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Self Esteem in Adolescents with Anorexia

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Self Esteem In Adolescents with Anorexia
Angelica Benavides
Passaic County Community College

Self Esteem
Self-esteem is a large contributing factor in adolescents with anorexia. A person’s self-esteem has to do with their feelings of self-worth and their judgment of oneself. A person’s self-esteem has to do with how they view themselves and whether or not they do so in a good or bad manor. Self-esteem is established in the younger years in life with the help of a persons loved ones, such as parents, educators, and role models. Educators, parents, business and government leaders agree that we need to develop individuals with healthy or high self-esteem characterized by tolerance and respect for others, individuals who accept responsibility for their actions, have integrity, take pride in their accomplishments, who are self-motivated, willing to take risks, capable of handling criticism, loving and lovable, seek the challenge and stimulation of worthwhile and demanding goals, and take command and control of their lives. (Reasoner, 2010) Building a healthy self-esteem is a crucial part of one’s growing process. It’s particularly important that a healthy self-esteem is established in order for someone to have positive thoughts about themselves in anything thing they do in the future. A positive healthy self-esteem is established with compliments and recognition. Unfortunately if an individual hasn’t received the proper recognition low self-esteem could develop. Individuals with defensive or low self-esteem typically focus on trying to prove themselves or impress others. They tend to use others for their own gain. Some act with arrogance and contempt towards others. They generally lack confidence in themselves, often have doubts about their worth and acceptability, and hence are reluctant to take risks or expose themselves to failure. They frequently blame others for their shortcomings rather than take responsibility for their actions. (Reasoner, 2010) Low self-esteem leads to negative behavior such as promiscuity, drug use, and eating disorders. In fact, women with eating disorders describe feeling that they were never “good enough” and feeling as though they could not live up to the expectations of others. (Groot, 1992) a. Negative self-esteem is a key factor in why many adolescents today have issues with anorexia. Group Therapy is a great way to help adolescents understand the feelings they are having and why they are feeling the way they are. It gives the adolescents an opportunity to see they are not alone and that others are struggling with the same body image issues as they are. Group Therapy can be utilized as a way to combat negative self-esteem and its relation to bad body image. Group Therapy could be used to educate our adolescents on healthy eating behaviors and positively motivate them in the direction of building a healthy self-esteem. b. Adolescence is a perfect population to target in regards to self-esteem and anorexia. Early adolescence gives the opportunity to change ones self-image and feeling of self-worth. An adolescent could gain education on how their eating disorder may be a primary factor of their lack of a healthy self-esteem. At such a young age there is room for improvement and change. With better understanding of one’s self esteem and the proper tools to improve it the adolescent can understand the source of their body issues and regain control of their thoughts so they could fight for a healthy lifestyle.

To assist in the recovery of adolescents with self-esteem issues suffering from anorexia, a peer group intermingled with family based therapy (FBT) has been developed. The group goes by the name of Consuming Confidence (CC). CC’s participants will be in a group setting with other peers dealing with the same problems along with an allotted time period where the participant’s parents join the group. Studies and clinical trials have found FBT to be the most effective type of treatment for adolescents with anorexia nervosa. (James Lock, 2011) “Outcomes using the approach suggest it is effective for adolescents in the short term with 80–90% of patients with good to excellent progress and that treatment effects are maintained at longer term follow-up.” (James Lock, 2011). Consuming Confidence will be a closed group and participants involved must have issues involving anorexia and self-esteem issues. The FBT portion of the group must also only include parents or legal guardians of the participants in the group to ensure participants are all comfortable with the privacy of the group. CC will be an open-ended group where participants can join at any point of group. Although the participants will be at different stages of development the participants could all benefit from the self-esteem exercises and beneficial information exchanged in the group. Consuming Confidence will be co-ed with up to thirty participants. This ensures that all participants have enough time if necessary to speak during the group.
Although CC will be open-ended it is highly suggested that depending on the severity of the case participants either attend for ten sessions for six months or twenty sessions for twelve months. “A further study documents that FBT is as effective in a 6 month/ten session dose as a 12 month/20 session dose, suggesting that FBT can be a highly efficient treatment for most adolescent patients.” (James Lock, 2011) Consuming Confidence will be held every Sunday from six forty five pm till nine pm with the FBT portion being help from eight-fifteen till nine. CC will be held downtown in the back entrance of the Town Hall building. There is mass transportation available to the surrounding area if necessary.
When Consuming Confidence’s first group of participants begins, we will then begin to establish the rules of the group. Each rule that is brought up will be brought up to all participants in the group and then they may vote by a show of hands whether or not they would like to put the rule into effect. Some of the rules being voted on are as follows:
1) One person talking at the time. (No cross talk)
2) No cell phone use.
3) Everything said in group, stays in group.
4) No downgrading or physical altercations.
5) Once a participant turns 18, they can no longer be in the group.
6) Speak using I instead of you or we.
After all the rules are agreed upon, each time a new participant joins the group, they will get a copy of the rules and have to sign off on them so we know they fully understand and are compliant to the rules. If at any time in the future a participant would like to add a new rule they are more than welcome to do so as long as we have a vote upon it. CC will be a welcoming and trusting environment.

