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Harmful Misconceptions About Eating Disorders

shutterstock_228722455As a therapist who has dedicated my career to eating disorder recovery, I have encountered many misconceptions about eating disorders and treatment.  I feel that they are important to address because these statements often create unnecessary obstacles for people seeking help.  Recovery is hard enough on it’s own!  We don’t need these ideas getting in the way of anyone working towards a better life.  We have a great opportunity here to start a more productive dialogue about these complex disorders.

“People choose eating disorders just to get attention”

This one is a painful misconception that I see expressed often on social media. This short statement is loaded with misinformation and I could write volumes about it. The short version is; eating disorders are not a black and white “choice”, they are legitimate disorders. Eating disorders usually start off with good intentions. A person is in some kind of emotional pain or trying to cope with trauma and they decide to try and help themselves through it either with a diet or eating as a way to comfort themselves. Nobody starts with the idea, “Hey, I think I’ll try having an eating disorder!”. During this process of using either weight loss or food as a coping mechanism, a structural change happens in the brain. The brain begins a developing a dysfunctional attachment the idea that these coping mechanisms are necessary and then it begins to reinforce these behaviors, strengthening them over time (this is where it becomes a mental illness).  Hunger becomes a source of satisfying comfort and often feels like the only way to have any relief from painful emotions. Binging and purging can feel like a necessary ritual in order to feel okay. Next, the behaviors start fusing with a person’s personal identity. The number on the scale becomes an indicator of being a “good” or “bad” person” and the weight loss behaviors start feeling like the only thing he/she is good at. It starts to become all-consuming and pushes out other interests, personality traits and relationships.  Life becomes centered around preserving the eating disorder.  It doesn’t happen overnight, it develops over time.

Most of this experience happens internally. The idea that it is “for attention” is not a fair assessment. Even if the eating disorder is visible to others, the person usually works very hard to keep the behaviors secret. The idea of being found out feels scary and very risky. Many people with eating disorders want to go unnoticed or “become invisible”. Eating disorders are not used as a tool for attention, that explanation is too simplistic to describe this complex condition.

“If you stop your eating disorder, you’ll feel better, right?”

This idea usually comes up when a person starts seeking out treatment. They have made the courageous step to get help and people around them are trying to be supportive, pointing out all the ways they’ll feel “healthier” and “happier” after they let go of their eating disorders. Again, the intentions here are good, but there needs to be more understanding of the process of eating disorder treatment. In the early stages of treatment, the idea of letting go of the eating disorder is terrifying. These behaviors have been a source of comfort for months or years, a part of the persons identity and the eating disorder has promised big things. If you follow the rules of the eating disorder, you’ll be happy! You’ll be successful! People will love you! It takes time and a strong, healthy relationship with a therapist and dietitian to challenge this. It often feels worse before it gets better. That is a normal part of the recovery process. If a person doesn’t know this, it could discourage them from continuing treatment. If weight gain is a part of a persons’ recovery, that is another level of adjustment that loved ones should be sensitive to. It’s not until the mid or late stages of treatment when the person starts to feel more positively about living life without his or her eating disorder. It often takes more time than parents/spouses/friends think that it will, I think our expectations need to be adjusted to reflect this. If we push that idea that recovery should equal happiness every step of the way, then I believe we are setting up an unrealistic expectation that will become an obstacle in recovery.

“If I accept my body, I will go out of control, gain weight and it won’t ever stop”

This is a common fear for people in eating disorder recovery. We talk a lot about body acceptance, but the idea of eating intuitively and accepting our bodies is often a scary one. If a person has lived for years with strict “rules” about food and weight, the idea of letting them go can feel like a direct connection to being “out of control” and gaining weight with no stopping point. The body’s metabolism needs time without restricting, binging or purging in order to regulate itself and get back to a fully functional place. This is where a relationship with a Registered Dietitian can make all the difference in recovery. Having a trained professional help guide you from your eating disorder rules to a place of eating intuitively is a tremendous burden off of your shoulders. A dietitian can help explain what kinds of things are happening with your metabolism and how to maintain a healthy weight without obsessing over a number on a scale. It is best practice to set up a treatment team that involves a mental health professional and a registered dietitian, this way the psychological/emotional facets of the eating disorder as well as the physical ones. Medical doctors are needed to keep tabs on the physical effects of the eating disorder, but they can not provide the specialized and ongoing guidance that a dietitian can offer.

