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    31 views148 pages

    Livro Skills Based Caring For A Loves One With Eating Disorder

    Uploaded by

    caroline

    Copyright:

    © All Rights Reserved
    Download as PDF or read online from Scribd
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    of 148
    Skills-based Caring for a Loved One with an Eating Disorder Skils-based Caring for a Loved One with an Eating Disorder ‘tih-bsed Caring equips carers with thesis and tnowledge needed to support those suffering fom an eating discret, and {o help ther to beak ree trom the Waps that prevent recovery ‘Through 3 coordinated approach, oes Geta teciques and strategies, hich aim to improve professional’ and carers! bility to bud contnuty of support fo ther loved ones. Using evidence bad research ana personal experience, the authors ave the reader on a number of dificulareasin cating for someone with an eating disorder. This new and updates tediion Is eseatial reading for both profesonae and famies involved in the care and support of anyone with an eating ors Professor Janet Treasure OBE, PhD, FRCP, FRCPiych is» psych [aust who works in research and teaching a King’s College {London ands acincian atthe Sout tondon and Maudsley NHS. Foundation Tus. Professor Treasure’ research interest incl onjoin wcrking with patente and carers using translational research to develop new forms of treatment From this she has oproduce ast of tools tat provide shared information about ‘he lines ana sls in management Gisione Smith, author and forme teacher, has tale to hun reds of carer both family and professional on ical and ‘atonal helplines a wel eat meetings workshop and conte ences, sine her adult daughter, who is now well was dagnosed ‘th anorealanerosa,binge/purge type ~ discussions she fe ‘quently quotes from n heron Fiction books forhome cares ‘Anna Cranes a geverl practitioner and has persona experence of Ting wth an eating dsrder at medal schoo. She has ‘wtten about he expertences nthe Student SM She heen to ‘aise the profile of eating disorders in primary care and improve ‘urculm coverage fr GPs in training. She gves sessions on diagrosing and supporting patients with eating disorders in ‘eneral practice to GPs ad junior doctors. Skills-based Caring for a Loved One with an Eating Disorder ‘The new Maudsley method ‘Second edition Janet Teasure, Grainne mith ‘snd An Crane Reser a a mtciecipgee etaeietio "koe ote mntortrr ens oumson Saaenacciaataaete rata paiyaaen et ane ete ee th ae Sieifenaatamsbonismcger song trstnearn Contents tae 1 Stand pane -bd pena ing 2 Reding ajantnfestandngl be row toevoegen | Caing erste ont ein seri 5 cogs (Sn se epg eine 9 compares 10 Scorn roe sings ones 1 Medetigemotatntatien ond etem snmp 12 Managing undrnig 13 Howto lp withing dering 14 Magda bowioes 15 tte onan Preface Why have we written thismana? ating daoder symptoms have 4 protound impact on both people with eating dsordrs ana thse whe care for them Often ‘he impoct on carers have ben eget Enplaining cent eating disorder reseaen aay help carers naertn the bas for aera thinkng 984 Bemus sito ‘Automatic reactions to these symptoms, however wel nen ‘ond, may nat be the mest hepa Taking 2 step back to react on the most effecive way to manage symptoms can lessen the averse impact on you 98:8 {amy sd the indual Practical sil pf in home management ae the same a: ‘those wsed by professional onspecaled eating Bsrces uns ‘chaste Maude, Fer example. our work with carers suggest tat seve C words ‘an be wil ues to keep in ind to rate content coord. inated ll round eae: calmness, communion, compassion, ‘eapaationcalaorstiontantreconsteny an oaching motes « Tis book therefore ives you stile and information about ‘woking with the caret Maley aod ‘ur research suggests at fathers in particular benefit rm this approach by hebping hem to step ino more ate tle when ‘they pu the Ups int practi, ‘ver many yeas, out ward teams at the Mauésley have © ACTION POTS mp a es | pearioe Sa ye bea rerenn-wennowe cnc a esc eee —_————_erectionpomnrs 1-Yu alone conc tt you condo alon'=In ts book we ty to share with carers some ofthe Lunderstancing that on hep them fee perpen b- {hs tnes and more abet cope, | 2 Secrets ar ot hl Openness and respec ae key components for eevery Ths booklaystoresome ofthe fontion about esting ose 3 erymstake a tesa ~mitkescanteach us alot, diate stint abot wentwongandhow tO ‘hang things and better next ne 2 Working with a joint understanding of the illness ~ basic facts about eating disorders, ‘The fve most common questions about oy Hines ae: 1 What the symptoms? 3 What stheexpeced time curse? “4. Wat are the consequences (aor the sate.) for oe thes? 5 How contoable/treatables tees? ‘sthisan eating disorder? ‘ih so many people on a et, hw do you know snk jas 3 passing pase? The fist is ofan ening scrder ae Sule Gnd ae often metus anceaiea by 2 utere, Behawous tray begin over many yeas ane ae often misonstrd ust ‘rormal roning up ot perce ats change nobis te “ets orcncenn The clic ema appearance of 9 ire ‘iggers immediate alr bale and 3 spot eagrave Bt when yg nora to detect an eating sorcer requires looking espe beyond physi, sting mth jt ndototing a In Table 23, tere ate sme pointers that can alert you tothe fact that something more seu than cating» iva. Someone dewapng an exing order may Rave weal Othe ‘spr shownin 9b 21 ‘iMie24 Ospina tg hm ang Oreos + Changin deve tconng wan mulher toning * Comryupteneght inion ger tes + aetna hn tn ya porns + ngs meno + erertng nt atten en ‘bere teamegreconpdiveanstasses cea bine Spang eaunng ‘Fem le abo eg encanto tn ns 7 + becineay oe iin mat *"DikRsntiiecethencetartehoension hehe + Secriam- ttc it tal apa ger ‘SSheemer psoas se Serer rent inathob chen aYm 1 naetacuiteneeraeeipe sed pag Common myths about eating disorders tough genera ‘xing cord inforation is applicable to ‘most afferes, there ae ano unique aspects to rey cave, ‘istaten assumptions abot theless can ead to unph 2 ening antrtontig Intervention trates. Tis turn wl couse tes, not oto ‘he fer bt oo famiy a red. Inthe folowing ection, we ive us 2 Few examples of ome ormmon mistaken assumptions You protaly have your ow lies = which mayor may nt be ep coping with he nese. + mies in portular mother ae eaponbe fr ther Aughterion deleping on eating dese ‘+ ope with eating donde chose to have the ines They onto be Ho deo no row op 1+ People wth eating donde oe tng to punsh ther poents cormtbocer thy beth + Famites min an cetirg sce nthe ist need heap + ating orders oro do wth vont ond expanse beo rode + st anther form teenage tention seeing behaviour + 2 someting tha people grow otf. posing phase + Thepeson cue, ompletey. tr apie nptent + You must doa you can to pleaseand humeur the peor who a" + The hosptaland