Addiction treatment programs, in general, are ill-equipped to properly treat clients with serious eating disorders. For many of our clients, this will ultimately result in a chemical relapse post-treatment, as the structure and approach often falls short of addressing the dysfunction that is pervasive in the client’s life. Clients are seen as resistant and defensive, difficult to treat, and often labeled “borderline” when we fail to adequately address this problem area.

Imagine trying to treat a heroin addict who was smoking marijuana after every meal or snack of every day. Imagine the lack of progress this person might display in treatment. Fortunately, we are able to identify this quite easily with drug testing. This is not the case with an eating disorder, but the result is much the same. The client is off the chemicals but is “using” in the sense that they are in a pathological relationship with a maladaptive coping response that triggers neuro-chemical reward pathways in the brain. As this maintains a vibrant and active old brain, and diminishes the capacity of the prefrontal cortex to be the modulator of behavior, emotion and personality, we see what appear to be pervasive personality problems, resistance and lack of progress.

The old school of addiction treatment continues to use confrontation as the primary tool of intervention for the behaviors viewed as resistant. When a person with an eating disorder experiences this style of counseling, they will typically experience judgment and ridicule and be triggered into further eating-disordered behavior. Of course, this prompts more confrontation from the counselor, which results in the perpetuation of symptoms.

Eating Disorder Support

Appropriate treatment of eating disorders can be given in an addiction treatment setting, but some of the following issues must be supported. If they cannot be, it is unethical to continue treatment and the client should be referred to a facility that is equipped to offer this kind of support.

• Bathroom protocols, such as monitoring an hour after meals
• Meal-time support: no calorie counting, no food talk at meals and offering emotional processing of meals
• Eating disorder specialists on staff
• Regular training for direct care staff
• Blind weights for medical monitoring
• A registered dietician
• Meal planning
• Supervised food exposure such as gardening, cooking, restaurants
• Challenge foods
• Caring, non-judgmental staff
• Eating disorder-specific therapy (Substituting “purging” for alcohol while doing an AA 1st step is not treatment for an eating disorder)
• Intense medical monitoring of shifts in weight, electrolyte unbalancing (can lead to heart attacks) and even bone density scanning, when indicated
• Body image support

This is not a comprehensive list of supports, but it is a great start. The field of addiction treatment, while well-meaning, has at times caused more harm to our clients by failing to address these significant needs. Where support, love and affirmation would have provided relief for our clients from a preoccupation with food and eating patterns, the field has historically confronted the illness aggressively and caused more damage to an already fragile sense of self-worth. It is up to us to learn the best practices for treating these deadly diseases, or it is incumbent upon on us to refer our clients out.

Most of the methods we may have tried to control our eating have not worked long term. This article will explore why diets don’t work, show how diets lead to eating disorders and present some ideas  to consider that do work.

Diets don’t work. Let me contradict myself now and say “all diets work.” The protein diet, the grapefruit diet, low carb diet, the (fill-in-the-blank) diet, all work. The more bizarre the regime the better it works, at least temporally.

The problem is that we go off them. We rebel. We get fed up with the diet and we eat all the things we have been depriving ourselves of. We go off the diet. Then we gain the weight back… plus more.

Due to the food restrictions of the diet, our metabolism has slowed down. Our body thinks it is experiencing a famine; it is in starvation alert mode and is trying to store every calorie. The result is that we gain weight with a vengeance, faster than ever before.

Repetitive behavior over time forms a predictable pattern. We gain weight, go on another diet, rebel, and then start the yo-yo cycle of eating and dieting over and over again.

When we diet, we set ourselves up to overeat because we subconsciously rebel over restricting our food. Binge eating often starts as a direct result of dieting. Thirty-five percent of “normal dieters” progress to eating disorders.

Currently over sixty percent of the population of America is overweight, and nearly one-third are obese. There are more overweight people in the US than any time in history. Americans spend over $60 billion on dieting and weight loss products each year. Weight loss is a national obsession. At any given time, 25 million Americans are seriously dieting. Only 1 out of every 200 dieters lose their weight and keep it off for a year or more.

Currently 2 million Americans suffer from eating disorders. At least 50,000 individuals will die as a direct result of their eating disorder. Because of the secretiveness and shame associated with eating disorders, many cases are probably not reported.
Even before a diet begins the thought of going on a diet begins to influence our overeating. Have you ever thought “I’ll go ahead and eat that cake now because tomorrow (or on Monday, or the first of the month or year) I am going on a diet”? How many times has this happened to you?

What is Disordered Eating?

Disordered eating involves a mental obsession about food, weight, diet, and body image. It affects our self-esteem and robs us of the quality of life that we deserve. We may become depressed, withdrawn, or anxious because of our eating patterns. It affects every area of our lives and our family’s lives.
There is a difference between unhealthy eating habits and disordered eating. A person with disordered eating is using food to cope with life. We overeat as a means to stuff down feelings or thoughts. We refrain from eating or go on a diet to feel in control. We may use the eating to avoid or block some painful part of our life.

Psychological factors that contribute to eating disorders include: low self-esteem, depression, anxiety, perfectionism, feelings of lack of control, inadequacy, loneliness, emptiness.

Situations that can set us up to develop eating disorders are limited coping skills to deal with feelings, denial of feelings, secrets, sexual abuse, excessive ridicule (real of perceived), unrealistic expectations for achievement, parental enmeshment, family disharmony or enmeshment, a cry for help, perfectionism, peer pressure.

Disordered eating has varied definitions and types. It is eating when you are not physically hungry and/or not stopping when you are full. It may result in excessive body fat. It is not necessarily apparent on the outside. We can be normal weight, but we know what we are doing to stay there. We may be bingeing, then starving or exercising excessively. We may use diet pills or other drastic measures. Labels associated with disordered eating are compulsive overeating, binge eating, anorexia, and bulimia (several types). We may go from one disorder to another and another.

Compulsive Overeating

I call this “grazing”. It’s eating non-stop all day. Some of us get through the day using food.
This person could be any weight. They may be a yo-yo dieter. They may binge and restrict foods. They could be obese.

Binge Eating

Binge eating is characterized by the following:

• eating  food when not feeling physically hungry
• mindless eating, eating in a short period of time, a large amount of food
• feeling that one cannot stop eating if they start
• while eating feels that one can not control what or how much one is eating
• eating until feeling uncomfortably full
• eating much more rapidly than normal
• eating alone because of being embarrassed by how much or what one is eating
• feeling disgusted with oneself, depressed, or very guilty after overeating
• constant thoughts about what to eat or not eat and weight.

