Eating Disorder Therapy Chicago


Eating Disorder Therapists In Chicago

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Living with an Eating Disorder can feel like trying to swim upstream while simultaneously trying to stay afloat. You are likely spending your days preoccupied with your body, the foods you are consuming, and feelings of emptiness and loneliness. Counting calories, daily weighing, constant negative self talk, and never feeling like you are enough is exhausting!

Additionally, Eating Disorder behaviors are often masked with secrecy leaving you to feel even more isolated and alone. Overall, struggling with an Eating Disorder is not only physically draining, but emotionally and mentally as well. 

We offer both individual therapy and group therapy for eating disorder recovery. Check out our eating disorder recovery skills group here.

Parting ways with your Eating Disorder can feel scary, especially if it’s been your primary way of coping for a long time. In the beginning of your healing journey, it might feel as though you are losing control of the very thing that has provided you with safety and comfort. In reality though, when you are living with an Eating Disorder, you really aren’t in control at all because you are controlled by your behaviors. At Cityscape Counseling we want you to know that there is hope for your life to look different and that recovery from your Eating Disorder is attainable. While the treatment process is hard work, the end result is so very worth it. 

Perhaps you’re not quite sure if what you’re dealing with would be classified as an Eating Disorder. You may be aware that your relationship with food and your body is not “normal”, but you also may feel lost on how to change or where to even get started.

Whether you are ready to change, thinking about change, or just concerned about your relationship with food and your body, starting therapy is the first step in taking care of you and getting back on the path to a life that is worth living. Our Eating Disorder therapists at Cityscape Counseling have collectively helped thousands of individuals struggling with disordered eating and body image concerns drawing on our many years of experience treating Eating Disorders both at Cityscape Counseling and in our roles at various treatment centers across Illinois. 

As licensed therapists, we will meet you where you’re at and work alongside you to help you progress towards living your best life – a life that is free of the chains of food and body obsessions. 

In a collaborative effort, we will help you:

-regain control of your life
-develop a healthy relationship with food and your body 
-uncover underlying factors contributing to your Eating Disorder/disordered eating 
-cultivate kinder, more encouraging self-talk 

How can I know if my relationship with food and my body is maladaptive?

One way to start assessing your relationship with food and your body is by looking at the content of your thoughts and the details of your daily behaviors related to food and your body.

Some Examples of Eating Disorder Thoughts

eating disorder therapy Chicago depicted by a person measuring their hips

“I hate my body”
“I can’t live with myself if I gain more weight”
“I’m the largest of all my friends”
“Carbs are bad and I need to cut them out of my diet completely”
“I can’t go to the pool party because my body is disgusting”
“I want my stomach to be flat”
“I’m so fat no one is ever going to love me” 
“Feeling full means I’m gaining weight”
“If I have 1 donut then I have to eat them all”
“I’m never going to be good enough” 
“I have to be a size zero forever”
“I can only eat X amount of calories per day”
“If I have a cookie I need to punish myself with X hours of intense exercise”
“If I had more self-control and willpower around food, I wouldn’t be fat”

Some Examples of Eating Disorder Behaviors/Warning Signs

-Feeling uncomfortable when eating around others -Following any new fad diets such as “no dairy”, gluten free, low carb/high protein etc.
-Weighing self or food obsessively
-Preoccupation with food and body 
-Refusal to eat certain foods or avoiding complete food groups such as carbohydrates, dairy, sugars, or fats
-Withdrawal from friends or normal activities 
-Increased mood swings 
-Increased rigidity and inflexibility with exercise routine despite illness, weather, injury or outside obligations 
-Counting calories 
-Intense fear of weight gain 
-Using language around fat talk or expressing a desire to lose weight 
-Frequently checking body in the mirror
-Food rituals (e.g eats only a particular food or food group, excessive chewing and/or doesn’t allow foods to touch)

*Please note, there are a wide range of Eating Disorder thoughts and behaviors that can be applied to an Eating Disorder diagnosis. The above lists include only some examples and are not at all inclusive of every possibility. 

What about body image concerns?

For adolescents, millennials and adults of all ages, going a day without exposure to some form of social media is quite rare. It doesn’t take long to scroll through Instagram, Facebook, Pinterest or Snapchat before you’ll encounter pictorial or written content relating to physical appearance, diet or exercise.

Sadly, people have become more obsessed than ever with pursuing a specific physical identity which often involves unhealthy weight and shape ideals. It doesn’t help that diet culture has been working hard to convince us that “wellness” and “dieting” are different things.”  Models on magazine covers, celebrities on our social media news feeds, actors on TV, and our favorite musical idols often possess what society perceives to be “picture perfect” bodies. As a result, society starts to associate a certain body type (usually low body weight) with success, popularity and attention. What we often forget is that the individuals portrayed in popular media are often at unhealthy low weights or the pictures are so digitally edited that the images our eyes are bombarded with are not even real. 

With such intense body image scrutiny, it’s no surprise then that in the United States alone, 20 million women and 10 million men will meet diagnostic criteria for an Eating Disorder at some time in their lifetime. And in 2019, statistics revealed that 96% of women do not like their bodies. 

eating disorder therapy Chicago depicted by a fork

Unfortunately, most studies don’t even account for the non-binary or trans community meaning that the statistics of Eating Disorders and body image dissatisfaction are probably even higher than what most studies report. We live in a culture that perpetuates, encourages, and glamorizes this belief in the thinness myth. This myth is displayed everywhere, and it tells us that if we are thin enough, then we will be successful, happy, and that people will love us. The reality though is in the name-it’s a myth. We cannot deny that our world is permeated with weight-based stigma where unearned privilege is given to those of a certain body shape that most closely matches the ideal image of beauty, but we can all learn to challenge this problematic paradigm. We can learn to accept our bodies in a world that tells us we need to hate it and change it. 

While those who suffer from Eating Disorders, such as Bulimia, Binge Eating Disorder, Orthorexia and Anorexia Nervosa, are usually born with a genetic predisposition to developing the disorder, the media definitely provides a perfect environment for an Eating Disorder to develop and at the very least normalizes an unhealthy obsession with food and bodies. 

