Are you tired of food, exercise, and body image dissatisfaction ruining your life and keeping you from living a life you can fully enjoy? Do you find that you have issues around controlling your weight and appearance such that it is affecting your closest relationships? Do you feel out of control with food or exercising?

Eating disorders affect at least 30 million people in the United States. Even more are affected by disordered eating where an individual may not meet full criteria for an eating disorder in the DSM-5, but still struggle with psychologically unhealthy eating, exercise, or body image related thoughts and behaviors.

Eating disorders do not discriminate amongst body size, type, ethnicity, race, gender, or sexuality. Eating disorders affect individuals of all ages as well.

Eating disorders have classically been thought of as a disorder that affects females. There are also many stereotypes out there that make individuals feel like the only way they would qualify for eating disorder treatment is to look like someone who is very thin.

Today we know that everyone can be affected by eating disorders. Eating disorders vary in presentation and the ways in which they manifest within an individual can be very complex.

Our eating disorder therapists treat disordered eating, anorexia, bulimia, binge eating disorder, avoidant restrictive food intake disorder (ARFID), body image dissatisfaction, body dysmorphic disorder, muscle dysmorphic disorder, and orthorexia.

Cognitive Behavioral Therapy for Eating Disorders & Disordered Eating
Our eating disorder therapists are trained in cognitive behavioral therapy (CBT) for eating disorders. This is the gold standard, evidence-based treatment for eating disorders and disordered eating.

Quite common amongst clients who struggle with eating disorders, we often find that thought patterns become quite rigid and inflexible. Body image perception and thoughts about food and weight become quite distorted as well. Many individuals also struggle with emotion regulation issues where food becomes a way to escape their emotions or a way to give an individual a sense of control.

In CBT treatment, we help clients build mindfulness skills to become more aware of thoughts, feelings, and emotions to more effectively manage them. We help clients identify distorted thought patterns, help them restructure their thought patterns, and help them create experiments in their day to day lives that challenge the pattern of living according to their existing thought patterns. Through this process, clients can begin to feel empowered getting unstuck, knowing that they can overcome hardships, and begin living a healthier life instead of walking through life influenced by their eating disorder thoughts all the time.

Acceptance & Commitment Therapy for Eating Disorders
Very similar to CBT, Acceptance and Commitment Therapy (ACT) has an added piece to address individuals' values. Through ACT, we help clients struggling with eating disorders to better understand what's important to them in their lives, or in other words, we help clients clarify their values. We then assess how the eating disorder, disordered eating, or body image symptoms stand in the way of living a life that is consistent with their values. In ACT therapy, we help clients align their behaviors with their values to again feel empowered that they are living life by their rules vs. the rules of the eating disorder mind.

Overcoming an eating disorder on your own is very difficult. It is not easy work. We are here to help, providing you with compassionate care every step of the way!

Call us today or email us to schedule an appointment with an eating disorder therapist on our staff. We have a number of psychologists who have been highly specialized and trained in evidence based treatments for eating disorders.

Do you struggle with anorexia? If so, then you probably know there’s a problem or someone has told you you have a problem you need to address. But you might be reluctant to change. That’s because anorexia nervosa is what we call an egosyntonic condition. What that means is you might have a certain level of desire in holding on to your symptoms because you feel that the person you are with those symptoms is who you truly want to be. Most other psychological disorders are egodystonic which means individuals feel unlike themselves and are eager to reduce or get rid of their symptoms.

Unfortunately, anorexia can cause significant damage to the body, can be extremely distressing psychologically, can cause significant issues in relationships, work and an overall difficulty in functioning on a day to day basis. Anorexia is also a psychological disorder with the greatest risk of mortality.

The good news is that all of this can be repaired through commitment to treatment (especially the physical consequences of anorexia). Nearly all the physical damage caused by restricting or overexercising in anorexia can be reversed through improved nutrition and dietary intake.

Using the gold standard, evidence-based treatment for anorexia, we will work with you as a team (a physician, psychologist, and dietitian) to help you recover.

Our psychologists will help you cope with the distress you might feel going through the process of recovery from anorexia. They’ll help you identify what the eating disorder has taken away from your life to help you increase motivation and attach meaning to why it’s worthwhile for you to go through the recovery process. Our psychologists will be a voice of reason in a sea of overwhelming eating disorder thoughts convincing you that recovery is just wrong. Our therapists will eventually help you in adopting a stance of your own against the eating disorder to help empower you to be in charge of your own life instead of the anorexia eating disorder mindset dictating what your every move has to be. Psychologists on our staff draw upon cognitive behavioral therapy (CBT), acceptance and commitment therapy (ACT), and dialectical behavioral therapy (DBT) to treat anorexia nervosa.