Anorexia

There is a refusal to maintain normal body weight, resulting in a 15% below normal weight. The anorexic denies hunger and is preoccupied with weight and body image. They believe they are fat even if underweight. They believe they look better the more weight they lose. Their whole focus becomes dieting, weight and body image.

They avoid eating and activities around food. When they do eat, they avoid whole groups of food; perform rituals around food such as eating in a certain order, excessive chewing of food, moving food around the plate. The person suffering with anorexia has an intense fear of getting fat.

The effects of Anorexia are many. The skin, hair and nails become brittle, dry and thin. Due to the absence of body fat they are usually cold and dress in layers even in the summer. They may lose their monthly period and develop fine body hair. They may exhibit compulsive hyperactivity followed by extreme fatigue.

Due to chemical disturbances and malnutrition, they may experience thought and mood distortions, making decision-making difficult, thinking illogical and marked confusion. Hospitalization may be necessary due to dehydration, malnutrition, depression, anxiety or heart and kidney problems.

After an episode of anorexia, approximately 2/3 completely recovers and 1/3 continues to have periodic problems with eating disorders later in life. They may transition into bulimia, compulsive overeating or take substances to control their weight or to cope. This eating disorder has a mortality rate of 20%, the highest mortality rate of any mental health condition.

Bulimia Nervosa

Bulimia is recurrent episodes of binge eating, zoning out on food, eating in secret, then getting rid of the food.

They may self-induce vomiting, misuse laxatives, diuretics, enemas, or other medications, periodical fasting, or excessively exercise. There may be an intense feeling of fullness even after a small meal, with an urge to get rid of the food. People with bulimia nervosa may binge 3 to 20 times per day. Once in place, this pattern of binge eating and purging can continue over a lifetime.

Research has shown a link between bulimia and severe depression and anxiety. Clinical studies have found a dramatic decline in the frequency of binge-and-purge episodes in response to antidepressants, regardless of whether the bulimic is suffering from depression at the time or not.

Bulimia nervosa is a potentially serious condition that disrupts the body’s chemistries, causes harm to the digestive tract, erodes tooth enamel, and creates the risk of potentially fatal heart irregularities due to impaired physical health or chemical imbalances.

Effects of Disordered Eating

Eating disorders can lead to substance abuse problems, obsessive-compulsive disorders, relationship, learning, spiritual and financial difficulties. It can affect every part of our life.

Physically, eating disorders can cause infertility, heart irregularities, osteoporosis, chemical imbalances in the brain & body, swelling of face, abnormal hair growth on the body or hair loss, rupture of the stomach or esophagus, malnutrition, mental  disturbances, and death.

The primary thing that keeps a person in the illness is FEAR . . . fears of being fat, fear of sharing the secret, fear of abandonment, and fear of feeling. By concentrating on our body size, our weight or diet we avoid this fear and numb the feelings.

What we are looking at is a battle between the mind and food with the body being the battleground.

Disconnection from our Appetite

Some of us are so disconnected from our appetite, our Self, and feelings that we are getting caught up in mindless habitual eating or yo-yo dieting. Some of us don’t know when we are hungry or full. We may confuse an emotion or feeling with being hungry. We may use food to comfort ourselves or as a way of relieving stress. We may feel hungry when we are actually bored or lonely. We zone-out on food or compulsive thoughts about food, weight or body image. We push all this down with a mountain of food. We don’t pay attention to our appetite.

We don’t access that internal control—our appetite. We just want to eat. It’s not about physical hunger. Food becomes our best friend, our companion, and our comfort. We reach for food to fill that empty hole that food cannot touch.

We have to learn to identify the feeling, thought or trigger behind the reaching for food. Many of us mistake hunger for many other feelings. We can not fix something we are not aware of. If we do not know what we are feeling, we can not take appropriate action to deal with that feeling. Food does not work for emotional reasons.

For example, a lot of eating is triggered by stress. Food does not fix stress. A few quiet moments to relax, meditation, connecting with a Higher Power or observing nature are tools that can help. Food has become a substitute for dealing with the stress in our life, but it creates more problems, health and self-esteem issues, and more stress.

Let’s take a look at what happens when we use food for reasons other than physical hunger. I call this the Binge Cycle.

The Binge Cycle

Something happens in our environment, a situation or even a thought. We immediately reach for food. It’s like we are hard-wired to reach for food. We don’t even ask our self if we are hungry. We just want to eat.
In the vain attempt to feel better, we use obsessive thinking and eating to block our pain. We focus on the food, the taste, what else to eat, etc. Some times we block out thoughts about our body size, our inadequacies, our negative self-talk, or what we are going to eat after we leave work. We’re not in the here and now.

Then we start beating our self up. “Why did I do that? I’ll never lose this weight. I am so fat.” So now we are focused on the negative self talk. We need to connect back to ourselves and become a friend with ourselves instead of battling this internal dialog. This internal battle actually perpetuates the disordered eating.

We don’t even know what triggered this binge because we automatically reach for something to eat. Our focus is the food and our body image. We never learn what sent us to the food in the first place. So we stay in this vicious cycle.

Food becomes the solution to our problems. Food can be distorted into becoming our best friend, our support, our escape, and our obsession. Dieting or thinking about what to eat or not eat and body image can become our focus in life. It takes away our energy and prevents us from becoming the people we were meant to be. We are really looking for relief and peace, but food does not provide relief or peace in the long run.

How to Get out of the Cycle:

It helps to recognize that there could be a relationship between our emotions, feeling, thoughts and our eating behaviors. Our feelings are there for a reason. They point towards our next step on our learning journey. We know we feel bad about certain actions, so we learn that those actions are to be avoided in the future. But what if we block that out with food or other things? After awhile we are not in touch with that learning mechanism. We may become addicted to our method of pushing our feelings down. We may overreact to situations that trigger the unrecognized pain from the past.

The triggers are our way of saying to self. STOP I need your attention here, something is wrong here. I need healing in this area. That healing does not come from food or outside distractions. It comes from being aware that we need help, ask for it and allow our self to receive it.

All behavior starts with a thought whether we are aware of it or not. Let’s examine our thoughts for a moment. What are we telling our self throughout the day? Are we thinking thoughts that are beneficial to our self and the people around us?

What percentages of our thoughts are about how we look, what we should eat or not eat, diet plans, etc?  Are these thoughts building us up or tearing us down? Does our negativity spill out onto others? Are these thoughts blocking us from becoming all we can so we can be of maximum use to God and our fellows?
Some people with eating disorders do not want to be alone with their thoughts or self-talk, so they drown them out with food. Crunchy foods seem to work best here.

