Beyond DSM-5: A New Model of Dysfunctional Eating Behaviors

Why We Need to Change the Way We Diagnose & Treat EDs

We have a huge problem in the eating disorder treatment field.

It is vital that we change the way we are describing dysfunctional eating behavior.

I have a real sense of loss that the research that we’re doing is so separated from the actual human experience of eating disorders and it all stems from the diagnostic criteria.

My goal is to present a different way of looking at things which are actually the way that many, if not most, clinicians in clinical practice actually look at eating disorders.

However, because the Diagnostic and Statistical Manual of Mental Disorders (DSM) is the basis for all research, any research done on eating disorders is only based on the diagnostic criteria.

Therein lies the problem: everything that we do when we talk about an eating disorder diagnosis (anorexia nervosa, bulimia nervosa, binge eating disorder, avoidant or restrictive food intake disorder, night eating syndrome, or any other disorder), we’re describing symptoms.

We’re describing the symptoms of not eating enough to sustain life, or we’re describing the symptoms of eating and then feeling the need to get rid of the food.

What we’re doing when we describe eating disorders with those names is we’re describing the symptoms that someone is experiencing, not the actual disease.

Of course, the problem is that we don’t know what the disease is.

We don’t know if bulimia is actually a hormonal disease, a brain chemistry disease, a brain morphology, or a genetic disease.

We don’t have the information about what these diseases are so we describe them based on their symptoms.

The problem with that is that we probably have more than one disease that causes, let’s say bulimia nervosa. Yet, when we research bulimia, we are putting people in groups based on their symptoms which may be adding people with different diseases into the same research protocol.

For example, let’s consider a totally made-up study. A hundred people, let’s think women because, for a long time, all of our eating disorder research was on women even though men have eating disorders at almost the same rate, which doesn’t even include individuals who are gender non-conforming. That’s a whole other issue that I won’t address but I just want to mention.

Continuing with our hypothetical example, let’s say we have 100 women who all meet the criteria for a diagnosis of bulimia nervosa. Going off of the diagnostic criteria, they’re all eating large quantities of food within a discrete period of time.

They’re all using inappropriate compensatory measures after eating to get rid of the food; they have body image distortion that has been going on for a certain period of time. This is the diagnosis of bulimia nervosa.

So, 100 women with bulimia nervosa are all administered an anti-depressant medication in an effort to see if it improves their symptoms.

Perhaps, the study found that 50 people get better and 50 people have no change or get worse. As such, the results of our study are now going to be published that this certain anti-depressant has a 50% effective rate in treating bulimia nervosa.

However, maybe bulimia that’s caused by a depression has a 100% effectiveness rate being treated with an antidepressant.

But, the 50 people with bulimia that was caused by a terrible traumatic event that happened in their life which triggers their bulimia are not going to get any relief from an anti-depressant because they don’t have depression, they have post-traumatic stress.

This is not meant to be a realistic example; it’s just to say that we are grouping people into the categories based on their eating disorder diagnosis that aren’t necessarily suffering from the same disease.

This is similar to saying that three people are coughing, we give them all a cough drop. One gets better, one stays the same, one dies, yet we still ask “Why? we gave them all the same treatment!” Essentially, we give everyone with an eating disorder the same treatment.

We give them nutritional counseling, psychoactive medication, individual counseling, possibly group therapy, possibly nutritional restoration depending on their needs.

We give everyone the same treatment, but not everyone gets better.

How do you explain that?

One person had a sore throat, and a cough drop solved the problem.

One person had tuberculosis, so the cough drop does nothing for them.

Finally, one person was already choking on a cough drop so giving them another cough drop was the end for them.

That’s what I’m talking about: if we are just looking at the outward symptoms of someone’s eating disorder and treating that, we are not treating the underlying cause of the disease, and it’s very challenging to treat the underlying cause if we don’t actually know what it is.

The solution is a middle ground where, instead of just looking at someone’s diagnosis, we look at a comprehensive picture of their dysfunctional eating behaviors.

Dysfunctional Eating Behaviors

I say behaviors because, usually, someone doesn’t participate in only one dysfunctional eating behavior.

Dysfunctional eating behaviors is a different way of looking at eating disorders rather than eating disorders diagnoses.

Dysfunctional eating behaviors are really on a continuum.

The same person who is diagnosed with anorexia might have binge eating and purging behaviors or just purging or just bingeing. We know this to be true, so, why do we put them in a box labeled anorexia nervosa?

Simply because they’re underweight?

Someone with binge eating disorder might also have periods of restriction. Why can we not label them with anorexia?

It doesn’t make a lot of sense if you think about trying to pigeonhole someone into one individual behavior.

We’ve all had patients who have restricted, binged, purged, cut, over-exercised, maybe even all in the same day, so, it doesn’t make sense to put people in boxes based on which behavior they’re doing now. They may need treatment for each individual behavior.

This new model is not specific about which dysfunctional eating behaviors someone is participating in now or this month or this week.

The idea being that we all have dysfunctional eating behaviors as human beings, meaning we all sometimes do things with food that are for a purpose other than fueling.

The significance is more whether your dysfunctional eating behavior is neutral in your life, are they damaging your life, are they destructive to your life, or are they threatening your life?

That’s the continuum that we’re seeing in our offices and our treatment centers.

We aren’t usually seeing people who have a positive relationship with food in our treatment. It’s people who are on that continuum of negative feedback or dysfunctional behavior.

This model focuses not on which behavior someone has but it focuses on the origin of the dysfunctional eating behavior, and that’s what, as I said before, most clinicians are actually doing already.

Most are actually assessing what’s behind someone’s dysfunctional behaviors but our research doesn’t support that, and we don’t have treatment protocols based on the origins of dysfunctional eating behavior.

The only treatment protocol is based on: if someone is doing this behavior with their food, they need this treatment.

We are confounding our research when we do that because we’re putting people with different diseases in the same research population.

I do believe that what we call anorexia nervosa probably has several different subtypes.

There’s probably a terminal version of anorexia nervosa; this is a patient who is not going to get better.

I hate thinking about it, honestly, because it’s depressing to think we may have no treatment for this person who is unintentionally using their eating disorder as a way to end their life. The person who will mess with their tube fitting or, if you give them a PICC line, they’ll contaminate it.

With these, I mean to say that this is a person who doesn’t want or cannot voluntarily accept treatment.

There are people, of course, who have terminal anorexia who do want treatment and that may be a different disease state or a different strain or strand or type of the disease.

It may be the same disease in a different type of person.

There are also types of anorexia nervosa that come from an autoimmune reaction.

There are types of anorexia that may be innate or inborn.

They may be related to puberty, which may mean that they’re hormonal.

We know that boys who have a female twin have a higher chance of developing anorexia than boys who have a male twin, so, is it something estrogen or testosterone related?

We really don’t know, but these may be very different diseases that all look like anorexia.

When we call all the diseases anorexia nervosa, we end up clumping people together who actually have different diseases.

Similar to saying, “all of these people are coughing” and to quarantine all of them, we’re not helping those people because someone might have seasonal allergies and they just need a Claritin, someone else might be choking on a chicken bone, and they need the Heimlich maneuver.

To just say they’re all coughing, so they all need the same treatment is just absurd, yet, we do it with people who have dysfunctional eating behaviors.

Foundations of the Dysfunctional Eating Behaviors Model

The origins of the Dysfunctional Eating Behaviors Model takes into account that there are many different paths to dysfunctional eating behaviors, probably as many different paths as there are human beings because no two humans have the exact same experience, the exact same brain chemistry, the exact same genes, the exact same microbiome.

Everyone is different.

If there are 7 billion people on Earth, there are 7 billion paths to dysfunctional eating behavior.

Even so, they seem to cluster into about four groups.

There are a lot of subgroups, but I’m going to put them into four main groups for ease of discussion.

Biology Based Dysfunctional Eating Behavior

Here, I’m specifically not saying genetic because genetics means different things to different people.

I’m an anthropologist by training, and so linguistics is part of anthropology, and the way we’ve used words is very significant to me.

Genes are of course part of biology. When we say genetics, I think we tend to think of something that’s inherited or in your DNA. Yet, we do know there’s a DNA related component of anorexia nervosa, that’s the only one that’s been identified so far.

Maybe not coincidence is that this happens to be related to the gene that codes for celiac disease, so, then we’ve got a possible link to an autoimmune component in eating disorders.

Those are biological predispositions or biological connections with eating disorders or dysfunctional behaviors.

There are other types of dysfunctional eating behaviors I can think of that are 100% biological, not just genetic.

However, one example that is a completely genetic dysfunctional eating behavior and that is called “Prader-Willi, which is a genetic disorder. It is something in someone’s genes that is a mutation, so it is not inherited.

It normally shows up around two years of age when a child will start to have an insatiable hunger and will eat basically almost anything, anytime.

This is a child who is eating off other people’s plates, possibly eating out of the trash can, hungry all through the day and all through the night. It’s a very serious condition, and it is incurable.

Recently, treatments have started to look at genetics and trying to change the DNA, but it’s not completed yet so all that can be done up to now is behavioral training to help teach a child that this is a feeling that you are going to feel and you can’t eat every time you feel hungry.

Prader-Willi would look a lot like binge eating disorder, but it’s not. It’s not a behavioral condition that needs behavioral treatment, but it is a totally genetic, totally biology based dysfunctional behavior.

Another example is PANDAS which stands for Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infection.

PANDAS is when a child will have a strep infection; maybe they go to the doctor, maybe they don’t, maybe it’s not bad enough to even get treated. Then, six weeks or six months later, they wake up with full-blown symptoms of either anorexia nervosa, generalized anxiety disorder, or obsessive-compulsive disorder.

In the case of anorexia nervosa caused by PANDAS, that would be a child who doesn’t live in a weight-focused home or a child who hasn’t been preoccupied with body image before but just wakes up one day and suddenly will not eat because they don’t want to get fat.

They’re using words that sound a lot like what we associate with anorexia nervosa, but they have anorexia nervosa that’s caused by a strep infection. That infection has caused an autoimmune response that has damaged the child’s brain.

That is a 100% biology based dysfunctional eating behavior that is not genetic at all, while there may be a genetic underpinning that makes that child susceptible, but we don’t know about that currently.

There are other infections besides streptococcal infection that can also cause this syndrome so many may refer to PANDAS as PANS, which stands for Pediatric Autoimmune Neuropsychiatric Syndrome.

These are some examples of solely biologically based functional eating behaviors, but there are a lot more that may be partially biology based or are majority biology based.

That would include some other autoimmune diseases like diabetes, which could be Type 1or Type 2. We know there’s such a pronounced overlap between dysfunctional eating behavior and Type 1 diabetes that the American Diabetes Association recommends that all teenagers with Type 1 diabetes be assessed for an eating disorder.

We know that dysfunctional eating behaviors often predate the development of diabetes type 2.

There’s also MODY, Maturity Onset Diabetes of Youth. Other autoimmune conditions can also prompt development of an eating disorder.

There are other biological precursors of eating disorders besides autoimmune responses. We also know that a concussion can lead to dysfunctional eating behavior.

It may be easy to say, “Well, an athlete who experienced a concussion and isn’t able to compete may stop eating because, now that they’re not competing, they don’t want to eat because they’re afraid they’ll gain weight.”

That’s possible and would be a behavioral connection, but there’s also a biological connection. A concussion is an insult to the brain, a closed head injury.

In some cases, an individual with a concussion will develop dysfunctional eating behaviors and, as the brain heals over time, the dysfunctional eating behaviors tend to step away.

In some cases, they don’t, and they’re permanent and need a different kind of treatment.

Any kind of illness that alters brain function, or even something that alters metabolism or body weight, such as hypothyroidism, hyperthyroidism, PCOS, hormonal problems, there’s even been a connection between cancer and eating disorders.

The connection between cancer and eating disorders is when someone loses weight due to cancer and then is concerned about gaining the weight back. This may sound a little bit controversial, but it absolutely has happened.

There’s also the possibility that some innate personality traits may contribute to dysfunctional eating behavior, such as perfectionism. It’s unclear how much of that is inborn versus environmental, but either way, there are biological underpinnings as far as how the brain works.

We don’t really know what all of these things are, but we do know that genes are biology and that genes interact with the environment, so, there is gene susceptibility that is separate from environmental biologic interference.

We know there’s at least one type of autoimmune eating disorder connection. Therefore, it’s possible that there might be more.

I would also add psychiatric issues here in the biological category, such as anxiety, depression, bipolar depression, schizophrenia and obsessive-compulsive disorder. I would include these as biology-based illnesses that can cause biology-based dysfunctional eating behaviors.

The reason this is important, of course, is not just because now we can say “okay, yes, you may have a biology-based dysfunctional eating behavior,” it’s that recognizing this helps us to see how we need to treat it.

Clearly someone with hypo or hyperthyroidism needs to be treated differently than someone with anxiety or depression or OCD or a concussion or diabetes or celiac disease or Prader-Willi or PANS.

Individuals need to be treated appropriately for the biological origin of their dysfunctional eating behavior.

This condition-specific treatment could be medication, psychotherapy, cognitive behavioral therapy in some cases, nutrition restoration and nutritional counseling probably in most cases. It would probably involve exposure and response prevention if it’s an anxiety-related biology-based dysfunctional eating behavior.

It might even include some brain treatments that haven’t even been invented yet. Some people have found relief with transcranial magnetic stimulation or implants in the brain that was developed to manage seizure. Meditation, neurofeedback – there are so many things that can help with brain training that may influence some of these behaviors.

Then, on top of that, there may be actual psychoactive medication or non-psychoactive medication such as insulin or Synthroid, something that actually treats the precursor of the dysfunctional behavior.

I’ve even heard from my dermatologist about someone who developed anorexia after having been diagnosed with eczema all over the body. After that eczema was treated, she no longer had anorexia.

I don’t know the connection or how it all works, but I can tell you that there are definitely connections between biology and eating disorders.

We don’t know what all of them are, but if we don’t accept that some of these things are interconnected then we’re only studying the biology of the eating disorder, and it is important to study the biological impact of the earlier or concurrent issue as well.

Addiction-Based Dysfunctional Eating Behaviors

The second type of dysfunctional eating behavior is addiction-based.

Addiction certainly has some biological components, and they definitely fall under some of the biological based dysfunctional eating behaviors, but I think that addictions have enough of their own individuality and symptomatology that they warrant a second section.

In referring to addictions, I include process addictions as well as anything that could be either an addictive substance or addictive behavior.

I’ll just use substance use disorder as a catch-all term, but the substance could be gambling, the substance could be sex, the substance could be a behavior.

Substance use disorder can lead to a dysfunctional eating behavior, or a dysfunctional eating behavior can lead to a substance use disorder. It is a chicken and egg question, and it may not even be important which one started because usually, they both have to be treated together.

Otherwise, someone switches to the other one when they can’t use whatever substance they are being treated for.

Now, is food an addictive substance?

I really don’t know.

I know that food is a mood altering chemical and we tend to sort of dismiss that when we talk about food not being addictive.

However, just because I’m not addicted to a food, why would I say that someone else can’t be?

If someone has been addicted to a substance and they describe their dysfunctional eating behaviors as feeling like an addiction, perhaps they could be treated with the same methodology that benefited them in their substance use addiction.

For example, if they benefited from 12-step or if they benefited from having a sponsor or whatever it is that they benefited from, that would be a skill that they could use to manage their dysfunctional eating behaviors properly.

Now, there’s also the possibility that someone developed a substance use disorder coming from a dysfunctional eating behavior.

They have actually turned to a substance such as meth, heroin, or cocaine, diet pills, a stimulant – something that helps them not have an appetite.

They turn to a substance in order to help them with their already dysfunctional eating behavior or their distorted body image.

In that case, we have to help someone with education such as nutritional counseling to help them no longer need the substance.

If they become addicted to the substance, either psychologically or physically, they’re also going to need addiction treatment.

It is really important that we also add on eating disorders and dysfunctional eating treatment together with the substance use treatment.

That is something that we are lacking in our study of dysfunctional eating disorder treatment because a lot of people are eliminated from research if they have an addiction, or, sometimes even if they’re only taking medicine, they’re eliminated from research.

We have this whole population of individuals with both dysfunctional behavior and substance use behavior that we don’t have information on because they often mutually exclude each other in a research population.

Stress and Trauma Based Dysfunctional Eating Behaviors

The third category is when stress and trauma cause dysfunctional eating behavior.

I was recently following along with the NEDA/BEDA conference via social media.

There was a presentation that studied people who had food insecurity as a precursor to their dysfunctional eating behaviors.

That was shocking to me, as I felt like I’ve been talking about this for so long and no one was listening.

Obviously, someone else had the same idea – and I’m so glad that they’re doing research on it because, in my profession, which is dietetics, there seems to be a total misunderstanding that food insecurity leads to dysfunctional eating behaviors.

I feel like it is common to try to treat food insecurity without looking at the dysfunctional eating behaviors that it causes or to try to treat dysfunctional eating behaviors without looking at childhood feeding experiences of food insecurity.

Food insecurity isn’t always a childhood experience, of course, it’s something that occurs all the time. It can occur for someone who is confined, who’s in prison, someone who’s homeless, someone who’s just impoverished and lets their children have what little food they have as they go hungry.

There are a lot of food insecurity related stresses and dysfunctional eating behaviors.

There’s also chronic stress or trauma to consider.

All of these things, because they cause brain changes, can also cause an eating change.

An example is whenever a traumatic event happens to a community. You will hear “watch your children for any of these signs of stress or depression,” like not sleeping and not wanting to go to school, and crying.

Never once have I seen changes in eating behavior mentioned, which is clearly a response to stress.

Now, some people eat less when they are stressed, and some people eat more, but either way, stress-related dysfunctional eating behaviors are different than an addiction-related dysfunctional behavior and different from a biology-based dysfunctional eating behavior.

Now, there’s obviously biology associated with trauma, so there’s some possible overlap here. And if the trauma is related to food, then we end up with an even more overlapping situation.

We have to treat the food trauma, and we have to treat the other trauma. We have to help someone in this situation get an appropriate relationship with food while also healing the traumatic experience that they’ve had.

This might look like PTSD, it may not look like PTSD, it may just look like someone who had a terrible experience and now, for whatever reason, doesn’t want to eat.

It could be someone specifically had an eating-related bad experience. Sometimes, we have kids who are afraid to throw up or afraid to swallow, appearing almost more like conversion disorder.

It could be a bad experience that happened totally unrelated to food.

There are a lot of times and ways that we humans inappropriately or incompletely process trauma and that unprocessed trauma can consciously or unconsciously change our eating behaviors.

Again, this is important because someone needs treatment for the underlying issues as well as the nutrition counseling and possibly the psych meds and counseling that they need to manage their eating.

Let’s say someone who has trauma-based dysfunctional eating behavior is put in the same group as someone who has a substance-related dysfunctional eating behavior.

They may not all be getting what they need because this person needs either crisis counseling or grief and loss counseling or EMDR for their underlying issues, not just talk therapy and not just nutritional counseling.

I believe that many, if not most, clinicians, dietitians, therapists, psychiatrists, nurses, and doctors who are really skilled at eating disorder treatment already do this.

We assess what it is that causes someone’s dysfunctional eating behavior.

Sometimes, someone thinks it’s something that it isn’t, “I developed my eating disorder when I didn’t make the soccer team,” when, really, they have mononucleosis, and that caused an autoimmune reaction in their brain, which causes their dysfunctional eating.

As such, sometimes, we have to be more of a detective because the person may not actually be able to verbalize what it is that causes their dysfunctional eating.

It may have been so long ago that someone doesn’t remember.

There are a lot of reasons for us to do very thorough assessments. This process lasts much more than the first session.

I do believe that this is what many in the eating disorder treatment field are doing, but, I believe that it is not what is being looked at when it comes to research.

The research is focusing on the outcome behavior and not the origin.

The problem being that they are different diseases.

Learned & Environmental Dysfunctional Eating Behaviors

The fourth category of dysfunctional eating behavior origins is learned and environment-related eating behavior.

This encompasses those philosophies or frameworks of eating disorder development that look at how the patriarchy, the media, a diet program, or family environment, etc., may act as a trigger for dysfunctional eating behavior.

An example would be someone like a wrestler. Before the NCAA enforced very strict rules about your competition and your offseason weight, there were no such rules. As such, someone could try to make weight by doing all kinds of dysfunctional eating behaviors in advance of their weigh-in.

Then, the more dysfunctional eating behaviors that came in after the weigh-in would be an example of the social eating behaviors that were learned or caused by environmental or what we might call peer pressure – not that someone is pressured to do them but that they are learned from peers.

Those individuals who are doing those dysfunctional eating behaviors may not actually have an eating disorder in the sense of a biologically based eating disorder. They may just be doing behaviors that are caused by body dissatisfaction, cultural food practices, unrealistic thin ideal standards, job requirements, or athletic performance requirement.

Those would be things that would also include cleanses or paleo and other restrictive diets that have either the explicit or implicit goal of weight loss or “feeling better.” To me, these are learned behavior dysfunctional eating patterns and are as insidious as any of the others. But the treatment might be different.

The treatment might not be medication for this person because they don’t have a biological illness. The treatment might be, for example, media literacy which we do teach in eating disorder treatment. It might be something like mindfulness or intuitive eating.

Intuitive eating is a great alternative to learned dysfunctional eating behavior but won’t help someone with PANDAS. Antibiotics that are needed for PANDAS won’t help someone with learned dysfunctional eating behavior.

Hopefully, you’re seeing where I’m going with this because I know I am repeating myself because it’s just so incredibly important to hit this home – that the origins of the dysfunctional eating behavior are essential in order to identify what it is that we need to do to treat.

This is individual. We can’t put all of these people in the same group with all of these other people and expect them all to benefit from the same treatment. Sadly, that is what we’re currently doing.

I haven’t even mentioned family therapy, or family-based therapy, which I think is probably very helpful for people as biology-based eating disorders because they literally need the support of refeeding. This doesn’t have to happen in family-based therapy but is the crux of family-based therapy.

Someone with stress and trauma-related dysfunctional eating behavior, especially if the stress and trauma are caused by the family, is not going to have beneficial effects from family-based therapy.

This is where our research gets really mixed up, and we have these numbers that are really quite terrible for family-based therapy that may say, “30% of people improve with family-based therapy,” yet, there are people who 100% benefited from it.

How do you explain that? It’s because they may not have had the same disease and so the same treatment is not going to help them.

Someone with environmental eating dysfunction may need, let’s say, self-esteem work, anti-bullying education and learning about how everything is photoshopped and about how it’s important to love yourself instead of expecting validation from other people.

This is a lot of what we talk about in body image work and in some eating disorder remediation, but for someone who really doesn’t have a problem with their body and has another of these types of dysfunctional eating behaviors, they may not even want to participate in that.

We’ve all seen an individual who may be feeling so depressed that they don’t care about being alive. They would just kind of sneer at the idea that they’re trying to be like a celebrity in Hollywood! That is the last thing on their mind!

We end up treating people inappropriately by assuming that their behaviors point to the same disorder. I have said the same thing in a bunch of different ways, and I hope it makes sense.

What I really dream of is that we can move forward as a field and start to look at categorizing eating disorders or dysfunctional eating behaviors as biology-based, addiction-based, stress and trauma-based, learned/environmentally-based. Or even a combination such as biology-related addiction.

I do think a lot of us are doing this work, and it’s very important but I think in order for it to move forward and for us to get better treatment protocols to treat people as individuals we have to be able to look at the origins of their dysfunctional eating behaviors and not just the outcome.

This way we can do better research on each different disorder, each person can get better treatment for what it is that they need. What is unsustainable is lumping people in categories solely based on their behaviors.

I’d like to end by adding one more thing, the very worst thing we can do to categorize eating disorders is to use weight or, God forbid, BMI.

The DSM is riddled with that, and so it would be really great if our insurance world, our treatment world, and our diagnostic criteria were completely weight neutral. Dysfunctional eating behaviors do not discriminate, and they especially don’t discriminate based on weight.

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Source:

Virtual Presentation by Jessica Setnick, MS, RD, CEDRD-S in the Dec. 7, 2017 Eating Disorder Hope Inaugural Online Conference & link to the press release at https://www.prnewswire.com/news-releases/eating-disorder-hope-offers-inaugural-online-conference-300550890.html

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About the Presenter:

Jessica Setnick, MS, RD, CEDRD-S envisions a world where all health professionals know how to help someone with an eating disorder. She created The Eating Disorder Clinical Pocket Guide and Eating Disorders Boot Camp to advance this vision, which she also does in her training workshops, phone coaching, and onsite training at hospitals and treatment programs. Reach Jessica at info@UnderstandingNutrition.com.

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About the Transcript Editor: Margot Rittenhouse is a therapist who is passionate about providing mental health support to all in need and has worked with clients with substance abuse issues, eating disorders, domestic violence victims, and offenders, and severely mentally ill youth.

As a freelance writer for Eating Disorder and Addiction Hope and a mentor with MentorConnect, Margot is a passionate eating disorder advocate, committed to de-stigmatizing these illnesses while showing support for those struggling through mentoring, writing, and volunteering. Margot has a Master’s of Science in Clinical Mental Health Counseling from Johns Hopkins University.

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The opinions and views of our guest contributors are shared to provide a broad perspective of eating disorders. These are not necessarily the views of Eating Disorder Hope, but an effort to offer a discussion of various issues by different concerned individuals.

We at Eating Disorder Hope understand that eating disorders result from a combination of environmental and genetic factors. If you or a loved one are suffering from an eating disorder, please know that there is hope for you, and seek immediate professional help.

Published on June 18, 2018.
Reviewed & Approved on June 18, 2018 by Jacquelyn Ekern, MS, LPC

Published on EatingDisorderHope.com