Overcoming Disordered Eating

The very real consequences of eating disorders– especially if left untreated — wreak havoc with body, mind, and spirit.

Messages involving false promises bombard us. The essence of the messages is that dieting and exercise will let you live longer and be happier. For people with an eating disorder, the message is reconfigured and taken to an extreme.

Diet Culture shortens lives and definitely detracts from its quality. Ironic.

In some cases, eating disorders are life-threatening.

Oh, and contrary to popular belief, eating disorders aren’t a phase, “white girl thing”, plea for attention, or about vanity. It bears repeating: They are illnesses with potentially serious consequences.

The media tends to glamorize eating disorders, featuring skinny white teens with anorexia as if they’re “poster people” for all eating disorders.

Anorexia — and any eating disorder — can happen to anyone. As in childhood, adolescence, or adulthood. And, all genders and demographics are susceptible.

Eating disorders commonly present during adolescence. But, they can also emerge in childhood or adulthood. Certain risk factors in genetics, biology, psychology, and culture play a role in ‘the perfect storm’.

Ironically, anorexia, the eating disorder most often featured and glamorized, is the least common among eating disorders.

Bulimia nervosa, Binge Eating Disorder, and Otherwise Specified Feeding and Eating Disorders (OSFED) are each far more common than anorexia.

All eating disorders are serious conditions that are unlikely to go away without proper treatment.

You might think that alerting people to the harmful consequences of eating disorders would motivate them to recover. It doesn’t. In fact, it can cause an eating disorder to become more entrenched.

Consider yourself forewarned: Educating a person with an eating disorder about possible consequences is unlikely to affect their behavior or thinking. Even though the consequences are real and the person suffering is knowledgable.

The other thing to keep in mind is that school-based education and prevention programs on eating disorders can backfire if not administered properly. Some research shows that attempts at prevention may be associated with increased rates of eating disorders.

There’s a general tendency, among teenagers especially, to think serious consequences only happen to other people, not to them.

They do not realize that some consequences of eating disorders are irreversible. (And fatal.)

Ahhh, the illusion of invincibility.

The personal fable, especially common for teenagers, is that nothing bad could, would, or will happen to them. Worrisome consequences only happen to others people.

And, the power of denial is another defense against acknowledging just how serious eating disorder symptoms are.

Denial is especially prominent in the case of anorexia nervosa. Denial of the symptoms, of having a disorder, and denial of just about anything related to anorexia.

Examples of denial take the form of: “I am just eating healthy.” Or “I don’t need to eat as much as other people do.” “I am not skinny/sick/(whatever) enough to need treatment.”

Eating disorders often start “innocently”.

I’ve yet to meet anyone with an eating disorder who set out to develop one. I’ve also not known anyone who has wholeheartedly agreed to treatment, at least initially.

Here’s a common scenerio as a parent:

Your teenager becomes a vegetarian. You think nothing of it.

After a few weeks she declares she’s vegan and gradually eats less variety. And becomes unusally interested in collecting recipes, watching Youtube cooking clips, and being by herself.

At her annual physical, her weight is lower than last year’s, although she is slightly taller. She dismisses your and the doctor’s concern by saying something about how much “healthier” she is eating now. She is convinced you are “overreacting and need to chill.”

The doctor may or may not be educated in the field of eating disorders. Don’t assume he or she is.

The response of an eating-disorder-savvy doctor will include recommendations for follow-up labs, vitals, and weight checks. As well as a referral to a Registered Dietician and to a psychotherapist – both of whom have a specialty in treating eating disorders.

A doctor who is not trained in eating disorder treatment is much more likely to mistake a patient’s denial as fact. The doctor may even compliment the patient on his weight loss “success”. (Cringeworthy!)

People of all ages with eating disorders often recall being told earlier in their life by their doctors that they need “to watch their weight”, “be healthier”, or “go on a diet”. Ouch.

Consequences of eating disorders can be divided into different groups, such as medical, psychological, and social.

Some consequences of eating disorders are short term, and some are long term. Some are reversible, and others are not. How dire the consequences are varies for each person.

The four main categories of eating disorders include anorexia nervosa, bulimia nervosa, binge eating disorder, and OSFED. The ways they’re different is less important than recognizing they all share harmful consequences.

In the case of all eating disorders, distorted thinking and behaviors overtake every minute of daily life and hold the sufferer hostage. Life becomes exhausting in mind, body, and spirit.

Even those who seem “ok” or appear to enjoy having an eating disorder are not living a life of rainbows and butterfies. Juggling their eating disorder and relationships, work, health, mood, and other aspects of life is eventually impossible.

The exhausting way of life with an eating disorder can quickly break down even the strongest people.

Having an eating disorder becomes all consuming. So much time and energy are spent micromanaging food and exercise. and evaluating worth based on food choices and the number on the scale (aka the gravitational pull between you and the center of the earth!).

Sufferers create rules for themselves. The self imposed rules are often but not always specific to eating, weight, and exercise. The rules inevitably erode relationships, school, career, and other aspects of people’s lives.

The lists of consequences below are true of eating disorders in general. They are not exhaustive or applicable to everyone.

1. Medical consequences of eating disorders

Physical health complications from eating disorders are common. They happen because of the particular combination of restricting food, bingeing on food, and/or purging (compulsively exercising, chewing/spitting, inducing purging).

Early physical side effects of eating disorder behavior can include:

• stomach cramps
• dizziness
• fainting spells
• muscle weakness
• sleep difficulties
• cardiac abnormalities
• tooth decay
• gum damage
• dehydration
• electrolyte imbalance

Eating disorders affect every system in the body:

• Nervous
• Respiratory
• Circulatory
• Digestive
• Musculoskeletal
• Integumentary
• Reproductive
• Endocrine
• Immune

Weight changes may or may not be noticeable at first. In some cases, weight changes may not even occur. But that doesn’t mean there’s no risk.

Over time, especially if left untreated, eating disorders damage organs, including the heart, kidneys, and liver. And the brain.

Just as each eating disorder involves slightly different behaviors, so does the impact. Despite differences, all eating disorder consequences are concerning and dangerous.

2. Psychological consequences of eating disorders

People with eating disorders have distorted thought patterns that keep negative thought loops in motion and self-esteem low. Already low self-esteem nosedives as harmful thoughts and behaviors play off each other.

A common consequence (and contributing factor for) of eating disorders is emotional dysregulation. People have difficulty controlling their emotions and behavior. They suffer from increased negative emotion-states, such as depression or anxiety. Hopelessness and a sense of worthlessness often occur and can lead to suicidality.

One of the functions of the eating disorder symptoms is to numb or distract from experiencing feelings head on. Without access to emotion, you become more of a robot than human.

3. Social consequences of eating disorders

Relationships suffer in the lives of people with eating disorders. Suffering occurs for people with eating disorders and their loved ones, friends, family, and even acquaintences. No one in their world is exempt from being negatively impacted.

The physical and mental health consequences cause huge worry and stress for loved ones.

Eating disorders are physical, psychological, and social disorders, and so are their consequences. The physical consequences occur alongside distorted thoughts and unhealhty behaviors. They make life difficult, whether due to extreme fatigue, dizziness, or secrecy. Socially, eating disorders negatively affect relationships of all types. And the relationship with yourself most of all.

Although eating disorder symptoms and consequences are serious, healing from one is fully possible and oh so glorious! Some of the consequences are reversible if treated in a timely manner.

The sooner, the better.

