Question: When I was a kid I found I couldn't leave my bowl of cereal alone or I couldn't eat it. If i was present and watching it I knew nothing bad had happened to it, If i left it for any reason my mind would suggest all the things that could be in there that I couldn't see, typically worms, and I would have difficulty choking it down. As an adult, this has morphed into, i see something i find gross, (worms and house centipedes mostly) the next time I go to eat my mind will give me vivid images of finding, ( or worse, NOT finding) those things in my food to the point where even if i do manage to put the food in my mouth I'm fighting my gag reflex to swallow and keep it there. The result is that I won't/can't eat the rest of the day and only manage light amounts the next. Extreme distraction at the time of eating helps, watching a isn't typically enough but reading a book or very compelling or passionate conversation can. Why does my brain do this to me? Why does it hate me? How do I get it to STOP? I have a very fast metabolism and am already teetering on being underweight.

William Anderson Says...:

The kind of experience you are describing is not unusual, but it is not a typical food addiction or eating disorder problem. The thoughts may be something that are called obsessions and might be relieved with a medication. Working with a therapist who specializes in cognitive therapy will also be helpful. The problem is solvable with the right approach of behavioral medicine, but is not something that you can just figure out on your own or with suggestions from well-meaning friends without the right training. Make an appointment with a psychiatrist who will assess the situation and help you form a treatment plan that will solve the problem as quickly as possible. There is no need for you to continue suffering with it on your own. The treatment plan will include specialized therapy and perhaps medication. 

Question: my friend told me that she made herself throw up and she stopped eating for two days cause her sister called her fat but she told me she's going to stop and knows it's unhealthy for her. What can I do to help her and would exercising with her help her stop?? She also seems really stressed out lately, is there anything I can do to help her get through this??

William Anderson Says...:

You don't have the power to control your friend, but knowledge is power. If you both acquire some good knowledge about dangerous eating disorders (which can even be fatal), that may be all you need to avoid a dangerous brush with a very dangerous eating disorder.

Read everything you can find from reliable sources about eating disorders such as the information you'll find at the National Institute of Health. Be careful about the articles you read and websites you find on the Internet, because a lot of what you'll find on the Internet is erroneous and even harmful "information". There are even websites that promote eating disorders and do a great deal of harm to many young women who are told it is a good idea to throw up and starve yourself.

Learn all you can, tell your friend what you've learned, and tell her where to find this information. If she continues with this dangerous unhealthy behavior, ask her to see a counselor, and go with her if it helps her.

You are in a great position to be helpful, because she trusts you and has shared this very personal information with you. Keep that trust by being caring and compassionate instead of critical and scolding. Write back and let me know what happens.

Question: my friend told me that she made herself throw up and she stopped eating for two days cause her sister called her fat but she told me she's going to stop and knows it's unhealthy for her. What can I do to help her and would exercising with her help her stop?? She also seems really stressed out lately, is there anything I can do to help her get through this??

Katie Brooks Says...:

Hello there-

I'm
glad you wrote.  Eating disordered behaviors, like restricting and
throwing up, have a lot to do with unprocessed negative emotions and, in this
case, self-esteem.  It seems to me that your friend had hurt feelings with
her sister, which triggered insecurity.  She chose to cope with those feelings of insecurity by using unhealthy coping methods. In regards to helping her, I'm not sure exercising with her
would send her the right message right now.  I think it might validate
that she is fat and that she needs to do something to fix it.  Sometimes
exercising can become part of an eating disorder as well.  Even though it
is healthy to exercise, it can be done to excess if it is done for the wrong
reasons.  For instance, if my self-esteem is low and I am trying to lift
it by exercising, then my self-esteem will be contingent upon being thin.
 I will never learn how to love myself unconditionally.  

