Erin Konheim Mandras Interviews Stacey Rosenfeld

I had the pleasure of connecting with and interviewing Stacey M. Rosenfeld, Ph.D. Dr. Rosenfeld is a licensed clinical psychologist in New York, California, and Florida. She is an eating disorder and addiction specialist, also focusing on sport and exercise psychology. She is, also, the author of Does Every Woman Have an Eating Disorder? Challenging Our Nation’s Fixation with Food and Weight (June, 2014).

Not every woman has an eating disorder but my point was to highlight how normal disordered eating is and the spectrum of eating disturbances we encounter. Many women struggle with OSFED but don’t think they have clinical eating disorders. Countless others engage in disordered eating behaviors. My point was to shine light on these conditions. I think someone needs help when the thoughts, feelings, and behaviors around food/weight impact her life in a negative way – when they interfere with her overall functioning.

My take is that even if someone is high functioning and “happy,” to be so rigid around food, exercise, etc. can create some internal distress and leads to inflexible living. It might be that things are ok when she’s functioning as usual, but she has difficulty eating flexibly when occasions call for it or taking time off from the gym to rest, recover, travel, etc. Again, I think these disturbances can occur on a spectrum, so while someone might be functioning well overall, it doesn’t mean she isn’t struggling with disordered thoughts or behaviors. She’d have to see these as impacting her somehow in a negative way in order to make a change. Unfortunately, in many cases, rigidity around food and exercise can be difficult to give up, because it somehow serves a purpose.

I think it’s often easier to recover when the motivation is internal, but plenty of people recover before they are ready. Typically, their families will get them into treatment and often, there’s resistance around this. In many cases, patients will come around once they are no longer in a starvation state and/or once they realize the impact that their disorders had on them and experienced some of the benefits of being less symptomatic.

We know that there’s a genetic component to eating disorders. There seems to be a certain personality type that is more prone to developing eating disorders, too, and eating disorders frequently co-occur with other psychiatric disorders, including anxiety, depression, and alcohol/substances misuse. I believe that our current cultural framework supports the development of eating disorders in those genetically and psychologically prone (and certainly can make recovery more challenging). Our diet industry, the thin ideal, our focus on the obesity crisis are all factors that can have a negative influence on people maintaining healthy relationships with food and their bodies.

Eating disorders are sometimes challenging illnesses to treat because in the throes of them, a person will seem to not want to get better (this doesn’t happen so much with other disorders). So, there’s a lot of trying to separate out what is the eating disorder vs. the “core” individual. Additionally, living in our current cultural framework (discussed above) makes recovery challenging – you have to swim upstream just to be healthy. Finally, financing treatment is tough, especially when a higher level of care is needed. I’ve had patients who need more help than I can offer on an outpatient basis, but their insurance companies don’t think they’re sick enough.

I think people can recover. That’s not to say that they won’t ever relapse, that they shouldn’t be mindful of events or circumstances that might trigger a return of symptoms, or that they’ll accept and respect their bodies the rest of their lives, but recovery from an eating disorder, with appropriate intervention, is certainly within reach.

I would handle the matter like anything else that concerns you about a friend. Mention that you’re concerned and state what you’ve noticed. Offer to provide support and/or help your friend get help. Try to refrain from being accusatory or blaming. Approaching the conversation in a positive, supportive way is likely to have the best outcome.

I think it’s challenging when someone has the “right” set of genetics, personality variables, and exposure to certain circumstances/stimuli. There are prevention and education efforts designed to target people before illnesses develop that I think can be helpful. Discouragement of dieting, and addressing weight stigma, for example, might help reduce the incidence of disorders in individuals and across the board. Certainly, the earlier someone gets help, the better. The Anorexia Nervosa Genetics Initiative (ANGI) is an international study, hoping to identify the genetic variation that is partially responsible for the development of anorexia – if they find it, it’ll be interesting to see how that might play out regarding treatment and prevention.