Category: eating disorder

What are the Signs of an Eating Disorder?

There is never one sure sign that someone you care about is struggling with an eating disorder. Eating disorders are complicated, so it is important to know what to look for. Physical symptoms of significant weight loss or gain, compulsive exercising, and vomiting are strong evidence but are not the only indicators. Below are other possible signs that may indicate they are struggling and are in need of support.sad6

  • Constant thoughts about his/her weight
  • Enjoys cooking for others, but not for themselves
  • Frequent weighing of self
  • Weight  determines their mood for the day
  • Avoids eating with family and friends
  • Feels guilty after eating
  • Frequently compares their body to others
  • Preoccupation with the eating behaviors of others
  • Eating to relieve stress or depression
  • Constant concerns about being fat
  • Difficulty concentrating
  • Increased isolation
  • Frequent participation in diet fads
  • Eats the same rigid foods all the time
  • Declines social engagements because they must work out
  • Quick exit after meals
  • Laxative/diuretic abuse



Is Food Addiction Real?

intuitiveeatingI will often hear from clients that what gets in the way of following a meal plan or eating in a non-dieting way is the fear that they cannot control themselves around food or are addicted to food.  The book, Intuitive Eating, addressed the debate around food addiction and below is their research explaining many of the compulsive and impulsive behaviors around food.

Survival of the Species

This brain-reward system is believed to be necessary in order to ensure human survival.  This involves the brain chemical dopamine, which triggers both a pleasurable feeling and motivation behavior.  Engaging in activities necessary to survival (such as eating and procreating) triggers a rewarding feel-good experience.

Hunger Enhances Reward Value

Hunger by itself enhances the reward value of food, through triggering more dopamine-related activity.  For example, if you discover you are hungry, you might find yourself suddenly interested and motivated to cook a meal.  Dieting (which can be a form of chronic hunger) also has this effect.

Pavlovian Conditioning

The dopamine effect could be attributed to Pavlovian conditioning (recall the classic study, in which Pavlov’s dog salivated at the mere ringing of a bell.  This anticipatory salivation occurred because the dogs were conditioned to receiving a treat each time, after a bell rang).  This is not addiction.

Dopamine Deprivation

Many pleasurable activities trigger dopamine, including socializing, hiking a nd playing games. The great majority of people we see in our practices, who binge eat, are often leading very unbalanced lives.  These unbalanced lives “deprive” them of the dopamine benefits.  When needs are not being met, food becomes even more enticing,  more  rewarding.

Music Lights up Dopamine Brain Centers

Recently, a new study showed that when people listen to music, it lights up the same region of the brain which has been implicated in the euphoric component of psychostimulants, such as cocaine (Salimpoor 2011).  Just the anticipation of hearing the music lit up the dopamine brain centers. (Yet, we really don’t think you can make the case for ‘music addiction’!)

Food Addiction Studies are Limited and Flawed

The research on “food addiction” is too much in its infancy to be drawing any conclusions.  In addition, the great majority of studies have been on animals.  The limited research on humans has only been focused on brain-imaging studies with a very small amount of people and not much exclusion criteria (Benson 2010).

Yale Food Addiction Questionnaire

This has generated a lot of headline news.  Yet, upon a closer look the questionnaire seems to actually be measuring compulsive eating or rebound eating from chronic dieting (Gearhardt 2009).  Here is a sampling of questions:
– I find myself consuming certain foods even though I am no longer hungry.  (Classic compulsive eating or distracted eating can cause this.)
– I worry about cutting down on certain foods (Classic compulsive eating or distracted eating can cause this.)
– I have spent time dealing with negative feelings from overheating certain foods, instead of spending time in important activities such as time with friends, family, work or recreation.  (Classic compulsive eating or distracted eating can cause this.)

Studies Show Eating ‘Forbidden Food” Decreases Binge Eating

Finally, there are three studies to date, in which binge eaters eat their forbidden foods as part of the treatment process (Kristeller 2011, Smitham,  2008).  Binge eating decreased significantly in all of these studies.  If food addiction were an issue, you would not expect these types of results.  Food addiction theory would predict increased binge eating, triggered by eating ‘addicting food,’ yet the opposite happened.


Shrein Bahrami, MFT  |  2146 Union Street, San Francisco, CA 94123  |  415.595.8963

The Real Issues Beneath an Eating Disorder

sad2For someone who is struggling with an eating disorder(ED), it can be very difficult to understand or explain to others why your ED developed.  This is a question that will continue to show up in individual therapy sessions and especially family sessions where parents or significant others are desperately trying to understand the reason for the ED and why their loved one cannot just let it go.  The list below is taken from the book, “Your Dieting Daughter: Is She Dying for Attention?” by Carolyn Costin.  It provides a very thorough list of the issues someone with an ED struggles with and will use their ED to cope.   Until these issues are acknowledged and addressed, the need for the ‘support’ from the ED will remain.  Often with my clients, I will give them this list in session and go through each bullet point, exploring if or how each issue resonates with them.  By doing so, significant clarity can be gained and then alternative and healthy ways to cope can be implemented.  Read my post on Self-Full versus Self-Less for ideas on healthy ways to cope.

Poor self-esteem/self-worth

I’m afraid of myself and of being out of control.

I’m not very worthy.

People don’t like me.

I’m no good.

I can’t trust my own judgments or make decisions.

Belief in a myth

I will be happy and successful if I am thin.

Eating helps me to forget my problems.

Thinner people are happy.

Being thin will make me attractive.

Need for distraction

When I’m bingeing or throwing up, I don’t think about anything else.

Eating takes my mind off things.

Worrying about my weight keeps me from worrying about other things. 

Need to fill up an emptiness

Something is missing in my life.

I feel empty inside, starving makes it better.