Our Registered Dietitian Nutritionists will help you nourish yourself in a way that supports repairing your mind and body. Our dietitians on staff will have you track your food through an app called Recovery Record and encourage you to increase your food intake overtime. This is a slow and gradual process as to avoid refeeding syndrome. Refeeding syndrome can occur in individuals struggling with anorexia. It is a set of medical complications that can occur if you gain weight too quickly. Our dietitian nutritionists will help you begin to listen to, appreciate, and honor hunger/fullness cues again. They will help you learn to enjoy a variety of food and reintroduce forbidden foods that the anorexia mindset has not allowed you to. Exposure to these forbidden foods is a necessary part of anorexia treatment to help your mind overcome the initial fear of eating “bad” food once again.

In the treatment of anorexia, we will ask that you be monitored by a physician. We are happy to work with a physician you’ve been seeing for quite some time and/or we have a few physicians we are happy to refer you to. The physician’s role is to ensure your safety in the recovery process to make sure you’re staying out of harms way. Some of the things medical doctors do in monitoring patients with anorexia is using an EKG to ensure your heart is safe, take bloodwork to ensure you’re not at risk for electrolyte imbalances which can lead to cardiac arrest, and use DEXA scans to determine if there is osteopenia or osteoporosis.

What about psychiatrists?
While we don’t have psychiatrists on staff, we are happy to refer you to psychiatrists in the area who can help you manage depression and anxiety symptoms that are often comorbid with anorexia and eating disorders. However, most psychological symptoms associated with anorexia are alleviated through weight restoration and proper nutrition.

What are the physical consequences of undereating and maintaining a low body weight? 
Cardiac complications: When you are undereating and maintaining a low body weight with anorexia, you could potentially be losing heart muscle, blood pressure and heart rate may slow down (bradycardia), and you may have irregular heart beats (arrhythmia).

Bone Density: Many individuals struggling with anorexia will be diagnosed with osteoporosis or osteopenia. Hormonal and dietary changes create more fragile bones and often there are great risks of fractures with falls.

Skin & Hair Problems: Lanugo is a condition where individuals with anorexia will begin to grow fuzz-like hair on their face and other parts of their body. This is the body’s way of trying to retain heat.

Individuals suffering from anorexia may also struggle with hair loss or thinning hair. When your body is at a low body weight, it tries to preserves what is essential in the body for survival. Hair isn’t important to survival.

Yellow-orange skin color can occur in those with anorexia because of elevated levels of beta carotene (primarily due to diet). This condition is called carotenosis.

Gastrointestinal Distress: Clients with anorexia will often complain of being constipated. This is a result of a gastroparesis or gastric delayed emptying due to muscle weakness in the digestive system. When you are undereating, your digestive system moves slower and it takes longer for food to move from the stomach to intestines. This can result in gas, bloating, constipation, and physical pain and discomfort.

Feeling Cold: Individuals with anorexia often experience feeling cold all the time, especially in the hands and feet. This is due to malnutrition and not maintaining a healthy body weight.

Restless, Non-Refreshing Sleep/Insomnia: Because of starvation and being malnourished, individuals with anorexia often describe difficulty falling asleep and having restless sleep. There are decreases in slow wave sleep, sleep efficiency, and overall less hours sleeping amongst those with anorexia.

Loss of Libido: Sex hormones and fertility are non-essential for survival. So many individuals with anorexia will lose their sex drive and have difficulty getting pregnant if their body weight is too low.

What are the psychological/social consequences of undereating and maintaining a low body weight? 
Cognitive: When individuals are malnourished, we see a pattern of very rigid thinking. It becomes harder for individuals with anorexia to make decisions as well. Concentration and ability to focus are also reduced. Clients with anorexia often describe a preoccupation with thinking about food all the time as well.

Mood: Individuals with anorexia often are very irritable and depressed.

Personality: Many individuals with anorexia will not always see this clearly, but loved ones will see that the individual is just not the same in terms of their personality. Individuals’ true personality tends to be restored with weight restoration.