Journey Back to our Appetite and Self

It is a worthwhile endeavor to make the long journey back to you and your appetite. Our real Self can be our best friend.

How can we have self-control if we are not connected to our Self? We don’t know what we need, feel, or want. We are disconnected from our body, our feelings, and appetite. We know what we should feel, want, and need or we think we know what other people need. These external controls running our life set us up for disaster.

How do we best move toward our goals? Does criticism, sarcasm, and belittling help us? Or does encouragement, respect, patience, and compassion work better?

We lose a lot of energy with negative self-talk. Imagine an athlete running a race. Can you imagine how much harder it would be if they were battling negative self-talk. How could they stay focused on achieving the goal of winning?

We come into this world and we leave this world with only one being—our Self, the real spiritual Self. If we don’t have this connection, life can be so hard and lonely. No other person or substance can provide what this connection can. They may seem to temporarily fix it, but after awhile, we are left alone again. If we don’t have our Self, we are really alone.

As we become more self aware, we start to notice the effects some foods have on our body and mind. Many of us see a link between sugar and binge cravings. We may notice we have a harder time with controlling our food intake after we have white flour. Once we make these connections we can think it through and we may decide not to eat that today.

The eating disorder has often pushed aside the person’s various interests and social activities. Helping them to reconnect and develop these interests is a necessary part of the recovery process. When we let go of the obsessive thoughts and actions associated with the eating disorder, we need to replace that with enhancing rewarding alternatives.

Summary

Awareness is the key. We can’t change something we’re not aware of. We need to learn how to CONNECT back to our SELF, FEELINGS, THOUGHTS, and APPETITE. Pay attention to your appetite. Eat when physically hungry and stop when full. We can always have more food when we are hungry again. If you are not physically hungry and you want to eat, ask yourself what do you really need at this time?

Get rid of the things you are pushing down with food. When you are reaching for food and you are not hungry, this is your red flag, your alarm system. Pay attention. Notice what you really need when you want to eat (rest or just some down time). Allow good nutrition to supply your body and mind. Feed your spiritual self on a continual basis. Freedom is thinking about food only when hungry or preparing for a meal.

My body was clearly unhealthy and out of balance, but my mindset toward my body was even more out of whack. Finding health meant gaining a balanced perspective toward nutrition, exercise, rest, and my body in general. It meant creating habits in my life that actually put these new perspectives into practice.

When it comes to food, I learned to apply the principles of intuitive eating. An approach to eating that teaches us to become the expert of our own body, I learned how to get in touch with my inner hunger and fullness cues. In other words, I learned to eat when I am hungry and stop when I am full (rather than eating according to the rules of the latest fad diet). This may sound simple, but for someone who was struggling with anorexia and bulimia, this seemed impossible at first. And, in the beginning, it would have been. So I actually began my journey to healthy eating with a food plan prepared by a registered dietitian who specialized in eating disorders. With her help over a period of several years, I eventually tossed the structure of the food plan away and embraced the no rules approach to eating. I stopped dividing food into “good” and “bad” categories, realizing that food is just food and does not have a moral value. At restaurants, I stopped saying things like, “I am going to be bad today,” when referring to eating cheesecake. Stealing cheesecake is bad. Eating it is not!

After I had some success with eating healthy, I began to incorporate moderate exercise into my life — with my entire treatment team of a therapist, dietitian, and doctors behind me. Rather than thinking about the calorie burning effect of exercise, I focused on feeling energized and on having fun. I began to participate in movement that I enjoy, so that I would actually look forward to doing it. I do not like to run, so I did not force myself to run. I do like to be outdoors and to be with people, so I started taking short hikes in a local park with a friend.

I could finally understand why my body needed food and exercise, but needing sleep was a different story. It did not seem very smart to me to spend eight hours a day in a state of near-total unconsciousness. My workaholic side said that sleeping would make me weak and unproductive. I felt guilty for sleeping, so I avoided it. Ironically, this lack of sleep is actually what made me weak and unproductive. It also made me irritable and angry. Throughout my personal growth work, I have learned that missing out on a good night’s sleep seriously affects — in a negative way — what happens when I am awake.

If I am taking care of my body by eating, exercising, and sleeping right, it is going to be the size and shape that it is genetically supposed to be. In the beginning, I did not like that size and shape at all. Over time, with the help of my Higher Power, I began to appreciate my body for what it does rather than for what it looks like. When I was at the height of my eating disorder, I did not even have the strength to do one sit up. Now my arms can propel me up a frozen waterfall while ice climbing in Alaska, and my legs can pedal my mountain bike through rugged trails in Tennessee. As a woman, my body is ingenious enough to nourish and to carry a child. This gratitude for what my body does ultimately led to my accepting my body. Today, I can honestly say that I not only accept my body, but I love it.

If I don’t eat, exercise, and sleep right, I don’t think right. When I am not thinking right, my eating, exercising, and sleeping habits are not right. So maintaining a healthy body is a priority in my life today. My body and me are no longer at war. We have called a truce, and we trust each other.

Do you have a war going on at home? Maybe it is time to make peace with your body. After all, like me and mine, you two will be together for a long time.

A lot of individuals get treated for the chemical addiction, eating disorders, or depression, but they just go out and find another unhealthy coping mechanism. So often the individuals in treatment that are working so hard to get over their addiction are outside having a smoke every chance they get; one of the strongest addictions to break, yet somehow more socially acceptable.

From the age of ten I watched people go in and out of treatment. My father was the Administrator of a psych hospital in Worthington, Ohio for 13 years. It struck me as young as I was, that people kept coming back—they weren’t getting well.

As I struggled with my own eating disorder, I began to research and study information in search of recovery. I observed that, sadly, the same problem exists in individuals with addictions, as those with psychiatric problems. People with eating disorders or drug and alcohol addictions go to treatment, relapse, go for more treatment, relapse again and create a new cycle of behavior sprinkled with varying lengths of sobriety, freedom from drugs or their eating disorders, before answering the call back to the addiction.

In my own experience when I was bingeing regularly back in my twenties, I always had this feeling there was something more than just my lack of self-esteem that was causing the binges. There was a chemical pull, something in my body that pushed me to binge, in addition to the fact I’d had a bad day, got embarrassed or was made fun of. If I stayed off sweets, I was fine. If I took the first bite, I was gone on a week long sugar binge and put on 10 pounds in a matter of two to three days. I didn’t have any scientific proof back then, I just knew.

