In The Field with Lori Osachy, MSS LCSW, Eating Disorder Specialist
Navigation through a disorder can be a murky process. Learning to understand yourself, your disorder, how it alters your life and what you can do to change or adapt with it, can be a daunting and dubious process. Within the world of psychopathology, it is imperative that when one has gotten to the point of seeking help, they do so with someone with knowledge and experience in that field. The psychopathology of eating disorders is one of particular interest as there is still more understanding to be gained of this field, especially in classroom curriculum.
The following interview is with Lori Osachy, MSS LCSW, Director and Owner of The Body Image Counseling Center in Jacksonville, FL. Ms. Osachy specializes in the treatment of eating disorders and presents with a positive and upbeat approach to practice and in general. She entices the public through her website with a “Text2bwell positive body image program”, informative and easy to find interface, and supportive coaxing to contact “when you’re ready” at (904) 737-3232. The following interview was conducted via phone call with this writer:
Ms. Osachy, thank you very much for this interview. This shouldn’t take too long so I’ll start with the first question: What is your job title?
Oh that’s no problem at all, I’m glad I could help! Goodness [chuckles] that would be a lot but I think I’d have to say my official titled would be, Owner and Operator of The Body Image Counseling Center.
What is your educational background?
I received my undergraduate degree in Political Science from Cornell University and my Master’s degree in Social Work from Bryn Mawr Graduate School of Social Work and Social Research.
What licenses or certifications do you hold?
I have an LCSW which licenses me as a licensed clinical social worker. I am also a certified Gottman Educator.
What influenced your decision to go into this field?
To be honest with you it’s always been in the family [chuckles]. My father was a school psychologist and my mother was a teacher so it was already in my blood. Also, I had a very close friend in high school who almost died from an eating disorder and no one knew how to help her. Along with that I’ve always held an interest in women’s studies and issues; I worked for a crisis help line and did lots of research for my masters which only fueled my passion for this field.
What other settings have you worked in and which do you prefer?
I was involved with an outpatient eating disorder treatment center called The Renfrew Center. I did my internship work in youth treatment and with the homeless and severely mentally ill. My preference and true love is honestly private practice working with eating disorder clients and couples therapy. I’ve been doing it so long and there’s really nothing like it.
What kinds of work related tasks do you do on a daily basis?
Oh goodness, everything having to do with running a business [laughs]. I mean I do of course, see patients, but since I’m also the owner of my business I also do my own marketing, I’ve done some writing, media appearances, product creation, research, bookkeeping and billing, I conduct supervision as well as lead team meetings.
What are the most common disorders that you diagnose and treat?
Bing eating disorder, anorexia nervosa, bulimia nervosa, eating disorder NOS, Body dysmorphic disorder, orthorexia which is an obsession with clean eating and I see it especially in boys, primarily athletes, and compulsive over eating. I most commonly diagnose anorexia nervosa, bulimia nervosa and compulsive over eating.
Do you see any common co-morbidity?
Yes I do actually. I see a lot of depression and anxiety, trauma – many people come in with PTSD - from abuse, such as sexual abuse. There’s drug and alcohol dependence, lots of marijuana addiction.
Which factors do you think predispose people for an eating disorder?
Yes, family history, there are genetic markers for anorexia and bulimia and history of trauma, being female in our culture, unfortunately rather predisposes women. There’s nature versus nurture, and a family history of dieting. It is a very complex group of disorders, and every individual has a unique story and contributing factors.
Is the treatment more one on one or are there others (i.e. family or friends) typically involved in treatment? Does that help or hinder progress?
Teenagers come in with parents but usually adults come in by themselves. I offer parent coaching and education on the understanding the disorder. Usually after coaching parents, spouses and friends of our eating disorder clients feel a lot more equipped to help and support them.
What is the average length of treatment?
Three to six months in general.
What do you like about your job?
I feel it’s what I was meant to do, it’s never boring, it suits my strengths, and I enjoy running a business. People with eating disorders are usually high driven and high achievers and very invested in treatment. There are always problems to solve and you have to be able to change with the times. I get many of my patients and referrals online and years ago it was never like that.
What do you dislike about your job?
It takes a lot of determination to be successful in private practice. I also hate to see suffering, and these illnesses cause a lot of suffering to individuals and their loved ones until they find the right help. Luckily, I’m in a wonderful position to help end the suffering.
If you were selecting a profession would you pick this one again? Why? Why not?
[Laughs] To be honest with you, when I was a child I wanted to be a marine biologist. But I think I made the right choice. I would have ended up helping people in some way anyway – it’s my nature and gift. If I had to do it over again, I probably would have tried to find a way to do both what I’m doing now and marine biology. Maybe I would have counseled the dolphins [laughs].
