May Q&A

Q: I have heard about two kinds of eating disorder: anorexia and bulimia. Are there are other kinds?

A: Yes there are. We know that about 5% of teenagers and young adult women have either anorexia (self-restricted eating with severe weight loss) or bulimia (binge eating followed by purging).

However, young females can have other types of eating disorders like Bulimiarexia. The is the condition where some women live on 500 calories a day, are extremely thin and also purge their food. This is one of the most dangerous conditions and has a high mortality rate.

• Purging Disorder. We have recently noticed that some women purge even though they don’t binge eat. Sometimes the purging will be induced by enemas or the abuse of laxatives or diuretics. Purging is most often done in secret accompanied by lying if questioned about the behavior.
• Binge Eating. Although binge eating is often a sign of bulimic behavior, we know that binge eating can occur without self-induced vomiting. What constitutes a binge can vary from person to person. Some people who think they binge are actually eating an appropriate amount of food.
• Chewing and Spitting. I’ve only encountered this twice in my practice but there is mention of it the professional literature. These females will eat food (sometimes large amounts) but will not swallow the food. One client I had would carry food and plastic bags in her purse. She would chew the food and then spit the chewed up food into plastic bags which she would put back into her purse.

Q: Why are some teens more anxious than others about dating?

A: By definition, the teen years can be filled with strong emotions. Anxiety, jealousy, and anger are part of making the transition from childhood to adulthood. Dating and romantic relationships during adolescence can add more emotional strain.

Research by psychologists at the University of Miami in 2007 found a strong correspondence between the amount of anxiety a teenager experiences over romance and the quality of close friends. The researchers found that two elements can influence teenage romance. First, a teenager will probably have less problem in dating if he or she has a number of supportive friends of both sexes. Secondly, dating is more difficult for those with little or no dating history. Like jumping into cold water, once a teen has started to date and has supportive friends, the situation tends to improve.

Q: My daughter recently told me about a friend who cuts on herself when she is feeling bad. Is this common?

A: Yes, it is more common than many people realize. The frequency is possibly between two and three percent of high school age females. The World Health Organization estimates that four times as many females than males attempt to harm themselves. The most common form of self-injury is cutting and the most prevalent place on the body is on the arms.

Many young girls will cut themselves, for example, to relieve tension and painful emotions. Others, ironically, will injure themselves to cause themselves to experience a type of pleasure. In these girls, self injury may release a type of opioid in the brain that make them feel better. Certain conditions increase a girls’s risk for self-injury: Any previous suicidal attempts; sexual intercourse before the age of 15; same sex romantic interest; poor social support; minimal attachment to parents.

Q: I’ve just quit smoking and am concerned about relapsing. What are the reasons people start smoking again?

A: Excellent question. The common wisdom has believed that smoking relapse is the result of drinking alcohol or coffee, being around others who are smoking, or socializing.

However, a recent study a few years ago found out this wasn’t so. Psychologists at the University of Pittsburgh Smoking Research Group wanted to find out what really got people to relapse. They discovered the most important reason for smoking relapse is negative emotions and distress. In order to guard against smoking relapse you need to find new ways of coping with strong negative emotions. You may want to check out The Worry Free Life -- a book full of coping techniques for distress and negative emotions.

Q: My best friend thinks that maybe I need to see a psychologist for therapy. Although I’m not against the idea, I’m not sure how to find a good therapist. I have heard too many horror stories about therapy and I also know that many people have been helped by it. What’s the best way to go about finding a therapist who might be right for me?

A: This a question I wish more people would ask who, not only are thinking of beginning therapy, but have also been in therapy for awhile but feel like they are not making any progress. As with people who seek the services of any professional you want to be able to make an intelligent decision.

Years ago a prominent psychologist, Arnold Lazarus, devised a questionnaire to evaluate the behavior and personality of a therapist. I give a copy of this to every one of my clients on their first visit. If you are interested in obtaining a copy, send me your request to me and I’ll send you the 2-page form that I use. It has 17 items for you to consider. On the second page, you can score your answers to determine if the therapist and you might be a good fit.

Here are some examples from Dr. Lazarus of the things to consider about a therapist:

• I feel comfortable with the therapist.
• The therapist does not treat me as if I am sick, defective, and about to fall apart.
• The therapist has a good sense of humor and a pleasant disposition.
• The therapist admits limitations and does not pretend to know things he/she doesn't know.
• The therapist answers direct questions rather than simply asking me what I think.