Eating Disorder therapy at Cityscape Counseling usually involves a strong focus on body image concerns provided that you feel addressing body image is relevant to your recovery. Our approach is always aimed at helping you cultivate a more accepting attitude towards your body as opposed to changing your body to “make it more socially acceptable”. We tailor therapy by providing you with cognitive and behavioral tools to help you change your unique relationship with your body in such a way that it enhances your Eating Disorder recovery. 

Wondering If You Might Have An Eating Disorder? 
Take Our Free Online Quiz Here To See If You What You’re Experiencing May Be A Type Of Eating Disorder

Are Eating Disorders a serious medical concern?

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Yes! Eating Disorders are serious, complex medical and mental health conditions. Many are surprised to learn that Eating Disorders actually have the highest mortality rate when compared to other mental health disorders. They frequently begin during middle school and high school especially around the age of puberty. However, many individuals are not aware that their behaviors are disordered and might only seek treatment for the first time during adulthood.

Eating Disorders can have serious medical consequences such as heart failure, osteoporosis, kidney problems, esophageal tears and infertility. Different Eating Disorder behaviors affect the body in different ways. Below is an image of common symptoms and medical complications associated with Eating Disorders. 

Therefore, it is critical that professional help is sought out if you or a loved one are struggling with an Eating Disorder and/or are starting to develop an unhealthy relationship with food or your body. 

Below is an overview to help guide your understanding of Eating Disorder complexities and help you to better determine if you or a loved one needs additional support.

Types of Eating Disorders

Binge Eating Disorder (BED) is characterized by consuming an abnormally large amount of food in a short period of time and experiencing what feels like loss of control during these eating episodes. Binges often lead to physical discomfort due to intense fullness, and is almost always followed by intense shame, guilt and negative self-talk. A binge episode will feel as though you’re eating food at a faster pace than usual, eating when you’re not really hungry, and /or eating in secrecy. According to the most updated Diagnostic Statistical Manual (DSM-5), to acquire the formal diagnosis of BED, the binge eating episodes must occur at least once per week for a 3 month period.

What you may not know about BED is that it’s actually the most common Eating Disorder in the United States. It affects 3.5% of women, 2% of men, is 3x more common than anorexia and bulimia combined, and has a higher prevalence rate than autism, Alzheimer’s and breast cancer. Along with being the most common, it is unfortunately the most misunderstood. For starters, it was not even a diagnosable medical disorder until 2013 when it was finally added to the DSM. There are also several assumptions associated with BED that are simply untrue:  

-you must be in a larger body to have BED
-BED is a willpower or self-control issue
-following a diet or excessively exercising will cure BED

BED has roots that run deep, as they’re tangled in nature and nurture. Although genetics likely play a role in the formal diagnosis of BED, it is also important to note that BED is tied to internalized weight stigma and a disordered relationship with food. Research indicates that BED may also very well be associated with trauma and certain mood disorders. This disorder is driven by misinformation, a weight stigma, and the thin ideal.

Utilizing a Health At Every Size® perspective, Cityscape’s therapists will help you to see that it is not your weight that is the problem- or the solution for that matter. Instead, we believe that it is the shame and secrecy surrounding your relationship with food and your body- the same shame and secrecy that was cultivated from a culture of diet-pushing.

 To properly treat BED, it is possible that you’ll need more support than outpatient therapy can provide. And that is more than okay! It is very common to expand your team to include a dietitian, psychiatrist, or even a treatment center for a higher level of care. Collaboration of all team members is crucial in truly treating the complexity of BED. Let us work with you to:​

-understand the Binge-Restrict Cycle and the harmful effects of dieting
-unlearn deep rooted diet culture assumptions/beliefs
-learn to believe that you are not “out of control” and that you can trust your body again
-neutral food judgements
-distinguish physical hunger and emotional hunger
-nourish your body on a regular and consistent schedule
-learn the harmful effects of equating self-worth with body size and/or amount of food consumed

Warning signs of Binge Eating Disorder: 

-Eating rapidly
-Eating in secret
-Feeling “out of control” around food 
-Hoarding or hiding food 
-Noticing large amounts of food missing (empty containers, finding wrappers, etc) 
-Feeling the need to replace missing food items to avoid being noticed 
-Creating a lifestyle of rituals and a schedule around binge eating behaviors 

While anorexia is marked by weight loss, there is no specific “look” to Anorexia Nervosa. Being clinically underweight is defined by being under that person’s unique set point weight range and therefore does not discriminate to a certain body type. The Diagnostic Statistical Manual for Psychiatric Disorders (DSM-5) states that an individual with Anorexia has a “significantly low body weight in the context of age, sex, developmental trajectory, and physical health”. 

Anorexia is defined by restricting one’s food intake, intense fear of weight gain, and excessive weight loss. It is the quest for perfection through using your body as a way to achieve ultimate thinness that is often associated with love and belonging, success, discipline, control and admiration.

There are two subtypes of Anorexia Nervosa: 

Restricting type: Using weight control behaviors such as limiting food intake, counting calories, self starvation/fasting, having an intense fear of weight gain, as well as preoccupation with body size and appearance. 

Binge/Purge Type: Using restrictive behaviors along with bingeing and purging behaviors to control weight.

Warning signs Anorexia Nervosa: 

– Skipping meals or eating smaller amounts of food 
– Eating small bites or eating slowly 
– Noticeable or dramatic weight loss 
– Wearing baggy clothes to hide body
– Hair loss, becomes easily cold and excessively fatigued
– Maintaining a diary of calorie amounts 

Bulimia Nervosa is marked by episodes of bingeing and purging. The use of restricting behaviors can also be present. Bingeing is defined as consuming an abnormally large amount of food in a short period of time (typically within 2hrs) and experiencing what feels like loss of control during these eating episodes. Binges often lead to physical discomfort due to intense fullness, and is almost always followed by intense shame, guilt and negative self-talk. With bulimia, purging will follow a binge and can be through self induced vomiting, exercise, laxatives or diuretics.

