In today’s world, we are flooded with images and messages fixated on physical appearance and attractiveness. Social media, film, and cultural ideals all impact how we view ourselves and want to be perceived. The glamorization of extreme thinness and unrealistic body types, often accomplished online with filters and Photoshop, or achieved through plastic surgery, are presented as attainable and desirable. It’s no wonder that many women, men, and adolescents struggle with eating disorders.
In fact, in 2020, a comprehensive report on the Economic Cost of Eating Disorders, performed by the Academy for Eating Disorders and The Strategic Training Initiative for the Prevention of Eating Disorders, found that 9% of Americans, or 28.8 million individuals, will have an eating disorder in their lifetime. Children as young as five years old present with eating disorders, and all genders, races, and sexual orientations are affected. Despite the prevalence of these conditions, eating disorders continue to be misunderstood and misrepresented.
Eating disorders constitute a spectrum of behaviors regarding the consumption or restriction of food. Symptoms of these conditions vary but include unhealthy and unsustainable eating habits and a disordered relationship with food. These disorders can affect any person during any stage of life. Without intervention, they may cause serious health complications, exacerbate other mental health conditions, and impact relationships and quality of life. Fortunately, eating disorders are treatable, and recovery is possible. We know that facing the shame and fear often accompanying eating disorders can be challenging. Our licensed eating disorder therapists specialize in eating disorders. They can help you gain skills to combat the disruptive thoughts, patterns, and behaviors that may leave you feeling trapped and out of control.
Anorexia nervosa is a disorder distinguishable by highly controlled behaviors related to eating. Persons suffering from anorexia typically adhere to strict diets where they may eat only certain foods or small portions of specific foods, restrict calorie intake, closely monitor and obsess on weight or BMI, or/and excessively exercise to achieve weight loss or avoid weight gain.
The two recognized sub-types of anorexia are restrictive type (in which one severely restricts the calories they consume) and binge-purge type (wherein they may ingest large amounts of food followed by inducing vomiting or using laxatives to evacuate what they have eaten). They may have distorted views of themselves and believe they are overweight despite being below healthy standards for their height and age.
These restrictive behaviors can have dire physical consequences in addition to causing mental and emotional distress. Thinning or brittle hair and bones, jaundiced skin, decreased pulse and breathing, heartburn and reflux, constipation, infertility, and, in severe cases, damage to major organs, including the heart, kidneys, and brain, may be observed.
Bulimia nervosa is characterized by periods of rapid, excessive eating of large amounts of food, followed by behaviors meant to compensate for and “correct” the effects of bingeing. Purging behaviors such as self-induced vomiting, fasting using laxatives or diuretics, or obsessively exercising are ways someone with bulimia may attempt to offset the effects of bingeing.
Persons struggling with bulimia exist along the whole weight continuum and may be underweight, normal weight, overweight, or even obese. They often experience painful and dangerous physical symptoms such as gastrointestinal issues, reflux, dehydration, tooth decay and weakened enamel, and chronic throat pain.
Binge-eating disorder and bulimia nervosa both involve the rapid consumption of excessive amounts of food during brief, unbridled episodes. During these episodes, individuals often feel unable to control or moderate how much food they eat. This lack of control causes a great deal of anxiety and stress. These persons may feel ashamed, disgusted, embarrassed, or depressed after a binge.
Binge-eating disorder differs from bulimia in that these individuals do not rely on regular compensatory behaviors to mitigate the effects of binge episodes. Because they do not purge, they may be overweight or obese. Complications of binge-eating disorder are typically associated with excess weight, such as hypertension, diabetes, heart disease, and stroke risk.
Compulsive exercise refers to the obsessive desire and need to exercise to the extent that it interferes with health and other facets of daily life. It is also known as “exercise addiction,” as individuals exhibit compulsory behaviors and depend on exercise to feel they can function normally.
These individuals may feel unable to control the amount of time they exercise. Additionally, they may feel distressed, guilty, anxious, or depressed if they cannot exercise as much as they desire. They may use exercise to manage difficult emotions, purge unwanted calories, “earn” permission to eat, or compensate for feelings of inadequacy and low self-worth. Some may adhere to rigid, overzealous workout regimes and push themselves past the point of injury and fatigue. They may prioritize exercise over relationships, jobs, and other interests, exercise secretly, or exercise at inappropriate times or places.
Compulsive exercise can have harmful physical impacts such as loss of bone density, chronic bone and joint pain, physical injuries such as overuse and fractures, weakened immune systems, and relative energy deficiency in sports (RED-S).
Orthorexia is a recently coined term for individuals obsessed with eating only food perceived as extremely “healthy” and strictly avoiding foods considered “unhealthy.” Persons with orthorexia may fixate on rigid guidelines for what constitutes food “healthy” enough for eating. They may fanatically research dietary practices and nutritional approaches to the extent that it interferes with regular functioning and physical and mental well-being. The focus on adhering to these guidelines may result in prioritizing lifestyle maintenance over relationships, interests, values, and physical health.
Without treatment, physical health may ultimately deteriorate. Symptoms associated with orthorexia include malnourishment, lessened immunity, organ failure, kidney and cardiovascular issues, and cognitive decline. People with orthorexia may derive a sense of “goodness” or “worthiness” from following these eating restrictions. Conversely, they may experience deep shame or low self-worth when they fail to adhere to these guidelines.
When determining if therapy is right for you, it is important to understand what constitutes healthy or “normal” thoughts, feelings, and behaviors about appearance, food, and exercise. It is normal and natural to care for, evaluate, and appreciate one’s body and appearance. Additionally, it is healthy and appropriate to make thoughtful choices regarding nutrition and exercise. Our relationship with our bodies significant impacts mental health and overall satisfaction with life. Our goal should be to care for and strengthen our bodies, not to alter or punish them for existing outside imagined beauty ideals.
How do we know when our thoughts and behaviors develop into patterns jeopardizing our mental and physical well-being? Understanding potential signs and symptoms of eating disorders and checking in with yourself to evaluate their presence in your life may help you decide if it is time to seek help from a licensed therapist to make a change.
Because eating disorders manifest themselves in various ways, our multi-modal treatment model allows our therapists to address your concerns and needs. Cognitive Behavioral Therapy, Dialectical Behavior Therapy, and psychodynamic psychotherapy are effective treatment modalities we have utilized to treat these disorders.
DBT is a behavioral treatment that replaces maladaptive behaviors with beneficial life skills such as mindfulness, emotional regulation, and distress tolerance, becoming more effective in interpersonal relationships.
We incorporate CBT by identifying thoughts, beliefs, and values that maintain the disordered behavior. These typically include distorted beliefs about body shape, appearance, food, and weight. Upon identification, your therapist can formulate an individualized plan to help you develop skills and strategies to modify and manage these problematic beliefs.
After developing coping skills, we engage in psychodynamic therapy to understand the complexities of your disorder and the internal conflicts and motives that may drive your symptoms. Identifying unmet needs and wants, as well as the root of the disorder, can address symptoms and reduce relapse risks. Evaluating the role of social media, gender roles, cultural expectations, and beauty standards also plays a part in the process.
This multi-faceted approach allows our therapists to tailor your treatment to your needs and create a path toward healing and growth. We know you are much more than the number on a scale or a reflection in the mirror. We want to help you recognize your infinite value, too. Recovery is possible, and we are on your side.