08/05/2025
HOW SKINNY IS “TOO” SKINNY?
By: Raul J. Rodriguez MD, DABPN, DABAM, MRO
Psychiatry Redefined
I get this question a lot. I have been getting it even more in recent years. We can’t just blame MTV anymore. It is all over the media. Idealized, perfect, extraordinary images of female beauty and thinness. Images so alluring that they drive product sales for both men and women. Pictures so compelling that they influence the self-esteem and body images of countless females.
The effect is so powerful that it gives new meaning to the term “if looks could kill”.
Death, really? Is this guy serious or is it just his characteristic Cuban over-expressiveness? No, really, eating disorders have the highest death rate in all of psychiatry and are becoming more common. The pressure to be thin has increasingly spilled over into disorders such as Anorexia Nervosa and Bulimia Nervosa. Both disorders are characterized by an obsession with thinness and a preoccupation with losing weight. Anorexia manifests in extreme weight loss, often achieved through severe restricting. Bulimia usually involves food binges followed by a variety of purging behaviors, stereotypically self-induced vomiting. Both disorders are frequently associat- ed with prior trauma, major depression and addiction.
It was the very frequent co-occurrence of eating disorders with addiction and depression that caught my attention. When evaluated, many of my depressed female patients described active or prior anorexic or bulimic tendencies.
An even higher percentage of women with addiction exhibited emergence of eating disorder symptoms shortly after achieving sobriety from substances of abuse. The eating disorder had gone into hiding when the substance use was at it’s worst. It quickly became apparent that in order to effectively treat this population, these conditions had to be addressed simultaneously. This was the origin of the Delray Center Orchid Program for the treatment of eating disorders.
Treating eating disorders can be difficult. Once you have exhausted “just eat normal” or “but you’re not fat” (these techniques have never worked for me), structured treatment must be implemented. At the Delray Center for Healing, we developed the Iris Program to fulfill this need. A clinical team was assembled consisting of professionals experienced and specifically trained in the field of eating disorder treatment. We then built the Iris program from the ground up, based on the needs of the patients as well as what actually worked. The basic fundamentals are individual psychotherapy, group therapy, nutritional therapy, family therapy, client and family education, psychopharmacology, and meal support. Different groups focus on body image, nutrition, relationships, women’s issues, and depression. More advanced forms of therapy include movement therapy, art and expressive therapies, and Dialectical Behavioral Therapy (DBT).
Supportive therapies include philosophical book studies, meditation, acupuncture, and massage.
Exercise therapy for the treatment of compulsive exercises in eating disorders is an avant-garde modality that is being researched and developed at the Delray Center. Eating disorder patients with compulsive exercise histories are carefully screened prior to participation in yoga, spin classes, and individual fitness training. Early results show promise for this type of treatment to reduce compulsive exercise in this population. Resistance training using weights, under close monitoring, has also shown early promise in restoring lean body mass at a rate faster than re-feeding alone. These newer techniques are helping shift what used to be strictly inpatient treatment to the outpatient setting.
The outpatient format lowers treatment cost and adds a degree of comfort and convenience that cannot be achieved in inpatient care. The “kinder-gentler” approach to meals is also greatly appreciated, especially in comparison to some of the more aggressive feeding programs seen in inpatient facilities. Consistent treatment at the appropriate level of care has yielded the best results in the treatment of eating disorders. When properly treated, these disorders can actually have a favorable prognosis. Without adequate care, anorexia and bulimia can be disabling and even life threatening.