Warning signs of Bulimia Nervosa: 

– Frequent trips to the bathroom after eating 
– Hoarding or hiding food 
– Shame & guilt after eating
– Finding wrappers of food or noticing large amounts of food missing
– Drinking excessive amounts of water or non-caloric drinks
– Frequent brushing teeth, mouthwash or mints/breath freshener/gum 
– Dental problems such as cavities, enamel erosion or discoloration of teeth 
– Calluses on back of hands and knuckles 
– Preoccupation with food and body 
– Preoccupation with food and body 

A common misconception of OSFED is that it is not as serious as AN, BN or BED. However, OSFED actually has as many medical complications as all other Eating Disorders. 

This diagnosis is applied if you do not meet the full diagnostic criteria for any of the disorders listed above. For example, you might engage in Eating Disorder behaviors at a lower frequency, have experienced symptoms for less than 3 months, or be restricting your food intake but not be clinically underweight. Due to the restrictive and rigid diagnostic criteria the DSM offers, OSFED is actually very commonly diagnosed. 

Warning signs of OSFED: 

– Unhealthy obsession around food quality or “eating clean” 
– Eliminating or decreasing food intake around food groups such as only eating organic, no carbs, sugar or dairy, switching to a vegan or vegetarian diet not based on religious or dietary needs 
– counting calories

ARFID, often referred to as “extreme picky eating” is characterized by an “apparent lack of interest in eating or food”. Unlike some of the other Eating Disorders that are fueled by weight concerns, avoidance of food in ARFID is usually based on anxiety related to the aversive consequences of eating certain foods (such as choking, gagging, allergic reactions or vomiting) and/or an intolerance of certain textures, smells, temperature and colors of food. Individuals with ARFID usually have a very narrow range of foods they are comfortable or willing to eat. ARFID is also usually associated with nutritional deficiencies as well as failure to achieve growth/weight standards in children. 

While researchers are still trying to understand what causes ARFID, we do know that individuals with Autism Spectrum, ADHD and or a history of picky eating are more likely to develop ARFID. 

Treatment usually involves the use of exposure therapy to increase the range of food an individual can tolerate and helping them overcome their unique food and eating related fears.

Orthorexia: 

The unhealthy obsession with “clean eating.” Whereas anorexia typically places an emphasis on food quantity, orthorexia is more concerned with food quality. Orthorexic thoughts and behaviors are driven by the misconception that eating clean, organic, and/or raw foods are “better” than non-organic, processed foods. This can often lead to the unhealthy elimination of certain foods or food groups.

Compulsive Over-Exercising: 

This can look like rigidity and inflexibility with workouts and workout regimens, creating a “have to” mindset around exercise, missing life events or withdrawing from family/friends to exercise, exercising with the primary motivation to change your body or lose weight, engaging in extreme forms of exercise, and/or working out for several hours a day.

Purging Disorder: 

Purging not prompted by a binge behavior.

Night Eating Syndrome (NES): 

Recurrent night eating not accounted for by environmental or medical reasons. Night eating is a condition that combines overeating at night with sleep disturbance. With NES, the majority of your daily calories are consumed between dinner and bedtime, sleep is disturbed (falling asleep and/or staying asleep), and oftentimes, NES leads to waking up throughout the night to eat. Other symptoms include: morning anorexia (lack of appetite in the morning), a belief that eating is necessary to get to sleep or return to sleep, a depressed mood that worsens into the evening, and/or insomnia.

Body Dysmorphic Disorder (BDD): 

Body Dysmorphic Disorder presents itself in the obsessive thinking about one or more perceived defects or flaws in your appearance — a flaw that may be objectively minor or even unnoticeable by others. These perceived defects or flaws are typically relevant to face/facial features, skin, hair, breast size/shape, muscle size/tone, or genitalia. This obsessive thinking results in:

-Extreme preoccupation and rumination 
-The strong belief that you are defective and ugly 
-The experience of shame and embarrassment around appearance when in social situations 
-Avoidance of such social situations altogether or isolating due to insecurities around appearance  
-Engaging in behaviors aimed to fix, control, or change your appearance 
-Seeking frequent cosmetic procedures in an effort to change or “fix” appearance coupled with little satisfaction of the results 
-Constant comparisons of self to others 

What causes an Eating Disorder to develop?

Eating Disorders are unique in the fact that there is not only a mental and emotional component but also a physical/medical component as well.

The scientific field of Eating Disorders still does not definitively know what causes a certain Eating Disorder to develop in an individual and in fact, finding “the reason” behind the development of your Eating Disorder can be an almost impossible task to uncover. Researchers are continuing to investigate etiology in order to better understand the complexities of Eating Disorders. 

Shifting your focus from needing to know “why” exactly you developed an Eating Disorder to instead learning about and understanding your triggering factors and functions of your Eating Disorder is more realistic and helpful in treatment. While symptom presentations of Eating Disorders can appear similar, each person has their own uniquely different story for their own struggles. Eating Disorders do not discriminate based on age, gender, social class or race. Research has shown a combination of cultural, biological and psychological factors contributing to Eating Disorders. These factors include, but are not limited to:

– Eating Disorders have a high comorbidity rate with trauma, substance abuse, depression, anxiety and OCD.
– Bullying, media representations of the ideal body size and norms, low self esteem, weight stigma and a limited social support system 
– Having a relative who struggles with an Eating Disorder and/or another mental illness 
– History of dieting and/or cultural norms around dieting 
– Perfectionism or behavioral inflexibility (i.e. strict rule following/or doing things the “right way”)

eating disorder therapy Chicago patient depicted by a upset woman with her hands on her head

What will therapy for my Eating Disorder look like?

If you’re seeking support from an Eating Disorder therapist, whether it is your first time addressing disordered eating habits or you’re stepping down from a higher level of care, Cityscape Counseling is ready to serve you. We are expertly trained to treat individuals at all stages of the recovery process. 

