This post is for clinicians that want to lean into the work of disordered eating, but have been scared away from doing so by traditional training models. There is a longstanding stance that a client’s eating disorder can worsen in progression when working with a professional without formal eating disorder training. While that is incredibly true and valuable for the highest severity (namely persistent and high acuity Anorexia Nervosa), it is not accurate with the more generalized population that struggles with disordered eating. And even those that are diagnosed with an eating disorder need clinicians that can hold both a behavioral and psychodynamic/attachment lens, which many of us can and do all day every day. Furthermore, I find that instead of properly assessing for eating disorders, clinicians are just choosing not to talk about food. Or pleasure. Or body image. Or addictive processes. Does anyone else see a problem here?
As I educate more clinicians on disordered eating, I am reminded of the cultural shift in the eating disorder professional community. I only entered the field about ten years ago, approximately five years into my career. My clients themselves invited me into this work and taught me about the connection between food and spirituality, embodiment, and self-acceptance. Eating disorders are now understood to be more of a spectrum than rigid diagnostic labels, despite no recent changes in the Diagnostic Statistical Manual (DSM). For instance, we now focus less on binging as purely an addictive process and rather as a natural byproduct of restricting or shaming certain foods as “bad.” Restricting food is seen more as an attachment trauma response (one concept being “mother hunger”) rather than again, a purely addictive and manipulative phenomenon. It’s not either-or, but a both-and. Disordered eating is commonly co-occurring with trauma diagnoses, substance use disorders, and depression or anxiety.
There is an emerging intersection between feminism, social justice, and (anti) diet-culture that welcomes all mental health and medical professionals. Can I just say this community is phenomenal? I feel so at home in that it’s a community of fat-positive and inclusive dietitians, doctors, nurses, psychiatrists, trauma therapists, addiction counselors, group therapists, and treatment center “front-line” staff (milieu or behavioral techs). We understand it truly takes a village!
People often won’t talk about their disordered eating and body hatred unless their therapist knows how to ASK. Every woman in this culture has a relationship with food they want to talk about, but don’t know how. Every woman has struggled with the distress and associated ambivalence in conforming to a culture that values thinness, now hiding under the veil of “wellness” and “health.” Orthorexia is not yet approved for the DSM, but is a pending consideration, defined as being hyper-aware of the nutritional value of the food one consumes and its close resemblance to the physiological and behavioral nuances of restriction. Men receive societal rewards when they manage to create a hyper-masculine body at all costs, including obsessive weighing, steroid or other illicit substance use, and excessive exercise. Those that can’t or won’t, are punished and carry such deep, secretive not-enoughness. Poor body-image and body dysmorphia are everywhere. People that are transgender and non-binary step into this work due to living in a body subject to prejudice, discrimination, invalidation, and violence. Essentially, people inhabiting bodies that do not fit into the white, Euro-centric worldview are being harmed and in need of safety, support, and trauma recovery. Those that do have thin privilege carry anxiety in managing their image and especially struggle with natural bodily changes and aging. We all lose.
If you are a clinician and feeling inspired to specifically target or even weave body neutrality into your work, please reach out. In the meantime, digging deep into these themes personally is a tremendous offering to those you already work with. You can educate yourself on how to avoid rabbit holes that incidentally perpetuate diet-culture rhetoric. The Health At Every Size (HAES) movement has incredible resources. There are books and podcasts galore to initiate your self-study as well as the formal training and consultation available. It’s all so thought-provoking, and I can’t get enough of it. Finally, I would be remiss to say that knowing how to appropriately assess for a severe eating disorder is a required clinical skill to ensure you aren’t creating harm and that these folx are getting the care they need and deserve. I have provided plenty of consultation calls to help with determining a client’s level of severity and associated treatment recommendations.
I’ll leave you with a quote from one of the most brilliant, fearless leaders of the body-neutrality movement, Sonya Renee Taylor:
“Radical self-love doesn’t mean I never have a judgment again about my body. The difference is I separate that judgement from my inherent Self.”