R<$c$>efusing to eat, vomiting and exercising excessively are all methods by which you can shed pounds. They are eating disorders and are not a healthy way to manage your weight. In fact eating disorders are considered a psychological problem.The extent of the problem in Bermuda is unknown because there are no local statistics.

But there are local people suffering with bulimia, anorexia, obsessive exercising and even binge eating. Psychologist Lorrie Peniston sees many of them and thinks the picture in Bermuda is on par with the US.

At the moment she is helping 12 clients battle these disorders.

“This number, however, should not be used as an indicator of the prevalence of eating disorders in Bermuda for a couple of reasons: I tend to get quite a few referrals for eating disorder treatment because I am known to work with this type of client,” she said. “Secondly, there are many people who have eating disorders that do not seek help or treatment.”

There are an estimated 8 million people in the US who have an eating disorder.

That represents about three percent of the population. In Bermuda this would equate to 1,800 people — far more than the 12 Ms Peniston is currently seeing.

She said among those 12 there is a fairly even distribution between those with anorexia, bulimia, binge eating and combination of anorexia and bulimia.

“All of these eating disorders are life threatening,” she said.

n Anorexia<$> is self-imposed starvation.

ular">n<$> Bulimia<$> is the repeated cycle of out of control eating followed by some form of purging (i.e. vomiting, excessive use of laxatives or obsessive exerc).

n<$> Binge Eating <$>is also known as compulsive overeating and is characterised by uncontrolled eating and the consumption of large amounts of food.

It is important to note that weight is not an indicator of an eating disorder.

For example, not everyone who is thin has anorexia and not everyone who is heavy is a binge eater. “Some binge eaters are in fact underweight for their height,” Ms Peniston said.

Also we tend to think that eating disorders happen to women. Ms Peniston pointed out that while they are more prevalent in females, eating disorders are not gender specific and do affect males. She has treated two males locally for the disorder.

In fact it isn’t possible to paint a picture of the type of person affected.

Ms Peniston said locally she has seen teenagers, young adults and adults both black and white. “Years ago, we tended to think that eating disorders were an illness of young, middle to upper class females,” she said. “But it affects people from a broad range of ethnicities and socio-economic backgrounds.

“Research has shown that certain temperaments, characteristics, psychological and family factors can be identified as common or shared among those with eating disorders.”

New studies are also indicating that genetics plays a role in the occurrence of eating disorders. “This may not answer the question ‘Why?’ but it may indicate a profile that helps us understand underlying issues and develop more effective treatment plans,” she said.

Effective treatment plans are crucial for these disorders as they are life threatening.

In Bermuda Ms Peniston said she has had clients that required hospitalisation both locally and overseas because their weight loss was so drastic.

While she would not elaborate on the details of the weight loss in those patients, Ms Peniston said: “It’s important to mention that the most effective form of treatment for eating disorders involves a team approach. That team includes the physician and a dietician as well as the therapist. Family involvement is also a part of the process as this illness tends to affect the entire family.”

Ms Peniston said her clients come to her by a variety of methods including doctor referrals, referrals from other therapists and family members. “I also get self-referrals,” she said. “This doesn’t mean that those persons who come through my door are ready to give up their eating disorder. Many individuals with an eating disorder are ambivalent and conflicted about getting treatment.”

And these disorders usually require years of therapy. “Eating disorders are very challenging. No two individuals or illnesses are alike and it requires a long-term commitment on the part of the treatment team, client and family. Treatment, including restoring healthy behaviours and weight can take quite a long time,” she said.

But there is hope and she said recovery is possible.

“Long term recovery requires a change in the way one perceives situations and the skills that are acquired to deal with the disorder. Recovery is an ongoing process,” she said.

And that process is not as clear-cut as in many physical ailments. There is no ‘cookie cutter’ approach to treating eating disorders,” she said. “The first step is usually a thorough assessment including a complete physical. After the assessment, it is determined what level of care is required (outpatient, inpatient, hospitalisation, et cetera) and the appropriate treatment plan is developed.”

She added: “There are several approaches for treating eating disorders. The most common is cognitive behavioural therapy. Many eating disorder specialists and treatment programmes incorporate dialectical behaviour therapy (DBT), which teaches the skills necessary in recovery. These skills include mindfulness, emotion regulation, interpersonal effectiveness and distress tolerance.”Lorrie Peniston is a registered psychotherapist with over 20 years experience. She has been practising in Bermuda since 1994 and currently operates Synergy at Healthways. <$f"Wingdings-Regular">( 292-3230.