Regulate the Diet Industry

Disorganized and disordered eating have a profound impact on all body and brain function. The knowledge in our culture about dieting, fasting or unusual eating patterns is that these behaviors can be healthful and positive for our overall well-being. This false thought process opens the door to many negative health effects.

The diet industry continues to expand its reach into the modern psyche. So much time, energy and money has gone into changing eating habits. However, none of these changes involve normalizing eating but instead overvalue changes that undermine health.

There is no data to prove that fasting, avoiding certain kinds of foods or eating certain amount at certain times of day are beneficial. The diet industry is legally able to promote health effects of their plans without a shred of evidence. For a public desperate to exert power of food and body, these measures feel miraculous, even though they are never effective.

The endless attempts at finding the right diet is demoralizing and promotes a constant sense of failure. This is not a positive way to live.

However, the health effects of ineffective diets are even worse. Eating irregularly, avoiding necessary variety in a diet and periods of fasting cause poor health. People often experience fatigue or develop physical symptoms from eating a diet with limited nutrition. People often feel more depressed or anxious and have trouble concentrating. They can have gastrointestinal problems such as constipation or severe bloating. The large majority of these diets don’t work and actually cause medical and psychological problems if followed regularly.

And most concerning is the link between dieting and eating disorders. The number one risk factor for developing an eating disorder is dieting. It’s never clear how someone is programmed to respond to chronic dieting. Not infrequently, the result of a diet is the gradual development of an eating disorder.

There needs to be much clearer regulation of the diet industry. The money behind this business leads to endless false claims intended to confound and mislead the public. Without clear guidelines, the diet industry only exacerbates the general food and weight obsessions of our society.

Beware the Medical Community Prejudice of Eating Disorders

The bias towards people with eating disorders in the medical community is very prevalent. Doctors have little medical background or information about eating disorders and thus tend to conflate their own personal beliefs with clinical acumen. The result is a lot of anger and unprofessional behavior towards patients with eating disorders and, just as concerning, subpar care.

The greatest missing link from doctors treating eating disordered patients is compassion. It’s very difficult for doctors not to blame patients and their families for the illness. They struggle to comprehend that an eating disorder is a psychiatric illness that is difficult to treat. It is even more unfathomable that someone could not get better despite adequate treatment.

Doctors frequently tell these patients unceremoniously that they are wasting medical attention and money, will die anyway or are abusing the system for their own personal benefit. Families are often berated by medical professionals and are forced to endure unacceptable treatment in order to support their loved one who is getting medical attention.

Unfortunately, this attitude tends to allow doctors to feel justified in making poor decisions for their patients. If one’s attitude towards a patient is judgmental and angry, it is harder to feel compassion and thus harder to make the wise decision for a patient. It can be easier to make a safer decision, whether or not it’s best for the patient, since it is more difficult to trust a patient with an illness that makes no sense.

This attitude may lead a doctor to ignore otherwise concerning symptoms like chest pain or dizziness, to hold off on blood tests or scans or even suggest surgery even if other less invasive treatment is available. No doctor will make these decisions maliciously. But if a doctor has difficulty understanding the true medical situation, it’s harder to make wise clinical decisions.

Often I find myself arguing with doctors to consider the entire patient when making critical decisions. However, the bias runs deep in the medical world. The willingness to open one’s mind to new concepts becomes harder over time, and the medical community is still closed to understanding how to treat people with eating disorders.

One key step to change the circumstances is education. The more doctors understand these illnesses, the easier it will be to coordinate care. Another way to consider these patients’ best interest is through the discipline of medical ethics. This branch of medicine encourages doctors to think more broadly about clinical decisions and to consider all outcomes.

Perhaps through opening the eyes of doctors, the medical world can see the scourge of eating disorders more clearly and provide the care these patients deserve.

Diverging Paths of Eating Disorder Treatment: How to Treat the Chronic Eating Disordered Patient

A recent conversation with a colleague reached a sticking point: what options are there for an undernourished patient who is not able to go to a program and become nourished?

