Tely Toumani, MS, MFT

Eating Disorders - Adult & Adolescent Psychotherapy


in Santa Monica, CA

Anorexia Nervosa
Bulimia Nervosa
Compulsive Overeating
Binge Eating Disorder
Disordered Eating


Eating disorders are psychological disorders that have serious physical complications. The most common eating disorders are Anorexia, Bulimia, Compulsive Eating, and Binge Eating Disorder. There is also a range of disordered eating behaviors that don't neatly fall into any of the above categories they are commonly referred to as "Disordered Eating". Eating disorders are complex conditions focusing on issues of food/eating, weight and body image. It is important to identify disordered eating and intervene as early as possible to prevent it from become more severe. If left untreated, eating disorders can become chronic, crippling illnesses leading to hospitalization, or in extreme cases, death.

Anorexia Nervosa

A person actively tries to lose weight or maintain an abnormally low weight by severely restricting his/her food intake. Along with the restricting behavior, there is an intense fear of gaining weight or becoming fat. Some anorexics also engage in purging behaviors, even after eating small amounts of food.

Bulimia Nervosa

A person binges (consumes an abnormally large quantity of food in a short time), then tries to get rid of the food by some method such as vomiting, using laxatives or diuretics, fasting or obsessive exercising. This is called the binge-purge cycle. A person can have symptoms of both anorexia and bulimia.

Compulsive Overeating/Binge Eating

A person either overeats without regard to physical cues of hunger or satisfaction, or binges (eats an abnormally large amount of food in a short time) without purging.


Eating disorders can have many causes, but food is not one of them. It is important to understand that an eating disorder is merely a symptom of a whole set of underlying issues that express themselves through this self-destructive food/weight behavior. An eating disorder can be seen as an unconscious attempt to cope with unresolved emotional pain. There is not one simple thing that causes a person to develop an eating disorder. It is usually a combination of social, psychological, interpersonal/family and biological factors.

Sociocultural Factors

  • Cultural pressures that glorify thinness and place value on obtaining the "perfect body"
  • Narrow definitions of beauty that include only women and men of specific body weights and shapes
  • Cultural norms that value people on the basis of physical appearance and not inner qualities and strengths

Psychological Factors

  • Low self-esteem. People with eating disorders often feel as if they are not good enough. They may feel as if they don't deserve to be happy or have good things happen to them. Often, they feel like a burden to others, and they tend to put others' needs and feelings before their own. They may believe that their lives would be better if they could just lose weight. Eating disordered individuals are usually compassionate, warm, giving, sensitive and intelligent people. However, they tend not to see the beauty in themselves, focusing instead on what they believe is wrong with them.
  • Perfectionistic tendencies and unrealistically high expectations for themselves
  • Depression, anxiety, anger, emptiness, or loneliness
  • Feeling a lack of control in their lives or having a sense of inadequacy

Interpersonal Factors

  • Difficulty expressing one's feelings and needs, especially if they are "socially unacceptable"
  • Troubled personal or family relationships
  • Difficulty setting interpersonal boundaries
  • History of being teased about size or weight
  • History of physical or sexual abuse

Biological Factors

Researchers are still investigating the role of genetics and/or biological factors contributing to eating disorders. It is not yet clear exactly what the role of biology is in causing and/or perpetuating eating disorders.

Eating disorders arise from a variety of causes. They create a self-perpetuating cycle of physical and emotional destruction. All eating disorders require professional help.


Eating disorders profoundly impact a person's quality of life. Self-image, relationships, physical health and day-to-day living are often adversely affected. The medical complications from eating disorders can be dangerous and even fatal. Sometimes people with anorexia or bulimia do not appear underweight they may be of average weight or even overweight. The outward appearance of a person with an eating disorder is not necessarily an indicator of how much physical danger they are in.

Problems associated with anorexia nervosa include but are not limited to:

  • Abnormally low heart rate, which increases the risk for heart failure
  • Anemia
  • Amenorrhea (lack of menstrual periods)
  • Changes in brain chemistry
  • Osteoporosis

Some of the problems associated with bulimia:

  • Electrolyte imbalances that could lead to heart failure
  • Erosion of tooth enamel
  • Potential for gastric rupture
  • Inflammation and possible rupture of the esophagus
  • Chronic irregular bowel movements or constipation

Complications of compulsive overeating/binge eating:

  • High blood pressure
  • High cholesterol levels
  • Heart disease
  • Secondary diabetes
  • Gall bladder disease


  • Do you find yourself preoccupied with thoughts of food and eating?
  • Do you eat large quantities of food in a short period of time?
  • Have you used laxatives, diuretics or diet pills in an attempt to control your weight?
  • Are you continuously dieting or practicing restrictive eating?
  • Do you always feel you are "fat" regardless of other people's opinions?
  • Are you so dissatisfied with your body that it makes you unhappy?
  • Are you fearful of gaining weight or becoming "fat"?
  • Does you weight determine how you feel about yourself?
  • Do you eat when you get upset or stressed?
  • Do you avoid any food that contains fat?
  • Do you worry that someone will find out about your eating patterns?
  • Do you feel a lack of control over your eating behavior?
  • Do you feel self-conscious or embarrassed about eating...sneaking food or lying about eating habits?
  • Do you compulsive exercise which means exercising several hours every day and feeling you "have to" exercise after eating?

