Outpatient Therapy for Eating Disorders in Roseville,
California
What Does an Eating Disorder Look Like?
Most of us struggle at times with insecurities about our bodies, emotional eating or decreased appetite after a particularly stressful event, or wishing that we had more discipline in the areas of healthy eating or exercise. These phenomena are so common and relatable that often it is easy for us to shrug off concerns we might have in these areas, whether for ourselves or a loved one, and just chalk it up to “part of being a woman” or “the human experience”.
However, research tells us that at least 9% of the U.S. population, or roughly 28.8 million Americans will have an eating disorder at some point in their lifetime.
But, is a diagnosis really that important?
At 10,200 deaths annually, eating disorders are the second most deadly mental illness, surpassed by only opiate abuse. Additionally, the distress, fear, shame and isolation that accompany an eating disorder are devastating, resulting in astounding 26% percent of all individuals struggling with an eating disorder attempting suicide at least once. If you suspect that you or someone you love may have an active eating disorder, or be at significant risk for developing one, getting timely, accurate and competent information and therapeutic support is crucial. There is hope. Eating disorders are treatable. It is not worth the risk or the pain to continue suffering in silence for one more day.
Types of Eating Disorders
People with eating disorders commonly develop a preoccupation with food and body weight that affects their lives across all domains- from their behaviors, to their thought life, to the very way they feel about themselves and the world around them. What commonly begins as a voluntary method of losing weight, bringing structure to one’s eating habits or coping with stress, eventually becomes totally consuming and life-controlling. Below are a few of the more common ways that eating disorders tend to manifest:
Anorexia Nervosa
People with anorexia are consumed with an intense fear of weight gain and becoming ‘fat’, driving them to extreme measures to control and lose weight. Such measures may include some or all of the following: food restriction/fasting, skipping meals, eating only select “safe” foods, seemingly bizarre food rituals at meals, weighing themselves and counting calories excessively and engaging in compensatory measures to lose weight such as over-exercise, purging, laxative abuse and more. Most often, the person suffering with anorexia will attempt to hide, minimize or deny a problem altogether, often resorting to extreme rationalizations, emphatic denials and elaborate excuses aimed at convincing those around them that nothing is wrong. Among all the eating disorders, and in fact amongst nearly all other psychiatric disorders, anorexia has the highest mortality rate. As scary as that sounds, 50-70% will go on to recover with treatment.
Bulimia Nervosa
As in anorexia, people with bulimia nervosa also suffer from disturbance in body image perception and an obsession with weight loss or preventing weight gain and feel their body shape and size are strong determinants of their self-worth. However, bulimia nervosa is characterized by the binge-purge cycle during which an excessive amount of calories are consumed in a short span of time and later ‘purged’ by method of self-induced vomiting, compulsive exercise, food restriction and/or laxative abuse to prevent weight gain from the ‘binge’. Most clients describe feeling out-of-control during the binge portion of the cycle and will endorse feelings of self-inflicted violence during the purge. This behavior is almost always done in secret and often evokes extreme feels of shame and self-loathing afterward, although the cycle may bring temporary emotional release or a numbing of intense feelings. Many individuals with bulimia will deny any issue and/or minimize or excuse any concerns about their behavior upon confrontation. In contrast to anorexia, most individuals with bulimia are at average or above-average body weight.
Compulsive Overeating
Compulsive overeaters chronically over-eat in response to emotional and psychological hunger, but often without regard for physical hunger cues. They may overconsume at meals, but more often graze throughout the day, usually in an unconscious response to stress, overwhelm and/or emotional triggers. Compulsive overeaters share a preoccupation with body weight, shape and size as major determinants of self-worth and often experience a great deal of shame and self-loathing associated with their body image. This shame and self-recrimination often further isolates those suffering from the community they desperately need, further entrenching unhealthy emotional eating. Most compulsive overeaters are overweight, but many also use compensatory measures of weight loss such as compulsive exercise or frequent dieting, such that they may be of average or fluctuating body weights.
Binge Eating Disorder (BED)
Binge eating disorder is the most common of all eating disorders with most current prevalence estimates ranging between 1-2 million Americans suffering at any given time. Binge eating disorder is similar to bulimia in that it is characterized by discreet periods of out-of-control bingeing, in which a large amount of calories are consumed in a short period of time, ending in extreme physical fullness and discomfort or sleep. Due to the absence of the compensatory measures taken after the binge as in bulimia, many people with BED are significantly overweight, and as noted elsewhere in the other eating disorders, the resulting shame and disgust over body image and out-of-control food behaviors only fuel more social isolation.
