Do you feel controlled by food?
Do you obsess about food and weight?
You may be wondering whether you need help because you worry so much about your weight and think about food all the time.
It started with a diet, you wanted to lose a few post-holiday pounds or fit into a favorite dress for a special event. And the diet seemed to work, you lost a few pounds. But then you started craving food, and overeating. You tried another diet, but eventually ended up heavier and more miserable than before.
Or maybe you found you liked the perks of losing weight -- the compliments you got, the way your clothes were roomier -- so you kept on losing weight. It was hard, but you started limiting what and where you ate, begging off of social events so you wouldn't have to eat with other people, thinking more about food, making "food rules" for yourself, but eating less and less. Instead of you controlling food, food was now controlling you.
Maybe you have thought, "It's not that bad. I can lick this thing myself. I just have to try harder."
If these stories ring true for you, your problematic eating may have become an eating disorder. Or if you have witnessed this trajectory in someone you love, that person may have developed an eating disorder. And whether the problem is labelled "eating disorder," or it is simply that you, or someone you love, may have developed unusual food behaviors or weight and body image issues, know that help is available. Food and weight problems are painful, debilitating and life-threatening. Anxiety, depression, perfectionism, low self-esteem, and isolation can develop along with (or precede) the food or weight issues. But I know, from both personal and professional experience, that recovery from an eating disorder is possible. I know that people who suffer from eating disorders can heal, flourish, and develop healthy and fulfilling lives.
If you are the parent, sibling or other family member, your loved one's eating disorder affects you. You can experience pain, distress and confusion. The family dynamics are skewed, and emotions run high. But with the help of a skilled and knowledgable family therapist, you, too, can heal and recover.
If you would like to talk about your concerns, and about whether therapy is right for you, call me at 415-602-1403. I offer a free 15 minute consultation and would be happy to talk with you.
A story of anorexia and recovery
This is the micro-version of my own history of developing an eating disorder and of recovery.
When I was 11, my favorite grandmother died. I was sad and overwhelmed; so too was my mother, her only child. I thought it was my job to take care of my mother and be there for her in every way I could. Meanwhile, I ignored my own feelings -- feelings weren't talked about in my household. I started to focus on my body and food -- in some, not quite conscious, way, I needed to feel in control of something in my life, and controlling what I ate and how much I weighed became my major purpose.
I was more or less a normal sized kid. But I started dieting -- buying diet magazines, making diet concoctions, smuggling oranges into my bedroom when I found the Orange Diet, switching to celery and carrots to follow the Raw Vegetable Diet. I mostly hid my behavior -- I threw away my lunch at school and somehow avoided most family meals. In time, the fact that I was getting thinner became apparent, and my mother took me to see my pediatrician -- this was in rural Illinois, long before "eating disorder treatment" existed, let alone treatment centers. When the doctor threatened to hospitalize me if I didn't gain weight (I heard it as a threat), I got scared -- not scared into improving my eating, but scared into maintaining my weight at a number just above where anyone would be concerned, while pushing all my feelings, body hatred, bad self image and low self esteem underground.
And for way too many years, throughout my teens, college years and twenties, I struggled with controlling my weight. I stayed at a marginally ok weight for a while, but eventually, my weight dropped. And I was miserable -- depressed, anxious, hating myself, feeling like a thorn in the side of society. I was suffering from anorexia nervosa, a serious, life-threatening eating disorder, and I couldn't acknowledge it.
I was one of the lucky ones. A guardian angel at a medical drop-in center recognized that I was anorexic, and recommended that I go to a program for adults with mental health issues. It took me another year of misery before I decided to go there, and even then I didn't acknowledge that I had an eating disorder. I was just anxious and depressed.
But I had to gain weight to stay in the program, and I needed their support to manage my emotional distress. While initially my plan was to lose the weight as soon as I left, by the time I was ready to leave, I was experiencing the benefits of being at a healthy weight: I wasn't cold all the time, obsessing about never being thin enough, trapped between the scale and the mirror, convinced there was something wrong with me (inside) and determined to lose weight.
Many years of therapy and various kinds of emotional support followed -- I still had to heal the scourge of low self-esteem, shame, feelings of inadequacy, and a lifetime of stuffing emotions that I couldn't even identify. But I was fortunate to get guidance in the subsequent years that helped me continue on a trajectory of recovery, where I could be physically healthy, eat normally, have a healthy relationship with my body and manage my thoughts and emotions, have a career, interests, fun, a social life and a good marriage.