GROUP ACTIVITY #1
TOPIC: True/False Survey & The Magic Box
Objective:
• Educate participants on information on about eating disorders along with verifying the information they already know.
• Use the magic box to encourage positive self-esteem by allowing participants to view themselves as the most special person in the world through a mirror placed in the box.
• Promote group discussion on why each and every participant is uniquely special
Materials:
• True/False Survey along with writing utensil
1. Anorexia Nervosa (self-starvation) occurs most frequently in adolescent girls between 10-15 years old.
2. The cultural message that you can’t be too thin is communicated to impressionable youngsters through the media, family and friends.
3. Bulimics have a morbid fear of gaining weight; have episodes of binge eating, followed by purging through self-induced vomiting, or laxative abuse.
4. The incidence of anorexia and bulimia has increased during the last 10 years.
5. Bulimia is a secret addiction often undetected because bulimics usually are within 5% of their normal weight.
6. Anorectics engage in strenuous exercises after every meager meal to burn up the calories they have eaten.
7. Anorexia often begins innocently with a young person’s decision to diet.
8. Eating disorders affect more women than men.
9. Prolonged self-starvation can lead to the loss of muscle tissue, cardiac arrest and/or brain damage.
10. The binge/purge cycle can upset the body’s fluid balance.
11. Anorectics are pleasers who use starvation to gain control of their lives.
**All answers are TRUE
• Magic box with mirror inside.
• Chairs for all participants involved
• Long table with room for all participants
Description/Instructions:
Hand out True/False survey along with writing utensil to all participants in group. Explain to participants that you would like a better understanding on how knowledgeable they are regarding eating disorders so you would like them to answer the survey to the best of their ability. In the meantime as each participant quietly works on the survey, they will be asked to meet the facilitator in the corner of the room one by one in a clockwise rotation around the table. Participants taking survey are not permitted to speak to one another or discuss anything so nothing is revealed that may ruin the element of surprise. As each student meets with the facilitator the facilitator will ask the participant “Who do you believe is the most special person in the world?” After the participant responds the facilitator must explain to them they have discovered the most special person in the world and would like to share their insight with them by allowing them to look inside their magic box to discover the answer. The magic box has been constructed with a mirror placed inside to reflect the face of anyone who looks inside. Give each client a chance to look into the box after you ask them who they think they will see. Some client may have to be coaxed, because they may not believe what they see. Be ready with some of the following comments:
• "Are you surprised?"
• "How does it feel to see that you are the special person?"
• "You smiled so big -- are you happy to see that you're the special person?"
Before rejoining the group, ask each client to keep the special news a secret. After all the participants has had their chance with the magic box the remainder of the group should have had enough time to finish their surveys. Then the facilitator will open the group to discussion. The facilitator must ask the group who they discovered in the box to be the most special person. As each participant gets to respond with the answer of “me” explain the value of the box as it shows the importance of each and every one of them. The facilitator then must ask the group how it’s possible for everyone to be the most special person in the world. One by one ask each participant to explain to the group why they believe they are the most special. After the group has time to discuss the magic box activity have each participant read off one survey question to the group. After all questions are read the facilitator must explain that all answers on the survey are true. The facilitator will collect the surveys from the participants and explain how being knowledgeable about their disorders will give them a better understanding into what they are dealing with and their participation in this group has opened them up to help face their disorders with others dealing with the same things, they are no longer alone.
TIME:
1 minute to view magic box X (number of members in group-approx. 15) = Total time for survey 15 minutes 30 seconds for discussion as to why they are uniquely special X (number of members in group-approx. 15)
=Total discussion time 8 minutes Review Survey & Answers 10 minutes
FACILITATOR NOTES:
• Use the time spent as the participants answer the survey to meet with each group member one by one to show them the magic box.
• If participant fails to believe they are “the most special person in the world” reassure them by using appropriate compliments or have them reflect back on times others have given them compliments.
• Discussion of the group survey gives group members knowledge and a better understanding about either their disorders or other group members disorders in which they could come to a mutual understanding that they are not alone.
• Group discussion while each member gives reasons as to why they are the most special gives other members an insight into their positive qualities.

