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To help you determine whether you or your loved one has an eating disorder, we have developed the following short quiz. It is not meant to be used to give yourself a diagnosis, but it will give you an idea of whether you or your loved one should seek an evaluation by an expert.
If several of these sound familiar to you then you may be at risk of having or getting an eating disorder.
Experts vary in their opinions as to exactly how many eating disorders there are. The American Psychiatric Association publishes a manual, the Diagnostic and Statistical Manual of Mental Disorders(DSM), which is used by all insurance companies to determine what kind of psychological disorder, if any, that a person has. The eating disorders covered in this manual include Bulimia Nervosa, Anorexia Nervosa and Eating Disorder Not Otherwise Specified. In addition, many experts and national support organizations list compulsive eating as another eating disorder. The following is a brief description of each one.
Anorexia nervosa literally means loss of appetite, but this is a misnomer: a person with anorexia nervosa is hungry, but he or she denies the hunger because of an irrational fear of becoming fat. Anorexia nervosa is often characterized by self-starvation, food preoccupation and rituals, compulsive exercising, and often an absence of menstrual cycles. The person usually loses significant amounts of weight and may appear unhealthily thin to others while they themselves believe they are still fat. If untreated, anorexia can be fatal. It is not a "fad" which the victim will outgrow if left alone. The death of pop singer Karen Carpenter at age 32 was attributed to heart failure, following her eight-year battle with anorexia. The most common cause of death in a long-time anorexic is low serum potassium, which can cause an irregular heartbeat.
Bulimia nervosa is characterized by recurring periods of binge eating, during which large amounts of food are consumed in a short period of time - sometimes as many as 20,000 calories during the course of a single binge. The bulimic is aware that his or her eating is out of control. He or she is fearful of not being able to stop eating, and is afraid of being fat. The bulimic usually feels depressed and guilty after a binge. Frequently, the binges are followed by purging, through self-induced vomiting, abuse of laxatives and/or diuretics, or periods of fasting. The bulimic's weight is usually in a normal or somewhat above normal range; it may fluctuate more than 10 pounds due to alternating binges and fasts.
This is a catch-all phrase used in the DSM for something that is clearly a problem but does not fit neatly into one of the above categories. For instance someone might not binge, but still vomit after they eat. Technically this is not bulimia because there is no binge eating, but it is still an eating disorder, and a diagnosis of Eating Disorder Not Otherwise Specified would be given. There are many kinds of disordered eating behavior that fit into this category, such as binge eating without purging or regular chewing and spitting out food without swallowing.
Compulsive eating can take several forms. Some people with this problem feel an irresistible urge to nibble all day and into the night. They don't necessarily binge, but by the end of each day they will have consumed two or three times the amount of food they need. Others won't nibble all day but might eat five or six full meals. People with this problem think about food most of the day and use eating to cope with emotional stress.
You have already taken the first step towards recovery by asking this question. Maybe you have tried to recover on your own, but have always ended up returning to the same old habits. Maybe you have noticed that the actions which once gave you a sense of control now control you. The important thing is to recognize you have a problem which you cannot change on your own.
The second step is to decide that you are willing to do what needs to be done in order to recover. You must make this decision knowing that some steps in recovery will be painful.
Once you have taken these two steps, you are ready for the third: choosing the treatment that will be right for you.
Puzzle Pieces: a treatment program with several parts.
Maybe you have tried treatment before, and it has not worked for you. Maybe you don't even believe treatment can work. We believe that a successful treatment program is made up of several parts. It must deal with behavior, thoughts, and emotions. If any of these parts are missing, the treatment can easily fail.
Some other reasons for failed treatment are:
We have found that the most successful treatment program requires several people supporting you in different ways. Eating disorders are very complicated, and different aspects of recovery require different kinds of helpers. One benefit of the team approach is that it allows you to make more choices, giving you authority in shaping your treatment.
The following are examples of different components we might draw from to help develop your individual recovery plan:
An individual therapist's job is to help you find the underlying cause of your emotional pain. Then, he or she helps you deal with the pain and take charge of your life. An individual therapist is there to create a safe space where you can talk about your feelings and thoughts, as well as develop new and healthier patterns of thought and behavior.
A physician's job is to help you stay or become healthy. He or she is also there to help you stay alive while you recover. This means he or she must know when to be gentle by listening and understanding you, and when to be firm, if he or she sees a serious health problem. We work with your doctor to ensure that we stay aware of your medical issues and that he or she understands the psychological aspects of your eating disorder.
