ABOUT EATING DISORDERS THERAPY
People are not defined by labels. An “Eating Disorder” is a part of you that is telling the rest of you that something’s very wrong. I’ve worked for 30 years in this field, been to hell and back myself and I know there’s a great freedom to be had. You are not your weight; you are not what you ate or didn’t eat today. You are very well and able and filled with wondrous things. By working together, you will ultimately regain a trust in yourself that gives you the freedom to express exactly who you are without apology or fear.
EATING DISORDER THERAPIST SPECIALIZATIONS
- Binge eating
- Emotional eating
Anorexia nervosa is a type of eating disorder characterized by weight loss; difficulties maintaining an appropriate body weight for height, age, and stature; and, at times, distorted body image. The number of calories and the types of food eaten is usually restricted. Anorexia can affect people of all ages, genders, sexual orientations, races, and ethnicities. Although the disorder most frequently begins during adolescence, children and older adults are diagnosed with anorexia. Eating disorder symptoms are beginning earlier in both males and females. Not only underweight but also larger-bodied individuals can have anorexia, although cultural prejudices against fat and obesity have caused low numbers in diagnosis.
Atypical (not otherwise meeting a diagnosis) anorexia includes those individuals who meet the criteria for anorexia but who are not underweight despite significant weight loss. To be diagnosed, the following criteria must be met:
- Restriction of energy intake relative to requirements leading to a significantly low body weight in the context of age, sex, developmental trajectory, and physical health.
- Intense fear of gaining weight or becoming fat, even though underweight.
- Disturbance in the way in which one’s body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or denial of the seriousness of the current low body weight.
Some statistics include:
- Anorexia is the third most common chronic disease among young people, after asthma and diabetes (type 1).
- Young people between the ages of 15 and 24 with anorexia have 10 times the risk of dying compared to their same-aged peers.
- Males represent 25% of individuals with anorexia nervosa, and they are at a higher risk of dying, in part due to the fact that they are often diagnosed later since many people assume males don’t have eating disorders.
- Subclinical eating disordered behaviors (including binge eating, purging, laxative abuse, and fasting for weight loss) are nearly as common among males as they are among females.
Bulimia nervosa is a serious eating disorder characterized by a binge-and-purge cycle – frequent episodes of binge eating followed by efforts to avoid gaining weight, often by extreme means such as vomiting or exercising to excess. This can cause damage to your digestive system and create chemical imbalances in the body that harm the functioning of major organs, including the heart. It can even be fatal. While it is most common among young women, bulimia can affect women and men of all ages. When you’re struggling with the eating disorder, life is a constant battle between the desire to lose weight and the overwhelming compulsion to binge eat.
You don’t want to binge, as you know you’ll feel guilty and ashamed afterward, but time and again you give in. After the binge ends, panic sets in and you turn to drastic measures to “undo” your overeating, such as taking laxatives, vomiting, or going for an intense run. No matter how trapped in this vicious cycle you feel, though, there is hope. With treatment and support, you can break the cycle, learn to manage unpleasant emotions in a healthier way, and regain your sense of control.
- Frequent episodes of consuming a very large amount of food followed by behaviors to prevent weight gain, such as self-induced vomiting.
- A feeling of being out of control during the binge-eating episodes.
- Self-esteem overly related to body image.
Many people with bulimia also struggle with co-occurring conditions such as:
- Self-injury (cutting and other forms of self-harm without suicidal intention)
- Substance abuse
- Impulsivity (risky sexual behaviors, shoplifting, etc.)
Eating disorder symptoms are beginning earlier in both males and females and, at any given point in time, 1.0% of young women and 0.1% of young men will meet diagnostic criteria for bulimia nervosa. To be diagnosed, the criteria are:
- Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following:
- Eating, in a discrete period of time (e.g. within any 2-hour period), an amount of food that is definitely larger than most people would eat during a similar period of time and under similar circumstances.
- A sense of lack of control over eating during the episode (e.g. a feeling that one cannot stop eating or control what or how much one is eating).
- Recurrent inappropriate compensatory behavior in order to prevent weight gains, such as self-induced vomiting, misuse of laxatives, diuretics, or other medications, fasting, or excessive exercise.
- The binge eating and inappropriate compensatory behaviors both occur, on average, at least once a week for three months.
- Self-evaluation is unduly influenced by body shape and weight.
- The disturbance does not occur exclusively during episodes of Anorexia Nervosa.
Binge eating disorder is the most common eating disorder in the United States. It is a characterized by recurrent episodes of eating large quantities of food, often very quickly and to the point of discomfort, all the while feeling powerless to stop and a loss of control during the binge and experiencing shame, distress or guilt afterward. Unhealthy compensatory measures (e.g., purging) are not normally used to counter the binge eating. During a binge, you may eat even when you’re not hungry and continue eating long after you’re full. You may also binge so fast you barely register what you’re eating or tasting. Unlike bulimia, however, there are no regular attempts to “make up” for the binges through vomiting, fasting, or over-exercising.
