This month, we talked with Eric Spinner, Psy.D. Beginning in September, he will be working at The Center for Anxiety and Mood Disorders as a Post Doctoral resident.
For the past two years, Dr. Spinner has worked at a residential facility for women, where he treated adolescents to older adults with eating disorders. As a result of this experience, this area of treatment is of special interest to him. “I feel like eating disorders do not get the attention they deserve,” he said.
He pointed out that there are several misconceptions surrounding disordered eating. “Culturally, when we think of eating disorders, we might think of certain body types. For example, one common myth is that people with eating disorders are always very thin. The reality is that an eating disorder is not solely diagnosed based on body type or weight. Someone of average weight, or even above average weight, could be struggling with an eating disorder.”
He’s concerned that this body type misconception could allow the condition to go unnoticed by family or friends – or even by the person themselves. He told me, “The fact is, anorexia nervosa accounts for the smallest percentage of those diagnosed with an eating disorder, whereas OSFED (other specified feeding or eating disorders) and binge eating disorder account for the two highest.”
“When considering an eating disorder diagnosis, it is important to look beyond a person’s weight or body type. Instead, look for the behaviors that cause medical issues. These can be things like extreme dieting and losing a lot of weight in a short amount of time, missed menstrual cycles, and low heart rates.”
What Is OSFED?
Many people have a vague notion of what bulimia nervosa, anorexia nervosa, or binge eating disorder consist of, but what comprises the other specified feeding or eating disorder (OSFED) diagnosis that Dr. Spinner mentioned? “OSFED is basically an umbrella term,” he explained. “It is meant to capture individuals whose eating disorder presentation does not meet the diagnostic criteria for any other eating disorders.”
“individuals with OSFED may present with many of the symptoms of other eating disorders like anorexia nervosa, bulimia nervosa, or binge eating disorder, but will not meet the full criteria for diagnosis of these disorders. This, however, doesn’t mean that the eating disorder is any less serious or dangerous.”
A diagnosis of OSFED can be further specified using some of the following terms:
- Atypical anorexia nervosa (all of the criteria are met for anorexia nervosa except that, despite significant weight loss, the individual’s weight is within or above the normal range)
- Bulimia nervosa of low frequency and/or limited duration (all of the criteria for bulimia nervosa are met, except that binge eating and compensatory behaviors occur, on average, less than once a week and/or for less than three months)
- Binge eating disorder of low frequency and/or limited duration (all of the criteria for binge eating disorder are met, except that the binge eating occurs, on average, less than once a week and/or for less than three months)
- And purging disorder (recurrent purging behavior to influence weight or in the absence of binge eating).
Dr. Spinner warned that having lesser known diagnosis ,like OSFED, instead of a more defined “label,” such as anorexia or bulimia, can sometimes cause the person to feel they somehow don’t belong or they aren’t really that sick. Conversely, if the person receives an OSFED diagnosis, it can help to ease their anxiety to know that the most common eating disorder is OSFED.
“Don’t get hung up on the diagnosis, though,” he cautioned. “It isn’t always important, for the individual struggling with an eating disorder, or their loved ones, to know the exact diagnostic box that they fall into. What is important is being able to identify that they are struggling in a way that is negatively impacting their daily functioning, along with getting them the help they need.”
No matter which eating disorder diagnosis an individual is given, Dr. Spinner said they will get the correct treatment. “Most of the prominent treatments used with individuals diagnosed with an eating disorder are transdiagnostic, meaning the underlying concepts of the treatment are similar across the various types of eating disorder diagnoses.”
General Eating Disorders Signs To Watch For
When I asked Dr. Spinner what someone should look for if they are concerned a loved one may have an eating disorder, he was quick to respond. “Caregivers should be on the lookout for dramatic behavioral changes, like increased food intake or restriction, extreme dieting, or excessive laxative or diuretic use. A change in the duration or intensity of exercise behavior and increased mirror checking can also indicate a concern.”
“Sometimes an individual might engage in food rituals,” he continued. “This could involve playing with their food, cutting it into very small pieces, or pushing it around on the plate so it looks like they are eating, although they really aren’t. Caregivers should also watch to see if the activity [exercise, food preoccupation, and so forth] is a big topic of conversation or if the person talks in ways that indicate they have a poor body image.”
“Eating disorders are seen as emotional disorders,” he said. “The behavior helps the person avoid or escape the unwanted emotions or situations they don’t want to engage in. These individuals often have more frequent or intense experiences than others, which can be scary. An eating disorder can give them a feeling of control and help them avoid those emotions.”
Because these disorders are so closely linked with emotions, Dr. Spinner said a parent who suspects an eating disorder in their child can begin by asking about the child’s emotional state. “They can say something like, “I notice you seem down or anxious lately,” which can help the child understand the parents are open to talking.”
