Ask a Therapist: Overcoming Eating Disorders with Barry Tigay

Last Editorial Review: 6/3/2004

WebMD Live Events Transcript

Do you have an intense, persistent fear of gaining weight? Are you obsessed with exercise? Do you abuse laxatives, diuretics, diet pills or drugs to induce vomiting? Eating disorders affect both men and women and if not treated immediately, can lead to life-long medical and psychological problems and even death. Join Barry Tigay, PhD, as he answers your questions about eating disorders.

The opinions expressed herein are the guests' alone and have not been reviewed by a WebMD physician. If you have questions about your health, you should consult your personal physician. This event is meant for informational purposes only.

Moderator: Welcome everyone! Today's guest is Barry Tigay, PhD. He will be answering your questions about how to overcome eating disorders.

poontaasha: What is the most common eating disorder seen in teens and adults?

Barry Tigay, PhD: The most common is compulsive overeating. There are three types of eating disorders: anorexia nervosa (which is not eating enough), bulemia nervosa (which is generally eating too much on binges followed by extreme measures to undo the binge such as vomiting) and compulsive overeating.

PequenaB_IB: I'm not sure if I'm anorexic or not. Can you tell me some things about the disorder?

Barry Tigay, PhD: Anorexia is characterized by the inability to maintain even a minimal body weight, a fear of gaining weight and a significant disturbance in body image. People who suffer from this usually perceive themselves to be overweight even if they are underweight. For more definitions, please visit and look under the topic of disorders.

nora_charles_1936: What seems to be more useful in treating eating disorders, behavioral modification or meds?

Barry Tigay, PhD: We don't usually think in an either/or fashion. Psychotherapy is always indicated, and medication may or may not be. This depends on depression, anxiety or other symptoms. Each case needs to be looked at in its own right. You should not compare your case to others.

nora_charles_1936: Do you think eating disorders are perpetuated by the media, i.e. Spice Girls, Kate Moss, Calista Flockhart, etc.?

Barry Tigay, PhD: The media is out there and it does its thing, and men and women are exposed to role models that represent unobtainable body types. It is up to us as individuals to be realistic as to what we can and cannot do. Being a healthy individual and living up to our potential can be an admirable goal but there are limits to what we can accomplish. So let's not blame the media. Let's get ourselves to be realistic about what we are exposed to.

indu_narang: How do you avoid overeating?

Barry Tigay, PhD: It is important to get a good measure of how much we are eating. We can accomplish this by writing down what we eat. Keeping a food journal sounds simple, but when you begin, you will be surprised how you might skip small snacks or underestimate portion size. If you feel you are eating too much and are unconscious of it, begin with a food journal. A second good technique is to focus less on how much you eat and focus on the active things that you can do to become more fit. Increase your exercise and make sure you eat large amounts of healthy foods so that you will be less hungry, and not so vulnerable to the unhealthy foods. By healthy foods I mean lean protein and high fiber carbohydrates.

nora_charles_1936: Registered dietitians, doctors and psychiatrists - a team approach seems to show some success. What is your comment on this?

Barry Tigay, PhD: I agree that getting support from a number of professionals is likely to be helpful so long as this is coordinated. Professionals like to collaborate, and your chances of success are increased if you approach treatment from a number of perspectives.

lafreeka: Does bulemia or anorexia affect girls more than boys?

Barry Tigay, PhD: It is estimated that as many as 90 percent of eating disorders occur in females. There is some evidence that it is rising in men.

lafreeka: What is the youngest age that a child can be affected by anorexia or bulemia?

Barry Tigay, PhD: There is no lower age limit, and we tend to be seeing younger and younger children with eating disorders. Parents need to recognize that we need to show children acceptance, not to be nervous around food issues and find healthy avenues for them to find self-esteem.

warners43: Is it possible to recover from an eating disorder without professional help? Are there any books you could recommend?