“I can recover from this on my own”

This idea is the biggest one that I want to address. The most important thing a person can do for his or her recovery is to establish a relationship with a therapist. In order to fully replace the eating disorder behaviors and thrive, a person needs to build a healthy relationship with someone who can help guide them through the process. This relationship creates an atmosphere where a person can be challenged but in a safe and empathetic way. Books are great, reading articles like this are great, but they really are just primers for the real work. Gaining insight is a starting point, but it’s not the entire process. Recovery can not be achieved in a classroom setting, where a person is just absorbing knowledge but not going through the emotional side of the process. Eating disorder recovery is about finding ways to cope with difficult emotions and building positive connections with others, it isn’t a skill that can be taught through a book or a blog post. It is an experience that must be lived through. There is a community of experts out there who have years of experience with this journey, utilizing this rich resource can only benefit a person who is struggling with an eating disorder. Since the therapeutic relationship is a personal one, experience is not the only factor in choosing the right therapist. Feeling safe with a therapist, feeling like you are being genuinely listened to, and an overall comfortable feeling in the room with that person is vital for recovery. You can find eating disorder professionals through the website

Body Shaming Does Not Help People Live Healthier Lives. Period.

shutterstock_256857343Recently a viral You Tube video by an uncreative comedian brought some internet attention onto the concept of fat shaming. I won’t give the person’s name or details of the video, I’m sure most of you have an idea of the video I’m speaking about and I don’t want to encourage any more clicks to her website or contribute to any attention she is getting in the aftermath of this video. There is plenty to say about the myths about tough love and fat shaming without this poorly done video being attached to it.

There is a line of thought in mainstream culture that suggests that being “tough” on people who are overweight will lead to positive changes in their lifestyle (aka weight loss). Somehow society has taken on the responsibility of being truth-bomb-droppers for overweight and obese people, criticizing their body size under the guise of “helping”. This is exasperating to me on many levels and brings up a lot of discussion points (I could go on all day, but I’ll spare everyone the excess ranting and stick to my Top Three);

1) The idea that criticizing another person for their weight is somehow going to inspire them to lose weight is inaccurate and misguided. In the book “Health at Every Size”, Linda Bacon summarizes numerous research studies that show that people who are criticized for their weight tend to gain MORE weight and at a high risk for becoming obese. I’m not sure how the message got out there that people who are overweight are somehow unaware of their size and need this to be pointed out by another person. Who needs a “truth bomb” from a stranger on the internet when you are the one living in your body every day? If it doesn’t result in any positive lifestyle changes, then the point of this criticism is more beneficial to the person criticizing than the person receiving the so-called truth bomb. People who intend for this to be helpful call it “tough love”, but it is just plain old body shaming. The recipient tends to internalize all of the “tough” and none of the “love”.

2) In my professional experience as a therapist who specializes in the treatment of eating disorders, the presence of body shaming is a response to the collective fear we have of body acceptance. The idea that we can accept our bodies (Yes, even if we are not at our lowest, ideal weight. Stay with me.) is a tough pill for most people to swallow. Acceptance is not the same as giving up. Acceptance actually leads to more positive changes and is a powerful motivator. It is the thing that leads us to exercise for the good feeling it gives us, not as a punishment for “bad” eating. It leads to us choosing foods that make our bodies feel healthy and energized. There is a lot of fear that if a person fully accepts themselves, than they will become lazy and out of control. You know what sends people into a state of feeling and acting out of control? Anxiety. Shame. Trauma. All of these triggers are products of internalized criticism, not self-acceptance.

3) How do we know that weight loss is the secret to good health for others? How can we tell, just by looking at a person, that their weight is unhealthy? Only a doctor can make that conclusion about an individual. There is medical research (again, please consult the book, “Health at Every Size”) that states that people whose BMI lands in the “overweight” range actually live longer than people whose weight land in the “normal” range. Our bodies are designed to store fat as a survival mechanism, we don’t need to demonize this basic biological function, we need a more in-depth understanding of it. More medical information has been surfacing that shows that it’s healthy habits, not body size, that determines better health outcomes and longer lifespans. I encourage anyone interested in learning more to check out the the TED talk given by Sandra Aamodt, MD. There is a wealth of solid science out there that challenges this black and white idea that weight is a primary indicator of health. It is one fraction of a much more complex picture. We need to stop treating others like we have all the answers for them, just based on their body size.

I hope the conversation about fat shaming can move beyond the arena of who is offended, who is too sensitive, and who should or shouldn’t have opinions about being overweight. These are all part of the same smokescreen hiding the real issue; fat shaming is real, it is damaging and it isn’t inspiring anyone to make positive changes. Let’s do more to help people feel like they can trust themselves and make their own intuitive judgment calls about their health choices without being criticized. Let’s. Do. More.

What is Orthorexia? Is there really something wrong with “healthy eating”?

shutterstock_272048915There has been a lot of talk around the term “Orthorexia Nervosa”. It is defined by Steven Bratman, MD, as, “an unhealthy obsession with eating healthy food”. While this disorder is not officially part of the DSM-V as an official Eating Disorder, it still produces a great deal of pain for those who suffer from it and is worth the attention of the mental health community.

As a therapist who specializes in the treatment of Eating Disorders, this condition is not new to me. I have been seeing it for years, it only now has a name attached to it. I believe it is vital for our culture to start looking more critically at what it means to be “healthy”. Many people develop some kind of disordered eating habits or full-fledged eating disorders with the intention of being “healthy”. Somewhere along the way, things take a turn and these good intentions become harmful behaviors, but the intention is almost always coming from a place of wanting to be healthier or improve oneself. I want to look at Orthorexia through this compassionate lens.

