Living with an Eating Disorder can feel like trying to swim upstream while simultaneously trying to stay afloat. You are likely spending your days preoccupied with your body, the foods you are consuming, and feelings of emptiness and loneliness. Counting calories, daily weighing, constant negative self talk, and never feeling like you are enough is exhausting!
Additionally, Eating Disorder behaviors are often masked with secrecy leaving you to feel even more isolated and alone. Overall, struggling with an Eating Disorder is not only physically draining, but emotionally and mentally as well.
Parting ways with your Eating Disorder can feel scary, especially if it’s been your primary way of coping for a long time. In the beginning of your healing journey, it might feel as though you are losing control of the very thing that has provided you with safety and comfort. In reality though, when you are living with an Eating Disorder, you really aren’t in control at all because you are controlled by your behaviors. At Cityscape Counseling we want you to know that there is hope for your life to look different and that recovery from your Eating Disorder is attainable. While the treatment process is hard work, the end result is so very worth it.
Perhaps you’re not quite sure if what you’re dealing with would be classified as an Eating Disorder. You may be aware that your relationship with food and your body is not “normal”, but you also may feel lost on how to change or where to even get started.
Whether you are ready to change, thinking about change, or just concerned about your relationship with food and your body, starting therapy is the first step in taking care of you and getting back on the path to a life that is worth living. Our Eating Disorder therapists at Cityscape Counseling have collectively helped thousands of individuals struggling with disordered eating and body image concerns drawing on our many years of experience treating Eating Disorders both at Cityscape Counseling and in our roles at various treatment centers across Illinois.
As licensed therapists, we will meet you where you’re at and work alongside you to help you progress towards living your best life - a life that is free of the chains of food and body obsessions.
In a collaborative effort, we will help you:
-regain control of your life
-develop a healthy relationship with food and your body
-uncover underlying factors contributing to your Eating Disorder/disordered eating
-cultivate kinder, more encouraging self-talk
How can I know if my relationship with food and my body is maladaptive?
One way to start assessing your relationship with food and your body is by looking at the content of your thoughts and the details of your daily behaviors related to food and your body.
Some Examples of Eating Disorder Thoughts
“I hate my body”
“I can’t live with myself if I gain more weight”
“I’m the largest of all my friends”
“Carbs are bad and I need to cut them out of my diet completely”
“I can’t go to the pool party because my body is disgusting”
“I want my stomach to be flat”
“I’m so fat no one is ever going to love me”
“Feeling full means I’m gaining weight”
“If I have 1 donut then I have to eat them all”
“I’m never going to be good enough”
“I have to be a size zero forever”
“I can only eat X amount of calories per day”
“If I have a cookie I need to punish myself with X hours of intense exercise”
“If I had more self-control and willpower around food, I wouldn’t be fat”
Some Examples of Eating Disorder Behaviors/Warning Signs
-Feeling uncomfortable when eating around others
-Following any new fad diets such as “no dairy”, gluten free, low carb/high protein etc.
-Weighing self or food obsessively
-Preoccupation with food and body
-Refusal to eat certain foods or avoiding complete food groups such as carbohydrates, dairy, sugars, or fats
-Withdrawal from friends or normal activities
-Increased mood swings
-Increased rigidity and inflexibility with exercise routine despite illness, weather, injury or outside obligations
-Counting calories
-Intense fear of weight gain
-Using language around fat talk or expressing a desire to lose weight
-Frequently checking body in the mirror
-Food rituals (e.g eats only a particular food or food group, excessive chewing and/or doesn’t allow foods to touch)
*Please note, there are a wide range of Eating Disorder thoughts and behaviors that can be applied to an Eating Disorder diagnosis. The above lists include only some examples and are not at all inclusive of every possibility.
What about body image concerns?
For adolescents, millennials and adults of all ages, going a day without exposure to some form of social media is quite rare. It doesn’t take long to scroll through Instagram, Facebook, Pinterest or Snapchat before you’ll encounter pictorial or written content relating to physical appearance, diet or exercise.
