Lois Zsarnay
LMFT, BCPC, RD

Disordered Eating and Eating Disorders

Are you in a love/hate relationship with food? Is food, or your concept of eating, dominating your quality of life? What does "dieting" mean to you? Diets only treat the symptom (excess weight or under weight or fear of gaining weight) of underlying problems, while changing the relationship (habits, beliefs, and behaviors) with food is treating the causes and creates a lasting change. Balance, moderation, and variety are the keys to having a long-term healthy eating pattern.

Since I am both a Registered Dietitian as well as a Licensed Marriage, Family Therapist and a Board Certified Professional Counselor, one of my specialty areas is around the relationship with food. I have over 25 years of experience in various settings such as in-patient, out-patient, intensive out-patient and residential treatment centers. I understand that an individual's eating disorder affects the whole family, so the treatment should involve everyone being affected by the eating disordered individual's relationship with food/eating/weight with a full treatment team approach.

Today's statistics are alarming, to say the least, when we hear that about 1/3 of the U.S. population has an unhealthy relationship with food and may be using food/eating as a coping mechanism to deal with things in their life. The statistics also show that about 1/3 of the people who go to the commercial "conservative" weight loss programs actually have an underlying eating disorder or disordered eating (using food/eating as a coping mechanism) and that those weight loss programs often inadvertently aggravate the problems since they don't address the underlying issues. People who are using food/eating as a coping mechanism need professional counseling/therapy to help them learn new healthier coping mechanisms and the skills they need to be able to have a healthy relationship with food. Sometimes the relationship with food is very similar to an addiction with the loss of control and the negative consequences in their life (medical problems, relationship problems, work problems, etc.). The obvious difference is that an alcoholic or drug addict can completely quit their "drug of choice," however the "food addict" has to learn how to have controlled eating and use their "drug of choice" (i.e. food) about 3 times every day without losing control or having negative consequences! This is a classic example of my "what's your cane?" analogy. We need to really work on developing the coping skills to balance and walk in life without using food to cope.

If you are like thousands or millions of people who have tried numerous diet plans to change your relationship with food, then it's time to get specialized, individualized help to deal with the underlying issues that keep dragging you back to the unhealthy relationship with food. After all, it's not hard to understand that food has calories and activity (i.e. exercise) burns calories and a healthy weight is about finding that balance. So if you have tried more than one "diet plan" and find that you slipped back to the old unhealthy relationship with food, then it's time to work on the underlying unresolved issues with your Nutrition Mentor walking along beside you to provide guidance and encouragement along the journey to a healthier (and more content) you.

Anorexia Nervosa

Anorexia Nervosa is a life threatening eating disorder that needs a full treatment team approach to help the person move into recovery. Anorexia Nervosa has three key components: 1) The restriction of claories leading to a significantly low body weight; 2) An intense fear of gaining weight or becoming fat; 3) A disturbance in the way in which a person experiences or thinks of their body (i.e. thinking they are obese when they are clearly very underweight). The sooner a person gets professional help, the shorter the recovery time usually is. The research estimates that for every day a person is in Anorexia Nervosa, the person will need two days to recover. So a person that has been struggling with Anorexia for a year will take approximately two years in treatment to get into recovery. Part of that recovery time is helping the person eat enough to fuel their brain and body so it can make the neurotransmitters again to relieve the distorted thinking that comes with malnutrition alone. The rest is working with the underlying traits or characteristics that are typically seen with people who have eating disorders (perfectionism, people pleasing, feeling misunderstood by people, low self-esteem, interpersonal distrust, etc.).

Anorexia Nervosa can be more challenging to work with since the extreme malnutrition of starvation changes the brain chemistry and therefore their thought patterns. Helping them to move towards a healthier and more content relationship with food and their body involves what I call the "shuffle dance" with small steps moving slowly in what often appears to be a circle. However that circle's center is very gradually moving forward so where we are dancing around is gradually shifting. In my Counseling practice in Ventura, we have to take the journey at a slower pace than we could when I worked in treatment programs since the client doesn't have 24/7 support around them when the changes they are trying to make become overwhelming. Instead of the Client doing the "shuffle dance" to someone else's music, they develop their own music and pace. We work together to keep the pace moving with the Client's anxiety or fears being manageable but not getting stuck for too long. Through out this process we are working on their distress tolerance, emotion regulation and mindfulness skills as well as their underlying core beliefs that may be holding them prisoner to a pattern of thinking that may cost them their health or even their life.

Bulimia Nervosa

Bulimia Nervosa is also a life threatening eating disorder that needs a full treatment team approach to help the person move into recovery. The key components of Bulimia are: 1) Recurrent episodes of binge eating (eating large amounts of food and feeling out of control); 2) Recurrent inappropriate compensatory behaviors in order to prevent weight gain (i.e. self-induced vomiting, misuse of laxatives, diuretics or other medications, fasting or excessive exercise) and; 3) Self-evaluation is unduly influenced by body shape and weight. Again, no one wakes up one morning and decides to develop an eating disorder. Everyone in the beginning thinks it won't be a problem if I just ate too much and throw it up just this time. Over time it starts to become more frequent and the binge eating becomes more intense with larger amounts of food. After a while, instead of the person controlling it, the eating disorder starts to control them and runs their life. Getting professional help is critical as the eating disorder changes the brain chemistry (like taking a drug) and the brain starts to become dependent on the behaviors in order to deal with every day life. We start with where the client is currently at then work together to define where they want to get to with their relationship with food. I use Cognitive-Behavioral, Dialectical Behavior Therapy, Internal Family Systems and Motivational Interviewing techniques to assist the client in moving into recovery.

Binge Eating Disorder

Binge Eating Disorder is a new diagnosis in the DSM-V that was published in 2013. I have been working with people with binge eating disorder for many years but the professional psychological community did not recognize it as an actual eating disorder until now. In the past it was often referred to as Compulsive Overeating. It is characterized by: 1) Recurrent episodes of binge eating (eating large amounts of food and feeling out of control) and; 2) Feeling distress regarding the binge eating. It is similar to Bulimia Nervosa but does not have the compensatory behaviors to try to prevent weight gain. I often see people with this disorder who are very sensitive temperament and feel things more intensely than the average person. They often use the binge eating to numb themselves or escape the uncomfortable feelings. I use techniques from Cognitive-Behavioral, Dialectical Behavior Therapy (especially distress tolerance and emotion regulation), Internal Family Systems and Motivational Interviewing to assist the client in moving into recovery. Some of my clients have started treatment with a weight as high as 410 pounds. Over the few years that I worked with them, some have lost as much as over 200 pounds and kept it off for years. We focus on the underlying issues that have kept them stuck in the overeating cycles instead of starting another diet plan that only treats the symptom. It is a journey of recovery that takes one day at a time with progress, not perfection being the goal.