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Eating Disorder Recovery: Myth-Busting Is the First Step


Editor’s note: Abigail Natenshon, MA, LCSW, GCFP, is the author of the acclaimed e-book, A Recovery Primer: The Therapist’s Unique Use of Self in Empowering an Integrative Eating Disorder Recovery. Her continuing education presentation for GoodTherapy.org is scheduled for 9 a.m. PST on February 22. This event is available free with 1.5 CE credits for all GoodTherapy.org members. For details, or to register, please click here.

The most lethal of all mental health disorders, eating disorders are complex, multifaceted, and integrative diseases. Anorexia, bulimia, binge eating, and related issues, such as EDNOS (eating disorder not otherwise specified) and activity disorders, affect every aspect of the client’s physical, chemical, emotional, cognitive, and social functioning, all of which require ongoing attention and care in order to achieve complete recovery.

Frequently accompanied by co-occurring diagnoses on Axes I and II, hidden from families and practitioners alike, and cloaked in symptoms, certain aspects of which are typically shared by the non-eating disordered community, clinical eating disorders are challenging to diagnose and treat. Further complicating and compromising effective diagnosis, treatment, and recovery, widespread myths and misunderstandings surround these issues, reinforcing serious gaps in formal professional education about the uniqueness of these issues and their requirements for healing afflicted individuals and families.

  • Myth No. 1: An eating disorder is forever. Eating disorders, unlike addictions, are fully curable in close to 80% of cases when treated in a timely and effective manner. The commonly held notion that eating disorders are life-long afflictions can be a powerful deterrent to recovery, fostering ineffective treatment.
  • Myth No. 2: Eating disorders are self-chosen disorders, curable by sheer willpower. In fact, eating disorders are biological issues that are genetically determined. Though in some instances behavioral manifestations of disease may be alterable in the absence of professional care, the emotional issues, brain chemistries, and attitudes that underlie these disorders cannot be healed completely and lastingly except through psychotherapeutic treatment. Mood disorders that underlie and drive them are best managed through the psychopharmacological interventions.
  • Myth No. 3: Eating disorders are female disorders, afflicting only girls and women. One out of 10 people with eating disorders is male, a number that has doubled in the past 15 years. In men and boys, eating disorders typically co-occur with addictions and body-image disturbances. A recent study showed that 40% of boys in middle school and high school exercise regularly with the goal of increasing muscle mass; 6% had experimented with steroids. Because of societal norms regarding weight in males, overweight that may be connected with binge eating typically goes undiagnosed, as does thinness that may be connected with anorexia.
  • Myth No. 4: Treatment techniques for eating disorders are essentially the same as for a generalized mental health practice. The unique aspects of eating disorders require a unique approach to care. Because of their life-threatening nature, eating disorders demand that the safety of the disordered individual must remain the practitioner’s top priority. A “formative diagnosis,” achieved through an ongoing assessment of the client’s level of physical and emotional risk, is critical throughout the course of treatment and recovery, particularly in the case of young children, where malnutrition can be devastating to brain and bodily development. Eating disorders are unique, too, in demanding vigilance from a multidisciplinary, collaborative team of professional caretakers, attentive to the ever-changing status of physiological, cognitive, behavioral, chemical, and emotional issues throughout recovery. The client’s fearful and dependent attachment to the disorder requires practitioners to understand, recognize, and be prepared to respond to the client’s predictable regressions to precontemplative stages of treatment throughout the recovery process.
  • Myth No. 5: Manualized cognitive behavioral treatment, considered to be the treatment of choice for bulimia, is the preferred treatment mode. In fact, manualized CBT has been shown to be effective in only 50% of bulimic cases, and interestingly, more than 90% of eating disorder practitioners report noncompliance with the confines of the prescribed manualized CBT practice technique for bulimia treatment. It has been my experience over the past four and a half decades of practice that because eating disorders are integrative disorders, their most effective treatment requires an integrative approach to care. Though this work requires a strong foundation in cognitive and behavioral treatment techniques, it is appreciably enhanced by a psychodynamic approach to care with a family systems treatment orientation. An expertly skilled and versatile use of the therapist’s self to facilitate a trusting client/therapist relationship is pivotal in motivating and sustaining the client’s commitment to heal. Psychopharmacological interventions are recommended in cases with dual diagnoses, and holistic mind/body movement approaches have been found to be instrumental in facilitating body-image acceptance.
  • Myth No. 6: Parents are largely to blame for the onset of a child’s eating disorder. With the exception of cases where there has been incest or other abuses, parents are not responsible for the onset of their child’s eating disorder, except for the transmission of their DNA at the moment of conception. Eating disorders are biological disorders, determined by heredity and by gene clustering. Though it is said that genetics load the gun and the environment pulls the trigger, it is only the genetically predisposed child who is susceptible to environmental disease triggers. In actual fact, enlightened parents who are intelligently involved in their child’s treatment are invariably a recovering child’s greatest asset.
  • Myth No. 7: Eating disorders are disorders of the individual. Eating disorders, though they reside within the individual, set down firm roots within the wider family system, impacting all members of that system and the dynamics of their interpersonal relationships. The effects of disease and the individual’s attempts at recovery become evident around dinner tables and in family bathrooms, creating palpable communication barriers and emotional disturbance. The family requires its own source of support and education in learning how best to support and sustain their loved one’s commitment to recovery; this is particularly the case when eating disorders occur in young children and teens living at home. The family system needs to heal alongside the afflicted individual. Families of an eating disordered child are obligated to become actively engaged in family treatment in their role as recovery advocates in the face of the ever-changing disease status and needs of the healing client. It deserves mention that though maintaining the client’s confidentiality is a cornerstone of good therapeutic practice, privacy breeches become nonissues when family members speak together, openly, face to face, in the course of eating disorder treatment.
  • Myth No. 8: The restoration of body weight marks eating disorder recovery. Food, eating, and weight concerns are just one part of a larger integrative disease picture. Weight restoration remains a prerequisite for recovery, as effective psychotherapy cannot take place when the brain is malnourished. But that alone does not ensure the client’s improved capacity to cope,  problem-solve, and live a quality existence, all of which are significant markers for healing completely and sustainably from an eating disorder. Calorie counting and the setting of arbitrary “target” weights for recovering clients compromises and derails eating disorder recovery efforts, as recovery cannot be considered complete unless and until the body itself has been allowed to establish, and sustain, its own set point weight range.
  • Myth No. 9: Professionals should not treat eating disorders unless they specialize in this work. It is my belief that well-trained psychotherapists in general practice have already acquired the treatment tools and strategies they require to treat eating disorders successfully. What most generalists lack, however, is a clear understanding of the unique aspects of these disorders and how to accommodate the unique needs and demands of eating disordered patients within the healing process. These skills are all easily attainable, well within the grasp of well-trained practitioners.