Sadly, people have become more obsessed than ever with pursuing a specific physical identity which often involves unhealthy weight and shape ideals. It doesn’t help that diet culture has been working hard to convince us that “wellness” and “dieting” are different things.” Models on magazine covers, celebrities on our social media news feeds, actors on TV, and our favorite musical idols often possess what society perceives to be “picture perfect” bodies. As a result, society starts to associate a certain body type (usually low body weight) with success, popularity and attention. What we often forget is that the individuals portrayed in popular media are often at unhealthy low weights or the pictures are so digitally edited that the images our eyes are bombarded with are not even real.
With such intense body image scrutiny, it’s no surprise then that in the United States alone, 20 million women and 10 million men will meet diagnostic criteria for an Eating Disorder at some time in their lifetime. And in 2019, statistics revealed that 96% of women do not like their bodies.
Unfortunately, most studies don’t even account for the non-binary or trans community meaning that the statistics of Eating Disorders and body image dissatisfaction are probably even higher than what most studies report. We live in a culture that perpetuates, encourages, and glamorizes this belief in the thinness myth. This myth is displayed everywhere, and it tells us that if we are thin enough, then we will be successful, happy, and that people will love us. The reality though is in the name-it’s a myth. We cannot deny that our world is permeated with weight-based stigma where unearned privilege is given to those of a certain body shape that most closely matches the ideal image of beauty, but we can all learn to challenge this problematic paradigm. We can learn to accept our bodies in a world that tells us we need to hate it and change it.
While those who suffer from Eating Disorders, such as Bulimia, Binge Eating Disorder, Orthorexia and Anorexia Nervosa, are usually born with a genetic predisposition to developing the disorder, the media definitely provides a perfect environment for an Eating Disorder to develop and at the very least normalizes an unhealthy obsession with food and bodies.
Eating Disorder therapy at Cityscape Counseling usually involves a strong focus on body image concerns provided that you feel addressing body image is relevant to your recovery. Our approach is always aimed at helping you cultivate a more accepting attitude towards your body as opposed to changing your body to “make it more socially acceptable”. We tailor therapy by providing you with cognitive and behavioral tools to help you change your unique relationship with your body in such a way that it enhances your Eating Disorder recovery.
Are Eating Disorders a serious medical concern?
Yes! Eating Disorders are serious, complex medical and mental health conditions. Many are surprised to learn that Eating Disorders actually have the highest mortality rate when compared to other mental health disorders. They frequently begin during middle school and high school especially around the age of puberty. However, many individuals are not aware that their behaviors are disordered and might only seek treatment for the first time during adulthood.
Eating Disorders can have serious medical consequences such as heart failure, osteoporosis, kidney problems, esophageal tears and infertility. Different Eating Disorder behaviors affect the body in different ways. Below is an image of common symptoms and medical complications associated with Eating Disorders.
Therefore, it is critical that professional help is sought out if you or a loved one are struggling with an Eating Disorder and/or are starting to develop an unhealthy relationship with food or your body.
Below is an overview to help guide your understanding of Eating Disorder complexities and help you to better determine if you or a loved one needs additional support.
Types of Eating Disorders
Binge Eating Disorder (BED):
Binge Eating Disorder (BED) is characterized by consuming an abnormally large amount of food in a short period of time and experiencing what feels like loss of control during these eating episodes. Binges often lead to physical discomfort due to intense fullness, and is almost always followed by intense shame, guilt and negative self-talk. A binge episode will feel as though you’re eating food at a faster pace than usual, eating when you’re not really hungry, and /or eating in secrecy. According to the most updated Diagnostic Statistical Manual (DSM-5), to acquire the formal diagnosis of BED, the binge eating episodes must occur at least once per week for a 3 month period.