Treatment may consist of any or all of the following:
(tailored to each individual’s unique treatment needs)

-comprehensive assessment to provide formal diagnosis and assess eating and body related pathology scores in order to track progress
-individual outpatient therapy with a specialized Eating Disorder therapist *see various therapy modalities listed further below
-collaboration with external dietitians, physicians, psychiatrists & treatment centers
-outpatient group therapy at Cityscape Counseling *see current group offerings
-family based treatment approaches for adolescents and children 
-partner support/psychoeducation sessions
-in-session meal support and/or meal plan accountability
-weight monitoring, if relevant 
-Assessment, motivational work and referral to a higher level of care if necessary

Outpatient therapy is meant for those who are medically stable, working to maintain recovery and/or those just getting started on their journey.

Higher levels of care are recommended for those who:

-are needing more support than can be provided at an outpatient level to sufficiently address Eating Disorder behaviors 
– when Eating Disorder behaviors are interfering with your ability to function day to day (as is often seen when there is engagement with Eating Disorders at a high frequency). 
-when we are concerned about your medical stability

Our therapists draw from a number of different therapy modalities some of which are discussed below:

Dialectical Behavioral Therapy (DBT): Dialectical Behavioral Therapy (DBT) offers an evidence-based approach to individuals struggling with an eating disorder. Through the use of its core principles of mindfulness, interpersonal effectiveness skills, emotion regulation and distress tolerance skills, DBT can help people learn to decrease and better manage eating disorder behaviors. DBT can help to minimize and eliminate behaviors such as restricting, purging, and bingeing and help with the ability to cope with difficult feelings. 

DBT is modified from CBT and is a cognitive behavioral therapy with the main goals of teaching people to live in the moment, developing healthy ways to cope with your emotions, improve relationships. DBT can provide you with the tools to help you to take control of your life and work towards recovery from your eating disorder.  

Cognitive Behavioral Therapy (CBT): Identifying, challenging and changing unhelpful cognitive distortions and behavioral patterns to improve your quality of life. 

Acceptance and Commitment Therapy (ACT): Using acceptance and mindfulness tools, together with commitment and behavior change strategies to increase your psychological flexibility.

Radically Open Dialectical Behavioral Therapy (RO-DBT)Targeting over-controlled coping and personality styles, such as perfectionism, rigidity, and difficulty with flexibility.

Exposure & Response Prevention (ERP): Decreasing urges to engage in avoidant or self-destructive behaviors by deliberately exposing yourself to triggers under controlled conditions. ERP encourages you to face your anxiety, with the support of your therapist, and trust that the distress will naturally reduce over time, therefore decreasing the urgency to engage in avoidant or self-destructive behaviors.

Movement Therapy: Working to improve the lived experience in your body by creating a more kind, compassionate and engaging relationship with yourself.  

Understanding the Link Between Trauma and Eating Disorders

Eating disorders are often seen as isolated struggles, confined solely to food, body size, and weight. However, for many people, there is a significant link between these debilitating conditions and experiences of trauma. Understanding this connection is crucial, not only for providing effective treatment, but also for offering healing and hope to those suffering in silence.

The research is quite striking. Studies reveal that individuals with eating disorders are significantly more likely to have experienced trauma compared to the general population. The numbers speak volumes: up to 80% of individuals with anorexia nervosa report a history of abuse, and 75% of individuals with bulimia nervosa report a history of childhood abuse. Veterans with experiences of PTSD are more likely to develop eating disorders. Military sexual trauma (MST) is a risk factor for developing eating disorders especially among female identified veterans.

Why this complex link? Trauma, whether physical, emotional, or sexual, shatters our sense of safety, control, and trust. It leaves behind emotional scars, often manifesting as anxiety, depression, and dissociation. In this fractured state, eating behaviors become tools for regaining a semblance of control, numbing painful emotions, or even serve to punish oneself. Eating disorders, while painful and harmful, can also be experienced as a safe-haven and/or behaviors that elicit a perceived sense of safety.  

The consequences are extensive and pervasive. Eating disorders wreak havoc on physical and mental health, and severe emotional distress. Social isolation, strained relationships, and impaired academic or professional functioning become all too common. The quality of life plummets, leaving individuals trapped in a debilitating cycle.

But there is hope. While overcoming trauma and an eating disorder is a challenging journey, it is possible. Addressing both the eating disorder and underlying trauma is crucial. Therapies like trauma-focused cognitive behavioral therapy (TF-CBT) and dialectical behavior therapy (DBT) equip individuals with coping skills to manage difficult emotions and rebuild healthy relationships with food and their bodies. Radically Open DBT (RODBT) can help increase feelings of social safety that help individuals engage with others, as opposed to retreating in isolation, which furthers their emotional and physical suffering. Acceptance and Commitment Therapy (ACT) is another useful treatment that addresses experiential avoidance through increases in mindful awareness of distressing memories and psychological flexibility.

Addressing shame and stigma: Breaking the silence surrounding trauma and eating disorders is critical. Openly discussing these issues fosters understanding, empathy, and reduces the isolation felt by those struggling.

Building support systems: A strong network of support, including family, friends, and professionals, is key for sustained recovery. Creating a safe space for open communication and offering non-judgmental support becomes a must for healing.

By acknowledging the trauma-eating disorder connection and prioritizing holistic, trauma-informed care, we can pave the way for individuals to reclaim their lives, rediscover their strength, and embrace a future free from the shadows of the past.

Additional Resources:

If you or someone you know is struggling with an eating disorder and trauma, please reach out for support and resources.

Eating Disorders and Co-Occurring Anxiety

Eating disorders rarely occur on their own without another diagnosis being present, and a very common pairing is eating disorders and anxiety disorders. According to the National Eating Disorder Association (NEDA), “approximately 48% of adults with anorexia nervosa, 81% of adults with bulimia nervosa, and 65% of adults with binge eating disorder have at least one co-occurring anxiety disorder. Anxiety disorders most frequently precede the onset of an eating disorder”.  These two disorders have a complex connection and show up in a variety of ways. It is common for anxiety disorder to pre-date and even contribute to the development of an eating disorder, with the disordered beliefs and behaviors serving as a maladaptive coping mechanism for the anxiety itself. It’s also possible for the opposite to be true, where an eating disorder can lead to the development of agoraphobia or social anxiety for example. And finally, the two can become intermixed in complicated ways, one feeding the other without such a clear distinction between the two. 

