Does an eating disorder make you more likely to steal? – Brookhaven Hospital
Shoplifting is a serious problem among patients with eating Further research is required to elucidate the mechanisms responsible for the relationship between shoplifting and eating disorders. Open Peer Review reports. Bulimia nervosa (BM) and binge eating disorder (BED) are more likely to go The purpose of this article is to review and clarify the classification, diagnosis, in the American Psychiatric Association's classification of mental illnesses, the DSM-IV. . sexual promiscuity, lying, stealing, and other manifestations of personality. Women with eating disorders tend to be younger, have a history of routine reviews of criminal history during assessments for eating disorders." kleptomania, those who consistently have the urge to steal, is linked to other.
This challenge in expressing their own emotions can lead to a tendency to provide vague or over-generalized answers to questions about their emotional state [ 17 ]. One client described that she does not really know how she feels so she cannot put it into words. This has led to interpersonal conflicts with her spouse who wants to know how she is feeling and how he can help improve her mood.
Emotional Disorders in Children with Eating Disorders
Individuals with high levels of eating pathology have a challenge in recognizing subtle expressions of emotion and have a tendency to misidentify more intense emotions, reading fear as anger and anger as sadness [ 18 ]. Another study demonstrated that individuals with AN, especially those with strong obsessive-compulsive symptoms, had difficulty in recognizing sad facial affect [ 20 ]. Difficulties in these emotional spheres can have huge impacts on individuals with eating disorders as they work to make interpersonal connections.
Helping individuals understand their misinterpretation of facial cues and the link to feelings of rejection may be very important in the treatment of individuals with AN [ 19 ]. In addition, anger and, at times, sadness are seen as toxic and a danger both for the individual and the others involved [ 21 ]. In the clinic setting, family members often provide this message to individuals struggling with eating disorders.
Even as a brother was criticizing his sister and she was trying to defend herself, he told her to not get mad. These comments take away the power of these women to be able to react to criticism. It relieves the attacker of responsibility and hands it to the individual who is struggling with the eating disorder.
This leads us into examining aspects of interpersonal interactions with family and peers. However, are there times that interpersonal interactions could be fuelling the eating disorders?
Yet those adolescents who perceived a poor level of parental communication and caring were at a high risk of developing unhealthy weight-control behaviours, especially if they felt that their mother cared very little or not at all [ 22 ].
While perceptions may not always be the reality, within a group of adolescents those with binge-eating disorder BEDas compared to controls, had higher levels of perceived maternal criticism and lower levels of perceived warmth [ 24 ].
Weight-teasing by family members has been found to be most strongly and most consistently correlated with problematic weight issues [ 26 ]. Individuals who have more eating disorder characteristics often describe feeling less comfortable discussing their problems with their parents, feel that issues are not taken seriously and often feel lectured at rather than finding a collaborative stance [ 27 ]. Families in which the daughter is struggling with AN perceive their family functioning as significantly worse than matched controls and the daughters perceive the family functioning in a much worse light than the rest of the family [ 2829 ].
The most frequent parenting style in families where a child struggles with an eating disorder is low in care and high in control [ 30 ]. They do not feel cared for but feel as if they do not have any control or the ability to navigate the family situation. Individuals struggling with eating disorders who have a more positive perception of their family functioning generally had a more positive outcome, irrespective of the severity of their symptoms [ 29 ].
This left them isolated and potentially participated in maintaining the eating disorder [ 28 ]. She feels isolated and not understood. They may be trying to understand why their mothers are so withdrawn from them and are trying to find ways, through the messages of society, to make themselves into individuals who are loveable.
When individuals experience neglectful parenting, they have lower self-esteem [ 30 ]. In clinic interactions, some of the young woman often describe a feeling of isolation in the family and relate that their eating disorder is the only thing that they can count on. For individuals struggling with bulimia nervosa BNthree family variables appear to be involved, including negative comments related to appearance, external control of food intake, and rules related to family mealtime [ 32 ].
Often family meals have been seen as positive and protective, but it depends on how the meals proceed. One client whom I worked with described that when she was growing up, her parents would not speak to each other but would argue through her.
She was the conduit for all conversation and disagreement during the family meal. Afterwards, she would go to her room and binge and purge to try to relieve herself of this negativity.
This clinical example reflects research findings that document a link between negative family food-related experiences and disordered eating [ 33 ]. Families who have poor problem-solving skills can spur increased bulimic symptoms because individuals need to relieve feelings of distress and frustration in that immediate point in time when a problem is being mulled over but not solved [ 34 ], whereas individuals who restrict often experience excessive cohesiveness in the family.