Relationship stressors: Individuals not only become very rigid in their thinking patterns, but in their behaviors as well. They often must do things a certain way or else they will become quite irritable. They may only be able to eat at certain restaurants where they feel there is something “safe” to eat on the menu. Because socializing often involves food, individuals with anorexia may become increasing isolated. Individuals with anorexia may not have an interest in sex and can become more focused on themselves vs. others. All of these behaviors can significantly impact relationships with loved ones.

But I’m getting my period, so I must be okay, right?
Though a loss of periods (amenorrhea) may be indicative of anorexia, it is no longer a criteria for anorexia nervosa. There is a lot of variability in regard to those that get their periods and those that do not in anorexia. An important thing to note, though, is that if you are not menstruating, it doesn’t mean you cannot conceive. Again, fertility is not essential for survival, so many women will struggle with infertility issues if they are underweight. Weight restoration can reverse these issues.

When do you determine if there is a need for a higher level of care? 
We are happy to try outpatient treatment with individuals who struggle with eating disorders. However, if it is medically unsafe for you to be in an outpatient setting, we will recommend a higher level of care where you can be closely monitored by medical staff to ensure your safety.

At Mind Body Health, our registered dietitians and psychologists use the American Psychiatric Association’s Guidelines for Higher Level of Care. These guidelines factor in suicidality, percentage of ideal body weight, motivation, severity of obsessive thinking patterns, severity of co-occuring psychological disorders, ability to complete meals and follow through on nutrition recommendations, ability to follow exercise recommendations provided by the team, and ability to abstain from laxative and purging behaviors, and family/environmental stressors that may stand in the way of recovery.

But I’m purging, so that means I have bulimia, right? 
Anorexia nervosa has two subtypes: restricting type and binge/purge type. It is not uncommon for individuals with anorexia to not only restrict their food intake to reach a low body weight, but also to be exercising excessively and compulsively and/or vomit, use laxatives or diuretics.

Who is affected by anorexia? 
Anorexia can affect individuals of all ages, ethnicities, genders, races, and sexual orientation. Anorexia is more common amongst women, but there are adolescent boys and adult men who also suffer from anorexia nervosa. There are heightened prevalence rates of eating disorders amongst the LGBTQ population. Because there is less awareness about the prevalence of eating disorders amongst men and individuals of various sexual orientations or ethnicities, there can be a reluctance to discuss symptoms and seek treatment. We strongly encourage you to reach out to us! We are well trained in the treatment of eating disorders as it pertains to very specific populations.

What is the typical age of onset for anorexia? 
Teenage and early adulthood years are typically what we see in regard to the onset of anorexia. Puberty and changes in the body can often be a trigger for the onset of anorexia in adolescence.

Is family involved in treatment? 
For adolescents and very young adults, we use Family Based Treatment for Anorexia. You can read more about this treatment here. For adults, we often encourage involving supportive family members in treatment so that in between sessions, you’re having someone hold you accountable and help you through what can be a difficult recovery process.

What causes anorexia? 
As with most psychological disorders, it’s complex! At Mind Body Health, we use a biopsychosocial model in understanding the etiology of psychological disorders. Essentially the answer is often a mix of nature and nurture (biological and environmental factors).

Individuals with anorexia typically have a genetic predisposition. Often there will be another family member in the immediate or extended family that has suffered from an eating disorder. The likelihood of having an eating disorder if a family member has had an eating disorder is significantly higher.

That combined with certain personality traits and environmental stressors can cause anorexia to manifest within an individual.Personality traits often associated with anorexia are perfectionism, neuroticism, harm avoidance, and being an overachiever.

Environmental triggers can include perceived cultural, peer, or familial pressures to be thin, dieting or unhealthy weight control efforts, professions or recreational activities that promote weight loss or being thin (modeling, ballet/dancing/gymnastics, wrestling), sexual abuse, trauma, past history of bullying/teasing.

Call us today to get help. We have six staff members with specialized training in the treatment of eating disorders using evidence-based treatments.

Do you find yourself eating large amounts of food in a short period of time? Do you feel a loss of control over your eating? Do you find yourself trying to compensate for the food you eat by exercising excessively, fasting, vomiting, or using laxatives, diuretics, or diet pills? Do you find that your shape and weight largely influence how you feel about yourself?

If you answered yes to any of the questions above, you may be suffering from bulimia nervosa.