The key to understanding what makes this a disorder different from “healthy eating” is a person’s rigidity of thinking and the level of distress that one experiences when deviations from that diet are made. Making solid efforts to eat healthy food is not what makes Orthorexia a disorder. One person could eat the exact same organic kale salad and it isn’t necessarily the food choice itself but the thoughts and anxiety behind it that make it a disorder. If a person is not able to be flexible with food choices, a serious red flag goes up for me in thinking that this person is at high risk for some kind of Eating Disorder. We deal with many unexpected events in the course of our lives, from life-changing, traumatic disruptions to smaller but still significant disruptions in our everyday routine. Allowing our brains to accept this uncertainty and be able to adapt to new circumstances is a huge part of being an emotionally healthy person. For a person with Orthorexia, deviations from his/her routine that are food related are met with intense guilt, anxiety, and self-criticism. Being at a party and being “forced” to eat outside of his/her comfort zone is not something that is acceptable to a person with Orthorexia. The focus of everyday life is about maintaining the “purity” of his/her diet and removes the person from fully being present. Planning meals for the day begins to take up more and more time. A person starts saying no to social engagements or travel because they are unsure of the food that will be available. When a person must deviate from the food plan, the level of anxiety that it triggers is painful. This is much more than a simple, “Oh wow, I think I overate at that party, I’ll just balance things out tomorrow”. The thoughts are more focused on personal weakness or “what damage has been done”.  Weight loss is not the main goal for the person with Orthorexia, the focus is on food purity.

What makes this such a difficult issue to address is the good intentions of the person suffering from the disorder and how difficult it is for others to understand why this is a problem. Maybe the person is focused on eliminating carcinogens to avoid cancer, or eliminate chemicals from their diets. These goals start off well, but the time involved to succeed at them becomes more than a person can realistically commit to. It also becomes tied to a person’s self-esteem. Food is important and it can bring up a lot of emotions for us, but it is not tied to our self-worth. A person with Orthorexia often judges him/herself based on their food choices. That organic kale salad goes from being a simple lunch choice becoming a source of personal validation. When the person “falls off the wagon”, the shame is so intense that it furthers a tendency to isolate and become disengaged with life outside of the world of Food. It can also have physical consequences, including nutritional deficiencies and illness.

When I read articles on Orthorexia on social media sites, I am often struck with the backlash that I read from people who are outraged that “healthy eating is now a disorder”. I hope we can expand our dialogue here. This is an opportunity to have an honest look at what “good health” means. I hope that we can acknowledge that we are allowed to choose how we spend our time. We are allowed to spend time fostering relationships, working on our careers and finding joy in our lives.  The purity of our food choices does not have to take priority over all of these other things. We are allowed to listen to our bodies and make intuitive food choices based on our healthy hunger cues. We are not “weak” or “bad” when we don’t execute these diets perfectly. There is a big difference between “eating perfectly” and having a balanced life that is focused on flourishing. I hope we can continue to strive for this and support others who are struggling to do so through their eating disorders.

For more information on Orthorexia, please visit:

National Eating Disorder Association:

Steven Bratman, MD, MPH (the person who coined the term “Orthorexia”):

What it Really Means to be Kind to Yourself…and How We’re Doing it Wrong

In my psychotherapy practice, I often guide my clients to a place of trying to be kinder to themselves. It seems like a very basic idea, but it is often met with some confusion on how that would be helpful. I believe that many people have been given the wrong message about what it means to be kind to yourself. I am often met with objections, the person does not want to be “lazy”, “stop trying”, or “let myself off the hook too much and stop caring”. There is a greater fear that if we are kinder to ourselves, we will give up and our lives will become out of control in some way. There is a lot of fear out there of the dreaded “lazy” label, and somehow we have all been trained that the way to avoid that is to be highly critical of ourselves and to push ourselves to try and meet unrealistic expectations, all with the intention of being productive and hard-working.


To put it simply, we’re getting it all wrong.


When we are kind and compassionate with ourselves, our brains open up. We are able to think critically, be attentive to problems, feel confident in being able to tackle big challenges, and we allow ourselves to nourish our minds and bodies. When we tackle challenges with reasonable expectations, we are able to be more thorough in our approach and generally handle that task with more skill and effectiveness. Backing away from an unrealistic challenge gives us the mental and physical energy to focus on the things that we truly have a chance to tackle effectively. Being kind to ourselves also puts us in a more positive mindset, which allows us to handle the unexpected with more flexibility and resiliency.