What you may not know about BED is that it’s actually the most common Eating Disorder in the United States. It affects 3.5% of women, 2% of men, is 3x more common than anorexia and bulimia combined, and has a higher prevalence rate than autism, Alzheimer’s and breast cancer. Along with being the most common, it is unfortunately the most misunderstood. For starters, it was not even a diagnosable medical disorder until 2013 when it was finally added to the DSM. There are also several assumptions associated with BED that are simply untrue:
-you must be in a larger body to have BED
-BED is a willpower or self-control issue
-following a diet or excessively exercising will cure BED
BED has roots that run deep, as they’re tangled in nature and nurture. Although genetics likely play a role in the formal diagnosis of BED, it is also important to note that BED is tied to internalized weight stigma and a disordered relationship with food. Research indicates that BED may also very well be associated with trauma and certain mood disorders. This disorder is driven by misinformation, a weight stigma, and the thin ideal.
Utilizing a Health At Every Size® perspective, Cityscape’s therapists will help you to see that it is not your weight that is the problem- or the solution for that matter. Instead, we believe that it is the shame and secrecy surrounding your relationship with food and your body- the same shame and secrecy that was cultivated from a culture of diet-pushing.
To properly treat BED, it is possible that you’ll need more support than outpatient therapy can provide. And that is more than okay! It is very common to expand your team to include a dietitian, psychiatrist, or even a treatment center for a higher level of care. Collaboration of all team members is crucial in truly treating the complexity of BED. Let us work with you to:
-understand the Binge-Restrict Cycle and the harmful effects of dieting
-unlearn deep rooted diet culture assumptions/beliefs
-learn to believe that you are not “out of control” and that you can trust your body again
-neutral food judgements
-distinguish physical hunger and emotional hunger
-nourish your body on a regular and consistent schedule
-learn the harmful effects of equating self-worth with body size and/or amount of food consumed
Warning signs of Binge Eating Disorder:
-Eating rapidly
-Eating in secret
-Feeling “out of control” around food
-Hoarding or hiding food
-Noticing large amounts of food missing (empty containers, finding wrappers, etc)
-Feeling the need to replace missing food items to avoid being noticed
-Creating a lifestyle of rituals and a schedule around binge eating behaviors
Anorexia Nervosa (AN):
While anorexia is marked by weight loss, there is no specific “look” to Anorexia Nervosa. Being clinically underweight is defined by being under that person’s unique set point weight range and therefore does not discriminate to a certain body type. The Diagnostic Statistical Manual for Psychiatric Disorders (DSM-5) states that an individual with Anorexia has a “significantly low body weight in the context of age, sex, developmental trajectory, and physical health”.
Anorexia is defined by restricting one’s food intake, intense fear of weight gain, and excessive weight loss. It is the quest for perfection through using your body as a way to achieve ultimate thinness that is often associated with love and belonging, success, discipline, control and admiration.
There are two subtypes of Anorexia Nervosa:
Restricting type: Using weight control behaviors such as limiting food intake, counting calories, self starvation/fasting, having an intense fear of weight gain, as well as preoccupation with body size and appearance.
Binge/Purge Type: Using restrictive behaviors along with bingeing and purging behaviors to control weight.
Warning signs Anorexia Nervosa:
- Skipping meals or eating smaller amounts of food
- Eating small bites or eating slowly
- Noticeable or dramatic weight loss
- Wearing baggy clothes to hide body
- Hair loss, becomes easily cold and excessively fatigued
- Maintaining a diary of calorie amounts
Bulimia Nervosa (BN):
Bulimia Nervosa is marked by episodes of bingeing and purging. The use of restricting behaviors can also be present. Bingeing is defined as consuming an abnormally large amount of food in a short period of time (typically within 2hrs) and experiencing what feels like loss of control during these eating episodes. Binges often lead to physical discomfort due to intense fullness, and is almost always followed by intense shame, guilt and negative self-talk. With bulimia, purging will follow a binge and can be through self induced vomiting, exercise, laxatives or diuretics.
