"I help people make peace with food and themselves,
so they can live their best lives."

WHAT IS AN EATING DISORDER?

In recent years, anorexia, bulimia and binge-eating have become more common in children and adolescents. Reports of eating disorders in adult women (and men) have risen dramatically. The prevalence of eating disorders has historically been higher than reported but it is now more acceptable to seek treatment. Many women in their 40s and 50s, or older, are finally seeking help after struggling alone for decades.

Eating disorders are not about food, but about feelings. Most people develop eating disorders as a way of coping with difficult feelings. As an example, imagine a woman who just broke up with her boyfriend. If she let herself feel the emotions of the break-up, she might be devastated, sad, depressed, angry, and so forth. If she is has an eating disorder, she may try to cope with these intolerable feelings by berating herself for being "too fat" and by focusing on food, worrying about calories and criticizing her body. Rather than process the devastation of the break-up, she distracts herself with thoughts of food/weight and successfully avoids the pain of the break-up. Thus, the eating disorder helps her cope with a difficult circumstance, but causes her to feel terrible about herself, and the cycle goes on.

Therapy can help people to understand and recover from their eating disorders. The therapeutic process helps people develop new ways of coping with stressful situations. They learn to identify feelings and cope in healthier ways.

Warning signs include:

• Food disappears from the house at a faster-than-normal rate (people with eating disorders often create elaborate excuses to explain the disappearance of food, explaining that the food went bad or fell on the floor and had to be thrown away).
• Frequent statements such as "I'm not hungry" or "I just ate"
• Going to the bathroom after every meal. Frequent complaints of stomach problems (laxative abuse is a common method of purging)
• Rapid weight loss or weight gain
• Focus or fixation on body image, clothing size, comparisons to others
• Sudden interest in becoming a vegetarian, with extremely strict rules about diet
• Excessive exercise
• Withdrawal from friends and family, increasing isolation
• Moodiness and an insistence that nothing is wrong

The focus of therapy at this point is to commit to treatment and to consider acknowledging that there is a problem.

If you or a loved one is struggling with an eating disorder, you may be familiar with one or more of the following statements:

"I DON'T HAVE A PROBLEM" (DENIAL)

Often, people with an unhealthy relationship to food do not recognize it as such. They get angry or defensive if others express concern about their eating habits or their weight. It's common for them to completely deny the existence of any disordered eating or to minimize anorexia or bulimia as a means of weight control. They may tell concerned friends and family not to make such a big deal, maintain that nothing is wrong and insist on being left alone.

"OKAY, IT'S A PROBLEM, BUT I DON'T WANT TO CHANGE" (AMBIVALENCE)

Change is scary. Since the eating disorder serves a purpose - usually as a way of coping with difficult feelings - it's especially difficult to want to get rid of it. People feel lost without the comfort and certainty of their eating disorder.

Many people define themselves by their eating disorders. Instead of seeing themselves as struggling with disordered eating, they perceive themselves as being bulimics, anorexics, binge-eaters. It's difficult to separate their disorder from their identity. When the disorder has become such an integral part of someone's self-definition, she doesn't know who she would be without it.

The focus of therapy at this stage is on recognizing the adaptive function, or purpose, of the eating disorder and acknowledging the possibility that there might be other ways to cope with difficult feelings.

"I'M READY TO GIVE UP THIS EATING DISORDER, BUT I DON'T KNOW HOW" (ACTION)

It is important to recognize that eating disorders are often a metaphor for emotional deprivation: people are "hungry" for something they may not be getting, such as love, acceptance, comfort, understanding and peace. Food is used to fill an emotional void. This emptiness can be too upsetting to acknowledge or tolerate. In fact, most people with eating disorders are very disconnected from their true emotions. They may be angry and frustrated at themselves for what they are eating or how much they weigh, but this is a distraction from what they are really feeling. They are so adept at focusing on body image or calories that they completely avoid their inner experience. In therapy we explore the triggers to the eating disorder - situations that bring up uncomfortable feelings - and together find ways to cope with and tolerate their discomfort. When they can cope in other ways, they can let go of the eating disorder.

"FREE AT LAST!" (RECOVERY)

At this point, people are eating more intuitively. They can separate physical hunger from psychological hunger. They are comfortable nurturing themselves both physically and emotionally. They can tolerate the pain or discomfort of emotions such as anger, sadness and fear. They do not see food as "good" or "bad", nor do they see themselves that way. They are free from the tyranny of their eating disorder.

"I MESSED UP - I'M BACK AT SQUARE ONE" (RELAPSE)

There will likely be times when the disordered eating returns, whether for a day, a week, a month or even longer. Usually stress triggers the episode and the person reverts to old coping skills (the eating disorder). It is important to recognize that a relapse does not erase all the work the person put into recovery. It is a normal and expected aspect of recovery. Also, nobody ever goes back to "square one." They may feel as if they are back at the bottom of a very steep hill, but in fact they have only lost a little bit of ground. Nothing can take away the hard work and recovery they have already achieved.

HOW TO HELP

To help someone you suspect has an eating disorder you must ACT immediately.

Ask the person how she would know if her food issues were a problem. What would tell her that the situation was out of control?

Create a safe environment without judgment and encourage your friend or loved one to open up about her eating disorder. Connect her to resources that can help.

Therapy is the treatment of choice for eating disorders. Help your friend or loved one find a therapist with whom she feels comfortable. Not all therapists work the same way. It's crucial to find a therapist with the style and personality that is a good fit.

If your loved one refuses therapy:
Some people fear therapy means they are "broken" and are going to be "fixed" by the therapist. Therapy is actually about getting support and understanding. If your loved one thinks of therapy as a punishment, help her (or him) feel positive by gently pointing out the supportive and collaborative nature of therapy.