wectment team can alas cre them + tisjoste question eating” + People ith eating doers ow what oath at hoe 1+ ating tore areust extreme dts’ + ‘once you haw meting doe you con neve recone + Once the incl aches heathy eight hey ae cared” rong mit ndetodng 2 hen famly member o avon ee ld betes the these, raga emetons uch 35 ul. ems, ange, futation and ‘etionnatin fours lenin inrease sess and tension. Te Gate, eddence forthe causes of eating order pat, ‘much scene esearch til faced onthe ates Many wten ‘urcecontan myths about tenes which can be urtuland smtp "Whats iow that neating orders nat ust» problem with eating nd fod. Thee ae depe ses relating ode. ‘emotions telefs and values Teatment can ake tne. and sme ‘ipects of recover tae pace within the context of arma evelopment A joutneytowars recovery often ng and hak lengng butbeatng an extingdsorder can be achieves Facts 10 fr. In an seal station evene ~ steer fmy members a health profesional woul be working rom the same unde Standing of exting rds, wth formation based on esearh ‘eadence important knowledge, tls and ates fe est, ‘oe to enabe coloration an tamer Thi no ME ‘easy to achieve pratcetecause there 1 great deal of Con. ‘icing ifermation abou esting disorders These tering pe sgectes and eiece do suppet an imptnl pcp tere es ot sem fb ay ane clea cose We hope tat the fon ing information provides 2 sold, foundational understanding ted on high ust wey aceped renee findings. ‘what factors contribute tothe development of eating ‘disorder? Bitgical factors cent research suggests that many ofthe mechanisms that Under eating Ssorers are nt under eons of wil nto Sather 2 nebwor of olagial sytem ~ ining a“ wong whet nding the nay tat the brain processes Information, emtions and behaviours conte othe liners Some ofthese fctrs te fed and ae rated to genes. whereas ethers emerge from rivet and uporiging However the ty that genes an tehavourareconneced unknown tthe present tine ay eo cig + Genet factors account for oer 50 percent of the isn ating orders + often, though not nay. an eating disorder develops ator ‘ound pert, which sa phase of complex ala Imstuntion/evlopment Ths timingcancrest 3 Perpetua apa slawaton and leaned behaviours Interrupt this developmental process, ming every mote ‘iat. + Feope wth eating dsordershave bee found tohavea ‘hemicalimtalance inthe bran Receptors fo erctonin ad dopamine both hey signaling chemicals which play 2 oe ‘ood and appetite~areedaced othin the acute stateot ness and afer ecoery. + Grain cana have reveled thet when peope with eting ‘order ae show ood elated cues, ei brie respord in ‘uunual way More special the front ofthe bran hich Isinolvedin decson making nd emotional regulation) abo becomes ciated Te uggess thatthe meaning and reaction to feo becomes entangled wth regulation of ‘motivation and planning motional ond cognitive fectors mtionl an thiking dispositions appear tobe of reevance In tating dscrders. These characeritice may be Innate, or may Aevelop spat of theless process orig ih ont andrtandog rs Aeyrteorch ings + Peopewitheating srdes tend to be more sense than thers to percened teat. For example, they are more ily find starting new shoo yar, staying ve th ends, more frightening than other people + often people wth ting orders are more consclentous, ‘eyhaaerto please others and do things toa very igh sndars + They ay oun nt sacl ical, cluding suddenly etngexcise som fiend group + Athining tylethatnteases ies ks one that favours sttention to deta with a super abi 0 ecu Beng abe ‘te concentrat and focus on dtl can De rest ate but ‘his thining style becomes problern when individuals have trouble being flexible and when the foci becomes so mens ‘atthe bigger itr ost. © For example, El ocuses on food and eating tthe exon of eventing (eg school wor tends/soca aces, ste inading heath + As Edimay havea preisposton to develop automatic hats which can be great fr eating bu those utomatichaits arent healthy thiscan Bevery philly deste These gues Musa how eating order symptoms get stuck as 2 est of the secondayy eflets of stanaton and Btnormol eating habits onthe Ban This ess in eed and focused habs when are diet o change. Pa orig ith ott ending fcwm2s etree depoyesen sgn ‘Setnetopnn ume netgear sunspot agen oprobesntay ctoematcneges ene Sietenentenrearnes Sreptabie These eed to be combines wth eae ps ‘mentoring In some abs, hese estnets snd mantrng mong tot andertantig ‘maybe etecive though outpatient department. n othe cases, pet ‘Snmcessry in a Specalied hosptl unit intent vesmet say asin test weg in rif the indi groundwett Ia ‘Siresing th wenger oben i ot one ere ‘Satin chanceotreupse worn mht enetnding ‘ance - Somme orcnim troy Secreemeememnecureetees, Beiaiat arent tara + Tchad ne an ew oped + Mergers aout eouirnt ne ae ‘eo dre ig egln te tings en ees (Feeg tat ost srt ot ne mow bebe epctoamgy erode sacne tte + Rieger sortenrthnnn in no ot 8 + orartponot conn, nda i on tg ads ‘enn pean tining oer epyn ers! ‘Sana tarpeco el haptom ond Sota page + For many people with etngdoorder eg anctens nervosa, iy sage eatin iwale eestor er health. Ths yarcaarlyimporant because starvation Inteups train development, nds people canbe stack they remain undetroured or ng period + Some media consequences of stanation suchas the fare of toe development and reproductive function ae revere ‘weight gin Utewse st imbaarces fom nate ore rr voting are reverse uring perio reson The traincontal a applies the mary problem andshould be the focus of eaten (te Chapter 12 or more deals). + Once weight ainhos been achive secondary targets wight maintenance Canthe india stan te weght without a high evel oferteral conte eg what happens ecween outpatient resumen appointments orc eben leave tom hospital ce) ‘rong th te enentntng » 18s ao important fr people with eating dors to putin time and eto to gett eno themes thee stent 386 ‘weattesses 0 that they can creat add a enorme in vac they wl fur For example you ae someone who lies order aed pannng andes to sole pcbemsin sequence. you ae es Hel to oursh Ie an cadet and emergency apartment orm work wih 3 high evel of interaction wth he public However. encourage people to whom oder and planing bre very important fo work na ab or 8 tary ~ and works of ents may ae People wh have recovered from an eating order often fee that they arebehndin if They have los out on yas of emo tional maturation and fe experience 25 the ess has squashed ond reticed the wold ond thinking. “Catch up i posable and often treatment propramenes inde every nperince that peers wou tae for granted eg glag tthe ‘onera a beach day a pampering session ‘Why ae eating disorders so diffu to treat? ‘ne ofthe reasons that people become stuck within an eating ‘dcrder that ban damage resting rom starvation makes ‘mote dificult to change. The