She said that she cannot work with someone who is malnourished. Since a starved brain doesn’t work, any form of therapy is ineffective and meaningless. Until the patient is ready to seek help, therapy is pointless.

I said that although that may be true, how can a clinician reject a patient because she is so stuck in her illness? Isn’t it the obligation of the treater to stand by the patient and shepherd her into beneficial care?

This conversation reflects a larger issue with eating disorder treatment. What is to be done about the people with chronic eating disorders who are unable to seek more intensive help?

Standing one’s ground about becoming nourished has its merits. Treatment will be challenging for someone who is working hard to follow a meal plan, but there will inevitably be progress. Creating new thought and behavior patterns around food naturally evolve from actively working on a meal plan. And for the clinician, it is easy to feel secure in the direction and goals of treatment. There is little risk for the therapist.

Working with someone unable to start a meal plan is a different, challenging and potentially dangerous endeavor. The risks of serious medical consequences are high. The effects of being malnourished or compensatory behaviors such as purging or laxatives are concerning. And there is no guarantee the patient will find a way to start to eat more regularly again.

This path demands patience from a therapist to tolerate a high level of illness and the brutal honesty of seeing what someone in an active eating disorder looks like. Yet the potential rewards of taking the more dangerous route are great.

The effect of standing by someone too sick to begin a path towards recovery is significant. The patient feels heard and understood. She realizes she is not a pariah but instead someone with an illness who wants and needs to get help. She starts to see that she can be cared for in her illness and she won’t be alone in the process of recovery either.

Those messages are necessary to create the trust that opens a heretofore invisible road to wellness.

So it’s not that I disagree completely with my colleague. But maybe there are multiple ways to help someone with an eating disorder see the opportunity to get better. Flexibility and the willingness to find that road are sometimes more important than anything.

Why are People with Eating Disorders Blamed for their Illness

Another component of eating disorders that differentiates them from other mental illnesses is blame. More than every other psychiatric problem, people with eating disorders are routinely blamed for their illness and their inability to get well.

Not just family and friends but even clinicians often tell the person to just eat a sandwich or drink a milkshake. The lack of compassion and limited inclination for people to even try to understand eating disorders are so powerful that it’s hard not to look for other reasons to explain hard-hearted responses.

Eating disorders are contradictory for most people. Eating is a basic component of living, not far behind breathing and sleeping. It’s anathema for people to conceive of a world in which they willfully don’t eat or purge food in some way. The instinct to tell someone just eat a sandwich comes in part from the incredulity that a person would do otherwise.

However, that reaction makes sense the first few times a person tries to understand an eating disorder. Why would family and friends continue to say the same thing months and years later? How can experienced clinicians repeat the same mantra to eating disorder patients?

Another part of the confusion is the dearth of successful treatment. Medications, by and large, are ineffective. Therapies are specialized and take a long time to have a significant impact. Moreover, not enough clinicians are experienced in treating people with eating disorders even though many people profess to have that expertise.

The decades of social pressure to be thin and diet has glamorized eating disorders. On the one hand, many people in general see an eating disorder as a prolonged successful diet. Few understand the psychological torture of the illness. On the other hand, the cultural zeitgeist professes that once someone has an eating disorder, they always will. It’s a life sentence. The concept of full recovery is one most people have never contemplated or even heard about.

All of these aspects of eating disorders leave the public with the sense that eating disorders are the person’s fault. The final blow in this scenario is that the blame ultimately disempowers the person, usually a woman, from feeling like she has any ability to get better. Since recovery involves a constant, daily fight against the disorder while attempting to tolerate the discomfort of changing an automatic behavior pattern, the blame undermines a chance at getting well.

It behooves family, friends and clinicians to scrap the assumption of blame. Eating disorders are true illnesses. The sufferers need and deserve support, comfort and compassion.

Connecting Eating Disorder Recovery with Women’s Emotions and Power

The first part of eating disorder treatment is typically focused on normalizing eating and implementing a meal plan. Regulation of food and nutrition allows the body and brain to receive adequate energy to heal and function normally again.

