COVID-19 UPDATE: VIRTUAL “TELEHEALTH” APPOINTMENTS:
Joseph Contorer MFT and CounselingLA.com continue to offer support during The Covid-19 Pandemic.
In response to the ongoing impact of Covid-19, therapy sessions are provided virtually.
"TeleHealth" options include FaceTime, Skype, Zoom and telephonic appointments.
For more information and flexible appointment scheduling please contact the office at any time at:
310-486-0087 or you may also email directly: joseph@counselingLA.com
Hope to hear from you soon!
Eating Disorders and Body Image Issues
EATING DISORDER RELATED COMPLEX (EDRC)™
This office can provide post-rehabilitative/follow-up and out-patient counseling-treatment for more complex eating disorders. For example, if you have been through an in-patient program and are in need of follow up treatment after discharge.
Treatment is available for compulsive overeating and body image disorders, and also for what I refer to as
“Eating Disorder Related Complex." (EDRC)™
COMPULSIVE OVEREATING/ Which frequently includes obesity and sometimes morbid obesity:
Perhaps the most commonly seen form of disordered eating is what is referred to as compulsive overeating. This describes a set of behaviors and actions that results in a style of eating and consuming food(s) beyond the point of satiety (fullness) or physiological hunger. Sometimes also known as "emotional-eating" or "stress-eating," the short explanation of this term is the idea that there are underlying drives to this behavior. Obesity is considered a disease that is defined as a physical state of being where the patient is carrying about 20% more body weight (fat) than that of their normal/predicted weight range would call for, given their other body type and height statistics. Other times the term Morbid Obesity is diagnosed if there is an even more excessive amount of overweight/weight gain, usually more than 100 pounds overweight.
Anorexia and Bulimia
Anorexia Nervosa is a disorder that involves self-starvation. Anorexia is a complex psychological and physical disease and disorder that involves a pathological self-destructive irrational plight to restrict food intake and maintain a distorted abnormal weight. Despite the likely emaciated physical state that also includes cognitive deterioration, most Anorexics perceive themselves as being overweight, fat, ugly, weak, inadequate or unattractive.
Bulimia Nervosa is a disorder that consists of binging grossly large quantities of food and then quickly eliminating the consumed food, typically by purging (vomiting) or some other form, like laxative abuse and or compensatory exercising/excessive cardio. Bulimics use their binge-purge cycle as a substitute for being assertive, taking charge and getting their needs met. With Bulimia, the “Binge/Purge” or “Binge/Restrict” cycle involves a pathological way of expelling feelings. There is literally a physically calming effect that occurs after the rush and excitement of a binge that culminates with a self-induced elimination like vomiting it up. For many suffering from this complex condition, the various feelings are theoretically vomited up as well.
Both Bulimics and Anorexics (which can be diagnosed together and or intermittently present in some eating disorder patients) typically develop a distorted sense of their bodies and a compromised sense of their personal control or lack thereof. With many eating disorders, particularly Anorexia and Bulimia, patients develop a paradox of control. They think they are in control by having a seemingly rigorous level of self-driven micro-management, but in fact, they are very much out of control by being in a volatile state of mis-management of their food intake and weight levels in drastic alarming capacities. Anorexics will deliberately stage extreme restriction and regulation of intake and engage in self-starvation. Bulimics will spiral with semi-repeating monumental sneaky binge episodes and then inducing vomiting as if it never happened until it happens again depending on the severity and frequency of the cycles.
Typical behavioral traits that accompany Anorexia Nervosa or Bulimia Nervosa include that of needing or being in or out of control, passive-aggressiveness, obsessive perfectionism and having low self-esteem. Related disorders, symptoms and issues include anxiety, depression, grossly distorted body image, abuse history of some sort, and co-morbid addictions to drugs, alcohol or other compulsive behaviors. Also sometimes related to Anorexia and Bulimia is a presence of personality disorders, such as *Borderline Personality Disorder (*See section on Personality Disorders.)
MORE EMPOWERED YOU
The end goal of treatment in most any case, is a stronger sense of you-
of self and self-respect and ultimately an improved level and ongoing managed situation of self-care with decreased restriction and or binge/purge symptoms. The ultimate goal is learning, implementing and maintaining a healthier relationship with food, body image and with your body in general.