I learned about what I call the whack-a-mole syndrome first hand. Once I quit bingeing, I spent ten years using alcohol to “numb out” in exactly the same fashion. But I didn’t realize that was what had happened until I started to write a book about my recovery. When it hit me, I was stunned and disappointed to see that although I thought I had overcome my eating disorder, all I really did was find a new secret flavor to send me to my favorite hideaway where I was safe from the interaction of the world. Snickers, Oreos, pizza, pasta, Pralines n’ Cream were exchanged for an even simpler sugar in the form of wine. Part of why I missed the connection is because it started with my first job in sales. I was entertaining clients on a regular basis and it was part of the job. It’s socially acceptable to have the nickname, Happy Hour Queen- always ready to entertain.

In my early forties I developed a number of health problems. I had no energy, everything I ate (and I ate very healthy foods) bloated my stomach and my right ear was completely blocked. I had ear problems throughout my life. More ear infections than I can even count. I was on antibiotics regularly as a child and numerous times in my teens and twenties. Antibiotics wreak havoc on your internal system.

In my twenties, every time I took antibiotics I asked for the Diflucan because I knew I would have a yeast infection within a day of going on the medication. This time I refused to go on antibiotics and went searching for an alternative. This search led me to recovery from my eating disorder, writing a book and finding my purpose in life.

By working with acupuncture and integrative therapy, the inner knowing I had always had about body chemistry was revealed to me; and it wasn’t just body chemistry, it was also an issue of brain chemistry. I had studied diet and nutrition for years because I always wanted to compete at body building; but because of my bulimia that goal was never achieved. I’m a firm believer that diet and nutrition are the foundation for quality of life, but that was only part of the equation. The information I learned from the alternative practitioners helped me understand that it wasn’t my fault, the sugar cravings weren’t due to a lack of willpower and I wasn’t an alcoholic.

Kathleen Des Maisons book, Potatoes Not Prozac details her studies in working with alcoholics and how she noticed that most AA meetings came stocked with donuts, candy and other sugar filled snacks. She interviewed her clients and found that many of them skipped breakfast and ate primarily simple carbs (bagels, pasta, white breads, etc.). By getting her clients on a diet that included complex carbs (brown rice, millet, quinoa) and adding in lots of green leafy vegetables, her clients who had never been able to get sober were not only getting, but staying sober.

The impact of sugar in the American diet is horrifying. Many people are addicted to sugar and don’t even know it. It is now more socially acceptable to be overweight, eat cookies someone brought into the office, drink soda all day and dump sugar in your coffee or tea. It’s hidden everywhere in most processed foods that are consumed. I read an interesting article recently about how sugar was introduced to societies; it was brought in as a drug. Sugar consumption by the average American has risen from approximately 7 pounds per year in the 18th century, to over 150 pounds per year in the twentieth century!

Julia Ross’s book, The Mood Cure details her work with clients that experience “false moods” because their brains don’t have the required level of amino acids for proper brain function. By using natural supplements, her clients in some cases experienced rapid positive shifts in their obsessive behaviors, eating disorders, relief from depression and more. Julia also has written about the impact of sugar and sugar addiction in The Diet Cure.

By bringing these things together and adding body work I found the freedom I had so desperately sought for 34 years.

This is why I decided to write my book, It Started With Pop-Tarts®…An Alternative Approach to Winning the Battle of Bulimia. The five principles I detail in my book are now known as the Hot Pastry Principles™. I teach them to my clients who are ready to adopt a healthy lifestyle and want to learn how to balance their lives. We apply this to weight management (losing weight and keeping it off), eliminating stress or recovery from an eating disorder.

To eliminate the “whack-a-mole” syndrome and get the results you want in life, being free from addiction of any type, requires study in five areas:

• Improving and maintaining healthy self-esteem
• Understanding the causes of the addictive behavior
• Diet, nutrition and natural supplements
• Reprogramming negative self-talk and beliefs using the power of the subconscious mind
• Improving physical and mental health with body work. Several modalities I’ve found effective are:

• Acupuncture – helps to balance body chemistry
• Meditation – slows down the overactive, overly analytical brain and helps individuals learn to live in the moment and make the right choices
• Hellerwork – combination of dialogue, body movement, deep tissue massage
• Energy work – letting go of energy blocks stored throughout the body (done with practitioner)
• Exercise that moves energy – Tai chi, Yoga, etc.
• Exercise that includes cardio and resistance training
• Moderate outdoor exercise – getting ample sunlight and fresh air into the body

In March of 2009, I met Dr. Joel Robertson at the International Association of Eating Disorder Professionals Conference. He has been studying the science of neurochemistry for years. His book Peak-Performance Living, Easy, Drug-Free Ways to Alter Your Own Brain Chemistry for Improved Productivity, Greater Energy, Sharper Thinking and Optimal Health came from his own experience working with alcoholics early in his career. Like me, Dr. Robertson observed that traditional treatments weren’t working and he got into the study of brain and body chemistry. He’s doing some incredible things through his research and company.

One of the most reassuring things I learned as part of my alternative path to recovery is that it really isn’t about willpower. You don’t have to “work hard” on your recovery. Instead, individuals can choose to “surrender” to their healing and “allow” it to come into their life. It’s a big shift for some people, but very effective.

Instead of constantly focusing on the problem (the addiction they don’t want), try getting clients focused on what they DO want from life, what they want their life to look like, feel like and be like. It is very empowering. Life plays out and manifests according to focus. If a client spends all of their time focused on how much they hate their body, how much they don’t want to drink, how much they don’t want to be a drug addict anymore, then they are still affirming that behavior in their life by focusing on it.

Instead, help them get to a place where they can get a glimpse of what normal life would feel like, smell like, taste like, be like. Have them tell you a story about a day in the life they want, describing every detail as if they were on the phone with you. Or have them write a story of a day in their life and write a new one every day. It is a powerful tool for helping them change focus and reach a point of hope and inspiration.

clients by incorporating a plan that covers all aspects of mind, body and spirit:

• How to use their subconscious to support them
• How to eat healthy balanced meals that will make them feel good, give them energy and help them make good choices
• How the balance of body and brain chemistry can make recovery possible, by shifting their moods instead of an exercise of will
• How to love and accept themselves and find their value and purpose in life
• How to nurture their mind and bodies through diet, exercise and quiet time

They will have a stronger connection to sustainable recovery and can live a fully balanced life.

“Free,” I answered.