These two disorders are so commonly co-occurring because anxiety itself is part of every eating disorder to some degree: fear of weight gain, obsessively thinking or worrying about food, the body, exercise or other’s perception or judgment, fear of fullness or the feeling of being nourished. Likewise, when a person is engaging in eating disorder behaviors, such as binge eating, purging, or restricting food intake, anxiety symptoms can decrease at least for a short time, making those behaviors even more desirable and prompting them to continue. 

While an eating disorder and anxiety disorder are separate and have their own set of criteria, they can also be treated concurrently by a trained therapist. Often, eating disorders are centered around experiential avoidance, meaning they ultimately function as a way to avoid an undesirable experience. If an eating disorder is co-occurring with an anxiety disorder, the likelihood is high that the anxiety itself is the experience that the individual is wanting to avoid by engaging in eating disorder behaviors. Because of this connection, interventions that are helpful for the treatment of anxiety will also be helpful for the treatment of an eating disorder. A therapist trained in the treating of eating disorder and anxiety disorders can help a person struggling with both to distinguish between each disorder, and also identify the overlaps. They can then provide tools for reducing the intensity and frequency of symptoms, which also providing space for healing and building a fulfilling life without the present of either disorder. 

Understanding the Intersection between Eating Disorders and Self-Injury

Within so many of us, we experience a complex interconnection of physical and emotional pain. For individuals struggling with eating disorders and non-suicidal self-injury (NSSI), this connection can form a tangled web that can feel impossible to navigate alone.

The co-occurrence of eating disorders and NSSI is actually quite common. Studies estimate that as many as 30% of those with eating disorders engage in NSSI, while conversely, up to 40% of people who self-harm experience disordered eating patterns. This alarming overlap paints a picture of shared underlying factors, suggesting that both behaviors serve as unhealthy coping mechanisms for struggling individuals.

Shared Underpinnings, Different Forms of Expressions:

The roots of this connection run deep, and are compounded by psychological and emotional vulnerabilities or risk factors. Both NSSI and eating disorders often stem from difficulties with emotional regulation, body image dissatisfaction, and low self-esteem. When confronted with overwhelming emotions, individuals might turn to either behavior as a way to numb the pain, express inner turmoil, or regain a sense of control. In this twisted equation, the physical act of self-harm provides a temporary release from emotional suffering, while the control exerted through disordered eating becomes a distorted sense of empowerment.

However, this temporary relief comes at a steep cost. The physical and emotional consequences of both NSSI and eating disorders can be severe, ranging from malnutrition and self-inflicted injuries to depression, anxiety, and increased risk of suicidal thoughts. It is crucial to remember that NSSI and eating disorders are complex emotional struggles that demand compassionate understanding and professional support.

Prevalence: 

The statistics paint a stark picture: millions of individuals worldwide grapple with the intertwined struggles of eating disorders and NSSI. In the United States alone, roughly 30 million struggle with an eating disorder, while NSSI impacts around 1 in 25 adolescents. These numbers highlight the urgent need for increased awareness, education, and access to comprehensive treatment options.

Stigma:

For many who engage in self-injury, it can feel as though no one understands why this would become a behavior you look to for relief. The stigma can exacerbate keeping your truth a secret. People may think you are attention-seeking when in fact the function may serve an entirely different purpose. Assumptions and stigma, fueled by misinformation and misunderstanding about NSSI can reinforce the shame connected with the behavior. It isolates individuals, making them feel ashamed and unworthy of help. It hinders open communication, pushing the conversation about self-injury further into the darkness. It prevents countless people from seeking the treatment they desperately need, perpetuating a cycle of silence and suffering.

Treatment: There is Hope:

Fortunately, there is hope. Evidence-based therapies like cognitive-behavioral therapy (CBT), dialectical behavior therapy (DBT), Radically Open DBT (RODBT) and acceptance and commitment therapy (ACT) have proven effective in treating both eating disorders and NSSI. These therapies focus on identifying harmful thoughts and behaviors, developing healthy coping mechanisms, activating social safety, and improving emotional regulation skills. Additionally, medications can play a vital role in managing co-occurring disorders, especially when symptoms like depression or anxiety are severe.

Supporting Loved Ones: 

For friends and families of individuals struggling with eating disorders and NSSI, offering support is critical. By validating their experiences, encouraging open communication, and providing information about resources, loved ones can become a vital source of strength and hope. Learning the warning signs of both conditions, such as changes in eating habits, self-isolating behavior, and physical injuries, can also empower loved ones to offer timely intervention.

Remember, eating disorders and NSSI are complex conditions, and recovery is a nonlinear journey. Offering patience, understanding, and unwavering support, without judgment or pressure, can make a world of difference.

RODBT for Eating Disorders

Radically Open DBT (RODBT) is an evidence-based treatment with over 20 years of research underlying its principles and treatment strategies. RODBT is aimed at targeting disorders of emotional overcontrol (OC). An OC personality style is characterized by excessive self-control, rigidity, and tendencies toward rule following and perfectionism. While this treatment is trans diagnostic, which means its focus is on the personality style more so than the diagnosis itself, research shows that RODBT is a highly effective treatment for eating disorders across the ED clinical spectrum. This can include but is not limited to restrictive eating behaviors, excessive exercise, binge/purge and binge eating behaviors. 

Why would RODBT be helpful for eating disorders?
We know what underlies many eating disorders is often a sense of control. Eating disorders are often isolative and make the world around us terribly small. As our world shrinks so does our social network. An array of clinical problems often result, including depression, anxiety, and a profound sense of loneliness.


