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Food & Body Image Therapy: An Interview

Psychotherapist, Lindsey Arens, and registered dietitian, Mary Radovich, are Elle’s experts in treating eating disorders and developing a healthier self image. Learn more about eating disorders and how Lindsey and Mary have made it their life’s mission to combat them.

How do you work in tandem with your clientele? And why is this best practice?  

Lindsey: To keep it simple, Mary is the expert in food and nutrition and I am the expert in emotions and body image. It’s best practice because a lot of therapists out there try to provide advice on food and nutrition when it’s more complex than “just eat” or “change how you’re eating.” Mary is a certified eating disorder dietician, which is rare. When someone is working on recovery from an eating disorder, they really need support from both the nutrition expert and the emotion expert. 

How did you become interested in working with clients who struggle with eating disorders? 

Lindsey: I’ve always been an avid reader. As young as five years old, I was flipping through our set of encyclopedias when I came across the topic of concentration camps. I was fascinated by pictures of the prisoners, how emaciated their bodies were, and yet how they survived. Theirs were stories of resilience. Fast forward 30 years and I work with people who intentionally starve themselves and I join them in the journey of survival and healing.

So maybe it wasn’t by chance that I landed an internship at a local eating disorder program because as soon as I began working with this population, I was hooked. The disease is so complex and heartbreaking. But being a witness to the recovery process is inspiring. I was lucky enough to work with an incredible interdisciplinary team of therapists, dietitians, and psychiatrists from whom I learned an incredible amount. I then accepted a position to work in that program full time, and did so for the next 8 years. 

What’s the most common type of eating disorder and what do you attribute this to? 

Mary: The pursuit of thinness in our culture, plus the propensity to minimize mental health struggles has created a perfect storm for eating disorders. Food rules and chronic dieting/diet cycling (restricting intake to cause weight loss, followed by a period of rebound eating and subsequent weight regain) have become normalized, and many people are ashamed of their diet “failures” so they don’t talk about it or realize that their eating habits might be an actual eating disorder. I think this is one of the main reasons Binge Eating Disorder is so common, and under-diagnosed. It is the most prevalent ED, with 3 times as many cases as anorexia + bulimia. 

Weight stigma in the medical community also causes the most common form of anorexia that is missed.  It is falsely assumed that most people with restrictive eating disorders are “underweight” when in fact, most have what is considered to be “average” or larger body sizes. “Atypical anorexia” is actually much more common than anorexia nervosa and is just as medically dangerous. 

Does one ever recover from an eating disorder? 

Lindsey: There are two arguments on this – yes, you can recover from an eating disorder and no, you cannot. Some people believe that you are in a state of “recovery” always – similar to those who struggle with addiction (aka, once an addict, always an addict). If that mindset helps you stay in recovery – great. It’s a journey every day, one day at a time. Others however, believe you can be recovereD. The “D” at the end of that word is very intentional. Their eating disorder is in the past: no more behaviors, and they live freely in their bodies. 

Mary: I agree, and will add that both options are characterized by being at peace with food and not letting emotions dictate how you treat your body, so in essence, that is what we are hoping clients can work towards. 

What other mental health conditions are commonly seen in clients who struggle with eating disorders? 

Lindsey: The most common co-occuring mental health conditions are anxiety based disorders: generalized anxiety disorder, social anxiety and OCD. Many people attempt to manage their anxiety with food and/or exercise. When life feels “out of control”, those with eating disorders have a feeling of increased anxiety that makes them feel the need to “control” food/exercise for a reduction in anxiety. This all perpetuates the cycle.

How has the Covid-19 pandemic impacted the eating disorder population?

Mary: Disordered eating is on the rise with the isolation the pandemic has caused. Again, our culture’s obsession with not gaining weight in combination with so much isolation and increased anxiety have led to lots of people making weight loss their “project” during quarantine. It is estimated that about 25% of people who habitually diet will go on to develop a full-blown eating disorder.

What does recovery success look like? 

Lindsey: Recovery success looks a little different for everyone. But generally speaking, it includes “food freedom” and being at home in your body. It means eating what you want, when you want, and as much as you want. It means acceptance that the general size of your body is genetically predetermined. Our society teaches us that food and our bodies are the enemy. Quite the opposite is true; food is a basic need and our bodies are our home. 

What is one memorable experience of you working with a client suffering through this disorder? 

Mary: There are so many aspects of this work that I enjoy, it’s hard to say. My top 3 favorites are: 1) giving people permission to eat foods they have previously categorized as off-limits; perhaps even for years (for example, working on believing that eating bread is okay). 

2) Advising someone and having them think I’m completely wrong and ridiculous, but then they come to find, months later after doing the hard work to re-nourish themselves, that it is true. For example, that they can trust their hunger cues and that their preoccupation with food is actually from not eating enough. 

Finally, 3) discharging people from my care when they are in a much better space around food and really don’t have anything further to work with me on! If my job didn’t have to exist, I’d be thrilled, but it’s honestly so rewarding to be able to help people normalize food, which is such a big part of everyday life and a wish I have for everyone. 

What’s your favorite coping mechanism for intrusive thoughts around food and/or eating?  

Lindsey: I talk a lot about coping with our problematic thinking through writing. When we can identify what we are thinking about, we can actually do something about it. If we don’t somehow externalize the problematic thinking, it leads to a sense of panic and being overwhelmed. Additionally I’m a big fan of “micro-strategies” such as repeating mantras. An example: when you sit down to eat a food you’re afraid of, you repeat a helpful mantra: “I can do hard things” or “Food is energy, not the enemy.” 

Learn more about Lindsey and Mary’s Food & Body Image Therapy and Lindsey’s Eating Disorder Support Group currently being run virtually once a month.