To present the career issues of clients with eating disorders (EDs) from a more holistic perspective, the author gives an overview of EDs, describes the career challenges that such clients may experience, and identifies several theories that may be helpful in conceptualizing their career choices. Suggestions for practice are offered.
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Employment counselors are likely to encounter clients who struggle with eating disorders (EDs). Although literature on the causes and treatment of EDs has burgeoned over the past 20 years, there is scant research on the workplace, employment, and career issues associated with this population (Anderson, Lundgren, & Morier, 2004; Sonnenberg & Chen, 2003). This may be due to the perception that such issues are irrelevant to individuals with EDs or that their career concerns do not differ substantially from those of the general population. Moreover, the notion that career/employment counseling and personal psychotherapy are distinct services offered by different helping professions may have contributed to the lack of attention to this topic (Richardson, 1996). However, contemporary career theory emphasizes the interrelationship between life and work (Amundson, 2003a; Bedi, 2004; Sonnenberg & Chen, 2003). This trend, coupled with the tendency of an ED to pervade all aspects of an individual's day-to-day life (Anderson et al., 2004), suggests the importance of both understanding the impact of EDs on the work lives and careers of those who struggle with them and exploring how employment counselors might best support and facilitate the employment/career exploration and decision making of these clients.
There has been some indication in the literature that certain aspects of EDs may present particular challenges in the areas of employment and career. For example, it has been suggested that, in addition to facing difficulties in the personal and interpersonal realms, individuals with EDs may experience a severely diminished quality of life in terms of finances (e.g., due to large amounts of money spent on food for bingeing) and work (e.g., decreased effectiveness due to impaired concentration; Gleaves & Cepeda-Benito, 2002; Kashubeck-West & Mintz, 2001; Piran, Levine, & Steiner-Adair, 1999). Furthermore, an ED often usurps the majority of the individual's time and energy so that life becomes structured around the pursuit of thinness and its associated behaviors (e.g., dieting, bingeing, purging, overexercising; Sonnenberg & Chen, 2003). Thus, it seems unlikely that the work life and career of an individual who has an ED will be unaffected by the disorder, particularly in the case of anorexia nervosa (AN), which is more likely to require hospitalization (Anderson et al., 2004). However, the degree of impact is likely to vary depending on the type of disorder, its severity, and the degree to which co-occurring mental health issues are present (Gleaves & Cepeda-Benito, 2002).
Indeed, there can be significant mental health issues associated with this population, as well as the potential for serious physical complications if the ED is chronic or the behaviors extreme. For these reasons, an ED may influence a client's employment history and career path and is likely to have presented unique obstacles in the work arena. These challenges tend to be the norm for individuals with serious mental health issues (Caporosa & Kiselica, 2004). As such, it may be appropriate to view some clients with EDs as being "on the fringe" with respect to employment and career issues. Recently, there have been calls from the career counseling field to identify and develop innovative career and employment counseling services for fringe clients whose needs may not have been met by more conventional services (e.g., Amundson, 2005, 2006b; Caporosa & Kiselica, 2004; Muscat, 2005). Thus, possessing a basic knowledge of EDs and their potential to affect work and career may enhance the employment counselor's ability to assist clients with EDs in resolving their employment and career concerns. In addition, this knowledge may encourage a counselor to understand a client's career concerns from a more holistic perspective (e.g., Amundson, 2003b, 2005; Hansen, 1996).
This article provides an informational resource on EDs for employment counselors. I begin with a basic overview of EDs and then present some of the unique experiences and challenges that clients with EDs may encounter in their workplaces, employment choices, and career development. Subsequently, I identify career theories that may help employment counselors conceptualize their ED clients' career choices and concerns. Suggestions for practice are offered throughout. It should be noted that the symptomatology, epidemiology, and mortality associated with the EDs described may seem daunting to employment job counselors who are unfamiliar with the disorders. Indeed, certain aspects of EDs (e.g., ambivalence about recovery) can be discouraging for even the most seasoned ED treatment specialist. Yet the possibility of conducting productive employment and career counseling with individuals who have EDs should not be dismissed. Possessing some knowledge of EDs and their potential to affect work and career may increase the counselor's confidence in providing assistance to these clients as well as help the counselor determine when to refer. Employment counselors who are informed and prepared to work with clients who have EDs will undoubtedly be providing much needed services to individuals who may find themselves on the career counseling fringe as a result of the potentially multiple challenges they may encounter.
OVERVIEW OF EATING DISORDERS
EDs are often portrayed in a sensational fashion in popular culture. Unfortunately, this depiction may have led to a simplistic understanding of the disorders by the general public and perhaps even among some helping professionals, such that EDs are perceived as trivial expressions of vanity, that they are "all in a person's head," or that people with EDs should "just get over it and eat (or stop eating)." However, EDs are serious psychiatric disorders as defined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR; 4th ed., text rev.; American Psychiatric Association [APA], 2000a). EDs are considered to be multidetermined (i.e., having no single cause; Garner, 1997), which has led to the acceptance of a biopsychosocial model that includes individual, psychological, biological, familial, and cultural factors (Garner, 1997). The classification of EDs has been debated for many years. Some researchers have argued that EDs lie at the extreme end of a continuum on which milder forms of the syndromes sit in the middle, and normative dieting and weight concerns lie at the other extreme (Ruderman & Besbeas, 1992). Others have advocated a categorical model of EDs, as exemplified by the DSM-IV-TR. Both sides have amassed considerable evidence, and yet each has been plagued with conceptual problems. Recent literature has suggested that neither of these systems may be adequate to describe the full spectrum of disturbed eating (Williamson, Gleaves, & Stewart, 2005). Nevertheless, the DSM-IV-TR criteria remain the most widely used system for conceptualizing EDs; thus, the following information is organized according to this system.
Essential Features
Three EDs are listed in the DSM-IV-TR (APA, 2000a): anorexia nervosa (AN), bulimia nervosa (BN), and eating disorder not otherwise specified (EDNOS), with the criteria …
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