Eating disorder treatment at Ridgeview Institute

Honoring Appetite

Deborah Russo, Psy.D., Christine Engstrom, RD, LD, Laura Maloch, RD, LD.

Healthy infants come into the world completely skilled in detecting their body’s signals for hunger and fullness. Yet, as professionals we meet so many people who have not only lost sight of this simple process but also describe fear, shame and disconnection from being able to “honor their appetites.” For a woman to have a balanced understanding and skill over her true hunger, she must begin to trust herself, her feelings and her experiences.

“As far back as I can remember I have been uncomfortable with my body. There is not one part from head to toe that I wouldn’t change!” (18 year old suffering with Anorexia)

“I cannot trust myself to make a decision. I do not know when I am hungry or full. Eating is so stressful and occupies most of my thoughts of every day.”(15 y.o. with Bulimia Nervosa)

“I don’t want to grow up! I have been given everything I want, but I feel so empty and discontented. I go into a total panic and compulsively eat with even the smallest day to day decision.” (24 y.o. Binge Disorder)

Each of these young women is searching for something that can never be attained on the physical level and consequently are trapped in feelings of deprivation, inadequacy and confusion. This attempt to perpetually seek connection, expression, or control through food or body image elevates food to a position it was never intended to fill.

In our experience working with girls and women presenting with eating disturbances, there is paramount confusion about appetite. Cloaked in the language of food and weight, they tell disempowering stories about themselves and expect the foods they eat to do something for them. Whether to be tantalized, entertained or soothed, these attempts cannot fulfill their true hunger. The result is searching for something that can never be attained on the physical level resulting in guilt feelings, restraint from food through dieting, and ultimately isolation.
The development of a healthy relationship with food and our bodies can be interrupted by many different causes. They may range from the more subtle experiences of inconsistent boundaries in childhood to the extreme cases of verbal or physical abuse. And we live in a culture that contributes greatly to confusing and contradictory messages encouraging suppression of appetite. To help relearn to trust hunger, those we work with may need assistance piecing together the reasons behind their struggles.

From a developmental standpoint, children learn self-confidence and trust through mastery of skills. For example, in the context of eating, a child learns to trust hunger and fullness cues by being able to ask for food when hungry and refuse food when not. If well meaning parents interfere in this process by controlling the amounts or reasons food is or is not given, they interrupt this internal learning process.
Sara was raised in an overindulgent environment where the word “no” was a foreign concept. All her life she found it difficult to say no to food, yet found herself bound by family and cultural expectations to restrict her size. Unable to balance her appetite and hunger, binge eating and purging ensued. She was caught between desire and restraint.

These seemingly harmless parenting choices over time chisel away at the child’s development of individuality and a strong voice. Under the guise of “being helpful” parents may be sending a loud message of …”let me do it for you since you aren’t capable.
…or let me make those decisions because yours will be wrong.”

For women reaching for recovery, part of the growth process is learning to distinguish her appetite and needs separate from others while remaining connected. Individuating from others expectations and projections takes courage, support and inner strength. To individuate in some families may mean losing valued support, because looking outside of oneself for answers is a threat to the family system. To change a lifelong style of functioning takes identifying unique appetite and body boundaries, paramount to inner trust, growth and sustenance.

For a woman to know her true hunger, she must begin to trust herself, her feelings and her experiences. The work of separating spiritual, physical and emotional needs from food help to uncover deeper needs. Starting with the basics, we explore the messages and experiences associated with eating, body and self image. This information provides stepping stones for rebuilding and filling in necessary gaps in recovery.

There are many creative tools to encourage reclaiming appetite and living more fully in ones body. Creating a Body Image Genogram often facilitates a consciousness about food and weight that have been passed down through generations.
In Melanie‘s Body Image Genogram, she found out that her father always felt insecure about the color of his skin and his body type, he recalls memories of comparing himself to other children on his block. Her mother recalls her own mother and grandmother taking diet pills with every meal. Neither parent recalls trusting their appetite or receiving grounded messages from their families about accepting their body and shape. Being aware of what Melanie inherited from her parents struggles, brought
to light her own internal conflict associated with food and weight which translated to other areas of her life.