In RODBT, we recognize that we are social beings and conduct ourselves in ways that can keep us IN or OUT of our social groups. Eating behaviors can serve to be maladaptive social signals, and whether we are aware of it or not, can keep us out of our communities and contribute to extreme feelings of loneliness. RODBT helps us recognize how eating disorder behaviors can keep us at arm’s length from others. It encourages us to identify and look at our values related to others and how we can use skills to create a sense of safety within ourselves so that we may rejoin our communities. RODBT identifies social signaling as the primary mechanism of change

Maladaptive Social Signals 

Maladaptive social signals are often experienced as behaviors and/or emotional expression that is incongruent with one’s internal experience. This can be experienced in a range of experiences including a fake smile or masked/constricted affect. It can be confusing or off-putting by the receiver and over time, can impede emotional closeness with others.    

Emotional Loneliness

In addition to its focus on examining and working through deficits in social signaling, RODBT posits that emotional loneliness is another significant program to be addressed. It suggests that if we address social isolation, we can address the eating disorder and its accompanying disorders and symptoms like depression. 



How does the treatment look?
In RODBT individual therapy, you’ll likely focus less on a meal plan or focus on food (which can be addressed by others on your treatment team) and will focus more on your problematic social signals. You may identify how eating behaviors serve as maladaptive social signals and through a manualized protocol, will identify how you can use skills to signal to others more effectively in ways aligned with your values. 
You will also likely be encouraged to participate in an RODBT skills class, a 30-lesson curriculum that teaches skills to activate social safety and address habitual over control. Because RODBT is transdiagnostic, the class cohort may have a range of clinical presentations, but will all share the OC personality style. 

ACT for Eating Disorders

Acceptance and Commitment Therapy (ACT) is an evidenced-based treatment modality that focuses on helping people engage more with their life by engaging less with their unhelpful thoughts. ACT has been proven to be effective for treating many mental health conditions including eating disorders. ACT has 6 core principles, all of which are useful in treating eating disorders:

  1. Mindfulness: Mindfulness is a critical foundational skill to practice for anyone recovering from an eating disorder. Mindfulness allows the individual to pay attention to emotions, thoughts and urges, and cope effectively. It is also foundational for practicing intuitive eating, a concept often practiced in eating disorder recovery. Mindfulness emphasizes a non-judgmental stance, which when practiced in the context of eating disorder recovery promotes self-compassion and healing. 
  2. Values Identification: ACT encourages individuals to identify their most important values. Values serve as a compass, guiding the individual toward the life they want to be living and what is most meaningful to them. Value identification provides motivation for the individual to pursue their goal of recovery. 
  3. Committed Actions: Once a person’s core values are identified, committed actions serve as an opportunity for the individual to actively serve their values. An example would be “I value health. In service of this value, I commit to following the meal plan that my dietitian created for me”. A committed action is a specific, value-driven goal that the individual holds themselves accountable to pursuing in service of a value that is important to them. 
  4. Cognitive Defusion: Eating disorders are highly cognitive in nature, with many disordered thoughts and urges coming into the person’s awareness every day. Cognitive defusion offers an opportunity for the individual to alter their relationship with those thoughts and urges. Rather than taking them at face value, cognitive defusion encourages the perspective that thoughts are just thoughts, not necessarily truths. By gaining space from disordered thoughts and urges, a person seeking eating disorder recovery can more successfully challenge those thoughts and act in opposition to them.
  5. Acceptance: ACT encourages acceptance of a reality as it is, even if that reality is distressing or feels unfair. Rather than trying to avoid or deny an uncomfortable reality, ACT posits that acceptance is the first step to being able to recover and heal. 
  6. Self As Context: This core principle of ACT centers around the concept that people are not their thoughts and feelings, but rather they are a whole person who can observe their inner experiences without being caught up in them. This space allows for interventions to take place, and changes in mindset to occur. 

The treatment of eating disorders is complex and nuanced, and ACT has the ability to cater to the specific needs of the individual. With the 6 core principles listed above, a person struggling with an eating disorder can build a meaningful life and reach complete recovery.

ERP for Eating Disorders

Exposure Response Prevention (ERP) is a treatment modality that focuses on helping people to respond more effectively to their intrusive thoughts by eliminating compulsive behaviors. This is done by exposing them to situations that feel distressing and teaching new ways to respond to those thoughts and emotions. This process builds tolerance, decreases distress, and therefore decreases avoidance of those distressing situations.

ERP is most often associated with the treatment of obsessive-compulsive disorder but has been shown to be very effective in the treatment of eating disorders as well. Often times people suffering from an eating disorder avoid situations because they are distressing, which can create a narrow and less fulfilling life, allowing the eating disorder to thrive and feel more prominent. The aim of ERP is to expose the individual to distressing events, so they can then learn to alter their response. Rather than engaging in compulsive behaviors or avoidance, they build up tolerance to the distress. ERP is the key to opening up the individual’s life again.

The first step is to identify a hierarchy. This is essentially a list of things that the individual finds distressing and tends to avoid, ranked in order of difficulty. An example focused on body image could be:

  1. Wearing a bathing suit in public
  2. Wearing shorts in public
  3. Wearing a tank top in public

In this example, #3 would be the starting point, and slowly the individual would work their way up the hierarchy, facing more distressing situations as they go. The aim would be for the individual to learn to tolerate the distress without engaging in any other compulsive behaviors, such as closed off body language, staying off to the side without being seen etc. Over time, the individual will feel more comfortable wearing a tank top in public, which means they will have more options for dressing when it’s hot outside. Moving up the hierarchy means challenging the intrusive thoughts that led to avoidance in the first place, and it also represents the individual getting more and more of their life back from their eating disorder. 

Another example of a hierarchy could be:

  1. Feeling very full without purging
  2. Eating fried foods
  3. Eating dessert after dinner

Again, the individual would work with their therapist to expose themselves to eating dessert after dinner without any compulsive behaviors to help ease the distress. Examples of compulsive behaviors could include planning to over-exercise the next day, throwing away part of the dessert, planning to restrict the next day, or pacing around the room while eating. The aim is to feel the emotions and be present with the thoughts that come up, tolerate them, and observe as they pass. Once one level is completed, the next item on the hierarchy can be worked on. 