The second part of treatment is amorphous and more complex. The last several posts highlight, on a larger scale, how the suppression of girls’ and women’s emotions and anger is very much related to eating disorders. Thus, it’s not coincidental that recovery focuses on identification and expression of those suppressed feelings along with exploration of someone’s true identity once the eating disorder is no longer the only driving force in her life.

The true engine of an eating disorder is the obsessive, persistent thoughts about food and weight. At its worst, an eating disorder so dominates one’s mind that there is no room for all the thoughts, feelings and experiences that come from living life. Once the eating disorder thoughts begin to dissipate, the mind almost feels blank and people often find themselves longing for the old thoughts to occupy all the empty space.

It doesn’t take much encouragement or living to bring up new and different thoughts and feelings. They come automatically just by living in the world. However, the experience of true reactions to the world can be overwhelming after having been sheltered for years behind the wall of the eating disorder.

Fairly soon, the new feelings land on anger and often this anger relates to the ways in which the person has been suppressed, oppressed or kept down in some way. The reaction and feelings can be very overwhelming yet the path to recovery has to go through those very real and valid feelings.

In the context of the recent posts, this step in recovery represents the idea that eating disorders have become the newest psychiatric disorder that pathologizes girls’ and women’s emotions. The goal of recovery isn’t just to help people eat and live their lives again. The goal is to open the door to living fully and freely, including the ability to express all of one’s feelings in the world.

Anger as the Engine for an Eating Disorder

At the emotional root of many eating disorders is suppressed feelings, most commonly anger. For people taught at a young age that anger is not an acceptable emotion, food is an easily found, effective and socially acceptable way to manage emotion.

Indulging or overeating, secreting food or binging and restricting all help transform emotions into behaviors that either express feelings or numb them. As society continues to reinforce these behaviors as a viable alternative to acknowledging feelings, we collectively increase the likelihood of triggering eating disorders in those who are susceptible.

It’s also not a coincidence that most people who develop eating disorders are girls or women. As evidenced by the recent political events, anger in women is taboo in our culture. Women who express their anger are most often called names or vilified until they are able to control and channel their anger. The reality of human emotion is that no one can tamp down anger indefinitely without repercussions. 

Pushed into a corner where the reality is either express unacceptable anger or repress it, women often find themselves focusing on food behaviors or body shaming as a coping tool. The general pressure on women to eat and look a certain way only reinforces the behaviors as appropriate and meaningful. As I have written many times in this blog, the main risk factor for developing an eating disorder is food restriction or dieting, and using food behaviors to manage emotion is a first step to possibly developing an illness.

One hope I have behind the growing movement towards equality of women in the workplace and culture is the freedom for women to express their emotions, especially negative ones. Being trapped by their own feelings leaves women unable to embrace their full self. Subjugating their beliefs, thoughts and feelings for the meaningless obsessions with food and weight is a waste of time and energy. The goal is for girls and women is to be their true selves and not get lost in the inanity of an eating disorder.

Why Someone with Anorexia Should See a Doctor

For people with anorexia, one irony is that getting medical help often reinforces the illness. I will frequently hesitate before referring these patients to their primary care doctor, and this conundrum presents a complex path towards getting better.

The anorexic thoughts repeatedly tell people that they just eat a little less than others and that their medical symptoms are exaggerated. The fact that they cannot see their bodies realistically means that they think they are fairly healthy when they are actually severely malnourished.

How else can people who wear very small clothing sizes or get weak and dizzy from walking down the street believe they are healthy?

As their health continues to deteriorate, the eating disorder thoughts strengthen and convince the person their health is normal. Even abnormal tests, worsening physical health and increasingly debilitating symptoms don’t change this delusional thought. 

A confusing factor for these patients is that the human body is programmed to adapt to periods of starvation. Centuries of intermittent famine have built this protective mechanism into our DNA. Accordingly, blood tests often remain normal even when someone is severely starving. This does not reflect health but instead the body’s resilience.

Also, modern medicine is not designed to diagnose the medical problems associated with starvation. Outside of anorexia and end-stage cancer, people don’t experience chronic starvation in the first world. Thus, doctors aren’t trained to treat malnutrition and modern medical tests don’t pick up on the problems associated with starvation, especially the common cardiovascular ones which look for heart problems of the elderly, not the starved.