This sense of over-control is a more global experience and not a discrete episode related to solving a problem. The response to this style of parenting typically leads to more restrictive behaviours because that is the only thing they can control [ 34 ]. While we will examine the effect of the media and peer interactions, it appears that parental comments have the largest impact on young adults and the development of body dissatisfaction and eating disorders.
Females can be influenced not only by negative comments, but also by positive comments, when the focus still fuels the pressure to stay thin; in males, only negative comments have been related to body dissatisfaction [ 35 ]. In addition, in females, eating disorder patients have lower self-esteem as compared to controls and are very sensitive to both positive and negative remarks, such that just one comment can have a significant effect [ 36 ].
Dissatisfaction with appearance, lack of regular meals and poor communication with parents increase the likelihood of eating disorder symptoms in both girls and boys [ 37 ]. An additional challenge within parent-child relationships is in families where communication between the father and child emphasizes conformity and sets very high standards, which are often unachievable [ 38 ]. This spurs self-perfectionism and can make the individual vulnerable to media and society standards, because of the message to conform and achieve.
A recent example in my program was a father whose daughter had just returned from an extended stay in a residential eating disorders program. She describes that her first morning backs that she was peeling a grapefruit because that is how they ate it at the program. While knowing this father, I do know that he cares deeply about his daughter.Impulse Control and Eating Disorders - CRASH! Medical Review Series
But controlling and critical comments can set a standard that seems unreachable and may end up leading to individuals not pursuing their goals since they feel that no matter what they do, they are going to fail anyway.
There is often a tendency to avoid conflict so communication is stunted. Girls may be aware of the underlying emotional tone but feel powerless to change it; boys, less concerned with family interactions, find support outside the family as they seek their independence [ 40 ].
This can leave daughters more vulnerable. This can be a significant issue if mothers have had their own challenges with food and body image. This stays true even as women move on into adulthood. The level of concern that adult women have about their weight and their overall body dissatisfaction is often related to comments that they remember their parents making to them when they were young girls [ 43 ]. The comments were weight-related or criticism of their appearance.
So how can parents help their children who may be overweight or obese? This is clearly a current societal challenge. The evidence suggests that the focus should be on healthy eating rather than focusing on weight or size. Even for non-overweight adolescents, having one parent engage in weight conversations was triggering, such that the prevalence of dieting went from Clinically, it is a challenge when mothers struggle with their own relationships with food and their body image.
Unfortunately, many of these food-related discussions and observations are so engrained in our culture that women may not even realize that are making these comments. This is further escalated if the mother has a clear eating disorder whether it has been diagnosed and treated or not.
Often the untreated eating disordered behaviours can be extremely challenging. Daughters find it hard to comply with their meal plan when their mothers are only eating plain lettuce or not even sitting down to eat. Some mothers of patients in our program modelled that they do not eat when they are feeling stressed and often engaged in exercise with their daughters who were being treated in an intensive day program.
These mixed messages communicate an ambivalence related to the eating disorder and recovery. How can the daughter value her complete nature and inner talents, when ongoing discussions focus on weight, diets and appearance? Many times, these interactions occur without the mother even being aware of the negative messages.
For mothers who have clearly documented eating disorders, there are other ongoing struggles. They worry about being a negative role model, and they want to shield the child from an awareness of symptom use, but this becomes impossible, and in the end, many children end up as caregivers for their parents [ 47 ]. Mothers with eating disorders may, in particular, have more difficulty interacting with their daughters around food than their sons, with increased monitoring and food restriction and more appearance-related comments [ 48 ].
Difficulties in social communication have been observed in children at a high-risk of an eating disorder, particularly if they were exposed to a mother who experienced bingeing with or without purging behaviours [ 49 ].
Their findings suggested a possible shared liability for eating disorders, social anxiety and autism spectrum disorders and raised the possibility that maladaptive eating could result from social difficulties in these individuals [ 49 ]. Often certain shared traits in the family precede the eating disorder and can fuel symptom use. These traits run in family, such as anxiety and compulsivity.
Family members clearly become anxious when their family member is sick and that anxiety can make the individual more anxious, which can escalate symptom use, and this can fuel the cycle [ 50 ]. Overly analytic family members who focus on detail and continually try to argue the individual out of their eating disorder can often strengthen the symptoms because the patients have the chance to rehearse and state their beliefs over and over such they become even more entrenched [ 50 ].