DISSCUSION POINTS:
• Educational facts displayed on survey
• The value of the magic box because it portrays the importance of each participant
• Uniquely positive characteristics about each group member

OUTCOME: At the end of the group all participants should be a little more knowledgeable of their own disorders along with their fellow group members disorders. The participants should also have a boost in their own self esteem along with a greater understanding of the special qualities that make up their fellow group members as well. This group is to encourage positive thoughts and feelings.
REFERENCE:
Conte, F. (2012). Yale. Retrieved from http://www.yale.edu/ynhti/curriculum/units/1984/5/84.05.05.x.html
Cook, D. (1999, February 10). Self esteem activities, programs, and protocols. Retrieved from http://recreationtherapy.com/tx/txself.htm

Group Activity #2
TOPIC: What do you need?
OBJECTIVE:
• With the involvement of fellow participants in the group, encourage each participant to obtain what they need with suggestions of healthy and positive ways to achieve their needs from themselves or whomever else they feel they need something from.
MATERIALS:
• Table and chairs for all participants in group.
• Blank paper for all participants
• Markers or Crayons
DESCRIPTIONS/INSTRUCTIONS:
• Hand out paper and writing utensils to everyone in the group.
• Facilitator must instruct group to think deeply about what they need that they are not receiving and who they need it from.
• Facilitator may give examples such as love, friendship, attention, independence, understanding, validation, etc. etc.
• After the participants have had a moment to think the facilitator must instruct them to write their NEED in large writing on the top of their papers along with whom they need it from near the bottom of the paper.
• Facilitator must then ask participants to pass their paper clockwise to the right to another group member.
• Facilitator must now ask the members to observe what they see, give the participants 30 seconds to suggest a positive way of obtaining the need specified on the paper.
• Once the paper has been passed in a full circle the facilitator shall ask the group members to take a good luck at their paper. Now there is a useful list of how the participant can help with acquiring their need.
• Facilitator should then ask participants if anyone would like to share their need and a suggestion given to them that they feel is a great idea in acquiring what they are missing.
• Give all participants an opportunity to share and discuss.

FACILITATOR NOTES:
Each of us suffering with or recovering with an Eating Disorder may feel deep down that there is something we are missing within ourselves, or something that we need from someone that we aren't getting. This activity gives the participants a chance to look at deeper feelings within themselves that may contribute to their eating disorder. With help from their peers this activity will open up the participants to positive alternatives to deal with their feelings. This activity is to help promote healthy positive thoughts. Facilitator MUST advise group members that none of their answers are to involve weight, food, or negativity.
DISCUSSION POINTS:
After the activity is completed the facilitator must encourage discussion within the group on what they have learned and gained from this experience and how they will use the information they have gathered to address their needs.
OUTCOME:
This activity is intended for the group to look deeper into their own feelings and what they believe they are lacking in their lives. Participants will be open to different kinds of thinking other than their own. The activity is meant to motivate participants to inner healing.
REFERENCE:
Medina, A. (n.d.). Motivations for Recovery - The Something Fishy Website on Eating Disorders. Eating Disorders | Anorexia | Bulimia | Binge Eating Disorder | Compulsive Overeating | The Something Fishy Website on Eating Disorders. Retrieved April 3, 2013, from http://www.something-fishy.org/reach/games_needing.php