In some cases, Anorexia and Bulimia require a period of more intense treatment, such as in-patient "Rehab" therapy that also consists of a medical component, due to the complex physical ramifications of these conditions. Therapy provided in this office can be thought of as a source of post-treatment/follow-up for Anorexics or Bulimics who have already been in some type of rehabilitation or who are somewhat stable at this point in their lives without an in-patient setting.
Therapy can assist with improving self-image, strengthening boundaries and improved assertiveness skills. Related goals are achieving an increase in levels of insight as well as managing distorted thinking; cognitive behavioral therapy may be applied as a treatment modality as well. Other goals include improved management of emotions/emotional regulation, more recently a part of what is known as Dialectical Behavioral Therapy (DBT.)
Treatment in this office can also address related symptoms and other diagnoses, like mood disorders, anxiety disorders and personality disorders, such as Borderline Personality Disorder (BPD)
Eating Disorder Related Complex (EDRC)™
EATING DISORDER RELATED COMPLEX (EDRC)™ is a conception that Joseph Contorer MFT developed to describe a more generalized composite of descriptions of scenarios, thoughts, actions and behaviors that are summarily related to eating disorders. While a mild presence of the various separate traits may be common and connected with many of those who are overweight or obese, the combination of the traits of EDRC are definitely not normal.
DO YOU HAVE EDRC™ ?
In many cases, EDRC can be considered like a more involved complicated case of compulsive overeating that will include compulsive overeating behaviors, along with several other factors, such as:
Excessive, abnormal levels of intention; feeling emotionally consumed, focused on and obsessed with:
- Body Image- poor self image/connected with eating and food. Some Body Dysmorphia symptoms but completely meeting the criteria of a that full blown disorder.
- Body size, image and measurements (Such as specific statistics, size, BMI, body weight amount.)
- Caloric intake/obsessive food combining and restriction.
- Compulsive overeating/ and or alternated with food restriction.
- Demonizing of certain "taboo" foods; defining self as good or bad depending on fluctuating eating habits, feeling full or hungry and power vs. powerlessness.
- Exercise/physical activity tracking and assigning generalized value if enough was accomplished or not.
- Weight loss or gain amount.
- Weight control/diets and dieting: crash diets, fad diets, gimmicks weird trendy diets.
- Weight fluctuation between gaining, losing and frequent changes in body weight up and down.
Presently, unfortunately, the average teen or adult person in The USA is likely somewhat overweight; millions of Americans are technically classified as obese and morbidly obese but this does not necessarily constitute an eating disorder or EDRC. However, being overly focused on weight and the related neuroses is also not what normal eating habits consist of. The DSM-5 has a diagnostic category titled “Other Specified Eating or Feeding Disorder." Perhaps that is a miscellaneous grouping for remaining abnormal symptoms or criteria that still clearly does not constitute Anorexia or Bulimia or "Binge Disorder." The "Other" category of The DSM-5 really doesn’t pinpoint the extent of much of the generalized eating disorder-related behavior and pathology, even considering an absence of more severe Anorexia or Bulimia symptoms; hence the EDRC™ concept.
Abnormal intention, consumption and focus on, or obsession with:
- Weight control/diets and dieting: crash diets, fad diets, gimmicks weird trendy diets;
- Caloric intake/obsessive food combining and restriction
- Body size and measurements (I.e.: statistics, size, BMI, weight in pounds;)
- Exercise/physical activity;
- Weight loss amount/weight gain amounts;
- Compulsive overeating/ and or alternated with food restriction
- “Body image disorder” specifically related to weight/body fat and size more than a true bizarre distortion of physical abnormality that would be seen in a specific diagnosis of "Body Dysmorphic Disorder."
Here is more detail about the behaviors and traits that would equate a plausible “diagnosis” of EDRC:
-Abnormal/over-worrying or obsessing about a number of related matters such as:
Body weight, body mass index (BMI,) dieting, body fat percentage, calories consumed or burned, overkill on counting calories, always needing a diet or food plan, trying every stupid trendy gimmick in the book such as fat-free, sugar-free, low-carb, low-fat, high protein, high fiber, food combining, only fruit, only vegetable, gluten-free, dairy-free, raw foods, “Paleo,” organic, only this, only that, plastic surgery/over-vanity emphasis on looks/body image issues/hyper-concern (not to be confused with truly heavy-duty irrational delusions about one’s body, known as a separate non-eating disorder, basically personality disorder otherwise known as “Body Dysmorphia Disorder.”
