3/14/19

Self-Loathing in an Eating Disorder

A common core belief at the heart of an eating disorder is self-loathing. It feels like a deep, unshakable fact. That person feels like there is something wrong at their core. It’s an old thought they typically have believed for a long time and not one that even feels very logical. It just feels true.

Interestingly, someone can feel trapped by a sense of self-loathing and simultaneously be able to recognize positive traits about themselves. They may see they are competent, kind or caring. They may recognize an innate ability to be a good friend or employee. However, recognizing these qualities doesn’t seem to make a dent in the core negative belief.

Often when someone has a deep sense of themselves, it isn’t based on true events from their past. The belief seems to precede any sense of identity or of the true essence of that person. It’s a belief that feels grounded in their basic self-image. Rather than the belief stemming from events in someone’s life, generally facts of one’s life are twisted to reflect the core self-loathing.

This is the place where the eating disorder becomes relevant. Once the eating disorder starts, the behaviors reinforce the core belief that there is something wrong with the person and justifies the self-loathing. Even though the self-loathing always precedes the eating disorder, the eating disorder morphs into the overall explanation and justification of the self-loathing.

It then becomes easy to see why this cycle becomes difficult to break. If the self-loathing encourages the eating disorder and the eating behaviors strengthen the self-loathing, it feels like there is no escape.

Treatment needs to aggressively question the self-loathing. The therapy can bring to light the nonsensical logic behind the self-loathing and help that person see that this core belief is not rooted in reality.

The harder part of treatment is that the self-loathing needs to be replaced by love. This doesn’t mean a false belief in self-love. It means the experiment of being lovable, of accepting a profound sense of being loved even when that core of doubt and fear is exposed.


It’s remarkable how letting that love land can help someone find their way out of the vicious cycle of an eating disorder and self-loathing. As I have written many times in this blog, love is the true antidote to an eating disorder.

2/28/19

The Difference between Eating Disorders and Addiction

The comparison between eating disorders and addiction is increasingly prevalent in the media understanding of these illnesses. Unfortunately, this link negates the main difference that makes eating disorders a very different type of illness and confuses the public understanding of eating disorders. 

Addictive behavior represents a problem in the brain’s reward system. The addictive behavior strengthens the reward circuit of brain chemistry in addicts so that the actions become impossible to avoid.

However, the stimulus, namely drug or alcohol use, is an action not necessary for human life and survival. We can live without those substances. The cravings for the chemical reward are strong, but the behaviors do not tap into the more basic human functions.

Eating disorders are connected to one of the most basic human necessities. Some essential activities are hardwired into the brain and escape conscious intention and thoughts.

Breathing, sleeping, walking and eating represent some of these basic needs for human life. Since we share these needs with other mammals, our brains are wired into the more primitive and essential parts of our brain which perform these actions without any conscious thought. We just do them.

And so eating disorder behaviors, even if they do trigger the reward system, are also linked to some of the most essential brain functions. When an activity is unconscious, changing it takes much more work and attention. It’s one of the reasons people in recovery from an eating disorder describe feeling so exhausted. They are struggling against the most automatic workings of their mind, a very different experience from addiction.

It’s important to reiterate that this fact doesn’t change that recovery does happen. It makes it more challenging in some ways, but full recovery is a reality for many people.


The most essential piece of information is to recognize that eating disorders are not addictions. Often the behaviors do highlight the brain’s reward system, but the true nature of recovery is about changing ingrained, automatic brain systems.

2/21/19

Medications for Binge Eating Disorder

There are several medications that are used for Binge Eating Disorder with mixed results. As opposed to other eating disorders, people with binge eating disorder often seek urgent pharmacological help hoping it sustains longstanding recovery.
The pharmaceutical industry has targeted weight as a primary focus for medication research with limited results. Many of those medications are also tested for Binge Eating Disorder (BED). Inevitably, people with this disorder assume it’s reasonable to seek medications to solve the issue.

However, BED is very similar to other eating disorders. The eating disorder thoughts and behavior cycles are generally consistent so treatment is also not very different. Medications can have some benefit, but therapy and nutrition work are crucial as well.