Kelly is a young woman struggling with an eating disorder. She was talking with me, because I am recovered from anorexia and bulimia. I have been there.

“Free” means a lot more than simply freedom from destructive behaviors with food. It means much more than just a life without bingeing, purging, and starving. That kind of a life is really not free at all.

“Free” also means independence from the unrelenting obsessions related to food and body image. It is a release from fear’s daily control. It means freedom to live life to its fullest.

Recovery encompasses every facet of life. When someone truly recovers from an eating disorder or any addiction, they get much more that just “not bingeing,” “not drinking,” or “not using.”

When I first began therapy for my eating disorder, I thought that my ultimate goal was to stop acting out with the negative behaviors surrounding food. I believed that my life would be magically transformed into something wonderful if I could just eat right. After years of hard work in recovery — and lots of stumbling — I did finally begin to “eat right.” I could not have been more wrong about eating right.

I should say that we could not have been more wrong. Other people in my life thought that I was better when I began eating better. They said that I looked “healthy,” and they were proud of me. I received lots of pats on the back, and ironically, I felt more destructive than ever. I looked healthy on the outside, but I was dying on the inside.

I had stopped using food, but not much else had changed in my life. In fact, without my eating disorder as a coping mechanism, I felt more lost and crazier than ever. I even started thinking about engaging in other addictive behaviors — ones that had never crossed my mind before.

I asked myself, “If I can’t turn to food anymore, then what can I turn to?”

Switching addictions is not better. I almost switched. Thinking about food all of the time is not better. I thought about food twenty-four hours a day. Feeling constant despair, anger, and anxiety is not better. I felt all of these things. I was not better.

I could have easily been compared to a dry drunk. I had heard in Twelve Step meetings that a dry drunk is someone who has stopped drinking, but who still demonstrates the same alcoholic behaviors and attitudes. I was still engaging in the same thought processes of my eating disorder. Similar to the dry drunk state, these thought patterns eventually led to relapses back into eating disordered behaviors — even more intensive and harmful. Although these behaviors seemed worse than ever, they no longer produced the same soothing, calming effect as previously.

I began to think, “Why did I fight so hard for this?”

Then I realized that I needed to keep fighting. My journey was not over. I had worked hard and learned a lot, but I needed to keep working. I needed to wrestle with my inner demons. I needed to connect with my higher power. Because recovery is not only physical, but it is also emotional, mental, and spiritual. It is about functioning in society and quality of life.

So I dove headfirst into therapy. I explored my spirituality. And I learned coping skills that helped me deal with life on life’s terms in healthy ways. I practiced experiencing my emotions (instead of stuffing or starving them) and realized that feelings do pass in time. I combined self-compassion with genuine self-care to discover self-acceptance. I fell down lots on my journey to this acceptance, but I trusted my support team of friends, family members, and professionals to help me get back up each time. I trusted myself.

Recovery is about uncovering passions and learning to have fun. It is being able to sit still and live in one’s body. Recovery is about seeking balance, having a voice, and letting go of perfection. It is letting go of the fear of judgment from others. And it is much more.

Recovery is more than a standardized textbook definition or some insurance company’s criteria. It encompasses all areas of life and is personal to each individual.

Kelly asked me how I would define recovery in one word.

“Free,” I answered.

I am free.

Someone struggling with anorexia may deny her hunger and not eat, but she is secretly obsessed with food and fat.  She spends much of her day counting calories, weighing herself, exercising excessively, preparing food for others, and thinking about the foods she didn’t eat.  Compulsive eaters find themselves thinking about the foods they are not supposed to be eating and scolding themselves for what they did eat and for how fat they look.  Those who are caught up in the binge-purge- process of bulimia spend enormous amounts of time planning and preparing for their binge and worrying about how they will be able to purge in secret.  For concerned family members and friends who are witnessing this, all the evidence of an eating disorder points to food.  And yet, food is not the real issue.  It is a smoke screen.  It is the red herring.

A “red herring” describes something designed to confuse or divert attention from something else.  Let’s say you are following a whodunit and the question is “Who killed the old lady? Was it the maid, the butler, or the chauffeur?”  As you are following the mystery along everyone is watching the maid because she was around the old lady the most and had been acting suspiciously.  At the end of the story, there’s a twist and it turns out not to have been the maid who committed the murder, but the butler, who no one suspected because they were busy scrutinizing the maid.  The maid is the red herring.  She’s the distracter.

With disordered eating food becomes the red herring.  It can distract those struggling with an eating disorder as well as concerned family members and friends and even professionals who are trying to help.  When we focus on what someone is doing with food, we fail to see the real culprit.  We become caught up in illusions that cause us to stray from the path of recovery, because we start looking for solutions in all the wrong places.

This old English fairy tale is about a girl who longed to touch the stars in the sky.

Every evening, just before falling asleep at night, she would lie in her bed and gaze out at the stars through her bedroom window.  On clear nights she would be delighted to see them twinkling ever so brightly.  Other nights she would watch them play hide-and-seek with the clouds.  On stormy nights they wouldn’t show their faces even though she suspected they were still behind the clouds.

One warm summer evening when the moon was full, the girl decided to satisfy her yearning and set out in search of the stars.  She walked and walked until she came to a smooth, glassy pond.  “Good evening.”  The girl said.  “I’m off to find the stars in the sky.  Can you tell me how to reach them?”

“They’re right here in my face,” Replied the pond.  “Jump in and catch them.”

The girl looked at the stars glistening in the pond and jumped right in, her hands cupped so that she might catch one.  But not a star did she find.

She went on her way until she came to a bubbling brook.  “Good evening,” Said the girl. “I’m off to find the stars in the sky.  Can you help me?”

“Oh, yes,” answered the brook. “ They are always here, dancing in the water between the stones.  Come on in and catch them.”

So the girl waded into the brook, with her hands cupped so she could scoop them up. But not a star did she find.

“I don’t think the stars are really here!” the girl cried in dismay.

“Well, they look like they are here, and that’s just the same thing,” said the brook.

“No, it’s not,” insisted the girl.

She continued on her way until she encountered a group of fairies dancing on a hill. “Good evening,” said the girl as she approached the wee folk. “I’m off to find she stars in the sky. Can you help me?”

“They are right here, in the dew on the grass where we are dancing. Come and dance with us and you will catch one.”

So the girl danced and danced with the ring of fairies, swooping down with her hands, trying to scoop up some stars. But not a star did she find. In frustration, she sat on a mossy stump and said to the fairies as they whirled by, “I’ve searched and searched for the stars but I cannot find them. Can’t you help me?”

