Eating disorders are serious, complex, and treatable, psychological illnesses that can impact a person’s health and ability to function. The eating disorders that I help people with are Anorexia Nervosa, Bulimia Nervosa, Avoidant-Restrictive Food Intake Disorder (ARFID/hyper selective eating), Binge Eating Disorder, Disordered Eating, and Other Specified Feeding or Eating Disorder (OSFED). Across all specific diagnoses, eating disorders are generally characterized by an unnatural relationship with food that damages, rather than promotes, physical and psychological health.
According to the National Eating Disorder Association (NEDA), eating disorders affect around "20 million women and 10 million men" in the United States (1). This means that eating disorders are unfortunately common problems. Statistically, eating disorders are also some of the most dangerous mental health conditions, surpassed in overall lethality only by opiod use (2). This means that getting specialty treatment from a professional who understands is extremely important.
Do you find yourself struggling these problems?
Is it hard to feed yourself without feeling guilty?
Is spending time with others stressful because it might involve eating?
Do you have "another side" of you that controls you and lashes out at others?
Is it impossible to see your body accurately and is it strange that others don't see what you see?
Are your thoughts constantly getting stuck on your body, what you ate, what you are going to eat, or how much you weigh?
Eating disorders often start out with a simple intention to lose weight, become more "fit", or develop "healthier" eating habits. What begins as minor lifestyle changes then progressively spirals out of control.
What used to be an intention to "just cut down on carbs" can suddenly shift to eating no carbs and then to potentially very little to no food. Evening snacking can become a frightening experience of tempting an out-of-control binge-eating episode. Activity choices can become dictated by access to private bathrooms so that intentional vomiting can take place.
Body image, once a single factor among many in determining self worth, can become the only way to judge a person as good or bad. Food and body go from a part of a varied life, to all that life is about. Relationships between loved ones are eroded and hobbies or other activities of interest fade away. Life loses its meaning, and life's purpose becomes focused on adjusting appearances, controlling food, and numbing out.
This is what eating disorders do to real people every day.
Located below are some other signs and symptoms of an eating disorder:
- Under-eating for bodily needs
- Excessive exercise or movement
- Intentional episodes of vomiting
- Eating large amounts of food in short periods of time
- Unnecessary use of laxatives
- Anxious or depressed moods
- Inability to perceive body size properly
- Obsessive thoughts about food or body
- Equating weight to self-worth
- Compulsive discussions around body
- Rigid rules around eating
- Guilt after eating
- Changes in weight, up or down
- Feeling lightheaded or dizzy
- Bodily weakness
- Stomach/GI discomfort or upset
- Sensitivity to hot or cold
- Dental problems
- Irregular heart beat
- Too much or too little sleep
- Abnormal medical test results
- Dry skin and brittle nails
- Hair falling out
- Withdrawal from typical activities
- Avoidance of interactions that involve food
- Increased interpersonal conflict
- Eating in isolation
- Changes in academic/work performance
- Seeking excessive reassurance from others
- Ignoring/dismissing health concerns
- Disappearing after meals or snacks
- Wearing temperature inappropriate clothing
How Treatment Works
Many people with eating disorders start out completely unsure if they even want help. The people who come to my office are often pressured in to therapy by loved ones, rather than coming in because they themselves want help. The prospect of getting better sounds simultaneously fantastic and frightening. When starting therapy, I always take in to account that you may have not made your mind up about recovering - and I am OK with that!
Half or more of the therapeutic process is about YOU deciding how far you want to go. Many people need time to think through their options, take small steps, and reassess their commitment throughout their experience. Below, you will find some brief descriptions of the approaches that I use in therapy so you can get a sense of what working with me would look like.
The 8 Keys To Recovery From an Eating Disorder
My approach to therapy is outlined in the book “8 Keys To Recovery From an Eating Disorder” by Carolyn Costin and Gwen Schubert Grabb. Both Carolyn and Gwen are fully trained therapists who completely recovered (i.e. they no longer have disordered thoughts, urges, or behaviors) from their own eating disorders and then went on to help others who suffer.
