Eating Disorders are psychiatric conditions. Those with these disorders experience problematic relationships with food and body image. Learn more about the different struggles people face as well as the therapy for eating disorders that Lauren provides, below.
ANOREXIA NERVOSA (AN)
Anorexia Nervosa (AN) is one type of eating disorder. People with AN limit the amount they eat, and, as a result, have a low body weight. They are also afraid of weight gain and, by and large, refuse to gain weight. Thinness is central to these individual’s self-evaluation. Because of this, people with AN fixate on their weight. In addition, their skewed perception often leads them to believe they are living larger bodies. Because of this, individuals with with the disorder may not even think that they need to gain weight.
Meanwhile, people with AN often receive praise for their low weight. This, likewise, makes those with this mental illness more reticent to gain weight. Most of those with this eating disorder also do not recognize how serious their condition is. This also encourages their desire to maintain an unhealthy weight. When taken together, these factors often make these people resistant to getting help. All told, they often like a great deal about their disorder in spite of its drawbacks.
There are two types of AN:
- Restricting type involves a range of behaviors, for example: dieting, fasting and excessive exercise.
- Binge-eating/purging type involves purging behaviors, like self-induced vomiting or laxative abuse, after binges.
Even though the binge-eating/purging type sounds like Bulimia Nervosa, there is one key difference. Namely, those with Bulimia have a more “normal” weight than those with AN.
THERAPY FOR ANOREXIA NERVOSA
An Intuitive Eating approach is ultimately part of recovery for those with AN. To start, though, those with AN follow structured meal plans to restore a healthier weight. This may include a meal plan or the use of a food exchange to begin with.
In addition to Intuitive Eating, CBT-E is an evidence-based therapy for Eating Disorders. Like Cognitive-Behavioral approaches generally, CBT-E considers the function of behaviors. Thus, in this case, the focus is on understanding what causes and maintains Eating Disorder behaviors. In order to help those with AN gain awareness, CBT-E makes use of behavioral logging. In treatment, people consider how much importance they are giving to weight. More often than not, people with AN measure there worth based on a limited number of categories. As stated above, these individuals also place a lot of their self-worth on their weight. Therefore, it is important to explore other categories considered in self-evaluation and the amount of importance placed on each. For many with AN, moods also impact their behaviors. Therefore, learning how to manage feelings can be part of CBT-E.
Bulimia Nervosa (BN) a involves episodes of binge eating followed by compensatory behaviors such as self-induced vomiting, laxative abuse or excessive exercise. Binge eating involves eating large quantities of food in a short period while experiencing a lack of control. Clinicians diagnose BN when a person repeats these behaviors over time and the actions cause distress and impairment in their life. There are some similarities between the Binge-eating/purging subtype of Anorexia and BN, in that both involve bingeing and purging. The main difference is that those with AN are underweight according to they Body Mass Index (BMI) and those with BN are in an average weight range given their age and height.
THERAPY FOR BULIMIA NERVOSA
Intuitive Eating is used to support those with BN in disengaging from binging behaviors. Given that much of binge eating is as a response to external restrictions people internalize, giving yourself unconditional permission to eat foods is integral to recovery. Simultaneously, trying to maximize overall satisfaction is a powerful tool for those who have historically assumed that eating as much of a food as possible will result in satisfaction. Once binges subside, individuals no longer feel compelled to address their discomfort through compensatory actions, like purging. What’s more, learning to respect your body – which is one of the principles of intuitive eating – supports individuals with this disorder in making the choice to practice kindness rather than harming themselves through purging.
CBT-E is also used in the treatment of BN. Regular eating is an important element of treatment for Binge Eating. Regular eating prevents excessive hunger. Restriction, on the other hand, leads to extreme hunger and often leads to binges. Through CBT-E, individuals are taught the relationship between over-evaluation of weight and shape, restriction, binging and purging so that they can intervene in the cycle. Through this treatment, people with BN also learn to diversify the elements that compromise their self-evaluation. This is particularly important as those with the disorder usually over-emphasize the importance of appearance in the way they appraise their worth.
BINGE EATING DISORDER
Binge Eating Disorder (BED) is similar to Bulimia Nervosa, but does not involve compensatory behaviors. When people with BED binge, they do feel the same lack of control as those with Bulimia do. A number of behaviors surface as a part of BED, for example eating in the absence of hunger, experiencing extreme fullness, hiding eating due to embarassment and shame, and feeling guilty or disgusted in the aftermath of a binge.
THERAPY FOR BINGE EATING DISORDER
Intuitive Eating helps those with BED in having a healthier relationship with food. First, those with BED must give themselves permission to eat all foods. This may seem strange given that those with BED tend to eat all sorts of foods. The reality is that those with BED still negatively judge their food choices. While they eat all sorts of foods, it is not with their “permission.” Thus they vacillate between being “good” and eating healthy foods or being “bad” and overeating unhealthy foods. So much of the work here is to learn to make space for all foods at the table.
Once all foods are allowed, individuals cease cramming in foods that they enjoy but “shouldn’t” eat. They start to actually listen to their hunger and fullness cues in order to optimize their overall satisfaction. It doesn’t take long for people to appreciate that the experience of eating past fullness is unpleasant and isn’t worth the enjoyable tastes associated with overeating.