Eating fills up my emptiness.

Need for perfection and black/white thinking

I have to be the best at anything I do.

I will be the best dieter.

I will have the best body.

Black/White thinking:

     I’m either fat or thin.

     I either binge or starve.

     I’m perfect or a failure.

     If I can’t win, I won’t try.

Need to be special/unique

I get a lot of attention.

Who will I be without this?

I get to be taken care of, worried about.

Nobody is like me.

It is the only special thing I have.

Need to be in control

My family is too involved in my life.

I have to be in control of something.

I’m always in control of everything else, so this is my way not to be.

The eating disorder behaviors fill unstructured time.

I’m proud of the willpower it takes.

This is the one thing no one has control over but me.

Need for power

I base my feelings of self on how others treat me.

I feel powerless.

This gives me power over myself and others.

It’s powerful to be able to give up food, like a saint or a monk.

I can really get at my parents this way.

Need for respect and admiration

Everyone respects me when I lose weight.

People admire you if you are thin and/or if you don’t eat.

Society perpetuates respect and admiration for thinness:

     Obtains it through weight loss (restricting).

     Tries hard to get it through weight loss, but can’t do it (restricting and bingeing).

     Rebels against it (bingeing).

Has hard time expressing feelings

Very difficult time with anger, rebellion, resentment.

Symbolically swallows, denies or rejects feelings.

Can’t deal with conflict or confrontation.

Denies feelings or expresses them in destructive ways.

I don’t know what I’m feeling, even if I do, I can’t express it.

Safe place to go – doesn’t have coping skills

It’s a special world created to keep all the ‘bad’ out.

If I follow my own imposed rules, I know what to expect, how to ‘win’.

Lack of trust in self and others

I don’t trust myself emotionally.

I never know if someone really likes me.

I don’t trust anybody.

I can never make a decision.

It’s easier just to follow rules.

Terrified of not measuring up

I can’t compete, so this way I take myself out of the running.

What are my good qualities?

I won’t have anything if I don’t have this.

I’m constantly comparing myself to everyone.

Terrified of being fat.

Terrified of being deprived.

Terrified of being deprived and of being fat.


Shrein Bahrami, MFT  |  2146 Union Street, San Francisco, CA 94123  |  415.595.8963

Eating Disorder Statistics

flower_buddhaEating Disorders Statistics

From ANAD (National Association of Anorexia Nervosa and Associated Disorders) website


• Almost 50% of people with eating disorders meet the criteria for depression.
• Only 1 in 10 men and women with eating disorders receive treatment. Only 35% of people that receive treatment for eating disorders get treatment at a specialized facility for eating disorders.
• Up to 24 million people of all ages and genders suffer from an eating disorder (anorexia, bulimia and binge eating disorder) in the U.S.
• Eating disorders have the highest mortality rate of any mental illness.


• 91% of women surveyed on a college campus had attempted to control their weight through dieting. 22% dieted “often” or “always.”
• 86% report onset of eating disorder by age 20; 43% report onset between ages of 16 and 20.6
• Anorexia is the third most common chronic illness among adolescents.
• 95% of those who have eating disorders are between the ages of 12 and 25.8
• 25% of college-aged women engage in bingeing and purging as a weight-management technique.
• The mortality rate associated with anorexia nervosa is 12 times higher than the death rate associated with all causes of death for females 15-24 years old.
• Over one-half of teenage girls and nearly one-third of teenage boys use unhealthy weight control behaviors such as skipping meals, fasting, smoking cigarettes, vomiting, and taking laxatives.
• In a survey of 185 female students on a college campus, 58% felt pressure to be a certain weight, and of the 83% that dieted for weight loss, 44% were of normal weight.

For Women:

• Women are much more likely than men to develop an eating disorder. Only an estimated 5 to 15
percent of people with anorexia or bulimia are male.
• An estimated 0.5 to 3.7 percent of women suffer from anorexia nervosa in their lifetime.14 Research suggests that about 1 percent of female adolescents have anorexia.
• An estimated 1.1 to 4.2 percent of women have bulimia nervosa in their lifetime.
• An estimated 2 to 5 percent of Americans experience binge-eating disorder in a 6-month period.
• About 50 percent of people who have had anorexia develop bulimia or bulimic patterns.
• 20% of people suffering from anorexia will prematurely die from complications related to their eating disorder, including suicide and heart problems.

Mortality Rates:

Although eating disorders have the highest mortality rate of any mental disorder, the mortality rates reported on those who suffer from eating disorders can vary considerably between studies and sources. Part of the reason why there is a large variance in the reported number of deaths caused by eating disorders is because those who suffer from an eating disorder may ultimately die of heart failure, organ failure, malnutrition or suicide. Often, the medical complications of death are reported instead of the eating disorder that  compromised a person’s health.

According to a study done by colleagues at the American Journal of Psychiatry (2009), crude mortality rates were:

• 4% for anorexia nervosa, • 3.9%  for bulimia nervosa and 5.2% for eating disorder not otherwise specified



• Risk Factors: In judged sports – sports that score participants – prevalence of eating disorders is 13% (compared with 3% in refereed sports).
• Significantly higher rates of eating disorders found in elite athletes (20%), than in a female control group (9%).
• Female athletes in aesthetic sports (e.g. gynmastics, ballet, figure skating) found to be at the highest risk for eating disorders.
• A comparison of the psychological profiles of athletes and those with anorexia found these factors in common: perfectionism, high self-expectations, competitiveness, hyperactivity, repetitive exercise routines, compulsiveness, drive, tendency toward depression, body image distortion, pre-occupation with dieting and weight.


Shrein Bahrami, MFT  |  2146 Union Street, San Francisco, CA 94123  |  415.595.8963