What are some topics in the field you think need more research?
Oh that’s a good one. I think there needs to be more information in the field about how to get funding for treatment. Unfortunately many insurances do not sufficiently cover eating disorder treatment and I think if more people had access to it through funding they would take more advantage of it. Research on the nature versus nurture arguments, and better understanding of the changing genes that predispose someone for an eating disorder. Maybe we could figure out how to alter these genes. They should also look into body positive ad campaigns and whether they improve the bottom line so we can stop worshipping ultrathin supermodels.
What changes do you hope to see in this area in the next 5-10 years?
Pretty much the same areas I’d like to see more research in. More funding so there’s access to treatment for all and hopefully more achievable ideals for men and women in beauty and body image.
What suggestions would you give to students to prepare them for a career in this specialty?
Get a business degree if you plan to go into private practice because if you want to be successful in it you need that business knowledge. They don’t teach you that in school. Do an internship and work in an accredited program for several years where you can learn how to treat eating disorders; don’t just wing it. In this type of field you really need to know what you are doing to be able to truly help people.
[End of interview]
At the conclusion of this interview, Ms. Osachy graciously wished me luck with my continued education and asked if I came across anyone who could use her services, to send them her way. It was easy to agree to her request. In accordance from classroom text and lecture, I was not surprised to hear about anorexia nervosa, bulimia nervosa and compulsive eating. Along with that, her information of trauma such as sexual abuse and genetic history predisposing someone for a disorder aligned with what I had previously learned. Treatment of an eating disorder often has to deal with treating not just the eating disorder but a comorbid disorder as well, typically depression and obsessive compulsive disorder (OCD) which are life-long disorders that require life-long monitoring and treatment.
During the course of this interview, my eyes had been opened to information I previously had no knowledge of. For instance, the cultural differences and demographic differences (which part of me expected based on textbook and lecture information) and yet some of it is still surprising to hear from someone working in the field. While I have heard of body dysmorphic disorder (BDD), from the textbook definition it as classified as an Obsessive-Compulsive related disorder (Davey, 2014) and not an eating disorder. However, I can see how preoccupation with appearance and an eating disorder would be related to each other. Olivardia et al., (2004) studied men’s preconceived notions of muscularity, fat index, self-esteem, mood disorders and eating disturbances and found that men were more concerned with having more muscle then more fat. Self-esteem issues, mood disorders and eating disturbances were more significantly correlated with men seeing themselves as less muscular than female ideals.
Ms. Osachy also mentioned orthorexia nervosa, which was a disorder foreign to me. Promotion of clean and healthy eating is frequently seen in the media by celebrities, chefs, athletes and fitness trainers. The United States, heralded as one of the fattest nations with obesity running rampant, gains spokesperson after spokesperson to change the way Americans eat and adopt healthier lifestyles. According to Dr. Karin Kratina of the National Eating Disorder Association (NEDA), orthorexia is not an officially recognized disorder according to the DSM-V, however it is an eating problem that has been recognized since 1996, first coined by Dr. Steven Bratman.
People seem to be leaning from one extreme to the other. Understanding why Ms. Osachy works with two other nutritionists in her practice is suddenly very clear. Getting people to understand, and not just recognize the truth of themselves physically and what they eat, but also “how” to eat properly is just as important.
I can’t say for certain whether I can see myself as an eating disorder specialist, as Ms. Osachy is - as I am much more passionate about the educational system - but she has compelled an interest in me to look into research in cultural and demographic differences in eating disorders: exploring the notions of the African – American community in regards to eating disorders, male versus female eating patterns and onsets to orthorexia, and even monitoring the eating patterns of male versus female school age children. Across cultures it has already been found that cases of anorexia nervosa and bulimia nervosa are increasing and that it is not just a western civilization (or Caucasian) disease (Makino, Tsuboi & Dennerstein, 2004). There is much more research to be conducted in this field and I’d like to contribute something to it.
Davey, G. (2014).Psychopathology: Research, assessment and treatment in clinical psychology. West Sussex, UK: John Wiley & Sons Ltd.
Kratina, K. (date unspecified).National eating disorder association: Orthorexia Nervosa. Retrieved from https://www.nationaleatingdisorders.org/orthorexia-nervosa.
L. Osachy, personal communication, July 25, 2015.
Makino, M., Tsuboi, K. & Dennerstein, L. (2004). Prevalence of eating disorders: a comparison of western and non-western countries.MedScape General Medicine, 6(3).
Olivardia, R., Pope Jr, H. G., Borowiecki III, J. J., & Cohane, G. H. (2004). Biceps and Body Image: The Relationship Between Muscularity and Self-Esteem, Depression, and Eating Disorder Symptoms.Psychology of Men & Masculinity,5 (2), 112-120.