ERP often feels quite intense and challenging because it encourages people to do the things they either avoid or engage in compulsive behaviors to manage, so by definition it isn’t going to be an easy experience. The benefits far outweigh the costs though because it is proven to be effective, and it helps return the individual back to a meaningful, complete, and fulfilling life.

Do I Need To Work With A Dietitian?

Treating an eating disorder can be a complex process that often requires the attention of a multidisciplinary team of professionals. Dietitians are among the many experts who can play a vital role in helping people establish a solid foundation for long-term eating disorder recovery. Dietitians use the science of nutrition to help people understand the connection between food and health. Additionally, they provide guidance, support, and education to help individuals achieve improved health by expanding their understanding of nutrition-related concepts, reducing self-defeating behaviors, and developing a better relationship with food.

Whether you are experiencing significant weight changes, obsessive thoughts about food, concern about your eating patterns, physical health issues, emotional distress related to food/body image, or are simply curious about the ways a dietitian can support your health journey, talk to a therapist well-versed in eating disorders who can help assess your situation and guide you to the appropriate resources for support and treatment. Early intervention is critical in the treatment of eating disorders, and a dietitian plays a pivotal role in that treatment process.

Below are specific ways that a dietitian can assist you in the treatment of your eating disorder: 

  1. Nutritional Assessment
    1. A dietitian will assess current eating habits, nutritional status, deficiencies/imbalances in your diet, body-image concerns, activity level, culturally-relevant practices, family history, goals, and more in an attempt to gather data about your current lifestyle and the changes you are hoping to see. 
  2. Meal Planning
    1. Developing a more structured and balanced meal plan that meets your specific nutritional needs is often an essential part of recovery. A dietitian can work with you to establish these changes and address any fears or challenges related to food that you may encounter. 
  3. Education
    1. A dietitian is an excellent resource for information and education. They will provide nutritional guidance as well as assist in the discovery of how an eating disorder develops and how eating disorders affect mental and physical health. 
  4. Behavioral Strategies/Coping Skills
    1. A dietitian can collaborate with other mental health professionals to address the behavioral aspects of your eating disorder. This may involve exploring triggers, developing coping strategies, and fostering a healthier relationship with food. 
  5. Support and Accountability
    1. Regular sessions with a dietitian can offer ongoing support and accountability. This can be particularly helpful in navigating challenges, setbacks, or moments of uncertainty during the recovery process. 

Please discuss your curiosity and/or uncertainty about dietary support with your eating disorder therapist and let us support you in your recovery journey. Therapists at Cityscape Counseling have close and well-established relationships with dietitians all around the Chicagoland area with a wide variety of specialty and availability.

How to Help a Loved One with an Eating Disorder

  1. Learn about eating disorders and treatment. 

Take time to research all eating disorders and the various treatment options. Eating disorders are never actually about the food or wanting to look a certain way, they are always symptoms of a deeper issue.

  1. Be considerate when expressing your concerns. 

Find a time and place that is private and not during a mealtime to talk. A respectful, one on one conversation goes a long way in opening up the conversation with a loved one about the symptoms you’ve noticed and the concern you have. 

  1. Communicate your concerns using “I” statements, no blame or shame!

An example of this would be “recently I’ve noticed that you push your food around your plate at dinner time but aren’t eating very much” or “I am concerned about your body image, I’ve heard you talk negatively about your weight quite a lot recently”. These statements are loving in nature and also directly relate to what you have noticed without assigning blame to your loved one. 

  1. Validate your loved one’s feelings and experience. Listen compassionately.

Being invited into a conversation about their relationship with food, exercise and body image can be daunting. Make sure to be patient and allow space for your loved one to share how they feel. Validate their feelings and ensure they feel heard. This builds trust and security within the relationship.

  1. Emphasize the importance of professional help. 

Acknowledge that an eating disorder is a serious medical and psychiatric concern that warrants professional help. Talk to your loved one about the options of treatment, group therapy, individual therapy, psychiatric support, and dietetic support. Your earlier research will come in handy here. 

  1. Ask your loved one what support looks like for them, and really listen to their response. 

Get clarification on how you can show up for them, what’s helpful and what isn’t. If they aren’t sure, feel free to offer options so they can give feedback. Some ideas include checking in with them daily about food, exercise, and body image, asking about therapy goals and homework, cooking for them, eating meals with them etc. 

  1. Have willingness to make changes based on your loved one’s recovery plan. 

Being willing to make changes to your habits to support your loved one’s recovery demonstrates a great deal of love and support. This might mean changes to meal times, eating patterns, exercise habits and language used about bodies, food and exercise. 

  1. Understand that recovery is not linear. 

Relapse will happen and it’s important to acknowledge it without emphasizing, blaming or shaming. If you can remain calm during a challenging time in recovery, that will encourage your loved one to calmly address the challenge and get back on track. 

  1. Strive to be a good role model. 

This means refraining from body talk, body comparisons, dieting etc. Your words and actions being aligned with your loved one’s recovery will show your support and will normalize recovery-focused language and actions. 

  1. Engage in self-care so you can be the best version of yourself to support your loved one. 

This means being in your own therapy, engaging in meaningful and mindful activities that you enjoy, and addressing stress as it creeps in.

Body Dysmorphia – Is It an Eating Disorder?

The short answer is, no. Body Dysmorphic Disorder and Eating Disorders are classified differently in the Diagnostic and Statistic Manual. 

Body Dysmorphic Disorder (BDD) is listed under Obsessive-Compulsive and Related Disorders in the DSM and is marked by a preoccupation with perceived flaws in one’s appearance (this perceived flaw is either non-existent or appears very slight to others) companied by repetitive behaviors and mental acts such as excessive grooming, mirror checking, comparing their appearance with others, or reassurance seeking. Often these repetitive behaviors and mental acts take away a significant portion of time from the individual with BDD, sometimes multiple hours per day are lost to this disorder. These preoccupations and accompanied behaviors cause significant distress to the individual and impair their ability to appropriately function in important areas of their lives such as socially or occupationally. 

