Disordered Eating

According to Canadian statistical databases, disordered eating is among the most prevalent mental health issues in the country. At any given time, there are between 600,000 and 1,000,000 people suffering from an eating disorder, and 80% of these are female bodied people. Disordered eating has a very wide range of styles and severities, and it often happens in secret. Unfortunately, at its most severe, this hidden suffering can cause serious impairment of physical and psychosocial functioning, including long term biological consequences and even death. 

If you are currently in crisis, please call or text the BC Crisis Centre at 1-866-661-3311.

The good news is that disordered eating is treatable. There are a variety of evidence based approaches and numerous medical programs available for patients with severe needs. Because eating disorders affect both the mind and the body, a multidisciplinary approach is often recommended. At Nightingale, we are one of the only group psychotherapy practices in Vancouver that is connected directly to a variety of affinity practices including dieticians.

By using a combination of counselling therapies—including traditional talk therapy as well as more embodied practices—and connecting your care with dieticians or doctors as needed, healing from disordered eating is possible.

Disordered Eating, or an Eating Disorder?

In this article we use the phrase “disordered eating,” or “experiences of disordered eating” instead of the more common (and less of a mouthful!) phrase, eating disorder. You might be wondering why.

The cornerstone of the approach we take at Nightingale is non-pathologizing. What that means is that we don’t take the big leap of declaring a person “sick” or “ill” just because they have particular experiences, behaviours, thoughts or emotions. Instead, we recognize that “the problem is the problem, the person is not the problem.” So, in this case, the problem is not you, it is an experience with disordered eating. 

 When we say “you have an eating disorder,” it changes how we view the problem. That sentence implies that this is something you “have,” that it is a part of who you are and what you are. We don’t believe that to be true. So, throughout this article we do our best to reject that very idea by not using the phrase eating disorder, in preference for re-framing the problem as a verb—not a part of your identity, but something that happens in your life. Lorem ipsum dolor sit amet, at mei dolore tritani repudiandae. In his nemore temporibus consequuntur, vim ad prima vivendum consetetur. Viderer feugiat at pro, mea aperiam

Biopsychosocial Approach

Disordered eating at its root is a complex and interwoven set of motivating causes and compulsive strategies and behaviours. It is tempting to wonder “What is wrong with the person?”, but the complexity of these disorders tells a different story. Talk therapy for disordered eating must go beyond merely looking at individual psychology and behaviour. Instead, there must be a three-way focus on the biological and physiological aspects, the psychological aspects, as well as the sociocultural influences, each of which play roles in both the development and sustenance of disordered eating.

Gender

Part of the sociocultural story is evidenced by the fact that 80% of eating disorders in the clinical environment are with girls and women. Adolescence and the teenage years are a common time for development.

In recognizing this, it is important for both Counsellors and clients to explore the meaning behind such a stark gender gap. By acknowledging the role of our wider culture, we are able to shed light on some of the factors which influence the development of this disorder. The gender gap suggests that it is not merely a syndrome that is generated from within, which is to say that it is not entirely psychological.

Unfortunately, our culture makes a variety of very specific claims on women’s bodies, many of which become apparent as female bodies begin to develop after puberty:

●     your body is not your own

●     thinness is beautiful

●     woman’s worth are in their appearance

●     the male gaze is the only important perspective, and it is the way in which you should see yourself

These are harmful and degrading beliefs, which are interwoven into parts of our culture, as seen in movies, magazines, and commercials, and often replicated in school yards and beyond. Confronting eating disorders asks Counselling Therapists and clients to investigate how these (or other) beliefs may have influenced relationships with food.

Severity

At its most severe, disordered eating can lead to extreme situations. The most severe subtype is called Acute Anorexia Nervosa, and at this level of severity hospitalization is required: patients experience a dangerously fragile body, with most major systems—blood, bowels, bones, muscles—all in a severely weakened state. This can lead to downstream health complications and even death. If you, or someone you know, is in this condition, it is important to seek medical help. 

Fortunately, most cases of disordered eating are not this severe. In fact, there is an incredibly wide range of behaviours that constitute disordered eating. Perhaps surprisingly, not all instances of disordered eating lead to underweight bodies. Less severe eating disorders are treatable in traditional, multidisciplinary settings, and do not require more intense medical interventions. 