Because of these complications, seeking medical help often reveals little: blood tests and imaging are usually negative. Instead of receiving useful medical attention, people with anorexia end up without any useful information which then reinforces the eating disorder thoughts and leads to further slips. Unfortunately, a medical work-up can just as often lead to a relapse and hospitalization as it can medical findings.

The Flawed Messages to Parents about Food and Weight

After recently talking to an acquaintance about her daughter’s eating, I was reminded of the pressures on families to adhere to the societal mores around food and weight. It’s no wonder that so many children are essentially raised to have eating disorders.

The biggest disservice our culture provides is couching these pressures in hackneyed science and medicine. There are several examples that trick even the most well-meaning parents into questionable practices. 

The erroneous research into sugar as an addictive substance has created communal terror of this component of food. Yes, the human body is not designed to process the added sugars in all sorts of foods, but sugar is not the new cocaine or oxycodone. Understanding the risks of consuming too much sugar while also figuring out how one’s own (or one’s child’s) body reacts to sugar is important, but using this information to ban sugar from your child’s diet is troublesome. It only reinforces the child’s desire to eat sugar and creates a mystique that makes sugar the forbidden fruit and the most desired food.

The increase in children’s weight in recent years has become a public health obsession. However, the guidelines pediatricians use to manage weight as a medical indicator for health risk do not take into account the child’s overall health. As a result, many children are branded overweight and parents are charged to change that child’s eating and exercise habits or else fear the shame of a fat child. The line between fat phobia and sound medicine is not so clear. Often the well-intentioned doctor only encourages the possibility of an eating disorder.

Last adults who likely discourage peer pressure at school condone the shaming of fat children. Since being fat is considered a personal flaw or weakness, parents expect their fat children to be teased and, perhaps subconsciously, blame the child for the situation.

It’s easy to see how a child can internalize these messages about weight when they come from doctors, science, adults and peers. The message is clear: being fat is a personal flaw and losing weight is the only way to rectify the situation. Parents need to be focused on their child’s emotional and psychological well-being and not the number on the scale.

Hope: the Cornerstone of ED Treatment

Too many people with chronic eating disorders feel like they run out of options. It often takes quite a bit of time to summon up the courage to look for help and then actually get to an appointment. The shame about the illness and the fear of discussing the disorder—making it real—are overpowering. But after that first difficult step, what’s happens next?

Too often, people end up very frustrated and disappointed. Perhaps they see a clinician without much experience treating people with eating disorders. Perhaps they see someone who shames them for their illness. Perhaps they feel blamed for being sick. Or perhaps they go to treatment for a while and make no progress at all.

If that pattern happens a handful of times over a few years, it’s easy to see why someone would become demoralized and expect that the eating disorder is likely a chronic condition. As time passes and opportunities are lost, a sense of hopelessness grows even larger.

I have seen many people 10-15 years into an eating disorder in this frame of mind, devoid of hope and stuck in a cycle that feels like it will swallow their lives.

I don’t pretend to have all the answers to help these people. Sometimes they need behavioral intervention just to break the eating pattern. Sometimes they need education to understand the difference between their own thoughts and eating disorder thoughts. Sometimes they need someone to believe in them. Sometimes they need to see that love is the antidote to an eating disorder.

Most of all, the one component of treatment that is critical is hope. What these people who have struggled for years without any true progress need is hope. They need to see there is a way to recovery and that people who have been sick for years can fully recover. They need to see that the path may be hard, but someone has an idea of what that path might look like.

My wish for the many people struggling with chronic eating disorders is to know that help does exist for you. Look for the right kind of guidance and maintain hope that wellness and recovery can be in your future.

The Political and Social Biases of Eating Disorder Treatment, Part III

The difficulty with fully understanding the eating disorder epidemic of the last forty years is distinguishing between the clinical and social aspects of the illnesses. Psychiatry has historically created disorders aimed at marginalizing minority groups such as pathologizing homosexuality or hysteria as a form of invalidating women’s emotions. However, eating disorders are real psychological and medical problems that need treatment but which also just happened to begin a few decades ago. These two facts make them unique in the field.