When we are unkind to ourselves, when we are highly self-critical or we take on an unrealistic number of tasks, our brain becomes rigid. We operate out of a place of fear, anxiety, and self-punishment. The “tough love” mentality is not something that should be used regularly. When we use “tough love” on ourselves, often it is done without the “love”. We focus on our weaknesses and convince ourselves that the only way to become better or stronger is to be critical and determine that our efforts are “not good enough”. This provides the illusion that we are motivating ourselves to do better. What is actually happening, is that it closes us off to the good kind of critical thinking. The kind of critical thinking that allows us to be creative problem solvers and able to handle the unexpected. We then operate more out of survival mode, doing just enough to make things ok but never really tackling the more in-depth roots of the problem. It also drains our brains and bodies of energy. Being unkind to ourselves takes a tremendous amount of energy to carry out. We will often take on too many tasks and ignore self-care. Sacrificing sleep for an important deadline is understandable occasionally, but if it becomes everyday life, there will be consequences for your mind and body. Being unkind to ourselves often means we ignore our human needs for a specific goal, and this is not sustainable.


This is what it REALLY means to be kind to yourself, and trust me, the desired end result is exactly what we have been striving for all along.


Being Kind to Yourself Means Acceptance

Acceptance is a huge part of being kind to yourself. We have to accept the good and the bad. If we are preparing for a performance and try to reject the pre-performance anxiety that we are experiencing, then we are rejecting a part of ourselves, making the anxiety more powerful. Accepting that anxiety is just a part of the process is a way of moving through it and minimizing its impact. If we accept our weaknesses, we can validate our own experiences, acknowledge what is difficult for us, and think of ways to work through it. If we reject our weaknesses (i.e. “I shouldn’t feel this way”), it will not lead to any meaningful changes.


Being Kind to Yourself Does Not Mean Resignation

Let’s all say it together, folks…. “Being kind to yourself is not the same as giving up”. Just because you attend to your needs and don’t berate yourself 50 times a day doesn’t mean you’re giving up on anything. It doesn’t mean you avoid challenges, or let things get out of control just because you don’t want to do something. It means sometimes you take breaks, sometimes you walk away from a challenge that needs to be walked away from, and sometimes you put your needs first. This will help you accomplish more and be more effective in what you do, it is not a way to get out of being challenged. You’ll just feel better doing it.


Being Kind To Yourself Means Avoiding Criticizing Your Core Sense of Self

It is common to take our weaknesses and mistakes and generalize them into bigger, grander statements of self-criticism. We are constantly trying to assess where we are and how we are doing. Often it is difficult to see a mistake as an isolated incident and we determine that we are just the type of person who is prone to these mistakes. We mistake behavior patterns for deep character flaws. Being kind to yourself means looking at the problem at hand and focusing on the solution or ways to heal whatever wounds were inflicted. Determining that we are hopelessly flawed will only lead to more negative criticism, and rarely leads to any kind of positive solution. It can be very productive to look for patterns of behaviors that we should be aware of, but again, approaching this task with a negative, self-critical lens will not help you make any changes. This is an area that can be helped greatly in therapy. It can be tough to do this completely by yourself.


Being Kind to Yourself Means Self-Care

We are human beings. Not robots or super-humans. It is important to pay attention to what self-care means for you as an individual. Not just the basic stuff, like eating and sleeping enough, but what are the things that help you feel centered and rejuvenated? We often sacrifice the activities that help us take care of our emotional needs for tasks that we feel are more “productive”. That is a surefire way of draining our mental energy reserves and leads to burn-out, feeling overly agitated or impatient, and overall feelings of unhappiness. Whether it’s playing a sport, creating art, reading, walking, yoga, or just making time to see friends, carving out small amounts of time for those things during our busy lives can make a world of difference. We have to value this time just as much as the time spent on our “To Do” list. These things don’t have to happen every day, but they do need to be on a fairly regular basis in order to be effective.

Do We Need to Stop Fighting Against Emotional Eating?

By Erika Hirsch, MA, MFT, ATR

October 29, 2013


When people talk about changing their relationship to food or losing weight, I often hear the complaint, “I wish I wasn’t such an emotional eater”. If you look around on the Internet for articles or websites on emotional eating, even people that want to help negatively reinforce this. Oprah’s website lists the “Cure for Emotional Eating”. Other websites claim to show you “How to Gain Control of Emotional Eating” or “How to Overcome Emotional Eating” and of course, the ultimate, “The Trick to Staying Slim if You’re an Emotional Eater”. It has become very common in our culture to see emotional eating as an enemy, a disease, and a powerful force beyond our control that we need to trick in order to overcome. The images that come up in a Google search for emotional eating are an even bigger reinforcement of this; tortured looking women with messy hair and smeared chocolate all over their faces, hunched over piles of candy or cake frosting. Emotional eating has become an enemy that takes away all of our self control and leaves us powerless.

