An Interview with an Eating Disorder Therapist

Hey everyone!

I recently had the honor of being interview for a therapy podcast, “For The Love of Therapy” with Cesar Palos, to talk about eating disorders! A big passion of mine is advocacy and de-stigmatizing eating disorders by getting the correct information out there to the general public so that we can have more support, understanding and community involved in eating disorder treatment, especially for teens and adolescents in eating disorder treatment- this podcast was a way to do just that! Below is our interview, I hope you enjoy!

Listen to the podcast, here.

1: Introduction: Introduce yourself, how long have you been a therapist, where is your private practice located, why eating disorders ?

I have been a therapist for 4 years, but I’ve been working in the field of child and adolescent development for 10 years. My private practice is located in Ohio and also serving clients in Utah and soon to be New Jersey. Eating disorders became my area of interest because of the complex development, the population they impact and the typical onset during adolescent development which fits right into my experience and interest in behavior and development. The complexity of psychological, biological and social mechanisms that go into the development of eating disorders is fascintating to me.

2: What are eating disorders and how can eating disorders be categorized ? Anorexia, Bulimia, Binge Eating

Eating disorders are mental and physical disorders that impact patterns of eating, restricting and body image. They often have medical and physical complications.

Eating disorders are defined by the DSM-5 which is how therapist can bill insurance companies for certain diagnoses and that section was added in the 1980s, even though eating disorders had been around for likely hundreds of years at that point, they were becoming more researched and more prevalent in society with the rise of college attendance. Binge eating wasn’t added to the DSM until 2013.  

3: What is the difference between Anorexia, Bulimia and Binge Eating ?

The difference between eating disorders really shows up in how the behaviors of the person present. You can be diagnosed with AN at assessment and that eating disorder may morph into bulimia nervosa by your next assessment. Really the differences are in the intensity and frequency of restricting, bingeing, and purging as well as how thoughts, fears and body image are impacting the person.

4: what are the warning signs that an individual may be developing an eating disorder? What can parents look out for ?

This is a great and very important question. Often times eating disorders start out very inconspicuously with what may seem like healthy behaviors- your child taking an interest in ecercising more or wanting to eat healthier or cleaner. It may be cutting out sweets or dieting. Suddenly, these behaviors start to add up and intensify and before you know it, you have an eating disorder on your hands. So make sure if you notice any behaviors in your child of increased exercise or sports participation, cutting out food groups, skipping meals, eating meals alone in their room, not eating in front of you, going to the bathroom after meals, waking up in the middle of the night, eating “clean” foods only, difficulty eating out or eating with friends, avoiding foods they used to enjoy, looking in the mirror often, making negative body image comments, food in their room or wrappers in their room or hidden, you check in on them and ask questions.

5: How can you help your client separate the rational part of their brain from the irrational part that is forcing them to binge & purge or restrict eating?

Something we use in eating disorder treatment that is extremely helpful for this is “Externalizing the eating disorder”. This means giving the ED a name, a distinct voice, and even drawing a picture of what it looks like. This helps clients to separate the ED voice from their own and makes it easier for clients to join in the fight against the eating disorder with their treatment team and support system. It can feel odd for clients at first, because they feel like that voice is their own, but they didn’t always have that voice. And they didn’t wake up one morning and say “im going to develop an eating disorder today!” so we know that the voice is not their own. By externalizing the ED, clients can feel less ganged up on, and more empowered to take control back from the ED. And it’s a constant daily battle against that voice.

6: How traumatic can an eating disorder be on a parent or family?

Eating disorders and their treatment can be extremely traumatic on families. I have seen many families struggle to hold onto any sort of semblance of the life they had before the ED. I have seen them mourn the loss of that life before ED. It is so so important for families to get the right treatment team and the right support system during ED treatment. I talk non-stop to my families about self-care because caregivier burnout is the #1 leading cause of relapse in eating disorders- if you aren’t taking care of yourself you can’t take care of your loved one with an eating disorder. And a big part of this is breaking the stigma around eating disorders and helping families to reach out and ask for help as they would if their child had cancer or another serious illness. Eating disorders are serious medical and psychological illnesses that require intense treatment involoving their entire family- and families cant do that if they don’t have support from their jobs and communities.

7: What information can you give as an expert that would allow a trainee or associate be better prepared when working with an individual who has an eating disorder ?

My advice for every therapist or social work trainee is to get some basic training on eating disorders- because even if you don’t want to treat them or don’t think they will be present in the population you want to work with- they will be. They do not discriminate across age, gender, race, occupation and you are almost guanranteed to encounter one. My other #1 piece of advice is DO NOT treat eating disorders unless you are highly trained. Please refer out to a specialist. I know a lot of providers who have given patients harmful advice and encouraged eating disorders behaviors- I know this is not their intent- but please seek training or consultation if you want to continue working with a client with an eating disorder.

8: At what point do you make the decision to transfer your patient to a facility in order to get the proper resources ? Also, if a parent declines services, is that considered neglect ?

Transferring a patient to a facility is a difficult decision and should be made by lots of consultation with peers and resources in the eating disorder sector. It is better to make that recommendation too early than too late. I would advise professionals to make the decision just as they would for any patient who they are considering a higher level of care- if its coming to your mind, you are probably right.

If a parent declines services for their child it is a complicated situation- at a certain point it can absolutely be considered neglect, but that is extremely hard to prove and enforce. The best thing you can do is provide options for treatment and resources and meet them where they are.

If you have more questions about eating disorders or eating disorder treating in Ohio, eating disorder treatment in Utah or eating disorder treatment in New Jersey, please reach out here.

Navigating eating disorder treatment during the holidays can be daunting. If you need help along your journey, please reach out to schedule a free consultation call.

DISCLAIMER: The advice on this blog is for entertainment purposes only and is not indented to be medical or therapeutic advice.