UpDate - Vol. 13, No. 26, Page 11
April 7, 1994
Eating disorder help through group therapy

     An innovative, two-step counseling approach is available and has
proven effective for University of Delaware students with eating disorders,
 according to Leslie K. Orysh, psychologist at the Center for Counseling
and Student Development.
     Since treatment of these problems is complicated by the varied forms
of eating disorders (anorexia, bulimia and compulsive overeating) and the
many stages students may be in when they decide to seek help, the Delaware
program employs group therapy, a particularly effective treatment for
eating disorders because it provides peer support, decreased isolation and
interpersonal learning, Orysh said.
     Two types of groups are used.
     The first is recommended for students who are just beginning to
address their eating problems. The eight-week sessions are both therapeutic
and educational in that, each week, a new theme is addressed through
various homework assignments and in-group structured activities.  One of
the assignments is to keep a journal for the duration of the group.  A goal
is to help students find a low-pressure environment where they can learn by
reading and writing.
     "In this group, we hope people will 'warm up' to the idea of  therapy.
The students receive education on such topics as the effects of starvation,
information on the impact of cultural pressures and family dynamics, and
they get a chance to talk about things they feel most concerned about,"
Orysh said.
     In the first group, clients are struggling with persistent symptoms
and one of the goals is to help them decrease those activities, such as
bingeing, purging and restrictive eating. Symptom management, monitoring of
food intake and the teaching of alternative coping strategies are all a
part of the first group. Secondarily, it is designed to help clients begin
to identify issues underlying their eating disorders.
     In contrast, the second group is unstructured so that the focus of
each week is left open. Individual members bring up topics of concern from
their specific eating disorder, along with broader concerns, such as
relationships, academic pressures, stress and family problems. The group is
designed for students who have completed the first group or who have had
previous treatment for their disorders.
     "In the second group, students may still have symptoms but are able to
move beyond them to their underlying concerns. They are able to practice
feeling and relating-not just talk about doing it. We have found that there
is a powerful impact that results from sharing with other people who speak
the language."
     Clients in the second group have more stabilized symptoms. Many have
successfully decreased bingeing or purging, for example.  Participants are
ready to move beyond a symptom-focus to gain insight into their disorder.
Typical issues that might be discussed include separation and
individuation, family relationships, dating and friendships, managing
emotions, self-esteem, body image, stress management, sexuality and loss.
     At follow-up interviews, participants in the first group reported
significant decreases in eating disorder symptoms and notable decreases in
depression. They reported being able to make connections between their
eating behaviors and emotional concerns and issues.
     Members of the second group reported that they had gained insight into
their disorders, learned to identify and express feelings and developed
intimate relationships with other students.
     For research purposes, Orysh said, clients considering the first group
are screened before treatment with an eating disorder inventory and the
Beck depression inventory, and are surveyed about how they feel about their
bodies. Using the same indicators after treatment, Orysh and her colleagues
found that, in most clients, the eating disorders subsided and the
depression lifted, but negative feelings about body image had not changed.
     "Future forms of treatment need to focus more and more on addressing
body image," Orysh said.
     "We see individuals with a variety of symptoms," Orysh said. "Some
(suffering from anorexia) rarely eat, deny themselves food and have hunger
pains that they ignore. Some are at least 15 percent below normal body
weight yet have an intense fear of being fat. They suffer body image
distortion. They look in the mirror and see fat where we would see a
skeleton.
     "By definition, persons suffering from bulimia engage in binge eating.
They feel out of control and can't stop themselves when they binge. Then,
they engage in some form of undoing-vomiting, using laxatives, dieting or
exercising excessively.
     "And, we are, unfortunately, seeing a growing problem with students
who do not binge, but who purge or undo in some way after taking in a small
amount of food, e.g. a few pretzels," Orysh said.
     "Other people are compulsive eaters. They are overweight and can't
stop eating. They use food to address their emotions.  While these students
struggle with their weight, they are not encumbered by the added dangers of
purging.
     "We see individuals with all these problems at various stages. We see
some who are just able to say for the first time in their lives that they
have an eating disorder and some who have had prior therapy, some who are
in ongoing therapy and some who have actually been hospitalized."
     For more information, call the center at 831-2141.
                                                  -Beth Thomas