How to Address an Eating Disorder

10/19/2011 03:01 pm ET | Updated Dec 19, 2011
  • Gabrielle Bernstein Speaker, Author of Add More ~ing to Your Life, Spirit Junkie and May Cause Miracles

I spent decades suffering from an eating disorder. I was a binge eater. After each binge, I'd spend hours in the gym trying to burn off the calories I'd consumed. Through my spirit junkie path and a lot of self-love, I'm happy to say I've overcome this addiction. There is hope and help.

If you or someone you care about is struggling with an eating disorder, then this interview will be a powerful guide. I'm thrilled to introduce you to my dear friend and psychotherapist Tracy Goodman. Not only is Tracy an incredible eating disorder specialist, but she's also experienced her own recovery first hand. She is a true power of example for us all.

My interview with Tracy Goodman:

Gabby: How do I know if I have an eating disorder?
Tracy: You have a problem if your eating behavior or your attitudes about food and weight are taking the pleasure out of your life. Those with eating disorders typically worry excessively about their weight and about the food they are eating (or trying not to eat). Some of the following are indicators that you might have an eating disorder:

- Excessive concern and preoccupation about calories or fears of weight gain.

- Eating habits that you know in your heart are abnormal.

- A significant amount of shame and guilt around eating.

- Others are worried about you.

- You vomit to avoid gaining weight or use laxatives.

- Your weight is fluctuating.

- There are many foods you strictly avoid to control your weight, and you feel like a terrible person if you eat any of these foods.

- You have unmanageable cravings for certain types of food that you think you should not be eating.

- You are driven by exercise, and can feel truly bad if you miss an exercise routine.

- You are depressed and irritable.

- You pretend that you have eaten to get people off your back.

Gabby: What are eating disorders?
Tracy: There are three types of clinical eating disorders. Each of them are concerned with control of weight and shape. Anorexia Nervosa, Bulimia Nervosa and EDNOS (Eating Disorders Not Otherwise Specified, which include compulsive eating and types of anorexia or bulimia which are not severe).

There is a less familiar eating disorder called the "Night Eating Syndrome," named Orthorexia, which is thought to be similar to anorexia. People with Orthorexia are obsessed with healthy eating plans such as food allergy plans, but this masks a bad relationship with food. The bottom line is, if eating seems to rule your life, help may be necessary.

About one in three anorexics recover (this may take some time) and about one in three start overeating and my have long term problems with food control. The death rate is unacceptably high, between one in five dying early mostly as a result of starvation effects or suicide.

Gabby: Why does someone get an eating disorder?
Tracy: There is no simple explanation, and there has been a lot of research into the causes of eating disorders. We know that we cannot simply blame the culture, fashion magazines, family relationships, early traumatic experiences, or abuse or buried psychological problems like depression or anxiety.

Eating disorders arise from a combination of personal, family, physical or genetic factors, as well as life experiences that may cause someone to be both emotionally vulnerable and sensitive about their weight and shape. Dieting has a role to play in the development of an eating disorder, in fact in most sufferers the eating disorder grew out of dieting behavior.

These are the key common areas for those with an eating disorder:

- Feelings of powerlessness or worthlessness.

- Sensitivity to imagined rejection or abandonment.

- Poor assertion skills and difficulty in managing healthy relationships.

- Perfectionist attitudes and extremely high standards on the self.

- Avoid life's difficult situations.

- Lack of assertion skills, difficulty in saying "no" and in asking for what they want in life. Often are people pleasers or go out of their to be nice. May have moments of aggression when things get on top of them.

- May lack confidence in managing relationships in a way that serves their needs rather than those of other people.

Gabby: What's the connection between dieting and eating disorders?
Tracy: Most people diet at some point in their lives, believing that weight loss will make them happier and more attractive to others and to themselves. Dieting can give a sense of success and accomplishment -- a feeling of being in control. It can attract compliments and positive feedback from others.

Research tells us that in most cases eating disorders follow the onset of dieting behaviors. Restrictive dieting is poor at keeping weight off, with a large percent of dieters regaining lost weight, plus a little more. Physical changes make it hard to keep weight off. Chemicals released in the brain lead to massive cravings for food and abnormal hungers, which may persist for many months following a diet.

The fight-back process against our attempts to create a perfect body shape can also show up as abnormal cravings for forbidden foods. Also, with extended periods of dieting, the body may act to protect itself against future famines by setting the set point higher and reducing metabolism.

Emotional changes may make it hard to maintain weight loss too. It is only human to feel deprived and irritable when we cannot have foods which have become "taboo." They become much more desirable than they need to be. Breaking dietary rules leads to feelings that you have "blown it" and you binge on those forbidden foods in the expectation that you will start again tomorrow. Cycles of guilt and remorse usually follow from breaking these arbitrary rules.

