What are the first steps that I as one with an eating disorder must walk through?

If you have an eating disorder, you must first not only admit it, but then you must take a step to do something about it - take an action. You can find a list of psychologists that deal with eating disorders from doing a search on the internet. That is the most efficient way. It is very important that you are ready, though. So many say they want help but when they get into my office, they are extremely hesitant to make any commitments around changing their way of eating (or not eating if they are anorectic) plus they are very reluctant to consider the idea that food is not really the main problem, rather deeply-held unhealed issues from years earlier are.

It is extremely critical they you find someone that you are comfortable with right from the start. Don’t stay with a psychologist because you sense you might hurt their feelings. This is your life we are talking about and you must be clear with yourself, first, and then to them about how open you imagine you can be. You are in charge now, maybe for the first time in relationship to someone else, in terms of choosing the match for you. I personally think it is important to find someone who integrates spirituality with psychology because I firmly believe that that is the only way for true healing to occur.

A bulimic said to me many years ago, “I will binge to the point of unconsciousness until my Soul is no longer starving.” It is a very powerful statement, one I will never forget. One of the reasons for binging is to feel that “full” feeling, the sense that one isn’t empty anymore. But, of course it is never food that can fill one up, it is all about finding meaning in one’s life. You, as one with a disorder, can’t know that yet. You will, over time, though, get a sense that, indeed, your eating disorder is a defense against issues you’ve not wanted to examine that make you want to stay numb. When you aren’t connected with yourself, you can do many things that aren’t satisfying for you but you think they will be - “maybe this time,” you say to yourself.

So, the very first step is to say to yourself that you do have an eating disorder, that you are tired of being tired, tired of trying to manage it, tired of the obsession with food, tired of having to hold this huge secret inside and act as if nothing is wrong, tired of worrying about the possible side effects that could happen, including death (both for bulimics and anorectics), tired of having to have your whole life revolve around food, whether you eat or don’t eat on a particular day, tired of the scale getting to decide how you feel at any one moment of the day, tired of not enjoying life because there are so many rituals you have to attend to, tired of lying to suspecting people, tired of the stress you are always feeling, tired of the energy that it takes to deal with all the guilt, the shame, the many feelings that are attached to the eating disorder, just tired.

Then, once you find that you have the courage to find someone, you go to a session. When you have found the one that you know can assist you, you must begin to uncover all that you have kept deeply inside of you for the years that you have been doing the behaviors that surround the eating disorder. You also have to refrain from telling your psychologist that “You have no issues other than your obsession with food.” That is never ever true, so it is very important that you drop the belief, even if you don’t buy that it is untrue - yet.

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How does a professional help patients with eating disorders?

Turning to the professional, I want to underline the most important aspect of your time with the patient. You must go slowly and you must realize that they have no language for their feelings. If you ask them how they feel, no matter if they are severely anorectic or bulimic, you most likely will get “I feel fat.” You won’t get a genuine feeling because they have had to tune out (or have never learned how to feel from the start).

Before you accept a patient, though, you must be sure you have the credentials to deal with this kind of issue. So many say they have dealt with people that are overweight so they know what to do - they don’t and can often miss extremely necessary information and clues along the way. It is a very challenging situation to be in a session with a person who has an eating disorder, so you need to be trained in the various levels, stages, things that must be paid attention to, etc. I do trainings all the time for therapists so I know what kinds of questions they/you may have and what the answers are, after being known as “the expert” since the eighties.

Anyway, if you know that you are well-skilled in this area, the first thing you must do is insist on their having a physical and that you will need a copy of the results - a blood work-up being one of the things you will want to see. They also must agree to tell the physician that they have an eating disorder. Often, they just go in and say they need to have some blood tests but not say how come.

The most important part of any psychotherapy with these patients is building trust, more than anything else that happens, the relationship you develop with the patient who has this disorder can either facilitate or limit your ability to assist them.

Since I will be talking about several things in the columns ahead, I won’t go into any more detail about the process. This particular segment is for you to get information on the first step when you know someone has an eating disorder.

If you don’t feel qualified, once you have heard their admitting to the disorder, it is certainly critical, and you know this, that you refer them to someone you trust who does know a lot about how to treat them and has shown you, over the time of your knowing them, that they do have the background and experience to handle the patient.

Reading articles and looking up information on the internet are not sufficient, in the least, to feel that you (or someone you refer them to) can or should begin the process with these patients.

This group of patients is very complex and has learned, in order to survive, an extremely embedded way of coping with horrid childhoods, very painful experiences. I always, in fact, talk to them, from the start, about how much they are to appreciate, rather than abhore, the eating disorder because it did provide a way for them to survive whatever they had to go through as they were growing up.

I must have faith that both you as a patient and you as a psychologist who is taking on the responsibility to treat them will be authentic - meaning will be honest with yourself and the other, supportive of yourself, and open to going through the journey, whatever that means and however long it takes, to have the healing occur.

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How do I tell if a patient has an eating disorder?

How do I tell if a patient has an eating disorder or “I“ have an eating disorder? What are the main signs to look for in the way they talk about food, weight, control, etc. or “I” speak about these same topics?

I am going to start with the basics, so I will address what you need to pay attention to. I have seen patients both inside of an inpatient unit and in my office for many years who continually say to me - I don’t have a disorder, I have just found the best way I know to keep my weight the way it is. I like being a size one. I used to be a 12 and now I am a one. Let me be. I am fine. If someone says that to you (or you say that to yourself), know that you are talking with someone who is in denial (or minimizing) the truth, that she in fact does have an eating disorder. By the time they get into my office, of course I know that they have a disorder, but I also know they are going to refuse to admit it or even to allow themselves to take this opportunity to explore the possibility in depth. How come they are even in my office, at a presentation I’m giving or inside of a hospital? That’s a great question, many are only there because someone forced them to be. I have one right now who said that her husband would divorce her if she didn’t get some help. What help she keeps asking herself? She is so embedded (and I use that word advisedly) in her disorder that she finds it impossible to imagine not having the chance to eat whatever she wants and then vomit to get rid of it.

I am going to begin with bulimia and then turn to discussing anorexia.

You have an eating disorder if you are using either laxatives, vomiting, diuretics, or all of these to get rid of the food, most often an immense quantity, that you consume. Now, that doesn’t mean you do it every day, you may do it twice a week, only on week ends, or periodically, but, if you are doing it as a way to control your weight, you have a disorder. Let me say that a “disorder” means that you have a distorted view of food, a distorted perspective of what use it serves for you and a distorted perception of how much you are focused on it throughout the day (and night). Some have bulimia and are overweight because they have stopped vomiting or taking laxatives (or rarely ever did), yet still binge.

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