Categories of disordered eating

There are four major diagnostic types of disordered eating: 

Anorexia

characterized by highly restricted eating patterns and weight loss

Bulimia

characterized by binges followed by corrective behaviours such as purging, excessive exercise, and the use of laxatives

ARFID (Avoidant Restrictive Food Intake Disorder)

characterized by highly selective or disinterested (“picky”) eating to the point of distress

BED (Binge Eating Disorder)

characterized by binge eating WITHOUT the purging behaviours associated with bulimia

Although it can be helpful to name these different subtypes, it’s important to understand that, like with most things, these are not exact categories. People with anorexia may purge. People who binge may not binge all of the time. 

 Perhaps what’s most important is to note that the disordered eating falls into extremes of either restriction or “binging,” including oscillations between the two. Many people with disordered eating will have particular and idiosyncratic patterns. 

Experiences with Eating Disorders (disorder eating)

Although the primary fear related to eating disorders is dramatic weight loss (or gain) to the point of health complications, this is not the only distressing quality of disordered eating. Beyond the physical symptoms, there are a host of psychological and emotional challenges that people with disordered eating may experience.

Some of the psychological and emotional components might include:

●     feelings of inadequacy

●     shame and guilt

●     the need to hide, to not be seen, including avoiding events, gatherings, classes, etc.

●     a sense of life or death desperation tied to food and one’s body

●     self criticism, self loathing, or self hatred

●     obsessiveness

And on top of this, for many people, these behaviours are held in silence and secrecy, a strategy that means suffering from disordered eating often means suffering in solitude. 

Starting Therapy

For many people, approaching treatment can be a frightening experience. It is essential to recognize that a therapist will not tell you what to do but, in fact, will do the opposite. The goal of therapy will be to discover the roots of behaviours that you have decided are misaligned with your own goals or your own sense of healthfulness. A therapist will not dictate to you what you must do with your body, what you must start or when you must start. Critically, disordered eating is about staking a powerful claim to the control of the self. The Counsellor’s job is to help to provide the space where the client can expand that sense of healthy control beyond the narrow bounds of what the client allows in and out of their body. 

Therapy begins by creating a space for conversation that is safe enough for you to begin naming your experiences and receiving the support you deserve. Therapy begins in safety and acceptance, so that you can explore what’s underneath these behaviours towards regaining a deeper feeling of ownership over who you are, what you do, and why you do what you do. A feeling of ownership built through understanding and self compassion that allows you to decide for yourself what kind of relationship to food, eating, and your body feels best for you.

Treatment for Eating Disorders

Treatment for eating disorders should consider severity. In the most severe cases it is vital that a doctor be involved. Stabilization is key to a successful course of therapy, and this is the first step when the downstream health consequences of disordered eating have occurred.

For most clients, however, Counselling Therapy can be an enormous source of support and change. An eating disorder focused therapy should consider some of the following:

●     the core beliefs which influence your relationship to your body, eating, and food

●     feelings of control, trust, and resistance/rebellion 

●     the degree of either embodiment or dissociation from natural sensations like hunger and satiation

●     behavioural patterns, compulsions, or rituals associated with restrictions or binges and any corrective strategies (like purging or exercising)

●     the sense of self that accompanies different parts of the eating cycle

●     the emotional and relational influences and consequences

Which type of therapy is best?

Perhaps the most widely researched therapy treatment for eating disorders is cognitive behavioural therapy (CBT). One of the reasons for this is that CBT is easy to research! It is important to remember when seeking out therapy for anything that the single most important factor in the success of the therapy is not the type of therapy but the connection and relationship between the client and the therapist.

There are a variety of evidence-based approaches to eating disorders beyond CBT, including psychodynamic therapy (e.g. traditional talk therapy), as well as more emotional and relational approaches. Because disordered eating is so complex, it benefits from a therapeutic approach that is capable of investigating the wide variety of factors: cognitive, behavioural, emotional, relational, social, physiological, and somatic (embodiment). 

What is the outcome of therapy?

The outcomes of successful treatment may look different to different people. However, in general it can be useful to look at a few:

●     reconnection with natural bodily sensations like hunger and satiation

●     a sense of trust in the self instead of doubt, suspicion, discipline and/or control

●     challenged beliefs about what it means to be acceptable to people and the world

●     a renewed sense of agency (not control) over one’s self

●     less effort, intensity, obsession, or time spent in regards to eating

●     reduced need for silence, secrecy and hiding, and thus reduced isolation

 Eating disorders have a wide range of severity, and at their most serious can be among the most dangerous “mental illnesses.” But they are treatable, and that is why it’s so important to seek help if you have noticed these patterns in your own life.