This post was adapted from episode 17: "Are Eating Disorders Easy to Treat?"
of the Nourished & Free™ podcast.
I'm so honored to have had the chance to sit down with Gayle Goldstein, author of illuminate: a memoir,. and talk about her book and her journey through battling an eating disorder (along with the professionals facilitating the treatment). Her story is one of such vulnerability, honesty, and illumination (no pun intended) that I absolutely had to bring her on for this podcast episode.
This written article, based on the podcast episode, will serve to answer some of the common questions and wonderings that come along with discovering if eating disorders are easy to treat and even some of the risk factors for why eating disorders develop.
Please read and/or listen responsibly.
Let's dive in about today's topic, "Are eating disorders easy to treat?" and Gayle's responses based on her lived experiences. But first, let's get into the 'why' of eating disorders.
Why Eating Disorders Develop
There is no perfect answer for why eating disorders develop. Some are genetically inclined towards the development of an eating disorder. For those who are, there can be precipitating factors that pile onto the ultimate development of an eating disorder. These risk factors for developing an eating disorder can include but are not limited to:
Internalizing messages around food/body
Involvement in aesthetically-focused sports such as dance, gymnastics, or figure skating
Type 1 diabetes
How do you think the dance community and dance culture impacted you in your relationship with food and your body image?
Gayle: "I think the culture of dance as a whole wasn't necessarily helpful, but I also think [it wasn't] the cause. I've heard of studios that have very disordered rules, and I don't necessarily feel like mine was [but] it depends on the instructor. When you go into a ballet class and you're standing at the barre and quite literally having a teacher come up and pinch and poke and prod different parts of your body when you're struggling with your body at the same time... I mean, it just made me feel horrible about myself...
I do think that some instructors were better about it than others, but I remember an instructor once saying while watching a fellow teammate of mine perform her solo, 'I wish she would lose a few and she might win.', and I was like, 'oh my God'. Hearing these horrible things... I'm going to internalize all of that and I'm gonna do that. Like it's just, I mean it's horrible."
Grief and Eating Disorders
Trauma can often be the launch point for an eating disorder to finally take root in someone who has been genetically prone and has had precipitating factors.
You mentioned how dance did not cause the eating disorder; It might have contributed, but what was really going on underneath all of this was the trauma that was in your life and had gone unprocessed, right?
Gayle: Right.... I was set up on a silver platter and that white picket fence life. Both my parents were doctors. It was that perfect kind of life that you think about and then all hell broke loose and my mom was diagnosed with cancer a couple of times... She ended up dying when I was nine and then there were other [adult women] throughout my life who I would find myself connecting to, either family or not, and it felt like every woman that I connected with died... There definitely was this feeling of, 'I'm the common denominator, I'm causing this, this was my fault' and really taking on responsibility that I didn't need to hold onto....
and I think just continued to have struggles throughout middle school / high school experiencing typical bullying experiences in a public school system, but [the bullying] wasn't great for [what] led up to the full blown eating disorder, body image issues, depression, anxiety, all of that."
Self Harm and Eating Disorders
It's important to understand that an eating disorder can be its own form of self-harm. Self harm and eating disorders are not necessarily separate.
You had talked in your book about how you had started to experiment with self harm, and then thought, "well, you know, that's a little bit too obvious, people will know." so then an eating disorder was your form of punishing yourself instead, right?
Gayle: "Absolutely. I mean, it was so normal, I think, and [I was] being praised for dieting as a preteen teen and [I would say] 'I'm healthy. I'm choosing to eat clean. I'm choosing to be vegetarian' for no other reason than to have an excuse to not eat a whole food group... Morals and values go into vegetarianism for some people, and I hid behind that. But I mean it was never that it was always just an excuse."
Can Eating Disorders Be Treated?
In order to answer the question, "are eating disorders easy to treat?", we need to know that it is even possible to treat them begin with.
Eating disorders may be complicated, but that does not mean they are untreatable. Especially with early intervention, eating disorders can be treated and full recovery is possible!
Eating disorder treatment is best approached with a team. Treating an eating disorder should involve:
A primary care physician
Due to the psychological nature of an eating disorder, therapy is a huge part of making sure an eating disorder can be treated well. Additionally, medications may help relieve psychological distress for some.
What role did therapy play for you in your recovery?
Gayle: "Monumental. Like, the biggest and most important piece of... I think arguably my treatment team. Obviously I needed a registered dietitian, I needed a psychiatrist, I needed a physician... all of that, but the real root work happened in therapy and my entire perspective on what a therapist was and what they did shifted... It wasn't just this person that I was paying to pretend to care about me in my life. It truly [is] another human in the room with you.
I think when you get a therapist that you connect with really well and you form a really strong alliance with, the work that you can do together is terrifying and also really important. For the therapists in my mind that had [an] impact on me, I want to hopefully do that for other people and... be that person that you can yell and scream and cry at and you're just going to stick around... That was definitely the most important piece."
What are Eating Disorder Treatment Centers Like?
For most, eating disorder recovery involves attending treatment. This can look a few different ways depending on the person or depending on the stage of their recovery (listed from most intervening to least):
There is a lot of stigma around needing treatment. It is common to think, "I'm not sick enough to get help." However, it's important to not prolong an eating disorder - early intervention is key, and it can potentially save a life.