One of the fairies began to dance around her and with a high sweet voice said. “Since you are so determined to find the stars, I will tell you how to reach them: If you will not go backward, then go forward. Be sure to take the right road. Ask Four-Feet to carry you to No-feet, who will carry you to the Stairs Without Steps. If you can climb them, you will reach the stars.”

The girl quickly stood up and began to go forward, making sure she was on the right road. She came to a horse grazing underneath a tree. “Good evening,” she said. “I’m off to find the stars in the sky. Can you carry me there?”

“I don’t know the whereabouts of the stars in the sky,” said the horse. “My purpose is to serve the fairies.”

“I was just dancing with them,” said the girl, “and they told me to ask Four-Feet to carry me to No- Feet.”

“Well, I am Four-Feet, and if the fairies say I am to take you to No-Feet, then climb on my back and off we’ll go,” said the horse.

The girl rode and rode until they came to the end of the land where the sea stretched out in front of them as far as the horizon. Way off in the distance was a ribbon of brilliant colors that arched up into the sky.

The girl slid off the horse’s back and stood at the water’s edge. A very large fish swam up to her. Good evening said the girl. “I’m looking for the Stairs Without Steps. Can you take me there?”

“I am not available to serve anyone who asks.  I am only to do the bidding of the fairies,” replied the fish.

“I was just dancing with them and was told to ride Four-Feet who would carry me to No-Feet who would carry me to the Stairs without Steps.”

“Well in that case, hop on my back. I am No-Feet, and I will carry you to the Stairs Without Steps,” said the fish.

Off they went, the girl holding tightly to the fish’s back until they reached the horizon where the brilliant colors arched high up into the sky. “Here they are,” said the fish. “Be careful as you go up. They are not easy to climb.”

The girl slid off the fish’s back and began to climb the bright arch of many colors. The fish was right. They were not easy to climb, but she moved slowly and cautiously, inching her way along. As she became weary she would occasionally lose her grip and slip backwards. It was cold and she was surrounded by darkness, but she pressed on until she reached the top of the arch where she was surrounded by the brilliant light. At last! There they were- the stars in the sky! She reached out with her hand to touch one of the simmering stars. As she reached farther and farther, she suddenly lost her balance, and with a sigh that was half regret, half contentment, she fell, slipping and sliding, faster and faster into the darkness below.

When she opened her eyes, it was morning and she found herself in her bed. “I did reach the stars, didn’t I?” she wondered. “Or did I only dream it?”

Then she looked at her hand that was still tightly clenched into a fist, and as she slowly opened it, she saw a speck of stardust.

Breaking free from struggles with food, fat and dieting can seem as impossible as reaching for the stars. This story tells us that if you want to reach your dream you must not spend much time chasing an illusion. While the girl was initially fooled by the reflection of the stars on the pond, in the brook and in the dew, she soon recognized that the reflection was not the same as the stars themselves. Problems with food are simply reflections of the real issues with which we struggle. It is important to recognize that food is not the problem itself.

If I am obsessing with food, fat, and dieting, what I am doing with food is distracting me from the real issues I struggle with in my life. As horrible as it is to feel fat and as painful as it is to struggle with that feeling, focusing on feeling fat gives one something tangible, which in turn gives some definition to troubled feelings that may seem unresolvable.  It seems to be a way, literally and figuratively, to “put one’s finger on” the source of the problem.  But like stars in a pond, it is only an illusion.

Think of the “fat attack.”  Anyone who has struggled with disordered eating is familiar with fat attacks.  A fat attack occurs when you all of a sudden feel extremely fat, as though you’ve just gained twenty pounds overnight.  You know, rationally, that you did not actually gain twenty pounds overnight but it sure feels that way.  Yesterday you might not have felt terrific, but you felt okay.  Today you feel horribly fat.  What’s going on?

When you are having a fat attack, this is a signal that something else is going on that is upsetting you.  Maybe you are angry at something your mother said, maybe you are nervous about an upcoming date, maybe you are feeling frustrated with a supervisor at work, maybe you are feeling bad about something you said to a friend.  If these are things you don’t quite know how to handle comfortably, you may begin to focus intensely on your fat and the original problem will appear to fade into the background.  As bad as it feels to see yourself as fat, at least you know what the solution is: lose weight.

A fat attack is different from generally feeling bad about your weight.  It comes on rather suddenly and is very intense.  It is not based on reality, even though the feelings that it generates are very real.  It seems like the source of your misery, but like the starlight in dewdrops, it is only a reflection of something else that is troubling you.

What if the real problem is that you have a terrible relationship with your mother or you’re in a marriage that’s intolerable for you, or you hate your job, or you feel lonely even in a room full of people?  These are much bigger, more complex issues that can often become overwhelming.

Here’s where food comes into the picture.  If you starve yourself, all you seem to think about is food.  If you binge and purge, you spend much of your time planning your binges and finding the time and place to purge.  If you are eating compulsively, you focus on food, food, food.  And those other problems at home, at school, at work, or in relationships, magically seem to disappear.

Coping with the “real problems” requires skills that you may not have, and resolving them may seem like an impossible task, as difficult as climbing a rainbow.  When you embark on a journey to uncover and resolve underlying conflicts or feelings, and don’t allow yourself to be fooled by any illusions of what is truly troubling you, you may learn something important about the function and purpose of your disordered eating. You may discover how it helps to distract you from the issues in your life that overwhelm you, that you haven’t yet learned how to deal with effectively.  You may also discover how effectively it distracts you, moment to moment, from the fear of facing things head on, and from the pain of past hurts.  No wonder it can be so addictive.

The relief you get, however, is only temporary.  The disordered eating distracts you only temporarily from the emotional stress you are experiencing.  It doesn’t do anything to make the stress go away.  Although what you are doing with food distracts you from your sadness, your anger, or your fear, it doesn’t help to resolve problems.  In fact, it helps to make them worse.  The stress inside worsens and the disordered eating behavior increases.  The real issues never do get resolved.

When we decide to follow our dream of being free from disordered eating, what is required is not just a longing to reach for the stars, but a willingness to go forward on the right path.  That means not gettingdistracted by the illusion that thinness creates happiness, or be sidetracked by the belief that all we need is enough willpower to stick to a diet.  We must realize that calorie counting is not the answer, and food is not the problem.

They are astounded when I tell them that according to the Institute of Scientific Research at least 26% and as much as 28% of ALL bulimia nervosa is first diagnosed by a dentist. That usually gets their interest and piques their professional curiosity.