Bulimia nervosa can impact your physical and mental health. Some of the medical complications of bulimia are listed below:

• Esophagitis
• Tearing of the lining of the esophagus, ruptures, bleeding of esophagus lining
• Edema
• Colon damage (due to laxative use)
• Ulcers, acid reflux, constipation, irregular bowel movements, digestive problems
• Dehydration and electrolyte imbalances can lead to heart irregularities or heart failure
• Erosion of tooth enamel
• Infertility

Using evidence based approaches, clients will self-monitor their food intake, regulate eating patterns, and address feared foods, interpersonal problems, and body image concerns. Clients will gain a better understanding of what their personal triggers are for binge eating and purging and develop skills to eliminate or manage emotional distress around triggers.

Do you feel out of control around certain types of food? Do you feel like you eat until you get physically sick in response to certain emotions? When your eating feels out of control are you also finding that you’re eating much more rapidly than normal? Do you sometimes eat alone out of embarrassment? Do you feel depressed or guilty after eating large amounts of food?

You may be suffering from Binge Eating Disorder. Clients often use the following terms to describe binge eating disorder: food addiction, compulsive overeating, loss of control eating.

Who is affected by Binge Eating Disorder?
Binge Eating Disorder is the most common form of an eating disorder diagnosed in the United States. It’s three times more common than bulimia or anorexia. Approximately 3.5 % of women and 2% of men in the United States will develop Binge Eating Disorder in their lifetime.

Adolescents are often affected by binge eating disorder as well starting anywhere from 12 – 14 years old. A study by Stice, Presnell, & Sprangler (2002) found that body image concerns, depression symptoms, appearance-oriented emphasis on self evaluation, dieting, and feeling pressure to be thin often predicted the onset of binge eating. There are adolescents who develop a loss of control of eating even before dieting begins. These adolescents often develop binge eating disorder at an earlier age.

Clients struggling with binge eating or compulsive overeating will benefit from an evidence-based treatment approach. Below are approaches we take to help those with binge eating disorder:

Most of our clients make the most progress with binge eating disorder treatment when working with our nutritionist and a psychologist on staff.

To maximize efforts, our Registered Dietitian works with you to normalize your eating patterns (see below) and the eating disorder therapist will work to target the underlying psychological triggers for binge eating episodes.

Normalizing eating patterns. Many people struggling with binge eating disorder go very long periods of time without eating or are highly restrictive and have a long history of chronic dieting. In working with our eating disorder nutritionists, clients begin binge eating treatment by practicing eating something every 3-4 hours.

Targeting chronic dieting and all-or-nothing thinking around food. Part of the work with our registered dietitian nutritionists is targeting long held beliefs about “good” and “bad” foods. Often creating strict rules around food can create all-or-nothing patterns of thinking and behavior. When breaking a rule, a client can feel extremely guilty or upset which can often lead to binge eating. The cycle of restricting and then binge eating can continue for a long time to come. Instead, we’ll help you gain skills to be able to eat all foods in moderation.

Manage emotional and life stressors that trigger binge eating. Clients struggle with binge eating disorder typically are not reaching for celery sticks and carrot sticks when they have an urge to binge. Typically the food is high in refined carbs and sugar. These types of food tend to light up the reward centers of our brain. It makes sense if you were feeling upset, stressed, lonely, etc. that you’d want to find an escape from feeling those painful emotions. An easy, reliable way to do that can become food. Our psychologists use a variety of psychological interventions to help our clients become mindful of their emotions and observe them without judgement. We help them build distress tolerance in being able to sit with their emotions without feeling the need to run from them or suppress them. Food, then, becomes less of a tempting option to escape emotions.

Approximately 25% of those suffering from obesity report binge eating. Binge eating disorder complications are similar to medical complications associated with obesity:

Because we don’t believe in fad diets and because chronic dieting often results in binge eating in the first place, we have to work with our clients in helping them change their relationship with food and their body such that their body gets to the place it’s naturally intended to be at. Instead of talking to you about what to cut out of your diet so that you can begin losing weight, we will talk to you about becoming more mindful and keeping track of how much you’re eating, what you’re eating, and how you’re feeling physically after. With mindfulness, you’ll begin to learn what your body wants you to be eating more of and less of or what quantity of certain foods it can tolerate. Sound complicated? It can be. That’s why we encourage finding the right balance and harmony with your body working with our registered dietitian nutritionists and psychologists.