Those with anorexia have a special capacity to hold out against the abnormal hunger that follows naturally from dieting. This is something that we do not fully understand. But anorexics are hungry, and their hunger is so intense that they believe that if they were to start eating at all, they would never stop. This is perhaps their greatest irrational fear. For the bulimics and compulsive eaters, their attempts to restrain their eating has become undermined by reactive overeating (which is predictable). Intensified efforts to pay for their sins by more dieting just keeps them trapped in the vicious cycles of their disorder.

You should seek professional help to treat an eating disorder. The treatment usually involves giving up dieting for regular, healthy eating -- a diet rich in nutrients and containing a little of everything. This, together with work on emotional eating, can help to master food cravings. In many cases this will result in a return to a normal healthy weight and a physical body that burns energy and controls weight effectively.

If you are compulsive about dieting, the idea of stopping is terrifying. You fear that you may totally lose control. You may need help to bring your body and emotional brain back to normal.

Gabby: If someone cannot get to a treatment center, what can they do?
Tracy: People with eating problems live all over the world. Concentrate on self-help, which includes learning as much as you can about your problem from books or in the internet. Be curious and realize that an eating problem is not a sign of weakness or character flaws. People from all walks of life can develop problems with control of eating.

Talk to your doctor -- do so from a position of strength, having learned something about your situation first. Your doctor may be able to recommend you to a local counselor. It is up to you to ask the right questions to be sure that your counselor has a formal training in eating disorders counseling.

A good competent therapist will be willing and able to answer your questions. Some questions to ask include:

- Do you understand the physiological/biological aspects of eating disorders and appetite?

- What is the extent of your knowledge of nutrition?

- Are you trained in cognitive behavioral therapy (CBT) for eating disorders?

- What other formal training have you done for eating disorders?

Gabby: What help is available?
Tracy: Help for eating disorders is easier to find these days than it was five years ago. Doctors may not be formally trained to understand or treat eating disorders, although their help in managing physical risk is invaluable.

Help is available in many forms. A form of therapy called CBT adapted for eating distress is recommended for bulimia and compulsive eating. Many counsellors and psychotherapists claim to treat eating problems and may do so with success, however, I urge you to check the credentials of any therapist who advertises eating disorder treatment skills.

The treatment of anorexia poses more problems. Family therapy is regarded as helpful for younger patients, although few receive this in practice. The therapist should ideally be trained in the management of family interactions specific to the range of anorexic behaviors, as well as general family behaviors.

Some people are more comfortable with therapy groups or support groups, which help people to come together, find friendship and normalise feelings around food and weight.

Under certain conditions, where an individual's eating problems have led to physical or emotional crisis, a more intensive approach may be needed such as hospitalization or in a more structured treatment program.

Gabby: If someone feels overweight and unhappy what can they do?
Tracy: If you are overweight -- and this depends on the relationship between your height, weight and age -- then some weight loss may benefit your health and emotional well-being. You may wish to read the section below on treatment for obesity, but please bear in mind that successful therapy for obesity requires in part a healthy relationship with yourself and a level of respect for your body and your health.

Many women today feel fat even when they are not fat. Many women who are currently on a diet are not overweight. There is enormous pressure for us to conform to a particular body size. In reality, people come in all shapes and sizes. This means that some people will be thinner than others, just as some are taller. We are at our most healthy when we are at our natural body weight.

Giving up restrictive diets and addictive exercise programs is important. Replace these with treating yourself well and with compassion. Eat in moderation and do not deprive yourself of any foods since this may set you up for a binge. Also, be moderately active in a way that you enjoy. This does not mean going to a gym to punish yourself or burn off forbidden calories.

Research suggests that women with poor body image misinterpret negative emotions such as anger, sadness and feeling unlovable as "feeling fat." Next time you have a fat moment and experience those familiar self loathing thoughts, ask yourself, "What else is it I might be feeling?" Then calm down and say, "I approve of myself." Give yourself a hug or find something nice to do for yourself.

If you keep practicing this, your feelings could change and your eating habits could start to get better. There is simply no point in responding to those fat thoughts by starving, binging or punishing yourself with promises to eat as little as possible, or to lose weight as soon as you can. This will just set up an endless cycle of yo-yoing up and down, and getting more and more frustrated with yourself.

You may wish that your natural weight was lower. Most women do, some more intensely than others. You may have to make a choice between trying to fit your body into a size smaller box, or having more energy for life, better skin and less depression and irritability.

When you understand that "I feel fat" is a code for other reasons for not liking yourself, you can become free to develop the parts of yourself that will give you greater self confidence. Ask yourself, "Is my weight the real problem, or is it the way I feel about my weight?" Please learn to treasure your body -- because it's yours.

For more from Tracy visit the website. For community support visit's Food Addicts Posse.