Eating Disorder Therapy

If we're going to talk about eating disorder therapy, we need to engage the question of just what we mean by the word disorder and their related labels. Like so many diagnostic terms, anorexia, bulimia, body-dysmorphic disorder and their ilk have emerged from the obscurity of the Diagnostic and Statistical Manual and into the lexicon of our daily lives. There are variably those who assert that nearly everyone has some manifestation of an eating disorder and those who believe these terms to be over-used.

The topics of eating, disordered eating and relating to our bodies are so much more complicated than knowing what to eat, when, and how much. They have meaning and power and can create secret, sometimes shameful universes within our lives. Thoughts that revolve around food, body and size in a seemingly endless loop are thoughts that are not being used for creating a life you want to live. Therapy can help create new ways of viewing and living in our bodies and with food. Talking about eating, our body and food in therapy can change our relationship with all three.

We believe that eating disorder therapy, or more broadly, the cure for painful challenges with food and relating to our bodies (which is to say eliminating the painful struggle and not necessarily the need to examine and develop how we relate to food and the bodies we exist in—that’s rightly a life-long struggle) needs to go beyond changing thinking and behaviors.

It is only as bodies that we relate to the world and to other people (by way of relating to their bodies, of course). Our experience in our bodies (as bodies, really) is our experience of the world. If there’s a fracture in how we care for those bodies, how we live in those bodies and how we fuel those bodies, that fracture is a relational fracture. If we can heal relationally, be less private in our seeing and evaluating our bodies, the work to change how we see and feel about those bodies will be transformed.

Eating disorders therapy and therapy for teens

It is important to note that adolescence is a time of particular challenge as young people take increasing ownership of their bodies, often not fully equipped to manage the myriad inputs of conflicting ideas about their bodies, their emerging sexuality and discovering healthy ways of relating to food as they make more of their own choices. Teens who seek therapy overwhelmingly need to discuss food, exercise and how they're changing bodies engage the world. Creating a space where difficulties can be explored early, particularly in the context of therapy for teens, can prevent more serious problems related to anorexia or bulimia.

Everyone’s an eating-disorder therapist

We are all amateur eating-disorder therapists--everyone has an opinion--it's talked about all over and yet we're all clearly in so much pain and muck around how we relate to food and our bodies. How about a new kind of conversation?

The fact is, we all eat, and we all have to eat in order to stay alive. Our relationship with food is as primal as anything.

In other words, as with most instances of diagnostic scope creep, the words "eating disorder", "bulemia, anorexia and body dysmorphic disorder obscure the more meaningful parts of the story of eating and disorder, best understood but engaging questions that deepen our understanding beyond the diagnostic labels:

How do you feel about the place of food in your daily life?

What does hunger, feeling full, craving and worrying about food, preparing food or restricting food have to do with how I’m living my life?

What’s the relationship between a desire for healthy eating and emotionality?

Are the ways I attempt to control my diet, exercise and my body working? Is control desirable?

What is the social context of my relationship with food and my body? What function do these issues play in my romantic relationships and in my family?

And, most importantly, How's your life going?

When we shift the conversation around eating disorders away from the categorical, descriptive domain of diagnosis we can begin to examine our own particular relationship with eating, exercise, health, weight and the question of how we see ourselves in physical space and gain space to make increasingly heads-up decisions about what we want these relationships to look like.

So do I have an eating disorder?

No. Yes. Maybe all of the above. We all have eating disorders. There is a seemingly endless catalogue of words to describe the pain so many feel with eating, the ways food and exercise impact our bodies and how we feel about our bodies: under eating, over eating, binging and purging, thin, fat, bloated, skinny, too-skinny, obese, obsessed, and disordered. This is not in anyway to make generic the particular struggles some have with seriously disordered eating, but rather to locate anorexia, bulimia, body dysmorphic disorder and other categories in the broader scope of understanding of problematic issues related to food and our bodies.

Yes, eating disorders can be incredibly painful experiences with serious emotional, physical, and psychological consequences and treatment is important in helping bolster someone’s ability to recover. But someone with an eating disorder usually knows the effects of disordered eating, it is not new information. Pain, anxiety, preoccupation, fear and elation (at times) are often companions on this road.

But what we think many people need to hear is this: You can be comfortable around food. You can live peacefully in your body. You don’t have to be treated like a lab rat to do so. You don’t have to be weighed, prodded, measured.

