Shrink Rap: Eating Disorders

Shrink Rap: Eating Disorders

Eating disorders are characterized as an unhealthy relationship with food. The literature in the field discusses anorexia nervosa (AN), bulimia nervosa (BN), and binging eating disorder (BED). Additional focus on behaviors related to eating disorders would be on compulsive eating, anorexia athletica (or compulsive exercising), body dysmorphic disorder, including muscle dysmorphic disorder: impaired perception of one’s own body, musculature, facial features, etc., and subclinical eating behavior (abnormal preoccupation with food, weight, eating, and weight control behaviors).


Over 60% of Americans are overweight. Our society is obsessed with diets, fads, nutritional supplements, exercise routines, equipment, and surgery promising to help an overweight population lose the pounds.

Society’s fixation with weight no doubt contributes significantly to the development of eating disorders in this country and Western cultures in general.

Most research (which is spotty and often not well conducted) concludes that more women than men are affected by AN and BN – although a study conducted in 2011 found an equal prevalence in adolescent males and females with emerging eating disorders. It is estimated that about 1% of females have AN; and about 4% of college-age women have BN. About 50% of people who develop anorexia nervosa end up also developing a binging disorder. One study estimated that about 70% of alcoholic women under 30 also have an eating disorder.

Treatment for eating disorders is difficult for several reasons.

People tend to hide their disorder. You could be living with someone who has a severe eating disorder and not recognize the problem.  The more serious the disorder, in my experience, the more artful the deception.

Often the disorder will require inpatient nutritional therapy. Cognitive impairment is associated with significant weight loss; people with anorexia at a severe stage of weight loss suffer from a perception they are still fat.

Victims often abuse laxatives, exercise excessively, and wear baggy clothes to hide weight loss. There is an excessive fear of gaining any weight at all and resistance to any attempt to encourage them to eat food.

Serious medical issues can result from such abuse of the body and lead to death. Excessive vomiting dissolves tooth enamel and causes tooth and gum disease. Because these disorders are so serious, the earlier the intervention, the better.

Complex dynamics are often found in the eating-disordered family. For that reason, family therapy is the treatment of choice for adolescents with eating disorders. Cognitive Behavioral Therapy (CBT), combined with mindfulness and acceptance strategies, are recommended as well for both adolescents and adults.

People with eating disorders also have a high prevalence of functional impairment, depression, obsessive behaviors, and suicidality. Onset usually occurs around ages 12 or 13. Statistics show that the number of people who die from AN is about 20% when there is no treatment; about 3-4% when there is. However, total recovery occurs in about 60% of people treated; the rest vary tremendously as to how well they are able to cope and control their disorder.

In my own treatment of eating disorders, if the entire family will participate, adolescents have a much greater chance of overcoming the challenge. This usually involves active participation in inpatient as well as outpatient therapy.

I have also found that adults with residual eating disorder issues find a high correlation between their compulsive desire to eat or obsess on food and life stressors; in particular, familial stress. I have also found that a focus on additional high quality protein sometimes helps offset the desire to binge, as these cravings are almost always for simple carbohydrates and sugars, including sugary alcoholic drinks. Eating quality foods, along with stress reduction techniques, CBT, and mindfulness and acceptance exercises, can go a long way in helping one control their eating disorder.

Chew on that.

About Dr. Susannah Smith:

Dr. Susannah Smith, PhD

Dr. Susannah Smith, PhD

Dr. Susannah Smith is a licensed practicing clinical psychologist and organizational development consultant, with offices in Telluride and Ridgway. If you would like to contact her, she can be reached at;; or 970-728- 5234.


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