Food for thought on eating disorders

“An eating disorder is a scary diagnosis and problem to deal with,” says social worker Elrika Hugo who works with mental health and eating disorders. “It’s often what we call a systemic problem in that it’s not just the person who has the eating disorder that struggles, it often spills over to the family unit.”

Eating disorders, which are a real challenge in our community, can be effectively treated with early intervention, Hugo said at a talk hosted by Chevrah Kadisha Community Social Services at the David Lopatie Centre this week. She was speaking alongside registered dietician Eliana Dawood.

They work together to treat eating disorders as part of a multidisciplinary team at Tara Psychiatric Hospital, and now in private practice at Oxford Day Clinic, where the two are launching an outpatient eating disorder programme. Discussing practical measures to identify eating disorders and manage them – where they say problems most often arise – the two shed light on an area that’s often misunderstood.

The main aim, says Hugo, is to prevent hospitalisation. That’s why it’s so important to have resources and professionals that have worked in the field that one can consult. Though eating disorders have the highest mortality rate among mental health illnesses, with early intervention, the prognosis is good. “We just need to make sure that we end up in the right place at the right time with the right people,” Hugo says.

The most important thing to understand in starting the recovery process is what keeps the eating disorder cycle going. Yet this isn’t always easy to establish. “That’s why it’s so important that during our interventions, we include families as part of the recovery process,” says Hugo. There are so many dynamics, and that’s why we need open forums to discuss eating disorders and address the guilt and shame attached to them.

Through practicing cognitive behavioural therapy specifically for eating disorders, Hugo and Dawood target the behaviour and challenge the thoughts around it. “We take a dialectical behavioural therapy approach,” Hugo says, “which is really important because we also now don’t just talk about how we challenge thoughts and behaviour, but also give practical, concrete skills to regulate feelings and emotions. This is what eating disorders are actually rooted in, the inability to access and control what feels very uncontrollable in your internal world.”

There’s no single cause for an eating disorder, says Dawood. It’s something that develops over time and is usually shrouded in secrecy. “An eating disorder is a mental health condition where food and eating is being used as a means to communicate, to cope, and to control feelings and situations in a chaotic world.” Eating disorders are often associated with body dissatisfaction or dysmorphia, and have biological, psychological and social factors, which is why a multidisciplinary treatment approach is needed. Anxiety and depression are common co-morbidities that are either present before or manifest after the eating disorder develops.

Full recovery is possible, Dawood stresses. “The longer it’s left unattended though, the poorer the outcomes, and those habits and behaviours become ingrained,” she cautions. “It takes on a life of its own.”

Challenging popular beliefs around eating disorders, Dawood highlights the fact that men are just as susceptible as women. Furthermore, eating disorders don’t just have an impact on teenagers, with a lot more people being affected later in life, often when they go through transitions like menopause. “Yet,” says Hugo, “we haven’t seen as many adolescents between the ages of 13 and 16 being admitted for eating disorders as we have in the past few years”. Schools, therefore, need to be part of the conversation.

Eating disorders don’t always look the way they’re portrayed on social media and in popular culture, Dawood says. Those who suffer aren’t necessarily emaciated. An eating disorder is also not something you choose, she stresses, and recovery goes far beyond just eating. People often label eating disorders as attention-seeking behaviour, which is a damaging way to define them.

Though such motivations may be an aspect of the disorder, it goes far deeper than that. “If you think about manipulation as a survival skill, that this person is so desperate, that they’re basically just trying to stay afloat, we feel more empathetic to those who suffer,” Hugo says. Similarly, we can replace the term “attention-seeking” with “someone who just wants to be seen”, the behaviour is the tool that they use to make you see them when they feel like they don’t have a voice. “Eating disorders are about dysregulated emotions.”

We need to re-evaluate how to respond to people who lose weight because we don’t know how they’re interpreting our comments, Hugo says. “The initial positive response when you start losing weight is, ‘Wow, tell me what’s your secret?’” she says. That makes you feel good, reinforcing the behaviour until eventually physiologically, the body then starts taking over the weight-loss process and behaviour, which is why eating disorders aren’t a choice.”

Families often carry a lot of guilt when their loved one develops an eating disorder, Hugo says. “As families or caregivers, we can unknowingly contribute towards keeping the eating disorder going.” It’s advisable to look at how you are perhaps subconsciously enabling certain behaviours, even with the best of intentions. Yet, you cannot take on the burden of sole responsibility for the development of the illness. It’s not a one-size-fits-all.

The way we respond to loved ones who may suffer from eating disorders needs to be assessed. Rather than being reactive to the behaviour, go deeper to find the emotion in which it’s rooted. Instead of immediately trying to come up with a solution and fix the problem, listen non-judgementally and validate the person’s feelings. Ultimately, they want to be heard, and from there, treatment and healing can begin.