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Posts tagged ‘Children with Eating Disorders’

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

“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.