A nutritionist is there to help you create a healthy diet out of foods you feel safe eating. She does this very gradually, at a pace comfortable for you. A nutritionist is not there to tell you about calories, even though calories are one thing she knows about.
Group therapy is the step after individual therapy. It is a safe space where you can share your experiences without shame, and learn from others who have struggled with the same issues. In group therapy, with the help of other group members, you can discover new ways to deal with pain and take charge of your life.
Family and friends are there to give love. In the midst of pain, fear and frustration, the expression of love can sometimes get lost. In family therapy, family and friends can learn how to be loving and supportive even during difficult times. With adolescents and children, we have found family therapy is essential for recovery. A Better Way Counseling Center also offers couples counseling and individual therapy for family members of all ages.
"The Three R's" are reading, writing and recovery. Reading can help you get facts and information, along with teaching you new ways of thinking about yourself and the world. We can recommend many books to help you learn how to support yourself. Writing in a journal is another way for you to be your own best friend.
Learning to support yourself is the key to successful recovery. We are here to empower you in this process. We will help you find the unique sources of support that mean the most to you. Perhaps this source is a beloved pet or a spiritual belief. Or perhaps it is something you have not yet discovered.We can also provide spiritual support to fit an individual's goals (religious or spiritual orientation).
It is essential to have others in your life who understand what you're going through and support your recovery. Some people have family and friends who love them, but don't know how to support, or who live far away. Others have no one.
Many people with eating disorders feel hopeless. Having the support of others in recovery can help defeat this hopelessness. To fill these needs, A Better Way Counseling Center offers two free support groups. One helps family and friends understand their loved one's suffering. In this group, families can also get feedback so they know they are in fact helping - something that can be difficult to know. The other group is for people who have disordered eating. They can use this group to not feel so alone, and to get support in maintaining efforts to recover.
An eating disorder can be very hard to talk about. For some, art therapy can help, especially those who have had a difficult time with therapy in the past. Art therapy accesses the non-verbal parts of the brain, and can therefore be quite helpful for people who are stuck or unable to discuss feelings. Art therapy is about self expression and self-discovery; it is not about creating "art." Therefore one does not have to have any artistic skill or talent to benefit from it.
Residential and hospital programs help to stabilize people who are medically at risk as a result of their eating disorder. They can also be useful for people with an eating disorder who deny they have a problem, or who feel so defeated by their eating disorder that they need intensive care. These programs are essential when a person’s weight has dropped to the point where their brain is not getting enough food to function properly. A person in this situation cannot think clearly enough to utilize psychotherapy. Sometimes hospitalization is in a special section of the hospital specifically designed for eating disorders treatment. Other times it is in another section of the hospital where a person is treated for life endangering illnesses associated with eating disorders.
Day treatment, partial hospitalization and Intensive Outpatient Programs are similar to residential and hospital programs, except that a person comes home in the evenings and on weekends.
Unfortunately, many individuals who undergo one of these intensive treatment programs will need to repeat it one or more times at a later date before they recover.
Most people with eating disorders do not need residential treatment, hospitalization, partial hospitalization, day treatment or an Intensive Outpatient Program. But for those who do need it, these types of treatment can be save lives if followed by ongoing Outpatient Team Treatment.
Outpatient Team Treatment at A Better Way Counseling Center
This treatment is much less expensive and much less time-consuming than the treatments described above. One can still participate in regular activities when participating in this treatment.
This ongoing Team Treatment is critical to full recovery after an intensive outpatient or residential treatment program. This continued therapy, sometimes called “aftercare” by residential or hospital programs, helps clients to maintain their positive choices and helps them learn how to support themselves. This ongoing treatment can include individual psychotherapy, group therapy, support groups, family or couples therapy, a dietitian, physical therapy, a psychiatrist and a primary care physician. Generally one sees an individual therapist once per week in this type of treatment, and other providers as needed. When a person’s eating disorder and/or other problems are more severe, a total of three to six different kinds of appointments per week can necessary. This follow-up care is essential to minimize the otherwise high probability that hospitalization, residential or intensive outpatient treatment will need to be repeated down the road.
At A Better Way Counseling Center, we provide this Outpatient Team Treatment. For most people, this is the first and only kind of treatment they will require, but for many it is a follow-up to their intensive treatment.
How long does treatment take?
Generally, treatment for eating disorders is a long-term endeavor. Effective treatment does not just stop the problem behavior; it addresses the root causes of the disorder. Stopping the problem behavior is a consequence of personal growth at a deep level. Permanent change must occur deep within the person, at the source of emotional pain which is behind the eating disorder.
