Therapy in LA
Therapy in L.A.

  article of the month
August 1998
by Margaret Stoll Ph.D.

Are you preoccupied with food, focused on what you have eaten or always planning you next meal? Do you feel controlled by food, eating more than you intend, often in secret, and then feel guilty or depressed afterward? Do you try to "undo" overeating through vomiting, exercise or dieting? Or maybe you severely restrict your eating, fearing that eating normally will make you fat. Often such people become significantly underweight while still disliking their bodies and believing they are too heavy. People with eating disorders may have any one or a combination of these symptoms. They also often experience depression, anxiety, work or school difficulties, relationship problems and a host of medical complications. If any of this describes your behavior, you or maybe someone you know, may be among the many people who are struggling with an eating disorder.

The three major eating disorders are Anorexia Nervosa, Bulimia, and Compulsive Overeating. Anorexia, developing most frequently in adolescent and young adult women, is characterized by extreme weight loss, fear and avoidance of food and distorted body image. Bulimia, also most common in females, consists of rapidly consuming large quantities of food and then "undoing" this by vomiting, exercise or dieting. Finally, compulsive overeating is the inability to contain food intake to that needed for nutrition. Instead food is used for emotional purposes, resulting in overweight and obesity.

The effects of an eating disorder are far-reaching. Anorexia is one of the few emotional disorders than can be life threatening. Severe weight loss and malnutrition can compromise many major bodily systems such as digestion, circulation, reproduction and particularly the cardiovascular system. Bulimia, also potentionally fatal due to electrolyte imbalance, can result in dental impairment and esophageal tearing as well. While the physical consequences of an eating disorder seem most dramatic, there is also likely to be serious damage to one’s relationships, self-image and mood and ability to function in the world.

While the origin of an eating disorder is complex, it is believed that biological, social and familial factors are involved. Often families of eating disordered patients have difficulty with such issues as independence, recognition, management and communication of emotions, conflict , control, problem-solving and flexibility of family roles. The fact that our society promotes and idealizes thinness as an indication of beauty in women most likely contributes to the disproportionate number of eating disordered patients who also have depressive or anxiety disorders and the fact that these disorders all seem to run in families, is evidence that suggests that there may be a biological "predisposition" toward developing an eating disorder.

While disordered eating can be extremely distressing and disabling, the good news is that effective treatment is available. This consists of a comprehensive approach including medical, nutritional and psychological help. Psychological treatment often includes individual, group and family psychotherapy with a psychologist, social worker or marriage and family counselor who specializes in treating eating disorders.

One of the hallmarks of any addictive disorder, including eating disorders, is denial. Therefore, the sufferer is often unaware of or at least defensive or minimizing of their condition. If you think someone you know may have an eating disorder, it is important that people they know and trust speak to them gently yet directly about their concerns. This should be presented as observations, questions and concern; never criticism. They should be encouraged to consult a physician, psychotherapist or nutritionist.

Dr. Stoll is a psychotherapist working in Redondo Beach and Glendale. She is a member of the Independent Psychotherapy Network.

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