What is confusing is that there is a small subset of people with BED whose food cravings are different from binge urges. Typically, binge urges are a powerful pull to eat quickly in a way that numbs emotions and calms anxiety. However, a small number of people have food cravings and need certain foods to satisfy the desire for a certain taste and experience rather than block their feelings. Occasionally medications do seem to block these cravings.

Topamax, Wellbutrin, the discontinued Meridia and Naltrexone are medications known, in rare circumstances, to stop binges for people with BED with food cravings rather than binge urges effectively and for a long period of time. Other medications such as Vyvanse may do so temporarily but do not seem to last longer than a year or two at most.

The desire for a permanent fix is strong for people with any eating disorder including BED. It’s rare to find that relief, especially one with such an immediate effect. I hesitate to ever suggest this as an option to expect since it is very rare, but it’s important to understand the different forms of BED and the reasonable expectations and limitations of medication treatment for BED.


The misleading pharmaceutical industry has lumped BED treatment with weight loss medications and encouraged these patients to believe in a quick fix, much to their detriment. These patients need to understand how unlikely a quick fix is and instead seek an overall treatment plan as for any eating disorder.

2/14/19

Stimulant Use and Abuse for People with Eating Disorders

The link between eating disorders and Attention Deficit Disorder is unclear and tenuous. There is no research-based connection in the psychiatric literature, but many patients with eating disorders seek stimulants, the standard ADD medication, because this class of medication causes decreased appetite and weight loss. And some patients end up abusing these drugs too. The line between diagnosis, treatment and abuse is complicated.

An important caveat is that stimulants like Adderall are prevalent among young people. Some are prescribed for actual ADD, some find doctors who will dole out the drugs for academic or recreational use and some buy it illegally. The result is that many young people have tried a stimulant at some point in their lives.

Subsequently, people with eating disorders can experiment and find that these medications are aids in their plight to eat less and maintain a low weight or lose weight. They can find some way to keep a supply and take the medications whether or not a doctor manages the medication. 

On the other hand, there are a handful of patients whose ADD seems to be the root cause of their eating disorder. One symptom of ADD is feeling overstimulated by daily life. Some people find that restricting food, binging or purging eases the overwhelmed feeling and helps the ADD. When given a stimulant, these people experience a lot of relief in general and from their eating disorder.

The resulting situation is complicated. It’s important to be sure that ADD is not a primary cause of the eating disorder. Those people need stimulants, but that is the minority.

Other people need an open conversation about the risks of stimulant use and why taking it can lead to insomnia, tax the cardiovascular system or cause abuse. 

And some people simply use the stimulant as a crutch and find that they have the ability to stop the medication and continue with their lives and recovery.


Because stimulants are a fact of modern-day life, no hard and fast rule will suffice. These drugs are too easy to get and too easy to become intertwined with the reality of an eating disorder. Instead, recovery needs to lead to open discussions about these medications and to a path to stop these drugs unless they really are necessary. 

2/7/19

Assessing the Labeling of Foods as Healthy or Unhealthy

There is a new government regulation of food labeling that will deem foods healthy or unhealthy. The intent of this new plan is to attempt to persuade people to avoid more processed foods and the illnesses that come from overconsumption of those foods. However, this new tack is a double-edged sword.

The benefit of this agenda is to educate people otherwise unaware of some necessary nutrition facts. One of the few tenets from nutrition studies is that eating too much processed food has long-term health repercussions. The food industry offers tasty, cheap food accessible to everyone without warning against the potential results of eating too much of their products.

The government plans to present warnings to the public about these foods to continue a public health campaign to decrease the power these companies wield over unsuspecting customers. Certainly no one could have predicted the overall success the public health campaign against the very powerful tobacco industry, so why question this initiative.

The difficult question is where to draw the line about labeling foods. For people stuck in an eating disorder or very restrictive eating, labeling is likely to only encourage and sustain the eating disorder symptoms. Labels will only make it harder to change ingrained behaviors around food and very rigid eating. 