Warning signs of Bulimia Nervosa:
- Frequent trips to the bathroom after eating
- Hoarding or hiding food
- Shame & guilt after eating
- Finding wrappers of food or noticing large amounts of food missing
- Drinking excessive amounts of water or non-caloric drinks
- Frequent brushing teeth, mouthwash or mints/breath freshener/gum
- Dental problems such as cavities, enamel erosion or discoloration of teeth
- Calluses on back of hands and knuckles
- Preoccupation with food and body
Other Specified Feeding and Eating Disorders (OSFED):
A common misconception of OSFED is that it is not as serious as AN, BN or BED. However, OSFED actually has as many medical complications as all other Eating Disorders.
This diagnosis is applied if you do not meet the full diagnostic criteria for any of the disorders listed above. For example, you might engage in Eating Disorder behaviors at a lower frequency, have experienced symptoms for less than 3 months, or be restricting your food intake but not be clinically underweight. Due to the restrictive and rigid diagnostic criteria the DSM offers, OSFED is actually very commonly diagnosed.
Warning signs of OSFED:
- Unhealthy obsession around food quality or “eating clean”
- Eliminating or decreasing food intake around food groups such as only eating organic, no carbs, sugar or dairy, switching to a vegan or vegetarian diet not based on religious or dietary needs
- counting calories
Avoidant Restrictive Food Intake Disorder (ARFID):
ARFID, often referred to as “extreme picky eating” is characterized by an “apparent lack of interest in eating or food”. Unlike some of the other Eating Disorders that are fueled by weight concerns, avoidance of food in ARFID is usually based on anxiety related to the aversive consequences of eating certain foods (such as choking, gagging, allergic reactions or vomiting) and/or an intolerance of certain textures, smells, temperature and colors of food. Individuals with ARFID usually have a very narrow range of foods they are comfortable or willing to eat. ARFID is also usually associated with nutritional deficiencies as well as failure to achieve growth/weight standards in children.
While researchers are still trying to understand what causes ARFID, we do know that individuals with Autism Spectrum, ADHD and or a history of picky eating are more likely to develop ARFID.
Treatment usually involves the use of exposure therapy to increase the range of food an individual can tolerate and helping them overcome their unique food and eating related fears.
Related Eating & Body Image Disorders
Orthorexia:
The unhealthy obsession with “clean eating.” Whereas anorexia typically places an emphasis on food quantity, orthorexia is more concerned with food quality. Orthorexic thoughts and behaviors are driven by the misconception that eating clean, organic, and/or raw foods are “better” than non-organic, processed foods. This can often lead to the unhealthy elimination of certain foods or food groups.
Compulsive Over-Exercising:
This can look like rigidity and inflexibility with workouts and workout regimens, creating a “have to” mindset around exercise, missing life events or withdrawing from family/friends to exercise, exercising with the primary motivation to change your body or lose weight, engaging in extreme forms of exercise, and/or working out for several hours a day.
Purging Disorder:
Purging not prompted by a binge behavior.
Night Eating Syndrome (NES):
Recurrent night eating not accounted for by environmental or medical reasons. Night eating is a condition that combines overeating at night with sleep disturbance. With NES, the majority of your daily calories are consumed between dinner and bedtime, sleep is disturbed (falling asleep and/or staying asleep), and oftentimes, NES leads to waking up throughout the night to eat. Other symptoms include: morning anorexia (lack of appetite in the morning), a belief that eating is necessary to get to sleep or return to sleep, a depressed mood that worsens into the evening, and/or insomnia.
Body Dysmorphic Disorder (BDD):
Body Dysmorphic Disorder presents itself in the obsessive thinking about one or more perceived defects or flaws in your appearance — a flaw that may be objectively minor or even unnoticeable by others. These perceived defects or flaws are typically relevant to face/facial features, skin, hair, breast size/shape, muscle size/tone, or genitalia. This obsessive thinking results in:
-Extreme preoccupation and rumination
-The strong belief that you are defective and ugly
-The experience of shame and embarrassment around appearance when in social situations
-Avoidance of such social situations altogether or isolating due to insecurities around appearance
-Engaging in behaviors aimed to fix, control, or change your appearance
-Seeking frequent cosmetic procedures in an effort to change or “fix” appearance coupled with little satisfaction of the results
-Constant comparisons of self to others
What causes an Eating Disorder to develop?