To overcome an eating disorder, you must learn new ways of coping and dealing with pain. You must learn to praise and value yourself in new ways. You must let go of one of our culture's strongest messages: being thin equals being lovable, powerful and good.
As children we develop enduring beliefs about who we are. We also develop strong, habitual ways to handle the good things and bad things that happen to us. Some of these beliefs and behavior patterns are useful and helpful, others are not. To learn new, healthier ways of behaving and believing is the goal of treatment at A Better Way Counseling Center.
There is never just one right way or one right combination of methods to recover. At A Better Way Counseling Center we want to work with you to develop the best treatment possible. Call us at (503) 226-9061 to find out more.
The first thing to do is to gather information in order to gain a better understanding of the person's problem. Reading this information is a good start. There are also several good books available (see www.bulimia.com for a reading list). You can also contact us for our free "Steps to Recovery" pamphlet. And feel free to come to our free support group for family and friends that is listed below in the section entitled "Is there any free help available?"
The next step is to realize what family or friends can and cannot do. You cannot force a loved one to recover. Parents can force minor children into treatment, but ultimately the person with an eating disorder must want to change if they are going to recover. We have found that the best way for family and friends to influence this "wanting to recover" is twofold.
First, you can learn to offer caring attention in a way the your loved one will accept. Often this means listening to them speak about concerns other than their eating behavior. Typically, this leads to their feeling more comfortable talking with you so that they will eventually feel more free to discuss their eating disorder.
People with eating disorders get all kinds of information about what they should and should not eat. They are often very critical of themselves and neglect to give themselves love. Loving support is critical to recovery from an eating disorder.
Second, you must take care of yourself. This could mean setting limits on what you will do to accommodate your loved one's eating disordered behavior. Or it could mean getting help for yourself, such as going to a support group or getting your own counseling.
When one person in a family has an eating disorder, the entire family suffers. It is not only the person with the disorder who feels discouraged and frustrated. Therefore, to recover, not only does the family member with the eating disorder have to grow, but the rest of the family will have to change as well.
Because of their own pain, beliefs or habits, sometimes it can be difficult or impossible for family members to give their loved one the support they need. Before being able to help, family members often need to deal with their own frustration, discouragement and fear. This might mean that the entire family will need to get therapy together, or it might mean that someone else in the family could require their own individual therapy.
A Better Way Counseling Center offers family and individual therapy for family members of all ages, as well as couples con what is effective and what you, the parent, are comfortable with. There is no single best way to support a child with an eating disorder. Generally, we find that parents' behavior does have to change in some way for a child to successfully recover. This can be uncomfortable but fruitful.
As therapists, we must balance privacy for the child with disclosure to you. This balance, which is sensitive and important, is often difficult for parents. Because we know it is essential for parents to be able to give input and get information about their child's treatment, we often recommend family therapy in addition to the child's individual therapy. You will always have different therapists doing family therapy and individual therapy. The goal is never to keep information away from parents; but the information the child discloses in individual therapy must be kept private in order to build trust. Typically, the child begins to share more thoughts and feelings with parents as therapy progresses.
This is one of the most difficult issues a parent of an eating disordered child can face. The answer to this question depends on how far the eating disorder has progressed.
At A Better Way Counseling Center, generally we have found that forcing a child or adolescent to come to individual or group therapy is not very helpful. In those forced situations, a child usually views therapy as a punishment and/or will not disclose much information, or will not develop a good relationship with the therapist. In these situations, the child is often much more willing to do family therapy, and this might be all that is recommended at first. As therapy progresses the child realizes that the therapist is on their side and is helping the family get along better. At this point the child usually becomes more open to their own individual therapy.
On the other hand, if the eating disorder has progressed to the point at which your child's life or health is in immediate danger, you might have to consider hospitalization or residential treatment. Getting the child professionally evaluated is crucial so you know which of these options to choose.
You can come to the free family support group without committing to therapy. In the family support group, which meets once a month, there is no commitment to say or do anything. You and/or your child are welcome to just listen, or to ask questions. Give us a call at (503) 226-9061 to find out more.
Yes. Men get every kind of eating disorder that women get. The majority of people with eating disorders are women, but according to a study reported in the American Journal of Psychiatry, one quarter to one third of them are men.