brain ctily wes calito think nd lam along wth al hemor unconscious aspects of ving ‘on average 500 calories per €3y ae neded to support bain faciy. Without those Cals, essen for thinking and ‘woking things ou is ch harder to lay down ne learning ‘he brain reaction io starvation to produce an extreme sess state ith ite ite force + Not ony brain funtion dstrbedin many ways by an ‘ating order, butte bain sess reduced The mest Sophisticated aspects of bran function which se larger, ‘network suffer most These inde te areas ofthe bain {ruse in sacl unetaring sndemetions| regulon (Mere dscsion on thin Chapter 10) Thus sea emotonal » noting et fant antntnng Junctorng ruta, an fey and the aby a see he bape pcture are mpaces + snot st the bslute amount of tavation hat counts a terms of brain damage but aio how and whats btn. Nevroadaptve changes oc there pater of sting 2a easing, partly he easing cans of gh Dalatabe igh sugar and igh ft ood (wich are common Irbirgenah eventing the formation of ew negative habits and pattems ‘sverymprtant one they erm they ae very atic to, reat Enuing that thera rua patter eating with 2 broad ange rie an lp prevent his ce developing bingeing andowresing dusted farther chapters + maddie, binges produce addi ite changes ia the bain “croings orem type of ons ness, ana the pute, automatic signals that ve the ned to acton tere Processes abo crease, > These secondary net adaptive ranges Bese Nad rte, sarpin the changes paters of eting a slate trend ‘hese factor together cause an net epi: stanaton po: ces bam problems, these In turn cause analety and ses, Doble eating then seme to reduce amet inthe sot em = but the lange ter prosuces braun problems nd So the spi contnues Thus once the stanation has peusted for Socal years there are many more problems tobe overcome Carectig coke (hcthern dating cringing end ‘puging.ora mi of hath) o early as posse m the coun ofan tinge con terrapin ‘roving jt nseonng a ‘How long wil tas ‘The course of an eating orders vale Rests rom specast cenressuggestthaton average he durations 6-12 eas Tus. netting doe stat atcexcenc moat ppl cote to have bles when they ae young ads. Howeve within ths ‘ange here ne people who ene thi yar and ater who have an endutag sve couse of less Although the couse of the tncas often bosoms more complicated oe fre 0 tet how ong someone as benl covery ispossbie ‘What isthe prognosis? Because the course of an eating dcr variable between ind ‘als, 0 Rs prognosis Some uefa post remember are fellows + Thecutcomeot younger ass othose with short uation ines 5 0 «+ tect treatment erin the cours ofthe les, whieh s lessthan ve years ads tom good eutomeino0 per ent © When the ins fs to espnd to several attempt at ‘tester ery gl tng and behaviour tae to breakdown and overcome, Nevertheless aby posse to beak away rom eines and attain at only Fecorery but state ats been erp aumatie ‘wth = where the deepened se andestarcing nd "hile that re needed to recover fom theless an sow ‘indndounl ove highly meaningt te + Restoring weight rarmalevel in hospital by sel, does tetersretha the outer good Understanding and Unpcking the assocation a fo and weigh suet emotions sjesct tinting aed support tations a ‘rent for nective iste. a soning wot nding << tenecrion points: 1. Myths ave anlar etl They eects ‘snd behavious towards you other far members a, aswelasinceasingsvess lees 2. The development fan esting orders otunder oecous oil cntoh 2. mist thee uncertainty about he ois feating orders theconaquerees rece Profesional and {amy members can my the conseauenes By ‘wong ederease the ie spent inaseveey mates of regulate state andy conn the India to stan matureematona cogive snd socal deveopment. ACTION POINT —> your own myths and ble about eting dors Being ntormation om rele sources sch athe Bullies Beate Acad of Eting Ose he efcration wth far a ends void in Tyytoensre that eveyoe working om he rondestandig, ote ‘Safran ntti nee somos atthe ete SReeceetchrem tcc ono noting ot neta = Further reading ‘eh lead ree ting ety en ‘Dinan nace tron na ena nea eee menage "ionic Sec on odo sage 8 ™ ring molt ontetaning 3 Consequences - and awareness of medical risk Important observations ‘Most peopl living wth someone with an esting disorder ae te tied about the medial dangers, and the long term and shat tem consequences of poor ruttion. As we have already ttressed, ti elf in dscusson with medial professionals {you canbe spect about what cberations wory you. ca so Be useful to jt any examples down, with ay relevant etal such 35 how often you have observed thi, when hap ened ete (Hopeful at ater stage youl ao be abe took Back and appreciate progress) Finding 3 balance between being minul of the media sk that yout loved one faces, and not paniching over what may or ‘may not be important rom 3 medical point view, is often very ‘acu This enapter offers basic gldance which may be dis cussed with an experienced profesional on what o lookout fo, ‘what means and wien to cal for hep, meget and eae ef maa » ‘Body mass index ‘term vied by health professionals a a measur of weight in al patient, not just those with eating srders fs Boy Mass index 6m ‘Question How s Ba catulate? ‘Ut form of volume measurement, ots aklated by ‘ding weight biograms by the squore of eight metres. Ther ar online Bl cocoa aroiobe Mis one way that healthcare profesional aka a rough ‘stmete of medica sk. The World HesIth Organisation suggests tha he underweight itera for alte with arena nervors ir 8 of es than 185 ‘ad dangerous low body weight or ‘severe hina’ f 2 BMI ies than 160 For schoo ged chien and alder adolescents, things area ite more complicated because of growth Imadalton tothe absolute measure of BML ether factors that cancontbute tokio: «+ therateat which weight fling “+ whether behaviours suchas the use onesies ad vomiting te present + there are preening medical conditions eg abet. Regular weight monitoring ‘2a important pat ofthe treatment of snorelsnewors it ‘monitor medic isk regulary, by measuring weight ab. iia Proxy measure of risk Both professional and family members ‘Should be aware that, ding the ln, some sufferers may ty {persuade other people that their weights preter than act ls by using devious ploys, such 35 secreting weights/eatees 2» quae en arene of ete ik onthe prson eg In thee pockets) o dking ge aout Ff iquld before bang waged. ro-anorena webstes ge eta of mast these wits and Sometimes eating dsrdeted Indviduos wil exchange iformatan on these Thetlore, igh x BA ane ot 2 sitcary measur oft ad 3 ‘mor complex aah of how the body anton needed (Caner importan waystoassess sk and manor heath naude: + od pressure temperature + masciestength + ateofwlgtloss + blood tet tocheck any defieny nese mtn, Tisassessment neds tobe mage bya medial profesional who {an abo cary ot regu