It is because of my own history of misery and recovery that I chose to work with people with eating disorders and their families. I can understand the suffering, denial, heartache and despair felt by people with eating disorders. I know their inner world of relentless self-torment. As an empathic and compassionate therapist, I can be the guide that holds the hope and points the way to recovery.
You are not alone
The National Eating Disorders Association estimates that 10% of adults in this country now or at some point in their lives have suffered from an eating disorder. And when one person has an eating disorder, there are 3 or 4 family members or friends who are affected by the problem. Eating disorders have touched the lives of many, many people.
Our culture around food and weight is rife with contradictions and serves as a breeding ground for distorted eating and eating disorders. The media urges us to eat: fast food restaurants abound, billboards proclaim the joy of mega-meals, maxi-burgers and super sized servings. A slim physique with six pack abs is revered, yet over half of Americans are overweight, and half of those fit the criteria for obesity. This craziness literally feeds the diet industry: a multi-billion dollar industry with a 98% failure rate.
Creating a healthy relationship with food in this environment can be a challenge for anyone, let alone for someone who is susceptible to the messages and contradictions by virtue of their own emotional strain, stress, trauma or genetic predisposition to a non-ideal body type. The fact that people develop issues with food -- under eating, overeating, food addiction and life-threatening eating disorders -- is not surprising. Fortunately, sanity can prevail, bad habits can be replaced, food addiction can be treated, and people can and do recover. With support and guidance, you can develop a healthy relationship with food and with your body.
What is an eating disorder?
Someone with an eating disorder uses food in self-harming ways. The most common eating disorders are anorexia (under eating), binge eating disorder (overeating) and bulimia (overeating and purging.) Other patterns can include not eating during the day but eating excessively at night or alternating bouts of overeating with episodes of overexercising. The food behaviors are driven by negative, self-critical thoughts, distorted self image, skewed body image and painful feelings. The person uses food to try to soothe, control or suppress what is going on inside. These self-injurious behaviors are the external signs of an eating disorder, but the inner torment is the source of the problem.
Someone who has severe food conflicts and body image disturbances generally suffers from low self-esteem, harsh self-criticism, feelings of inadequacy and incompetency (often despite high achievement), depression, anxiety and despair. People with eating disorders are plagued by self-hatred and feel uncomfortable living in their own skin. The development of these feelings can be complex, but the reality is very painful.
Obsessing about food, focusing on weight, constantly criticizing oneself for perceived physical and personal imperfections, and using food in self-harmful ways can compound distress and undermine health. These behaviors also rob a person of quality of life. They may become severely anxious or depressed. They can develop physical problems that range from anemia, fatigue, sleep difficulties and chronic digestive problems, to severe dehydration, irregular heart rhythms and heart damage.
When someone reaches a point that they cannot stop themselves from self-harming behaviors and the self-destructive part of their mind has taken charge, they have crossed a line to a serious food disorder. One of the classic definitions of addiction is being out of control and unable to stop using or to stop behaving in self-destructive ways. This criterion holds in the arena of food addiction and indicates the severity of an eating disorder.
How can I decide if I have an eating disorder?
If you have concerns about your behaviors around food, and your mind swirls with negative thoughts about yourself and your body, you may identify with some of the traits listed below. If you have questions, consult with a therapist who understands and works with food and eating issues to help you determine if there is a problem and what to do. Food patterns can progressively get worse and develop into addictive patterns, and these behaviors are more easily arrested before they become severe.
Some symptoms that can occur with eating disorders:
- Increasing concern with weight or body size and shape
- Frequent negative comparison of your body to others' bodies
- Pronounced weight change, especially over a short period of time
- A change in eating patterns, as when a “fad” becomes a habit
- Isolating or avoiding family or social meals
- Significant worry about food ingredients, especially fat and calories
- Obsessing about food
- Feeling out of control with eating or exercising
- Eating when alone, and then feeling guilty or ashamed about it
- More frequent or more severe bouts of anxiety or depression
I would be happy to talk with you about any concerns you have. Please feel free to call me at 415-602-1403. I offer a free 15 minute consultation.
Can emotional eating develop into an eating disorder?
