February’s National Eating Disorders Week may come once a year, but for Holly Starkman, helping others overcome one disorder in particular, binge eating, has become a passion in her daily work.
With a Ph.D. in clinical social work and extensive training in psychotherapy, Holly, a licensed clinical social worker (LCSW), works with clients across the shoreline from her Guilford office.
Holly just completed guest co-editing a special issue of the Clinical Social Work Journal (March 2016) “Body Meets Mind: Eating Disorders and Body Image—a Twenty-First Century Perspective.” For the journal, Holly interviewed a pioneer in the eating disorder field, Susie Orbach, for an article. Orbach’s ground-breaking first book, Fat is a Feminist Issue (1978), analyzed dieting and over-eating in women, and was a touchstone for Holly early in her career.
Holly also authored an original paper in the journal, titled, “An Integrative Group Treatment Model for Women with Binge Eating Disorder: Mind, Body and Self in Connection” discussing her innovative group treatment for women with binge eating disorder.
Holly says the good news is that binge eating disorder, one of the most prevalent eating disorders reported among women, has been recognized as its own diagnostic category by mental health professionals. “So I’m really thrilled about that. It’s been very much part of the trajectory of my career.”
Holly began focusing on women’s eating disorders soon after earning her LCSW from Hunter College.
“One of my first jobs was working in a health clinic in Brooklyn Heights with a woman who trained with Susie Orbach. I was 27, and she said, ‘Do you want to learn about eating disorders?’ I didn’t really know a lot about it, except for Karen Carpenter,” says Holly.
Pop singer Carpenter’s untimely death in 1983 increased visibility and awareness about anorexia.
Holly says she benefited immensely from having eating disorder training early in her career, but adds she’s also been able “to draw from my own experience. Although I’ve never had an eating disorder, I had two really good friends—one that was seriously anorexic, and one who had binge eating disorder. So I feel like I’m tuned in to what that can be like. I just found that I was really drawn to the work.”
A little more than 20 years ago, after first opening a private practice in Manhattan, and then working with adolescents as a social worker in a diversely populated Brooklyn High School of 4,200 students, Holly was asked by Fairfield public schools to help launch elementary school social work services. Holly took on the challenge and also opened a part-time private practice Westport, where she began noticing a surge in women with binge eating disorder.
“More and more, I was hearing about women’s emotional eating, overeating, binge eating...more so than anorexia and bulimia.”
At the time, clinicians had reams of research to assist clients with anorexia and bulimia. But in seeking research to assist women battling binge eating, Holly hit a wall. So, she decided to help break it down.
“There was really no research, if you can believe it, on women’s actual experiences,” says Holly. “By 1996, I was doing a bunch of research.”
Holly’s research became the basis for her dissertation for her Ph.D. at New York University. The work not only allowed Holly to earn her doctorate, but went on to merge with other research to help bring binge eating to the forefront as a diagnostic disorder.
Holly says her research, along with the research of others, contributed to the decision to make binge eating disorder its own diagnostic category. “So the new version of the diagnostic statistical manual, which lists all the psychiatric disorders, now includes binge eating disorder as its own category. That’s really cool.”
From her Guilford office, Holly works with women’s groups to tackle binge eating with an eight-week program she’s developed, based on her study. The work includes a focus on eight common themes drawn her research, such as shame, trauma, loneliness, or boredom.
By focusing on changing habits linked to binge eating, Holly’s approach emphasizes skills such as mindfulness principles (being in the moment) to help overcome triggers. She also incorporates other skills, matched to “unique and shared needs” in the group.
“These skills are less about food and eating and more about being more fully present in your body, and being able to engage yourself so that you become more aware of your hunger and your satiety [fullness], and that’s the key,” she says.
Holly says binge eating disorder can start at a young age and continue for years.
“The average span of the disorder for women in my group is 17 to 18 years,” she says.
“What’s really important is that there’s so much shame, and to be able to talk about it and hear from other women,” says Holly of the group. “It’s so good for people to know it’s really common and there’s good support and help, and not just through me.”
Many women may not consider what they’re experiencing as binge eating disorder, Holly notes.
“If someone doesn’t identify with being a binge eater, they may identify more with being an emotional eater,” she says.
While using food to manage emotions is “a very common kind of part of normal eating,” Holly says it’s the “frequency and prevalence” of emotional eating that tips the scales toward binge eating disorder.
“I often frame binge eating as self-care gone awry,” says Holly. “And when women hear that, they really feel like they’re understood. I think a lot of times, in mainstream culture [there is] the sense of someone who’s ‘fat’ doesn’t care about their body and their appearance, but it’s really so completely opposite. The intention is to feel good and comfort oneself [with] food.”
Holly says there are alarming statistics showing young girls are at risk due to societal norms (and social media) filled with unrealistic body images and “impossible standards.”
“Of American elementary school age girls who read magazines, 69 percent say pictures influence their concept of the ideal body shape, and 47 percent say the pictures make them want to lose weight. Eighty-one percent of 10 year-olds are afraid of being fat,” says Holly, who’s also mom to a young teen.
A Focus on the Next Generation
Holly lives in Guilford with her husband, Martin Smith, and daughter, Sadie, 14.
“Seeing what Sadie’s generation is up against really concerns me and goes to my community involvement because of my concerns and what I know as a professional, and what I see in young girls,” says Holly, who supports Guilford Youth & Family Services by coming in annually as a speaker. She also joined the Guilford Fund for Education (GFFE) board nine years ago.
“I’ve been part of the GFFE grants committee and one of the grants supported Shoreline Girls United (SGU). It’s a fabulous program, so I’ve supported them and volunteer on that day.”
SGU workshops, led by girl role models, take place Saturday, April 30 at Guilford Community Center. Call 203-453-8047 for more information.
With regard to adolescent females, Holly shares a troubling statistic: “Young girls who diet are 12 times more likely to binge eat.”
She has many more telling statistics, such as that, among all mental health disorders in adolescents, anorexia leads to the highest rate of death.
Holly says images and messages promoted by the multi-million dollar dieting industry can exacerbate anorexia, bulimia, and binge eating. She recommends parents seek out details from National Eating Disorders Association (www.nationaleatingdisorders.org).
No matter what age, Holly strongly advises against dieting, noting that what’s really effective is learning to eat properly. She shares another important statistic: 95 percent of all dieters will regain their lost weight in one to five years.
From feedback gathered from women who’ve joined her groups (and those who return for once-monthly gatherings after groups end), Holly’s found her integrated approach to helping women battle binge eating disorder is “working very well.”
“I’d say 90 percent have been able to sustain the positive benefits from the group. So it’s kind of an anti-diet,” she says.