Over the last few decades, eating disorders have risen to troublesome levels in the United States. Compulsive over-eating has affected both men and women of all ages, and anorexia and bulimia have become disturbingly common among teens and young adults, especially in women. Increasingly, researchers in this field are noting the biological roots of these behaviors and, particularly for compulsive over-eating, establishing realistic goals for treatment. Compulsive over-eating creates extreme psychological pain for the sufferer and, when nutritionally unsound, may be associated with health problems as well. This pain is made all the worse by the common misconception that over-eating is simply a failure of willpower. Anorexia, or the restriction of food to below-subsistence levels, similarly is extremely dangerous; of all mental disorders, it has one of the highest rates of death for those afflicted. Bulimia, commonly known as “binging and purging,” can take the form of induced vomiting, overuse of laxatives, or both. Bulimia can be life threatening at times, and it can produce lasting dental problems, ulcerations of the throat, and other medical complications. Common denominators of all eating disorders are secrecy, shame, and self-hatred. Sufferers frequently hide their problems even from their significant others, blaming themselves in an imitation of social attitudes.
Because we believe that eating disorders are deeply rooted in biology as well as having environmental influences, we know that admonitions to use “willpower” do nothing but drive the person with an eating disorder deeper into secrecy and shame; people with eating disorders are not in control of their behavior. If you have an eating disorder, it is our job to help you regain control to the extent you can, but it is also important to help you set realistic goals. For example, most experts in the eating disorders field believe that a loss of ten percent of body weight is a rational goal for compulsive overeaters. Therefore, part of our treatment approach if you have this problem will be to discourage you from thinking you should conform to a “weight chart” or to look like a supermodel. We use what is called a “non-diet” approach, and we will encourage you to focus on body fitness instead of weight and help you learn to love your body even if it is bigger than you have been told it should be. Anorexia and bulimia can be difficult-to-break habits with frequent relapses before total remission is attained, so we encourage clients with these disorders to change by degrees if necessary and to focus on improvement rather than blaming themselves for lapses.
Like our treatment of substance abuse, many of the methods we use to help people with eating disorders are behavioral. We might help you design a food plan, weigh-in at our office, or plot out with you methods to cope with “trigger” situations like eating out in a restaurant or being with people who comment on your eating habits.
Most eating disorders include a strong cognitive component as well. People who have these problems are plagued by unpleasant intrusive thoughts about food and eating, which has caused these disorders to be compared to obsessive-compulsive disorder (OCD). In addition, anorexics and bulimics often have body-image perceptions that are so distorted they seem almost “crazy”. We help bring unrealistic body image back to normal and help with “thought-stopping” of unwanted food thoughts. If you suffer from compulsive over-eating, even if you are successful in reducing your weight by ten percent, you may still have to accept having a larger than average body, and so we will work to help you feel beautiful in the body you have despite prevailing cultural norms. For all eating disorders, gently we attempt to refocus you on health rather than looks; being fit is more important than being thin. When appropriate, we will help you make connections between your eating behavior and other issues in your life, present or past. We also refer to support groups like Overeaters Anonymous, to local groups for anorexia and bulimia, to nutritionists, and, in extreme cases, to residential programs for anorexia and bulimia.
Our belief that many eating disorders have biological roots informs our methods in other ways. We are realistic about weight loss and gain and help you set goals for yourself that may not fit within “official” weight guidelines. As with substance abuse, we take a “harm reduction” approach: e.g., we don’t encourage diets, which create health problems, but instead will help you incorporate exercise into your life to make you more fit; if you can’t gain weight, we will help you make a food plan that at least meets your basic nutritional needs. We will also help you explore medical possibilities for treatment. Such as use of certain antidepressants to help decrease, the intrusive food and body image thoughts associated with anorexia and bulimia.