In some people – with sufficient stress, inner conflict and pain – eating for emotional reasons can develop into an eating disorder. The person who at first decides to use food, dieting or exercise to feel better becomes compelled to diet, overeat or exercise. What was a choice becomes a compulsion. The emotional pain becomes worse as the person feels more out of control. The obsessive, self-critical thoughts and self-harming behaviors get increasingly more difficult to manage. As thinking patterns and behaviors become entrenched, recovery becomes more challenging.
No one “chooses” to have an eating disorder. And people who have eating disorders also can’t simply “choose” to stop having an eating disorder. When someone has an eating disorder, they are no longer able to control their food behaviors.
People with eating disorders often feel shame and despair. They may not admit they need help because it seems like they “should” be able to fix the problem. They may blame themselves both for having the problem and for not being able to overcome it. An ever more vicious cycle of self-blame gets added to whatever emotional or self-esteem issues, or other internal and external stressors, caused the original pain and discomfort.
If you or someone you love has a problem with food or weight, do not hesitate to get help. The earlier you get help, the sooner recovery can begin.
What Causes Eating Disorders?
Eating disorders are complex in origin. An interplay of cultural, biological, psychological and emotional factors contribute to their development. No one situation or event causes an eating disorder.
Our culture contributes to the development of eating disorders. We live in a society with distorted values around food and body image. We have an abundance of food, and a media that encourages us to eat. Many of us lose sight of the original function of food: to satisfy physical hunger and give our bodies fuel.
In addition, our culture idealizes a female body type that few women are genetically programmed to attain. We develop unrealistic expectations of how we should look. If we feel bad about ourselves, it may seem like changing ourselves on the outside will make us feel better about ourselves inside. Some of us get caught in the trap of controlling food and weight to try to look like we think we should look.
Men, too, develop eating disorders. Men are pressured culturally to have an ideal physique -- slim but solid, muscular, well-toned. Men, too, deal with unrealistic societal expectations and the scourge of "not fitting in"or being "not good enough." For men, food or exercise can offer the illusion of control to deal with emotional stressors and life's inequities.
Some people are more susceptible to eating disorders simply because of their innate biological makeup. Certain personality traits seem to be more prevalent in people with eating disorders. These include perfectionism, problems handling change, difficultly expressing feelings, and needing to please others. Of course, not everyone who has these traits develops an eating disorder.
Recent studies have shown that eating disorders can run in families. Genetic research has identified a couple of specific genes that are markers for susceptibility to eating disorders.
Brain physiology also plays a role in vulnerability to eating disorders. Brain imaging studies have shown that people with eating disorders have lower than normal levels of some neurotransmitters. Neurotransmitter imbalances can make someone more prone to anxiety or depression. These moods are common in people with eating disorders.
We think about ourselves and others based on numerous interactions we have with other people throughout our life. We influence and are influenced by immediate and extended family members, authority figures, friends and peers. Some people who are vulnerable to eating disorders are more prone to feeling insecure and bad about themselves, or see others as more competent or more deserving than they are. They use food or focus on weight to manage uncomfortable thoughts about themselves and how they fit in the world.
Mood disturbances or difficulty handling feelings can make it harder for someone to cope with stress and to express feelings. People who develop eating disorders are often stressed and overwhelmed by feelings they don’t know how to handle. They focus on food or weight to control and manage their discomfort and pain.
Difficult situations can bring up intense feelings that a person vulnerable to an eating disorder may find unmanageable. They may feel overwhelmed by sadness, anger or hurt from a breakup with a boyfriend or partner, grief and depression following the death of a loved one, or anxiety and fear about a new school or job. And sometimes they may have experienced trauma – from a car accident to an addiction or mental health problem of a close family member – that adds to the emotional overload. Food can become a source of comfort or a way to suppress painful feelings.
An eating disorder can begin when someone uses food as a way to feel better and to cope with painful thoughts and feelings. But using food as a way to manage emotions is progressive. It can become a habit that the person can’t stop.
I am the parent of a teen with eating problems -- what can I do?
What parents of teens need to know about eating disorders:
Teenagers are more susceptible to eating disorders than any other segment of the population. While girls are more prone to eating disorders than boys, boys, too, develop eating disorders. The National Institute of Mental Health estimated in March 2011 that as many as half a million teens have had an eating disorder . Furthermore, many of these teenagers never get help. Emotional eating and eating disorders are progressive. Eating disorders can lead to more serious physical and psychological problems, and they are life-threatening. Among females age 15 to 24, twelve times as many die from eating disorders than from all other causes combined . Early intervention is essential.