What if we approached emotional eating not as an enemy, but as a helpful source of information? Biologically, our brains are hard wired to make eating as rewarding as possible. The part of our brain that is focused on survival is also looking for information regarding potential food supply scarcities. If your cortisol levels go up because you are experiencing stress, your brain will probably think to itself, “Well, it looks like there is a chance that we need extra energy to deal with this, especially because whatever is going on might involve famine and we should just make sure we get enough to eat so we can survive it”. This part of the brain hasn’t received the memo that there is a grocery store or restaurant on every corner; it hasn’t fully caught up with our modern lives. When it comes to survival, the human brain doesn’t like to take any chances, it feels stress and it will link it to survival in some way. Instead of recognizing that biological function that we all have, we reject it and pretend that somehow there is a way for us to be Zen-like robots that just eat for fuel and don’t have any temptation to eat “unhealthy” foods that give us enjoyment. Somehow the love we have for kale should overthrow any love we might have had for cupcakes or cheese, and if that doesn’t happen then we have failed. We are weak for finding enjoyment in food. Does this seem unrealistic to anyone else? Why are we fighting so hard against our own brains? Certain foods give us a spike in serotonin, which makes us feel better when we are stressed out. This is not a crime; it is not a character flaw. We should understand it and be informed about it, but it is counterproductive to see it as a sign of failure.

Instead of condemning emotional eating immediately after we identify it, I believe that we need to observe it happening without judgment, and then ask ourselves a series of more in-depth and compassionate questions before we determine if the situation is a problem or not:

-Is my body legitimately deprived of something? Food, sleep, or something else? Many times we turn to food when we really are looking for a soothing routine at the end of a long day. This is not a reason to feel guilty, but it is informing us that we need extra support or comfort to deal with our everyday stress.

-The food I’m craving will make me feel better for a little while, but then what? What am I looking for in the long term? We often turn to food multiple times to chase that serotonin spike that comes when you first start eating that desired food. When we only use food to help ourselves emotionally, it never feels like enough. That is not because we are weak; it is because it is true. Food will never be enough to help us feel better, we need to look to more direct ways to deal with our feelings that will sustain us longer than food can.

-Do I need to get outside of my head? Is something causing me stress that I need to deal with? Maybe talk to a friend and vent it out? Keeping stressful thoughts locked up in our own heads often is not enough. Writing or talking out a problem utilizes different parts of our brain, making it more efficient in working through the problem.

-What else, besides eating, could help me feel better? Instead of focusing on the guilt associated with eating when stressed, move on and focus on what could be done next. Often our guilty feelings keep us focused on the “damage” done by the foods that we have indulged in and we then ignore the original emotions that still need care and attention.

-Do I need a break but am denying myself for some reason? Often food is what we turn to when we need a break but feel that it is more important to power through whatever is going on at the moment.  Even a short amount of time that is dedicated to taking a real break (not checking your phone, email, or watching TV) can be very helpful.

If we immediately tell ourselves that food is a “bad choice” in dealing with our feelings, then we start a cycle of negative thoughts about ourselves. We judge ourselves, feel guilty, and feel like food is now off limits and we can’t have it. This usually leads to some kind of emotional rebellion where we decide we will have the food anyway, and not just that, but keep eating more because damn it, we want to and nobody can tell us not to! Following the rebellion comes the guilt aftermath. We are rebelling against ourselves, and it isn’t helping. If we look at food as just one of many ways of coping, without intense negative judgment, then we can accept it and move on from it. It is much more productive to look at emotional eating for what it is, a temporary way to boost our mood. Sometimes it has a purpose; sometimes it is just a distraction from something bigger. If we can accept that, then asking ourselves what else could be done to help us feel better doesn’t have to feel like we are depriving ourselves. That mindset will decrease the urgency that the food craving has, and we are now able to look more directly at what we are really feeling in that moment and what can be done about it. The goal is to look at what we need, address it directly, and give us positive feedback for doing so. Only then can we start to create a more positive relationship with our emotions and with food.

Intuitive Eating and Creating Healthy Relationships with Food

March 14th is Registered Dietitian’s Day, and I wanted to support all the RD’s out there who are challenging harmful food myths and working to be true advocates for good health.   “Good health” is not defined by a number on the scale, or a clothing size, or on how well you can stay away from “bad” foods, or how many days a week you can get to the gym.   What is healthy for me may not be the same for you, we have to look at the biology of our own body and how to respect our bodies enough in order to give them the fuel that they need.  It is so common in our culture to be in a cycle of dieting, focusing on how our bodies look, and not what they can DO, and when there is a focus on what our bodies can do, it is often competitive.   That easily leads to feelings of guilt or self-judgment… and the cycle continues.

This is the work that RD’s do, they look at what your body needs and help you build a positive relationship with food.  I find that people who combine talk therapy (with an MFT, LCSW, clinical psychologist or psychiatrist) and nutritional counseling with an RD are able to create long lasting positive changes in their physical and emotional health.  If you are looking for an RD, I recommend a person who works with the Intuitive Eating Philosophy, created by Evelyn Tribole and Elyse Resch.  Intuitive Eating is described by Evelyn and Elyse in this way: “Intuitive eating is an approach that teaches you how to create a healthy relationship with your food, mind, and body–where you ultimately become the expert of your own body.   You learn how to distinguish between physical and emotional feelings, and gain a sense of body wisdom.   It’s also a process of making peace with food—so that you no longer have constant “food worry” thoughts.  It’s knowing that your health and your worth as a person do not change, because you ate a food that you had labeled as “bad” or “fattening”.”