Dr. Elayne Daniels is a licensed psychologist in MA, specializing in eating disorders, body image, and Highly Sensitive People. Her passion is helping people of all ages recover and live life with ease and joy. You can contact her here.

Eating disorders are insidious. They hide behind social media, dating, fitness-conscious workouts, and bathroom doors. By the time parents catch on, the challenge of catching up can be overwhelming…and consequential. It’s therefore important – imperative, really – that all parents become educated about the early signs of an eating disorder. 

Indicators of eating disorders are often much easier to recognize in retrospect than in the present. Parents commonly look back and say things like, “if only I had realized ‘x’ when I first noticed ‘yz.’”

There are definitely more helpful and productive ways to channel your energy than lamenting all the “if onlys.” If you knew then what you know (or will know) now, you would have proceeded differently. 

Give yourself some grace. 

But educate – and continue educating – yourself and others in your sphere of influence. Grace and education today may very well save a life tomorrow.

One common challenge that parents lament is distinguishing between “normal teenage behavior” and eating disorder symptoms. Signs of an eating disorder in one child (e.g. weight loss) may not be the same in another child (e.g. weight loss due to undiagnosed Crohn’s Disease).

Another common challenge occurs when parents wonder why their child is showing signs of an eating disorder. Almost by default, they blame themselves. 

The real issue often boils down to guilt. “What did I do or not do to cause this?” 

Please hear me loud and clear: Your child’s eating disorder is not your fault. Eating disorders are caused by a combination of factors – biological, cultural, emotional, and social. And then the perfect storm results. You cannot single-handedly cause your child to develop an eating disorder.

To better understand your child’s path to an eating disorder, put yourself in her or his shoes.

The scenario might go something like this:

You’re 14. You’re convinced that the only way to build your self-worth is to lose weight. So much happening around you is beyond your control. Your perfectionism has earned you a lot of praise, but it feels as if it’s never enough. You still feel crappy about yourself. 

Social media feeds tell you that the way to love your body and self is simple: Just lose weight, “be hot,” and you will get more “likes.” be more confident, and become really worthy of love. #guaranteed. 

It’s all about how you look and the number of likes you get. 

So you cut back on the amount you eat. You skip snacks and eat less at meals. You work out more. 

People tell you how awesome you look. Changes in your appearance make you feel like the work is worth all the effort. (Having trouble concentrating and feeling lightheaded when you stand up are secondary to the perks.)

You decide that each day you have to eat less than you did the day before. It’s all you can think of. The rule is non-negotiable.

You’re convinced that if you just lose “x” more pounds, then you will be happy. But you are never too thin to feel fat. And fat, you believe, you are.

Eventually the biological drive for fuel prevails. You eat something from your forbidden foods list. Or you eat more than the rule you made allows.

You decide to make up for what you have eaten by not eating for the rest of the day or by exercising even more. 

Maybe you even induce purging. 

You compulsively body-check. And jump on the scale a few times a day “just to see” your weight, making sure you have peed before you do. 

You suck in, pinch, and measure, always praying that you’re taking up less real estate today than you did yesterday.

Whatever the scale says determines how the rest of your day goes and how you feel about yourself.

The “restraint” is temporary. Eventually you eat. And then feel guilty. And then do it all again.

You’re now a hostage to eating disorder symptoms. You want – and simultaneously don’t want – to “be normal.” 

You want someone to intervene, but you don’t want someone to call you out. 

So, parents, what to do?

Step 1: Identify the Problem

There are early signs of an eating disorder that your child may be presenting. 

You may be aware that something doesn’t feel quite right about your child’s behavior, but you’re reluctant to make “too big a deal” out of your concerns. After all, maybe your tween/teen is “just acting like a teenager.” 

Or perhaps you think, “I don’t want to upset him by asking what he ate for lunch. He gets so defensive.”

Some signs of an eating disorder occur before the more obvious eating disorder symptoms. Others occur during the eating disorder. Still others intensify along with the eating disorder.

That’s a lot to tune into, let alone know how to respond to.

Below are what I call “The Big 5” – 5 classic, red-flag early warning signs of an eating disorder. 

After these 5 major signs, I will list categories and detailed examples of how they present. But these are the biggies that you, as parents, should always be on alert for.

1. Weight Changes

It’s normal and a sign of good health for human beings to gain weight into their 20’s.

If your child doesn’t gain weight – especially during early adolescence – s/he may be in the early stages of an eating disorder. 

Any weight loss, even unintentional, can trigger an eating disorder in at-risk children.

How your child responds to your or the doctor’s recommendation for weight gain may provide another sign of an eating disorder.

2. Anxiety/Depression

An increase in anxiety is common when developing and/or in the midst of an eating disorder. Anxiety can occur following weight loss or before any noticeable change in weight. 

Depression, too, can be a precursor and/or outcome of an eating disorder.

3. Unusual Food Behaviors 

People with eating disorders sometimes develop unusual behaviors around food. A few of the most common include: cutting food into tiny pieces, using a lot of hot sauce, and suddenly eliminating food for no valid reason. 

It’s common for an interest in veganism to mark the start of an eating disorder.

A sudden interest in cooking (but not eating) is another example of an eating disorder-related food behavior. It’s common for people who are inadequately nourished to develop an interest in all things food – including shopping, preparing, and cooking.

4. Obsessive Behaviors 

Eating disorders often take the form of a compulsion. If your child builds her day around exercise, she may have an exercise compulsion. This can be especially tough to determine if she is on an athletic team at school. 

One revealing clue is her anxiety level. Does she freak out if something keeps her from her exercise routine? Does she exercise when injured, sick, or encouraged not to? 

OCD is known to overlap with certain eating disorders. 

5. Changes in Activity and Interests

Eating disorders are often secretive and isolating. People with eating disorder symptoms have little interest in the activities they used to enjoy. They may isolate themselves from peers and family, showing a preference instead for staying in their rooms, alone.

If these 5 major early warning signs sound too broad for you to confidently put your finger on, let’s dive into specific examples that might be easier to catch.

Below are detailed, categorized lists of early warning signs of an eating disorder. Note that you may not be privy to many of these signs, as not all are behavioral, and those that are may present only in secrecy. 

Note also that many of these examples may fit under more than one of the Big 5. Compulsive behavior, for example, can show up in eating behavior, exercise, academics, and intrafamilial relationships.

By examining these signs in the context of unavoidable life components – eating, activity, health, thoughts, social life – you will have a heads-up on what to look for as your child goes through an “average” day.

Here are specific early warning signs, broken down into “lifestyle categories,” to be on alert for:

Food-related:

• dieting – can be disguised as “healthy eating,” “lifestyle changes,” veganism, or a specific diet, such as Paleo
• avoiding certain foods – foods often deemed ‘bad’ are sweets, snacks, and other foods that are “unhealthy”
• refusing to eat in front of other people
• sudden interest in “healthy,” “clean,” or “low-carb” diets
• rigidity about how much to eat, when to eat, and what to eat
• focusing on what other people eat, and deliberately eating less than everyone else
• insistence on knowing calorie content of the food before eating it
• sudden interest in cooking, watching food shows, reading recipes
• frequent baking and giving away the baked goods
• secretive eating
• having rules around time of eating (e.g. avoiding food until noon and after 7 pm)
• hostility if encouraged or “pressured” to eat something
• self-criticism for eating or not exercising
• fear of weight gain from a meal or type of food
• using the bathroom or showering right after meals
• cutting food into tiny pieces, mashing food, moving it around the plate to disguise the amount eaten. Maybe even hiding food in napkins or giving it to the dog on the downlow.