weight es, Weight montoing an be undertaten in. GP serpy by ether» Gor by» practice ‘Alhechects mentioned should be dcssed witha ster, alongwith hat they mean velit he pil health {he sul of theve checks plac an inva 3 igh ik, then there fe 2 need to reflect about wht sep ate required ¢0 Improve the heath Azure's the on ptson wh cn ay take those steps, "our CPipractie rue wil keep 2 regular record of Es weight ctstons You may. fr your ow Secunia peace of ‘ind. ned 1 aeep your oun Chto ef Kas weigh. THE "3p have» postive cra negate response fom Ee depending {nthe indi ond har tae toward and Bek out ‘het ness t that po in ime Some steers wil Kep thet weekly weighs a secret ~angy and unl to let on wheter ‘hee nest has won F lin terms of the Kae’ ean, amnguct and van of ea tt » ‘ters may adopt an open atid, apreiting he pores by haing 3nd plying rests. Some fares and seers ‘ind home sales beef Tor weit motoring For ethers a's obseson with weight means that scales atound the ose ‘ae help dstressing ad hindrance to prowess You rast. ‘workout weight montoning stem that sus you ond ES You noi that hands and fetlok Bue and colts “eign cl ccsation problems. dis ny and faint ater standing up ily oyu ‘otc putes around the eyes nthe roming sor “Sellen ankiesin the afteroon the above can “Signy stand water balance. Kaha itu climbing sts, or brushing thei at, _ orrasing their arms fr any length of time. This is veto “muscle stengtnbengatfecedy the ess. » cernqac-andananen ef matt tt es sleepy ort? of pins ard neeles inthe toes" hand tt toa spas These indicate serious sttimblance Important changes ~ Taking it ver with Eat Skis of postive communication and asartiveness (Chapter 8) re needed when ascssing Fk with your loved one. THs inves + volcing our concems + stating eat hat ation youve taken + cferngto tp, ‘The conversaton may gosomething ets eriequnes-ontonerennsef meat » ‘Vee youre about ou so much... and ve nti seer! thing whieh have made me woe about your heal Fst _yovsre ver sensitive to cold -you have the eater tured on Ia your ro 0 that i fel ie o furnace Asa. ve niced that yu ied opening hear dors dif. ke yout go ‘ond have mec check opt put my mind ot re Could ‘help by meking you on opprtment with eu GP? you want mete happy to cometh you 61 may of may not respond postive to your request for 3 ‘media apoletment sed may ty to persuade you to delay an {ppointent oo miimise your concerns there ae ig oF ‘giant flow though with your stints a's py heath nes tbe 3 op print The sence 1 Stay calm But fo Ist your cancers wth composion. ‘Mental Health Act ‘he Mental Heath Act MHA) exists to protect people who ‘cannot understand danger ther health when tis hapoens 23 person maybe admited to hospital against thet wl Gentle ‘asuason of the ned for spect hospital care perhaps ying, Some ofthe suggestions in ths book such as the Readiness Ruler (eee Chapter 7, "Undertanding change) may work — whereas cntontaion may dive El further Into entenched resitance in vey extreme cicumstances, after attempts at gee pe suation there evidence of high medial ik to Ed andthe nation hae become Ife threatening. may be necessary £0 ‘se this Act and ad the person to hasta agaist he wl ” enseqvees-and ammeter ‘Starvation as a maintaining factor ‘We have outined how anotexia nervosa can put lfe acutely ia Jeopardy because of inadequate nutition, and in Chapter 2 we escrbe how starvation can Interfere with brain function, ‘making more difficult to recover from the ilies, “Adolescence in particular sa time of important changes in brain function, Developmental changes that occur i a heathy braininciade the ability to: + think abstractly and eectvely “+ monitor and put the brakes on automatic aspects of brain function fie responding impulsively to novelty ane perceived rewards eg with sex, drugs and rock andl) ‘+ eveop skis in emotional intetigence.incding understanding and regulating emotions (both positive and ‘negative, Poor nutition during this phase can inhibit these processes, ‘causing the brain to remain In the immature state. Prolonged oor ution can freeze brain development, which makes recovery dificult. Similar problems may develop in indhiduals ‘who develo eating disorders after adolescence: even in these ‘cases you may notice regression in ability to moritor and regu- late thoughts and emctons, which highlights the Importance of testing adequate nutiion in a sustained manner as ealy 8 possibleinthe course of theless. {5 tive soarnees + Ifyou are concerned about Eds symptoms, jt down ‘examples When didi happen? For how long? How often? ete + Report to your GP, by letter oF phone if urgent hing televant details + Establish a routine for egular weight monitoring + Talkwith Et '+ Assure of yourlove and your wish to help possible + Voie your concerns. + aplain your aeons + offerhep <—_————_ REFLECTION POINTS. 1. Be mind ofan recruit lp to manage thisif neces. 2. Prolonged poor nutrtion interferes wth ain function, impeding recovery 2. the eglatonof mation abstract and soa Imeligerc affected by prolonged por mutton again creating barr to rece. i 4 Caring for a loved one with an eating disorder — first steps The pesbtent extreme behavoursaetoced with eating ‘ter are tghtening and conan wnen you re encounter ‘her You ray er hat yor oved areas cance hen you see ‘he extreme weightless Simla, persistent voting andthe ‘Stress coed by bingeing Is upreting, Mary facts ofthe ‘sya are held in ere You ay Rave mo eo what {org ore can be ey gos at concealing dsorered eating ‘on poerty longterm conequences secgnising tat the Protersan eating disorder may be har for you aed even fr Jour general practioner, Were an you sa? The folowing Section may. 2 Broaching the subject frst thoughts (Caples 2 explained jet how et can be 2 carte an entng créer Once suspccus the net step to ennurape fa to ace that thee may be rote Rereterthe AP sep nthe eles varenes Pom yt Use abe 21m Copter 2 tp wth bul Ing our tnoweipe ad awareness eared on tn rer » People wth eating orders are not eny to hep Some inde ‘sls persist with meagre etary rations whe or eters the Compulsion to eat beaks down the resche.They then fa ‘ent ue entree menses to compensate fr har nd force wthower enero, vomiting ot nates patter ther Mean adatom can sty develo, wth te dhl at ‘rsubsting on monstonos low cla et fr long pees then, sudden i» smal potion of palate fod pases ht lips bang unabe to stop eating Oher compu, driven behaviours sich a ove-enecie ogy ua can cc AS an obser you may notice that eating Behaviours (ther too mucho toot} re impacting om na ony Ee quay oe, Sat youre on ‘er though your sberatens ar atesing you may fit impose orase your concerns eect wih Els they get ‘rushed de One the core cca rs fan eating cer “ together |s that the india perceives sme postive Benet to thie ‘ondtion 9 