In other words, even if you don’t have an extensive, more classic case of Anorexia: self-starvation/abnormal, chronic restriction of dietary/nutritional intake or Bulimia- Binging huge quantities of higher-calorie foods and then making yourself vomit (purging,) you can still have an eating disorder! Abnormal eating habits alone do not necessarily constitute EDRC; it is the full gamut of assessment to make about one’s thought processes and certain combinations or intensities of behaviors and actions. EDRC may include excessive amounts of time, energy, thought and focus that is devoted to the whole concept of weight management, how fat you are, how much you ate, what you ate, how many calories you ate, how many calories burned walking with the fit bit or working out or are you allowed to eat because you worked out or do you not eat at certain times or after certain times or do you skip meals or have “cheat days.” Were you “good” or “clean” today about your eating or were you naughty?
Experiencing each one of these individual items by themselves would not otherwise necessarily be considered an eating disorder since there are additional circumstances to take in to account. Sometimes there is enormous focus or presence of each characteristic listed below. Frequently there are more than just one relative trait out of the ten examples listed.
- Abnormal / pre-occupation with food/nutritional content, which may include such typical identified negative food ingredients that can become highly disparaged. Common examples of forbidden or demonized foods include: dietary fat, cholesterol, saturated fat, trans fat, sugar, corn syrup, white flour, wheat, non-organic vs. organic, gluten, how much protein, how many carbs, calories/calorie counting or similar/related.
- “Body Building” for competing as a physical body visual aesthetic which is achieved from meticulous food consumption and adherence to rigid exercise regiments and supplements, some illegal or risky, like steroids and stimulants. Higher risk associated if these conditions concurrently apply; (not every single body builder/professional competitor would have EDRC, but there is a higher risk.)
- Body Image issues- beyond a reasonable expectation, such as desperately seeking pre-approval and self-determination/hoping or wanting to be perceived as presentable enough in public/work/school/social setting etc. Never feeling good enough.
- Compulsive overeating- Routine, habitual eating beyond physical satiety; eating when not hungry in response to other cues, such as emotional eating.)
- Obesity or morbid obesity is frequently associated and also present for most compulsive overeaters who are not in some kind of abstinence or state of healthy weight maintenance. There is a likelihood and propensity to overeat periodically outside of a normal/predictable fluctuation in food consumption or deliberate dieting/restriction.
- Consumed with the whole process: using food, weight, dieting and other related thoughts and behaviors as a substitute for other more constructive activities and actions ("Living to eat," instead of "Eating to Live.")
- Determining one's emotional state relative to food, eating habits/content, weight, self-driven compliance with goals; feeling safe, happy or “strong and determined,” based on whether adequate exercise has been completed or not or whether the eating has been positive or determined to be "clean." (vs. dirty?) Happiness is assessed relative to weight, body size, exercise compliance, self-driven food plan and nutritional intake compliance.
- Diet pills or other quackery and gimmick-concoctions semi-regularly, in an effort to drop weight or maintain weight.
- Model/fashion industry-Being a model or similar/working in the fashion industry, the fitness or health industry or mental health industry/intermittent or inconsistent or over-reliance or over-involvement in and on 12-Step Communities (leading to sometimes rigid adherence other times combative avoidance/hypocrisy this is the only way vs this doesn't work at all/diminishing personal responsibility.) Higher risk associated if these conditions concurrently apply.
- Semi-regular or regular deliberate attempts to lose weight. This cycle results in periodic weight fluctuations, often backfiring as weight-gain, as the efforts generally are not long-lasting. This becomes similar to a lower level binge-purge like cycle, (but not consistent with Bulimia that customarily involves ritualistic cyclical a more immense binge-purge/self-vomiting cycles.)
- Statistics-Abnormal, over-obsession with personal measurements and indicators relative to weight, body mass index, body fat percentage, how many calories consumed, how many calories burned. There is over-concern about being too heavy, being fat or maybe becoming fat or overeating. Preoccupation with what foods are eaten relative to weight and body image.