Eating Disorders are unique in the fact that there is not only a mental and emotional component but also a physical/medical component as well.
The scientific field of Eating Disorders still does not definitively know what causes a certain Eating Disorder to develop in an individual and in fact, finding “the reason” behind the development of your Eating Disorder can be an almost impossible task to uncover. Researchers are continuing to investigate etiology in order to better understand the complexities of Eating Disorders.
Shifting your focus from needing to know “why” exactly you developed an Eating Disorder to instead learning about and understanding your triggering factors and functions of your Eating Disorder is more realistic and helpful in treatment. While symptom presentations of Eating Disorders can appear similar, each person has their own uniquely different story for their own struggles. Eating Disorders do not discriminate based on age, gender, social class or race. Research has shown a combination of cultural, biological and psychological factors contributing to Eating Disorders. These factors include, but are not limited to:
- Eating Disorders have a high comorbidity rate with trauma, substance abuse, depression, anxiety and OCD.
- Bullying, media representations of the ideal body size and norms, low self esteem, weight stigma and a limited social support system
- Having a relative who struggles with an Eating Disorder and/or another mental illness
- History of dieting and/or cultural norms around dieting
- Perfectionism or behavioral inflexibility (i.e. strict rule following/or doing things the “right way”)
What will therapy for my Eating Disorder look like?
If you’re seeking support from an Eating Disorder therapist, whether it is your first time addressing disordered eating habits or you’re stepping down from a higher level of care, Cityscape Counseling is ready to serve you. We are expertly trained to treat individuals at all stages of the recovery process.
Treatment may consist of any or all of the following:
(tailored to each individual’s unique treatment needs)
-comprehensive assessment to provide formal diagnosis and assess eating and body related pathology scores in order to track progress
-individual outpatient therapy with a specialized Eating Disorder therapist *see various therapy modalities listed further below
-collaboration with external dietitians, physicians, psychiatrists & treatment centers
-outpatient group therapy at Cityscape Counseling *see current group offerings
-family based treatment approaches for adolescents and children
-partner support/psychoeducation sessions
-in-session meal support and/or meal plan accountability
-weight monitoring, if relevant
-Assessment, motivational work and referral to a higher level of care if necessary
Outpatient therapy is meant for those who are medically stable, working to maintain recovery and/or those just getting started on their journey.
Higher levels of care are recommended for those who:
-are needing more support than can be provided at an outpatient level to sufficiently address Eating Disorder behaviors
- when Eating Disorder behaviors are interfering with your ability to function day to day (as is often seen when there is engagement with Eating Disorders at a high frequency).
-when we are concerned about your medical stability
Our therapists draw from a number of different therapy modalities some of which are discussed below:
-Dialectical Behavioral Therapy (DBT): Using emotion regulation, distress tolerance and mindfulness strategies for managing urges and eliminating maladaptive behaviors.
-Cognitive Behavioral Therapy (CBT): Identifying, challenging and changing unhelpful cognitive distortions and behavioral patterns to improve your quality of life.
-Acceptance and Commitment Therapy (ACT): Using acceptance and mindfulness tools, together with commitment and behavior change strategies to increase your psychological flexibility.
-Radically Open Dialectical Behavioral Therapy (RO-DBT): Targeting over-controlled coping and personality styles, such as perfectionism, rigidity, and difficulty with flexibility.
-Exposure & Response Prevention (ERP): Decreasing urges to engage in avoidant or self-destructive behaviors by deliberately exposing yourself to triggers under controlled conditions. ERP encourages you to face your anxiety, with the support of your therapist, and trust that the distress will naturally reduce over time, therefore decreasing the urgency to engage in avoidant or self-destructive behaviors.
-Movement Therapy: Working to improve the lived experience in your body by creating a more kind, compassionate and engaging relationship with yourself.