sense of wel-bcing, per, contr aniqueness, fete You may feel fozen and poweress a5 our loved one ‘becomes angry and/or umiated when you ty to broach the subject. The following sections ai to help you prepare for 3 conversation with Ed Alok head ‘+ Chapter? Understanding change. ané how cers con encourage Ed to move away fom behaviour with regative consequences ‘+ Chapter 9: With eating cove spect fie relatinships Can become fought both in fares ain peoessnal setting This chapter describes the commen reactions o and esti inthe welationsip. “+ chapter 10: How ell connections and reationhipe can be damaged by theless 2 reaching the subject ~preparation and trouble shooting Fi tetera an practise tie senanie tat might are when you beach te sublet wth a Dede where and when you wil rose the conversation ~ nda good opportunity when you and Eiare lone together perhaps» que room witha danger of interruption or dstvacion best, o perhaps en out ‘orawaie nth preparatory phase. tcan hep to mate natesof the pote symptoms and behaviours that have made ou fel nea. Have these observations to hand when you tak ering fre tored on wthon ting rds * Find 35 much information about eating orders 3 you ‘an and compare your observations with case descriptions possible al about your concerns witha wise ens Te takes time for at babe ta sep aie rom the com- pulsv spas of thought and action and tobe wing or ‘Beto tent your pt of view. You need 1 ty to help a shit four from thet Ineressingy narrowed eating! food-diven perspective ont deeper values such thet health and time ambitions fr the future for example, won tae fami orton "rouble shooting obstaces ~ be aware of and try to avo oning in and hence encouraging, eating disorder {GW sue 8 dscutson about ood, calves, body shape oF ‘weight. These are major preocupatios for the inidal eth probaly developed detaled knowtedge af hese ‘pics and swell practice in rasing them n conversation ‘Stepping away frm this “dance” wil requie you 10 be refeive snd se deine. ettng into an argument ‘wil mate things worse 50 If necesaty you can agree to “agi. which hopelyheps the badges of commun ‘ation open fr ater work Frthe inter, bide your ime, but remain aware and start to mate plans ~for stance think of what youl say H €al strongly esagees wth ‘everything you tay about dodered eating Fr instance, Tove you 0 much and my man concer isto see you wel ‘Butwe don apie on th You soy but think soe’ ‘eave tas now ond moybe we cn tak about ioe. Now fm going to hee ¢shomertake the dog fro wats @ neighbour” Some general preparatory adic gen in Table. “ ing forte one thon tin dr ices Pornng nigtoben teste mce2 onelpnguepraee + Goreng AF mget aon renga een ‘Reese wenn soe ety + botbesty. ont comer ynoe symtoms erBreupon te Fone. + tert ye they hae pete ay ong (isc emer con cont ond ads bey prom + ume puri more -anins mone ny + Dot atotewtening-yo dort edo inet, at tatty 3 Broaching the subject precise planing fan ahead and spt a posse interaction suse ere, en ad wth worn Tink canal of what you wart to say about you concerns and imagine Es Fesponse As nal things pace invaluable perhaps ath rate amy member of endo even witha Try to poston your a alight detached ober 3 ‘ayonthe wal “Thave noted. 1am coneered about. ese can youtel tome obo tet me how you fe. Sometines inking othe eating disorders an ante min ‘anorexic help yout separate the eating ard ards behaviour fem yur loved one Taka act El has ‘mised elngs about charg, aster are to prt them {he welsie andthe side’ Be calm and compote Talle 42 gies some starters to help res develop ther own lef pvases Mare arefered tough the bok. rg fated onto etig ter » ‘Sitar ontronsyae. ype anes ‘eC Tahu mn npn oan + ease essa stem aa th arth neta ‘eet eyo font oe owe a + can cea tote sr na tm nigh e ig gt tt ‘rereeteteengon atone ape + feu fang nigra th eg te voyloe Wht nyu Di fbn hap fey dea ‘Wmctaton sane tae fg esc + unenwipet semen ‘Troyer tet nT ol hey ace yet Som. + Make ett econ ent nt opine (oar + stat yosan tes ghee nate ‘Siw ign st cnrtke huge ctoen ts aetote beer + Sage ote eh and coer en ple essere Ea * flpscesltns Src seh erste ot eg {Sthowihatk wae ehanauryo dle yrs peo “Teyana hn oes owhanlen my omeabcawtodathahayerl opanacae ‘angrrie “retour ng ft tte fad 7 Mpesccomnten te ga banyan jena ey ‘apogee somo hw rere at ourzatng ‘raat aroun ced ep tnd sandal tse UMsinscestn potas Uneennaonwcr ah ma + part -tv atte cnge and ae te ” rng fora tved cnt on oig rer aly Ready to get a What do youerpec to happen? [Bi wns youtesnedt sup 5 you allthis time “Tea ge through to him He denies eve thing ‘Se st ot angry ying | wos being overprotective ad snags tings ‘she sai thot she was st hong t work hard for exams. She sid shewasfoe though" “Somehow meee up talking bout me! Tht realy wasnt ‘hepont Dont consider ging up If your Fst ~ and maybe many more _dbvequet~ attempts ae me with anger ae rl, gored, erie or brushed aside ‘onl gv up Keep watching, Walt for other opportunities, The goings very tough ~ dont ve up. Remember during ths stage Ei needs you, but not eta the stage fovea 6 Other support? Tis aly stages vey dtu. You ay felt alone and co ‘ued You may not be abl to gett the Stage where Ea agrees ‘thither she wants el, btn the meantime you can do more arenes and preparatory work ing frelon ith on tig hander » (G] wescronrvn For example you could goto you genera practioner youre esrb what you andatherfamly members Observe notes ofmcideats and Hequery of behav a8 beset here ating sores ate eater: may not be am ae our rows t about s/he may know what teat Boks {ay but have ro trowledge cf pose ficlties the ome situation However you can ask what help ard resources are avalable you local area were youcan fiodout + concer about canfdentiaity professional ae unable to pve you nals information but they ae ale to dese the problem in genera Cong 1 your CP, even without dl. may be 2 good rs sep + Hfyou fd yours becoming Fequent fussed with dv seek suppor Foristanee, Bet runsan eating ‘orders hen with yoltees who hve Rod personal ‘xpecnce of an cating Geode inthe fay. ey be ‘worth speatingtosomeene whe can empsthse ard [Pehapste able to suggest whee to findmore evant [fomation or fer scontact moat fora sleep [oupwainaveingdatence of wher youl « igre loved owt ing ade, <————EecTIOnpownts 1 Isthisaneatng sore AWARENESS - wath sans. 2 REMEMBER geting an india to accep they haves roblem sey = ut never ay 5. PREPARE yous to broach he subject. Cather Information research and posse tak tothe Decider tne a place 4. SCR in your bead what you wat to sy Rehearethe convertion, Sag ream oe {6-REFUCT on what youve leant salsyou have ned. 7 See SUPPORT fanayiends? Teephone heltine? Sette group? Poesiona Yu dont have to sive thialone ig fore toe it on garter « 5 Caring styles of close others Ie