You may find that binge eating is comforting for a brief moment, helping to ease unpleasant emotions or feelings of stress, depression, or anxiety. But then reality sets back in and you’re flooded with feelings of regret and self-loathing. Binge eating often leads to weight gain and obesity, which only reinforces compulsive eating. The worse you feel about yourself and your appearance, the more you use food to cope. It becomes a vicious cycle: eating to feel better, feeling even worse, and then turning back to food for relief. As much as you may feel powerless to break this cycle, there are plenty of things you can do to better manage your emotions and regain control over your eating and your health.
The formal diagnostic criteria are:
- Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following:
- Eating, in a discrete period of time (e.g., within any 2-hour period), an amount of food that is definitely larger than what most people would eat in a similar period of time under similar circumstances.
- A sense of lack of control over eating during the episode (e.g., a feeling that one cannot stop eating or control what or how much one is eating).
- The binge eating episodes are associated with three (or more) of the following:
- Eating much more rapidly than normal.
- Eating until feeling uncomfortably full.
- Eating large amounts of food when not feeling physically hungry.
- Eating alone because of feeling embarrassed by how much one is eating.
- Feeling disgusted with oneself, depressed, or very guilty afterward.
- Marked distress regarding binge eating is present.
- The binge eating occurs, on average, at least once a week for 3 months.
- The binge eating is not associated with the recurrent use of inappropriate compensatory behaviors (e.g., purging) as in bulimia nervosa and does not occur exclusively during the course of bulimia nervosa or anorexia nervosa.
Sometimes we turn to food for comfort – some ice cream when we are feeling low, some pizza or drive through on a tiring or lazy day. It’s okay to use food as a reward or to celebrate, but when eating is your only way to cope (e.g. opening your fridge is your first instinct) you get stuck in an unhealthy cycle where the real feeling or problem is never addressed.
It is emotional eating when eating is used to satisfy emotional needs, rather than to satisfy physical hunger. Emotional hunger can’t be filled with food. Eating may feel good in the moment, but the feelings that triggered the eating are still there. You often feel worse than you did before because of the unnecessary calories you’ve just consumed.
No matter how powerless you feel about food and your feelings, it is possible to make a positive change. You can find healthier ways to deal with your emotions, learn to eat mindfully instead of mindlessly, regain control of your weight, and finally put a stop to emotional eating.
Are there situations, places, or feelings that make you reach for the comfort of food? Most emotional eating is linked to unpleasant feelings, but it can also be triggered by positive emotions, such as rewarding yourself for achieving a goal or celebrating a holiday or happy event. Common causes of emotional eating include:
- Stress – Ever notice how stress makes you hungry? It’s not just in your mind. When stress is chronic, your body produces as it so often is in our chaotic, fast-paced world, it leads to high levels of the stress hormone, cortisol. Cortisol triggers cravings for salty, sweet, and fried foods—foods that give you a burst of energy and pleasure. The more uncontrolled stress in your life, the more likely you are to turn to food for emotional relief.
- Stuffing emotions – Eating can be a way to temporarily silence or “stuff down” uncomfortable emotions, including anger, fear, sadness, anxiety, loneliness, resentment, and shame. While you’re numbing yourself with food, you can avoid the difficult emotions you’d rather not feel.
- Boredom or feelings of emptiness – Do you ever eat simply to give yourself something to do, to relieve boredom, or as a way to fill a void in your life? You feel unfulfilled and empty, and the food is a way to occupy your mouth and your time. In the moment, it fills you up and distracts you from underlying feelings of purposelessness and dissatisfaction with your life.
- Childhood habits – Think back to your childhood memories of food. Did your parents reward good behavior with ice cream, take you out for pizza when you got a good report card, or serve you sweets when you were feeling sad? These habits can often carry over into adulthood. Or your eating may be driven by nostalgia—for cherished memories of grilling burgers in the backyard with your dad or baking and eating cookies with your mom.
- Social influences – Getting together with other people for a meal is a great way to relieve stress, but it can also lead to overeating. It’s easy to overindulge simply because the food is there or because everyone else is eating. You may also overeat in social situations out of nervousness. Or perhaps your family or circle of friends encourage you to overeat, and it’s easier to go along with the group.
If you don’t know how to manage your emotions in a way that doesn’t involve food, you won’t be able to control your eating habits for very long. Diets so often fail because they offer logical nutritional advice, which only works if you have conscious control over your eating habits. It doesn’t work when emotions hijack the process, demanding an immediate payoff with food. In order to stop emotional eating, you have to find other ways to fulfill yourself emotionally.
In order to stop emotional eating, you have to find other ways to fulfill yourself emotionally. It’s not enough to understand the cycle of emotional eating or even to understand your triggers, although that’s a huge first step. If you’re depressed or lonely, call someone who always makes you feel better, plays with your dog or cat, or look at a favorite photo or cherished memento. If you’re anxious, expend your nervous energy by dancing to your favorite song, squeezing a stress ball, or taking a brisk walk. If you’re exhausted, treat yourself to a hot cup of tea, take a bath, light some scented candles, or wrap yourself in a warm blanket. If you’re bored, read a good book, watch a comedy show, explore the outdoors, or turn to an activity you enjoy (woodworking, playing the guitar, shooting hoops, scrapbooking, etc.).