As with women, eating disorders in men are often accompanied by low self-esteem, depression, body image disturbances, shame and other emotional issues. With men, however, there is the additional shame of their having what is generally thought of as a "woman's problem." Another problem men have is that they often do not know enough about eating disorders to know when they are at risk. Women are more likely to know about eating disorders because women's media, such as women's magazines, regularly publish articles about them. Media directed at men rarely address eating disorders, and if it is addressed most often it is in relation to their female friends and family.
Men can read other parts of this website, such as the "Do I have an eating disorder?" section above, to determine if they might have an eating disorder and how to recover if they do. The process of recovery is very similar for men and women, however some men may not feel comfortable in an eating disorder group made up of women. At A Better Way Counseling Center we work with men to find the best combination of treatment options. For example, if you are one of the men who prefer to work with a male counselor, we encourage you to see our male counselor.
Eating disorders can be expensive to treat. Some residential or hospital programs cost $800 to $1200 per day, and patients typically stay in these programs for at least two to three months or more. Fortunately, most people do not need such extensive -- and expensive -- treatment.
Typically, at A Better Way Counseling Center:
In addition to the above services, we might also recommend a visits to a physician and a dietitian. Sessions with a dietitian generally last for 30 to 60 minutes and cost around $50 to $85.
At A Better Way Counseling Center, we understand that there will always be a balance between optimum treatment and what you can afford. We work with you to find the best treatment your finances will allow. Many insurance programs cover most or a part of the cost of treatment at our Center. We are now accepting Oregon Health Plan when it is through FamilyCare. Give us a call at (503) 226-9061, and we can figure it out together.
As part of our mission to help people overcome their eating disorders, we also have several free and low-cost alternatives. These include free support groups for people with eating disorders and for their friends and families.
The free support group for people with eating disorders meets every first and third Thursday of the month from 6 to 7pm at the offices of A Better Way Counseling Center. This group is only for adults who have eating disorders or body image issues who are at least 18 years old. It is guided by a therapist from A Better Way Counseling Center. It is a time to share information and get support in an educational format from other people who have similar struggles. In the support group we often touch on ideas, feelings, beliefs, processes, and experiences, however the support group is not therapy and it is not the time to delve deeply into personal emotions. After introducing yourself, you are welcome either to talk and ask questions or just listen.
Sometimes we will have a different speaker to help participants explore the topic for the evening. The speakers can be experts in the field of Eating Disorder Treatment, such as a physician or dietitian, or they can be individuals who have recovered or been affected.
The free art therapy support group is a safe and supportive group that
meets twice a month on the second and fourth Thursdays of the month from
6 to 7pm in the offices of A Better Way Counseling Center. Although it
is led by a Registered Art Therapist, it is not therapy but educational.
The group is only for adults who have an from eating disorder or body
image issues who are at least 18 years old. It is for people who are
interested in how art and art therapy may be beneficial to them in their
recovery from an eating disorder. The group consists of directed art
activities designed to encourage discussion of general issues relevant
to eating disorders and recovery. Some of the activities are directly
related to one’s struggle with eating disorders, and some are more
general for the purpose of self-expression and self-exploration. There
will be individual activities, as well as an occasional group project.
Art supplies will be provided, and no art experience is necessary to
participate in the group. Following the art activity there will be an
opportunity to share your artwork with the group and talk about it.
Because this is a support group, and not a therapy group, it will focus
on art experiences that are not designed to facilitate an in-depth
exploration of feelings, but rather to explore how concepts and culture
interfere with personal growth and fulfillment.
A Better Way Counseling Center's free support group for family and friends of people with eating disorders meets on the first Friday of every month from 6:30 to 8pm at the Zion Lutheran Church. This group is for people with eating disorders and/or their families and friends. Family members or those with an eating disorder are encouraged to attend on their own or with their loved ones. Children and adolescents are welcome to attend as long as they are accompanied by a parent or guardian. Although this group is guided by a therapist from A Better Way Counseling Center, it is not therapy but educational. It is a time to share information and get support from other people and families who struggle with an eating disorder, and to hear from people and families who have overcome these struggles. No one is required to participate after introducing themselves. You are welcome to just listen or you can talk and ask questions.
As in our other support group, we sometimes have a different speaker to help participants explore the topic for the evening.
Learn the 7 secrets to fully recover. Healing from an eating disorder is almost never easy, but it is very possible. It needs to be done correctly with lots of help and support along the way. In this pamphlet you will get a roadmap that many have used to live happier, healthier lives free from an eating disorder.
Families and family involvement are generally essential components in an individual's recovery from an eating disorder. This free brochure talks about how families can grow to help their loved one.