Barry Tigay, PhD: Yes, it is possible to recover without professional help. I don't recommend it though. It depends on the severity of the disorder and the level of support, as well as the strength of their personality. A good place to start looking is the article "Triumphant Journey" which is a cyber guide to stop overeating and recover from eating disorders at You will find other links there for treatment opportunities.

poontaasha: What is the difference between fasting and anorexia?

Barry Tigay, PhD: There may be no difference, though I would consider fasting to be a technique that can be controlled and limited as the person wishes. Many people fast for a day at a time for health purposes or religious purposes, and they control the duration of the fast and return to normal eating patterns normally. If you are unable to do so, this may be a symptom of an unhealthy eating pattern or an eating disorder.

innocent93_99: If someone has been in therapy for three years for anorexia and it has gone no where, what can that mean?

Barry Tigay, PhD: It can mean a lot of things. It is not a good sign. Talk to a therapist about it and set some realistic goals. You might need more therapy. You might need something to supplement therapy, or you might need to find a new therapist. It might take a long time but you should see some progress or be gaining some insight in that length of time.

shyness_11798: Are there any self help groups for eating disorders?

Barry Tigay, PhD: There are quite a few, and I don't wish to recommend them at this time. I think it is important that you get professional help in addition to self-help. I think they could be most likely found on the Internet.

bizkit_babe_23_45: I want to become a psychologist and I have had an eating disorder. Do you think people will be more likely to listen to me about eating disorders because I have been there?

Barry Tigay, PhD: There is some truth to that. If you have successfully overcome this, you will have a lot to offer to the public. You will have some credibility that another person might not have. I hope you have other motivations for wanting to pursue a career in psychology also. It can be very gratifying and you may be able to do a lot of good for a lot of people. Good luck.

pixieshine: Is there such a thing as fat phobic?

Barry Tigay, PhD: In laymen's terms, that is a good description of anorexia. Anorexics generally have an extreme fear of being fat and can perceive themselves as fat even when they are quite undernourished and thin. They may be vigilant and on the look out for the slightest weight gain. They may make extreme judgement of people that are overweight. It may be their greatest fear that they may become overweight.

shady_chic2000: Is it normal to lose a lot of weight and be at a healthy weight, then look in the mirror and think that nothing has changed?

Barry Tigay, PhD: If you are at a healthy weight and you feel that nothing has changed after a great weight loss, you may have some symptoms of a body image distortion. It can take a little time for your self-perception to catch up with the sudden weight loss, but it is something to be concerned with if there is a misperception of body weight. If the weight is in the normal range, the individual has not crossed over into eating disorder territory, but one would hope that in time their self-perception conforms with the reality of their current weight.

innocent93_99: How long does it take to recover from anorexia?

Barry Tigay, PhD: There is no set time. It can be months or years. However, as I mentioned with an earlier question, if it is taking years and you are seeing little or no progress, it is wise to reconsider the therapeutic program and make sure that everything possible is being done.

katey21619: How can I help a friend try to overcome an eating disorder?

Barry Tigay, PhD: The first step is getting professional help. Do not assume that you or your friend can make the diagnosis. Problems with food are widespread. This does not constitute the diagnosis of an eating disorder. If you are unable to get professional help, it would be important to educate yourself about eating disorders. The resources I mentioned earlier are a good way to start. Also, take a look at the therapist directory at

jojennty: How do you know if you are a compulsive eater or just a normal eater?

Barry Tigay, PhD: One way to check your eating habits is to look at your state of fitness. If you are at the proper weight and you feel strong or energetic, then you probably are eating reasonably well. Another way to look at your eating behavior is to try to access your level of self-control. Can you change and modify your behavior, can you add or limit certain foods, and can you maintain a certain weight? If you are under control and feel healthy, you probably are on solid ground.

marrigold8: What should I look for in a therapist that I go to see?