Their treatment philosophy focuses therapy on the battle between the conflicting voices in the minds of people with eating disorders: the Eating Disorder Self and Healthy Self. By helping individuals find and strengthen their healthy voices, the supportive parts of eating disorder symptoms are understood, and then if the person chooses, replaced with other ways of coping with their problems.
My job is to help you develop your own interest in recovering, and then help you to strengthen your Healthy Self so that it can do for you whatever your Eating Disorder Self does.
Cognitive Behavioral Therapy (CBT)
CBT focuses on helping people change how they feel by challenging their thoughts and creating realistic plans to overcome ineffective behaviors. To adjust repetitive patterns of thinking, I provide exercises that bring out your underlying beliefs and then help you change them. On the behavioral side of things, we will look at how you spend time on a daily basis and begin tweaking small choices that introduce positive emotions into your life. From those successes, you can build new skills to tackle larger problems and take bigger and bigger steps towards your goals. CBT is well researched, and for many mental health problems, it is considered the "gold standard" of care.
Exposure Therapy (ET)
ET guides people through a process of desensitizing themselves to situations that would typically make them feel very uncomfortable. For someone with an eating disorder, this could mean overcoming certain "trigger" foods, dining situations, or discomfort that comes from their body image. ET can help you build confidence in your ability to tolerate difficult feelings and teach you how to make those difficult feelings smaller, smaller, and smaller. ET is especially known for being an excellent treatment for anxiety problems, which often happen alongside eating disorders.
Family and Supporter Therapy
With your permission, we can meet with the people who are most important to you: parents, spouses, partners, siblings, coaches, clergy - anyone that you feel would be helpful to talk to. I have found that involving loved ones can help someone boost their motivation for recovery by addressing important relationship dynamics, explaining the basics of how eating disorders work, or just communicating about what feels supportive. Having an informed community of helpers around you can make the difference when you feel like giving up.
What Healing Looks Like
Over time if you choose to stick with therapy and ride the ups-and-downs of being in recovery, you will find that your life gets better. You will choose to use your eating disorder behaviors less frequently, think about your body less often, and experience fewer urges to reengage in symptomatic behaviors.
How much you care about your appearance will shift from your #1 concern to something more like 'a human average' - you still care but its not an obsession. You'll also notice that you can solve problems real-life problems in ways that don't hurt you and make you feel worse. You will develop a sense of growing peace that may start out as tiny moments of relief, but as your recovery rolls forward, it begins to become your new normal.
The people I work with also talk about their eating disorder voice becoming quieter, and quieter, and quieter as it becomes less and less relied upon. As time continues to move forward and you keep strengthening your healthy voice, you'll find that you start thinking of your eating disorder as a 'thing you used to have', rather than something you currently struggle with.
If this goes on long enough, and someone really abstains from symptom behavior use while they keep working on their underlying emotional issues, they can reach a place where they feel "recovered".
What Does It Mean To Be "Recovered"?
Being recovered (sometimes also referred to as “having a full recovery”) is the complete end to eating disorder thoughts, urges, and behaviors. My therapeutic philosophy has a strong commitment to the idea that anyone can be 100% recovered from an eating disorder.
Regardless of how long you’ve been sick, how many previous treatments you’ve had, what other professionals told you, or how hopeless you may feel about yourself – you can be recovered too. Carolyn Costin's book "100 Questions & Answers About Eating Disorders" gives this definition of "recovered" on page 164:
Being recovered is when the person can accept his or her natural body size and shape and no longer has a self-destructive relationship with food or exercise. When you are recovered, food and weight take a proper perspective in your life, and what you weigh is not more important than who you are; in fact, actual numbers are of little or no importance at all. When recovered, you will not compromise your health or betray your soul to look a certain way, wear a certain size, or reach a certain number on the scale. When you are recovered, you do not use eating disorder behaviors to deal with, distract from, or cope with other problems.
(1) NEDA.org - What are Eating Disorders?
(2) Chesney, E., Goodwin, G. M., & Fazel, S. (2014). Risks of all-cause and suicide mortality in mental disorders: a meta-review. World Psychiatry, 13(2), 153-160