ioftenvery eat fx cove others to identity the peoound ways In which cating oder symptoms negatheyIuence 3 loves ‘ones soa emotional and pyc hea. Seeing these neg Ste Impacts ns Me may ve felngs of fa, angers {waton and confusion aedtonto other ematens The ty fad tary members respond tothe hihy surest Gecumstances ungue, however in out experienc, there are several common ptterns of behavaut that mary ‘res exhib Thee responses, describe ere wing 3 ees of animal metaphors ae nur! an typical reactions to etng. ds ‘rer symptoms. These ae nsnctne recone 4 concerned Sd tightened cater Even when stemming om the Bet nen thos some of thee eaclons can Rave emetic on the may dove thers prove hep "he set fail metaphors are ued tila common eho vectbons and emotional vexone Os ae m2 fahib in reaclon fo eating Barer symptoms. Se F you ate Seto notice yousalm any of thse metaphos We hope hat tecogning youre n the animal metaphors depicted may Uk ‘mately improve you rapport anacannecton with Ed a ing ef oe te, How do you react? Emotionally Tre onc Save farsi meres may fr dificult cope with the di toes and upet f challenging confronting eng dander thavour Ty try to m0. tinting o ting about the problems at all te ‘OseN ApS wh Reed yin the andl While tying to Ignore and deny the elects of fs behaviour, Ortch may =r may nol~ be wel aware of eonsequencs fo the famiyOsch may spent 36 mach tne bay rom the home situation 25 poste, waking, constantly WSyoe mactuuran seen ta ora state non "din abit In popes on TY oF finding ay other acy ‘ater thon conflonting the acu stuton and bxhawour of Ei They may ignore Ed's behavious and symptoms anor undermine the seer ofthe station. Sometimes aver can be angled in an intend rapa ‘entemetioral response to theses that confounded by ase interpretations of the Hess (ee Chapter 2 for myth and Belts) One common melee tat Raving» ed wth ‘ating sore means hey have ales a3 patent glee oF {ett ale produce iy espns Mirena oui bs preci in yo peng sl and expectations and hal yourself tay espa" yout ‘is Me ana hapiness. Ths senativ, often ert eon teacion may adionly be due to exhaustion and despa ‘When carers fel heiples and have this react, threw heats affected Confort. advice and support maybe need Preven epeson anda father detvetlon nthe stustion eames ans ete te ene airgap o “ arog fc es Mhest Bernd dog We recommend tying to model yeu emationa response on St Semard dog A'S mar ieclmandaleted~ even hens Stone ate dangerous, He does not pan or shout and seam, ‘hich may cause an aalanche Het orgie and proves fompanonsip, warmth and mute. He ts dedated to the welfare and safety of those who ae hepa lst Cal, warm, uring try to mode yous on at Beard How do you react? Behaviour Kangorocare angst Car’ reaction emerges when Eds fagle pyc tate eau ouinto potest hot het compete, to heep tem Safe asf a pen. Kangaroo wil do eveything possible to Supper an protect Edy aang oe al orto aspects of Me. ‘gato wl teat Eth lowes ina flo fe av ay pose upset or ste. Kangaroo wil accommodate to al emands, whether they ae rainal ot driven by the ealing ‘rower + Where binge eating exits Kangaoomight shop fr much lager amounts food replace mising food. + Where underetingexsts Kangaroo might re mies tong 2 speci food when st mgt tempt Es appette + Kangaroo might make spcal meta or which sre separate rom he res othe ony. «Kangaroo ay earrangethe family schedule as cre hele ‘The down of ting ovr al Es eponabes that ‘alfa to earn bow to approsch cope with and maser the cha [engetofife~and become raped nthe re of an infant canny ef tes s eames agony poeta er ene cuteness ey ncomunteetainasnep tes ton shay ahaa The Rhineceos response ‘aca. you may become stressed an exhausted by Es une ‘tng nransgence nthe face ofthe, appre, pe ok tin toeat a ious and adeuate amour and you may get ‘awn ito adopting 3 Rhinoceros Response gue 5) ction tempts may bec Shr 3 food appease bth room sin constant tse, sinks and tats ae Wace Ff ‘meas ar cota neupted You temperament may be ot that fcies on deta and o you want Elf understand your broly othe tation fin teste persuade sd core alto change by argument. a charging at ying osc {heestngenrdered behaviour and bela vinglogic The dowrsie of this sat El cbeys, E's confidence in the bel that they can de ths thems without aston, vl at be develope Or a5 more ly El ay Spend a 6 area eof tes energies In self protection, arguing back with eating disorder loge, rehearing a the astorted eating dorered thinking — and digging a deeper hole toe in, SEC cere ots tht ges ea dy Cinencnhp ler ‘The Teer respon ‘The Jack Russel Teer Response is yapping at E's ankles — reminding and gulzing her about Tood an eating. Ooes {his wor for you? Ordo you think El ust tunes you out as part ofthe nae’ of acl comments and fod tought hat jangle Inece Ms or her nen? Time spent listening to al ~ rather than tling at Ed — worth weighting. The Eating Disorder Martyr: Accommodating ond encling ‘A frequent caregiving reigonte to cmeone who i ito spl them ad reat hem as pec. Tying not to provoke stress a ‘ining to ep the peace around srnone with an eating Sscder ‘may mean acepting eating oder es This invohes hanging {oodulated behaviour inte shops, kichen ad ning om ot ailewingcompensaterybehavours to intra nto fray fe Ts Undertandblereocton has a bod sie fect = als eating ‘Seordehabtsto become even more deeply embeded. ag psf shes o Vet ayant an wcrc ers ys stig my and they hatte ani res ‘ses and emrcn-tritane dng pate opted ‘Sronrcnsnig theorem sees sot sateen ‘Stan enantio Senet Sp The coting order breeding ground Maye others nthe sual network have share values with loveremphassing the importance of weight and shape. This ‘may be experienced outside the family = In part, soll ‘media, pets at schoo or work, sport/dance coaches et. ~ But tften someone ele inthe family may have ad an eating i fdr and hae these ral tras. ol aay yan ing oneerstions round to fond, weight shape, boy image tp. Sich conversations ge the eating dover ‘ar time, Seng tring belts and habs and propagating more rig hiking « ing sof oe cto ac of the cating sys an offer cata strengths when used De partofscolaboratve and integtaed approach to kenge. Continuing the animal metaphor, we suggest that rather ‘an ng rt ninocers or Kangaroo extremes, yt adel aing es ea thes ° yousif on 2 Dolphin, nud Ea towards safety. The figure ‘wearing fe vest in igure 5 represents Et eos El at Sea, with the eating dora a6 th Me bet uring 2 ge pth perceived satety of the ile bel weit hy feta te ‘words sess and dangerous. Delphin may a times sm hea, leading the way and guiding Ea tough sift pas fapes. at ther times swim alongside coaching and iin ‘ncouragement and suport Aad a ines when Es main peste progress que swim behind Perhaps you can recognise some unhelpful features in your