Eating disorders can affect all of us. Eating beyond feeling satisfied, getting rid of your food, not letting yourself eat when hungry, exercising excessively and yoyo dieting are all symptoms of an eating disorder.
Eating disorder therapists like me recognize that these tendencies represent a dysfunctional relationship with food and body. Instead of food serving as nourishment and a pleasurable part of life, it can become an obsessive, negative force and constant drain.
As an eating disorder therapist, I’ve spent the bulk of my career helping people heal their relationship with food and their bodies.
The Hidden Power of Food
Food is an essential part of life. We shop for it, prepare it, clean up after it, take pictures of it and reward ourselves with it. Food is a centerpiece of celebrations. We have favorite dishes and embrace comfort foods. In fact, if you think about it, you might NOT be surprised at the powerful role food plays in our lives.
Everyone has family memories of food. In my family, we all try to replicate my Grandma’s potato salad and her award-winning “Minton bars” that were served at all of our special occasions. Since food serves as nourishment both physically and emotionally it’s no wonder that we are vulnerable to taking out our feelings on our food.
Eating disorders can affect anyone.
Many people think eating disorders mainly concern young women, but that’s a myth. Eating disorders do frequently develop in teen and college years, but my patients range in age from 12 to 60 both male and female. All genders, ages, ethnicities, body shapes, sexual orientations, and incomes are affected by eating disorders.
People also develop eating disorders or have reoccurrences of an earlier disorder later in life. Divorce, loss of a loved one, difficult transitions in life and traumatic events can lead to using eating disorder symptoms to cope during a difficult time.
Binge eating disorder is the most common eating disorder. Unfortunately, people who struggle with compulsive eating often don’t see themselves as having an eating disorder. They often turn to Weight Watchers, medical fasts, cleanses or other weight loss programs that tend to mess up one’s relationship with food and body even more. Chronic dieters often feel so much shame, believing they need more self-control or willpower. In reality, when someone “fails” at dieting, it’s a surge of self-esteem. It’s knowing on some level that you deserve to be treated better than your diet is treating you.
The Cause of Eating Disorders
Eating disorders like bulimia, anorexia, and binge eating disorder as well as behaviors such as excessive dieting and over-exercising involve complicated medical issues with serious health consequences. In fact, anorexia has the highest mortality rate of any mental health diagnosis.
An eating disorder is not a choice one makes. They are serious biologically influenced illnesses and their causes continue to be researched and understood (New Insights on Eating Disorders.)There is evidence that an eating disorder can develop purely in the brain and is not rooted in emotions or issues in the environment. The resulting eating disorder behaviors result in malnutrition and the treatment is to nourish the brain with food as medicine. It’s difficult to know whether brain differences cause the eating disorder or are the result of the eating disorder.
Controlling food and body can also be a way for people to feel a sense of control during overwhelming times. Life tends to have its share of traumas: “little t” traumas that are more common but still unsettling and upsetting and “Big T” traumas that are more serious and life-threatening. When malnourished, we tend to feel our feelings less and feeling less emotion can be desirable during hard times.
The familiar story can seem innocent enough. You may want to drop a few pounds or start eating clean. For many people, it stops there. For others, these common pursuits take on a life of their own and can become a force to be reckoned with. Before you know it, you’re obsessing about food, calories, the scale, and all sorts of numbers and mathematical equations. You begin to see food as either good or bad, saying, “I can’t have that.” This creates a state of deprivation and disconnects you from your body’s natural instincts that tell us when we are hungry, what we are hungry for and when we are satisfied.
Hopefully, all of this is starting to make sense. I do know that it has been my life’s work to help people therapeutically so that people can experience the emotional healing that’s so important for growth and a full recovery.
According to the National Eating Disorders Association (NEDA), “The most effective and long-lasting treatment for an eating disorder is some form of psychotherapy or counseling, coupled with careful attention to medical and nutritional needs. Some medications have been shown to be helpful. Ideally, whatever treatment is offered should be tailored to the individual; this will vary according to both the severity of the disorder and the patient’s individual problems, needs and strengths.”