Activity-related:

• intense, compulsive exercise
• refusal to cut back on exercise, even if injured or sick
• insistence on using a fitness tracker, calorie tracker, and/or other similar device/app
• sneaking exercise during the day or even in the middle of the night
• downplaying the distance or duration of exercise
• preference to stand and not sit
• unusual routines, such as having to use the same plate
• frequent daily weigh-ins on a scale
• wearing oversized, baggy clothing

Medical-related:

• no longer growing as expected according to growth chart
• weight loss at any time as a child or teen
• dehydration
• injuries from overexercise
• sore throat if purging
• gastrointestinal problems, such as diarrhea, constipation, reflux
• feeling cold
• teeth damage
• exhaustion
• rapid, extreme, unexplained weight loss

Thinking-related:

• denial of seriousness of symptoms
• preoccupation with “flaws” of the body, body parts, or aspects of the body
• constant need for reassurance about appearance
• distorted beliefs about food, weight, exercise
• inability to recognize distorted thinking
• difficulty concentrating
• belief of not being sick enough

Social/emotional-related:

• disinterest in and withdrawal from friends, family, activities
• unable to describe feelings
• refusal to spend time with friends if eating is involved
• low self-esteem
• depression
• anxiety
• shame about eating
• feeling stressed
• fixation on weight, body size, and shape

Parents, here are some questions to ask yourselves:

Does your child/tween/teen:

• seem to be losing or have lost control over how she eats?
• make herself sick?
• believe she’s fat, even when others don’t? Or believe she needs to lose weight in order to be happy?
• seem to be controlled by negative food thoughts and low self-worth?
• appear preoccupied with changing his body or weight?
• make family meals difficult because of behavior or comments about food, eating, or body image?
• isolate from family and friends?
• have unexplained weight changes?

Step 2: Then what?

Recognizing that in fact your child is developing/has developed an eating disorder is difficult to admit and accept. 

You are not alone. Support for you and your child is just a call or click away.

For starters, you may want to contact your child’s pediatrician. Schedule an appointment for your child to have lab work done and vitals and weight taken. Find out about local resources. 

Recommendations may include eating disorder treatment programs, eating disorder specialists (e.g. registered dietitian, psychologist), and/or family treatment.

Finding treatment and support can be daunting. Connecting to resources that offer support is often identified as one of the most helpful things a parent can do. 

Reaching out like that helps the parent, the suffering child, and the entire family.

Here are some helpful resources:

• National Eating Disorders Association – family resources
• An international support organization for parents and caregivers – F.E.A.S.T.
• Multi-service Eating Disorder Association – MEDA

Parents, your role in identifying early signs of an eating disorder is key. 

You also have a huge role to fulfill in recognizing when it’s time to seek help. 

Trust your gut. YOU are also central in your child’s recovery. 

Effective help is out there. The sooner treatment begins, the better the prospect of a successful recovery. 

Without proper diagnosis or treatment, prognosis nosedives. 

But, with proper treatment,  full recovery is absolutely possible.

Dr Elayne Daniels is a psychologist specializing in eating disorders, body image, and High Sensitivity. For more information, contact her here.

Relationships are mysterious things. Even the obvious ones that define our commitments and priorities can be enigmatic. But there are relationships we often don’t recognize as “relationships,” despite their behavioral influence in our lives. Money, work, food, to name a few – they are all reflective messages of often confined emotions. Binge eating, for example, is, on the surface, about a relationship with food. But it’s really a manifestation of a deeper relationship with oneself. Therefore, Binge Eating Disorder (BED) recovery goes beyond the food itself to the relationship with oneself that drives the binging.

Eating disorders are especially complex and sensitive, in part because everyone has to eat! Survival depends on having a “relationship” with food.

So, unlike addictions such as alcohol, drugs, and gambling, whose “recovery” demands complete sobriety, eating disorders aren’t so black-and-white. Food sobriety doesn’t foster survival.

Before we go into the details of Binge Eating Disorder, please know that help and successful management are within reach. 

BED recovery looks different for every person, depending on the factors fueling the disorder and the specific treatment approach taken.

The list of contributing factors includes variables like genetics, biochemistry, personality, and environment.

If you suffer from BED, you may know a truth that the oblivious onlooker doesn’t: Body size is not a determinant of BED. 

People of all sizes suffer from this disorder. And, sadly, they often suffer alone because physical appearance alone doesn’t give away their secret.

What is Binge Eating Disorder?

BED is the most common eating disorder in the United States.

• Approximately 12 million American men and women have BED.
• The disorder is defined as eating large amounts of food and feeling out of control, at least once a week for 3 months.
• Bingeing is associated with feelings of shame, embarrassment. depression, anxiety and isolation. Feeling uncomfortably full after a binge is common, as is eating when beyond fullness or not even hungry.
• BED is different from bulimia nervosa in one very distinguishing way: People with BED do not purge (i.e. rid themselves of the food).
• Binge Eating Disorder was only recently (2013) included as an official diagnosis. That’s why knowledge about it lags behind knowledge about anorexia nervosa and bulimia nervosa.

Binge Eating Disorder recovery can be delayed for many reasons, including:

• erroneous beliefs that BED is about willpower and white-knuckling and not truly an eating disorder
• weight stigma based beliefs that people with BED “should just eat less”
• assumptions that BED is the person’s own fault – “he just can’t get food under control”

A huge underlying cause of delays in recovery stems from Diet Culture.

What are Binge Eating Disorder recovery methods?

Psychotherapy, medications, nutrition therapy, and guided self-help interventions are common methods for BED recovery.

Recovery from BED has to extend beyond binge eating behavior and address underlying causes.  

BED is not just about food!

Understanding underlying causes of BED provides insight into what to address in recovery.  For lasting change, psychological, historical, genetic, and cultural factors are often included.

Recovery typically incorporates strategies to:

• identify and understand cravings
• recognize and manage binge triggers
• heal underlying issues
• learn to eat and exercise with mindfulness
• understand the role food has played in your life
• explore the why of bingeing
• heal relationship with your body
• consider role of cultural messages (Diet Culture) and those from family
• learn to meet needs beyond food
• “legalize” all food (Food is just food. It’s neither “good” nor “bad.”)
• disengage body weight and food choices from sense of worth as a human

Why do people binge?

Reasons people give for bingeing include: distraction, grief, loneliness, reward, escape, rebellion, avoidance, boredom, companionship….or “just because.”

People binge eat for lots of different reasons. More often than not, there is an underlying “diet” mindset – ie a plan to lose weight. 

Way more often than not, dieting/restriction inevitably lead to rebound-eating. The amount eaten violates the diet rules. Shame and hopelessness develop, and the cycle continues. 

And continues. And continues. 

Unless, of course, you seek treatment. (Left untreated, BED tends to persist.)

All this suffering because of Diet Culture and the stigma and shame associated with bingeing and weight gain.

Bingeing helps people manage tough times, even though it doesn’t solve underlying problems.

As people recover, they learn to have self-compassion. They learn to acknowledge and embrace the bingeing that has been part of their path. 

Diet Culture, being its tenacious self, makes the healing process more difficult than it would otherwise be. (Self-compassion, where are you?)

What is Diet Culture and why does it matter?

You don’t have to be on a diet to be caught up in the culture of dieting or to have a dieting mindset.