Treatment For Eating Disorders
Because there are many variables that therapists need to consider, it can be difficult to apply a particular treatment strategy to a particular eating disorder. ”The thing to target may be different from one person to another, so we focus on the different thoughts and behaviors specific to each individual, and treat those. A particular diagnosis can help us know what to focus on, but may not change the person’s treatment exponentially.”
Cognitive behavioral therapy (CBT) is generally used along with other treatment modalities. CBT helps the patient become aware of their unreasonable thoughts and beliefs so they can view the situation more realistically and react in a healthier way. In addition, therapists might use any other therapy that works to address thought change.
Specific Support Strategies For Parents (Emotional Distress Strategies And Meal/Post Meal Strategies)
Dr. Spinner listed some strategies that can be used to help support someone who is going through therapy for an eating disorder, both in general and during and after meals.
Emotional distress strategies (when trying to support a loved one during times of emotional distress):
- Notice the person’s cues, both verbal and nonverbal. You know them and their characteristics, so you’ll know that being short with you means they are angry or depressed, sighing means they are frustrated, and so on.
- Help them to label and express their emotions. “You can ask, “How are you feeling? Put it into words.” If they can’t verbalize their feelings, then try saying, “It seems you are feeling like…” or “I thought you might be having…” This can help them identify their emotions.
- Validate their emotions. Caregivers are encouraged to put themselves in the shoes of their loved ones struggling with an eating disorder to better understand and validate their loved ones’ distressing emotional experiences.
- Meet their emotional needs and give empathy, support, and comfort.
- Fix or problem solve. If your loved one can’t resolve the issue on their own, don’t collude with the disorder or try to avoid it. For example, don’t give them one piece of chicken if their recovery meal plan says they should have two, because you send the message that it is okay to disregard the plan or not follow it exactly.
Meal/post meal strategies for someone who is struggling with an eating disorder:
- People who have eating disorders have intense emotions, so if they get distressed, remain calm to help them calm down.
- Show compassion and concern and don’t confront them or argue about their eating.
- Be consistent and confident with the nutrition meal plan given by the therapist or nutritionist (“I know you can do this, it will get easier.”).
- Refrain from talking about calories or food. Instead, keep mealtime light and enjoyable. Talk about a class the person likes in school or the job or hobby they love.
- Refrain from talking about a stressor, such as an upcoming exam.
- Also, it may not be helpful to engage in distracting activities like watching television during meals as it allows them to avoid dealing with the emotions that may come up during the meal, which serves to further perpetuate avoidance behaviors.
- After each meal, engage in relational activities to get them out of their head. Plan a structured activity for the first 45 minutes to 1 hour (work on arts/crafts, look at photos, do scrapbooking, play games, or work on hands-on projects). Again, it may not be helpful to engage in distracting activities like watching television after meals as it encourages emotional avoidance.
At the end of our conversation, I asked Dr. Spinner if he had one takeaway that he wanted to be sure our readers understood.
“Be aware that an eating disorder can affect anyone – of any size or gender,” he responded. “If the person’s perceived self-worth is tied into weight, size or body image, and it is interfering with their daily life, please encourage them to talk to someone. It is possible for someone to have an eating disorder and not realize they have one.”
We Can Help
If you or someone you love has questions or would like further information about eating disorders or other mental health concerns, the professionals at The Children’s Center For Psychiatry, Psychology, And Related Services in Delray Beach, Florida, can help. For more information, contact us or call us today at 561-223-6568.
About Eric Spinner, Psy.D.
Dr. Eric Spinner is a postdoctoral resident specializing in individual therapy, partner and family therapy, and group therapy across the lifespan. His primary focus is on the treatment of eating disorders, anxiety, and depression. Utilizing a collaborative approach, Dr. Spinner focuses on each client’s strengths, life experiences, and cultural background to address their individual needs, while providing a safe, open, and judgment-free therapeutic environment. He incorporates a variety of treatment modalities, including cognitive-behavioral therapy, acceptance and commitment therapy, dialectical-behavioral therapy, and rational emotive behavioral therapy.
During his APA-accredited Clinical Psychology Doctoral Internship, Dr. Spinner provided treatment at the Renfrew Center for Eating Disorders in Coconut Creek, Florida. There, he obtained extensive experience in treating primary eating disorder diagnoses, including working with individuals, families, and groups, and within various levels of residential, day, and intensive outpatient care. Additionally, Dr. Spinner provided comprehensive treatment of his client’s co-occurring mental health challenges, including anxiety, depression, substance use, trauma, and personality disorders, as well as facilitating numerous group therapy sessions, process groups, and manualized skill-based groups.
Dr. Spinner earned both his Master’s and Doctor of Psychology degrees in Clinical Psychology from Nova Southeastern University. He graduated from the University of Central Florida with a Bachelor’s degree in Psychology. He holds a certificate in Rational Emotive Behavior Therapy and conducted research into the treatment of specific phobia for older adults during his doctoral training. Dr. Spinner also has clinical experience working at both the Intensive Psychodynamic Psychotherapy Clinic and the Adult Services Clinic at the Psychology Services Center at Nova Southeastern University.