counelfonstocare for Ea? (SD « tinge of sts ‘One ofthe fs things that you can do to bing about change In tocxamine ad if pecesary change your own behavior. “ht meane stepping Buck rom the une automa rae: ‘ons for example Ostrich Bin, elif or angar. “swe mentioned inthe rlace, the athe fr one not condo you break tonic pattem of interaction but also youleam™ ty experience ow dificult ke to change ~ and you snow by example that you ae ready to mate changes Co though te ieuar APT steps we outlined in the Peace: AWARENESS, PLANNING, TRYING TOUT ‘Awareness: What kind of carer are other ‘members ofthe family? ‘tiscomman for member ofthe fami to have sferent ‘yes More often tan ot the esting Georer cues pls ‘within the fom those who ae who ge into as ‘demands anddrdered eating hats ancl behviours— ‘and thse wo ae tougher. The eating srr tives on thisehion AMES ewe aie ey ene et intent e Das speedyaan enw) Scrum et esbng eee ssn al eat dre note oy Gv gon ‘ones tenets teense Seep compe antes a (2) Pann fe cabraton and cooperation We ann sess stronly enough he ingrtance of eating these pits and having a coherent team response Here sone way you ould set stout dong this you wil probably thik of others: sometimes someone fem ouside the dos family wha can be mere detached can ep The ‘instructions or this task are given fr pret; noweve. th. ‘may need inode ther fray member fortes, sibegs) Fst planta communicate wth respect and hur Set 2side uninterrupted time to doit= pss ot fora mealor Cotte! ett sheets f pape. one see for youand one fr your parte and daw ou saledtines on hem two lines (thch sale emotions activ nd wo for emetinal behaviours Gee Figue3.9at the end ofthe caper Anchor cacend ih he animal ‘Net onyour own sheet pve youselfa mark ad ato mak our parneon tse rulers. Then get together and explain ty yu gave these marks Do this ia compassionate na ‘ang wy. How snr war the two matt foreach, ‘pesen Ater scussion, do you want to move the poston sFthe mack ok ech other hou youcan help exch fou petit 3 Sima utes positon~the consistent See spt maybe round eof! many behavous but for etng You both ‘may needto agree on taking frmtine Astep-at atime ‘is approadto goal setingisneedd, done wth warmth Sndcomposson 2 ning ote then ‘took Ahead ‘ead some of the ater chapters to decide what hls ve ‘needed ond where the sweet spo of 9 cnsstent caring ‘yenecd tobe, Chapter 9: Give mare deta about developing acon fentandtupporive caring tye {Chapter & portal emphasis onthe changes for Sibings ond partners: Chapter Howto marage emotions The subsequent chapters fous on the specific sits needed for severe restiction (Chapter). binge eating (Chapter) ond ether safety behovous (Chapter i) = e thote habits that eep teeing coder stuck ‘Once you have done ths you wil be ready to TR, and TaViF ogo, ating eof esther REFLECTION POINTS. ‘Think about wich metaphor depicts your attitudes oF behaviour ae those of ther members the family and ‘ring team 1. Kangaroo! Overprotecive too accommraating 2nd foo controling 2 thinaceros Angry and forceful ushing into make things change, : 2 Tener Crean maging. 4. The Marty? Accommadting and enabing. 5 Dolphin? Guiding. coaching encouraging and subtle, Think who depits your emotion: 1 Ostrich refering exapsm and aveidance 2h? Over emotional andsensiive 3. St eran? Calm warm and nurturing ‘And nally look tthe bigger picture ofthe envionment = Sr thee riggers that keep Es thoughts about nation Inaction? ‘Remember ~changingsomeane ee thar. Changing ‘youre might be ileal Working a tam inspects PeURS9 tees we cramps! hw yao tes ‘amonstontomoe ton rete saen rentvepotenp sent | Seca eee ehar || pimatdqemen ewer || per |cerpee| Sacco aeyntergtcog | Sates ‘rs" | eseyertinemeraet, || “hye fre Secs pene | Teeny pecans ang spe et ters 6 Stress, strain and developing ‘Stress: Why are carers susceptible? Indy fe. certain degree of stress cam serve 353 challenge, tut # wecan evenly mate the problem ican be enep Ing and failing However unrelenting stress beyond ou cap cyto cope tans nt prea tran and leds to dates. Living ‘than eating dover a huge chatlengeeven toa large eam Thigh trained prtesionas, et alone any individual oly oF {oa snglenome caver strugaing te support loved one ‘One ofthe difties that the probler ' mu-acted and fetal areas of ie for everyone who shares accommodation wine "The eating dondrs eng can pote 3 significant teat to any ate erestence Once there xcllape of coping esc, “amily (rome tear) members can become depressed of over anv o walk ata ome problems, Bf which wlimpact ‘on and hel cate Tensan between being dawnt protect ‘and ty to help Ea and frequent rejection both active and ashe) of that hel. eadstofuther misery. ‘Coping and resence canbe improved ough geting height information a the ight ee, by arin nee kil nd ulin, ‘on exiting ones The apie 0 anyon in cle penny tothe “ sre i ond evel sufferer, whether fmby a rend The deseness ofthe relation: Ship and amount of time sper together are major factors in how ring on resources the expvence Can be. In speci Uns ‘reting eating orders, staf burmout. snes or dficities wth recuteat and ta otiuty eguery ec. And in a tome station indval members may become exhausted 3h Ielsted an develop cincal vl of preston or analy ‘The flowing text ges you more in depth niermation about eacofthese probe areas 1 Unwilingness to accept help there ta huge divergence between your understanding of he eating Sserdet ard ts consequences ae that of Ey # can ‘ure much fition. In anor, caer se hat G6 il nd ‘ins al hereas i i's strongly held bel hat i or her caren weight ad phys state te satistacary IE ‘ew nothing ie wrong, Serr of bum ate aso scepteal of the medial consequences oftheir behaviour They may fel Incapabieor unable to conceive the fe without the Teas ‘oping strategy that purging gves them is thus very cit toperseae Edt seekmedial hep-and even more ic for alto adhere to any advice given. This i interly frantrating for all aes a5 is fr professionals. Chapter T deals extensey ‘th the prospect of change 2 Contacttime ‘ten amis, determine to d ther best fr Ed lb totally emitted in thi efforts a hep and ryt be with Eo mach 235 posible. Unfortunatly ths soperhuman effet canbe coun {erproductive, lacing t exhaustion and 2 bullap of tension ‘that may explode unexpected or come out in other mote ute ‘ways Carershave tod us that they in that one ofthe porta things n helping the ved one it stat totakesome ime af toste boc. toreflect and have espe fomthei caring ties. 21a a ond devpng rence ° Caving or youre vial importance a cre sain man. apingeating sone enabling you to maintain acl, compas Sonate stance Ths impose unless yeu can nurture ‘ond replenish youre Not onl the impor for your on we tbeing=i aso sets an example for Ed of god eae 3 Role strain ~ fostering consistency at