In our therapy together, I will help you tune into your body and your instincts as you once did. Your body holds the answers as to how to eat and move. At the same time, I’ll help you discover what personal and emotional issues play a role in your eating disorder and are in need of some attention.
Body Image and the Diet Mentality
Attempting to lose weight ultimately fails people and perpetuates weight stigma: judgment and shame placed on people because of their body size or weight. Furthermore, the disordered eating and weight cycling inherent in the diet mentality are undeniably bad for our health. I truly believe that just like height, eye color, and hair texture, our bodies have a natural size that they are meant to be that varies widely and is unique to each of us. I promote health without focusing on weight loss and help people with their personal wellness goals, whatever that may mean to them.
How Do I Help My Loved One with An Eating Disorder?
You may be the spouse, friend or parent of someone struggling with an eating disorder. It’s natural to be confused about how to help them. In fact, in my years of practice, I’ve learned that parents and other loved ones need a lot of support and guidance too.
You might wonder whether your family member should see a therapist or a nutritionist to help recover. If the disorder is severe, you may wonder if your loved one needs to go into an eating disorder treatment center or if weekly therapy is sufficient. These are all valid questions.
The truth is, many clients with significant eating disorder issues do benefit from additional care. I can meet with you and make recommendations for next steps. I have a deep network of eating disorder specialists in the Philadelphia area, and I can recommend physicians, dieticians, treatment centers and other professional care if needed.
What Can I Expect from the First Session?
Our first session is a time to get to know each other. I want to learn about when the eating disorder first became an issue. It may stem from something years earlier. We’ll talk about early food memories, how you currently eat, how you feel about it and how you are trying to manage it now. I’m also interested in how the people around you try to help (whether it is helpful or not). You can ask me any questions that you may have.
The goal is to help you reconnect with your body cues and instincts so that you eat when you’re hungry and stop when you feel satisfied. At the end of the session, I’ll make a recommendation about how to move forward, check in about whether you would like to return and make a plan with you.
Will I Need Medication?
Some people have concerns about using medication. They often worry about side effects. If someone is dealing with intense symptoms, medication can be a tool to help them through a period of time. The benefits can outweigh the side effects.
Medications can be used to help manage anxiety, obsessive thinking or depression and can be useful tools in your recovery. Ultimately, it’s a decision my clients make for themselves and I support them in finding what’s best.
As an eating disorder therapist, if I think medication could be useful, I recommend seeing a psychiatrist for an evaluation. (Psychiatrists and psychologists have different training. As a psychologist, I don’t prescribe medications.) Your general practitioner may also be willing to prescribe something if it’s an uncomplicated case. It’s good to know your options.
Eating Disorder Signs Include the Following
People generally won’t have all or even most of these signs and symptoms. Warning signs differ for the various eating disorders.
- In general, behaviors and attitudes indicate that weight loss, dieting, and control of food are becoming primary concerns
- Dramatic weight loss
- Dresses in layers to hide weight loss or stay warm
- Is preoccupied with weight, food, calories, carbohydrates, fat grams, and dieting
- Refuses to eat certain foods, progressing to restrictions against whole categories of food (e.g., no carbohydrates, etc.)