CBT-E is also central to the treatment of BED. As with Anorexia and Bulimia, CBT-E for BED focuses on understanding the mechanisms by which binge eating is triggered and perpetuated. Thus, a main focus of treatment is regular eating. In CBT-E, people also learn to cultivate other aspects of their lives that they believe are more important than weight and shape. For those with BED, this shift of focus can help people to prevent the dietary restraint that often precedes binges. Shifting priorities helps to limit binges indirectly.
While not yet a formal diagnosis unto itself in the DSM, Orthorexia is becoming increasingly prevalent as the idea of “clean eating” gains popularity. Orthorexia involves rigidity related to eating “healthy” or nutrient-dense foods. Of course, there is nothing inherently wrong with attempting to infuse your eating with a fair dose of nutrition, but those with Orthorexia become fixated on rules related to what foods are and are not acceptable, resulting in upset and life challenges.
THERAPY FOR ORTHOREXIA
Cognitive Behavioral Therapy (CBT) and Exposure and Response Prevention (ERP) are both used to treat Orthorexia. The cognitive part of the work involves learning about faulty thinking patterns. Awareness of these patterns helps people to spot them in action. For instance, many people with Orthorexia engage in all or none thinking, seeing food as either “good” or “bad.” When they recognize their thinking is flawed, people have the space to choose whether or not to let these thoughts influence their actions.
Mindfulness can also be helpful in treating Orthorexia. By viewing thoughts, feelings, urges and sensations non-judgmentally, people can learn to be in the presence of these internal experiences. That way, the thoughts, feelings, etc. don’t get to control how the person lives. Mindfulness practice can also support people in dropping rumination, in this case around food, so that less of their headspace is consumed with trying to control what is eaten.
Exposure and Response Prevention (ERP) is the behavioral part of CBT . This involves exposing oneself to avoided foods and learning how to tolerate the discomfort associate with eating these foods. This is done at the individual’s pace.
AVOIDANT RESTRICTIVE FOOD INTAKE DISORDER (ARFID)
ARFID involves food-related fears, a disinterest in food or a sensitivity to the sensory aspects of food that results in nutrient deficiency, weight loss or being underweight, dependence on supplements or feeding tubes, or interference with psychosocial functioning.
THERAPY FOR ARFID
Research supports the use of Cognitive Behavioral Therapy (CBT-AR) in the treatment of ARFID. CBT-AR includes a specific type of behavioral therapy known as Exposure and Response Prevention (ERP). In treatment, those with ARFID learn to slowly but surely face the foods that they’ve been avoiding. While facing the foods they’ve avoided, individuals with ARFID learn to refrain from safety behaviors. That is to say, people with ARFID practice eating without asking for reassurance or over chewing foods.
OTHER SPECIFIED OR UNSPECIFIED EATING DISORDER
AND DISORDERED EATING
Not everyone who has an eating disorder fits neatly into one of the categories above. Some people may restrict significantly without being underweight. Some people purge in the absence of binges. Just because your experience isn’t perfectly depicted by one of these diagnoses doesn’t mean that you shouldn’t seek out support or treatment for an issue that is negatively impacting your life. People who still have clinically significant distress and impairment as a result of their relationship with food may meet criteria for Other Specified Eating Disorder or Unspecified Eating Disorder.
More than that, you can seek help and support at the earlier stages, before your relationship with food turns disordered. If you have a lot of noise around food, your challenges and struggles are valid and deserve attention. You can click the links that follow to learn more about therapy for eating disorders including Intuitive Eating and CBT-E.
INTERESTED IN THERAPY?
Are you or a loved one struggling in relation to food and looking for help? Lauren uses , Intuitive Eating, Cognitive Behavioral Therapy and Acceptance and Commitment Therapy to support those with eating disorders. You can learn more about the treatments and services she provides here.
Lauren is a licensed psychotherapist in
several states. Learn more about where
Lauren sees Clients, below.
When she is offering face to face, Lauren does in-person therapy in Newport Beach. She also provides online therapy for eating disorders throughout California. Her Clients span from San Francisco down to Southern Orange County and San Diego.
Lauren provides treatment for eating disorders in the state of Utah. Since she provides teletherapy, she works with people who live in different areas of the Beehive State – from Salt Lake City and its suburbs, like West Jordan, Syracuse, Highland and Riverton, to Park City and St. George.
Lauren also offers therapy for eating disorders online in Florida, and sees people from all corners of the Sunshine state. Whether you’re from Naples, Orlando, Miami, or Boca Raton, Lauren can provide specialized counseling remotely in your area.
Lauren also practices teletherapy in Arizona. If you’re seeking help in Phoenix, Sedona, Scottsdale or Tucson, Lauren offers specialized therapy for eating disorders online across the Grand Canyon State.
In addition to all of the locations previously listed, Lauren offers teletherapy for eating disorders to a number of countries internationally.
Online therapy isn’t right for everyone. An assessment must be done to determine if online therapy is appropriate for your needs. You can reach out here to learn more
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©2021 by Lauren McMeikan Rosen, LMFT.
Disclaimer: The information contained on this website is intended for informational and education purposes only and is not meant to be a replacement for therapy. If you are interested in treatment, you can email me and I will happily provide you with more information