Questions…most frequently asked about eating disorders.  

What are Eating Disorders? Anorexia Nervosa (self-starvation), Bulimia (eating/binging and forcing oneself to rid the food by vomiting, laxative abuse or exercise) and Compulsive Eating (frequent overeating when one is not hungry, "grazing" from food to food or eating large quantities of food in a short period of time, usually when alone) are complex psychological conflicts, including conflicts in family relationships, self image and self-esteem; struggles with negative emotions (like anger, jealousy, shame); or physical, sexual or emotional abuse. The typical thinking for an eating disorder sufferer is, "If I am thin, then I will feel OK about me."

How can you tell if you or someone you know has an Eating Disorder? Often it is difficult to tell because a person can hide the symptoms for a long period of time. Typically, the person with an eating disorder will exhibit rigid behavior around food, like eating the same food everyday in the same quantity, after eating disappearing into a bathroom to vomit, obsessively counting calories or fat grams, or refusing to go out to a restaurant due to a lack of knowledge about how the food is prepared. Other signs include a person who frequently talks about feeling fat, someone who will eat very little in public but will binge when alone, someone who will avoid situations due to feeling fat, or someone who will not attend a social or other event if it interferes with an exercise schedule. Often eating disordered individuals determine how they feel by what they weighed or ate on a particular day.

Why does someone with an Eating Disorder want to hide it? Often a person with an eating disorder feels ashamed. People with eating disorders have very high expectations of themselves, and are perfectionistic and intolerant of negative emotions in themselves. Having people find out about the eating disorder often makes sufferers feel that others will judge them the way they judge themselves. The eating disorder symbolizes that the person is not perfect and represents a way to hide aspects of oneself that feel intolerable. A goal in treatment is to help sufferers become more tolerant of their imperfections and to become more accepting of their negative emotions. Recovery is about acceptance.

Why is compulsive eating and obesity often overlooked in the literature on Eating Disorders? Compulsive eating and obesity are serious eating disorders that are caused by psychological conflicts just like Anorexia and Bulimia. The individual turns to food to cope with, as well as to escape from, difficult feelings and uncomfortable situations or relationships. Medical complications like diabetes, hypertension, edema and reproductive problems are linked to excessive weight gain. It can be difficult for someone with graze eating or binge eating to acknowledge the problem and to ask for help. In a society where overeating and excess weight is equated with negative characteristics, such as lack of self-control and laziness, it becomes easy to understand the shame associated with admitting these problems. Typically, the person will exhaust many fad diets and weight loss programs before seeking out an eating disorder approach to treatment. Obesity and being overweight, however, may also be a result of a medical condition that is unrelated to an eating disorder.

How long does it take before serious medical problems emerge? This is a difficult question to answer definitively. Some individuals develop medical symptomatology soon after the eating disorder develops. Others do not face illness until many years into the disorder. Some never suffer profound or lasting medical consequences, however, the emotional damage is great for anyone who has an eating disorder. Some of the medical symptoms are loss of or irregular menses, which can lead to hormonal and reproductive problems; bone density loss due to severe weight loss; cardiac problems, which can lead to death; sodium and potassium deficiencies; chronic bloating and gas; and gastrointestinal disorders often brought on by vomiting or laxative abuse. Physicians must become part of the recovery process. The types of physicians most commonly consulted during treatment are internists, gastroenterologists, gynecologists, pediatricians and, sometimes, cardiologists. Dental care should also be given, particularly when dealing with a Bulimic individual due to tooth decay from continual or long-term vomiting.

Is it OK to be thin and healthy? Certainly: you can be thin and healthy. "Healthy" can be difficult to define when it comes to eating disorders, as even very thin persons can have "normal" physical exams. Physically healthy persons are not anemic, and they maintain regular menstrual cycles (in females). Truly healthy persons have balanced nutrition—including all the necessary vitamins, minerals, and dietary fats. In an American culture centered on a narrow definition of body image, healthy individuals can allow themselves to have a full range of foods, including desserts. Healthy exercise fits into one's life rather than life fitting in around one's exercise regimen.