The group for family, friends and those with eating disorders meets at the Zion
Lutheran Church. The two groups for people with eating disorders only
meets at our office location at 818 NW 17th in Suite 2. A map to the
church and to our office is available in the "Downloads" section of this
website. The schedule will remain consistent unless a particular group
falls on a holiday or the Zion congregation has an unexpected need for
the meeting hall. Call ahead or look under the "Schedule Changes" of
this website to be sure.
The first step is to make contact with someone who can help you -- usually a health care provider such as a counselor who specializes in eating disorder treatment or a physician. You can do this by email or by a phone call. Occasionally people with an eating disorder would prefer to have a person with whom they are close make this initial contact. Depending on your comfort level and the severity of your eating disorder, the expert will recommend one of two things in Step 2:
Step 2: |
Go to an eating disorder support group |
- or - |
|
Get an evaluation by a qualified professional |
An evaluation with a counselor at A Better Way Counseling Center generally lasts 50 minutes. During this time, you will be asked questions about the eating disorder such as how long you've had it and how severe it is. You will also be asked more general questions about your life in order to determine the best treatment for you. During this meeting, you and your counselor will come up with a preliminary plan for treatment based on the information you've provided. This preliminary plan also takes into account your financial resources, how much time you have to devote to treatment and how far away you live.
This could mean you see your counselor once every week. Or it could mean seeing several different health care providers each more than one time weekly.
As your habits change and you develop new ways of coping with emotional pain and stress, your need for help will diminish. Usually this is a gradual process; perhaps you were seeing your counselor and your dietitian once per week and you shift to seeing your dietitian once a month or even less.
Once you've recovered from your eating disorder, you will find you've replaced your reliance on dysfunctional eating with positive ways to cope with pain and stress, and with an inclination for personal growth. This includes maintaining an increased awareness of feelings and how to express them, as well as how to fulfill needs healthfully and joyfully. You might find a renewed or beginning interest in something spiritual. Or you might find an interest in in growth oriented books. And don't be surprised if you feel the need to re-visit your counselor or a different one now and then. One sign of health is knowing when to ask for help and knowing how to get it.
Often those who've recovered want to help others in some way. This might take the form of coming to a support group to offer hope and encouragement to those just starting on the road to recovery, or it might mean talking to the daughter of a friend who seems a little too preoccupied with how she looks. When you learn to enjoy giving to others in this way you are also working to further establish your own recovery.
A Better Way Counseling Center is an Oregon State Certified Mental Health Center and was established in 1997. The State Certification means we must meet rigorous quality control standards determined by the State of Oregon. The Center was founded by David Leventer, LPC, LMFT, a Licensed Marriage and Family Therapist and Licensed Professional Counselor. He has been counseling families, couples and individuals with eating disorders for over fifteen years and has worked in a variety of settings including hospitals, family agencies, and counseling centers such as the Women's Counseling Center and the Men's Resource Center. He designed the eating disorder treatment at the Center specifically to meet the needs of the Portland community.
Other providers at the Center include Valeria Lewandoski, LCSW, clinical supervisor, Alexis Wong, MS and Blair Allen, MA.
Valeria Lewandoski is a Licensed Clinical Social Worker and has been
the Center's clinical supervisor since 1997. She presently is also the
director of the Grotto Counseling Center, and has worked with adults,
children and families for over 25 years.
They bring expertise to A Better Way Counseling Center in providing individual psychotherapy, couples therapy, family therapy, group counseling and counseling about career concerns.
For a description of the kind of treatment that is offered at A Better Way Counseling Center, please see Outpatient Team Treatment at A Better Way Counseling Center in the How Do I Recover? section above.
A Better Way Counseling Center is also proud to be a leader in the field of continuing education of therapists. We are certified by the national organizations for both counselors and psychologists to offer continuing education for credit to both of these professions. We co-sponsor quarterly seminars for professionals to further their education in the treatment of eating disorders.
Our staff is also available to provide training and inservices to other
professionals in the areas of eating disorders, family therapy,
recovery from chemical dependency, anger management and violence
intervention counseling.
If you would like more information about our inservices, our continuing education offerings, or our national certifications, please contact us by clicking the blue “Contact us” link below.
Contact us for further information about our programs. We would also be happy to send you one or both of our free pamphlets: one describing the steps to recovery from eating disorders, the other on the way to having a happier, healthy family.
A Better Way Counseling Center
818 NW 17th Avenue, Suite 3
Portland, Oregon 97209
(503) 226-9061