The diet industry (I’m talking to you, Noom and WW) spends lots of time and money trying to suppress evidence that diets don’t work.  

The science is crystal clear: Binge eating is primarily a symptom of attempts at food and weight control (i.e. dieting).

Diet Culture is so pervasive that it’s easy to continue to think like a dieter, even when trying to allow all foods or behaviors.

For Binge Eating Disorder recovery, thinking differently means unlearning Diet Culture.

Often people with BED try to control binges by restricting foods. But that just makes binges worse.

Binges are a natural response to dieting and feeling deprived around food in an attempt to lose or control weight. 

Recovery from Binge Eating Disorder means replacing the diet mentality with something different, such as an Intuitive Eating approach. 

After all, you can’t stop binges with the very behavior that causes them. Dieting, food restriction, and other attempts at food or weight control pull the trigger for bingeing. Dieting leads to loss of control.

In other words, binge eating is what happens when you deny—or threaten to deny—your natural, biological instincts around food.   

By understanding Diet Culture, you’ll better and more compassionately understand the bigger picture.

(Ideally, the dismantling of Diet Culture will happen on a systemic level. And slowly but surely that is happening. Shout out to change agents and policy makers!) 

What does “recovered” mean?

Binge Eating Disorder recovery goes way beyond the cliché of “making peace with food” or “eating when you’re hungry and stopping when you’re full.”

Recovered means being aware of and responding to your body’s natural needs for fuel and joy, which will vary every day.

“Recovered” may also mean becoming an anti-dieter advocate!

Here are some tips for Binge Eating Disorder recovery:

• Find your tribe. Consider a support group for people with BED, in person or online.
• Read about Binge Eating Disorder, including anything by Chevese Turner  or Amy Pershing.
• Learn about Health At Every Size (HAES).
• Consider a Higher Level of Care for treatment.

No one chooses to have Binge Eating Disorder. Recovery can be challenging, even when you really want to recover, especially living in Diet Culture. (Recovery would be simpler if you could move to a less weight-centric place, such as a South Pacific island…say, Tonga?)

The takeaway: You don’t need to spend your life in a painful cycle of bingeing. Effective treatment is available.

Behaviors associated with bingeing are really more about coping than about food. Having a toolbox of effective techniques to cope with a complex array of emotions and feelings is essential. 

Be sure to keep your sparkly paint in your toolbox.

And give Diet Culture the middle finger.

Dr. Elayne Daniels is a psychologist specializing in eating disorders, body image, and High Sensitivity. She passionately believes your birthright is to enjoy comfort in your body at any size and a fantastic relationship with food. Contact her here for more information.

Common signs and symptoms of eating disorders can be tough to recognize. They’re sneaky, subtle, and often socially accepted. 

Distinguishing between what’s “normal” and what’s indicative or symptomatic of a disorder is difficult.

Thanks a lot, Diet Culture. (Trigger warning.)

Eating disorders involve so much more than food. They’re not about vanity or attention-seeking.

Eating disorders are treatable. But they are presentations of a serious mental health condition that requires expert medical and psychological care. 

Eating disorders are life-threatening.

Twenty-million American women and ten-million men suffer from eating disorders or have at some point in their lives. Whether or not you’re aware, you probably know people who have or have had an eating disorder.

People can and do recover, with treatment. Recovery is more likely the sooner an eating disorder is identified and treated.

That’s why it’s so important to know common signs and symptoms of eating disorders. This is life-saving knowledge.

People with eating disorders typically don’t volunteer the information.

They tend to deny their symptoms and often refuse treatment. Rarely do they seek help on their own.

Keep in mind that each person with an eating disorder will not exhibit all the signs and symptoms listed below. Signs and symptoms vary across types of eating disorders and across people.

What is generally true is that eating disorders affect all aspects of people’s lives, including emotions, behaviors, and physical well-being. People of all races, religions, sizes, shapes, genders, socio-economic status, and any other variable you can think of develop eating disorders.

What are emotional signs and symptoms of eating disorders?

• attitudes and comments that suggest weight, dieting, and control of food are the most important things in life
• sudden interest in weight loss, diets (e.g., keto), or specialized “lifestyle” (e.g. no carbohydrates)
• preoccupation with food, weight, dieting, carbs, calories, food labels
• mood swings
• irritability
• feeling guilty around food or about eating

Here is a hypothetical example for illustration:

Jess begins a diet because she “feels fat (even though “fat” is not a feeling).

First, she scours the internet for “best diets,” “clean eating,” and “how to go keto.. She follows Influencers on Insta and TikTok for tips. She has no interest in doing anything else, and her moods are up and down. For the first time ever, she refuses to eat her favorite birthday cake (red velvet) on her birthday. 

All she thinks about is food. Her goals in life revolve around weight loss. She feels happiest when the scale indicates weight loss. But the happiness is short- lived and quickly replaced by anxiety about how to keep losing weight. 

She feels “in control” and “out of control” at the same time.

What are behavioral signs and symptoms of eating disorders?

• excessive exercise, including exercising despite injury or illness
• dieting/starving
• binge eating
• self-induced vomiting
• laxative, diuretic, and/or diet pill abuse
• food-chewing and -spitting
• hiding food
• having an artificially low body weight
• impulsive or irregular eating habits
• refusal to eat certain foods or categories of food (e.g. no fats, no dairy, no sugar)
• food rituals (e.g. excessively cutting food, foods cannot touch)
• skipping meals or eating tiny portions
• suddenly becoming vegan
• withdrawal from friends, activities
• frequent mirror-checking
• using the scale multiple times each day and allowing the  number to determine the direction of the day.

Example:

After she weighs herself, Megan starts her day with a strict exercise routine. She has lots of rules she has made up that she has to follow in order to “earn” any food. Recently she declared she is vegan.

In response to dieting and excessive exercising, she binge eats 2x/week. The food she binges on is food she won’t otherwise allow herself to eat. 

Binge eating is secretive, rapid, and a source of shame. It is followed by a promise to herself that she will never do that again and will instead “try harder” to stick with fanatical exercise and extreme dieting. 

She constantly checks her stomach size in the mirror and by grabbing it to see how much flesh is there. Hanging out and chilling with friends no longer interests her. She doesn’t seem to care that so many people are concerned about her.

What are physical signs and symptoms of eating disorders?

• major/rapid weight fluctuations in either direction
• gastrointestinal complaints (e.g. constipation, acid reflux)
• menstrual irregularities (missing periods or having a period only on birth control, which isn’t a “true” period)
• difficulty concentrating
• abnormal laboratory results (anemia, low potassium, low white and red blood cell counts)
• dizziness, especially upon standing
• fainting
• 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, discoloration, and tooth sensitivity
• dry skin and hair and brittle nails
• swelling around salivary glands
• fine hair on body (lanugo)
• muscle weakness
• poor wound healing
• decreased immune functioning
• irregular ekg

Example:

At his recent physical, Sam’s doctor told Sam his pulse and body temperature are abnormally low. His PCP also told him he is “x” number of pounds lighter than he was a year ago. 

Sam reports sleeping poorly, despite feeling tired most of the time and dizzy when he goes from sitting to standing. He also complains of burning in his throat from acid reflux. 

The doctor’s visual impression of Sam is that he looks gaunt and has an empty look in his sunken eyes. She orders a blood draw and ekg.

The doctor is well aware that ‘even’ people with serious eating disorder symptoms often have normal labs. She also knows negative lab results don’t mean they “are “fine” or that their symptoms are benign.

