Many of our clients with anxiety also have reported struggles over food. Therefore, we interviewed a colleague who is an expert on eating disorders. Dr. Brenda L. Wolfe is a clinical psychologist who specializes in the treatment of obesity and eating disorders. In addition to private practice, she has published a number of articles and books. Her most recent book reflects her other area of expertise and is called Get Your Loved One Sober which is co-authored with Robert J. Meyers and available from most internet book-sellers.
Q. What is an eating disorder and about how many people have real eating disorders?
Eating disorders are characterized by an excessive preoccupation with body size and unhealthy attempts to control it. People with Anorexia Nervosa (AN) restrict their food intake in an effort to lose weight despite the fact that they are becoming malnourished. People with Bulimia Nervosa (BN) restrict their intake and end up binge eating, which triggers anxiety about gaining weight and so they try to purge the calories through a variety of unhealthy behaviors. Some people have unhealthy eating behavior that doesn’t quite fit AN or BN (such as binge eating) so they are given a label of Eating Disorder Not Otherwise Specified.
Because of the shame felt by people with these disorders, they tend not to show up in clinics until they are so ill they can no longer ignore the problem. Thus, I suspect we underestimate their prevalence. Available estimates are that AN afflicts 0.5% to 1% and BN about 10% of females, while binge eating occurs in roughly 15% to 30% of the overweight/obese population. Males report lower rates of eating disorders than do females.
Q. Is obesity really an eating disorder?
No. Obesity is a medical condition that involves an interaction of psychology, biology, and environment. From a psychological standpoint, anxiety and mood disorders frequently trigger overeating.
Q. What does anxiety have to do with eating disorders?
Fear of fat is central to the psychology of eating disorders. People with AN and BN are so terrified of gaining weight that they engage in all manner of harmful behaviors. Although it is an oversimplification to call eating disorders “fat anxiety,” that certainly describes a chunk of the problem.
Q. If you have both anxiety and an eating disorder, what should you treat first?
Rarely does a person experience an eating disorder and anxiety as separate problems. What I typically see are patients who have tremendous anxiety and/or OCD around body/food issues. Treating the ED component usually results in a lessening of anxiety.
Q. Do people with eating disorders ever get better?
Most patients move in and out of diagnostic categories so recovery statistics are hard to pin down. Nonetheless, the answer to the question is “Yes.” With treatment, people are able to minimize if not eliminate their dangerous behaviors as well as become more comfortable inside their bodies and around food. However, almost all find that feelings and thoughts about weight and food remain their Achilles Heel and pop up during times of stress. Thus, even recovered patients must remain alert for warning signs of slipping and actively protect their recovery.
Q. If someone in your family has an eating disorder, what can you do?
The first thing not to do is be the Food Police. What you should do is tell your loved one the behaviors you’ve noticed, that you are concerned, and you are wondering if s/he is feeling okay or needs help with anything. If s/he agrees that a problem has developed, encourage him/her to seek professional help. Your role as someone who loves that person is best protected and most useful if you let someone else be the therapist.
Q. Why do you choose to work with people who have eating disorders?
Easy question! Eating disorders occur in that space where the physical and the psychological most vividly connect. What and how you eat affects your brain which affects what you think and how you feel which affects what and how you eat, and so on. Thus, eating disorders are the toughest and most interesting of the conditions I treat. It is thrilling to help patients discover those intimate little spaces where their heads and hearts (mind and body) collide, collude, and ultimately collaborate to recover.
Q. If you had one piece of advice for people with eating disorders, what would that be?
Know that you are not alone in this disorder; you’re not a freak and you’re not weak. This is an illness that can be treated. Make an appointment with a mental health professional and start working on getting your life back.
Thank you, Dr. Wolfe. If readers have questions, they can contact Dr. Wolfe at www.BrendaLWolfe.com.
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