There are 10 Principals to Intuitive Eating, which are as follows (from the Intuitive Eating Website)

1. Reject the Diet Mentality Throw out the diet books and magazine articles that offer you false hope of losing weight quickly, easily, and permanently. Get angry at the lies that have led you to feel as if you were a failure every time a new diet stopped working and you gained back all of the weight. If you allow even one small hope to linger that a new and better diet might be lurking around the corner, it will prevent you from being free to rediscover Intuitive Eating.

2. Honor Your Hunger Keep your body biologically fed with adequate energy and carbohydrates. Otherwise you can trigger a primal drive to overeat. Once you reach the moment of excessive hunger, all intentions of moderate, conscious eating are fleeting and irrelevant. Learning to honor this first biological signal sets the stage for re-building trust with yourself and food.

3. Make Peace with Food Call a truce, stop the food fight! Give yourself unconditional permission to eat. If you tell yourself that you can’t or shouldn’t have a particular food, it can lead to intense feelings of deprivation that build into uncontrollable cravings and, often, bingeing When you finally “give-in” to your forbidden food, eating will be experienced with such intensity, it usually results in Last Supper overeating, and overwhelming guilt.

4. Challenge the Food Police .Scream a loud “NO” to thoughts in your head that declare you’re “good” for eating under 1000 calories or “bad” because you ate a piece of chocolate cake. The Food Police monitor the unreasonable rules that dieting has created . The police station is housed deep in your psyche, and its loud speaker shouts negative barbs, hopeless phrases, and guilt-provoking indictments. Chasing the Food Police away is a critical step in returning to Intuitive Eating.

5. Respect Your Fullness Listen for the body signals that tell you that you are no longer hungry. Observe the signs that show that you’re comfortably full. Pause in the middle of a meal or food and ask yourself how the food tastes, and what is your current fullness level?

6. Discover the Satisfaction Factor The Japanese have the wisdom to promote pleasure as one of their goals of healthy living In our fury to be thin and healthy, we often overlook one of the most basic gifts of existence–the pleasure and satisfaction that can be found in the eating experience. When you eat what you really want, in an environment that is inviting and conducive, the pleasure you derive will be a powerful force in helping you feel satisfied and content. By providing this experience for yourself, you will find that it takes much less food to decide you’ve had “enough”.

7. Honor Your Feelings Without Using Food Find ways to comfort , nurture, distract, and resolve your issues without using food. Anxiety, loneliness, boredom, anger are emotions we all experience throughout life. Each has its own trigger, and each has its own appeasement. Food won’t fix any of these feelings. It may comfort for the short term, distract from the pain, or even numb you into a food hangover. But food won’t solve the problem. If anything, eating for an emotional hunger will only make you feel worse in the long run. You’ll ultimately have to deal with the source of the emotion, as well as the discomfort of overeating.

8. Respect Your Body Accept your genetic blueprint. Just as a person with a shoe size of eight would not expect to realistically squeeze into a size six, it is equally as futile (and uncomfortable) to have the same expectation with body size. But mostly, respect your body, so you can feel better about who you are. It’s hard to reject the diet mentality if you are unrealistic and overly critical about your body shape.

9. Exercise–Feel the Difference Forget militant exercise. Just get active and feel the difference. Shift your focus to how it feels to move your body, rather than the calorie burning effect of exercise. If you focus on how you feel from working out, such as energized, it can make the difference between rolling out of bed for a brisk morning walk or hitting the snooze alarm. If when you wake up, your only goal is to lose weight, it’s usually not a motivating factor in that moment of time.

10 Honor Your Health–Gentle Nutrition Make food choices that honor your health and tastebuds while making you feel well. Remember that you don’t have to eat a perfect diet to be healthy. You will not suddenly get a nutrient deficiency or gain weight from one snack, one meal, or one day of eating. It’s what you eat consistently over time that matters, progress not perfection is what counts.

You can find more information about Intuitive Eating at

Do yourself a favor, if you are motivated to make a positive change in your health, consult with a Registered Dietitian instead of researching the latest diet trends online.  It will be time well spent!

Emotional Eating and the Holidays – Looking at Emotional Eating and Stress Management in a Different Way

The holidays can often sneak up on us, and so can holiday stress.  On top of the stress of making travel plans, coping with family tension, and the financial strains of holiday shopping we also worry a lot about holiday foods.  There are a lot of “helpful” websites out there that give advice about emotional eating during the holidays, but most of them are aimed at ways to maintain your diet and not gain weight.  In my experience as a therapist specializing in the treatment of Eating Disorders, focusing just on emotional eating in terms of weight gain or weight loss is not enough.  We need to look at what emotional eating really is and how it functions during the holidays.  Understanding it can help us feel like emotional eating is more manageable and not such a scary, powerful thing.


