Brian Pollack, LCSW, CEDS-C
Brian is the Founder and Clinical Director of Hilltop Behavioral Health, a boutique eating disorder specialty practice in Summit, NJ. He is one of the few male master’s-level Certified Eating Disorder Specialists in the country, with expertise in FBT, male clients, athletes, and muscle dysmorphia. He hosts the Minding Men podcast and serves as an adjunct professor at Yeshiva University.
Learn more about Brian →In a recent video, Nick Cerami, LPC, LCADC made a point worth expanding here: eating disorders almost never live where they appear to live. From the outside, they look like a struggle with food, weight, body image, or appearance, and yes, those elements are real, and learning to grapple with them is critical for building confidence and freedom from the struggle. But underneath the surface, something else is usually driving the disorder.
For many people, that deeper driver is control! Either the need to create it, or a way of coping when life unpredictable.
The Paradox at the Heart of an Eating Disorder
The behaviors that come to feel essential, restricting, bingeing, purging, compulsive exercise, rigid food rules, usually start as attempts to manage something. Sometimes that “something” is anxiety, isolation, trauma, family stress, perfectionism, athletic pressure, or simply the chaos of being a person. The eating disorder is efficient, it runs like a machine, its offers order, predictability, and a sense of agency.
The painful irony is that the longer those behaviors continue, the less control the person actually has. The disorder runs the show. Every day revolves around food rules. Relationships shrink. The body suffers. The mind narrows. As Nick said in the video, those behaviors control you, not the other way around.
Part of treatment involves making choices that feel contradictory to the very beliefs and patterns that have come to feel safe. That can feel like a loss of control and it’s worth saying out loud that this is exactly why recovery is hard.
This isn’t just clinical observation; it shows up in the research. In a study published in the Journal of Eating Disorders, Froreich, Vartanian, Grisham, and Touyz (2016) compared six different measures of control and identified two dimensions central to eating pathology: a deep sense of personal ineffectiveness, and what they describe as “fear of losing self-control.” Those weren’t peripheral features, they were the dimensions that independently predicted disordered eating. Control concerns sit at the core of the illness, not at the periphery, which is exactly what most clinicians see in session.
Why Specialized Care Matters
There’s a meaningful difference between a clinician who has seen eating disorders and a clinician who has been trained and credentialed to treat them. Specialty care matters. A 2022 rapid review in the Journal of Eating Disorders synthesized 63 studies and concluded that “specialist care was found to improve patient outcomes” across diagnoses, with many people successfully treated through outpatient and day programs rather than long inpatient admissions (Pehlivan et al., 2022).
That finding lines up with what we see clinically. Specialized care:
- Recognizes diagnostic patterns earlier – atypical anorexia, ARFID, OSFED, muscle dysmorphia, and athlete-specific presentations that often get missed in general practice
- Distinguishes medical risk from psychological resistance
- Knows when a higher level of care is needed and just as importantly, when it isn’t
- Holds the long view on recovery, not just symptom reduction in the next four weeks
This is part of why Hilltop is a boutique specialty practice rather than a generalist clinic. Our team holds advanced eating disorder credentials precisely because this work demands them.
Specialized Care Helps Families, Too
Eating disorders happen in families and to families. When someone is suffering, everyone around them is affected often blaming themselves, walking on eggshells, or splintering under the weight of meals that have become battlegrounds.
Specialty treatment gives families structure, language, and a plan. Parents and partners learn:
- Clear roles during refeeding and recovery
- How to navigate meals without escalation
- How to support a sibling who is watching, scared, and confused
- How to set down the silent guilt that families carry and instead become part of the solution
When families have the right scaffolding, they stop being helpless bystanders and become a primary engine of recovery. That shift from helpless to active, from isolated to supported is one of the most stabilizing things specialized care can offer.
What Recovery Actually Looks Like
Recovery is not the absence of food thoughts. It is the return of the rest of your life. The restoration of mental and physical health, the ability to recognize and honor what your body is telling you, and the experience of food as nourishment, joy, and connection, not threat or punishment.