There are several different types of eating disorders.

These include:

anorexia nervosa; bulimia nervosa, binge eating disorder, and other specified feeding or eating disorder (OSFED). Others include avoidant restrictive food intake disorder (ARFID), pica and rumination disorder.

You can’t tell from looking at someone if they have an eating disorder.

People showing signs and symptoms of eating disorders need professional help. 

There are many approaches to treatment. It’s definitely not a one-size-fits-all.

Because there’s no singular approach that is ideal for everyone, finding what’s best-suited for each person is the way to go.

It all starts with recognizing the signs and symptoms of eating disorders and not being afraid to acknowledge them. 

You just might save a life.

Dr Elayne Daniels is a private-practice psychologist specializing in treatment for people of all ages and genders who have eating disorder symptoms. Contact her here for more information.

Knowing how to help a friend with an eating disorder can be tricky. If you’re reading this article, you probably have a friend you suspect has an eating disorder. And you want to help but don’t know how to. You’re especially concerned that anything you say could make things worse.

Perhaps one reason you want to help is you know that eating disorders are serious. They are not a choice, nor are they about vanity or attention seeking. Eating disorders can be life threatening, especially when left untreated. Of course, you do not want your friend’s health or life in jeopardy.

What makes helping a friend with an eating disorder tricky?

• Your friend may not be ready to acknowledge the eating disorder. This happens a lot.

• Many disordered eating behaviors are so common that distinguishing them from less intense but still damaging effects of Diet Culture can be impossible. After all, dieting is praised and thinness is admired in our culture. Often at a high cost, physically and psychologically.

• Third, denial of an eating disorder is common among people with eating disorders, especially Anorexia nervosa and Bulimia nervosa. Often, the person herself does not necessarily recognize she has a problem. Or she does realize it, and wants it to remain a secret. Especially with bingeing and with purging behaviors, shame is inextricably intertwined.

1. The first step to help a friend with an eating disorder is to educate yourself.

A great place to start is with the National Eating Disorders Association, which also has a helpline and screening tool. Other excellent informational and educational sites available include the Academy for Eating Disorders, and MEDA.

A basic understanding of how an eating-disordered mind works is essential. Otherwise, there is a good chance any attempt to be helpful could make matters worse.  

2. Next, consider the approach to use to help a friend with an eating disorder.

How do you anticipate your friend responding to your effort to help? With anger? Relief? Embarrassment? Denial?

Regardless, try your hardest to remain calm and compassionate. Your friend, after all, is in a lot of pain.

When you do speak with your friend, state your concerns clearly and concisely. Do not go on and on or put your friend on the spot. You’re not the Eating Disorder Police.

Even though your intention is to help your friend, s/he may not be ready to address the problem. S/he could even resent your concern. Do not get into a fight over it.

How to help a friend with an eating disorder could go something like this:

“I notice how negatively you talk about your body lately and how little you eat and laugh when we go out. You don’t seem yourself. I’m here for you if you want to talk. Please let me know if I can help in any way.”

What not to say, although you may be tempted, are things like:

• “Just eat more!” That never works because eating disorders aren’t about food. They are about so much more. And as the friend, your role is not to “fix”. That is the job of the therapist and treatment team.
  
  
• “You look (or don’t look) healthy.” Or, “You don’t look like you have an eating disorder.” Steer clear of making any kind of appearance related comments. Also, for someone with an eating disorder, “healthy” is interpreted as “fat”, and fat is feared.
  
  
• “Your self control is amazing.” Your friend has an illness, which has nothing to do with self control. If anything, your friend is out of control; her entire life revolves around weight and food.

3. Keep in mind that your role is “friend”, not “therapist”.

Eating disorders can be resistant to treatment. Even in treatment, recovery can be something your friend feels ambivalent about. You may be tempted to ‘therapize’ your friend. Instead, focus on your friendship. Do low-key things together (e.g. painting, doing a puzzle) that may take her mind off eating disorder things.

Eating disorders are complex.

No two people have the exact same eating disorder, even though certain symptoms may overlap.

Knowing what to say to a friend who is suffering with an eating disorder can be really difficult.

Open-ended questions are helpful. You could ask, for example, how your friend feels about the eating disorder. Or ask how you can support your friend. Maybe even suggest an activity for the two of you to do together that does not involve food or weight. Or social media!

If you do not know quite what to say, that’s okay too. Sometimes, the best thing to do is to just listen.

Dr Elayne Daniels is a MA-based psychologist whose passion and specialty are treating eating disorders and body image issues. Another area of expertise is working with Highly Sensitive People. Contact her here for more information.

There is a lot to unpack on the topic of how to recognize if you might have an emotional eating disorder.

“If you’ve never eaten while crying you don’t know what life tastes like.” – Johann Wolfgang von Goethe

Here are three facts, for starters:

1. Food is comforting, and that is ok.

2. All humans have emotions, and that is normal.

3. You are in charge of your own body and its needs, and that is your birthright.

Food is not just a source of comfort. It also keeps us alive. Food is a source of much more than keeping our organs working. It’s also associated with memories, events, people, and feelings. Even with pleasure.

Feelings are part of being human. People are wired to have emotions. We are not robots.

Both food and emotions tend to get a bad rap when combined, which doesn’t make a lot of sense.

So, to address the question of if you have an emotional eating disorder, let’s talk about eating, emotions, and being human.

First, all eating disorders involve emotions.

Anxiety and/or depression is often part of the mix. Other emotions like shame, disappointment, and jealousy may also be present.

Whatever the feelings are, they’re what led to the eating disorder, and they’re what keep it going.

One of the ‘functions’ eating disorders serve is to provide something other than feelings to focus on.

Instead of feelings, the focus is on numbers – on the scale, on the package label, on the clothing tag.

Another function of eating disorders is to numb emotion. Feeling nothing can be easier than feeling your feelings.

Mental health disorders of any type, and eating disorders in particular, also involve emotions.

To say an eating disorder is “emotional” is redundant. We don’t say “emotional anxiety”or “emotional schizophrenia.” So why add the “emotional” tag to eating disorders?

“Emotional eating disorder” is an odd phrase. There’s no such distinction between an “emotional” eating disorder and an “un” or “non” emotional eating disorder.

Eating disorders are eating disorders, with a wide range of emotions involved.

Second, emotional eating is not in and of itself an eating disorder.

Emotional eating is typically defined as responding to stress by eating, even when you’re not hungry. 

Sometimes other feelings — sadness, loss, anger, even joy and excitement — elicit emotional eating. Who hasn’t at times eaten due to feelings and not physical hunger? Everyone I know has eaten for reasons other than physical hunger. That doesn’t mean they have a disorder.

The kind of food you crave when you’re emotionally eating are, more often than not, comfort-type foods. Cake, cookies, pasta, chips, and other foods you may not allow in your regular routine are often the foods people emotionally eat. 

Why do these foods have “craving” and “emotional eating” written on the label?

Two reasons….

When under stress, you may feel emotions that are uncomfortable.

It’s within our human nature to seek comfort when feeling discomfort. It’s a normal reaction.

When it comes to seeking comfort, you’re more likely to reach for food that is sweet and/or carby than for fruits or vegetables.

Maybe your go-to comfort food is mac-and-cheese. Or chocolate. Pretzels and chips perhaps? 

No big deal. It’s OK! There is nothing inherently bad about eating for comfort to offset uncomfortable emotions.

Comfort food is considered “bad” because of Diet Culture.