Barry Tigay, PhD: The first thing to look for is experience with the problem you wish to treat. If you want to treat an eating disorder, make sure the therapist is experienced in that area. Look at their credentials and I would recommend choosing a psychiatrist, psychologist, or social worker. Take a look at in the section on treatments. There you will find a large section about psychotherapy and how to choose a therapist.

tiptopchick: Do you have to be underweight to be diagnosed as having anorexia and getting help?

Barry Tigay, PhD: Yes, the formal diagnosis of anorexia is reserved for those who are underweight. However, there may be individuals who are on their way to developing a problem who have been losing weight rapidly and may be passing through the normal range on their way to a problem. There are bulemics that might maintain a normal or above normal weight that might have an eating disorder.

poontaasha: How can a parent distinguish between a child that is watching closely what they eat versus being obsessed about what they eat?

Barry Tigay, PhD: Obsessions are generally recognized by an extreme concern with their appearance. These children will spend a lot of time in front of mirrors, will be concerned with their clothing, and may be picky eaters. Look for the distortion of body image. They might see themselves as much heavier than they actually are. Look for self-depreciatory comments about their weight and other aspects of their physical appearance. Also, be more concerned if they are below normal weight standards.

mtwhitneyplace: I'm having a hard time controlling my appetite and food intake. What can I do?

Barry Tigay, PhD: It is very difficult to stop eating or slow down your eating on willpower alone. I usually counsel people to do the positive things they can do rather than trying to exert maximum willpower. By positive things I mean start exercising, begin even by walking gradually. Add to your exercise program and you will be burning calories, getting yourself off the couch, and building self-esteem. Take a look at the article "Exercise Programs" in the self-help section at Also, start looking at what you can eat instead of just thinking about what you can't eat. Plan your meals in advance. Include high fiber carbs and lean protein. Eat lots of lean poultry, fish, and soy products like veggie burgers and low fat egg substitutes. Also, add in lots of broccoli, cauliflower, and sprouts. Enjoy eating healthy things. You will have a full feeling. Drink lots of water. Take control of your situation rather than trying to exert the discipline to tolerate hunger. Don't let yourself be hungry. Eat the good healthy things and you will feel good while you get fit and stay healthy. If you have any current health problems or any doubts about this, check with your physician before making any changes in your routine. This program will make you feel more confident for taking positive actions.

kristiny_1999: I have an 11-year-old and already she worries about her weight. She cries that she is fat and I am unsure how to help her. What can I do?

Barry Tigay, PhD: You haven't stated what the reality of the situation is. I would respond differently if I knew that she was indeed overweight. You should do the best you can to make her comfortable but it is important that your feedback is accurate. If she is overweight, the advice I just gave is good even for an 11-year-old. If she is underweight, she may be already showing some symptoms of an eating disorder. If she is in the normal range, then concentrate on building self-esteem and help her find interests that can help her develop more self-esteem.

dash_ing98: I was told there is a connection between sexual abuse as a child and women who have eating disorders. Is this true?

Barry Tigay, PhD: There may well be a connection with some people and others can have eating disorders without sexual abuse in the picture. They are connected because of self-esteem issues and also an alienation from one's body. People who are sexually abused often develop a negative view of themselves, their physical self as well as their personality. They also feel somewhat alienated from their body. In these cases, therapy should explore the history of abuse and the part it plays in their self-image.

innocent93_99: Is it possible for an anorexic to know what they have to do to get better, but they are not able to do it?

Barry Tigay, PhD: It is both possible and very common. This is true with most psychological disorders. Knowing what to do can be worlds apart for us. The therapy needs to work through and integrate these solutions with the patients. Solutions cannot be imposed from the outside. They need to be understood and felt as well as thought. The patient has to have the confidence to try new behaviors before they can successfully give up old habits. All of this requires a great deal of trust between patient and therapist and courage on the part of the patient. It is very challenging to make these kinds of changes but the rewards are great and well worth it.

Moderator: We would like to thank everyone for joining us today! We would also like to thank Dr. Tigay for joining us.

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