Exercise Addiction
Exercise addiction is an unhealthy obsession with physical fitness and exercise. Although exercise addiction is not itself an eating disorder, it is discussed here because it often co-occurs with, and must be ruled out from, part of a larger eating or body image disorder. Some signs distinguishing exercise addiction from a healthy routine involving heavy exercise or athletic training are: the need for greater and greater amounts of exercise to achieve the desired effect, feelings of irritability, anxiety or restlessness when unable to engage in exercise, unsuccessful attempts to manage or reduce exercise, excessive amounts of time being devoted to exercise to the exclusion of previously meaningful non-fitness related activities or relationships and continuance of exercise despite adverse physical or relational consequences.
Orthorexia
Orthorexia is an obsession with healthy eating that has a significant impact on one or more areas of daily functioning. Unlike in anorexia, in orthorexia the focus on food rigidity is not necessarily related to fear of weight gain, as much as it is a fixation on eating healthy or alternative foods. Many who suffer from orthorexia describe their obsession as having moral overtones, in which their self-assessment is impacted positively or negatively depending on the quality of their food choices. In the absence of available “safe foods”, those with orthorexia feel increasingly out-of-control and anxious. Over time, many find that fewer and fewer foods feel acceptable or “safe” to them, often ending in unhealthy weight loss or the development of a primary eating disorder such an anorexia or bulimia.
Body Dysmorphic Disorder (BDD)
People with body dysmorphia obsessively focus on a real or perceived flaw in physical appearance and spend excessive amounts of time and energy trying to hide or repair it. As in exercise addiction, body dymorphic disorder is not itself an eating disorder, but the disorder can precede, co-occur or end in an eating disorder. People with BDD often spend excessive amounts of time examining their appearance in the mirror, comparing their physical appearance to others and avoiding social situations or photographs which they feel highlight their perceived flaw. They may additionally resort to extreme measures such as repeated plastic surgeries or excessive exercise to alter their physical appearance. While there is no noted ‘cure’ for BDD, treatment can provide significant relief.
Causes
While there is no single known cause for an eating disorder, we are learning more everyday about the multifaceted factors that influence their development. In addition to what has long been known about the influence of genetics, body image, the media and culturally derived standards of beauty, in recent years we have come to understand much more about the role of trauma, co-occurring mental health disorders (particularly anxiety and depression and anhedonia) and neurobiology (specifically the role of feeding-reward related neurotransmitters) in the development and maintenance of eating disorders.
On Treatment
Tragically, less than 50% of those suffering from an eating disorder end up getting the treatment that they need. When it comes to seeking help for an eating disorder, early intervention can not be overemphasized. In general, because of the shame, secrecy and denial surrounding these disorders, by the time an individual (or their loved ones) become concerned, it is already past the ideal point of intervention. While this by no means is an indicator that you or your loved one are beyond help, it often can mean that a higher level of care may be required, especially as time continues to pass. My goal is to see you achieve recovery, health and freedom in the safest and least restrictive setting possible, so please, don’t delay!
Signs a higher level of care is needed
failure to thrive in outpatient therapy and dietary counseling after a significant period of time
medical complications (severe malnutrition, electrolyte imbalance, irregular heartbeat)
suicidal ideation
self-harm behaviors not safely contained at a lower level of care
Treatment Focus
I heard a quote once that I believe describes the evolution of the eating-disorder so succinctly and beautifully: “We are constantly telling our stories, sometimes with words.“
An eating disorder serves an important function in the life of the person battling it. If it didn’t, it wouldn’t be so hard to give it up! Often, the eating disorder has represented an attempt to care for the self and cope with deep pain. And despite the tremendous suffering, shame and bondage that it brings, in many cases for the person with the eating disorder, it is still considered preferable to facing life without it. There are many different functions an eating disorder can play from voicing a need, providing protection, calling attention to a problem, simulating control, preserving a sense of self, medicating feelings, creating an ‘identity’ and much more. The function of an individual’s eating disorder is as uniquely personal as the individual themself, and is very often unconscious at the beginning of treatment. Only through a safe, affirming and trusting relationship can such meaning be explored and processed. Only then, can the path forward be clearly perceived.
Additionally, I work with my clients on creating meaning from the pain of this experience, on clarifying their values and on grounding their identity and self-worth in what is eternal and true. In fact, several of my former clients have gone on to become therapists themselves and are today helping others on their path to recovery and freedom (wounded healers are the best in my opinion)! For most of my clients, the work they do in treatment proves to be some of the most stretching, gut-wrenching, messy, and ultimately profoundly liberating and rewarding, of their lifetime. Along the way, more than a few have been known to get a little loud, eat a piece of cake and smash a scale or two…
Sources: National Eating Disorders Association (NEDA), National Association of Anorexia Nervosa and Associated Disorders (ANAD), The Body Myth- Margaret Maine and Joe Kelly
Do I have an Eating Disorder?
Take the short screening tool developed by the National Eating Disorders Association (NEDA) below.