1.  ACKNOWLEDGE THE REASON WHY EMOTIONAL EATING EXISTS:  Emotional eating happens for a reason, and it is a good reason.  We all have emotional needs.  It is part of being human.  We come across stressful situations in our lives and we look for ways to meet those needs and cope with stress.  Finding ways to meet those needs in healthy ways is much harder than it sounds.   It is more common to look for ways to cope that make us feel good physically, which often involves using food.  That is not necessarily a bad thing, but often it just is not enough.  Filling an emotional need with a physical feeling often only helps in the short term.

2.  LET GO OF BLAMING YOURSELF: After acknowledging that food is being used to fill an emotional need, the second and most important step is to have compassion for yourself.  You are not a “bad person” for wanting to feel better.  In the dieting world, it is seen as “bad” to “go off track” and eat “bad foods”.  Let go of the idea that certain foods are bad and that you should feel guilty for breaking the “rules” of your diet.  Instead, contemplate the reason why you are reaching for the foods you are craving.  For most people, the holidays are a mixture of comforting, happy memories, stressful, difficult memories (especially if you have lost a loved one) and high expectations for a “perfect holiday”.  Those are not easy things to deal with.  Let yourself off the hook and try to let go of any unrealistic expectations that are causing you stress.

3. TAKE CARE OF YOUR STRESS DIRECTLY, NOT INDIRECTLY:  If you are having a hard time during the holiday season, let yourself make your emotional needs a priority.   Ways to directly deal with your stress is to talk about it, spend time with people who do not add to your stress levels, and schedule some time just for yourself.  Sometimes just having a few brief moments of quiet time in a peaceful place can make a world of difference. The holidays can become so hectic and busy that we often put our own needs last.  The less we directly deal with our own stress levels, the more we rely on indirect ways to cope, which can lead to using food, alcohol, or other ways to “escape”.  Trying to escape our stress does not provide an adequate outlet for us to process our emotions.   If you are having a hard time grieving the loss of a loved one around the holidays, it can be useful to look at the positive side of emotional eating.  If a certain food reminds you of the person you have lost, let yourself enjoy those foods and remember your loved one.  Combine this ritual with writing a letter to your loved one, writing in a journal, or talking with someone who understands how much you miss that person.  Taking care of yourself is just as important as your other obligations this holiday season.

4.  MAYBE I NEED MORE SUPPORT?  For approximately eleven million Americans, emotional eating is part of an eating disorder (National Eating Disorder Association,  Eating disorders can range in severity levels and unfortunately eating disorders can be misunderstood and many people do not seek out the help that they need.  If you feel like emotional eating is truly out of control or if food and weight is dominating your thoughts throughout the day, it is worth your time to talk to a professional who specializes in helping people with Eating Disorders.  You can find an Eating Disorder specialist in your area through the website

“I Think My Friend Has an Eating Disorder….How Can I Help?”

by Erika Hirsch, MFT, ATR – August 8, 2011

Most of us know someone who has suffered with an Eating Disorder.  It can be a friend, girlfriend, boyfriend, spouse, sibling, roommate, or a grown child who is now out on his/her own.  Almost everyone knows someone who has been through it, but most loved ones struggle with knowing how to help.  Eating Disorders are daunting and scary for everyone involved.  They are incredibly difficult disorders to go through personally, and as the friend of someone with an Eating Disorder, it can be frustrating just watching it happen and not knowing how to help.  There are things that you can do.

Ways to Support a Loved One with an Eating Disorder

1. It’s not about the food.  Approach your friend, ask them what’s on their mind, and talk about what kinds of things are causing them stress.  Are they having a hard time dealing with family or relationship stress?  Do they feel pressure at work or at school?  Are they being too hard on themselves?  Did something stressful or traumatic happen recently?  Listen to them and don’t worry about giving the “right” advice or “fixing” it.

2. Let your friend know that you are concerned about what you are seeing.  These are the basic categories of Eating Disorder behaviors that most loved ones notice and express concern about:


  • Binge behaviors – eating large quantities of food, almost in a “zombie-like” state.
  • Restricting behaviors – refusing food, having a lot of fears about food, not eating or only eating “safe” foods.
  • Purging behaviors – excessive or obsessive exercising, throwing up after meals, abusing laxatives.
  • Fear of weight gain – talking daily or often about weight and weight loss, weighing themselves often, emotions or self worth are determined by the number on the scale, weight gain is something they are intensely afraid of.


Be kind, compassionate, and non-judgmental when you talk about these behaviors.  Most of the time the person is hesitant to talk about their secret eating disorder behaviors and it’s very hard to be confronted about them.  They might not be ready to have it all out in the open.

3. Consider your approach.  Tough love is not going to help.  “Forcing” someone to eat with you or saying, “snap out of it and just eat”, will not help.   It’s more appropriate to try to help this person in a way they’re comfortable with.  For example, they might ask you, “Can you stay with me after I eat lunch and distract me so I won’t go throw up?”.  However, it’s best not to try to push this approach onto them.   Let them guide you in how to provide support.  Also, keep in mind that unless you’ve had an Eating Disorder yourself, there are limits to what you will understand about what they are going through.  Let your friend explain it to you, and listen without judgment.  For example, if a friend confides in you and tells you that he/she throws up after meals, replying with, “Wow, that’s gross! I don’t know how you can do that, I hate throwing up”, will most likely cause your friend to feel that it is unsafe to talk about the Eating Disorder.

