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Eating Disorder 101: A Mental Health Therapist Answers Your Most-Asked Questions - Part I

Part I - Getting Familiar With Eating Disorders

Note: There are two parts to this article. For “Part II - Effects & Finding a Dietitian,” click here.

Okay, to get you into the right frame of mind, I want you to really listen up. If you or someone you know is struggling with an eating disorder (ED), you probably have a lot of negative thoughts on the subject. You may be plagued by feelings of gloom, misery, and even depression. Put those thoughts on hold for a moment and picture yourself in a state of elation. Imagine being cured from a terrible, life-threatening disease. The truth is: eating disorders are terrible, life-threatening diseases, but you don’t have to fight them alone. We’re here for you!

I’m Limor Weinstein, founder of Bespoke Wellness Partners, and I am going to answer some of your most-asked questions about eating disorders. My background, experience, and education as a mental health therapist are centered on personal and family well-being. As a mother, wife, and psychotherapist, my goal has always been to provide emotional support and knowledge that may be absent due to a variety of variables. I myself am an ED survivor. I am also an Eating Disorder Specialist who works with clients to help them find their way to better health.

The following questions are questions that people have been asking me for the past 15 years over and over again, so I have decided to compile a list of answers and include some evidence as support. Since I had too many questions, I have decided to break this blog into Part I and II, but if you have any other questions related to eating disorders that you want answered please feel free to email me and I will answer them for you!

What is an ED?

An eating disorder is an illness that includes extreme emotions, attitudes, and behaviors surrounding weight and food issues. Eating disorders can have serious emotional and physical consequences on an individual’s life. Although the majority of people with eating disorders are female, this illness does affect males as well. In the United States, 20 million women and 10 million men suffer from an eating disorder at some time in their life (Wade, Keski- Rahkonen, & Hudson, 2011).

There are eight types of eating disorders including Anorexia Nervosa, Bulimia Nervosa, Binge Eating Disorder, PICA, Rumination Disorder, Avoidant/Restrictive Feeding Disorder, Unspecified Feeding or Eating Disorder (UFED) and Other Specified Feeding or Eating Disorder (OSFED). I am not going to go over all the eating disorders, but I will focus on the main three: Anorexia, Bulimia, & Binge Eating Disorder. This is not to say that the other eating disorders are not important, but I promise to write about the other disorders as well in later blogs!

Anorexia is characterized as inadequate food intake leading to a weight that is too low for that individual, intense fear of weight gain, self-esteem overly related to body image, and an inability to appreciate the severity of the situation. Within this categorization, there are two types of anorexia: binge-eating/purging type that involves binge eating and/or purging behaviors during the last three months and restricting type, which does not involve these behaviors.

Bulimia involves frequent episodes of consuming very large amount of food followed by behaviors to prevent weight gain, such as self-induced vomiting, feelings of being out of control during the binge-eating episodes, and self-esteem overly related to body image.

Binge Eating Disorder is characterized by frequent episodes of consuming very large amounts of food, but without behaviors to prevent weight gain, such as self-induced vomiting, a feeling of being out of control during the binge-eating episodes, strong shame or guilt regarding the binge-eating, and indications that the binge eating is out of control, such as eating when not hungry, eating to the point of discomfort, or eating alone because of shame of this behavior.

Is ED an addiction?

In short, the answer is yes. Growing research suggests that there are several similarities between eating disorders and addictive conditions. The American Society of Addiction Medicine now has a more comprehensive definition of addiction, which includes “process” addictions, such as food, in addition to drugs and alcohol. This is because the effect that these substances and behaviors have on our brain is similar across “substances.” The reward centers of our brains can be activated by food in a similar manner as by drugs and alcohol. Once this reward center is activated, an addictive cycle is created. Therefore, the stimuli, such as drugs, alcohol, or food, become a desperately desired substance. This is when addiction and dependency occur. Abuse of any substance creates a false sense of temporary happiness or relief, but of course, has long-lasting consequences. (Eating Disorder Hope, 2016))

In fact, research indicates it is the restriction that becomes addicting rather than the excessive food. Restrictive behaviors like starving and even exercising increase endorphin levels in a similar way as opiates, which is both fascinating and scary! However, this helps explain why people can’t simply STOP having an eating disorder. It also reinforces why you shouldn’t try to go it alone.

Is there a brainwashing component to ED?

Yes! Individuals who develop an eating disorder frequently tell themselves that eating less is better, eating more is bad, eating will make them gain weight, and gaining weight is bad. They repeat these ideas over and over throughout their daily life. These individuals can be compared to those who have been brainwashed. As explained in “Recovery from Eating Disorders: A Guide for Clinicians and Their Clients,”

“they brainwash themselves to prevent weight gain: their feelings of hunger are felt as positive and safe and they are proud of being able to resist hunger, which gives them a feeling of control and self- esteem.”

Feeling hungry is not the “norm,” but these individuals strive for that feeling. They also are brainwashed to believe that the image they see when they look in the mirror is not an attractive image, that even at a below normal weight they are still fat.

What do stress and society have to do with my ED?

Eating disorders are a prevalent issue in today’s society related to the constant pressures to be thin. Whether this is in the media or from friends and family, the pressures placed on people lead them to develop eating disorders. Those who suffer from eating disorders not only have issues with their eating behaviors, but these issues spread to other aspects of their life. There is no single cause for developing an eating disorder and it can be a combination of factors related to an individual’s social, psychological, interpersonal, cultural and/or biological influences.

We need to change the way beauty is portrayed; being thin should not be equivalent to being healthy and beautiful. Society over-emphasizes appearance and sets unrealistic goals when it comes to weight loss. It also associates a thin body with success and love, therefore convincing members of society that if they want to be successful or find love they must first meet this body type. Society also puts labels on food, labeling them as inherently “good” or “bad,” which perpetuates feelings of guilt for eating a “bad” food.