The Dieting Question. Dieting therapy?

If you want to lose weight, you’ll need to eat less and exercise more in some proportion. If you want to gain weight or otherwise make changes with your body, then you’re going to have to make changes in your diet and how much and in what way you move your body. These may be perfectly healthy and desirable ends (being a good owner of your body means claiming ownership of the decisions you make about what you eat and how you care for your body).

Criticizing dieting is nearly as cliché as dieting itself. For good reason: Rarely does “going on a diet” get carried out in ways that are kind to the very body presumed to taken care of by the diet, not to mention the disregard for emotional self-care.

So why do we suck at dieting? In our New York therapy practice we've come to see two reasons. For one, we suck at making changes in habits. We are saturated with inputs that convey ease and comfort as sacred pillars of a privileged life. Convention says that if it hurts, you’re doing it wrong (or you’re a chump). But of course our bodies are going to be uncomfortable if we restrict our usual intake or make drastic changes in the sorts of food we consume. How could that not be uncomfortable? Moving a body in a manner or with a degree of vigor that it is not used to being moved will cause discomfort for said body. But that’s at odds with our view of what it means to live a successful life. All of which exposes emotional challenges—great fodder for good therapy.

Second, there’s the isolation with which we so often confront challenges related to food. Our bodies, we’re told, are our bodies. We dismiss the fact that moving through the world in space in these bodies we’re in is something we do with other people. How we construct ideas about what’s attractive or not, what’s health or not—these are social experiences. And, of course, eating is a social experience (or ought to be). When forget this, the walls close in and it’s us versus a bag of corn chips, you versus treadmill or the daily battle with the scale. Therapy for eating disorders too often keeps its distance, focusing on thoughts and behaviors, charts and plans, motivation and perpetuation. But in order to develop our relationship with our bodies we need to be close to the inhabitants of the other bodies who are there in the room with us. Otherwise, we’re just on our own.

What if my body just wants to eat and eat and eat?

Fear of hunger is all too normal and justified in a culture that largely supports this fear. Dieting is often a way of reigning in what we think of as a never-ending appetite. However, this is rarely the case. When awareness of hunger and fullness is increased and responded to, our bodies tend to do a very good job at stabilizing our weight. The idea that our bodies can be trusted is a tough pill to swallow and therapy can be a partner in this change.

Does “healthy” mean my body/weight will change?

Yes: It means changing your whole relationship to gaining or losing weight so it becomes more of a real choice—you get to be free of the emotional muck and then you get to decide/ have more choices. Therapy can help create and support adjusting to these changes.

“So we have to talk about… food… again…”

Maybe. Or maybe not. Because maybe it doesn’t have much to do with food really… for some in therapy eating and food is not necessary to discuss because sometimes how we are using food has nothing to do with food. We discover in therapy this is where we will need to collaborate and make a plan together. ­

The Maybe is: Therapy can help in understanding how our eating and bodies became such complicated experiences. This means looking at how our families feel and think and perceive bodies and food. This means exploring the ways we want to alter or change our lives, but changing our bodies is more accessible. This means experimenting with how we eat, move, and sense our bodies. This means exploring how we connect with others, how we take in, digest, or push away people in our lives.

Lets build in therapy a life were you are creating new conversations with eating, your body, and food. Then we will be onto something.

Let’s not lose sight of the critical (creative) questions

The conversation around therapy for eating disorders needs to be bigger than disorders and categories. As fundamental a daily, life-sustaining activity as eating is, we know awfully little about how to do it well. The experts are conflicted about what is best to eat (even reconsidering what was one of the most cherished pillars of modern nutrition, the fear of saturated fat. There are conflicts about what constitutes a healthy weight and how much exercise and alcohol consumption are best. There’s even less understanding of how best to follow through on whatever practice one decides to follow. And of course, completely obscured by all of this chatter are questions about how we might better enjoy our bodies and our meals.

It's time for a new conversation, beyond eating disorders

About fat, thin, sexy, healthy, obsessive, disordered. We need to take the focus off of the overly quantified, categorized, medicalized and picked-and-prodded worry-inducing conversation to one of creatively exploring the beautiful possibilities that can emerge from developing our relationship with the food we eat and the bodies we live in.