Food metaphors can be used to describe the connection between food and feelings and serve as a means of exploring deeper meanings of food and weight conflict. What we put on our plate may be a metaphor for our daily moods, needs and deeper struggles.
Being aware of our eating behaviors guides us to explore beyond the food in front of us and to our inner wants and desires.

One way of becoming mindful, in order to listen and understand the language of food, is through Gentle Eating Exercises. Gentle eating exercises encourage honoring appetite and being present in ones’ body.

Prepare a balanced meal with foods that you enjoy. Select a moderate portion size. Light a candle at the dining room table. Remove all daily detractions. Play music that relaxes and feeds your soul. Breathe deep before you begin. Observe the food on your plate. What you see and smell? Take a bite. How enjoyable is this meal to you? Are you hungry? Now, put your fork down. Take time to appreciate your bodies’ signals. Honor your feelings. Continue this process throughout your meal and journal your experience. You can do this exercise alone or with others. Refrain from talking while eating.
Julia understood for the first time that she could be physically full. She never understood how her unease, time constraints and body disconnection kept her from enjoying her meals and relating to her physical needs.

In our work with eating and weight conflicts, we recognize that different techniques work with different women. There are multiple ways to food freedom and body acceptance depending on ones’ unique needs. As a team, we avoid recapitulating negative messages and inadvertently narrowing women’s ways of healing and reaching recovery goals. Recovery work often includes the reclaiming and trusting of disowned parts of self, the strengthening of internal boundaries, the honoring and managing of food and feelings, and expanding of personal narratives. As team members we work together to encourage women to begin to trust their appetite, honor their preferences and live “in” their bodies freeing themselves to blossom into who they are meant to be.

All vignettes were hypothetically composed to protect the privacy of individuals. Recommended readings available upon request.


Deborah Russo, Psy.D. has a private practice where she treats eating disorders and facilitates Growth Groups for women in recovery. She is the Professional Relations Representative for The Remuda Ranch Programs for Anorexia and Bulimia, and the “Listen to Your Body Week” Program Director for the Eating Disorders Information Network in Atlanta. Special interests include prevention work and teaching the power of media literacy to youth. Dr. Russo is published in several professional journals and has presented her work at various national conferences.

Christine Engstrom, MS, RD, LD is a veteran Nutrition Therapist in the Atlanta area specializing in Eating Disorders. She is a team member at The Women’s Center at Ridgeview Institute and has a private
practice in Smyrna. Christine was an Associate Professor of Nutrition at Georgia Baptist College of Nursing and an Education Specialist at University Health Services at the University of Georgia. Her extensive medical background is incorporated into her work assisting eating disorder patients suffering from co-occurring medical conditions.

Laura Maloch, RD, MS, LD is a licensed registered dietitian working with The Boswell Center for Life Enrichment in Jacksonville, Florida. Prior to this, she had a private practice in the Atlanta area working with pediatric through college age children. Laura is the author of the soon to be published book Mealtime Madness written to help parents understand the different temperaments in their household and the effects this has on eating behavior. She conducts various workshops on her areas of expertise in Atlanta and Jacksonville, Florida.

Ridgeview Institute is a private behavioral health care system with inpatient, partial hospitalization, and intensive outpatient programs for children, adolescents, adults and seniors with psychiatric and addictive problems. We are located at 3995 South Cobb Drive, Smyrna, Georgia 30080. For more information about Ridgeview’s programs and services, call (770) 434-4567 or 1 (800) 329-9775.

For more information about the Women’s Center at Ridgeview Institute, visit our website at www.ridgeviewinstitute.com or contact the Access Center at (770) 434-4567.