In this blog, I have written extensively about various components of eating disorder treatment. Clearly, these are serious illnesses that demand medical attention. That must be clear.

However, unlike other psychiatric illnesses, eating disorders are relatively new and have only become a problem because of social pressures largely aimed at girls and women. No other psychiatric disorders are directly caused by the social construct of our society. No other psychiatric disorders affect 90% women.

Although there are genetic and psychosocial factors that cause eating disorders, the number one risk factor is dieting. Without dieting, people very rarely develop eating disorders. Before dieting and thinness became social and cultural norms, these disorders did not even have a name.

The pressure to diet comes from our culture of thinness. The mass marketing of the diet industry, exercise industry, the pervasive images in the media and the false information spread by the medical establishment have created a culture that says thinness is superior and healthy. Any increase in weight is failure. And this information is mostly aimed at girls and women.

The result is a society that condones dieting and starvation and ignores the enormous risk for girls and women.

One aspect of combatting eating disorders is treatment. That machine exists despite the issues discussed in the prior posts. 

The second aspect is preventative. It is necessary for those knowledgeable about eating disorders to start to speak out about the pressures that continue to foster dieting among girls and increase the risk factors of developing these illnesses.

The founders of residential treatment programs were often charismatic and were in the process of starting the groundswell of support that could buoy a social movement to combat dieting pressures. However, the financial companies that have absorbed these programs have also silenced their leaders.

Girls need to learn and understand the pressures they face and the risks they endure. Dieting is not a rite of passage. It’s a form of subjugation and potentially a cause of life threatening illness.

The Political and Social Biases of Eating Disorder Treatment, Part II

The shift in eating disorder treatment needs to take into account the historical patriarchy of psychiatry. From the earliest days of the psychoanalytic theory, women’s emotions and experiences were marginalized. This trend remains central to the recent history of eating disorder treatment.

The spike in the incidence of eating disorders during the 80’s triggered a response by a handful of psychiatrists to begin hospital-based programs led almost exclusively by men. These revered psychiatrists were known to have created mini-cults of vulnerable, sick women who had nowhere else to turn for treatment.

Largely in response to these treatment models, several women who had recovered from eating disorders themselves began residential programs outside the hospital systems using a new model based largely on addiction treatment.

These strong, outspoken women created a concept for treatment aimed at full recovery, largely taken from their own experiences, rather than the previous approach of maintenance of chronic illness. The programs were for women and run almost exclusively by women. The program philosophy was organized around empowering women to accept themselves and accept the support and love needed to live a full life. Embedded in the idea of recovery was freedom from the tyranny of thinness and beauty society has burdened on women in recent decades.

The downfall of these programs was their success. Seen as potential moneymakers, financial firms run by men bought these programs and have spawned a multitude of new ones throughout country with the aim of making a large profit for their investment. There is still a hint of the old treatment philosophy, but the individualized approach offering true help has morphed into a corporate strategy with much more limited compassion for the people they treat. The ultimate aim is to build a company and sell it at a profit.

As a man in the field, I am hard pressed to insert myself into this dynamic. The current treatment options are no longer aimed at curing the societal ills that essentially create eating disorders. Instead corporate greed has infiltrated the ranks.

The true way to fight these illnesses is to promote a new way for girls to see their bodies through their own eyes, not through the eyes of boys and men. The leaders of the residential programs when they first began were creating a path to teach girls these critical points.

If the health teachers across this country are saddled with this teaching point, there is no way to insert a new message into the heads of the next generation of girls about to suffer from anorexia, bulimia or binge eating.

Educating adults with eating disorders will help recovery but won’t stem this set of psychiatric illnesses aimed to silence women’s voices, emotions and anger. The future needs to cut off the message at its head. When girls are inculcated in this false belief about who they are, the incidence of eating disorders and the cynical corporate machine that profits from it will only continue to grow.