Ultimately, the problem with labeling stems from the wide range of disordered eating in our society from the effects of a nefarious food industry to the power of the exercise and diet industries to fuel an obsession with thinness.

Since the companies market differently to different demographics, no government decision will help all sides of the problem.


Perhaps the balanced approach to labeling foods would be to also attempt to regulate the exercise and diet industries, not just the food industry. The industrial wellness complex, as it has been called, needs attention from all sides. Regulating one side may help one set of people while hurting others.

1/31/19

Reporting that Diets Fail Isn’t Enough: A Manual for Health Reporters

Finally, the message that diets don’t work seems to be seeping into the mainstream media. The risks of long-term food restriction and of chronic intermittent starving have made an impact on those who write about our food culture.

However, the effect of these articles still seems to be minimal. The pressure for thinness remains as strong as ever, and the incidence of eating disorders and disorders eating is as high as ever.

Reporters may be willing to debunk the well-honed message of the diet industry but have yet to tackle the overall thinness complex of our society. As long as thin privilege dominates our culture undeterred, everyone will seek out thinness as a necessary sign of success, no matter the risk and long-term costs.

Conflating thinness with other forms of bias is risky though. Although there are similarities in discrimination against fat people, many people believe thinness is attainable for everyone even if it means using drastic measures such as medications or Bariatric surgery. Thus, people tend to see being fat as a character flaw rather than an attribute. 

The truth is that we all come in different body shapes and sizes. Using one’s body shape as a way to discriminate is just a way of sorting people out into the haves and the have-nots. Thinness is not a sign of success, persistence or value. It’s largely how your body is built.

The media needs to take the next few steps to make a more significant impact.

Redefine the language of weight, specifically about fat and obesity. These terms are not interchangeable. One simply describes a body type and the other pathologizes weight in the medical vernacular.

Second, take the conversation about diets failing another step to include the significant risks of dieting, namely disordered eating and eating disorders.

And third, name the industries that profit from these myths: the diet, exercise and food industries.


The disempowerment of people, mostly women, through this longstanding fallacy needs to stop. Dissemination of the truth around these risky behaviors is one important way to change the pattern of eating in our culture.

1/24/19

The Dangerous Link Between Self-Awareness and Dieting for Women

A consistent message to young women is that they should figure themselves out first before embarking fully on their personal lives, relationships and professional lives. However, this message never seems to apply to young men.

The end result is that women feel compelled to sort through their own experiences, thoughts and feelings with the nagging doubt that they will never figure out who they are. And there is no clear endpoint at which someone knows they have reached this goal. Instead, the target always remains in the distance, just out of reach. The experience of searching for the elusive moment of self-awareness leaves women stuck in failure.

Although this message is intended to empower women, in the end it has the impact of diminishing confidence and delaying gratification. If one is always striving for an unattainable goal, then one can never be fully empowered to go after the important things in life.

Interestingly, the effect of this counterproductive message is to reinforce the power and lure of dieting and weight loss. For a cohort of women undermined by an inherent sense of failure, dieting appears to present a way out. Obsessively dieting and trying to maintain a low weight leads to an immediate, if brief, sense of accomplishment. The goal of weight loss engenders a wave of accolades and approval from men and women. It highlights the empty achievement of weight loss while distracting from the real life achievements that merit attention. And since diets never work, it fuels the cycle of endless dieting.

If women spend their energy on weight loss, they have much less time to focus on other aspects of life.

The underlying message is a myth. Women, just like men, have a right to go after professional and personal achievements without reaching the holy grail of self-awareness. No man is ever told to avoid relationships because he hasn’t figured himself out yet, and no man would decide not to pursue a promotion or a raise while finding himself.

As must as this soul searching made sense for women collectively trying to understand their place in a new world of opportunity after the feminist movement’s achievements in the 70’s, it’s important not to mix up steps forward with needless psychological obstacles.


If society presents immovable psychological hurdles, they stem from a fear of moving forward. But the idea of reaching psychological peace before moving ahead in life is not beneficial. It only reinforces the need for other salves, like dieting, rather than helping women achieve their life goals now.