These various identified traits are what I refer to as Eating Disorder Behavior, which is similar to the connotation discussed on the Chemical Dependency Page that refers to “Alcoholic Behavior.” Eating Disorder Behavior describes the various behavior traits and thought processes that we see projected, displayed or "acted-out" with those suffering from eating disorders and EDRC.
For example, a compulsive over-eater could potentially also be diagnosed with Bulimia Nervosa if they are engaging in a prominent chronic binge-purge cycle. Anorexics and Bulimics are known to be obsessed with eating/nutrition, diets, scales, food plans, weight etc. However, a person who has not been officially diagnosed with either Bulimia or Anorexia but still engages in an over-focus of the eating disorder behaviors could very likely still be in a potentially serious situation of EDRC.
A fashion model that works in the fashion industry may feel forced to be meticulous about weight management and body image, given that selling their physicality is what they are doing for their career. Some models are plagued with Bulimia or Anorexia, others will be lucky to have a more healthy relationship with their body and their nutritional intake and overall self-care. But there will be still other models who will be more on the EDRC range of eating disorders because of the over-focus on aesthetics with or without also meeting the criteria for Anorexia or Bulimia.
Those suffering with Eating Disorder Related Complex may frequently find themselves “always on a diet” of some kind. They experience frequent somewhat deliberate fluctuations in their body weight. The erratic nature of weight maintenance is also associated with EDRC. Any person might have some tendency to overeat occasionally and may put on weight over the years; they may try to eat healthier or exercise sometimes more than others. But those who don’t have heavily disordered eating and or EDRC, actually lack the eating disorder thought processes and behaviors. They don’t think and act like a person with disordered eating. Some people who are overweight, over-fat, or considered "heavy," may just be your average unfit and or ignorant American, who doesn’t prioritize their healthy weight management, proper nutrition and maintaining adequate activity levels.
It is common that when the term “eating disorder” is mentioned, what may come to mind, if anything at all, is typically one of three terms or concepts. Anorexia, Bulimia and Obesity/Compulsive Overeating. This may include images of an anorexic female or a very large/morbidly obese person. They may have heard about “eating disorders” in the media/TV/film etc or have some brief knowledge from some other educational source. Other cases may include personal or relatively personal experience.
Eating Disorders such as Anorexia Nervosa or Bulimia Nervosa are described in detail as per The American Psychiatric Association’s Diagnostic Statistical Manual’s Fifth Edition (DSM-5 ) definitions grouped together under the heading of "Feeding and Eating Disorders."
There are several other diagnoses identified from a clinical standpoint titled: “Other Specified Feeding or Eating Disorder” and "Unspecified Feeding or Eating Disorder." There is also Binge Eating Disorder, which is similar to Bulimia, minus the purging episodes. There are other related diagnoses such as “Body Dysmorphic Disorder,” referred to by some as “Body Image Disorder,” (which is not technically what it is called and is not exactly the same thing.) Body Dysmorphia is grouped with Obsessive Compulsive Disorder; it is related but can also be quite different.
There are varying opinions in the professional literature by a small number of eating disorder specialists and self-proclaimed specialists. Some contend that eating disorders, especially compulsive overeating is a product of a core addiction to food and certain foods or chemical in foods like simple sugar or flour, for example. There are related personality traits, characteristics, behaviors and factors have been linked to eating disorders, such as perfectionism, inadequate self-esteem, abuse and trauma history and anxiety. Insecurity, social anxiety and depression are also commonly associated with the realm of eating disorders, as well as Obesity and other associated health or physical consequences of disordered eating.
The DSM-5 and much of the literature and general information and knowledge fails to completely address the phenomenon that the term “eating disorder" refers to. Eating Disorders and EDRC can be thought of in a similar fashion to that of other addictions like drug and alcohol addiction, however, it is actually quite a much more broad term of reference. Eating disorder originally referred to “disordered eating,” with the main associated severe variations to be that of Anorexia Nervosa, (self-starvation/restriction,) or Bulimia Nervosa (binging and purging, usually from self-induced vomiting or similar laxative abuse of over-exercising.)
General treatment approach to Eating Disorders
and EDRC™ in this office
**This office provides psychotherapy for most clinical problems (like depression, anxiety or addictions for common examples,) including disordered eating/Eating Disorder-Related Complex (EDRC™.) Follow up treatment for patients discharged from various in-patient programs/adjunctive-out-patient treatment is offered. Referrals will be gladly be provided as relevant for other treatment needs, such as in-patient programs/treatment for serious Anorexia Nervosa or Bulimia Nervosa, for registered dieticians, physicians, psychiatry and other allied health professionals where appropriate.