It rocks them when I tell them that number is too low.  It should be above 50%!
Why is that?  It’s because the mouth does not lie. It cannot hide the truth about bulimia from a dentist. The telltale signs are everywhere. Very distinctive, very dramatic and very evident loss of tooth enamel on the backs of the front teeth is a giveaway to any dentist with eyes. Swollen, red salivary glands usually accompany the missing enamel. Periodontal gum disease is likely present and there could be a number of missing teeth in the most severe cases.  It all adds up to one diagnosis:  bulimia nervosa. Nothing else in the mouth has that pathology.  When you add in the social and psychological factors: age, gender, over-achieving nature, self-esteem problems, environmental issues, temperament – the patient in our dental chair is speaking volumes without having to say a word.

Her name was Megan. She was 26 years old when we met. She weighed a mere 71 lbs. at that time. She had been both anorexic and bulimic since the age of 12. Her life was tragic. She lived in a waking nightmare 24/365. Bingeing and purging consumed her when she wasn’t starving herself. The diseases controlled every action, every thought, every dream and every waking moment. She was imprisoned by the stark reality of trying to live with a terrible eating disorder. It had begun to consume the very tissues of her body. Bone began to resorb, her teeth became loose and fell out as the protective, encasing bone around them shrunk and became brittle. Her body was starved for nutrients as she vomited throughout the early morning hours to rid herself of what little food she retained. She was in the throes of full-blown bulimia and anorexia. At 26, most people still have all 32 teeth but Megan had only 12 when I met her – six upper and six lower. Her teeth and gums reminded me of someone in their 70’s, someone who had experienced a lifetime of neglect.

Her existence revolved around sleeping a very troubled sleep during the day and consuming massive amounts of food at night to fuel her purging activity. Her daily routine was to lie in bed throughout the day, not eating, restless, tossing and turning, too exhausted to find that deep, comforting sleep we all need to feel better. Megan never felt better during those times.

My good friend and professional colleague, Dr. Greg Jantz from The Center for Counseling and Health Resources in Edmonds, Washington contacted me about treating Megan’s dental problems. Dr. Jantz and I had had frank discussions about how bulimia nervosa attacked the mouth and how carefully one had to approach these fragile victims in order to successfully treat them. She was suffering with a very loose front tooth that was causing her unrelenting pain and she needed to see a dentist immediately. We obliged and arranged to see Megan as soon as possible.

When she arrived two things struck me right away. First, she was in dire need of full mouth reconstruction not just emergency care. Her mouth was in bad shape. It wasn’t just the loose tooth in the front. There were many missing teeth, severe gum disease, bone loss and a few abscesses. Her salivary glands were swollen and red.  Bulimia had ravaged her mouth almost to the point of total loss.  Secondly, this waif of a woman had volumes of character and strength deep within her that were untapped. Her spirit shone through the trauma she was experiencing as she looked me right in the eye and said, “I want to get better – I want you to help me.” My heart broke into a thousand million pieces. Her very presence impressed my entire office staff and me. She was a fighter and had been fighting alone for so long. It touched me far beyond my professional veneer and I was moved emotionally. In my entire career of over 20 years as a dentist, that had never happened before. I knew she was special.  I knew I had to help her. My staff felt exactly the same way and came to me after her first visit and told me “whatever it takes, let’s make this girl whole again.”

I had treated many bulimics in my office before Megan. Most had “turned the corner” and were well along the way toward recovery. Their teeth were usually the last thing they addressed in their treatment many telling me that their teeth and smile reminded them of that time in their lives when they were not in control. They were ashamed to smile.

I approach them all in a very non-judgmental way. Too many dentists and their staffs assume a parental role in treating their patients scolding them to brush and floss better. It has been years since I did that with my patients. I found that it just doesn’t work. People feel bad enough about their teeth. Why should I, or my staff wag their finger and admonish the patient about their oral hygiene and the condition of their mouth? It is what it is. And it is our responsibility to fix it.

My success rate with patients soared when I stopped being their parent and became their practitioner. I want to restore their smiles not be their parent. With bulimics and anorexics it is the same only much more intense. They will not return to your practice if you make them feel worse than they already do. It’s as simple as that.

Almost any dentist with advanced cosmetic training is equipped to handle the dental needs of an eating disorder victim, but I am saddened by their inability to deal with the whole person. The reason seems to be that a lot of dentists publicly judge their patient. They are not yet aware of the non-judgmental approach needed to successfully treat and complete the treatment of their patients, let alone someone dealing with a challenge that is so much larger than just their dental needs. Tony Robbins, the noted author and lecturer, taught me the Platinum Rule. It is stronger than the Golden Rule, which states, “Treat others as you would like to be treated.”  While the Platinum Rule is “Treat others as they would like to be treated.”  Another mentor, Walter Hailey, told me, “The more you know about your patient; the more they think you know about dentistry.”  That is the essence of relationship building with patients and the key to working successfully with bulimics and other eating disorder patients. Treating bulimics successfully was the natural next step in my development.

Both Dr. Jantz and I believe that dentistry for bulimics should be included in the standard of care. This may appear to be a radical concept when contemplated for the first time. However there is not an eating disorder treatment specialist practicing today that does not realize that bulimia wrecks the teeth and mouth of bulimics and that restoration improves their self-esteem, makes them feel whole again and finally helps to put their disease behind them. A new smile is a wondrous thing not only to behold but also to own. On a practical level there needs to be a meeting of the minds between the eating disorder treatment specialist world and the dental world. By integrating the two fields, teams can be formed that treat the entire person. From there a standard of care will emerge and a safety net will form around these patients in which all of their fears can be put to rest and we can successfully treat the mind and the body completely and with amazing results.

There are tens of thousands of “Megans” out there and thousands of “Marcs” too. Each is suffering in his or her own way with this terrible disease. Children as young as 9 years old are turning up at treatment centers like Dr. Jantz’s in Edmonds. How does this happen? Is it an indictment of our society? Is it a symptom of something much larger at work? My book examines what bulimia and purging disorders are and illustrates the uncertainty of a professional community that is struggling to catch up with it.  It also puts things into perspective for the dental professional. My hope is to enlighten many and motivate a few to take the next step. Learn how to talk to these fragile personalities. Treat them as whole human beings and follow up on their care. It takes years for them to complete their treatment and address the underlying issues that spark the disorder. I am sounding the clarion call to my fellow dentists to become aware, to become advocates of change and to work hand in hand with eating disorder clinics and professionals in turning this preventable situation around. You just need to see the smile within emerge to be convinced that you can be a vital part of the success equation for eating disorder victims.

