Eating Disorder Treatment and Recovery
What is an eating disorder and how is it different than disordered eating?
Most simply, one is listed in the DSM (Diagnostic Statistics Manual aka what Clinicians use to officially and unofficially diagnose their clients), and the other is not. In the DSM, there is a section called Feeding and Eating Disorders where you will find a variety of diagnostic labels that may fit your experience, such as but not limited to Bulimia Nervosa, OSFED (Other Specified Feeding and Eating Disorder), ARFID (Avoidant Restrictive Intake Disorder) and Binge Eating Disorder.
Each of these have specific criteria that a person needs to meet in order to be given an official diagnosis that can be used to either seek a higher level of care of treatment - such as an Intensive Outpatient Program (IOP) or Partial Hospitalization Program (PHP), or can be used on Superbills given by your therapist to submit to your insurance company for reimbursement for your out-of-pocket therapy costs.
Other than that, I don’t believe diagnoses are necessary, unless the client themself wants one for better self understanding and a label they can use to help better explain their experience to others.
Disordered eating, on the other hand, doesn’t fully meet the criteria for one of these DSM labels, but that doesn’t mean your suffering and experiencing aren’t real or valid. Quite the contrary.
Body Dysmorphia vs Body Image vs Embodiment?
Body dysmorphia is another DSM label that describes a certain set of criteria a client must meet in order to receive the diagnosis. In simple terms, it can be seen as a more severe version of body image issues - that many people (if not most people) in the world experience. But just because many people experience something, doesn’t mean it should stay that way. Just because many people experience poverty or being unhoused or sexual assault, doesn’t mean it should stay that way and shouldn’t be addressed. This is the same with the pervasiveness of poor body image in our society impacting people of all genders.
One key difference, though not always the case, between body dysmorphia and poor body image, is the former’s literal view of themself is highly distorted. Meaning, when you look into the mirror what you see is vastly different than what is reality - physically speaking. It’s like constantly being in a fun house mirror, except it’s anything but fun. It’s scary and discerning because your eyes tell you one thing, but everyone else is telling you another and you just can’t see it, and thus can’t believe it. Poor body image may have a degree of this experience, but not to such an extreme. More often, poor body image is seeing yourself clealry in the mirror, but not liking what you see.
Both have deep roots in a 1) lack of embodiment 2) low self esteem and 3) internalized thin ideal (or these days fit ideal) standards. This is why becoming embodied, though uncomfortable and likely intimidating, is essential. Some refer to it as body neutrality, but I just call it embodiment - being in ones body, having a connection to its sensations, emotions, and memories and knowing how to regulate it. It’s more about being inside your body than constantly judging it from the outside.
Common struggles and diagnoses I work with related to food, body and exercise
Orthorexia - an obsession with being healthy and a fear of fatness
ARFID - common for ADHD and Autistic folks, struggles with feeding yourself consistently due to fears of being expired or sensory challenges
Binge Eating Disorder - recurrent episodes of eating large qualities of food beyond fullness cues resulting in self hatred and physical discomfort
Bulimia Nervosa - recurrent cycles of restricting and purging through various means such as vomiting, laxatives and compulsive exercise / excessive exercise
Anorexia Nervosa - an obsession with thinness and a fear of fatness associated with restricting food intake and often compulsive exercise / excessive exercise
Binging - eating large amounts of food mindless, compulsively or as a way to soothe painful/uncomfortable emotions such as loneliness, overwhelm, and anger.
Restricting - limiting the amount or type or frequency of food intake
Unintentional Restriction - “forgetting to eat” or “being too busy to eat”, not noticing hunger cues or ignoring them because of being focused at the task at hand - common with neurodivergent folks, especially ADHDers.
Compulsive Exercise / Over exercise - having rigid rules around exercise, exercising to the point of exhaustion, having a “calories in calories out” mentality, forcing yourself to exercise because of something or how much you’ve eaten, feeling addicted to the “high” of exercise
Body checking - constantly adjusting your clothing or grabbing at areas of fat on your body
Low self worth and “Compare and Despair” - constantly comparing yourself to others and then despairing about a perceived difference or lack
Perfectionism and Overachievement - folks who need to be in control or feel a sense of control, especially over their body and food and exercise
A chronic and intense Inner Critic - self judgement, giving yourself a hard time, etc.
Always on a diet - yo yo dieting, tracking your food, tracking your exercise
Feels pressured to conform due to a job or hobby like dance, acting, or sports
Disconnected from the body and its cues, Body Dysmorphia and Poor Body Image
What is Treatment vs. Recovery?
Some of this is just provider specific, but most commonly the term treatment is used my medical professionals or those in higher level of care settings who see their clients as “patients” whose symptoms need to be fully fixed or stopped. They are explicitly treating the eating disorder diagnosis and are a time bound specific cycle of therapy such as three months, 6 months, etc. or whatever insurance will allow.
Recovery is another term also used in treatment, but many practitioners in more medicalized settings take the approach of being someone can be fully “recovered” which they mean they do not meet the criteria anymore for the diagnostic label. However, there are many clinicians, especially those with their own lived experience with recovery, who believe there is no such thing as “fully recovery.” This isn’t to mean someone is doomed or there is no hope, what it acknwoledges is that the root causes of many of disordered eating and disembodiment expeirences are due to systemic oppression. How can one be fully recovered when they have to keep existing in an recovered world full of diet culture and white supremacist beauty values?
Further more, eating disorder “behaviors” as they’re commonly referred to, such as restriction, purging, overexercise, body checking, etc. are the symptoms, not the root cause of the persons suffering. So often recovery is seen as a life long journey to know and heal the Self. A spiritual journey, a self discovering journey, something far bigger than a DSM diagnosis, and acknowledges how eating disorders are more often than not, the result of underlying unresolved trauma. So treatment is eating disorder behavior focused and recovery is radical self reclamation over time both in and outside of therapy.
My approach
I use a social justice, non-diet, interdisciplinary and Health At Every Size approach. The foundation of my practice focused on somatics - the body, expression - of emotions, ideas and creativity, identity - gender, brain style, sexuality, race, ethnicity and more, and purpose - what you feel called towards, what is your unique role in the greater web of life. Spirituality is often very important for recovery and I believe it is self-defined. For some its religion, for many its not, for others its a combination. I help clients discover what this means for themself and discover the tools and practices that help them stay connected to the sacredness of their body and the meaning of their life. It helps us keep going through the pain.
I love working with all bodies and their various genders, sexualities, sizes, races, and ages.
I especially enjoy supporting parents and partners with a loved one in treatment or in recovery.
I work with folks at many different phases of the recovery spiral - from questioning if they might want to do this work around food/body, to having graduated from IOP and wanting to retain and strengthen their recovery, to having been in long-term outpatient recovery for awhile and wanting to go deeper into trauma and embodiment work to radically heal.
Eating disorders and “body image” (really embodiment) work is often only treated cognitively and behaviorally. My approach is the opposite - trauma informed and about the roots of the symptoms being expressed.
Why I work with eating disorders, body image and disordered eating
I became a therapist because of my own eating disorder treatment and recovery journey. Through this journey, I’ve come to know recovery is a spiral and collective liberation work. I have years of personal recovery under my belt, directed an all bodies, all levels, all styles outdoor dance company focused on healing for six years, worked at The Lotus Collaborative IOP/PHP program as an individual, couples and group therapist, did my thesis on healing eating disorders with somatic and energy healing practices, and worked with the FedUp Collective.
How I conceptualize Eating Disorders and Body Image
I believe disordered eating, negative self image and fixation on the body, size and health are expressions of deeper trauma. This could be from your lifetime or passed down, unprocessed, from previous generations. As a white bodied, European descent person, I use a cultural somatics, social justice and internalized White Supremacy lens with clients.
I believe ED symptoms are often deeply tied to our experience of gender and desired gender expression. Whether you’re nonbinary, trans, a woman, a man or questioning, I center gender in the work and provide affirming care in the process to help you sift through which voices are Self and which are survival parts not interested in you thriving.
I believe ED symptoms are often deeply tied to sexuality, both our experiences of harm and need to feel desired - wanted. Whether you are queer, gay, lesbian, bisexual, pansexual, fluid, intersex, straight, are a survivor or perpetrator of sexual abuse or coercion, I center sexuality in the work and provide a non-judgmental space to explore, heal and integrate so you can enjoy life and your body again.
I believe ED symptoms are often experienced by folks with neurodivergent brain styles, such as ADHD, ASD, BPD, OCD and a combination of various diagnostic labels. I deeply cherish supporting folks who suspect or know they are neurodivergent and specialize in helping you develop embodiment practices that help you regulate your unique body and system.
Common Benefits Clients Experience After Working Together
Cessation of their outright eating disorder behaviors such as, but not limited to restriction, purging, overexercise, body checking, and binging
The freedom of throwing out your scale and the confidence to advocate for not knowing your weight at the Doctors office (nope! it’s actually NOT a requirement!!!)
Increased body acceptance and even satisfaction
Decreased anxiety around meals and food and “health”
A definition of Health and Wellbeing that supports your recovery and joy in life
A greater sense of passion for life and increased energy for things you want to do
Increased capacity for discomfort - like emotions and physical sensations, or even conflict or the unknown
Increased confidence, sense of self and sense of worth
Ability to dream and create again
Increased ability to eat a variety of foods, notice hunger and fullness cues and make decisions that algin with your definition of Health and Wellbeing
Decrease in your inner critic berating you all the time
Self empowerment to be able to regulate your nervous system
Increased self awareness as well as advocacy around social justice and self sovreighnty
A deeper and authentic relationship to spirituality and your own magic
If you are:
struggling with an eating disorder
in recovery
exploring your disordered eating patterns
want to experience any of the listed benefits