An interview with Gila Gohen, Director
Bergen Center for Eating Disorders:What did you have for breakfast this morning?Cup of coffee with a bowl of special k cereal with milk
What might an anorexic adult eat for breakfast, or lunch, or any meal for that matter?Imagine not eating breakfast; imagine not eating dinner last night either. You try to make your body forget what hunger feels like. Instead, you are always faint, weak and tired. Perhaps yesterday you went the entire day eating only an apple and a light yogurt. At dinner, you played with and picked at your grilled chicken Caesar salad, the dressing on the side left untouched because of course that would be too many calories. Today, you will spend the day obsessively thinking about how you could eat a little less and ways you could burn a few more calories. Perhaps you will eat only half the apple. Your desire to be thin supersedes your desire to eat.
We know anorexia and other eating disorders are illnesses. Aside from the inability to see themselves as they are … what else goes on in the mind of someone with an eating disorder (fixated at being thin)The anorexic’s biggest fear is that of gaining weight. They often have ritual obsessions and compulsive behaviors in regards to eating and food. They strive for perfection and the perfect person would be one who does not need to eat. Most of their day is consumed by their bodies, wanting food but trying to figure out how to deny themselves food. I often find that a severe anorexic has a blank like stare. I feel like I am sitting with someone who is as detached and empty as their stomachs. On further exploration I usually find they are suffering from depression and anxiety, among other things.
What role do you think media/tv/celebrities play in the increase of eating disorders in this country?We live in a society where it is almost bourgeois to suffer from anorexia. At times it is even glorified. But it is not just about being too thin; it is about inner torment and hidden pain.
The media puts so much emphasis on being thin and as a result so much of our resources go into dieting programs. We as a society praise people for loosing weight. In order for them to continue to receive that praise, they need to keep dieting. Often anorexia starts out as a diet which then gets out of control. Perhaps one way to prevent eating disorders would be to stop commenting on weight loss or gain. There is more to us then our weight.
What can parents do to prevent eating disorders in their children?To start with parents need to have a healthy relationship with their bodies and with food. Children will often learn by observing their parents. In addition parents need to teach their daughters that who they are on the inside is more important than what they look like. If daughters feel confident and good about themselves, who they are, and what they can become, then hopefully they will respect their bodies and treat it well.
We have long heard that this is a problem with teens. Tell us about what you are seeing among older women – in their 30s and older. Why is this different and why is this happening?Sometimes women have been suffering for years with a mild form of an eating disorder, which triggered by something like stress can then become exacerbated; the disorder becomes more apparent at this time. Sometimes they want children so they eat enough to menstruate, hiding the disorder. After giving birth to their children they revolt against the changes to their bodies and their disorder escalates.
Other times I have seen that an eating disorder develops in women at a later age. They need to feel separate and in control, often in response to an unhealthy relationship, such as a possessive or controlling husband.
If you could tell women with an obsession with being thin… just one thing… what would it be?No one goes around and says I wish I could be overweight just for a day. All of us in American society desire to be thin. I would want to help women shift their obsession to a more constructive way of living. I would let them know that they can move past these obsessive, all consuming thoughts about food, diet and weight and live a life that is less tormented.
When people call you for help, what are the first words they usually use?“I don’t want to gain weight but I think I need help.” I reassure them that psychotherapy is not about weight gain but about feeling and responding to your body more positively. Often, that includes weight gain, and if needed, I work with nutritionists and medical providers to supervise weight gain and provide medical stability.
What are the risks of eating very little? We hear lately that starvation even has health benefits. If someone eats very little and has enough energy for life, what is the problem? Most of America is too fat anyway right?To be slightly under ideal weight is healthy as there are a lot of risk factors that are associated with obesity. As I said earlier, anorexia often starts off as a diet which later gets out of control. Many anorexics were once overweight. An obese person suffers from a different kind of eating disorder and professionals need to be on the lookout to make sure the pendulum does not shift in the other direction.
Unfortunately it is when you cross the line to being too thin that problems arise. Anorexia has the highest mortality rate of any mental illness. 10% of Anorexics die from this disease or complications related to it. The medical risks of being anorexic are many. The two primary risks are: loss of bone mass which leads to premature osteoporosis and the most dangerous risk is that the heart rate slows, which can lead to death.
Eating disorders are not just about weight, and being underweight may be fine for your body. Eating disorders are psychological problems. What is most important is your feelings about your body and your sense of self. Seeking professional help may be indicated when you are not sure if you are simply too thin or suffering from an eating disorder.
What can husbands do if they are worried their wives obsess about food and fear it?First, speak to their wives and openly communicate concerns. Second, concerned husbands should educate themselves about eating disorders and if necessary encourage their wives to seek professional help. Offering to make the initial call, and going with their spouse for the consult may be a way to show support and concern. These gestures may help their wives take the first steps towards recovery. Lastly, husbands will need to learn not to comment on weight and food
Do you have an example of a case where an eating disorder proved dangerous for the patient?The most dangerous type of eating disordered patients are those that purge. I had a patient who spent the entire day eating nothing and then at night after she is truly starving, she consumes a lot of calories quickly and then purges. Her body does not have the resources to purge those calories and she has the potential to go into cardiac arrest. It is with patients like these where higher levels of care, including inpatient programs may be necessary.
Do you see men with eating disorders?I rarely see men with eating disorders.I have done a few consults but they do not stay in treatment. My hunch is that they prefer to be treated by males. The males that I have seen are usually anorexic athletes. Anorexic light weight wrestlers are common. They need to be below a certain weight in order to stay in the light weight catagory, this encourages starvation. Sometimes the psychological profile of a male with an eating disorder is different than females. Unfortunately there are not many programs available that address men with eating disorders and there is much more shame with males seeking treatment. Often they seek treatment for other presenting problemssuch as depression or anxiety.
Should friends and family approach someone with an eating disorder with questions?Some people with eating disorders like to talk about it and are comfortable doing so. Others will avoid the topic completely and are very ashamed. As with any issue, it is always okay to ask and then take their lead in respecting if they want to further discuss their eating disorder. I have found that those who have been in recovery and are doing well are more willing to talk about their experience with friends and relatives.
Has it been tough to maintain a normal relationship with food given your client base and professional expertise?My relationship with food has improved over the course of specializing with this population. I am much more aware and connected to how I feel about food. I am constantly trying to help clients be attuned to their bodies; to pay attention to their hunger cues and to respond to their hunger and not deny it. I encourage clients to pay attention to when they are no longer hungry and not to keep eating until full. The process of all this instruction reinforces to me how I should feel about food.