GROUP ACTIVITY #3 (TERMINATION ACTIVITY)
TOPIC: Goodbye Gifts
OBJECTIVE:
Upon termination of the group each participant will receive a parting gift to take with them as a reminder of wishes of hopes other members have for them along with metaphorical gifts they have received throughout group therapy.
MATERIALS:
• Table and chairs for all participants in group
• Large piece of white poster board.
• Markers and Crayons
DESCRIPTIONS/INSTRUCTIONS
On the day of a participant’s final group present the participant with a large piece of white poster board. Then hand out markers and crayons to all group members. The facilitator must first instruct the participant to write their name and decorate it in the middle of the paper. Then ask the participant to think and write down gifts that they have received from each member (including the leader[s]). These can be things like hope, courage, laughter, an understanding of another's particular perspective etc. All gifts written down serve as a reminder of things they have learned from others throughout their time spent in the group. While the participant is decorating their poster board ask the other members of the group to think of wishes of hope they have for the participant leaving. The facilitator must remind the other group members that this will be the last experience with that person so real feedback would continue to be helpful to that person in the future. Once the terminating participant finishes their part of the poster board the poster board should then be passed around the room to all members so that they could write down their wishes of hope for the terminating member. When all group members have had their chance to write on the poster board present it back to the participating leaving. The participant should then present their poster board to the group and discuss from which other group participant they received each gift they have written on their poster. The facilitator should encourage all feedback. The participant terminating can take their poster board home with them.
FACILITATOR NOTES:
• This activity should be joyous but may also be emotional for some group members, including the participant leaving the group. Comforting group members with reassurance they have the correct tools necessary is essential

DISCUSSION POINTS:
Participants must discuss their poster board with the rest of the group members. Discussion of their gifts from each member not only makes the participant acknowledge what they have learned/achieved it also gives the group members opportunity to see how they’ve impacted the participant.
OUTCOME:
This activity is intended to give closure to the participant leaving the group. The activity is in celebration of all the participant has achieved and learned over the period of time they were in group. The activity will be a joyous experience.
REFERENCE:
Terry, L. (2011). Semi-structured termination exercises: A compilation from the groups in college counseling centers listserv. Retrieved from http://www.apadivisions.org/division-49/publications/newsletter/group-psychologist/2011/04/termination-exercises.aspx

References
Resoner, R. (2010). The national association for self-esteem. Retreived from http://www.self- esteem-nase.org/what.php Groot, J. (1992, March 1). Women ,eating disorders and self-esteem. Retreived from http://nedic. ca/knowthefacts/documents/Womanbodyimageselfesteem.pdf James Lock. (2011). Treamtent of adolescent eating disorders: progress and challenges.
Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3083856

Conte, F. (2012). Yale. Retrieved from http://www.yale.edu/ynhti/curriculum/units/1984/5/84.05.05.x.html
Cook, D. (1999, February 10). Self esteem activities, programs, and protocols. Retrieved from http://recreationtherapy.com/tx/txself.htm
Medina, A. (n.d.). Motivations for Recovery - The Something Fishy Website on Eating Disorders. Eating Disorders | Anorexia | Bulimia | Binge Eating Disorder | Compulsive Overeating | The Something Fishy Website on Eating Disorders. Retrieved April 3, 2013, from http://www.something-fishy.org/reach/games_needing.php
Terry, L. (2011). Semi-structured termination exercises: A compilation from the groups in college counseling centers listserv. Retrieved from http://www.apadivisions.org/division-49/publications/newsletter/group-psychologist/2011/04/termination-exercises.aspx

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...Bibliography Eating Disorders: Anorexia Nervosa, Bulimia Nervosa, and Binge-Eating 3 Anorexia Nervosa: A Guide to Recovery 3 Beating Ana: How to Outsmart your Eating Disorder and Take Your Life Back 3 Beginner’s Guide to Eating Disorders Recovery 3 *Biting the Hand That Starves You 4 *Bulimia: A Guide to Recovery 4 Eating Disorders in Childhood and Adolescence, 3rd Ed. 4 Eating Disorders: Journey to Recovery Workbook 4 *Desperately Seeking Self: An Inner Guidebook For People With Eating Problems 5 *Life without ED: How One Woman Declared Independence from Her Eating Disorder and How You Can Too 5 Overcoming Overeating 6 *Overcoming Binge Eating 6 *The Anorexia Workbook: How To Accept Yourself, Heal Your Suffering, And Reclaim Your Life 6 *The Overcoming Bulimia Workbook 7 *Skinny Boy: A Young Man’s Battle and Triumph Over Anorexia 7 When Dieting Becomes Dangerous: A Guide to Understanding and Treating Anorexia and Bulimia……………7 Body Image and Self-Esteem 8 *Body Image Workbook: An 8-step Program For Learning To Like Your Looks (2nd Ed.) 8 *Body Love: Learning to Like Our Looks and Ourselves 8 *Feeling Good About the Way You Look………………………..……………………………..8 Girls Rock: Wise Teens Offer Tweens and Moms Advice on Healthy Body Image, Self-Esteem, and Personal Empowerment.9 Life Doesn’t Begin Five Pounds From Now 9 Love your Body: Change the Way You Feel about the Body You Have 9 *Self Esteem Comes In All Sizes 9 Healthy...

