Weighty Issues in Therapy

May 06, 2012 12:12 PM | Admin EBCAMFT
By Jacqueline Holmes, M.Ed., MFT

In our popular culture there is a focus on being thin and controlling one's weight and food through dieting. As a result of the dieting mentality we clinicians are seeing increasing numbers of clients struggling with Binge Eating Disorder (BED). An estimated 3% of women and 2% of men are suffering from BED nationally according to a study done by NEDA (National Eating Disorders Association). That is more then all the people struggling with Anorexia Nervosa and Bulimia combined. Binge eating is a natural response to dieting, since the client is often starving while dieting and this can set the body up to crave more food. This type of eating pattern can also interrupt the normal response to hunger and satiety. When you add the emotional drivers and stress of the behaviors, you create a binge eater. Many therapists miss the signs that this is a serious problem for their client and that if it is an untreated behavior it can become a more chronic issue.

The binge eater frequently can feel invisible or even discounted since they aren’t starving or purging, so they wonder if they even have an eating disorder. In January of 2012, Binge Eating Disorder was added to the DSM-IV adding some validity to the symptoms and behaviors with which these clients are struggling. The client may report that they can’t stop eating and then they continue to fixate on how to control their weight as it fluctuates with the binge episodes. To cope, they may restrict their food intake or over-exercise. As with all eating disorders the binge eating is also related to psychological issues like low self-esteem, stress, depression, anxiety and trauma. Over eating has become a popular coping mechanism to avoid more difficult feelings and situations.

Often the habit of turning to food for comfort, control or self-pleasuring can create new problems like increased depression, isolation, medical complications from poor nutrition and weight gain. My clients often say that it “doesn’t matter what the feeling is the answer is food!” “If I’m sad I eat. If I’m mad I eat. If I’m bored I eat. If I feel lonely I eat, and so on.” Food isn’t the answer to a feeling and we have to learn the difference between feeling hunger and these other feelings. If there are other feelings present then we need help the client to find ways to experience them and to decrease the self harming behaviors.

Breaking free from binge eating isn’t only about managing a food plan and increasing exercise, though those techniques can be helpful. It's also important to explore the triggers and underlying psychological drivers that take us to food for comfort.

There is an answer to anger, sadness, boredom and loneliness and that is finding ways to feel them and to learn about how to manage them in daily life. Identifying the situations and triggers for the binge can be helpful in developing other strategies for coping, rather than turning to food. Some helpful tools are: Keeping a “feelings journal” and becoming curious about the desire for food. Developing compassionate self-dialog around the following questions: When do I binge? What do I choose to binge eat? How am I feeling before, during and after the binge episode? Is food going to help or hurt me right now? The goal is to develop awareness and decrease the shame and judgment about the behaviors.

Helping the client to begin to ask themselves, “What else could I do?” is an empowering technique. It can be very helpful to assist the client to develop other forms of self nurturing and self comforting. “What other activities do you have that make you feel good?” Something like reading, taking a walk, calling a friend, playing an instrument, doing a hobbyundefinedknitting, painting, craft work or just tinkering and completing a chore.

I also feel it is vital to break the isolation of binge eating. You can recommend the client seek out a support group with other people who are seeking recovery. OA (Over Eaters Anonymous)and ANAD (National Association of Anorexia Nervosa and Associated Eating Disorders, Inc.) groups as well as recovery groups for people coping with eating disorders can be very helpful. The important thing is to allow the client to talk and not feel shamed or judged.

Working with eating disorders can also give us an opportunity to look at our own beliefs and habits around our own bodies. Our attitudes and comments are closely watched by the client. When we express appreciation and care for our own bodies we become a role model for health and body acceptance.

Jackie Holmes, M.Ed., MFT has been working with Eating Disorders for over 30 years. She offers individual, couple and family therapy in her private practice at the Concord Therapy Center. She has worked all levels of care: Inpatient, Partial, Intensive Outpatient and Outpatient settings, working specifically with Eating Disorders.

She is on the adjunct facility at John F. Kennedy University and UC Berkeley where she teaches continuing education classes in the Eating Disorders Certificate programs. She frequently is a guest speaker at conferences and schools where she speaks on a variety of topics related to recovery and healing from these deadly diseases.

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