Foods people include and exclude in daily eating are based in Diet Culture’s rules. 

The rules go something like this: Eating sweets is bad, and you’re bad if you eat them. So don’t. Plus, you’ll get fat if you eat ‘bad’ foods. Being fat is bad.

More Diet Culture rules include: You are morally superior if you only eat “clean,” have a “healthy lifestyle,” and/or track everything you eat. 

Or maybe the Diet Culture rule of the day is to “go Keto”,” “plant based,” or “xyz.” 

All these rules are driven by the desire for an unrealistic, thin body ideal. 

The other driver of the rules is the tendency to equate body size with personal worth.

When you’re feeling an unpleasant emotion and live in Diet Culture, the natural inclination to reach for ‘forbidden’ food is intensified. You judge yourself. It becomes a rebellious act, and one for which you tell yourself you will repent for tomorrow…or Monday…or January 1…or whenever.

Another reason we’re more drawn to sweets and carbs under stress is our built-in wiring. High-energy food helps to sustain us. 

Our ancestors never knew when food would be available again, especially during times of stress. So they had to be extra sure they consumed as much fuel as possible. 

And stress back in the Stone Age was often more life threatening than stress in modern day. Eating was, and remains, essential for survival, especially in the event of a famine.

There are also hormones at play. Epinephrine and norepinephrine increase under stress. They then decrease happiness- and mood-balancing hormones, such as serotonin.

Food increases happiness hormones, so of course we gravitate to it for comfort! There is no place for blame or shame with this natural inclination.

Emotions and eating happen at the same time. One also happens before and during and after the other.

We all eat at times due to emotions. That isn’t a “bad” thing.

Cake and ice cream for birthdays are ways to celebrate, for example.

True, we sometimes “eat our feelings.” But that’s normal and not something to demonize.

In fact, eating due to emotions can be a way of taking care of yourself.

It’s one tool in your toolbox of many tools.

Eating a pint of ice cream for comfort, for instance, doesn’t mean you have an eating disorder. Maybe you’re feeling an emotion like sadness or excitement, and, if you were feeling something different, you would eat something different.

Eating due to emotions is not in and of itself “bad”.

Even Oscar Wilde wrote on this topic:

When I am in trouble, eating is the only thing that consoles me.

Indeed, when I am in really great trouble, as anyone who knows me intimately will tell you, I refuse everything except food and drink.

At the present moment I am eating muffins because I am unhappy. Besides, I am particularly fond of muffins.

Third, sometimes, when people talk about an emotional eating disorder, they’re talking about an eating disorder called Binge Eating Disorder.

Binge Eating Disorder is the diagnosis people are referring to when they say they have an “emotional eating disorder.” It’s often referred to as “compulsive eating” or “emotional eating.”

Binge Eating Disorder

It (BED) is the most common eating disorder and affects almost as many males as it does females. 

BED is the name for when people eat a large amount of food, feel out of control when doing so, eat beyond fullness, and feel ashamed or guilty afterward. They may eat secretly and beyond fullness. 

People of all different sizes and weights suffer from BED.

Usually when someone has Binge Eating Disorder, she knows. Each binge is typically followed by feeling guilty, disappointed, and maybe even angry or disgusted.

Unfortunately, the person typically then restricts eating, only to set herself up again to binge eat. The pattern repeats, and it can be a difficult cycle to break.

BED is highly treatable, especially when the provider’s specialty is eating disorder treatment. Full recovery from BED is more likely when working with a registered dietician and a licensed therapist. Success is even greater when the treaters are certified in Intuitive Eating and are Health at Every Size informed.

Take-aways:

You’re allowed to eat for nourishment of all types, even if you do not feel hunger pangs. (Plus, you may have missed hunger cues along the way, thanks to Diet Culture-informed attempts to mask hunger.) 

You’re allowed to eat what you want to eat, hungry or not.

If you find that emotional eating happens a lot and consistently makes you feel worse, it may be time to seek support from an anti-diet psychologist.

Emotional eating is not something to be ashamed of.

The reason we feel shame in the first place is that we give our credence to Diet Culture and its influence.

Emotional eating is not a disorder. Diet Culture is disordered, and that’s the problem.

Healthy eating exists in the context of emotions, not to their exclusion. 

Both are essential for survival. And both can sit at the same table.

I am a Massachusetts-based psychologist specializing in treating negative body image and eating disorders and in helping Highly Sensitive People thrive. To find out more, please contact me here.

“If you’ve never eaten while crying you don’t know what life tastes like.” – Johann Wolfgang von Goethe

There is a lot to unpack on the topic of how to recognize if you might have an emotional eating disorder.

Here are three facts, for starters:

1. Food is comforting, and that is ok.

2. All humans have emotions, and that is normal.

3. You are in charge of your own body and its needs, and that is your birthright.

Food is not just a source of comfort. It also keeps us alive. Food is a source of much more than keeping our organs working. It’s also associated with memories, events, people, and feelings. Even with pleasure.

Feelings are part of being human. People are wired to have emotions. We are not robots.

Both food and emotions tend to get a bad rap when combined, which doesn’t make a lot of sense.

So, to address the question of if you have an emotional eating disorder, let’s talk about eating and emotions, and about being human.

First, all eating disorders involve emotions.

Anxiety and/or depression are often part of the mix. Other emotions like shame, disappointment, and jealousy may also be present.

Whatever the feelings are, they’re what led to the eating disorder and what keep it going.

One of the ‘functions’ eating disorders serve is to provide something other than feelings to focus on.

Instead of feelings, the focus is on numbers – on the scale, on the package label, on the clothing tag.

Another function of eating disorders is to numb emotion. Feeling nothing can be easier than feeling your feelings.

Mental health disorders of any type, and eating disorders in particular, also involve emotions.

So to say an eating disorder is “emotional” is redundant. We don’t say “emotional anxiety”or “emotional schizophrenia”. Why add the tag ’emotional’ to eating disorders?

“Emotional eating disorder” is an odd phrase. There’s no such distinction between an “emotional” eating disorder and an “un” or “non” emotional eating disorder.

Eating disorders are eating disorders, with a wide range of emotions involved.

Second, emotional eating is not in and of itself an eating disorder.

Emotional eating is typically defined as responding to stress by eating, even when you’re not hungry. Sometimes other feelings elicit emotional eating. Examples of such feelings include sadness, loss, anger, among others.

Who hasn’t at times eaten due to feelings and not physical hunger? Everyone I know has eaten and often still does for reasons other than physical hunger. That does not mean they have a disorder.

The kind of food you crave when you’re emotionally eating are, more often than not, comfort type foods. Cake, cookies, pasta, chips, and other foods you may not allow in your regular routine are often the foods people emotionally eat. This is for two reasons:

When under stress, you may feel emotions that are uncomfortable.

Human nature is to seek comfort when feeling discomfort. It is a normal reaction.

You’re more likely to reach for food that is sweet and/or carby than fruits or vegetables when it comes to comfort.
Maybe your go to comfort food is mac and cheese. Or chocolate. Pretzels and chips perhaps? No big deal. It is ok! There is nothing inherently bad about eating for comfort to offset uncomfortable emotions.

Comfort food is considered “bad” because of Diet Culture.

Foods people include and exclude in daily eating are based in Diet Culture’s rules.

The rules go something like this: eating sweets is bad, and you’re bad if you eat them. So don’t. Plus, you’ll get fat if you eat ‘bad’ foods. Being fat is bad.

