Eating Disorders and Body Image Concerns
What Are Eating Disorders, and Why is Therapy Vital?
Eating disorders drain the color and vitality from life. The term “eating disorders” refers to a collection of ways in which people lose the ability to sufficiently regulate their food intake and then find themselves engaging in compensatory behaviors. Typically, this means eating in unbalanced ways that yield significant medical and psychological consequences. Therapy can help you stabilize your eating behaviors and then get to the root causes of the disorder. With help, you can forge a path toward greater health and flexibility around food.
How Common Are Eating Disorders?
Struggling with an eating disorder can feel intensely lonely. But you are far from alone. In 2018, our best data suggested that at a given moment 7.8% of people were struggling with an eating disorder, up from 3.5% in 2002. To put that into perspective, if you struggle with an eating disorder, you are one of about 25 million Americans doing so. Alarmingly, hospitalizations for eating disorders have spiked (in some cases, more than doubled) since the beginning of the COVID-19 lockdown.
Eating Disorder Diagnoses
Although psychiatrists split eating disorders into distinct categories for diagnostic purposes, many of their symptoms overlap and meld into one another. Some people exhibit eating disorder symptoms that do not fit neatly into any of the diagnostic boxes or that fluctuate between these categories. If you feel this is the case for you, know that this is normal, and there is evidence that the distinctions we make are fuzzy and often miss the point–that your relationship with food and body is disordered and you need help. Thankfully, help is available. Below, you’ll find brief descriptions of different eating disorders as they’re currently categorized.
Anorexia Nervosa.
Anorexia refers to a pattern of food restriction (i.e., refraining from eating, even when hungry) in response to preoccupation with body image or weight loss. It ushers in a host of psychological and physical problems and is the second most lethal mental illness (just behind opioid addiction). Contrary to popular opinion and even some diagnostic manuals, it is not possible to tell by someone’s appearance if they struggle with anorexia. It afflicts people of every size, race, age, gender, and socioeconomic background. Multidisciplinary intervention is key to long-term recovery.
The term “atypical” anorexia refers to a restrictive eating disorder in someone whom physicians classify as “non-medically underweight.” This type of anorexia is not atypical at all. It is the most common type of diagnosed anorexia, and this term needs to be changed.
Bulimia Nervosa.
Bulimia is characterized by a cycle of bingeing and purging. The most common cause of bingeing, however, is restriction and/or over-exercise, both compensatory behaviors. Often, people restrict food until their bodies’ survival mechanisms kick in, then binge, and then purge to compensate. A less stigmatizing and possibly more accurate name for binge eating is survival eating. Purging can take many forms, all of which can be highly detrimental to health and even lethal. Bulimia, like anorexia, is a medically dangerous illness that is best treated as soon as possible.
Binge Eating Disorder.
Binge eating disorder mirrors the process in bulimia but does not involve as many of the compensatory behaviors (although restriction, even psychological restriction and shame, is often implicated in binge eating disorder). Still, many people struggling with binge eating report distress associated with feeling a lack of control around food. Binges might be triggered by calorie restriction (in amount, timing, or types of food), emotional distress, trauma, or learned patterns. Binge eating disorder is also often linked to socio-economic status and access to food. In many prevalence studies, binge eating disorder is the most common eating disorder, and it also improves with treatment.
Avoidant Restrictive Food Intake Disorder (ARFID).
ARFID describes a pattern of restrictive eating unrelated to concerns around body image or weight. These other factors include lack of interest in food, fears about consequences of eating, dislike of the physical sensation of eating, and so on. Even though it does not involve a drive to change one’s body, ARFID can nevertheless lead to psychological and medical problems that require attention.
Orthorexia.
Researchers recently coined the term orthorexia to describe a pattern of disordered eating centered around obsessive attempts to eat “cleanly” or “healthily.” This pattern often involves cutting out food groups, engaging with food in rigid ways, or evangelizing particular ways of eating. These behaviors can crystallize into disordered eating or an eating disorder.
Disordered Eating.
Many people who do not meet criteria for a clinical eating disorder nevertheless struggle in their relationship with food in real ways that impair functioning and thriving. In fact, the Western world’s relationship with food and body image is characterized by chronic dieting, over-exercise, fatphobia, moralization around food (i.e., judging some foods as good or bad, even judging other people as good or bad based on their diet), glorification of the pursuit of thinness, and body shaming. This set of practices and attitudes contributes to the toxic world of diet culture. It seems nearly impossible not to be affected by this forceful onslaught of cultural pressure. Some good news: the methods that help people heal from eating disorders often work for other eating concerns, too.