4. Encourage your friend to get professional help. Seeing a therapist who has experience in Eating Disorder treatment is vitally important.  If your friend refuses to see a therapist, then please encourage him/her to see a doctor to get a check-up.  There might be serious medical complications from the Eating Disorder that the person is not aware of, and these complications can be life threatening.  If your friend passes out or seems like they are in some kind of state of medical emergency, do not hesitate to call 911 immediately.

5. You cannot expect yourself be your friend’s therapist or doctor.  Be a concerned and compassionate friend, be there to listen, but you are not the person who is responsible for “fixing” your friend’s Eating Disorder, or watching him/her to make sure they are eating.  Becoming the Food Police will not be helpful for your friend or yourself.   If you are a parent with an adult child who has an eating disorder, collaborate as much as you can with your child, ask them what kind of support they need from you.   Parents should also not be their child’s therapist or doctor.  Kindness, an empathetic ear, and a non-judgmental approach will go a long way in helping a loved one get through eating disorder recovery.

Finally, my last tip for loved ones is to take care of your own emotional well-being.  Consider seeking out therapy for yourself, especially if you have an adult child, spouse, or very close friend or family member with an eating disorder.  Therapy can help you gain insight into what your loved one is going through and can help you in managing the emotions, worries and fears that you have for their well-being.  Things can get better with the right kind of support, don’t be afraid to ask for it.



Erika Hirsch, MFT, ATR (MFC #45824) is a psychotherapist in Los Angeles who specializes in Eating Disorder treatment.


This is a brief list of tips for loved ones and it is not a replacement for individualized treatment or a consultation with a licensed mental health professional.


Why Does Facebook Make us Feel Bad About Ourselves?

Author: Erika Hirsch, MFT  – July 11, 2011

“I was on Facebook  last night, and now I feel so frustrated, it seems like everyone else has their life together but me”.  As a therapist in the age of social media, these kinds of statements are heard frequently in my office.  Most of us take part in social media, like Facebook, for many good reasons.  We can keep in touch with relatives and friends all over the world, we can stay updated with causes and organizations that we find meaningful, we can reconnect with old friends and meet new people with similar interests as our own, and we can share milestones.  There have been many questions raised about using Facebook, some psychologists worry that increased time online leads to social isolation, or overstimulation and a decreased ability to focus.  I think that one overlooked question is related to something more personal:  Why does Facebook make us feel bad about ourselves?   Why can a half hour on Facebook result in hours or days of us berating ourselves for the life choices we made, or make us feel depressed about what we are not accomplishing?  I thought Facebook was supposed to be enjoyable… what happened?

I think we need to look at the significance of social comparison in order to address this growing problem.  Social Psychologist Leon Festinger developed the  Social Comparison Theory that was revolutionary in the 1950s and is still highly relevant today.  His theory states that humans have a significant internal drive to look for outside images in order to evaluate their own abilities and opinions.  We look to these images provided by others to be realistic and obtainable, which means that even if an image is idealized, we interpret them as obtainable, which can lead to emotional responses.  We are programmed to look at what others are doing and then evaluate ourselves to see if we “measure up”.  Facebook, with constant status updates and endless photos being uploaded multiple times per day, is providing us social comparison opportunities on steroids.  It can become a very legitimate and powerful source of stress, leading to feelings of guilt, frustration, and it can bring up anxiety-provoking questions about ourselves: “Why can’t I spend the summer backpacking in southeast Asia?  How on Earth did my high school boyfriend manage to become a CEO at age 25 and I’m still figuring out what do to with my life at 35?  Why can’t I train my cat to play the piano?  I wish I could afford to buy a new home, will I ever be financially stable enough to do that?  Everyone is posting pictures of their new babies, is something wrong with me that I don’t want to have a baby yet but all of my friends do?  Am I behind???”.

Facebook is a forum for us to carefully choose what images we put out there into the world.  Most people tend to choose the “best” images to post; the funniest moments, the most flattering portraits, the most interesting updates.  It is entirely unrealistic for us to see a Facebook profile and to assume that the person behind it is really living an idealistic or perfect life.  Very few people are posting photos of their kids screaming while in line at the grocery store, or photos of themselves getting into fights with their partners, or status updates that talk about getting laid off and the panic of not knowing what to do next.  I believe it is important to see social media for what it is, and not use it as a tool to evaluate our lives to see if we are “measuring up” or not.  The next time you find yourself comparing yourself to friends on Facebook, acknowledge that your response is understandable and normal, but it is not a valid reason to be hard on yourself or feel guilty for your life decisions.  Try logging off of Facebook for a day and give yourself permission to focus on yourself without comparing yourself to others.  It can be a surprisingly positive break.


Festinger, Leon. 1954. A theory of social comparison processes. Human Relations 7(2): 117-140