More Diet Culture rules include: You are morally superior if you only eat “clean”, have a “healthy lifestyle”, and/or track everything you eat. Or maybe the Diet Culture rule of the day is to “go Keto”, “plant based”, or by following the xyz diet. All of these rules are driven by the desire for an unrealistic, thin body ideal. The other driver of the rules is the tendency to equate body size with personal worth.

When you’re feeling an unpleasant emotion, and live in Diet Culture, the natural inclination to reach for ‘forbidden’ food is intensified. You judge yourself. It becomes a rebellious act, and one for which you tell yourself you will repent for tomorrow, or Monday, January 1, or whenever.

Another reason why we’re more drawn to sweets and carbs under stress is because of built in wiring. High energy food helps to sustain us. Our ancestors never knew when food would be available again, especially during times of stress. So they had to be extra sure they consumed as much fuel as possible. And stress back in the Stone Age was often more life threatening than stress in modern day. Eating was and remains essential for survival, especially in the event of a famine.

There are also hormones at play. Epinephrine and norepinephrine increase under stress. They then decrease happiness and mood balancing hormones, such as serotonin.

Food increases happiness hormones, so of course we may gravitate to food for comfort. There is no place for blame or shame with this natural inclination.

Emotions and eating happen at the same time. One also happens before and during and after the other.

We all eat at times due to emotions. That isn’t a “bad” thing.

Cake and ice cream for birthdays are ways to celebrate, for example.

True, we sometimes “eat our feelings”. But that’s normal and not something to demonize.

In fact, eating due to emotions can be a way of taking care of yourself.

It is one tool in your toolbox of many tools.

Eating a pint of ice cream for comfort, for instance, doesn’t mean you have an eating disorder. Maybe you’re feeling an emotion like sadness or excitement, and if you were feeling something different you would eat something different.

Eating due to emotions is not in and of itself “bad”.

Even Oscar Wilde wrote on this topic:

“When I am in trouble, eating is the only thing that consoles me.

Indeed, when I am in really great trouble, as anyone who knows me intimately will tell you, I refuse everything except food and drink.

At the present moment I am eating muffins because I am unhappy. Besides, I am particularly fond of muffins.” 

–Oscar Wilde

Third, some times when people talk about an emotional eating disorder, they are talking about an eating disorder called Binge Eating Disorder.

Binge Eating Disorder is the diagnosis people are referring to when they say they have an “emotional eating disorder”. Often times Binge Eating Disorder is referred to as “compulsive eating” or “emotional eating”.

Binge Eating Disorder

Binge Eating Disorder (BED) is the most common eating disorder and affects almost as many males as it does females. BED is the name for when people eat a large amount of food, feel out of control when doing so, eat beyond fullness, and feel ashamed or guilty afterward. They may eat secretively and beyond fullness. People of all different sizes and weights suffer from BED.

Most often when someone has Binge Eating Disorder, they know. They know they are bingeing. Each binge is typically followed by feeling guilty, disappointed, and maybe even angry or disgusted.

Unfortunately what typically happens is the person then restricts, only to set themselves up again to binge eat. The pattern repeats, and it can be a difficult cycle to break.

BED is highly treatable. Especially when the provider’s specialty is eating disorder treatment. Full recovery from BED is more likely when working with a Registered Dietician and a licensed therapist. Especially when the treaters are certified in Intuitive Eating and are Health at Every Size informed.

Take away’s:

You’re allowed to eat for nourishment of all types, even if you do not feel hunger pangs. (Plus, you may have missed hunger cues along the way, thanks to Diet Culture informed attempts to mask hunger.) You’re allowed to eat what you want to eat, hungry or not.

If you find that emotional eating happens a lot, and consistently makes you feel worse, it may be time to seek support from an anti-diet psychologist.

Emotional eating is not something to be ashamed of.

The reason we feel shame in the first place is because of Diet Culture’s influence.

Emotional eating is not a disorder. Diet Culture is disordered, and that is the problem.

Dr Elayne Daniels is a MA based psychologist specializing treating negative body image and, eating disorders. Working with Highly Sensitive People is another area of expertise. To find out more, please contact me here.

Looking into treatment options for eating disorders for yourself or someone you love can be overwhelming. Even knowing where to start is challenging. In fact, a recent Google search for “treatment options for eating disorders” yielded 11,800,000 results. You read that correctly – over 11 million results.

As hard as it has been for you to get to this point, there are a few things to know about eating disorders before you start looking into treatment options.

1. Eating disorder treatment should not be delayed.

If you have an eating disorder, chances are you’ve had it for a while. People with eating disorders have symptoms for an average of six years before seeking treatment. That’s six years for your mind and body to be at odds with one another.

2. A correct diagnosis is important for treatment.

A correct diagnosis sounds straightforward. It is not.

In fact, it’s common to downplay, overlook, or even dismiss eating disorder signs. (A huge reason eating disorder signs and symptoms are ignored is Diet Culture.)

Symptoms that are easily overlooked include negative self-talk, which by definition is private and not shared with others. That’s what makes identifying when thoughts, feelings, and behaviors are part of an eating disorder so difficult to recognize for what they are. The same kind of thinking is also a part of our weight-focused culture.

Society’s (diet culture’s) messages are super glue strong. And harmful. A person’s weight does not define worth. Even though diet culture insists it does.

You can see how easily the blurry line between ‘normal’ and ‘disordered’ delays diagnosis and treatment. It makes you believe that everything is fine, when in reality everything is not fine.

So how do you even know if you or someone you love may have an eating disorder?

A great place to start is to fill out an online screening questionnaire.

Eating disorder diagnoses: What are they?

Eating disorders are not about weight, vanity, or attention seeking. They’re a way of coping with emotions that would otherwise feel too overwhelming.

Anxiety and/or depression often exist before eating disorder symptoms begin and can delay getting an accurate etig disorder diagnosis.

The category of eating disorders includes:

• Anorexia nervosa (AN)
• Bulimia nervosa (BN)
• Binge Eating Disorder (BED)
• Avoidant Restrictive Food Intake Disorder (ARFID)
• Otherwise Specified Feeding and Eating Disorder (OSFED)

3. Have a treatment team

A typical eating disorder treatment team includes a therapist, dietician, and medical doctor.

All providers should have expertise in eating disorder treatment. Treating a person with an eating disorder is complicated.

Treatment with a therapist and dietician specializing in eating disorders makes treatment success much more likely.

Your treatment team helps with goals and guidelines and is there to support you every step of the way.

You may be familiar with referral websites such as Psychology Today. But did you know there are also places online to look for eating disorder experts, such as the National Eating Disorders Association?

The same applies to finding a registered dietician with an eating disorder specialty. Nutrition therapy for eating disorders is different from general nutrition therapy.

A family therapist may be recommended as well if the patient is living at home and/or is a minor.

Family-based treatment, also known as the Maudsley Model, may be helpful for families of teens with an eating disorder.

By the way

Many PCPs and pediatricians lack proper training in and knowledge of eating disorders. They too are a part of diet culture. Without even knowing it, they spread harmful myths and stereotypes about weight and well being. They mean no ill intent, certainly, However, you can not assume a medical provider is eating disorder savvy.

The person in need of treatment may downplay symptoms and/or refuse help. Partly because of the strong forces of diet culture. And, because an eating disorder always provides some benefit. Or it would not exist in the first place. Doing away with something that has brought relief is scary.

Denial and secrecy often go hand-in-hand with an eating disorder. Sufferers deny they have a problem and are secretive about their symptoms.