The Political and Social Biases of Eating Disorder Treatment, Part I

Not much has been written about why most people with eating disorders are women. The standard explanation is that the pressure of thinness and dieting is much stronger for girls and women. Since undereating is the number one risk factor for developing an eating disorder, this explanation has some merit. However, it feels like a facile and elusive way to understand a much more complicated situation. 

Psychiatry has often used certain diagnoses to explain women’s emotions. Hysteria, fainting spells and erotic fixation are examples of ways the mental health establishment has attempted to silence and pathologize women’s human reactions, whether emotional or sexual.

The question psychiatry and the eating disorder treatment world needs to address is whether eating disorders represent the newest way to silence women.

First and foremost, I know these illnesses are serious and real, much as the other illnesses I mention above are real. In no way do I doubt the severity of these disorders.

The problem is how psychiatry uses these illnesses to quiet women and explain away valid emotions women express.

For instance, most psychiatrists can compete their entire residency training program learning very little about how to treat people with eating disorders. This is odd considering how prevalent eating disorders are in this country. Accordingly, most eating disorder treatment exists as privatized business outside of the medical establishment and one that very often excludes the treatment of men. In fact, many eating disorder treatment programs openly endorse a feminist slant to their treatment, politicizing the existence of eating disorders. 

Sometimes, as most laypeople assume, eating disorders stem from a desire to look a certain way in order to invite attention to physical appearance. Much more frequently, eating disorders serve as a way to be more invisible either by being very underweight and resemble a young girl or by being overweight and effectively invisible in a fat phobic world.

I have written extensively about the treatment of eating disorders and said multiple times how the core of treatment involves close personal connection and that the antidote to an eating disorder is love.

These facts and treatments are very different from the treatment of any other mental illness such as schizophrenia or bipolar disorder. Clearly, there is a strong social component to this illness, and one aimed specifically at women.

The difficulty with these revelations is how to address them. I’ll write more about this in the next post.

Facing Eating Disorders as True Medical Illnesses

By considering the reality that eating disorders can be fatal, it’s hard for a loved one or clinician to ignore the severity of these illnesses. It’s too easy for people to minimize eating disorders as extreme diets or a passing phase to lose weight, but there is a stark difference between some weight fluctuation and serious medical illness. 

People with eating disorders find that their lives are taken over by the thoughts and behaviors. Attending to work or schoolwork becomes more difficult. Friendships tend to go by the wayside. One’s personality fades in order to accommodate the eating disorder. Any life goals that seemed important don’t matter in the same way anymore.

Someone may get distracted by a diet or weight loss plan for a few weeks and become upset once the period ends, but that person isn’t likely to lose track of everything and everyone that matter in life. The obsessive focus on eating disorder goals is all that is important to a sick person. This singleminded goal combined with the loss of everything relevant to that person are the key distinctions between an eating disorder and a diet.

Once that line is crossed, loved ones and clinicians need to stress the severity of the condition. Without adequate treatment, eating disorders can be chronic, even life-long illnesses, and compromise quality of life and longevity.

Treatment is not a guarantee of health and recovery and tends to take time, but minimizing the illness and avoiding necessary steps to get help can be dangerous. The risks to health and living a full life are great. Stressing this reality can make a difference in the long run.

Mortality and Eating Disorders

Eating disorders are so often misunderstood by laypeople. It’s too easy to chalk up the food behaviors to a desire to lose weight and disregard the severity of the symptoms. 

What’s even harder to comprehend is how these illnesses are not only debilitating but can be lethal.

I focus more often in this blog on the eating disorder behaviors and the psychological component of these disorders. Just as important in managing eating disorders is taking care of the medical complications. 

Purging and laxative abuse can lead to electrolyte abnormalities which cause two serious long term medical issues. The first is an abnormal heart rhythm from a low potassium level which can lead to death. The second is kidney dysfunction and even kidney failure necessitating kidney transplant. 

Starvation can cause poor function in many organ systems: metabolism, temperature regulation, heart function, brain function including cognitive symptoms and emotional dysregulation, bone marrow suppression leading to susceptibility to infection and anemia and the list goes on and on. The true takeaway is that starvation can cause any system to shut down. Whichever part of the body is more vulnerable is the one likely to shut down first. 

