What are Eating Disorders?
Eating disorders are complex, serious mental illnesses that can lead to serious long-term mental and physical problems and illness. They have one of the highest mortality rates of any mental illness. They can involve restrictive eating, fasting, over-eating, binge eating, feeling out of control while eating, purging (vomiting), laxative or diuretic misuse, excessive exercise, weight loss/gain, body image distortion, preoccupation and obsession with size, shape, weight diet and health, size, shape and weight being central to self-worth and identity, body dissatisfaction or hatred, and intense fear of particular foods and weight gain. Eating disorders can significantly disrupt peoples’ lives in every way – e.g., physically, emotionally, socially, academically and occupationally.
Eating disorders occur in people of all body sizes, shapes and weights.
Eating disorders occur in many varied ways. They can be formally classified as binge eating disorder, bulimia nervosa, anorexia nervosa, other specified feeding or eating disorder (OSFED) or orthorexia. “Underweight”, “Overweight” and “Obesity” are NOT eating disorders. They are medical terms based on body mass index (BMI), BMI is NOT a reliable indicator of health status, health behaviour, eating disorders or diseases.
Who is at Risk of Developing an Eating Disorder?
About 1 million Australians (4% of the population), are living with a clinical eating disorder, and many more live with disordered eating. Eating disorders are caused by complex genetic, environmental, psychological, social and cultural factors, that are different for each person. HOWEVER, dieting is the single biggest predictor of developing an eating disorder. People who follow restrictive diets (or lifestyles that involve following strict rules about eating), exercise excessively and are preoccupied with “health” (beliefs about what health is are often misconceptions), are particularly vulnerable to developing an eating disorder. Even people who follow diets due to medical conditions such as diabetes or allergies are vulnerable. Psychological risk factors include perfectionistic, obsessive-compulsive, rigid and avoidant personality and thinking styles, a high need for control, body image and appearance being central to self-worth and low self-esteem making one sensitive to absorbing cultural standards and ideals. Women and girls have traditionally been a lot more vulnerable to developing eating disorders but they are now increasingly being diagnosed in men and boys.
Treatment of Eating Disorders
People with eating disorders usually require multi-dimensional treatment and support, such as a GP, psychologist, dietitian and psychiatrist. This is essential when they are medically unstable, e.g., due to significant weight loss, nutritional deficit and risk of death, as in anorexia nervosa. Weight restoration is a goal of treatment for these people. Medical monitoring and dietitian support is essential for them, and for those who frequently purge (vomit), abuse laxatives and over-exercise. They may also require inpatient treatment. Families and carers of people with eating disorders also require support and assistance. Family based therapy is recommended for adolescents with eating disorders. The frequency and intensity of treatment required depends on the severity of the disorder and motivation/ability to participate in therapy. This can range from weekly consultations to more intensive outpatient or inpatient treatment programs.
What I Offer – Psychological Therapy
As eating disorders present in many varied ways, I only offer therapy to adolescents and adults when I assess that I have capacity to meet individual needs using evidence-based therapy. I work most effectively with individuals, who initiate their own therapy and are motivated to participate in therapy.
Referrals from GPs with Eating Disorder Plans (up to 40 therapy and 20 dietitian sessions a year with a Medicare rebate) are for serious eating disorders. I accept these referrals for adults only, who must be medically monitored by their GP and also attending dietitian support and psychiatrist reviews.
I focus on supporting people of all sizes, shapes and weights with healthy behaviour enhancement, including cultivating cognitive and behavioural flexibility, helpful self-talk, body acceptance, self-acceptance and self-compassion; promoting flexible, individualised eating based on hunger, satiety, nutritional needs, and pleasure, (rather than any externally regulated eating plan focused on weight control); encouraging enjoyable physical activities; and letting go of unhelpful beliefs, behaviours and harmful weight prejudiced diet culture.
I use evidence-based treatment approaches including cognitive behaviour therapy for eating disorders, adolescent focused therapy for eating disorders, dialectical behaviour therapy and Interpersonal therapy. I adapt therapy to individual needs.
I provide supportive counselling for carers of people with eating disorders.
What I Do Not Offer
I am not able to offer therapy to adolescents with serious eating disorders, who are medically at risk, require weight restoration, have serious co-morbid conditions and have limited or no motivation to participate in therapy. This is because they require more intensive treatment (including family-based or Maudlsey treatment), and regular liaison with the treatment team, which I do not have the resources to provide as an independent private practitioner. Therefore, I do not accept referrals with Eating Disorder Plans for adolescents.
I am not able to offer therapy to adults with serious eating disorders, such as anorexia nervosa, if I assess that they require more intensive therapy than I can provide or when they are not capable of engaging in therapy due to medical/cognitive instability.
I don’t “treat obesity”, as “obesity” is not a disorder. I will not encourage people with larger bodies to lose weight. Many people with larger bodies say they developed their eating disorders due to dieting – trying to lose weight – and unfortunately this was encouraged by medical and health professionals. This is despite over 50 years of research confirming that pursuing weight loss is ineffective for the vast majority of people and potentially physically, mentally and emotionally harmful. In fact, dieting is the single biggest predictor of developing an eating disorder. Therefore, research does not support weight loss as a goal of therapy. Healthy behaviour enhancement is a realistic, achievable, ethical and compassionate goal of therapy. Weight loss may be a consequence of healthy behaviour enhancement for some people, but mental and physical health can improve significantly as a consequence of healthy behaviour enhancement without weight loss.
*Health at Every Size and HAES are registered trademarks of the Association for Size Diversity and Health (ASDAH) and used with permission.