Why Treatment for Eating Disorders Matters
Without treatment, eating disorders typically worsen over time. With adequate care, they are highly treatable. The majority of people who receive treatment from a qualified, multidisciplinary team can expect full recovery, and a substantial proportion of those who don’t experience full recovery experience partial recovery. Only a small percentage of those who go through the process see no improvement.
Eating disorder treatment involves a full team of professionals because these illnesses affect a person’s body, mind, and relationships. Very often, they cause physical and medical symptoms that require the help of a diverse team of professionals. This can make treatment costly. But the alternative to early treatment is generally hospitalization, which is astronomically more costly. As is the rule in other fields, earlier and comprehensive intervention yields better results. Eating disorders are not likely to resolve on their own.
The Treatment Team
The gold standard treatment team for eating disorders includes:
- An individual therapist
- A dietician
- A physician and/or nurse practitioner
- If possible, an eating disorder therapy group
More severe cases require a higher level of care with increased and more frequent services, all the way up to inpatient hospitalization, which includes a treatment team with physicians, nurses, and occupational therapists. Receiving an evaluation to determine the correct level of care matters because treatment that is not intensive enough can lead to wasted time, money, and effort. Outpatient care for someone who needs inpatient care, for example, is unlikely to be of much help. It is additionally important that your treatment team be competent at treating eating disorders. In many cases, healthcare professionals lack adequate training to treat you properly. Don’t hesitate to ask if your providers practice from an Intuitive Eating framework and are Health at Every Size-informed.
What to Expect In Eating Disorder Treatment
We won’t sugarcoat it–recovering from an eating disorder is hard work. Your dietician will ask you to challenge your rules around food and movement and encourage you to eat and move more flexibly. Your therapist will help you to face and unravel difficult emotions. Your physician might deliver challenging news about your physical health and prescribe medical interventions. Each provider will offer their insight and guidance, and this can be a painful process. Know, however, that your treatment team understands the difficulty involved and will approach you with compassion and patience.
What keeps us going is knowing that there is every reason to face these difficulties. On the other side of recovery is a rich, more colorful life. Even before reaching full recovery, clients often report feeling more alive, more connected, and freer to be themselves. They experience less self-judgment and more emotional and relational safety. It is uncomfortable, but there is nothing more worth your time, energy, and effort than a full recovery. You will get your life back.
What You Can Do Now
Even before treatment, you can take steps toward healing. Note that these steps do not obviate the need for professional help, but they can supplement it. Here are some ideas:
- Dig Into Resources. It helps to explore books, articles, and podcasts about diet culture and eating disorder recovery. The work you do in treatment can reinforce what you learn outside of treatment. You can find our media recommendations in our Eating Disorder Starter Kit.
- Re-engineer Your Social Media Feed. Modern life happens online. What you see online has an affect on you and your relationship with your body and food. It is worth the time to unfollow triggering accounts and replace them with more body positive and food-flexible messaging. Again, you can find our recommendations for accounts to follow in the Eating Disorder Starter Kit.
- Practice Compassion and Patience. This is a hard process for anyone. Our guess is that if your friend were going through what you’re going through, you would wish them peace and success. Shame is the eating disorder’s ally, not yours. Self-compassion helps to turn down the volume on shame and make room for more positive feelings. This disorder took time to form, and it will take time to build new pathways to new behaviors. You can do this!
- Feel Your Feelings. Consider getting in touch with your emotions by journaling or meditating. Eating disorders function and perpetuate themselves sometimes as numbing agents. Getting back in touch with emotions helps you (1) fight back against the eating disorder and (2) realize that you can handle the emotions that come up as you pursue your best life.
Open Up to Others. Eating disorders thrive in secrecy and isolation. Reaching out and opening up to trusted friends and family is hard, and it is also empowering. It helps to realize that you are not alone and have others to lean on during the difficult process of recovery.
How Full Color Psychology Can Help
At Full Color Psychology, we offer individual and group psychotherapy as well as provide guidance in working with physicians and dieticians. Dr. Corinne Hannan is a certified eating disorder specialist and supervisor with extensive experience as a licensed psychologist. Dr. Eric Ghelfi also specializes in eating disorder treatment and has been providing individual and group eating disorder treatment for several years. Please reach out if you believe we might be of assistance to you.