Why are diets so harmful? Diets tend to advocate restriction and are short-term focused. They support the rigid, black and white thinking that maintains the eating disorder—for instance, that there are "good" and "bad" foods. This extreme thinking contributes to why a person who loses weight will put it back on shortly after reaching the goal. Eating disorder recovery focuses on eating for life, and on dietary balance. While sufferers learn to dispel the notion of good and bad foods, they likewise learn to dispel the notion of good and bad feelings.

Can you be psychologically Anorexic? Chronic thinking about food, fat grams, calorie counting, and rigid restrictions around types and portions of food are one way to suspect a problem. Other "emotional" anorexics exhibit extremely perfectionistic standards toward themselves and toward others; and they are self-critical and overly concerned about appearance and having people like them. Even if weight is normal, these psychological aspects of anorexia can have a severe impact on one's ability to function socially, in school or at work.

Do boys and men develop eating disorders? Yes, although the percentage of male-to-female eating disorder sufferers is about 10 females to every one male. Just as girls use eating disorders to express their own internal dissatisfaction and conflicts, boys can do the same. The pressures on females to be thin and boys to be muscular and thin provide an arena for eating disorders to develop.

Are Eating Disorders difficult to treat? Yes, eating disorders are difficult to treat. Recovery is generally a long-term process. The longer someone has had an eating disorder, the longer will be the time necessary for cure generally. Commitment, expertise and knowledge; a multidisciplinary approach; a willingness on the part of the individual to recover; truth in the treatment process; and a non-judgmental approach are all necessary components for a successful recovery. 

How do you treat eating disorders? Eating disorders are treated by incorporating several different approaches and modalities. Psychotherapy focuses on individual and familial conflicts. Cognitive/behavioral treatment focuses on how the disorder interferes in daily living and the behavioral steps necessary for lasting change. Medical intervention deals with resulting symptomatology. Nutritional counseling, group psychotherapy, and psychoeducation about the cause and function of eating disorders are also components of a well-organized recovery program.

Can there be lasting cure? Yes, although recovery is usually a long road involving many ups and downs. Merely treating the symptom does not guarantee recovery. Understanding what caused and maintains the eating disorder, taking responsibility for one's behaviors and being an active participant in treatment are essential to the recovery process. Developing self-esteem and acknowledging one's limitations are signposts along the road to recovery. Identifying, experiencing and expressing a range of emotions—without turning to or away from food—in conjunction with a return to normal body functioning are necessary criteria to be considered cured.

When is hospitalization necessary? Appropriateness for hospitalization is assessed on an individual basis. Some individuals require hospitalization immediately due to severe weight loss or other medical symptomatology, like cardiac problems, severe dehydration, and gastric disorders. For others, worsening symptoms over a period of time, especially ones that interfere with daily routine such as schooling and working, despite outpatient efforts, indicate a need for hospitalization. Depression and suicidal thinking are not uncommon and may require immediate hospitalization.

How do you help someone with an Eating Disorder? The most important rule to remember is that eating disorders are about profound psychological conflicts that ultimately have little to do with food. Food is the vehicle through which the conflicts are expressed. The individual "hangs on" to the Eating Disorder because it actually works to solve—though in a maladaptive way—uncomfortable feelings. It is recommended that family members and friends of the sufferer confront the disorder directly: no hiding or skirting the issue. Urge the person to get help immediately; or contact medical, psychological or school personnel yourself if the person is not yet willing. Remain supportive, but firm. Read about the disorder. Do not criticize or shame the individual. Once the sufferer has begun treatment, do not talk about food and eating, but focus on how the person is feeling. Try not to engage in the struggle around food. Until a person is ready to face the psychological issues and take responsibility for recovery and life, focusing on the struggle around food will remain a battleground where the sufferer will likely seek to defeat your efforts.