What to do if you suspect you have an eating disorder.

Before I get started, if you have an eating disorder and need support call the NEDA ED Helpline at (800) 931-2237.

Soooo, also before I get started (redux): hi. I'm Donna. I have binge eating disorder and used to weigh as much as a baby whale that just ate a small compact car. I am also a clinical therapist. I notice that many of us struggle with disordered eating (well duh) or outright have an eating disorder - or we might not know! Here is a rudimentary post with some suggestions, thoughts, and ideas which are hopefully helpful.

We'll leave disordered eating on the bookshelf for a moment, because that's a whole other circus full of monkeys. As for eating disorders, if you think you may have one, you wouldn't be alone if you did, certainly, as it's estimated around 30 million people in the US alone regardless of gender meet the criteria for diagnosis. Men and women are both underdiagnosed usually, however men are vastly so.

Eating disorders are vastly misunderstood, underdiagnosed, and also stigmatizing. Anorexia, an eating disorder, also has the highest death rate out of all mental illnesses. And yep, you can develop it post-WLS even if still overweight or obese. BED can also cause severe complications, too, that we don't often discuss, including malnutrition and vitamin deficiencies.

At any rate, there are a couple of avenues of approach. Finding a psychiatrist to work with is daunting normally, and even more so when it comes to EDs. Finding a counselor can also be hard. Here is a brief list of stuff to consider doing:

1. When in doubt, start with your PCP. They may also not know WTF to do, but they may be able to help if you also are experiencing anxiety or depression (exceptionally common).
2. Go to therapy. Seriously. All the drugs in the world will not help without therapy. If you can't do this, get a CBT workbook from the library. Go through it and do it. It sounds dorky, but it will begin the process even if it's hard to do without a professional. CBT is suggested by me because a lot of research shows that, for BED especially, it is just as effective if done diligently daily as working with some therapists.
3. Even pre-op or without WLS, get full bloodwork done annually, if not every six months. All the vitamins and other stuff, folks. Eating disorders cause very serious medical conditions. If you restrict or have severe malabsorption (DS, distal RNY) add a DEXA scan yearly if you can swing it to track muscle mass and bone density changes.
4. Research industrial eating disorder treatment programs carefully. Some are quite good, but many are for-profit and can cost about 30k/month. I'd rather go to a program linked to a hospital which does research rather than a private ranch. The care tends to be more cutting edge, though not always. Still, look at your options before you commit.
5. If you are on medicaid and have limited funds call your local state university. Many do eating disorder research and many might be willing to work with you or have financial assistance.
6. Most psych professionals can do a screening so don't fuss too much about this type or that. Bring a notebook to your appointment. Write down questions, observations before to bring up. Write down what the clinician says. Do not rely on memory alone, as our memories are imperfect.

More general advice:

1. Be honest if you do go to therapy. I used to eat 30,000 calories a day at one point. I've had clients who have a DS and eat two pizzas in 20 minutes. I've heard it all, and I don't care one whit about what you eat. I care about the fact that you are suffering, and I need the deets so I can do my job well.
2. Be wary of special diets or fasting as they can trigger disordered behavior. Better to get your self-care down-pat first. Rapid weight loss can also trigger disordered eating or binges, actually, both for psychological and neurological/biochemical reasons.
3. Practice spending 15-60 minutes a day without technology, and just focus on yourself, your mind, and being calm. Spend it in nature if you can. No, this won't cure the ED, but it will help reduce lapses over time
4. Know that, almost always (but not always) eating disorders are caused by trauma. They are not caused because you like to eat. They are not caused because you lack willpower. They are caused because you and I suffered at one point, and these behaviors helped us cope with the suffering. That means the eating disorder is not your fault!

Thank you for this post, Donna. Do you have any CBT workbooks that you specifically recommend?

Here are some of my favorites!

Pure CBT, these are some of the best. It may not say "for binging," but it can be applied.
1. CBT Toolbox: A Workbook for Clients and Clinicians - don't let the title scare you. This is one of the best out there, if not the best.
2. Mind Over Mood by Dennis Greenberger - this is a classic for a reason. Used for depression and anxiety, but exceptional when applied to compulsive overeating.
3. Cognitive Behavioral Skills Workbook for Coping with PTSD
4. Thoughts and Feelings: Taking Control of Your Moods and Your Life (mostly CBT, with some DBT)

These are binge/overeating related and use CBT (even if they don't outright say it):
1. The Food and Feelings Workbook by Karen Koenig - one of my all-time faves and, IMO, should be mandatory to do pre-op for everyone.
2. Food Addiction Recovery Workbook by Dr. Carolyn Coker Ross
3. Never Binge Again by Glenn Livingston
4. Brain Over Binge Recovery Guide by Kathryn Hansen

Other very good ones for BED, eating disorders, or overeating in general:
1. Mindfulness Skills Workbook for Clinicians and Clients
2. The Dialectical Behavior Therapy Skills Workbook, Matthew McKay
3. The Complex PTSD Workbook
4. Overcoming Trauma and PTSD Workbook, Sheela Raja

What an awesome reference list! Thanks for sharing!

I am always happy to make my pedantic nature, and way too crowded library, remotely useful

Thank you so much! I will check these out.

Donna,

Thanks for the list of workbooks.. ....even tho I am not aware of having an eating disorder, it is reasonable that it would be evident in the overweight populations. I know Eating Disorders are also in the population of very thin. like others, I will put some of these on my wish list, to have as a reference... have family and others who stlll struggle with MO.

Be careful about expressing "normal" . Her friend "Abby" is offended- not to be considered so. I was overweight from the time I can remember and as I became a teen and the hormones kicked in with poly cystic ovarian disease -Obesity became the major issue of my life.Diets of every stripe followed and the I continued thsoe for the better part of 20 years, destroying my metabolism in the process.

As a clinitician be sure to have your clients get checked( can be diagnosed from bloodwork-) for this issue.( I know you are probably aware of this, but those reading may not be) It is a hereditary disease process and is often manifested by sudden weight gain and heavy facial hair growth in women I had it(PCOS) for many years before one of the causes of my obesity was discovered thru my WLS surgery. Thankfully, I had an open surgery and all of my many physical issues were addressed in one surgery.

I had a very good support system- My Mom was my best one and had had WLS prior to mine- I and never found counseling necessary, tho it may have been benefficial...it was not part of the program in which I was enrolled.

Thanks again! I went ahead and bought all of them, lol, because yay for Kindle? Not that I have time to read right not because yay school, but I'll never read them if I don't have them. I already had The Dialectical Behavior Therapy Skills Workbook (although unread still) and Never Binge Again.

For anyone reading this, Never Binge Again often goes on sale for Kindle at super low prices.

If you saw my kindle library you would never feel guilty for buying books again, heh. My Kindle gets me in way too much trouble.

Most of the books I posted can also be read well in chunks. The Food & Feelings one especially lends itself well to an hour here and there.

Thanks :)

I also have a "book acquisition beyond life expectancy" issue with Kindle. So you're not the only one. My problem probably stems from the fact that I do, in fact, never feel guilty for buying books. Books are pretty much the only thing in life I never feel any sort of guilt for spending money on - they're books! Books are good for you! :D And Kindle just makes that all the more easy because they don't even take up physical space! Aaaaaah.

Are you on Goodreads?