And even more central is the hopelessness many people feel when in the throes of an eating disorder. Being so trapped makes many people feel helpless enough to consider or even attempt suicide.

The combination of the myriad medical consequences of eating disorders and suicidal thoughts makes an eating disorder much more than a desire to lose weight. It’s crucial to take these illnesses very seriously and understand how often an eating disorder can take a life.

Two Things to Look for in Eating Disorder Treatment

Even though the prevalence and severity of eating disorders has become clear to clinicians and laypeople, it remains very difficult to find skilled practitioners who can assess these illnesses and find he best course for treatment.

There is no clear license or certificate that proves competence in treating eating disorders, so there is no deterrent for anyone to hang out a shingle as a specialist.

For patients and families, the result is frequently a haphazard search for an able caregiver with multiple ineffective or failed attempts. Anyone would quickly get frustrated and demoralized by the process.

Understanding eating disorders doesn’t just mean being familiar with the physical symptoms and effects of eating disorder behaviors. More important is what people with eating disorders call “getting it:” a crucial understanding of the eating disorder thought process that drives the illness.

Most people with eating disorders light up when a clinician understands these thoughts. It means they won’t feel different and alien. They won’t need to explain every thought and action. They’ll be able to talk freely and know they will be understood and won’t be judged. The result is a truly open forum of conversation.

Understanding the thought process is necessary but not sufficient. The second critical aspect of a clinician is hope for improvement and change. Instilling true hope that there is a path out of the confusion and torture of an eating disorder is a critical step in starting recovery. The hope cannot be hollow but has to reflect real experience and confidence.

Once a patient or family finds both understanding and hope, a therapeutic relationship can have real meaning. It can jumpstart a new path in life and meaningful change.

Some Ways that Residential Treatment Works

Due to the proliferation and corporatization of residential treatment centers, the caliber of the admissions staff at these programs staff has declined. They are no longer compassionate outreach but largely an arm of the corporation. This change has made it even more important for clinicians to assess when and why a patient needs to consider this level of care.

Looking for a quick fix or magic cure is the worst reason to consider residential treatment. Used as a tool in recovery, this path can can be very beneficial. Having unrealistic expectations only makes the time, energy and expense used feel like a waste.

There are several clear reasons to look into residential treatment. And it’s only worth pursuing this option when there is a clear purpose in mind. 

The most obvious reason is a patient who is medically unstable due to the eating disorder. A program can normalize food and help the person regain medical stability quickly.

When someone becomes unable to function in their life professionally, academically or personally, residential treatment can be a reasonable choice. The consistent food and stable environment can normalize the body and brain and enable the person to resume their lives and be more able to work on recovery.

A third clear reason for residential treatment is someone who is very stuck in the cycle of their illness. Even if the person functions well enough, it may be clear that the eating disorder is very limiting and outpatient treatment won’t be able to break the cycle. The combination of a new food pattern and a new environment can alter a very destructive cycle and open the door to being able to challenge the eating disorder more directly.

Finally, some people need to better understand the philosophy of recovery. Some programs offer not only stabilization but a new way to conceive of how recovery progresses. This new mindset can open up a patient whose thoughts have become very fixed and rigid.

Although this list is not exhaustive, it highlights some clear indications for residential treatment and the potential benefits. What brings these different options together is a very clear goal for the treatment. The purpose of residential is to try to achieve certain specific goals, not present the idealistic and unrealistic goal of full recovery.

The Mistake of Blaming Someone for their Eating Disorder

Unlike many other chronic illnesses, families frequently become very frustrated with their child who has an eating disorder. Once the illness is out in the open, even for supportive families who find sufficient treatment options, it’s hard for families not to resort to blaming their child for not getting better.

Families and loved ones may get angry but don’t blame someone for getting other chronic illnesses yet almost universally blame for someone for not recovering from an eating disorder.

Although the lack of understanding around mental illness can lead to blame, this dynamic is even more pronounced for eating disorders.

