Laura Schoenfeld: An eating disorder versus disordered eating—we have to be really careful about definitions here because a clinical eating disorder, absolutely, yes, this person should be seeing a therapist. They may even need to be going to a hospital if they get advanced enough. Always keep that in mind. I have a naturopath that I’ve consulted with that had a patient who, she was worried, was going to have to go on a tube feed because of how little she was eating. In that kind of situation, I would definitely refer to a more conventional care system, and the main reason for that is because a lot of times you don’t want to be the one responsible if somebody gets really ill or potentially would die because of an eating disorder. Eating disorders, I think, have some of the highest mortality rates of any mental health issue, so don’t do it alone if you’re dealing with someone that definitely has an eating disorder that has been identified or you’re very suspicious of them having one. You don’t want to be the only one working with that person, so, yes, absolutely refer patients to therapists in that case.
Now, if you think it’s just a body dysmorphic syndrome, which I hate to say a lot of women especially have body dysmorphia of some sort, even if it’s just a little bit. It depends on the dietary change. Joy, do you have any extra information about the types of dietary changes you’re trying to recommend? Usually with body dysmorphia, you’re going to be seeing an aversion to foods that either would affect the person’s body, so if you’re recommending fat and they’re worried they’re going to get fat from eating fat, then just the education side of things is really important, making sure people understand that the foods that they eat do not guarantee weight gain, depending on what the food is. I have a lot of clients that refuse to add carbs back in because they’re worried they’re going to gain weight. Most of my clients have been able to get past that fear, but I’ve had a handful that weren’t able to, and then in that case, I just literally can’t help them.
Joy was saying, “I was thinking about the teenage girls that were mentioned earlier. Many teenagers have poor eating habits and poor body image.” Yeah, I think we can just go back to what I was saying in that earlier question, where you want to try to approach the girl’s health from what the real reason is for eating well. Again, this doesn’t just go for teenagers. This can go for any age of women. I work with women of all ages that deal with this. It’s one of my big niche topics that I deal with, so it’s very typical that I’m dealing with somebody that has at least a little bit of body dysmorphia. I would say focusing on the health benefits and actually building the girls’ self-esteem as being a better way to approach diet change than worrying about if it’s going to help them lose weight or something.
I think a lot of people make diet decisions based on fear and shame. There’s a lot of marketing out there in the “health and wellness” world that makes people either feel bad about themselves, the way they look, or it makes them feel afraid of food. This is something that really, really bothers me a lot, and it’s something that I have a big passion to help combat in the health and wellness industry. What I try to do with my clients, regardless of what age they are, is to really figure out why eating well is important to them and work on building their self-love and their self-care as opposed to making them feel like they’re a failure or that they’re not good enough if they don’t follow this diet. I’m not saying that clinicians do that, but you have to actively work against the forces of fear and shame when you’re working with someone that has poor body image. If you just think about the amount of advertising, like Facebook articles, Instagram accounts, all that stuff that these girls are probably seeing that are making them feel badly about the way they look, you really have to dig deep into why their self-esteem is based on the way that they look and help them discover why their self-esteem should be based on more important things that don’t have anything to do with their weight. If there are things that they value—like I said, sports performance or their energy or just taking care of themselves and doing what’s best for their body, regardless of the weight outcome—if you can get them to care about what happens to their body from a health perspective because they’re approaching it from a self-love perspective, that’s going to be a lot more effective than focusing on the weight at all.
This is a really complicated topic, and again, if somebody has an actual eating disorder, then, yes, absolutely refer out. If they are just feeling negatively about the way that they look and doing a little bit of dieting that’s not super healthy, then I don’t think you necessarily have to refer out if you feel like you can handle it, but realize that you’re going to end up being the therapist in that situation. If you’re not trained in counseling, then it might be something you don’t want to get involved in, but if you are trained or you feel comfortable with that kind of approach, then, yeah, definitely focus on building that girl’s self-esteem and talking about ways that the diet can help support their health and happiness that have nothing to do with their weight.