These tendencies can have other effects.
Communication Challenges Within Eating Disorders: What People Say and What Individuals Hear
In one couple, the husband had the need to think through the pros and cons of every decision in a very compulsive way. He would then ask his wife for her opinion of the options.
No matter what she answered, he provided the cons of her choice such that she always worried that she had made a mistake. She felt like she was never right and felt inadequate, and this escalated her restricting behaviour.
In addition to the difficulties within family dynamics that might be present prior to the eating disorder, there are challenges that can affect the family once the eating disorder develops, which can cause continual strain for the family and can exacerbate the eating disorder symptoms. Approximately, one-third of caregivers working with children struggling with eating disorders had moderate to severe levels of psychological distress, including depression and anxiety [ 51 ].
A review demonstrated consistent findings of psychological distress, expressed emotion, and accommodating and enabling behaviours in caregivers for people with eating disorders [ 52 ]. This can become understandable when we consider the stress that families can be under as they work to provide care to their loved one with an eating disorder. This is understandable if we consider that compromises with the eating disorder might be made as the individual becomes more ill, having them eat anything may be better than trying to engage them in the family meal.
In addition, caregivers in the family can get worn down as the day-to-day arguments over meals and exercise continue. In most families, mothers spend 2—5 times as that of fathers in caregiving tasks [ 51 ]. In these interactions, mothers have demonstrated more accommodating behaviours, which are often used to decrease distress or anger in their child who is struggling with an eating disorder [ 51 ].
However, these accommodating behaviours lead to poorer social aptitude for individuals struggling with AN [ 51 ]. This can lead to more social isolation and an ongoing cycle of challenges. This predicted lower confidence in physical appearance and a tendency to isolate and participate in sedentary activities because the over-weight children were not avoiding just one bully, they were avoiding an entire peer group that teased them [ 53 ].
All of these conditions are more common in women when thinness is advantageous, such as professional dance and certain competitive athletics including gymnastics and long-distance running 5. Anorexia Nervosa Hormonal changes The most extensively studied eating disorder is anorexia nervosa.
Typically, hypothalamic amenorrhea is accompanied by low levels of gonadotropins and a profound estrogen deficiency. Amenorrhea may be absent, however, and there is presently considerable debate as to the appropriateness of the criteria for anorexia nervosa due to the presence of multiple endocrine and metabolic abnormalities in some patients without amenorrhea 6. Some of the lowest levels of LH seen in secondary amenorrhea have been observed in this syndrome 7although the LH level may be higher if there are other endocrinopathies present such as an underlying polycystic ovarian syndrome PCOSan association that has recently been reported 8.
Twenty-four-hour studies of gonadotropin secretion, which reflect GnRH secretion, reveal persistent low levels throughout the day and night with the absence of the normal pulsatile peaks of LH every 60—90 min 9. With recovery weight gainsleep-associated episodic secretion of LH occurs similar to the peripubertal child, and with full recovery the normal pulsatile activity occurs without sleep-associated spikes 9.
Additional hormone changes of the eating disorders are summarized in Table 1. Low leptin levels have been reported 10 What happens then depends on who deals with them. It depends on whether the lawyer considers the mental illness aspect of it or not. And a defence of kleptomania is only really likely to convince the court if there is no financial need to steal. Stern believes that UK psychiatry is "probably only seeing the tip of the iceberg".
Jeremy Coid, professor of forensic psychiatry at St Bartholomew's hospital in London, says doctors have to be extremely careful in making the diagnosis. Coid talks of a kleptomaniac who was trying to come off Valium: She found that when she was stealing on two occasions from the supermarket, the excitement somehow made these unbearable symptoms feel a bit better.
She waited outside for the security guard to catch her. She also had depressive symptoms, but the main thing was what she called the 'woolly things in her head'. It was originally thought to be one of a number of single disorders of the mind - the monomanias - along with nymphomania and homicidal monomania. It is now considered to be an "impulse control disorder" in the US, like pyromania, tricotilomania where the sufferer has the urge to pull out hair and pathological gambling.
Some argue that many of the depressive and anxiety disorders are artificially separated by psychiatrists and drug companies into new syndromes for which they can re-market their existing drugs. Many patients have mixed disorders. Some would say that a bulimic woman who is a compulsive shoplifter is manifesting her mental turmoil in more than one way, rather than suffering from two separate disorders.
Coid thinks kleptomania is more of a symptom than a disease that exists independently of any other psychological condition. It is usually part of extreme misery and depression.