For the purpose of the online CE Course, the article objectives are:

• Inform eating disorder professionals of dentistry’s key role in early detection.
• Encourage the eating disorder professional to expand its understandin of the importance of including dental professionals in the treatment process.
• Developing programs with trained dentists to motivate eating disorder professionals to include a dentist in the treatment plans and be sensitive to dental health.  Keeping DDS informed while making progress with treatment.

My body was clearly unhealthy and out of balance, but my mindset toward my body was even more out of whack. Finding health meant gaining a balanced perspective toward nutrition, exercise, rest, and my body in general. It meant creating habits in my life that actually put these new perspectives into practice.

When it comes to food, I learned to apply the principles of intuitive eating. An approach to eating that teaches us to become the expert of our own body, I learned how to get in touch with my inner hunger and fullness cues. In other words, I learned to eat when I am hungry and stop when I am full (rather than eating according to the rules of the latest fad diet). This may sound simple, but for someone who was struggling with anorexia and bulimia, this seemed impossible at first. And, in the beginning, it would have been. So I actually began my journey to healthy eating with a food plan prepared by a registered dietitian who specialized in eating disorders. With her help over a period of several years, I eventually tossed the structure of the food plan away and embraced the no rules approach to eating. I stopped dividing food into “good” and “bad” categories, realizing that food is just food and does not have a moral value. At restaurants, I stopped saying things like, “I am going to be bad today,” when referring to eating cheesecake. Stealing cheesecake is bad. Eating it is not!

After I had some success with eating healthy, I began to incorporate moderate exercise into my life — with my entire treatment team of a therapist, dietitian, and doctors behind me. Rather than thinking about the calorie burning effect of exercise, I focused on feeling energized and on having fun. I began to participate in movement that I enjoy, so that I would actually look forward to doing it. I do not like to run, so I did not force myself to run. I do like to be outdoors and to be with people, so I started taking short hikes in a local park with a friend.

I could finally understand why my body needed food and exercise, but needing sleep was a different story. It did not seem very smart to me to spend eight hours a day in a state of near-total unconsciousness. My workaholic side said that sleeping would make me weak and unproductive. I felt guilty for sleeping, so I avoided it. Ironically, this lack of sleep is actually what made me weak and unproductive. It also made me irritable and angry. Throughout my personal growth work, I have learned that missing out on a good night’s sleep seriously affects — in a negative way — what happens when I am awake.

If I am taking care of my body by eating, exercising, and sleeping right, it is going to be the size and shape that it is genetically supposed to be. In the beginning, I did not like that size and shape at all. Over time, with the help of my Higher Power, I began to appreciate my body for what it does rather than for what it looks like. When I was at the height of my eating disorder, I did not even have the strength to do one sit up. Now my arms can propel me up a frozen waterfall while ice climbing in Alaska, and my legs can pedal my mountain bike through rugged trails in Tennessee. As a woman, my body is ingenious enough to nourish and to carry a child. This gratitude for what my body does ultimately led to my accepting my body. Today, I can honestly say that I not only accept my body, but I love it.

If I don’t eat, exercise, and sleep right, I don’t think right. When I am not thinking right, my eating, exercising, and sleeping habits are not right. So maintaining a healthy body is a priority in my life today. My body and me are no longer at war. We have called a truce, and we trust each other.

Do you have a war going on at home? Maybe it is time to make peace with your body. After all, like me and mine, you two will be together for a long time.

Dr. Ken Weiner, founder and medical director of the Eating Recovery Center, in Denver Colorado, is a board certified psychiatrist and leader in the field of eating disorders. Dr. Weiner believes the roots of an eating disorder are 40%-50% biological and 50%-60% psycho-social. Dr. Weiner states “If a mother or sister suffers from anorexia, there is a twelve time greater than normal risk that an individual will develop anorexia.”

One of the most interesting predictors of an eating disorder is temperament.  Dr Weiner looks at temperament as “hard wiring”. Individuals struggling with anorexia are often anxious, perfectionist, have poor self esteem, low novelty seeking behavior, and have high risk avoidance. People suffering from bulimia have many of the same temperamental aspects as anorexia. The big difference seems to be the propensity for individuals suffering from bulimia to have high novelty seeking behaviors, such as sexual promiscuity or substance abuse issues. Clinicians specializing in eating disorders recognize the impulsive nature of bulimia and the rigidity of anorexia, however on many levels, bulimia and anorexia mirror one another.

Dr. Anita Johnston, founder and director of the ‘Ai Pono EDIOP and Anorexia and Bulimia Center of Hawaii, also believes temperament may play a part in the development of eating disorders. She talks of temperament as “thin skinned individuals”. These are people who feel deeply and often absorb other’s feelings as well as their own. They are intuitive and emotionally sensitive, usually picking up quickly on family dynamics which may be unwelcome information to the family system. Dr Johnston often sees being “thin skinned” as a predictor of an eating disorder.

Psychological components include low self esteem. Obviously, developing healthy self esteem is a crucial factor in the recovery process.. Many clinicians see low self esteem as a family of origin issue, more “nurture” than “nature”.  However, some of the new research suggests self esteem may be genetically based. This could mean an individual might be parented with a specific goal of healthy self esteem and still develop low self esteem. If it is genetic, than there is a good chance that at least one parent is also suffering from low self esteem. So, a parent with low self esteem does become one of the predictors of an eating disorder.

Another predictor is a dieting parent who may lead a child or young adult to begin to diet or a parent who is obsessed with exercise, fat, weight, or body image etc. This family of origin or psychodynamic issue is often seen in the development of an eating disorder. If the genetic propensity is present, a parent with low self esteem or food issues, and “thin skin”, the climate is right to produce an eating disorder.

Of course, there are social components that may help pave the way for an eating disorder. The pressure to be thins, the billion dollar diet industry, the acceptance of plastic surgery and of course, the media are all recognized as societal influences. However, without the biological or genetic component, social pressures are not enough to predict an eating disorder.

As we begin to better understand the predictors of eating disorders, prevention and early intervention should make a difference in the number of individuals who suffer from this complex and dangerous disorder. Each predictor needs to be recognized and as research in the field advances, the hope is to see fewer men and women suffer from eating disorders.

For the purpose of the online CE Course, the article objectives are:

• Understanding the predictors of eating disorders.
• Learning to correctly diagnose eating disorders in a chemically dependent client.
• Gaining an understanding of what clinical interventions may be appropriate to those clients.