Contemporary Psychoanalysis in Action

A roundup of psychoanalytic points of view

Disordered Eating or Eating Disorder: What’s the Difference?

Disordered Eating or Eating Disorder: What’s the Difference? More subtle forms of disordered eating can also be dangerous. It’s pretty easy to diagnose a full-blown eating disorder like Anorexia or Bulimia Nervosa. But more subtle forms of disordered eating are difficult to pinpoint. By Carrie Gottlieb, Ph.D. Read More

I don't understand why

I don't understand why "achieving body acceptance" is necessariy a goal in psychotherapy. People with anorexia nervosa are typically at a very low, dangerous weight, that negatively affects them medically and psychologically. Unfortunately, they often "like" their body in this condition. The last thing we should be doing, therefore, is helping them "accept" their body as it is. Perhaps Ms. Gottlieb could clarify what she means in this post. Otherwise, I'm afraid the post is fairly nonsensical as it relates to anorexia nervosa.

Response: I don'r understand why

My reference to achieving body image acceptance in this post referred to those with disordered eating, not Anorexia Nervosa specifically. You are correct that individuals struggling with Anorexia would not be encourage to accept or remain at an unhealthily low body weight. In this case, treatment would focus on restoration to a more healthy body weight. Overall, treatment of eating disorders and disordered eating generally involves work on body image issues as well as maintenance of an appropriate body weight.
Thank you for reading and for your comment.

Actually, there is no

Actually, there is no evidence that treatment for anorexia nervosa generally should involve "work on body image issues" or that such "work" (a vague, ill-defined term) improves outcomes in the treatment of AN.
For children and adolescents who suffer from anorexia nervosa, the leading treatment is Family Based Treatment (FBT) as manualized by Lock and LeGrange. FBT is the model recommended by the American Academy of Pediatrics. It does not involve "working" with children and adolescents on "body image issues."
The modern paradigm, supported by the best available scientific research, is that anorexia nervosa is a neurobiological disorder involving the biological systems governing eating behavior, not a "body image issue." That's one reason why FBT, which targets eating behaviors directly, is the most successful treatment method developed so far, and why "body image" therapies have no support in the research literature and are only speculative and experimental, at best.

Dear Ms. Gottlieb, Your post

Dear Ms. Gottlieb,
Your post says you are on the steering committee of the William Alanson White Institute Eating Disorders, Compulsions, and Addiction Program. The website says that the program "focuses on integrating principles of interpersonal psychoanalysis with other treatment modalities." Can you provide an explanation of what this means? As discussed recently in psychologytoday, the best available research data is showing that psychoanalysis yields extremely poor results in the treatment of eating disorders, with rates of recovery around 10%, probably no better than a placebo or no treatment at all. At the same time, psychoanalysis is extremely expensive, financially, for sufferers and their families. Given this evidence, what is the benefit of "integrating" psychoanalysis with other treatments? The result would appear to be dysfunctional, effectively diluting other treatments that have been shown to be much more effective. I realize it is difficult for professionals who were trained in psychoanalysis to let go, but wouldn't that be in the best interests of the public?

Dr. Gottlieb makes an

Dr. Gottlieb makes an important point. Many people who do not have eating disorders show disordered eating behavior and a negative or over-focused relationship to their bodies. These individuals are more likely to have diagnoses on either the depression or anxiety axes. It is useful to address their disordered eating differently than those who meet criteria for an eating disorder.
The distinction between an eating disorder and disordered eating is an important one.

Disordered Eating vs. National Weight Control Registry

Several of your recommendations fly directly in the face of recommendations from the National Weight Control Registry. Let's face it - with over 60% of our population overweight or obese, focusing on "disordered eating" is taking your eye off the ball. People who have successfully lost weight and kept it off have three key behaviors: They continue to count calories at maintenance weight, they exercise regularly, and they weigh themselves regularly. Your behavior recommendations are exactly how to sabotage maintenance of a healthy weight.

I would suggest that if a person has a) a healthy BMI, b) a healthy bone density, and c) for women, regular periods, don't even address "disordered eating."

More than just a number on

More than just a number on the scale.

I read Dr Gottlieb's suggestions as attempting to ask us to think about how psychology and behavior play out in the realms of weight management. If your hypothetical person of stable weight is living in an anxious and compulsive way he or she could use some guidance. We need to address both the emotions/psychological aspects of our patients as well as their healthy weight goals.

For example, it is possible to weigh yourself regularly without owning a scale. If someone is compulsively weighing themselves this is not helping them to monitor there weight.

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Contemporary Psychoanalysis in Action, edited by Susan Kolod, Ph.D., and Melissa Ritter, Ph.D, is under the auspices of Contemporary Psychoanalysis, the journal of the William Alanson White Institute.

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