What did a typical day at residential treatment look like?
Gayle: "Get up 5 or 6 o'clock, weights, vitals, sometimes there are days where you had to do lab draws and all that medical side of eating a shorter treatment, and then it was breakfast, group, snack, group, lunch, group, snack, group, dinner, group, snack.... All day you are eating and then you have group therapy and then sprinkled in there are individual sessions with a psychiatrist, dietitian and your therapist.
...They purposely keep you super busy with recovery oriented things, which I hated...and I mean, I think everyone there did for the most part. It was a lot to do... it's doing the thing you hate most six times a day."
Being now on the outside and looking back retrospectively, what's your take away thought of that structure and the way they set everything up for you?
Gayle: "It was needed for sure. It's absolutely what I needed. I think the lack of independence and the lack of being able to be alone was infuriating... it didn't feel aligned with me to be like sneaky or manipulative, but it was like I felt compelled to do these like things that I knew I shouldn't be doing. So, I mean, that's why they watch you all the time. You can't go to the bathroom by yourself. In a way, it can sometimes be a dehumanizing experience. But there are definitely ways that it can feel a little bit more human and it's fighting something that is dehumanizing you."
Can a Dietitian Help with Eating Disorders?
Eating disorders impact the biological, psychological, and nutritional well being of an individual. It is not really about the food, but it also is about the food. Therefore, having a Registered Dietitian (RD) involved with your eating disorder treatment plan is crucial.
The nutrition component of eating disorders is strong, so let's examine the question, "what does an eating disorder dietitian do, exactly?"
What An Eating Disorder Dietitian Does
An eating disorder dietitian is highly involved in the treatment of an eating disorder. They monitor the nutrition status of their patients to ensure they are well nourished to provide every best opportunity for recovery.
The dietitian also provides eating disorder coaching for a proper and health-promoting view of food (both physically and mentally health-promoting). Eating disorder coaching from an eating disorder dietitian can feel like therapy, in some ways. There is a lot of overlap between therapy and nutrition in eating disorder treatment, so eating disorder dietitians are often well-versed in therapeutic methods to aid in the goal of nutrition rehabilitation.
Lastly, the dietitian oversees the meal planning. Often, it is most appropriate to begin eating disorder treatment with a structured meal plan (monitored by the eating disorder dietitian) until a meaningful amount of progress has been made. As time and recovery goes on, the structure and supervision of the meal plan releases.
What role do you feel like the dietitian had in your recovery?
Gayle: "Huge. Obviously [when you're] first into recovery, dietitian sessions are all about meal plans.
You talk about weight and body and food and that's what the focus is, but that's not all that dietitians can talk to you about. The further that I got into my recovery, the less we talked about specific meal plans, the less we talked about weight and the more it almost became a therapy session. Especially my outpatient dietitian was wonderful. We talked about like the root of like body image concerns and the functions behind the behaviors and not the nitty gritty of the meal plan."
How to Avoid an Eating Disorder
Are eating disorders easy to treat? Short answer, no. There are a lot of moving parts and for some it can take many, many years to fully recover.
So this begs the very important question of how to stop an eating disorder before it starts. The answer is to not wait until you're 'sick enough' to get help. If you are struggling with thoughts of food consuming your mind at all, immediately seek the help of a trained professional such as an eating disorder dietitian who can serve as your eating disorder coach.
In order to avoid disordered eating turning into a full blown eating disorder, reaching out for help is one of the most important things you can do.
What To Do if You Have an Eating Disorder
If you are concerned about your relationship with food and you think you may have an eating disorder, don't wait to seek professional help. Eating disorders and disordered eating are not easy to treat, but that doesn't mean you can not have freedom in your life and achieve full recovery.
Learn more about how I can help you through debilitating food guilt, food anxiety, and stress over your body.
Gayle: "The first time that I really saw an eating disorder therapist was in high school, and it was because a teacher of mine at school pulled me aside and [said], "what the f*ck is wrong with you?"... It was the first time that I think anyone had directly told me that I wasn't okay because I think she had learned if someone asked, I was just [going to say] "no, I'm good, I'm doing well, how are you?"
[When] I saw an eating disorder therapist and saw an eating disorder dietitian [for the first time], and [I heard] the things that they were saying, internally I was like, 'oh, shoot, yeah, that actually does reflect my internal world', but I wasn't gonna admit it... Doing different levels of care [and] different treatment stays each built on each other. I [went] from like this place of total denial like, 'it's all about food, it's all about the body, there's nothing deeper underlying it' to actually being curious about the function of it all."
More about Gayle:
"I live in Charleston SC and am currently working towards my Masters in Clinical Counseling Psychology! I graduated with my Bachelors in Psychology from Nebraska Wesleyan University. Being a therapist, particularly for those struggling with eating disorders, truly feels like my vocational calling. There would be no greater honor than to bear witness to people’s journey of finding food freedom and safety in their bodies. When I’m not studying or working, I enjoy playing with my dog Bentley! She’s a year and a half and my soulmate (in pet form). I also like to read, write, go to the beach, and FaceTime with family and friends!"