Eating disorders are serious mental and physical illnesses distinguished by abnormal eating behaviors and habits. Those who struggle with eating disorders exhibit severe distress regarding their weight, shape and body size. This distress is often seen in the form of obsessive thoughts and behaviors. The eating disturbances often lead to physical and mental instability and can be fatal. 

Certified Eating Disorder Specialist

​​I am a Certified Eating Disorder Specialist (CEDS) by the International Association of Eating Disorder Professionals (IAEDP). I am one of the ONLY therapists in Northern Colorado who holds this certification. Being awarded this certification means I have completed over 2000 hours of supervised experience (after licensure) with a Certified Eating Disorder Specialist Supervisor and I have completed extensive education and testing regarding the assessment, treatment and prevention of eating disorders.

Finding a knowledgeable, experienced and competent therapist who treats eating disorders is very difficult. This certification helps to inform you that I have the knowledge, training and experience to competently treat eating disorders, as well as strive to continue my education and knowledge regarding the latest treatments.

​I have years of experience helping those with eating disorders and their families in both inpatient and outpatient settings. I firmly believe there is hope in healing for anyone struggling with an eating disorder and I have been privileged to witness amazing transformations.  

Types of eating disorders

There are many types of eating disorders. However, it is important to understand not everyone fits each type perfectly. Someone could still struggle with disordered eating, even if they do not completely meet criteria for these types. Listed below are the most common eating disorders.

Anorexia Nervosa 

Anorexia Nervosa is characterized by restriction of food intake that leads to significant low body weight. There is an intense fear of gaining weight or becoming “fat” and a disturbance in how the person sees their body shape and size. Typically, the individual does not recognize their low body weight or see it as a problem.

Bulimia Nervosa

Bulimia Nervosa is characterized by reoccurring patterns of binge eating followed by behaviors to prevent weight gain such as purging. Binge eating is when someone eats a larger amount of food than most people would eat in a similar time and the person feels out of control while eating. Purging behaviors include self-induced vomiting, laxatives, fasting and excessive exercise. Those with bulimia nervosa also struggle with body image and fears of weight gain.

Binge Eating Disorder

Binge Eating Disorder is when someone engages in binge eating patterns (same as with Bulimia Nervosa), however the individual does not engage in behaviors to prevent weight gain. The binge eating patterns are very distressing and the individual feels extreme guilt for engaging in these behaviors. Those who engage in binge eating will often report feeling disgusted with themselves and eat alone due to shame about their eating habits.

Other Specified Feeding Eating Disorder

Other Specified Feeding Eating Disorder is a diagnosis for someone who exhibits distress related to food, weight and body shape/size. However, they do not have the full symptoms of anorexia nervosa, bulimia nervosa and binge eating disorder.

Avoidant/ Restrictive Food Intake Disorder

Avoidant/ Restrictive Food Intake Disorder or ARFID is often found in children, though can be seen in adults. ARFID is characterized by avoiding or restricting food intake, but the individual does not have body image concerns, weight fears or any other eating disorder. This eating disturbance often leads to a failure to meet nutritional needs, causes weight loss, dependence on supplements and causes marked psychosocial distress. Often those who struggle with this condition have problems with the sensory characteristics of food or the adverse effects of eating, such as choking.

 Note that each of these disorders cause emotional, physical, psychological and social distress for the individual. ​​

Symptoms, warning signs and red flags:

• Avoiding the feeling of being hungry
• Restricting food intake
• Feeling guilty after eating
• Weighing self obsessively and consumed by thoughts about their weight. This can be as much as once a day to multiple times a day and after meals.
• Feeling terrified of weight gain and uncomfortable if unable to weigh themselves
• Obsessive and preoccupied thoughts about food, weight, body size or shape and fat in the body
• Obsessively counting calories, reading nutritional labels or weighing and measuring foods
• Performing rigid behaviors around food such as needing the food to be made in a specific way, only eating certain types of foods or eating foods in a specific order or time
• Taking medications or supplements to lose weight such as weight loss pills, diuretics, laxatives, ipecac, etc.
• Weight changes not related to any medical cause
• Eating large amounts of food secretively or when emotionally upset
• Leaving quickly after eating (typically to the bathroom), often to vomit
• Exercises obsessively
• Feeling the need to exercise after eating or overeating or feeling the need to “earn” food from exercising.
• Engaging in fad diets or obsessing about new diet trends such as “clean eating” or “gluten-free” when diet is not prescribed by a doctor.
• Avoiding food groups and placing foods in “good/healthy” and “bad/unhealthy” categories, causing emotional reactions when eating “bad/unhealthy” foods
• Obsessively looking at one’s self in the mirror (mirror gazing) or pinching the body to measure the body size
• Reports others often comment that they should eat more or less
• Isolating from others and often during meal times
• Perseverates on wanting reassurance about how their body looks and comment about themselves negatively
• Persistently uses objects like clothing, belts, rings and bracelets to notice weight changes
• Obsessive about how certain body parts look or feel, such as thighs not touching or body looking muscular
• Uses large amounts of caffeine, diet drinks, energy drinks or gum
• Use of drugs to decrease food intake

Contributing factors

I like to share with my clients that there is usually no one factor that leads to someone struggling with an eating disorder. Usually there are multiple factors and each person is different. Here is a list of common contributing factors:

• Experiencing dieting in the home or being overly exposed to negative views about the body (such as a family member dieting or commenting about their body size)
• Mass Media and social pressures of thinness
• Family genetics (meaning someone in the family had an eating disorder, depression or anxiety)
• Trauma
• Bullying
• Family dynamics and struggles
• Temperament (personal characteristics that affect your mood)
• Lack of coping skills 

Levels of care

Treating eating disorders can be a complex process. Eating disorders have the highest mortality rate of any mental illness, so it is important someone who is struggling with an eating disorder get the most appropriate care. This means someone might require more support if they have more medical complications. Below is a list of the levels of care:

Hospital	In the hospital, a patient requires 24-hour care by medical staff. Someone might require staying at the hospital if they have unstable vitals or alarming lab work. Often, hospital stays are the shortest part of treatment. Services one receives are often medically driven (to stabalize the patient’s body), but they might include some psychotherapy sessions.
Residential Treatment	Once someone is medically stable, they are often referred to residential treatment. In residential treatment, someone is more medically stable in that they do not require medical staff present 24 hours a day. However, they might still have unstable vitals or lab work (such as low blood pressure and heart rate). In residential care, the patient is monitored by staff  (usually master’s or bachelor’s level counselors or nurses) 24 hours a day. The patients are also provided support when eating meals and snacks. Patients are provided psychotherapy, nutritional therapy, group therapy, medical treatment, etc. ​
Day Treatment or Partial Hospitalization (PHP)	Typically someone is transferred from residential or hospitalization to a partial hospitalization program. These programs usually run 8-10 hours of the day, 5-7 days per week. While some adult programs offer housing to patients, usually patients return to their homes each night. This level of care is unique in that the patient goes to the program during the day, goes home at night and returns the next day to work through any challenges that came up at home. Typically, someone must be medically stable and motivated to work in a PHP setting. Patients are provided with similar services as residential such as meal support, individual therapy, family therapy, group therapy, nutritional therapy, experiential therapy, etc.
Intensive Outpatient (IOP)	Once someone has graduated from PHP level of care, they are referred to intensive outpatient treatment. This program is typically 3-4 hours a day for 3-5 days a week. Here the patient gets meal support for typically one meal and one snack a day. They get more time away from program to test out their new coping skills and renewed sense of self.  They will receive similar services as residential and partial hospitalization treatment; however, they might have fewer therapy sessions each week.
Outpatient Therapy	This is the least intensive level of care. This is for individuals who are medically stable. Someone is likely to be in outpatient therapy for months to years. Frequency is dependent on the individual’s needs but often sessions are 1-2/week. In outpatient therapy, in addition to their psychotherapist, the patient is likely to be monitored by their primary care doctor, psychiatrist and dietitian. The frequency of visits with these care providers will also be less than with the other levels of care, because the individual requires less support to be healthy. ​

---

Treatment team

Due to the biological, nutritional and psychological components of eating disorders, treating an eating disorder requires a team of professionals. Here is a list of professionals usually involved in someone’s care. 

• Psychotherapist: Psychologist, Marriage and Family Therapist, Licensed Professional Counselor, Licensed Clinical Social Worker
• Family therapist: Marriage and Family Therapist, Psychologist, Licensed Professional Counselor, Licensed Clinical Social Worker
• Dietitian: Registered Dietitian Nutritionist
• Psychiatrist: Medical Doctor specializing in Adult Psychiatry and/or Child and Adolescent Psychiatry
• Primary Care Provider: Medical Doctor or Nurse practitioner (Internist, Pediatrician, or Family Practitioner)

How is an eating disorder different than disordered eating?

Disordered eating is characterized by abnormal eating patterns and habits similar to an eating disorder. The difference between disordered eating and an eating disorder is typically the frequency, duration and severity of the abnormal behaviors.

​Disordered eating is often the precursor to an eating disorder, when disordered eating habits go untreated. Those struggling with disordered eating can have the following symptoms:

• Using food as a means to cope with emotions or stress
• Frequent dieting or rigid beliefs about food
• Frequent weight changes
• Over use of the scale and weighing oneself
• Negative beliefs about the body shape, size and weight
• Over-exercise and rigid beliefs about exercise
• Feelings of guilt related to being unable to maintain food or exercise habits
• Compulsive eating
• Use of compensatory behaviors to reduce weight gain such as vomiting, laxatives and exercise. 

Importance of treatment

Early detection and treatment for eating disorders and disordered eating is extremely important. The more someone becomes ingrained in to unhealthy habits, the harder and longer it takes unravel these negative beliefs and habits.
​
If you or a loved one is struggling with symptoms of disordered eating or an eating disorder, it is best to be assessed by a trained and knowledgeable professional. It is important to find a professional (Medical Doctor, Psychotherapist, Psychiatrist or Dietitian) who is trained, knowledgeable and experienced in assessing and treating eating disorders. This is important because the individual struggling with the disorder often feels ashamed of their behaviors or is unaware that their behaviors are unhealthy, so they may have difficulty being open about their illness. Also, eating disorders and disordered eating are a biological and psychological illness, which can be deadly. It is best to have someone experienced guide the treatment process.