General practitioners with an interest in eating disorder treatment need to better understand the implications of these disorders, both for the individual client and for the family. They need to learn which techniques to use, when, and in what context, becoming more comfortable in an emotionally versatile use of themselves to facilitate healing in their clients. They need to sustain an integrative overview of the extent of the pathology, as well as of the healing process, prioritizing goals to ensure the ongoing physical and emotional safety of the recovering eating disordered individual, as well as the completion of a lasting, full-spectrum recovery.

© Copyright 2013 by Abigail Natenshon MA, LCSW, GCFP, therapist in Highland Park, IL. All Rights Reserved.

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  • birdie January 8th, 2013 at 11:11 AM #1

    I am so scared because I have been bingeing and purging for so long now that the idea of even trying to stop scares me. Even when I tell myself that I won’t ever do it again there I am doing the same thing over and over and I just don’t know how to stop. It is so integrated into my life that the thought of NOT doing it is far scarier than the act itself.

  • Abbie Natenshon January 8th, 2013 at 2:39 PM #2

    You find these behaviors so frightening because they feel so out of your control and are potentially so damaging to your health. Please be aware that you can become completely healed with the right professional help.
    I don’t know where you are located geographically, but I could possibly speak with you to guide you in getting the care you need.

    You must see a medical doctor straight away. That is of primary importance right now to insure that your life is not at risk.


  • Dale January 8th, 2013 at 9:27 PM #3

    Thank you for this post. I believed in many of these myths myself and I regret having done so for so long.

    It is easy for the lay person to fall into these myths,especially ones like believing that eating disorder is just the individual not being able to control himself.I now see how wrong I was.Thank you for the enlightenment.

  • ellen January 9th, 2013 at 10:41 PM #4

    eating disorders r often misunderstood.when I was binge eating a few years ago my family couldnt understand y I just couldnt stop or control myself.they didnt c it as something out of my own control,but as something that I did on purpose.this would have definitely made it worse if not for the timely intervention of a doctor who put things across to them and treated me.IO am thankful to the doctor to this day because not only did she help in my treatment but also helped my folks see d truth about an eating disorder.

    there r still a lot of people who carry the myths listed here and they ought to know the truth.

  • Destiny Nicole January 14th, 2013 at 2:00 AM #5

    My name is Destiny and I’ve been anorectic for 17 years. I’m 23. I stumbled upon this article in a desperate search for some hope for my anorexia, I’m glad I found this article. Its a sad thing when professionals not specializing in the treatment of eating disorders tell their clients that they no longer can be seen by them because they just don’t know how to help or don’t want the liability… Sadly there aren’t too many specialists out there however they are increasing.
    Anyway…thanks for the article. Not only do I believe some of those myths, I have way too many self-defeating beliefs.
    I don’t understand how to live life on lifes terms.
    let me know if you have any suggestions or anything…thanks.

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