• EATING DISORDER SERVICES •

EATING DISORDERS

The American Psychiatric Association has classified eating disordersinto several categories: anorexia nervosa, bulimia nervosa, binge-eating disorder, eating disorder-NOS and body dysmorphic disorder. The APA is also considering the addition of "night eating syndrome.”

Some eating disorder sufferers will meet the full criteria for these syndromes. However, there are many people who have painful emotional, behavioral and medical symptoms, but do not meet the full APA criteria for eating disorders. For example, you may find that you have some symptoms of anorexia and some of bulimia and some of night-eating syndrome, but do not meet the full criteria for any of them. You do not need to meet the full clinical criteria for these in order to receive help.

We consider all forms of eating disorders treatable at Rago & Associates. We are knowledgeable about all eating disorders and all possible levels of care, and we are well connected to establish a treatment team and guide you to find the correct plan to alleviate your symptoms. That could happen in our outpatient offices, a hospital, a residential facility or with a team of complementary treatment providers.

If you want to know if you have an eating disorder, ask yourself the following question:

~What percentage of my time each day do I spend thinking about food, weight and body image concerns?

Healthy people feel comfortable with their bodies, eat when they are hungry, stop when they are full, plan and eat meals and snacks they enjoy and have a stable, healthy body weight. People with eating disorders spend a tremendous amount of their time and energy worrying about eating. They experience extreme anxiety about eating certain types of "bad" or "unhealthy" foods. These "bad" foods are either avoided, binged on or eaten only if exercise or other purging methods are used. For indiviuduals who suffer from eating disorders, breaking any of their food "rules" will be followed by extreme and intense guilt.

People with eating disorders are severely compromised in their ability to enjoy their lives because they are so preoccupied with eating and body image concerns. Their daily happiness is determined by how much and what they ate and how fat or thin their body seems to them. When you have an eating disorder a large part of your self worth is decided by your feelings about your eating and weight.

• Anorexia Nervosa

Anorexia nervosa literally means "fear of fatness." Anorexia is characterized by an intense drive for thinness. These people are literally consumed by and driven by trying to restrict and avoid certain foods and to engage in activities that could cause weight loss, such as intense exercise or severe food restriction. People with anorexia have odd eating habits and preoccupations. As they restrict food more and more, they become increasingly preoccupied with food and body imagery concerns. You may see a person avoid eating with others, socially isolate themselves, have little energy and have difficulty sleeping at night. When an anorexic begins restricting food, the person may seem and feel pretty normal. That’s because a body can use the reserves and resources it has stored up in the past. However, as time goes on, an anorexic person can have increasing medical problems and physical and emotional symptoms.

• Bulimia Nervosa

In bulimia nervosa, a person has episodes of binge eating. That’s when they eat more food than they intend to, then are so upset about what they ate that they become obsessed with ways to purge. This may include throwing up food or over-exercising. There are many other types of purging, but they will not be discussed here since these behaviors tend to have a "contagious" effect. People who have anxiety about their eating and body image don’t need new tips about how to rid themselves of what they eat. Please speak to your counselor privately about the ways that you may try to rid yourselves of food, fat
and calories.

Some people with bulimia eat normally throughout the day and also binge and purge. Other people with bulimia alternate bingeing with restricting snacks and meals. People with bulimia often have co-occurring problems with substance abuse, depression and relationship problems. Counseling can address all of the underlying issues and co-existing issues of concern, along with developing a healthy lifestyle that eliminates bingeing and purging.

A hybrid of these problems is called bulimarexia. That’s when a person eats small amounts of food, and does not binge, but then purges these small amounts. The person with bulimarexia has many of the same
symptoms of anorexia. Basically, you could consider this a "purging anorexic".

In binge-eating disorder, a person has difficulty with bingeing on large quantities of food at one time, and does not purge. A person with binge-eating disorder feels just as much body and eating anxiety and depression as other people with eating disorders.

Eating Disorder- NOS means "Eating Disorder- Not Otherwise Specified.” It is the American Psychiatric Association's classification for eating disorders that do not meet all of the strict criteria for the above categories. Obviously, the more frequent and the more severe the symptoms, the more problematic the eating disorder is and the more urgently the person needs to get help.

Night eating syndrome is another type of eating disorder. In night eating syndrome, the individual restricts food as much as possible during the day and then has large binges at night.

• Body Dysmorphic Disorder

People with eating disorders typically have over-concern with, and excessive criticism of their bodies.Their thinking can become rigidly fixated on body criticism.

This can sometimes lead to another psychiatric concern called “body dysmorphic disorder” or BDD.

Body dysmorphic disorder is defined as an excessive preoccupation with a real or imagined defect in personal appearance. People with BDD have an irrational, or distorted perception of how they look, and are obsessed with certain characteristics of their appearance. They may exaggerate a perceived flaw out of proportion, and have trouble controlling obsessive, negative thoughts about the “flaws” in their appearance. This perceived flaw may be related to a specific part of the body, specific parts, skin, hair or facial characteristics. Reassurance from others does not seem to diminish the negative self-talk because it is so irrational and so strong. People with BDD may consider themselves so unattractive that social anxiety may develop due to fear of rejection from others based on this “flaw”.

• Medical problems associated with eating disorders

One main reason to seek treatment for an eating disorder is the way it destroys your quality of life. Eating disorders often co-occur with depression, anxiety disorders, obsessive compulsive disorders, social isolation, exhaustion, problems with other relationships and family problems. The age-old "chicken and egg" question seems to apply. Did the depression cause the eating disorder, did the eating disorder cause the depression or did they come at the same time, caused by other factors? In therapy, you can sort out these answers, and receive treatment for symptoms in all categories that concern you.

• Treatment for Eating Disorders

At Rago & Associates we offer research-based, creative, innovative and state of the art treatment for eating disorders. It is important to begin with a thorough assessment of your symptoms and the building of a treatment plan. Your treatment plan is the strategy that you and your counselor will use for your recovery. You, and your counselor together will make the blueprint for your recovery. It will be modified as you go along. It is often useful to include family members and friends to provide the support and resources needed for recovery.


It is often useful to find complementary, additional resources for treatment. Some common additions to your treatment team could include medical monitoring resources, evaluation for psychiatric medication, nutritional counseling, exercise consultation and support. You will be treated with respect and you will be involved in all aspects of planning your care.


At Rago & Associates, we would like to be your consultants as you travel your path to recovery from an eating disorder

Group therapy can make a critical difference in the progress of someone’s treatment for an eating disorder.  Consider our Specialized Eating Disorders Therapy Groups in order to accelerate your recovery process.  Some of the groups we regularly run: