Did you know? Eating Disorders affect up to 24 million Americans and 70 million individuals worldwide.
— The Renfrew Center Foundation for Eating Disorders

One in five women struggle with an eating disorder or disordered eating.
— National Institute of Mental Health

A staggering 90% of those who have eating disorders are women between the ages of 12-25.
— U.S. Department of Health and Human Services

After reading these shocking statistics and more, I called Mrs. Devorah Levinson, director of the Eating Disorders Division at Relief Resources, for enlightenment.

Readers may have heard of Relief Resources through this publication and others. What exactly does Relief do and why is it necessary for our community?

Relief Resources is a non-profit organization that caters to individuals with mental health issues.

Before Relief was founded some 15 years ago, it was very difficult to access quality mental health care. After all, most people aren’t willing to ask their neighbor or friend to recommend a mental health provider.

As treatment may be influenced by cultural mores, Jewish clients also require a clinician who is sensitive to their values and lifestyle. How do you find such a professional when you can’t even talk about it?

Our referral service was established to fill this chasm. We maintain an extensive database of qualified mental health providers with comprehensive information regarding range of specialty, location, therapeutic technique, and, where applicable, insurance participation. This service has proven to be a valuable resource for the Jewish community, and thousands of callers have successfully found the help they need.

Referral is only one aspect of our work, albeit a central one. As well as providing follow-up for all our callers, we liaise with, and provide seminars for, clinicians to keep them attuned to the specific needs of the community.

Additionally, we work to promote awareness of mental health issues among the community, thereby alerting sufferers and their families to recognize symptoms so that they can seek help. Seminars are also conducted for school principals, teachers, clergy and others to ensure that those in the religious and educational systems recognize problems and are equipped to take appropriate measures. The need for Relief was patently evident as people eagerly began to call us from the start. Many of them had never received treatment for their disorder because they just didn’t know who to turn to. We now receive over 700 new calls each month from people seeking referrals (and this does not include clients that we have made referrals for before). Although our original office was in Brooklyn, we now have branches in Lakewood, Toronto, Monroe, and Baltimore as well as in Eretz Yisrael and the U.K. Over 20% of all callers come from the Lakewood area.

Since Relief appears to embrace all aspects of mental health, can you tell us why there is a separate division that deals specifically with eating disorders?

Eating disorders — anorexia nervosa (dietary restriction causing low body weight and intense fear of gaining), bulimia nervosa (binging and purging) and to a lesser extent binge eating (binging without purging) — share many components with other disorders, but they are also more complex and harder to treat.

To be more specific, unlike other mental health issues, eating disorders inevitably have a physical component which must be treated together with the mental component. In cases of anorexia nervosa, hospitalization may be necessary both to stabilize weight-loss and to treat physical complications that may accompany it, including serious heart conditions and kidney failure which may lead to death.

A further complication is that eating disorders can co-occur with other psychiatric disorders such as depression, substance abuse, and anxiety disorders. As I work with general referrals as well as heading the Eating Disorders Division, I find that I am well-placed to refer the client to both an eating disorder specialist and any other therapist that she needs.

Eating disorders also generally require a longer treatment span and are more likely to recur than some — but not all — other disorders. Among individuals who suffer from anorexia nervosa — the most prevalent form of eating disorder — some fully recover after a single episode; some have a fluctuating pattern of weight gain and relapse; and others experience a chronically deteriorating course of illness over many years. Sadly, the mortality rate of anorexia is high due to complications from the disorder, such as cardiac arrest or electrolyte imbalance, and suicide.

For most people, hearing about the extent and severity of this condition is a real eye-opener. Why are there so many eating disorders around today?

People often ask why there seem to be so many mental health issues of all types in our times. But we shouldn’t forget that mental health used to be kept “in the closet”; people would live their lives either hiding their disorder or not even realizing that they had it. Advances in treatments for mental disorders have certainly gone a long way to bring these disorders out of the closet, leading to a less judgmental attitude toward mental disorders in general.

After all, since mental disorders are treatable, there is less to be gained from being secretive, so we definitely hear them talked about more. Inevitably, this may create a false impression that mental disorders are a phenomenon that exists now but did not exist in the past.

While this is clearly not the case, we cannot deny that a significant number of people have eating disorders today, and this figure shows no signs of declining. Much of the blame for this is put on the superficial importance of externalities in our times, in particular the “fat is bad” culture that has overcome the media and has entered our own circles. You don’t need to look at photographs in secular magazines to realize it. Mothers of bachurim in shidduchim — and even the bachurim themselves — openly insist that a girl is thin without a sense of shame.

But this does not mean that societal pressures are the cause of eating disorders, although they certainly aggravate them. Research has shown that the ground has to be ripe for an eating disorder to occur. Once the “seed” has taken root, the “thin” culture may help it to grow.

Can you elaborate on this?

Let me give you a hypothetical example of a girl who is the anxious type and not very popular with her peers. She then gets pneumonia, misses a lot of school and returns some weeks later having lost quite a bit of weight. She receives a lot of compliments and — for the first time — feels good about herself. This encourages her to lose more weight, under the false assumption that a “thinner self” will continue to bolster her social standing.

Another case concerns a girl with OCD, even though it may not have been recognized by her family, whose obsessions and compulsions start to involve her food. When she eats, how she eats or even the plates she may eat with are sources of extreme anxiety and she drastically loses weight.
Low self-esteem; feelings of inadequacy or extreme stress; depression, anxiety, anger, or loneliness are some of the (many) examples of trigger points that may predict the possibility of eating disorders. People who are perfectionists are also at risk because they have unrealistic expectations of themselves and others. In spite of their many achievements, they may feel inadequate, defective, and worthless.

However, it should be mentioned that scientists are still researching possible biochemical or biological causes of eating disorders. Current research also indicates that there are significant genetic contributions to eating disorders.

We often hear — and the examples you have given us suggest this — that eating disorders are disproportionately found among female adolescents. Why is this?

Many mental health issues manifest themselves in the adolescent years. Brain and hormonal changes can certainly be connected to susceptibility to eating disorders and yes, eating disorders are heavily found among the adolescents. But this is not exclusively so. Triggers often happen at times of transition or stress where increased demands are made on people who already are unsure of their ability to meet expectations.

Such triggers might also include starting a new school, beginning a new job, death, divorce, marriage, family problems, critical comments from someone important, graduation into a chaotic, competitive world, and so forth. We therefore come across people of all ages who suffer from eating disorders, even though the preponderance is among the young.

Can you comment on the recovery rate of people with eating disorders?

This depends on many factors, including the age of the sufferer, the amount of time she has had the disorder before seeking help, her attitude toward her disorder and her support system. We must add here that the choice of clinician and the treatment chosen will also make a big difference. Not all clinicians are equal. At Relief we always try to pro-cure the best for our callers by only referring to licensed mental health professionals with an expertise in the problem at hand.

Younger sufferers who are diagnosed at a relatively early stage of their disorder are easier to cure and many can make a full recovery and go on to lead normal lives. The recovery rate has been shown to be highest when Family Based Therapy can be applied. According to research-based studies, Family Based Therapy — FBT — that makes the parents responsible for the sufferer’s meals and nutrition, is the most effective method of dealing with eating disorders.

But don’t think it’s easy. People with eating disorders generally go to great lengths to resist food, and it’s very challenging to try to “feed” them. We actually have a wonderful telephone support group for parents involved in this daunting task.

Once the sufferer is beyond young adulthood, it is obviously more challenging to use Family Based Therapy and eating choices depend on the sufferer, which can severely impede progress.

A final question — and one that readers are probably asking: Are you also a therapist?

It may surprise you that I’m not. My training and prior experience were in community service.
Relief staff does not consist of therapists and this is by design. It’s our job to find the highest quality care for our clients, not to offer therapeutic advice or a quick therapy session on the phone. Ultimately, this is what helps callers connect and utilize their mental health clinicians more effectively.

It is nonetheless our task to keep abreast of every aspect of the disorders we serve. The treatment of eat-ing disorders is a constantly changing field and I make every effort to keep up with its developments. I attend conferences, visit facilities, speak to leading clinicians regularly and I have the good fortune to discuss my cases on a weekly basis with Dr. Katharine Loeb, professor at Fairleigh Dickenson University and one of the main voices in the treatment of eating disorders using a family-orientated solution.

What strikes me again and again when I speak with these leading clinicians is how much they want to help our community. Sufferers have to know that there is excellent care out there waiting to improve their lives. All they have to do is to call Relief and we’ll refer them to the type of care that will be most effective.