Matching treatment intensity to symptom intensity makes for a faster recovery. And, a greater chance of a successful outcome.

Higher levels of care

More intensive treatment is called a higher level of care (HLOC). There are 4 main forms.

Medical stabilization, including refeeding, requires an inpatient level of care. Length of stay is usually a few days to a couple of weeks.

Residential treatment is for people who would benefit from round the clock support and structure but are not medically compromised. Residential programs typically last for up to 3 or so months.

A third level of care is partial hospitalization. Structured group therapy for 6-8 hours/day occurs, and patients then go home to sleep. Meals are included as part of treatment.

The lowest level of care is intensive outpatient. These programs are held for three or so hours, three or so times per week. Length of stay is typically a couple of months. Usually patients have a meal and snack together.

Sometimes people start at the lowest level of care and then return to their outpatient team. Others may need higher levels of care. Sometimes treatment involves cycling through different levels of care. There is no standard sequence of treatment levels.

The recommended level of care is mostly based on severity of symptoms. Within each program, treatment is tailored to the person’s needs. There is no ‘one size fits all’.

Some higher levels of care include additional treatment programming. For example, there may be a trauma specialization track, a substance abuse track, or a specialized program for athletes. The tracks are for people who have an eating disorder along with concerns related to one of the areas of special focus.

It’s best if everyone involved in the treatment communicates with each other as a team. That way, adjustments can be made to treatment as needed. And to minimize the ‘he said she said’ that can happen when direct communication is missing.

4. Treatment planning

A comprehensive approach to treatment is ideal. Eating disorders are complex and require several specialists.

Make a plan for eating disorder treatment. This may include settings goals, providing some education, creating parameters for safety, and coming up with a crisis plan.

Treat physical complications. Health and medical issues need attention. That being said, often the sufferers’ lab results are normal. Normal lab results DO NOT mean everything is fine.

Identify resources. Find out what resources are available. Are there support groups, for example, either online or in person? How about specialized movement classes, such as yoga for eating disorders?

Make sure resources are eating disorder sensitive. For example, taking a rigorous yoga class is not a good idea. However, a gentle class taught by an instructor who’s eating disorder informed could be helpful.

Speak with your insurance company to discuss coverage for treatment, regardless of the level of care needed. The insurance company will pay more over time for someone with an untreated or partially treated eating disorder.

Medications don’t and can’t cure an eating disorder. They work best when combined with therapy.

The most common medications used to treat eating disorders are antidepressants. Especially the eating disorders that involve binge-eating or purging behaviors. Antidepressants may help reduce symptoms of depression or anxiety. These symptoms often co- occur with eating disorders.

Medications for physical health problems caused by the eating disorder may also be required. For example, co-occurring gastrointestinal symptoms (constipation, diarrhea, reflux) are commonly treated with medications.

Therapy is a must to successfully treat an eating disorder. The psychological aspects of an eating disorder can be as difficult or even harder than the physical recovery.

Cognitive behavioral therapy (CBT) is a common and effective treatment for eating disorders. CBT improves attitudes about body shape and weight, replaces dieting with Intuitive Eating, and helps develop coping skills.

5. Have hope

Treatment works! Healing happens!

Generally, treatment is more effective before the disorder becomes chronic. However, even people who have had an eating disorder for many years can and do recover.

Eating disorders rarely, if ever, just go away on their own.

It’s OK if you “slip-up” during treatment. It’s normal. With each relapse comes opportunity to fine tune treatment and re-commit to recovery.

The most important takeaway message: People recover. Fully.

Your loved one (including if it’s you) with an eating disorder can too. The key to healing is being in the right level of treatment as early as possible. And staying hopeful along the way.

I am Dr Elayne Daniels, a MA-based, anti-diet, certified Intuitive Eating psychologist. My passion is helping people conquer eating disorders, feel comfortable in their body, and live a life of meaning. Contact me here for more information.

No one thing causes eating disorders to develop. It’s more like a perfect storm of genetics, biology, psychology, culture, and environment. Lots of factors merge together at the same time.

Genetics is one of many factors in how eating disorders develop.

Genetics contribute for sure! In fact, they predispose individuals to eating disorders.

Eating disorders tend to run in families. And the rate of eating disorders is higher in identical twins than in fraternal twins or other siblings.

Biochemistry is a factor in how eating disorders develop.

Certain neurotransmitters, hormones, and other chemicals are out of range among people with eating disorders. The levels are either too high or too low. These chemicals in the body are what regulate appetite, stress, mood, and sleep.

Among cis-gender girls, early menarche (compared to peers) can be part of the perfect storm.

Psychology plays a role, too.

Psychological factors contribute to how eating disorders develop. People with an eating disorder often also struggle with depression and/or anxiety. Obsessive Compulsive Disorder is particularly common, occurring in 25-69% of women with anorexia. 

Other psychological factors include:

• Poor self esteem
• Feeling a sense of hopelessness
• Perfectionism

Certain personality temperaments put a person at higher risk for an eating disorder. Traits like reward-dependence, harm-avoidance, and sensation-seeking may be part of that perfect storm. Obsessive-compulsiveness too.

Culture is another contributor.

We live in Diet Culture. It’s so pervasive and sneaky. In fact, we often don’t even realize how very much we’re impacted by its toxicity. It’s omnipresent. Ubiquitous. The lens through which we see ourselves and the world.

Dieting, body dissatisfaction and a drive to be thin increase the risk for an eating disorder. Diet Culture encourages all three.

Diet Culture is sneakily disguised as ‘a healthy lifestyle,’ ‘clean eating,’ or a trendy way to eat (like Whole30, Keto, or Noom).

If it has rigid rules or involves math, it’s probably a diet.

Diet Culture contributes to how eating disorders develop in many ways:

• An over-emphasis on appearance, at the expense of valuing inner qualities like kindness.
• Societal standards that promote an unrealistically thin body shape.
• Associating thinness with positive qualities like attractiveness, health, success, and love.
• Media’s focus on dieting and striving for a slim and toned body for women.
• Messages that perpetuate a fear of fat and food; viewing fat as undesirable or foods as “good,” “bad,” or “sinful”.

Intuitive Eating is a better alternative on all fronts. Its first of ten guiding principles is to ‘reject Diet Culture’. Mind you, the principles are not mandates. They’re gentle steps, associated with improved physical and psychological well-being. And unlike anything in Diet Culture!

Environment is an important factor in how eating disorders develop.

Your environment also plays a role in how eating disorders develop.

For example, what was your home environment like? How did family members communicate feelings? Did family members diet? Were/are they weight conscious?

What kinds of extracurricular activities did you participate in? How about the kind of friend group you were part of?

Aspects of an environment that may be relevant to how eating disorders develop:

• Family conflict
• Physical or sexual abuse history
• Activities that focus on weight, such as gymnastics, dancing, running, wrestling 
• Peer pressure
• Being bullied because of weight or appearance in general

You have agency over some factors associated with how eating disorders develop, but not all.

In the same way that fish don’t know they’re wet, you may not realize the extent to which you’re immersed in Diet Culture.

However, you do have agency over many aspects of recovery.

With support, you can emerge. And you will. Stronger than ever. And as a true power source.

You will be the fish that went to school (pun intended), recognizes Diet Culture, and knows your way out of the storm.

I am Dr Elayne Daniels, a MA-based psychologist specializing in treating people with eating disorders and negative body image. Join me in ditching Diet Culture! Contact me here for more information.