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Biological Explanations of Anorexia

...There are 4 main characteristics that are caused by anorexia nervosa, and they are all serious health issues. Sufferers of AN will get anxiety and have an excessive fear of being fat and putting on weight. However, the opposite happens as  they lose weight as a consequence of starving themselves. If their weight drops below 85% of their average weight then they will be diagnosed with AN. They have body image distortion and see themselves as fat, rather than their real image, which is bad for their self esteem and extends their disorder. Amenorrhoea occurs and after 3 months, it is a clinical characteristic of anorexia, because the lack of nutrition means your body wouldn't be prepared to provide for a baby to it stops the menstrual cycle. The media is full of thin models and air brushed photographs which portrays thin as the 'perfect' body image. Adolescents with low self-esteem- particularly females- are largely influenced by this and compare themselves to the images of models and celebrities (Jones and Buckingham 2005). This can lead to girls losing weight to reach the 'perfect' image that their idols have. This is supported by Becker (2002) who studied teenage girls from Fiji and found that after the introduction of T.V. in 1995, the girls stated that they wanted to have the figures of the actresses and lose weight. Not only does it show media effects, but it shows it is applicable to other cultures who are usually less exposed to media. However it has been found that giving...

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Anorexia Nervosa

...Anorexia is an eating disorder of abnormal weight loss dropping below 85% of what was previously considered normal. This is characterised by low blood pressure, amenorrhoea and depression, as well as other bodily changes. Anorexia is caused by strict controls on weight and unusual eating habits which can be explained through both psychological and biological explanations. The psychological explanation of anorexia is explained through cultural ideas in the media which portrays thin models on TV and magazines. This is a significant contributory factor in body image concerns and the drive for thinness among Western adolescent girls. Research by Jones and Buckingham found that people with low self-esteem are more likely to compare themselves to idealised imagines portrayed in the media. There is a wealth of evidence to support the view that the mass media portrays slender as a beauty ideal which people strive to follow. For instance, Goresz et al (2001) reviewed 25 studies and showed that this ideal causes bodily dissatisfaction and contributes to the development of eating disorders, particularly affecting girls aged 19 and below. Furthermore, there also comes support from a natural observation carried out by Becker et al (2002) in a study of Fijian adolescents. It was found that after the introduction of television to an island, these girls stated a desire to lose weight and be like the Western women on the television. This study can be praised for being extremely high...

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Athletes and Eating Disorders

...William Kuschner SOC 228 Over the past few decades, there has been a great increase in the prevalence of anorexia nervosa and bulimia nervosa. This increase in eating disorders has resulted from the intense societal pressure to diet and conform to an unrealistic weight and body size. For the general population of women, the lifetime prevalence of anorexia nervosa is approximately 0.7%, and that of bulimia nervosa is as high as 10.3%. Since many athletes contain similar behaviors to those with eating disorders, there has also been an increase in interest in whether athletes are at a risk for eating disorders.  An increased risk of eating disorders among athletes has been proposed for several reasons. For starters, athletes tend to exemplify many personality characteristics such as perfectionism and striving for high achievement which is found in patients with eating disorders. Other factors include high self-expectation, competitiveness, compulsiveness, drive, self-motivation, and great pressure to be thin. In order to improve performance, athletes may need to maintain a strong control and constantly monitor their body shape. This behavior has been identified as a risk factor for both anorexia and bulimia. In addition to the societal pressure to be thin, athletes have extra pressure for increased performance and ranking, which make them more cautious of their body size and shape, leading them to become more susceptible for eating disorders. Although these characteristics...

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