The diet industry spends billions of dollars each year to promote diet pills and magic tricks that will "make" people lose weight instantly. If these “tricks” really worked, then why are there so many of them? The reason that there are so many options out there is because diets don’t work.  

With the increased access to celebrities’ lives it is easier than ever to know what our favorite celebrities are doing to keep their “perfect bodies.” Between this and fad diets we are susceptible to developing body issues and disordered eating.

Is it a myth that people use ED to relax and calm/soothe themselves?

No! It’s not a myth. Eating disorders aren’t always just about wanting to be thin. In addition to striving for some body image ideal, individuals may use unhealthy behaviors such as dieting, starving, binging, and purging to cope with unpleasant and overwhelming emotions and stressful situations. For someone who doesn’t suffer with an eating disorder, this can seem like an unusual concept, but for many people, these restrictive and controlling behaviors in regards to food actually bring some sense of peace. While these behaviors may relieve anxiety and stress in the short-term, in the long term, however, they actually increase anxiety and stress - in addition to creating other serious complications (, 2016). It is important to note, though, that binging and purging can feel like the only way the individual knows how to receive pleasure.

What about healthy eating diets?

Today many people are showing symptoms of orthorexia nervosa. While this disorder is not currently recognized in the DSM-5, due to the “clean eating” phenomenon it is becoming popular. These individuals have an “unhealthy obsession with otherwise healthy eating,” meaning they have a “fixation on righteous eating” (NEDA). While orthorexia may start out as an individual looking to eat better, it can turn into an unhealthy obsession. Individuals look to eat perfectly each day, sometimes taking drastic measures to overcompensate if they “mess up,” which could lead to bulimia. This obsession can also take over their lives, taking joy out of everyday activity and making it difficult to have a social life. Rather than anorexia or bulimia, which focuses on calories and weight, orthorexics focus on healthy eating.

Why do people with ED feel intimidated?

People with eating disorders may feel intimidated by everyone around them. They could feel intimidated by the really “skinny” woman on the street because of the way she looks. They could feel intimidated by the “heavier” woman who is smiling, wondering how she could be so content living like that.

Individuals with eating disorders may feel intimidated to let their secret out. For so long it has been kept a secret between that person and their eating disorder. Letting someone into that secret can be overwhelming and scary.

Another aspect of intimidation can be within the eating disorder community itself. A person may feel intimidation from those who have “worse” cases than them, those who eat less calories, or those who have seemingly more self-control. On the other hand, they could also feel intimidated by those in recovery.

It seems like the ED person has already “programmed themself to fail.” Does our society encourage that?

Recovery from an eating disorder is hard, but it is definitely possible. One of the most important aspects of recovery is willingness to recover. If a person goes into treatment and recovery with the attitude that they do not want to recover, they do not want to gain, and that they are happy with how they are currently, it is very difficult for treatment to be successful.

Those who have recovered are always in recovery, which is because there will always be those little triggers and thoughts that could have potential effects on an individual. Similar to how our society can influence the start of an eating disorder, society can also help someone to fail in his or her recovery. The messages about being thin and getting the best body are still out there. Granted, there are now stories about feeling good at any weight and plus-size models are being featured, but those do not stand out as much as the “5 easy tricks to drop 10 pounds in a week” articles.

Society reinforces eating disorder related behavior. Unknowingly, others who are unaware that an individual has an eating disorder may give positive reinforcement. They could tell their friend how skinny they look and they admire how they can control themselves in front of food or go to the gym for so long. For people who have friends who do know about the disorder, they probably offer care and support. The client may feel that without the eating disorder they would not get the same care and attention from those around them. Whether it’s negative or positive attention that an eating disorder brings to an individual, they likely appreciate this attention and it becomes an additional “plus” to the eating disorder.

What population of the USA has ED? How about the world? Is there any country where ED is not prevalent? Why?

In the United States, 20 million women and 10 million men suffer from a clinically significant eating disorder at some time in their life (Wade, Keski-Rahkonen, & Hudson, 2011). Eating Disorders affect 70 million individuals worldwide (The Renfrew Center). A study done by Medscape’s General Medicine (2004) shows that prevalence rates in Western countries for anorexia nervosa ranged from 0.1% to 5.7% in females. Prevalence rates for bulimia nervosa in females ranges from 0.3% to 7.3% and from 0% to 2.1% in males. In non-Western countries, prevalence rates for bulimia nervosa ranges from 0.46% to 3.2% in females. Disordered eating in non-Western countries, though lower than in Western countries, have increased, likely due to the influence of Western culture (Makino, Tsuboi & Denerstein, 2004).

Is an eating disorder an oral satisfaction? Is there any evidence relating it to our early childhood development?

Oral satisfaction is a strong biological urge in every human being. It is common for an infant to suck on his or her thumb for self-soothing. As people get older they may smoke cigarettes or chew gum to get this satisfaction. Overeating and chewing nails has also become common practice when an individual is nervous. We know that “eating disorders are centered on fixations on food, which go beyond mere satisfaction of hunger” (Urdang, 2002). An eating disorder is not just about food or an unhealthy relationship with food, but about something deeper within the individual. There must be something else that is “unsatisfied” within the individual that the client tries to fix with the disordered eating behaviors.

What else should I know? And where can I find a mental health therapist near me?

This topic is so broad and we have so much to write about that we made it two blog posts! To read more about the effects of eating disorders, as well as how to find a mental health therapist or a dietitian, read Part II of this article here.

If you would like me to connect you with one of our expert therapists or coaches, contact me. I look forward to hearing from you!

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