I believe that it
would be more loving for you to help your friend cope with the hurt feelings.  Send her the message that she is beautiful inside and out and that she does not
need to change a thing in order to be loved by herself or anyone else.
 Help her to stick up for herself by encouraging her to ask her sister not
to call her fat because it is hurtful.  Teach her to love herself and her
body by striving for health rather than being thin.  Tell her that she
will feel better if she was eating healthy foods regularly and staying active.
 In addition, teach her that purging and restricting will not bring her
health and wellness.. it will only bring more pain and stack a problem on top
of a problem.  I hope this was helpful.  If you have any more questions
please contact me at goodtherapysandiego.com.

Warmly, 

Katie Brooks, LCSW

Director of Good
Therapy San DIego

GoodTherapySanDiego.Com

(760) 525-9565

Question: my friend told me that she made herself throw up and she stopped eating for two days cause her sister called her fat but she told me she's going to stop and knows it's unhealthy for her. What can I do to help her and would exercising with her help her stop?? She also seems really stressed out lately, is there anything I can do to help her get through this??

William Anderson Says...:

You don't have the power to control your friend, but knowledge is power.  If you both acquire some good knowledge about dangerous eating disorders (which can even be fatal), that may be all you need to avoid a dangerous brush with a very dangerous eating disorder. 

 Read everything you can find from reliable sources about eating disorders such as the information you'll find at the National Institute of Health. Be careful about the articles you read and websites you find on the Internet, because a lot of what you'll find on the Internet is erroneous and even harmful "information". There are even websites that promote eating disorders and do a great deal of harm to many young women who are told it is a good idea to throw up and starve yourself. 

 Learn all you can, tell your friend what you've learned, and tell her where to find this information. If she continues with this dangerous unhealthy behavior, ask her to see a counselor, and go with her if it helps her.

You are in a great position to be helpful, because she trusts you and has shared this very personal information with you. Keep that trust by being caring and compassionate instead of critical and scolding. Write back and let me know what happens. 

Question: Do I have an eating disorder? Even though I know I am very thin and most people say I am too skinny I still feel good when I wake up in the morning and I look even skinnier than usual. I am kind of confused by this because I can see that this is messed up…I know it is not good, but when I get worse I feel better…WTF? I am not sure if this means I have an eating disorder because I am not blind to this situation I can see that I am too skinny but at the same time I am always thinking about not eating too much so I won’t get fat.

William Anderson Says...:

It sounds like you might have a problem that could become very serious. You are aware that something is wrong. You know something is messed up and you are alarmed that you feel good when you get worse. You know there is something wrong with that. You know that you're too skinny and being worried about being fat doesn't make sense. You know that your friends are seeing something disordered and are worried about you. 

Trust your friends who care about you and trust the insight you still have that tells you something is wrong. If you have an eating disorder and it continues to get worse, you may lose that good insight. 

It is imperative that you consult with a medical professional that specializes in Eating Disorders as soon as possible. Go to an emergency room at a hospital or an acute care clinic if you can't get an appointment. Don't delay. If your body becomes too compromised by weight loss, you'll lose mental and physical functions that are important and may even become at risk of death. If the doctor says you have a serious problem, trust him or her and do exactly what they say. If your illness has progressed to a dangerous state, you may be tempted to discount what the doctor says, so that will be a red flag. Trust that the doctor has better insight into the situation than you do. 

Make that appointment today and write back to tell me what happens. 

Question: Is it weird to feel very guilty about bulimia. When my mom gives me dieting advice I feel so horrible and guilty I want to scream but I don’t say anything.

Rob Danzman Says...:

Dear Anonymous,

Thanks so much for reaching out. I'll answer your question with some other questions first. 

When you say you feel guilty about bulimia, I'd like to understand more. More specifically, what do you mean by 'about?' This is not a challenge to you but a path I would take to better comprehend how you are experiencing bulimia and the underlying causes (or, more accurately, stressors). I'd like to define what the stressor is and how specifically you feel about it and how it impacts your choices and behaviors. Seems simple but pretty complex when you break it down. It's not uncommon for folks to say they feel 'upset' about something but what does that really mean? Are you angry, sad, sick? I want you to have a safe place where you can define for yourself what you mean by feeling guilty. 

