I frequently receive calls to my practice from people looking for help with eating-related issues. Some have a clinical eating disorder, while others want help with emotional eating or poor body image, which often co-occur with depression or anxiety. Some callers are desperate parents looking for help for their child and can’t find anyone with openings or who is willing to take an eating disorder case. These calls break my heart. Mental health resources in Montana can be scarce in general, but especially for the pediatric population and especially for this issue.
For this reason, I believe that all Montana mental health providers should be able to recognize the signs of disordered eating and conversely, the signs of a healthy relationship with food, so that we can make appropriate treatment decisions or referrals.
In honor of Eating Disorders Awareness week, which is Feb 27-March 5, I’d like to share some quick snippets of information to hopefully inspire you to learn more and be a part of improving access to care in Montana.
Let’s start with the end in mind. We can’t treat disorder if we don’t know what constitutes health. So, what exactly is a healthy relationship with food?
You feel positive about your eating; it’s not stressful or a source of worry.
You are reliable about feeding yourself.
You can adapt to different eating contexts on the fly, but can also organize and plan for satisfying meals.
You eat a variety of foods you enjoy.
You eat as much as you need and let your body weight reflect your genetics and lifestyle.
You are able to respond to internal hunger and fullness signals versus relying on external rules to guide eating.
You have a repertoire of self-soothing and coping skills that don’t always involve food.
These listed criteria are based on the work of Ellyn Satter and her Eating Competence Model (Satter, 2007). You’ll find many great resources, including parenting tips and research articles, on her institute’s website: https://www.ellynsatterinstitute.org/satter-eating-competence-model/
In our clinical practices, clients frequently discuss the desire to “get healthy” or lose weight. Be mindful that these discussions of health include psychological health. If the way we eat causes guilt, shame, stress, difficulty eating with others, or increased obsessiveness, it is not a positive relationship with food.
What are signs of disordered eating?
Avoiding eating meals/snacks around others
Labeling food as “good” or “bad” or other moralistic terms
Constantly counting calories, fat grams, carbs, etc.
Frequent worrying or talking about weight or shape
Frequent weighing and using the number on the scale to set the emotional tone for the day
Over-exercising or exercising out of guilt or to compensate for eating
Irregular menstrual cycle in females
History of weight fluctuations related to yo-yo dieting
Numerous allergies and/or food intolerances that have not been substantiated by medical professionals
Picky eating or food aversions that severely limit food choices
Using substances like caffeine or nicotine to intentionally lower appetite
Using laxatives or diuretics to lose weight
Frequently going to the bathroom after meals
Forgetting to eat when stressed
Frequently relying on food for self-soothing
Extreme focus on “health” or “clean eating” which limits adaptivity and food choices
Cycling between undereating and overeating or binging
This list is not exhaustive, but it’s a start. Many of the described warning signs may be present with common, sub-clinical eating concerns but could also point to a clinical eating disorder, such as Anorexia, Bulimia, Binge Eating, Avoidant-Restrictive Food Intake, or Other Specified Feeding or Eating Disorder.
We need to build questions about eating into our intake process so that we catch it early in treatment. It’s important to know that most people with eating disorders are not underweight. You cannot rely on your visual observation of a client to determine the presence of disordered eating.
Learn more about signs and symptoms from the National Eating Disorders Association (NEDA): https://www.nationaleatingdisorders.org/warning-signs-and-symptoms
NEDA also has a free screening tool. It’s completely anonymous, and you can use with clients or link on your own website. Check it out! https://www.nationaleatingdisorders.org/screening-tool
If you are interested in learning more about the treatment of disordered eating, I offer a 6 CE hour home study course, Best Practices for Evaluating and Intervening with Disordered Eating. Through a mix of video lecture, practical exercises, and case study, participants build foundational skills to diagnose and treat using evidence-based practice. Visit my training platform to learn more: https://montanamentalhealthtraining.thinkific.com
I am also available for individual consultation if you have current disordered eating cases you’d like to discuss. Don’t hesitate to reach out!
Thanks for taking the time to read about an important issue facing our state and nation. Eating disorders, like other mental health concerns, are on the rise since the onset of the pandemic. This poses unique challenges for Montana and other rural areas. While we don’t all need to specialize in this issue, being able to recognize the signs and identify evidence-based treatment is a great start for Montana clinicians.
That’s all for now! Please share this newsletter with colleagues if you see fit.