Step 1 Identify the problem/the diagnosis as Eating Disorder Related Complex (EDRC™.) Acknowledge that there is more here than just an occasional positive effort to be healthy/lose weight/eat healthy, etc.
Step 2 Identifying and learning about the specific traits, features, behaviors and distorted or false thoughts and actions that you are afflicted with, that effect you, that you specifically are engaging in pertaining to your relationship with food, hunger, satiety and body image.
Step 3 Identifying the specific feelings and underlying drives and triggers behind the Step 2 Items and start to envision alternate ways to respond.
Step 4 Empowerment and re-programming the thinking, the behaviors and improved emotional control/trigger management.
Step 5 Healthy goal achievement- Establishing more realistic, self-loving, less neurotic eating and exercise/activity habits, nutrition, exercise/activity level, self-esteem/self-efficacy/self-confidence bolstering.
The presumption is that underlying driving forces surround a predictably low sense of self-esteem and fractured confidence and compromised overall sense of self and empowerment. Therapy will aim to fortify the core “ego-strength” by offering additional understanding and analysis, improved coping mechanisms, tools and improved boundaries with self and others. The emphasis is shifted away from needing external approval to being or becoming increasingly unconditionally internally self-accepting.
Weird Science? Not really. Basically in addition to genetics, body weight is mostly ultimately determined by an energy-in/energy-out balance; this is combined with a much more challenging goal to master intuitive eating habits. Recovery consists of learning about general nutritional guidelines, as applicable, and basic concepts like responding to natural hunger and fullness or satiety. This is about creating personal awareness about approximately how much food and what foods you can/should consume to support this scientific formula in accordance to a desired weight or body type. Also beneficial is achieving a more accurate understanding of healthy activity, exercise and duration.
Another goal is to achieve healthier coping mechanisms for stressors, triggers and emotional drives, like emotional eating. It is likely the case that a large number of overweight people are suffering from compulsive overeating, which is also a form of disordered eating; they may not be formally clinically diagnosed with Anorexia Nervosa or Bulimia Nervosa, but compulsive overeating and or restricting and compulsive dieting is still abnormal behavior and would be classified as an eating disorder and a part of
Eating Disorder Related Complex.(EDRC™ )
Compulsive Exercise/Conflict with Excessive Exercise
IS WORKING OUT NOT WORKING OUT?™ [CONFLICT WITH EXERCISE:]
Using exercise in a similar capacity to purge (vomit) calories. This is sometimes referred to as Compensatory Exercise, which, by definition is a more extreme, less healthy use of exercise. The attitude and intention behind exercise in this capacity is typically to manage or control weight, counter-balance binging or perceived overeating, or a distortion of some weight problem.
Clients are invited to take an inventory of their exercise/activity behaviors and routines. This self-assessment is relative to the frequency, and length of exercise, number of days per week, number of times per day and how long each period is. The issue is about how much emphasis is placed on exercise and “weight management” or “staying in shape,” vs. a real persistent drive to get rid of something… like food/calories consumed and implied feared weight-gain.
Do you like to stay fit and receive the energy boost and stress release of exercise so you do it almost every single day? Is the common cliché goal of 3-4 times per week not good enough? Is one time per day not enough, so you need to have some designated exercise/gym or fitness location visit up to 2-3 times per day? Do you “allow” yourself to eat more when you have the additional exercise days/”double-exercise,” etc? Do you sometimes tell yourself: “Well, I was ‘bad” today (like binging/or eating something threatening or feeling fat etc.,) so I will just have to do an extra hour of cardio tomorrow to make up for that (get rid of the fat etc.) These are all various parameters and examples of how exercise and working out efforts can become a sometimes sugar-coated version of eating disorder behavior or (EDRC™.)
Why RU Fat? Under 2K a Day
“Realistic” Weight Management
Scientifically speaking, it is rather simple: energy-in vs. energy-out = weight maintenance, gain or loss. Psychologically-speaking, this is much more complex. One useful tool here is called Intuitive Eating, which is about responding to the body's hunger and fullness.