If you answered yes to more than one of these questions, you may have an eating disorder.


Discuss your concerns about what you have observed in him/her.

Encourage the person to talk about his/her problems/feelings. Be gentle and supportive.

Avoid placing shame, blame or guilt on the person for what he/she is doing. Do not use "you" statements like "You just need to eat" or "You are acting irresponsibly."

Do not expect him/her to admit to having a problem right away. Give it time.

Provide resources for professional help. Ask him/her to consider going for one appointment before making a decision about ongoing treatment.

Do not place heavy emphasis on his/her weight, eating habits or exercise. Remember that these are only the symptoms of other underlying issues.

If the person denies the problem, becomes angry or refuses treatment, understand that this is part of the illness. Rather than getting into a power struggle, express your concerns using "I" statements that focus on your own feelings (e.g., fear, worry, or caring) about what you see.

Remember that you cannot force someone to seek help, change their habits or adjust their attitudes. If you do the best you can to help on several occasions and the person does not accept it, stop. Realize that you may have planted a seed that will encourage them to get help when they are ready.


Eating disorders are not simply about food and weight but are far more complex. Underlying issues as well as current stressors may bring about the onset of eating disorder symptoms. The eating disorder is merely a voice through which the mind and body express their unmet needs. The most effective treatment for an eating disorder is psychotherapy along with medical and nutritional support and guidance. The treatment should be individually tailored, and treatment will vary depending on the severity of the disorder as well as the client's particular problems, needs and strengths. Psychological counseling needs to address both the eating disorder symptoms and the underlying psychological, interpersonal and cultural forces that contributed to the eating disorder.

Some guidelines for getting treatment:

The first step is to reach in to yourself. Admit your have a problem that needs to be addressed, and make a decision to do so.

Tell someone. It is important to find support from a friend, relative or loved one. Encouraging words can go a long way. Ask them to read about eating disorders so that they can better understand how to support you.

Find a therapist you feel comfortable with. Everyone is entitled to this. Remember that your therapist is bound by psychotherapist-patient confidentiality laws and that anything you tell him/her will be kept in the strictest of confidence.

Make an appointment to see a doctor (one who has experience with eating disorders) so that you can assess and begin to address the medical complications arising form your eating disorder. You may also want to consider a dietitian (one who specializes in eating disorders) when you feel ready.

Admitting that you have an eating, exercise or body image problem that requires treatment is a difficult step to take, and getting the right help is essential. It is very common for people who enter treatment to be ambivalent about getting better. They may not feel ready to give up the eating disordered behaviors. Remember that your recovery is about you. Keep an open mind about things that are recommended, but know that you set the pace when it comes to your treatment.


When you come in for your first appointment, you may have a lot to say, or you may be so nervous that you don't know what to say. Trust is a key issue in therapy. You may feel afraid to trust, or you might want to dive right in. Either way, I am aware that in order for our work to be meaningful, trust has to be earned.

My approach to therapy emphasizes insight, self-awareness and empowerment to help my clients grow, learn about themselves, and lead more gratifying lives. Through an alliance of trust and collaboration, we work together to understand he meaning of symptoms. I realize that many clients enter treatment with a great deal of ambivalence about giving up their eating disorder. Whatever your stage of readiness is, I will work with you from there, knowing that you may not be quite ready to give up your eating disorder just yet, but trusting that the time will come when you no longer need it. As you become better able to navigate your inner obstacles, you will rediscover your capacity to live a life that is healthy, joyful and free.

I have a passion for this work and honor and appreciate my clients. Having personally struggled with an eating disorder for many years myself (from which I now have 10 years of recovery), I have a great deal of respect for the courage it takes to undergo the process of growth, self-discovery and healing. I offer compassion, strength and hope to help you in making your own journey a rewarding one.


  • Depression
  • Anxiety
  • Self-Esteem and Personal Growth
  • Addictions and Substance Abuse
  • Relationship Issues
  • Stress
  • Crisis Counseling
  • Career and Job Issues
  • Communication Skills
  • Women's Issues
  • Grief and Loss
  • Anger Management
  • Assertiveness

For information about making an In-Office Consultation Appointment

CALL (310) 572-2700

Tely Toumani, MS, MFT
License #MFC36245
3130 Wilshire Blvd., Suite 550
Santa Monica, CA 90404
(310) 572-2700

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