The difference can easily be summarized by a common refrain heard in treatment: no one understands. This seeming complaint is actually much more complex and subtle because it hints at the depth of the misunderstanding of eating disorders.

People without eating disorders just eat meals and eat food. Although they may worry about food components and their own weight, eating itself is not a fraught endeavor. People with eating disorders suffer enormous ambivalence, struggle and suffering with every bite of food, even every thought about food. Their entire day is loaded with painful struggles about what to eat or not eat and about their body. The extent of this suffering is unfathomable to even the closest and most educated family members.

So when a child is getting help and trying hard but still slipping regularly in the process of recovery, this is not an example of failure. To the contrary, this is the arduous process of recovery.

During those difficult moments, blame will only serve as another roadblock on the path to getting well. Compassion and love are by far the most helpful responses to the challenges in recovery, even when it is the hardest feeling to summon.

Families need to work hard to avoid blaming their child for an eating disorder. It’s an illness like any other.

The Void after Normalizing Eating Behaviors

Eating disorders typically start in adolescence or early adulthood. Food manipulation and overvaluing weight are important to people at this stage of life but not nearly as all encompassing as they are for people with eating disorders.

Thinking too much about food and weight represents a way to feel calmer or more secure for a stage of life that is very uncertain. Looking a certain way of managing food appear to be superficial tools to find comfort.

For people with eating disorders, these tools become the sole important aspect of their lives. The thoughts are so dominant that all other parts of life become irrelevant. It is worth sacrificing anything and everything in order to achieve the goals the eating disorder sets forth.

The total obsession about food and weight has unforeseen repercussions in recovery. As someone begins to learn how to counter the eating disorder thoughts and make changes in behaviors around food, they start to realize that they are unsure what else to think about or focus on. The concept of other interests or goals has long since been ignored and replaced by food and weight.

This realization is often accompanied by a sense of emptiness and loneliness. Without guidance to know how to face this terrifying prospect, it often feels simpler to lean back into the eating disorder. The person may not even want to return to those thoughts and symptoms. The vast expanse of an open day of thoughts and feelings seems too overwhelming to have it any other way.

After successfully changing eating patterns, recovery needs to switch gears and focus on rebuilding an internal and external sense of what life means. Many recovery philosophies have an existential bent for this reason.

At any age, the person in recovery will need to look at themselves and their own lives and start a crash course in emotional and psychological development.

As hard as this step can be, it also will be very rewarding. Being willing to look at oneself opens the door to a full life. The desire to learn and grow, weathering the excitement and pain that comes along with it, does enable the person in recovery to fully find a way out.

The Simplest Tool for Recovery is the Most Effective

While working with people with eating disorders, I am reminded time and again that the most simple tool is the most effective one. Eating disorders may be known as intractable and very challenging to treat, but the food journal is a critical part of any success in recovery.

Initially, the journal provides a daily accounting of what someone’s eating disorder looks like. Although eating disorder symptoms are somewhat consistent from person to person, the exact way a person thinks about food and eats through the day can change. The eating disorder thoughts tend to be the most dominant thoughts in a person’s mind so the journal also gives insight into a day’s worth of thoughts.

Allowing a clinician to look at the journal symbolically represents an opening of the eating disorder itself into treatment. The therapist can ask specific questions to better understand the process involved and the decisions that are made by the eating disorder rules. The process of asking questions, giving answers and even making small suggestions to change the eating behaviors show that there can be a dialogue around the disorder, something usually very new to the person in treatment.

People often say to me that writing out the details of their food each day is the most personal thing they could imagine doing. The act of writing the journal and then sharing it allows for an intimacy not usually possible because the eating disorder dominates one’s life. Exposure of the central power of the illness invites change and progress.

When I think over the duration of my practice, any person with a moderate to severe eating disorder who I have seen make progress has committed to the food journal for a period of time. The tedium of writing down food combined with thoughts and feelings are worth pursuing for the true benefit that this tool provides. As long as the food journal is a part of recovery, there is nowhere the eating disorder thoughts and symptoms can hide.