- Makes frequent comments about feeling “fat” or overweight despite weight loss
- Complains of constipation, abdominal pain, cold intolerance, lethargy, and/or excess energy
- Denies feeling hungry
- Evidence of binge eating, including disappearance of large amounts of food in short periods of time or lots of empty wrappers and containers indicating consumption of large amounts of food
- Evidence of purging behaviors, including frequent trips to the bathroom after meals, signs and/or smells of vomiting, presence of wrappers or packages of laxatives or diuretics
- Appears uncomfortable eating around others
- Develops food rituals (e.g. eats only a particular food or food group [e.g. condiments], excessive chewing, doesn’t allow foods to touch)
- Skips meals or takes small portions of food at regular meals
- Disappears after eating, often to the bathroom
- Any new practice with food or fad diets, including cutting out entire food groups (no sugar, no carbs, no dairy, vegetarianism/veganism)
- Fear of eating in public or with others
- Steals or hoards food in strange places
- Drinks excessive amounts of water or non-caloric beverages
- Uses excessive amounts of mouthwash, mints, and gum
- Hides body with baggy clothes
- Maintains excessive, rigid exercise regimen — despite weather, fatigue, illness, or injury — due to the need to “burn off ” calories
- Shows unusual swelling of the cheeks or jaw area
- Has calluses on the back of the hands and knuckles from self- induced vomiting
- Teeth are discolored, stained
- Creates lifestyle schedules or rituals to make time for binge-and-purge sessions
- Withdraws from usual friends and activities
- Looks bloated from fluid retention
- Frequently diets
- Shows extreme concern with body weight and shape
- Frequent checking in the mirror for perceived flaws in appearance
- Has secret recurring episodes of binge eating (eating in a discrete period of time an amount of food that is much larger than most individuals would eat under similar circumstances); feels lack of control over ability to stop eating
- Purges after a binge (e.g. self-induced vomiting, abuse of laxatives, diet pills and/or diuretics, excessive exercise, fasting)
- Body weight is typically within the normal weight range; may be overweight
- Extreme mood swings
- Noticeable fluctuations in weight, both up and down
- Stomach cramps, other non-specific gastrointestinal complaints (constipation, acid reflux, etc.)
- Menstrual irregularities — missing periods or only having a period while on hormonal contraceptives (this is not considered a “true” period)
- Difficulties concentrating
- Abnormal laboratory findings (anemia, low thyroid and hormone levels, low potassium, low white and red blood cell counts)
- Dizziness, especially upon standing
- Feeling cold all the time
- Sleep problems
- Cuts and calluses across the top of finger joints (a result of inducing vomiting)
- Dental problems, such as enamel erosion, cavities, and tooth sensitivity
- Dry skin
- Dry and brittle nails
- Swelling around area of salivary glands
- Fine hair on body (lanugo)
- Thinning of hair on head, dry and brittle hair
- Cavities, or discoloration of teeth, from vomiting
- Muscle weakness
- Yellow skin (in context of eating large amounts of carrots)
- Cold, mottled hands and feet or swelling of feet
- Poor wound healing
- Impaired immune functioning
What Type of Recovery Period Can I Expect?
Every client is so different. The recovery period is hard to estimate. During our first meeting, I’ll get a feel for your prognosis based on how entrenched the eating disorder is and how motivated you are to receive help and change.
If the eating disorder is relatively new, it can be a briefer period to help someone get on the road to recovery. If it’s been an ongoing issue, it can take longer. The recovery period can be as little as 6 months while others have a much longer relationship with me.
You probably want to know how often someone might come to therapy. One session a week is typical. Some clients come twice a week when they can use extra support. As things improve, we’ll decide together when to reduce sessions.
Can We Discuss Other Things Besides My Eating Disorder?
Yes, in fact, we must!
Sometimes people will ask if it’s ok to discuss issues affecting them that seem unrelated to their eating disorder. The answer is always, “yes.” Everything is connected. In therapy, it’s appropriate to discuss whatever is on your mind. It’s all relevant. I’m not just your eating disorder therapist, I’m your therapist.
When my clients find it helpful, we invite spouses, parents and friends to sessions to help them learn how to support them in recovery. I encourage including others in your treatment. Having good support in recovery is essential.
My best advice is to not underestimate the seriousness of eating disorders. I’ve witnessed a great deal of loss and destruction due to the force eating disorders have. Get help soon and get good help. As an eating disorder therapist in the Doylestown area, I’ve worked with mental health and medical facilities throughout the Philadelphia Metro area and beyond. I can make recommendations and help create a plan for recovery and change.