Next, I'd really like to dig into the relationship with your mother (and family in general). When I hear a parent is providing dieting advice, a few concerns start to pop up. Like, why is mom giving dieting advice? Is this in conjunction with other wellness advice like exercise, respect for yourself, yoga, healthy relationships, etc? Does mom have her own eating disorder or psychological issues? Asking and answering some of these questions could help figure out the best way to make some healthy changes in the family system. 

Finally, it sounds like you are not happy with how or what your mom is communicating to you about eating, food or healthfulness. This obviously is tied to the relationship with your mother but also a separate question - How do you respond to anyone that seemingly pushes you in a direction you don't like? I wonder if this is isolated with your mother or a larger pattern manifesting in other relationships. Not a pattern that's your fault but a pattern that if you can recognize, you might be able to change. Here is a really great resource focused on Dialectical Behavioral Therapy or DBT we use often in our practice. This is just one example of some skills you might find useful. 

You have a fantastic opportunity here if you seek help from a professional. If nothing else, reaching out to a therapist that will provide a safe space for you to share your thoughts, feelings and choices will be vital in transcending how stuck you feel. You may not be able to change those around you but you can certainly personally evolve and grow through this tough period. 

Please do reach out to someone whether just a friend, religious leader or therapist for help. You do not need to carry this burden alone. Contact us for help or simply to find some resources. 

Hope this helps. 

Question: Why is occasional purging considered such an unhealthy practice? If you eat more than your body needs you can either let it turn into unhealthy fat or just get it out of your body in 2 seconds. I get it that if you are bingeing first on purpose and then purging that is really unhealthy but is it really so dangerous if you just do it occasionally, like once a month or less, after you eat or drink too much? Hysteria aside and scare mongering aside, how much damage is this really going to do to me? By the way, I have stayed at a healthy weight for my whole adult life and I have purged probably 100 times since I was 15. I am 26, a university graduate without any major issues. I do not lose control.

Jim LaPierre Says...:

Hi there and thanks for your question. I have no interest in fear mongering or hysteria - I'm a bit perplexed that you seem to see purging as not a big deal - it's a problem for 1 in 4 college aged women in the U.S. It may not be an issue for you, but it certainly is a huge problem nationally.

To answer your question, you're doing a minor amount of damage to your G.I. system, esophagus, and teeth every time you purge. Once a month is something you have control over as you say and I concede that you may very well have it in check. Two thoughts - every person I've ever served who developed an addiction believed at many points that they had control...until they didn't. Secondly, if you were truly comfortable with this, I don't know why you'd rationalize it by explaining that it's ok to purge excess from your body. I wish you well.

Question: If my friend always thinks she is fat and needs to lose weight when she is very skinny already does this mean that she had anorexia? How long does it take to get anorexia after you start dieting? This is my best friend and she has been dieting since she was about 13 and now she is 15.

Rob Danzman Says...:

Dear Good Friend,

Let me start by saying that just the fact that you are reaching out says so much about what a great friend you are. You clearly are concerned and want to help. Next, I'm going to give you some basic information about anorexia and then the warning with some specifics on what you really want to know - What can you do to help. 

First - To be diagnosed by a mental or medical professional, someone needs to have one or more of the following: 

• Refusal to maintain a body weight that is at or above the minimum normal weight for their age and height
• Intense fear of gaining weight or becoming fat, even though they are underweight
• Denying the seriousness of having a low body weight, or having a distorted image of your appearance or shape
• In women who've started having periods, the absence of a period for at least three consecutive menstrual cycles