home with family and other carers atin famies (and ako within profesional teams) there ate often healed ferences of opinion and plates, conicting Strategies about the we and responses that each fay ‘member shuld taken reation othe eatlng order. Ts nev ably causes confit an distress and an nconsistnt reaction to ‘the ines. Consistency s 3 corel and 0 needs special atten tion. Husbands, sings grandparents ae the farlymembers may tee aeghected and resent ~ ether pasvely of by 2h protest the sttenton devoted Ed ACUNEE Te cary dot ne Degen ac Se anne fue nhsl my mente et nh {ee Onspeneesy um to shards Sth _Sayvtot puney terete mob ag pm DRED ‘Try nett let the lines ake ovr your fe entire Fine te ar energy fr other arly members andthe aie, and as « ss tn and dep rence emphasised hee or yous This no eas with such 2 ‘demanding ness which affects 0 many aipect of fe may tenes to simplify fe in some wy, peop by expiring how tayo et and asin for help and delegating. perhans lyfnaing at east one rele youcan sop r share (By tat wp 2 so ave tas find» ime 3) when everyonein our household's tgetner and ay Yul the help fom everyone wio vest the house Tak out baling a team ef helpers. Ask which tasts each ‘son wil undertake” Would yu eto othe curing ‘ery eh? Hep wash the does after or evening mal? Ot ‘maybe you'd prefer t cen the atvaom? On the ish {o avo the ost people ely detest dong tere cou be 2 stampede of oer of hlp wih ate sts hey preter ot, delegate the tasks on your at. Ard 5 thatthe tu tion canbe reviewed after et ve, perbap review Shera west ona fortnight) ‘21 canbe very pfu here too bing ate of how a your fos to prowée the muchreeded extra Support for Eds sffecing eat home for eveyone in the family, icing or fetops especialy impact on Ue ma are apt hee In {hisbook osu you ow tution. "he main cater in 2 household the geton who orgies most howsehol chores. eaning. shopping. coking. weshing Sed arying the ites, etc ~for stance spent, sibling, one (of group of fara Whatever tants members ofthe Rome team undenat, fi at eat hghening te load BY the int tp aie AWARENESS nthe howd of how you'e fesing tak sbovt how much energy takes te, for xm, rane the hoe leaning coking shopping). Tet ~RANMING and TT ce Bo stm nb deep esiece ” ‘Any changes needed? Refi and een 8 neces, femembe to ntice an rae alte new effets andthe lnceasdp being tee 4 Disorder related problems ‘though mls te the major focus ad cause many problems ‘ter sympons = depressor antes, expose are, mpl Sion and iti, excnsve eure, oii, socal ition 10 fame afew itu int famiy fe and ae very ett tere Bak iis cn ekg to phe sme Se {share and enplre devs ad rales abut managing sp toms Chapters 1213 nous on iret proaches ep Juande problem se and cope withehalengng behaviours ‘emt? tavcecanbaane sty avo nc ace (tency sed wheat Mtr pansy ces ond Mineroomaelcndemerwtee « se sodden rane 5 Reliefs about theiliness In Chapter 2, we cussed some of the common aeumptons adm el abou eating orders. These ae ble on be arf they tiger emotional responses whch can ge inthe sway of Seng em, anastet an companions, and cn ue {me of thee thang personal neracns Teis poste to ater how aroused and stressed you ae by aneing how ou tink aout an event. This the ba f vey ‘sucesfl form of treatment cogitne behavioral therapy, oF (BT. Comide the flowing example ‘You cannot gett ep you ar on lyn town where 2 estval is hppering ad there ose oie of people laughing taking and dancing you allow your thoughts 0 be dominated bythe ea that people ae beng inconsie. ae rue and eterately tying to up yous iy that Jou wil continue to tot and turn a you become mere and moran On the cer had youty to tate 3 erent Perspective ~ ash yourself whether the intentions of the ‘thers ate basically onthe ideo good Ye, they ar eroy Ing the peatres of soc connection and contbting 10 {om and happiness. yt foc on # tine when you to enjoyed thee pleases You may no fin that your fee ings bout the rae can change fom ange to please ard ‘ampazson. The snsiton of ral and beng weaned UP do Sette and yu ean relax Thiscan allow yout behaviour techange ta bing tied ad reset peace Inthe cones of caring for someone with an eating dorset you say hove a peconcted We tha es i wit a of {alah ateton seeking benavour You may begin toresent Et they create family argent, tension and sess and requle rach atetion and artre Tey ate stubborn cbstnate rade nd unpretale and, thout tnking of posible con: Sequences, go agains you advice se a an draping race a However, informing yous of the nature of thi ness changes your thinking You read about the subject and dscove? a medically unwel ther berawour is unmtentoml You" behaviour tomards them changes ~ you have sympathy, show Understanding nd begin develop ood appar mth thers 6 Interpersonal relationships ‘he animat metaphors described in Chapter 5 ate 2 weft jure to help ently problematic relabonsips. chapter 9 {2 0 to expain thee these since reactors Nave on but the following paragraphs serve as an itadton ategies hel n eating disorders ferro thse that wr fran sete es without any emational underonings Forinstanc, is very ney tobe effective if ou ty to argue guint Eas eatig behavior dominate and demand charge the ino response) Indeed this wl pobably mate the st on woe ater tel someare overcome he eating ds ‘der, tering to and ing to understand the pon of ew ‘Sse Evenifyou cont understand how o why he inal |S nking and behaving the way they ae you can ty to accept that thir 'show the suftere fc a hat moment The eroional tore mayest Between ard within home ‘ean’ members ho may be pares, segs, andere, Spouses, chien fatmates, cose frends sruggtng 1 cope In the ouside word with work and other acatcs whit ao tying 1 support Edt often with ile Infomation or help. Uno rate entreme responses desebed~Kangaren Shin, sh or Osrch — though ata, an be harm 95 they can resulta ettion or eresion and even more ertenche esting ‘iseder behaviours Fig the correct balance of com pasion ie guidance within a warm relationship wis acknowledging the problems cused by te entremely challenging behaviour of theless svey feu emee the ned for consistency which can be blown away by song eretns mn the manta ofthe crt, remerber the thre important Cam, Consistent Compasionate . se, nan etpgaence + beware of ehaginginforehange’ ke Srnec, + Beware of wyngto provide ttl prtecton by tying to protected in a angen’ oud + Beware of having your emotional esponsesondsplay ihe 2 selytsh + beware of ishing inte a Tere. constanty yappng oa bout wha ou Pinks reed + eroemg symptoms hoping El wil grow ou ot. tke an sth ith ts headin the sand wal ot ele + Beware of stig to hard for pace and changing youre “ompietey to acommodate testing depos + Tsao get alongside El andhep guide in the ight

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