and health

essentially a way of listening to oneself.


Therefore, analytic work should be create meanings and invent forms, thus able to lead these patients to listen to freeing their phantasmic activity from its themselves.

defensive modalities which gave such a privileged place to experiences and

The analytic situation functions here

feelings in the body. Treating these

by letting the analysand bring back

young women opens up the unavoidable

bits of memory, join pieces together, road to physical sensation, described


and invested at the beginning as

thinking, will help us resist having to

material that we analysts must become

cross the desert. With them we must

used to listening to without prejudice. It

face the need to manage the anxieties

is this voyage through the body of the of intrusion, destruction, collapse and anorexic, at a slow and delicate pace, emptiness. There is also need, of that will permit a transition from this

course, to guarantee the development

refused body to a body that is invested, of a protective shield function that or libidinized, by the analyst’s presence

mediates and libidinized and, at the

and word.

same time, takes into account both the body and the word in the management

These young women are asking us for

of the transferential relationship.

the ability to live with their emptiness and incompleteness, to patiently move between vulnerability and tenderness,

Everything

takes

place

so

that

the analyst’s word will encourage

They want from us the willingness to these patients to develop their ability creatively construct fictional theories

to imagine in such a way that the

which, feeding our capacity to keep on

experiences which affect the body,

28 | Nutrition and health


the emotions and thinking take on

will safeguard his ability to daydream

metaphoric possibilities. As Fedida

with words and create images based

wrote (1977), “The metaphor is a

on silence, and thus become able to

dwelling place and the psychoanalyst

discreetly and serenely occupy the

needs the poem in order to inhabit void. As René Chair said, “A poet must the metaphor” (p. 131).11 The analyst

leave traces of his passage, not proof.

should therefore seek inspiration from

Only traces make us dream.”

the figure of the poet. In this way he

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