Getting closer to the core of
- Underlying emotions that manifest themselves as compulsive and destructive behavior.
- Specific behaviors that lead to weight gain with less emphasis on gimmicks and quackish-trends. What is really causing the weight/problem for you? Is it because you had two slices of whole wheat toast instead of one? Was there too many fat grams in your lunch? Was it because of the sugar in your ketchup? Probably not.
- Should you invariably eat unlimited fruit and vegetables or other seemingly healthy or lower-calorie foods? Probably not.
- Should you completely cut out carbohydrates or fat or white flour or white sugar or some other de-valued foods or ingredients? Probably not.
- Identifying healthier food choices that are satisfying but will also potentially prevent a destructive binge.
Our body’s need a certain number of calories to maintain a certain weight, sometimes referred to as a Set Point. Given consideration to the already long-standing basic scientific theory: “Energy-In/Energy-out,” My vision of a very generalized, fairly simple proposed plan consists of consuming no more than (approximately) 2000 calories per day.
As I stated, this is a very general “ballpark” concept that does not come with detailed professional medical (MD/MSRD) or nutritional guidelines (while it could certainly be incorporated in to a medical or nutritionist-managed program or modified accordingly- i.e. specific and precise calorie recommendations from the 2000 estimated amount.
This office highly discourages associating eating habits as being overgeneralized in a judgment as being good or bad or defining yourself as a good or bad person depending on your eating or your weight. It is value judgments like these that feed the premise of Eating Disorder Thinking.
For the most part, there are no foods that should be considered off-limits.
What should be more towards the “off-limit” side of things is the less healthy behaviors and thought processes that elevate shame and self-loathing, thus devaluing assertiveness and empowerment.
Although it lacks the fun and trendy gimmicky glamour of various fad diets- this philosophy may be a very simplified, basic approach to weight loss/weight management. A basic, but less glamorous program to follow is what I call “Under 2K a Day.” This implies that very generally speaking, (but probably mostly okay to refer to this in a "general" capacity, compared to the consequences of binging well over that estimated general amount,) weight gain occurs as caloric intakes start to soar moving greatly over 2000 calories. This is a very rough estimate and it is not coming from a registered dietician, parlaying specific nutritional advice; it is a very general guideline intended to re-direct out of control eating patterns and habits back to an approximate normal “range."
The 2K per day (2KD) assumes that the average mid-range caloric intake requirements for most people is a ballpark somewhere around this amount. While this is an approximation, for most people they would achieve proper nutrition with 2000 calories per day or fairly close to that amount. The 2KD concept is a more feasible, still obtainable, mid-range indicator/marker; It is hopefully a preferred alternative to fad diets, complex, gimmicky, gamey diet programs or sporadic diet trends and catchy regiments. Most of these fad-like diets and trends are guaranteed to be counterproductive failures. Also a tried and true failure are old-school diet-mentality programs that are overly limiting and constant reminders that you are "on a diet." The real experts in the still fairly young world of eating disorder treatment will definitely concur that the diet mentality can quickly generate a shaming effect, which is what fuels eating disorders and EDRC™ along in the first place.
The 2KD Concept is perhaps most relevant and applicable when thinking about managing compulsive overeating and weight loss goals; 2KD may also be of some assistance to more severe eating disorders such as Anorexia Nervosa or Bulimia Nervosa, depending on what stage of recovery the client would be at. This is another “gage” that can be factored in to the mix when considering how much to consume.
Using 2K per day to actually lose weight and inevitably regulate overeating might be a less stressful, more obtainable option for those who are either over-saturated with sensationalized diet and nutrition “advice,” or for those who would otherwise stay stuck in their eating disordered conflict with food state and thus not lose weight or feel defeated and have to give up the battle.
The crux of the 2KD Concept is that many compulsive overeaters and those suffering from EDRC could potentially be consuming 2500, 3000 or maybe upwards of 5000-10,000 calories per day, depending on how severe their overeating conflicts with food have become. By consuming closer to the 2000 calorie ballpark range, those suffering from EDRC™ will be much less likely to gain weight and more likely to lose weight eventually. The 2KD approach suggests adopting some degree of manageable commitment and modification to a typically long-standing struggle and history of erratic food and diet habits that hopefully includes healthier eating behaviors where maintenance can be achieved.