Addressing the emotions involved with eating disorders

While anorexia and bulimia are commonly treated in eating disorder treatment programs, the issue of emotional eating is being addressed in a new program at Princeton House Behavioral Health (PHBH). The recently launched outpatient program, Emotional Eating (Princeton, N.J.), is designed for women 18 and over who cope with their emotions by overeating or under eating.

Emotional eating is not a diagnosis or a specific eating disorder itself – other factors must be considered in order to diagnose a person, including:

• percentage of ideal body weight;
• loss of menses;
• binge/purge frequency;
• preoccupation with body/weight; and,
• other criteria, which can be found in the DSM.

Individuals in the program are diagnosed with ED NOS (eating disorder not otherwise specified) if they do not meet criteria for anorexia or bulimia. Many patients who are engaging in disordered eating patterns do so in an attempt to self soothe, say Princeton House professionals. Emotional eating is also related to feelings of inadequacy. An individual may feel that her emotions are at the level of intensity that she must manage them by escaping through disordered eating patterns. Additionally, many people engage in these types of behaviors because they lack other strategies to cope with stress.

When it comes to reimbursement, Sheri Solinski, LCSW, LCADC, manager of the Women’s Program at the PHBH outpatient center says, “Typically insurance will reimburse for eating disorder treatment; however our program has mood disorder as primary so insurance would be looking at that diagnosis.”

Solinski explains that typically eating disorders occur during periods of transition. Because the transition into puberty and the transition to college are some of the more common triggers for eating disorders, the adolescent/young adult population is often seen in hospitals.

“I think eating disorders and body image issues affect women throughout the life span in different ways,” Solinski says. Women in different stages of life are going to be dealing with a variety of different stressors. They might’ve found that they have had disordered eating throughout their life that hadn’t been addressed and a transition later in life (children growing up and leaving the house, a divorce, death, etc.) could trigger more severe eating issues, she says. She worries that many times these older women get missed.

Program specifics

Emotional Eating is a track in PHBH’s Women’s Program, which serves patients in Princeton, Hamilton, Moorestown, and North Brunswick. It is offered at a partial hospital (6 hours a day) or intensive outpatient (3 hours a day) level for three to five days per week. Solinski says women will typically participate in the program for eight to 10 weeks until they are ready to be transitioned to receiving treatment from community providers, such as therapists or registered dietitians.

A typical day in the Emotional Eating program looks like this:

9:30 a.m. – Patients arrive and eat a supported meal under the supervision of either the clinician or the registered dietitian who works in the program.

10:30 a.m. – Process group in which patients discuss a variety of issues related to emotion regulation, coping strategies, and body image, as well as a variety of quality-of-life issues that affect disordered eating behaviors, with a primary focus on emotion dysregulation.

11:30 a.m. – Psychoeducation group in which patients can focus on trauma issues, body image, self-compassion, relationship issues,  and transforming thought processes that have contributed to a negative self-image.

12:30 p.m. –  Second supported meal under the supervision of either the clinician or the registered dietitian.

1:30-3:30 p.m. – More time spent in psychoeducation groups.

“It’s kind of a holistic approach to treating the eating disorder where we’re not only looking at the food issues, but at all the contributing factors in someone’s life that can impact eating issues,” Solinski explains about the program.

The main aspect that sets the Emotional Eating track apart from others is that the clinicians are monitoring the women more closely. The content of this includes meeting with the nutritionist on a weekly basis, meal planning, making sure that the women are incorporating healthier eating patterns into their daily lives, and addressing coping strategies for how to maintain that structure outside of the program.

Family involvement

Additionally, the program encourages family members to join the patients on Wednesday mornings for a multi-family breakfast and a multi-family group. “With eating disorders, the behaviors can be so enmeshed with the family dynamics that it’s important to not only look at the function of the eating disorder for the individual but also looking at the function of the eating disorder within the family structure,” Solinski says.

Also, it’s helpful for families to learn how to be supportive of the patient while they’re going through eating disorder treatment.  Whether it’s a husband, a sibling, or a parent who the patient is sharing meals with, that person should be able to support the patient in a way that’s healthy and appropriate.

Substance abuse intersection

When people experience an intense emotion, whether it’s related to a life stressor or a pattern of not having the skills that they need to regulate and manage their emotions in a healthy way, they will usually reach for external sources of control, Solinski says. This can manifest in shopping, sex, eating disorders or substance use.

“One of the patterns you might see if you’re not addressing the root of that emotion dysregulation, is that the eating disorder behaviors have stabilized but now the person is engaging in some other maladaptive coping strategies—whether it’s substance abuse or self-injury or something like that,” she explains.

As long as programs can help patients learn how to identify their emotions, how to manage them in healthier ways, and how to develop coping strategies that help them to feel grounded and in control of their emotional experience, some of those externalized behaviors start to regulate themselves and drop off.