At Mind Body Health, we treat Avoidant/Restrictive Food Intake Disorder (ARFID) in children, adolescents, and adults.

ARFID often begins in childhood, but can be prolonged into adulthood if not treated early on. Clients struggling with ARFID often have difficulty swallowing foods or digesting foods not for organic reasons, but psychological reasons (mainly anxiety). They often have had a negative experience or have a fear of vomiting, choking, or having food poisoning around the food that they avoid. Many clients with ARFID may have difficulty with eating foods that have different textures, smells, or tastes than the foods they are used to eating. Clients with ARFID may only eat a very select few foods that they feel comfortable around. This can lead to nutritional deficiencies or lack of adequate weight gain for children if they are not eating enough in quantity and quality.

Treatment for ARFID involves cognitive behavioral therapy (CBT) and mindfulness training for clients of all ages. With CBT, we will work on helping clients learn relaxation strategies to manage their physiological anxiety response to new foods. We will also work on addressing the anxious thoughts by using mindfulness training. Instead of getting caught up in the anxious thoughts about food, clients will learn to shift their attention to think more about the taste, texture, and flavor of food. In this way, clients connect more with food instead of avoiding it. In treatment, we create a hierarchy where we gradually expose clients to difficult or challenging foods they may be avoiding.

Treatment also involves family members of young children. Parents will learn not to cater specifically to what the client prefers in terms of food, but learn techniques that help foster trying new foods vs. reinforcing the avoidance of different foods. Families will learn to eat together at the dinner table with no other distractions to help facilitate connection with food vs. being distracted from the experience of food.

Lastly, another important part of therapy with clients suffering from ARFID is assessing for other forms of anxiety. Often if there is a diagnosis of generalized anxiety disorder or trauma, for instance, food can be a mechanism used to help clients feel more in control of their day-to-day environment and their emotions. Helping clients feel better about managing their anxiety creates less of a need to depend on control of the food that they eat. This will help foster exposure around new foods.

Do you feel like you or a loved one doesn't necessarily meet criteria for an eating disorder, but still struggles with a difficult relationship with food and your body?

We encourage you to reach out anyway. Body image dissatisfaction and behaviors such as chronic dieting, "clean" eating, skipping meals, fasting, vomiting, taking diet pills or laxative, and compulsive exercising can be a precursor to developing a more severe eating disorder. These behaviors can also be related to deeper concerns such as feeling out of control, major life changes occurring, identity-related concerns, and interpersonal distress. These concerns can be worked on in therapy such that clients are not reliant on disordered behaviors to feel a sense of control. 

Prevention is key and we love working with clients who are beginning to see the warning signs of developing an unhealthy relationship with food and their bodies. 

Though not formal diagnoses in the DSM-V, orthorexia is a condition that can cause significant distress and harm psychologically and physically.

Orthrexia is when someone becomes so fixated or obsessed with eating "clean," "healthy," or living such a lifestyle to the point of it actually becoming harmful to one's own well-being.

Symptoms of orthorexia may look like the following: 

• Obsessively checking ingredients on food labels and obsessively thinking about eating healthy
• The desire to eat only pure or safe foods begins interfering with personal, social, and work life
• Judgement and preoccupation of others and what they are eating
• Cutting out many groups of foods all at once (i.e. no sugar, no carbs, no meat, no dairy)
• Eating only a narrow range of foods that are deemed"pure" or "clean" foods
• Avoiding social interactions for fear of no healthy food being available
• Getting distressed, anxious, or preoccupied in situations where no "safe" foods are available to eat
• There is an obsession about following a healthy lifestyle and includes an obsession around following "healthy" and "clean eating" social media accounts
• Experiencing the physical and psychological signs of malnutrition (see more under the anorexia tab)

Knowing how to support a loved one who has an eating disorder can be difficult and confusing. 

• Are you concerned and don't know how to help a loved one get to an appropriate level of care?
• Are you confused about levels of care (outpatient, intensive outpatient, partial hospitalization, residential, inpatient)?
 
• Are you unsure how to talk about food or body weight around a loved one?
 
• Are you confused about what to say all together when it comes to helping a loved one get better?

Our therapists have years of experience working with clients with eating disorders and helping loved ones learn how they can be effective in their efforts to support their loved ones. We can provide consultation to you so that you can be in the best position to provide support to your loved one.