It is also, paradoxically, the regaining of real control. Not the brittle, compulsive kind the eating disorder pretends to offer, but the kind that lets you be flexible, present, and free. That’s the freedom we mean when we talk about recovery.
Treatment Options That Address the Root, Not Just the Symptoms
Recovery isn’t about white-knuckling your way through meals. It’s about gradually exchanging the false control of an eating disorder for genuine, flexible self-trust. Several evidence-based treatments support that work:
Enhanced Cognitive Behavioral Therapy (CBT-E). A transdiagnostic outpatient model developed by Christopher Fairburn that targets the cognitive and behavioral processes maintaining the disorder across diagnoses. In a randomized trial published in Behaviour Research and Therapy, Fairburn and colleagues (2015) tested CBT-E against interpersonal psychotherapy across 130 adults with eating disorders, concluding that “CBT-E is potent treatment for the majority of outpatients with an eating disorder.” After twenty weeks, the CBT-E group reached remission at roughly twice the rate of those receiving IPT.
Family-Based Treatment (FBT). The first-line treatment for adolescents with anorexia nervosa. FBT empowers parents to take an active role in nutritional rehabilitation while the family system stabilizes. In a landmark randomized trial in the Archives of General Psychiatry, Lock, Le Grange, Agras, and colleagues (2010) compared FBT to adolescent-focused individual therapy and reported that “FBT was more effective in facilitating full remission” at both six- and twelve-month follow-up.
Dialectical Behavior Therapy (DBT). Especially helpful when the eating disorder is functioning as emotional regulation – common in bulimia nervosa, binge eating disorder, and presentations with co-occurring trauma or self-harm.
Nutritional therapy with a CEDS-credentialed dietitian. Food behavior is part of the picture. A specialty dietitian helps rebuild a flexible, attuned relationship with eating, not another rigid meal plan that becomes one more rule.
Group and process-based work. Recovery doesn’t happen in isolation. Group therapy normalizes the struggle, builds skills in real time, and dismantles the shame that keeps eating disorders hidden.
At Hilltop Behavioral Health, our team weaves these modalities together based on what each person and each family actually needs.
Continue Reading on the Hilltop Website
If something here resonated, we have additional resources to help you go deeper:
- Learn about the specific eating disorders we treat anorexia nervosa, bulimia nervosa, binge eating disorder, ARFID, OSFED, and more, on our Eating Disorders hub.
- Explore our specialty pages, including male eating disorders, muscle dysmorphia, and eating disorders in athletes.
- Visit our blog for posts on family-based treatment, recovery in men, supporting a loved one through an eating disorder, and the clinical realities behind these conditions.
If you or someone you love is struggling, reach out. Specialized, compassionate help is available and recovery is real.
References
Fairburn, C. G., Bailey-Straebler, S., Basden, S., Doll, H. A., Jones, R., Murphy, R., O’Connor, M. E., & Cooper, Z. (2015). A transdiagnostic comparison of enhanced cognitive behaviour therapy (CBT-E) and interpersonal psychotherapy in the treatment of eating disorders. Behaviour Research and Therapy, 70, 64–71. https://doi.org/10.1016/j.brat.2015.04.010
Froreich, F. V., Vartanian, L. R., Grisham, J. R., & Touyz, S. W. (2016). Dimensions of control and their relation to disordered eating behaviours and obsessive-compulsive symptoms. Journal of Eating Disorders, 4, 14. https://doi.org/10.1186/s40337-016-0104-4
Lock, J., Le Grange, D., Agras, W. S., Moye, A., Bryson, S. W., & Jo, B. (2010). Randomized clinical trial comparing family-based treatment with adolescent-focused individual therapy for adolescents with anorexia nervosa. Archives of General Psychiatry, 67(10), 1025–1032. https://doi.org/10.1001/archgenpsychiatry.2010.128
Pehlivan, M. J., Miskovic-Wheatley, J., Le, A., Maloney, D., National Eating Disorders Research Consortium, Touyz, S., & Maguire, S. (2022). Models of care for eating disorders: findings from a rapid review. Journal of Eating Disorders, 10(1), 166. https://doi.org/10.1186/s40337-022-00671-1