An important distinction to make is that BDD does not include any engagement with food, exercise or purging like eating disorders do. Someone who is diagnosed with BDD has identified at least one part of themselves they don’t like, but their solution to managing this is not necessarily to change their eating or exercise habits, or to engage in purging behavior. For example, a person diagnosed with BDD might fixate on their nose or their forehead or their hands, and they will not change anything about their food intake or exercise as a result. Even if the person diagnosed with BDD fixates on the fat on their legs for example, they would not engage in any eating disordered behaviors as a result. BDD is a stand-alone disorder that focuses on the fixation of a perceived flaw, the repetitive behaviors and mental acts, and the impact on functioning which is why it was placed in the Obsessive-Compulsive and Related Disorders category in the DSM. 

BDD and an eating disorder can be co-occurring if the individual meets criteria for both disorders. This means they would meet the above-mentioned criteria for BDD and also engage in eating disorder behaviors such as binge eating, purging, excessive exercise or restricting their food intake. In this case, their functioning would also need to be impaired, and the disorders would cause a great deal of distress to the individual on a daily basis. 

The primary overlap between these two disorders is body image dissatisfaction which can be found in BDD as well as several eating disorders. This dissatisfaction goes beyond not being happy with the reflection in the mirror and involves the heightened level of distress and the impact in functioning described above.  

When finding treatment for BDD, and eating disorder, or both it is important to look into the specialty of the therapist, as these disorders fall into different categories and often require different modes of treatment and different accompanying treatment providers. Both BDD and eating disorders are highly treatable with the right treatment team in place.

Body Image Interventions

Body image refers to the perception, thoughts, and feelings that individuals hold about their own bodies. Body image is described as negative or positive, and often encompasses how people see themselves, the level of comfort felt in their respective body, and the attitudes they hold regarding their physical appearance. It is important to note that body image is subjective in nature, is not reserved for any specific body type, and is variable in presentation as it is influenced by cultural, societal, and personal factors that are not static. 

Negative body image occurs when individuals hold critical or distorted views about their bodies, often leading to feelings of dissatisfaction, shame, or disgust. Positive body image occurs when individuals can accept, appreciate and respect their bodies for what they have to offer and how they look in any present moment. 

Depending on the presenting concern and the goals established at the start of therapy, therapists will use a variety of body image interventions to target negative body image and the associated cognitive, emotional, and behavioral factors that accompany it. Please see the list below for some of the more commonly utilized interventions.

Please note that these interventions should not be attempted without the support and oversight of a therapist. 

  1. Exposures and Desensitization
    1. Description: Guiding individuals through exercises where they gradually spend time looking at their reflections in a mirror or specific parts of their body. The expectation is that over time, an individual will experience less distress, negative thoughts, and body dissatisfaction. 
    2. Focus of Intervention: Desensitization to promote self-acceptance through visual confrontation with one’s body and a reduction in avoidant behaviors. 
  2. Cognitive Restructuring 
    1. Description: Identifying and challenging distorted thoughts and beliefs about one’s body. An eating disorder therapist work with clients to reframe negative cognitions and develop more realistic and positive perspectives.
    2. Focus of Intervention: Changing negative thought patterns to foster a kinder and more accepting self-image. 
  3. Body Mapping
    1. Description: Creating a visual representation of the body where individuals mark areas associated with positive or negative feelings. It serves as a tool for self-reflection and communication between therapist and client. 
    2. Focus of Intervention: Identifying and exploring emotions, thoughts, and perceptions related to different parts of the body. 
  4. Journaling
    1. Description: Encouraging individuals to keep a journal to track and reflect on their thoughts and feelings about their bodies. This can help identify patterns, triggers, and changes over time. 
    2. Focus of Intervention: Self- reflection, identification of negative patterns, and progress tracking. 
  5. Narrative Therapy
    1. Description: Focusing on the stories individuals tell about themselves and their bodies. Therapists may guide clients in re-authoring their body image narratives with the intention of exploring alternative perspectives. 
    2. Focus of Intervention: Reconstruction of the narrative surrounding body image to foster empowerment. 
  6. Guided Imagery and Visualization
    1. Description: Using guided imagery exercises where individuals visualize themselves in positive and empowering scenarios. This can help shift the focus from negative body thoughts to more positive and affirming ones.
    2. Focus of Intervention: Changing mental imagery and promoting positive self-perceptions. 
  7. Positive Affirmations
    1. Description: Clients work on developing and repeating affirmations that challenge negative beliefs. These affirmations can be provided by the therapist or written by the individual. 
    2. Focus of Intervention: Reinforcing positive self-talk and promoting self-compassion. 
  8. Social Media Overhaul
    1. Description: Providing education on media influences, unrealistic beauty standards, and image manipulation. This helps individuals develop critical thinking skills and reduce the impact of media on their body image.
    2. Focus of Intervention: Increasing awareness, challenging societal norms, and fostering a realistic understanding of media representations. 
  9. Art Therapy
    1. Description: Art Therapy allows individuals to express their feelings and thoughts about their bodies through various art forms, such as drawing, painting, or sculpting. The creative process can offer insights and serve as a non-verbal means of communication when words don’t feel accessible. 
    2. Focus of Intervention: To promote self-expression, self-discovery, and a positive shift in body image through artistic exploration. 

If you suspect that you struggle with negative body image, seeking support from a therapist can be very beneficial. A therapist well versed in body image interventions will be able to provide guidance, psychoeducation, and tangible strategies to promote a more positive relationship with your body. The effectiveness of these body image interventions rely on a collaborative relationship between you and the therapist. 

We know that seeking out therapy can be a daunting endeavor so we’re dedicated to helping you each step of the way.

if you’re looking for therapy for eating disorders in Chicago, cityscape counseling would love to work with you.