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Posts from the ‘Eating Disorders – Support and Resources’ Category

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”):

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!

“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.