Teens often have erratic eating habits and heightened concerns about appearance. However, if your teenager exhibits unusual, exaggerated or obsessive behaviors around food or weight, or a significant change in mood or a tendency toward isolation, it is important to take note. If you suspect your teen has a problem, do not ignore your concern. If you can, express your concerns in a calm, understanding, empathic and non-judgmental way. If you don’t know how to talk with your teen about your fears, please don’t hesitate to call me to get help with how to do that.
If you are a mother or caretaker of a teenage girl, I also invite you to get a copy of my booklet, Tips for Mothers of Daughters with Eating Disorders, available here. Mothers can use these tips to begin making sense of what their daughters are going through, and to help their daughters and themselves.
Treatment of teens:
Eating disorders have physical, emotional and psychological components, and effective treatment must address all of these aspects. Initially when someone calls me, I will set up a meeting to talk about their concerns. We will talk about what they see as the problem, what they would like to change, and what scares them about changing. We will discuss how we can better understand what is going on, and what can help. We will talk about medical, nutritional, and other kinds of support in the recovery process. We will discuss bringing in other family members.
When the parent of a teen calls, I will set up a meeting with the parents first. After exploring the parents’ concerns, I will meet with the teen and the parents together. We will decide how to address the problems, both for the teen and for the family who is trying to help their son or daughter. Eating disorders, especially in teenagers, require family involvement and support.
What if my loved one shows signs of eating problems?
If your spouse, partner or significant other exhibits unusual eating patterns, yo-yo dieting, or self-harming eating behaviors, you can talk with a therapist well-versed in the treatment of food and weight issues about your concerns. You need to be able to express your own feelings in a safe place and to learn about eating disorders. You can get guidance about how to treat your loved one with empathy and understanding and how to manage if your loved one is not open to hearing you or does not respond to what you say. Couples in a relationship which is stressed by food or weight issues can benefit from working with a couples or family therapist who specializes in eating issues. A therapist can help you communicate your fears and concerns to each other and help you sort out what each of you needs, how each of you can support the other, and how to preserve trust, love and respect in the relationship.
What if the person I am concerned about won't get help?
Sometimes a loved one has a problem with food, but refuses to get help. Often the person doesn’t recognize the severity of the problem, or realize their behavior has progressed to an eating disorder and become an addiction which they can't control. They also may not realize the impact their eating problem is having on others, or the level of concern others have about them. In these cases, it can be helpful to enlist the help of an interventionist. A skilled food addiction interventionist can help guide and educate all family members in understanding what they can and cannot do and how best to interact with their loved one.
An intervention is a process in which loved ones come together to explore and discuss the situation. An intervention is not a surprise capture of a person with a problem who is then escorted to treatment against their will. It is an opportunity for everyone who is affected to learn more about eating disorders and about how their loved one's eating disorder has impacted them and their lives.
An eating disorder, like other addictions, develops within the family dynamics, and the resolution generally must occur within the family as well. As family members get clear about what they can and can’t do to help their loved one, and how they can help themselves, they can prepare to meet and talk with their loved one who is suffering from a food addiction. The person with the food problem is invited to join the discussion. An interventionist can then guide family members and friends to express, with respect and compassion, their love and concern, their loss and their fear, and the limits of what they can tolerate in witnessing their loved one’s self-harm. The food addict can similarly express their thoughts, fears and other feelings, both about themselves and their family members. While there is no guaranteed outcome from an intervention, the process is educational for everyone present and clarifies many things that have been unsaid. Sometimes when someone suffering from food addiction understands not only the depth of their problem, but also the severity of its impact on their relationships with others, they are willing to get the help that they have refused before. Other family members. who perhaps previously had not realized the depth of their own suffering, may choose to seek further help.
As an Eating Disorder Specialist, Licensed Marriage and Family Therapist and Certified Intervention Professional, I have over thirty years of experience helping families with food problems recover and flourish. I am dedicated to helping each family member, and the family as a whole, heal and grow. I am available to answer any questions you have about the process and goals of an intervention.
If you have questions about yourself or a loved one, please call me at 415-602-1403. I offer a free 15 minute phone consultation and would be happy to talk with you.