• Death
• Anemia (low number of red blood cells which move oxygen throughout body)
• Heart problems, such as mitral valve prolapse, abnormal heart rhythms and heart failure
• Bone loss, increasing risk of fractures later in life
• In females, absence of a period
• In males, decreased testosterone
• Gastrointestinal problems, such as constipation, bloating or nausea
• Electrolyte abnormalities, such as low blood potassium, sodium and chloride
• Kidney problems

• Remind your friend what a healthy weight is for your body, especially at times when you or she sees images that may trigger her desire to restrict calories.
• Don't visit pro-anorexia websites. These sites can encourage your friend to maintain dangerous habits and trigger relapses. Anorexia isn't a lifestyle choice. It's a disease.
• Acknowledge that your friend may not always be the best judge of whether she is eating enough or are at a healthy weight. If you (or your parents) are worried enough, talk to your friend's parents. Your friendship may suffer but you may help her avoid a much larger issue later on. 
• Identify problem situations that are likely to trigger thoughts or behavior that may contribute to your friends anorexia so that she can develop a plan of action to deal with them. 
• Look for positive role models. Remind your friend that ultrathin athletes, models or actors showcased in women's magazines may not represent healthy bodies.

Question: I am not trying to diet but sometimes I can’t help it but do the tricks I know. I am too skinny already (I know this so I don’t have any false body issues) but when I actually do lose a pound or two I get so happy even though I know that I actually don’t need to lose weight. I think it’s probably a bit of an eating disorder that I have but mostly I am in charge. If I can pick a weight that’s OK and stick to that weight does that mean I don’t have to worry about how I think about eating? I don’t do any purging or binging.

Katie Brooks Says...:

Hi Anonymous-

I
know that it can sometimes be very confusing diagnosing yourself.  I think
it depends on your weight and age.  If you are an adult and your BMI is
under 19 then you are underweight and that can be dangerous for your health.
 You can calculate you BMI here: 

BMI Caluclator

Anorexia is the most
dangerous mental disorder at this time.  If eating, food, and weight control become
obsessions, or are already, you may need to seek treatment. People with
anorexia nervosa typically weigh themselves repeatedly, portion food carefully,
and eat very small quantities of only certain foods. Some people with anorexia
nervosa may also engage in binge-eating followed by extreme dieting, excessive
exercise, self-induced vomiting, and/or misuse of laxatives, diuretics, or
enemas.  At this time it seems that you do not engage in this behavior,
but you may want to watch yourself.

Mostly,
it's up to you to get treatment.  You will know when the time is right.
 Keep an eye on your behaviors.  If you continue to feel that you are
having trouble maintaining a normal weight because you engage in behavior that
interferes with weight gain and / or if you notice that you continually minimize
the seriousness of your low weight, call for extra support.  Here is a link to my website that will give
you further information on signs and symptoms.

GoodTherapySanDiego.Com

Question: People don’t understand why I try to lose weight. They say I look healthy and good but when I look in the mirror naked I still see a lot of fat around my stomach and thighs. If I still have extra fat than I can’t be underweight. I want to look good and if I eat too much I make sure to balance that out with exercise. I am diagnosed with EDNOS. It don’t understand how I can have an eating disorder if I am stable at a healthy weight.

Jim LaPierre Says...:

Hi there and thank you for your question. Please know that eating disorders occur in people of eery shape and size. Regardless of how we see ourselves (and our perceptions are often skewed by strong negative emotions) having an eating disorder is more about how we nurture our bodies and seeking control in a very unhealthy manner.

I cringe whenever I see a diagnosis of NOS - Not Otherwise Specified. What NOS often means in reality is "we're not sure." I encourage you to look less in the mirror and more at your life. What's working? What isn't? What do you need beyond your desire to lose a few more pounds?

Please seek feedback from loved ones - people that you trust and know to be healthy. Relying on your own perception may be problematic at this point. Please consider respected sources on what caloric intake is considered healthy. Then step back and ask yourself why that number on the scale is so important?

For far too many of us, when we look in the mirror all we see are faults. Please consider the whole person and ask yourself how can I be healthier? Good luck to you.